Death by negligence: Jubilee Hills Apollo Hospital asked to pay Rs 5L to patient's family

Patient R.Pushpalatha, 56, a resident of Nallakunta was having pain in the right knee and was advised to undergo 'total knee replacement surgery by the doctor at Apollo Hospital Jubilee Hills. She was operated on March 8, 2011, and shifted from the ICU to a room.

At 9 pm the same day she was fed semi-solid food (curd rice) and the patient vomited soon after. The family alleged that the duty doctor who attended to the patient failed to take any precautionary measures. The next morning, the patient was stated to be having oral secretions and though the doctor tried to resuscitate, the patient was declared dead at 6.30 am i.e. Within 20 hours after the surgery.

The family in its submission to the commission said that after the surgery, the patient who was a known case of Asthma, Hypertension, and Hiatus Hernia was not kept in the ICU and was not monitored. She was not given due care and attention and for this gross negligence,

The hospital in its submission said that patients' right knee was more suffering from Bilateral Osteoarthritis severe than the left. The patient was a known case of Hypertension, Bronchial After a thorough pre-asthma, and had Hiatus Hernia and Diverticulosis. After operative evaluation, she underwent TKA of the right knee with Stryker Scorpio Knee Implants under spinal anesthesia.

Postoperatively the patient recovered well and during the night, the patient became unconscious and she was immediately shifted to IP-ICU, unresponsive. In spite of all the intubated and mechanical ventilation being initiated, the condition of the patient deteriorated and she developed cardiac arrest and was declared dead at 6.30 a.m.

"The allegation that death was caused because of food particles entering into the lungs is false and the expert opinion obtained by the complainants are baseless. Postoperative vomiting is not uncommon and the patient was well managed. The complainants, despite being well aware of the risks involved, are attributing negligence against the hospital without any basis," said the hospital in its submission.

Hearing the argument, the state commission said the patient, a known case of asthma, had just undergone knee replacement surgery. Hospitalized patients are especially at greater risk and more especially those who have just undergone major surgery.

The commission said the depressed level of consciousness and impaired airway defenses are contributory factors. Anesthesia certainly depresses the level of consciousness and increases the risk of aspiration in the semi-conscious. This should have been taken care of to reduce the risk of pulmonary aspiration. The vomitus produced by the patient should have been drained out instead of going back down her pharynx. Was immediate care provided to the patient when she vomited at 9 pm?

"Repeatedly the same question surfaces and a thorough perusal of the records submitted by the complainant and the hospital reveal that the patient was not closely monitored. Immediate management should have been provided by the surgeon and the anesthesia team. Anesthesia places patients at risk for aspiration. She vomited at 9 pm and passed away in the early hours of the morning. There was sufficient time to have safeguarded the patient," observed the commission.

The commission said that the knee replacement surgery by itself is not a life-threatening procedure and had reasonable precautions been taken, the ensuing complications could have been avoided and the tragedy averted. The hospital failed to be continually mindful of the risk of aspiration. It was a preventable emergency and having the suction unit ready in high-risk situations would have the catastrophe prevented.

"The care was given entirely by the hospital staff consisting mainly of the nursing staff & duty doctor. They should have monitored the patient closely and especially after she vomited, the immediate response was totally lacking. Prompt care and attention were certainly lacking and the sequence of events is clearly indicative of negligence. The amount granted as compensation will never relieve the pain but may provide a modicum of solace to the complainants," the commission said.

"We hold the Apollo Hospital vicariously liable for the treatment given to the patient by their empanelled doctors and employees," said the commission.

Apollo Hospital is directed to pay Rs.5 lakh to the family of the patient along with Rs 25,000 as the cost of litigation.