“Study Of Medical Negligence Cases Under CPA (Consumer Protection Act) Admitted And Judgment Delivered In Nagpur District Consumer Forum
Between 2010-2015.’’
1) Dr.Priya M.Raut, Asst.Prof.,Dept. of Agadtantra Evum Vidhi Vaidyak, DMAMCHRC,Nagpur
2) Dr.Rajendra Urade,HOD Dept.of Agadtantra Evum Vidhi Vaidyak,BMAM,Nagpur 3) Dr.Mohan S.Raut ,Asso. Prof. Dept.of Kaumarbhritya, DMAMCHRC,Nagpur
4) Dr.Anuja Nagrare, Asso.Prof.Dept.of Agadtantra Evum Vidhi Vaidyak,DMAMCHRC,Nagpur
5) Nandkishor Bankar Associate Professor Dept. of Microbiology Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences Sawangi (Meghe), Wardha
6) Sanika Kalambe Assistant Professor Dept. of ENT Datta Meghe Medical College, Nagpur- 441110.
Address for Correspondence Dr.Priya M.Raut,
Asst.Prof.,Dept. of Agadtantra Evum Vidhi Vaidyak, DMAMCHRC,Nagpur
Introduction:
In India as well as other parts of the world since ancient times, certain duties and responsibilities were borne by persons who entered into the sacred medical profession. The Hippocratic oath that the medical practitioners wont to take exemplifies these duties and responsibilities.
In India this concept is not a new one. The ancient text of Charaka’s oath clearly proves it.
However, medical negligence and therefore the legal aspects of drugs have acquired great significance in recent period. Awareness among people regarding the elemental rights guaranteed by the Constitution has increased in previous couple of decades which have brought the medical community under the scrutiny of both the public and the judiciary. As one act was passed in parliament of India named - Consumer Protection Act in 1986, it has always been a strong tool for consumers in fighting the menace of any service available to them. The Act may be a milestone within the history of socio-economic legislation to satisfy the long felt necessity of protecting the commoner from wrongs that the remedy under the common law for various reasons has become illusory. Medical services is as important as any other service for consumers and like other services, consumers have been facing hardships in this area also. The doctor- patient’s relationship has deteriorated significantly and litigation against doctors is increasing day by day. 1
Since last couples of decade there has been substantial increase in medical negligence and malpractices. The deterioration in the standard of patient care is considered to be due to interest
in the monetary gains in various terms. In contrary patients have also become more aware of their rights with help of advocates and there have been sudden increase in the number of complaints against doctors of various pathies in the consumer forums. Doctors may commit an error by negligence or thanks to other causes. Thus, the ultimate sufferer is none other than the patient. Earlier the patients aggrieved by medical negligence did not have any effective adjudicative body for getting their grievances redressed, but now the situation has changed.
There are provisions in the Civil and Criminal law offering remedies to aggrieved patients.
Aim & Objectives:
Aim:
To Study the medical negligence cases under CPA (Consumer Protection Act) admitted and judgment delivered in Nagpur District Consumer forum between 2010-2015.
Objectives:
1. To do critical review and study the CPA (Consumer Protection Act).
2. To study the type and pattern of medical negligence cases in Nagpur District Consumer forum during 2010-2015.
3. To determine the reasons of medical negligence in Nagpur city.
Materials & Methods:
Data collection method:
Nagpur District Consumer Dispute Court’s forty cases which are admitted and judgments delivered of alleged medical negligence cases from year 2010 to 2015 were collected for study.
After thorough study of judgments, 20 cases in which medical negligence was proved were selected for further analysis in present study.
For accessing the cases judgments permission and active support were obtained from District Consumer Forum in Civil Lines, Nagpur.
Judgments were also accessed from website http://confonet.nic.in/ and /or http://cms.nic.in/ncdrcusersWeb/login.do?method=caseStatus [by using Key Word “Medical Negligence” in text phrase search box]
The CONFONET project has been implemented in the backdrop of The Consumer Protection Act, 1986 which is developed by National Informatics Centre, Ministry of Communication &
Information Technology (Govt. of India).
Study Design: Observational Study.
Methods of selection of Cases for study:
Inclusion Criteria:
1. Proved medical negligence cases and which are admitted before the court and judgments are delivered.
2. Cases were selected during the period of 2010-2015.
Exclusion Criteria:
3. Cases in which are related to rape or any criminal assault.
Assessment Criteria:
Following parameters/variable were assessed during each case of study for assessment.
Various parameters /variables such as medical subjects and consultant involved in medical negligence, types of Specialty, Profile of hospital, hospital liability, consent, medical records, unqualified staff, investigative tests, operative skill and diagnosis, hospital facility, operative and postoperative complications, referral, advice, time to attend patient, other deficiency in services etc. were studied and discussed.
Observation & Results:
In this study, Nagpur District Consumer Dispute Court’s 40 cases which were admitted and judgments delivered of alleged medical negligence cases from year 2010 to 2015 were collected for study. After thorough study of judgments, 20 cases in which medical negligence was proved were selected for further analysis in present study. For accessing the cases judgments permission and active support were obtained from District Consumer Forum in Civil Lines, Nagpur.
Various parameters /variables such as medical subjects and consultant involved in medical negligence, types of Specialty, Profile of hospital, hospital liability, consent, medical records, unqualified staff, investigative tests, operative skill and diagnosis, hospital facility, operative and postoperative complications, referral, advice, time to attend patient, other deficiency in services etc. were studied and discussed.
Collected data properly classified in the form of graph, tables, and charts and were represented as bellows
Collected data properly classified in the form of graph, tables, and charts and were represented as bellows-
Table.1 Showing Cases admitted Year wise & judgments delivered:
Sr.No. Case No.
Admitted Year
Judgment Delivery year
Duration required for judgments
1 CC/01/335 2001 2011 10 Years
2 CC/93/537 1993 2013 20 Years
3 CC/99/317 1999 2012 13 Years
4 CC/96/380 1996 2012 16 Years
5 284/1997 1996 2013 17 Years
6 CC/06/87 2006 2013 7 Years
7 CC/04/66 2004 2007 3Years
8 188/2007 2006 2008 2 Years
9 CC/09/527 2009 2015 6 Years
10 CC/11/102 2011 2016 5 Years
11 CC/99/719 1999 2015 16Years
12 CC/97/229 1996 2013 17 Years
13 CC/06/14 2007 2014 7 Years
14 CC/06/65 2008 2014 6 Years
15 CC/99/487 2002 2014 12 Years
16 CC/97/116 2000 2015 15 Years
17 CC/21/2006 2008 2015 7 years
18 CC/153/06 2007 2015 8 Years
19 72/2007 2008 2015 7 Years
20 CC/13/30 2013 2014 1 Year
Table.2 Showing Year required for judgment:
Sr.No. Duration in year Number of Cases Percentage
1 01-05 year 04 20.0%
2 06-10 year 08 40.0%
3 11-15 year 04 20.0%
4 16-20 year 04 20.0%
Total 20 100
In this study total 20 cases were observed, it was observed that 04 cases required the duration about 1 to 5 years, 08 cases were taken the 6-10 years duration for judgment delivery,04 cases required 11-15 years of duration awhile another 4 cases taken near about 16-20 years of duration for the judgments. So an average the duration for judgment delivery was about 9.85 years which is quite more.
Graph.1 Showing Year required for judgment
Table.3 Showing Types of specialty for cases admitted in the court:
Sr.No. Types of specialty Number of Cases Percentage
1 General 06 31.6
2 Obstetrics & gynecology 03 15.8
3 Ophthalmology 03 15.8
4 Orthopedics 02 10.5
5 Pediatrics 02 10.5
6 Urology 01 5.3
7 Pathology 01 5.3
8 Multispecialty 01 5.3
Total 19 100
It was observed that out of total 20 cases 19 cases described the specialty of treatment.
Among them most of were from General category.i.e.06 [31.6%], 03[15.8%] cases were from Obstetrics & gynecology department, 03[15.8%] cases were from Ophthalmology specialty, 02[10.5%] were from Orthopedics, 2[10.5%] cases were from Pediatrics department while single case reported from the Urology, Pathology and Multispecialty respectively.
Graph.2 Showing Types of specialty for cases admitted in the court:
Table.4 Profile of hospital from cases admitted in the court:
Sr.No. Profile of hospital Number of Cases Percentage
1 Government Hospital 04 20.0
2 Private Clinic 08 40.0
3 Private hospital 05 25.0
4 Multispecialty Hospital 01 05.0
5 Not mentioned 02 10.0
Total 20 100
In this study of twenty cases, 04[20%] hospital were government, 08[40%] were run by privately which are run by someone, 05[25%] hospital were private big hospital, single was multispecialty hospital, status of two hospital not found in judgments.
Graph.3 Profile of hospital from cases admitted in the court:
Procedural Investigation points in Judgments:
1. Consent :
It was observed in access that well informed consent was obtained from either patients or relatives of patients before starts of any clinical or investigational medical procedure to be carried on patients in order to provide medical managements to the patients. This consent was taken either by hospital staffs or doctor present at the time of procedure or treatment.
2. Medical records:
As it is mandatory to keep the records of clinical procedure or any other legal documents prepared by hospital during rendering the medical service to the patients. In this study it was observed that in 8[40%] cases didn’t maintained proper medical records by hospital while in other 12[60%] cases, medical record maintained by the hospital.
3. Unqualified staffs:
As per Bombay nursing home act and all concerned council of medical education has laid down the rules regarding qualified staff has to be kept in the hospital. In this study 12[60%]
hospital has not appointed any unqualified staff in their hospital however there was no record found in the judgments of 8[40%] about appointing unqualified staff in the hospital.
4. Investigation or Pathological Tests:
All routine investigation (CBC, BSL, Urine) were carried out in 08 [40%] hospitals, in some cases blood investigation and urine test was advised while in two cases CT scan and
ureteroscopy was advised. However in five cases there was no any laboratory investigation or blood investigation was prescribed.
5. Operative skills and Diagnostic skills.
It was also observed in the judgments that, court has noticed about the operative skill and diagnostic skill so doctors. Out of 20 cases it was noted that, in 13[65%] cases it was appropriate, in 04[20%]cases it was not adequate or incorrect operative skill or diagnosis, while it was absent in single case.
6. Hospital facility:
It was also noted in the judgments about the existing facility available in the hospital. It was about the basil life support, oxygen, medicine, skilled staff, electricity etc. In this study near about 15[60%] hospitals were having adequate facility and infrastructure, however there was no basic hospital facility was available in 5[20%] hospitals.
7. Operative and postoperative complications:
Among twenty cases five cases were related to operative and post-operative care. In which two cases were from Orthopedics surgery, each from urology, ophthalmology and general.
The Orthopedic, Urology and Ophthalmology were private clinic and having taken care of all standard protocol during operative and post-operative procedures. However one case at orthopedic surgery and one was at general hospital where inadequate care was done in operative as well as during postoperative complications.
8. Time to attend Patients:
In almost all cases there was adequate time given by medical staff to attend the patient for any complains or routine round of doctors. However in single case there was delay to attend the patient in time, this was general hospital owned by government. Along with delay in attending the patient there was not having adequate Operative and diagnosis skills of medical staffs.
9. Referral:
Among 20 cases four cases are referred further in view of further management of any complication aroused thereof. Among that two from orthopedics and surgical specialty, one was from Ophthalmology and one from multispecialty. However there was adequate facility in hospital, in spite only one hospital was not having adequate diagnosis or operative skills.
10. Type of Medical Negligence: (Table no. 5)
Type of medical negligence Specialty involved Number of cases Percentage
Incorrect analysis of blood Pathology 01 05.0%
Acted negligently while giving injection
General 01 05.0%
Wrong Treatment & diagnosis , delay in caesarean operation
Obstetrics &
gynecology and general
02 10%
Delay in treatment & required test not done immediately
General 01 05.0%
Negligence in performance of service & delay in treatment
Orthopedic, Urology, Ophthalmology and General
07 35%
Non availing of benefit under family care plan
Pediatrics 01 05.0%
Deficiency in rendering Medical Service & treatment
Obstetrics &
gynecology and
general, pediatrics,
07 35%
Observations:
In one case where the patients was opted for the service of pathological investigations, in which incorrect analysis of blood was the medical negligence. In one other case where it took place in General hospital where medical staff acted negligently while giving injection. Wrong Treatment & Wrong diagnosis at general hospital while in another cases, delay in caesarean operation was resulted in medical negligence.
Most of medical negligence was noted for the cause of Negligence in performance of service & delay in treatment in seven cases (35%), Deficiency in rendering Medical Service &
treatment was also observed in seven cases. (35%)
In different case Non-availing of benefit under family care plan is the reason held for medical negligence in pediatrics specialty.
Table:6 Distribution of Medical Negligence Cases (Negligence: Proved/Not Proved)
Sr.No. Types Number of Cases Percentage
1 Negligence not proved 11 55
2 Negligence 09 45
3 Withdrawn(Compromise) 01 05
Total 100
There is need to create awareness and interaction among medical fraternity and patient and advocate dealing with medical negligence cases.
In this study act of negligence was proved in nine cases (45%) and are also entitled for compensation. In 11 cases (55%) medical negligence was not proven due to Allegations not substantiate by a cogent evidence, respondents not liable to pay compensation hence appeal dismissed in most of cases. In single case complaint is disposed off as withdrawn (Compromise).
Graph.4 Distribution of Medical Negligence Cases:
Discussion :
The ancient text of Charaka’s oath clearly proves the ethics of human being in medical profession. However, medical negligence and therefore the legal aspects of drugs have acquired great significance in recent period. Awareness among people regarding the elemental rights guaranteed by the Constitution has increased in previous couple of decades which have brought the medical community under the scrutiny of both the public and the judiciary.
In this study, Nagpur District Consumer Dispute Court’s 40 cases which were admitted and judgments delivered of alleged medical negligence cases from year 2010 to 2015 were collected for study.
Various parameters /variables such as medical subjects and consultant involved in medical negligence, types of Specialty, Profile of hospital, hospital liability, consent, medical records, unqualified staff, investigative tests, operative skill and diagnosis, hospital facility, operative and postoperative complications, referral, advice, time to attend patient, other deficiency in services etc. were studied and discussed.
Conclusion:
1. An average the duration for judgment delivery was about 9.85 years which is quite more.
2. Medical negligence cases are admitted from both private and public sector.
3. Most of negligence cases happened due to delay in attending the patients, unqualified staff, in most of cases the cause of negligence in performance of service & delay.
4. In 11 cases (55%) medical negligence was not proven due to Allegations not substantiate by a cogent evidence.
5. Medical Ethics teaching and training on soft skills, especially of good communication skills, doctor patient relationship will be fruitful to avoid raised cases of medical negligence.
Recommendations:
1. Hospital and doctors should have taken any indemnity liability insurance for the compensation.
2. There is need for similar studies and frequent audit of medical negligence cases to find out the new and emerging causes of medical negligence.
References:
