2008(2) CPR 69(NC)
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
K.S. Gupta, Presiding Member and Dr. P.D. Shenoy, Member
H.S. Tuli —Appellants
versus
Post Graduate Institute of Medical Education and Research and Ors. —Respondents
First Appeal No. 705 of 2003
Decided on 3.1.2008
Held: Express written consent is to be obtained for:(i) all major diagnostic procedures;(ii) general anaesthesia;(iii) surgical operations:(iv) intimate examinations;(v) examination for determining age, potency and virginity; and(vi) in medico-legal cases.”
Brain surgery is a major surgery requiring several hours and use of general anesthesia. Informed consent for high risk in writing has to be obtained either from the patient or from her close relatives and if that is not taken and if the patient becomes paralyzed or dies then certainly there are chances that the patient’s relatives would allege negligence, on the part of the treating surgeons and the hospital. Hence, informed consent is very essential.
Informed consent: The concept of ‘informed consent’ has come to the force in recent years and many actions have been brought by patients who alleged that they did not understand the nature of the medical procedure to which they gave consent. All information must be explained in comprehensible non-medical terms preferably in local language about the:(i) diagnosis;(ii) nature of treatment;(iii) risks involved;(iv) prospects of success;(v) prognosis if the procedure in not performed; and(vi) alternative methods of treatment. The three important components of such consent are information, voluntariness and capacity. (Paras 32, 33)
Result: Appeal Dismissed.
Dr. P.D. Shenoy, Member—Case of the complainant:
Smt. Mohinder Kaur was admitted for surgery at Post Graduate Institute of Medical Education & Research, Chandigarh(hereinafter referred to as PGIMER) at 1 p.m. on 7.3.2001 in the emergency ward under the supervision of Dr. V.K. Khosla, Head of Neuro-Surgery Department. Tests recommended by Dr. Khosla were conducted on 08.03.01. It is the say of the complainant that angiography of the brain and other tests confirmed leaking aneurysm in the brain and immediate surgery was advised which was not done. Surgery was not performed on 9.3.01 due to ‘Holi’ holiday and non-availability of staff. Dr. Khosla assured the complainant that the surgery would be conducted on 10.3.2001 and the complainant should make necessary arrangements like purchase of medicines etc. At about 1.30 p.m. on 10.3.2001 the complainant was told by the opposite parties that operation theatre(hereinafter referred to as OT) was not available. The condition of the patient continued to deteriorate and, therefore, on 11.3.2001 she was admitted to intensive care unit after it was declared that her brain was dead. Patient was declared dead eventually on 14.3.2001. Alleging negligence and carelessness, the complainant claimed a total compensation of Rs. 17,50,000/-.
Case of the Opposite Parties:
2. The Ops No. 1, 2 and 4 PGIMER, Dr. V.K. Khosla and Dr. Kajal Jain in their written statements denied the allegations of negligence, deficiency and unfair trade practices on their part. They have submitted that despite repeated verbal requests the relatives of the patient Smt. Mohinder Kaur did not give any written consent for surgery of the brain. On 8.3.2001 Dr. Khosla explained to the relatives about the high risk involved due to the patient’s old age, hypertension, drowsy state, multiple brain haemorrhages and double aneurysm. They were also told that they were free to explore other treatment options available elsewhere. Endovascular procedure was suggested to the patient’s daughter and son-in-law Dr. Navdeep Khaira who thought that this procedure was a better option than open brain surgery. At the request of the relatives Dr. Khosla gave a letter of reference in the name of Dr. Karapurkar, a Neurosurgeon working in Apollo Hospital, New Delhi for eliciting his expert opinion. X-ray films were made available to the relatives of the deceased at 5 p.m. on 8.3.2001 after the deposit of
Rs. 1000/- as security. Neurosurgeons were willing and prepared to do the main surgical procedure but there was no written consent. It was not disputed that the condition of the patient deteriorated around 10.00 a.m. on 11.3.2001 when she was shifted from private ward to ICU. At about 12.45 p.m. she became unfit for surgery. Later in the night she was declared brain dead and ultimately declared dead on 14.3.2001. Ops 1, 2 and 4 denied the allegations made by the complainant that brain surgery was postponed due to holiday and non-availability of the OT. All preparations were made in anticipation of prior consent.
3. OP No. 3 Dr. Promila Chari, Head of the Department of Anaesthesia, PGIMER filed her separate written statement wherein, she had alleged that she had no contact whatsoever at any point of time with the patient or her relatives nor she was responsible for the non-performance of any surgery that might have been required. There was no negligence on her part as she was on sanctioned leave on 10.3.2001 and was not on duty on 9.3.2001, which was the holiday, and 11.3.2001, which was the Sunday, therefore, she was absent from 9.3.2001 to 11.3.2001.
Evidence:
4. The complainant led evidence in the shape of his own affidavit. Affidavit of Dr. Navdeep Singh Khaira, son-in-law of the patient, Prof and Head of Nephrology Unit, DMC & Hospital, Ludhiana was also filed. The Ops No.1, 2 and 4 led evidence in the shape of affidavits of Dr. V.K. Khosla, Professor and Head, Department of Neurosurgery, PGIMER; Dr. Kajal Jain, Assistant Professor, Department of
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