The National Consumer Disputes Redressal Commission has held Metro Heart Institute with Multi Speciality, Faridabad, and its attending doctor, Dr. Bhanwar Lal Kamawat, liable for medical negligence, following the death of a 39-year-old patient shortly after undergoing hernia surgery. In a judgment delivered by President Justice A.P. Sahi and Member Bharatkumar Pandya, the commission ordered a total compensation of ₹20 lakh to be paid to the widow of the deceased, Smt. Parul, for the deficiencies in post-operative care that led to the fatal outcome. While the hospital and the operating surgeon were absolved of negligence regarding the surgical procedure itself, the tribunal found that the hospital’s management failed to provide necessary specialist oversight during the patient’s critical post-operative decline.

Daksh Kumar was admitted to the hospital on March 25, 2014, for a laparoscopic mesh hernioplasty to treat an umbilical hernia. Although the hospital classified the procedure as an emergency to address an obstructive hernia, the patient appeared stable immediately following the surgery. However, the situation deteriorated rapidly throughout the night. Kumar began experiencing chest pain and breathlessness, eventually collapsing in the early hours of March 26. He was declared dead by 6:00 a.m. that morning, with medical reports identifying the cause of death as pulmonary embolism.

Critical Gaps in Patient Monitoring

The commission’s scrutiny of the hospital records revealed a significant period of clinical inactivity during which the patient’s condition worsened without adequate intervention. According to the findings, while the patient complained of chest pain as early as midnight, the subsequent hours lacked the diligent monitoring required for a post-surgical case. The tribunal highlighted a concerning gap in medical attention between 2:00 a.m. and 4:00 a.m., despite the patient’s clear indications of distress.

The judgment noted, “The patient was treated in a routine way with practically no attendance between 2 a.m. and 4 a.m. on the presumption that everything was normal.” The commission observed that nurses' notes suggesting the patient was "sleeping well" or had requested sips of water were not corroborated by any doctor’s visit, leaving the patient effectively unattended during the most critical period of his deterioration.

Furthermore, the commission found substantial discrepancies in the documentation provided by the hospital. Evidence indicated that diagnostic tests, including an echocardiography, were attempted only after the patient had already collapsed. The bench remarked on this belated effort, stating, “The CPR could not have been for an hour as per the discharge summary and therefore the learned counsel for the complainant is correct in her submissions that the CPR timing has not been reflected correctly.”

Defining the Standard of Specialist Care

A central issue addressed by the commission was whether the hospital and its staff possessed the requisite expertise to handle complications of this nature. The patient was placed under the care of Dr. Bhanwar Lal Kamawat, who was described by the hospital as an intensivist. However, the tribunal concluded that the hospital failed to mobilize a cardiologist or a pulmonologist despite the clear symptoms of chest pain and breathlessness—classic indicators of potential pulmonary embolism.

The commission emphasized that in a medical facility claiming super-specialty status, the presence of specialists is not a luxury but a protocol-driven necessity when complications arise. The judgment observed, “This deficiency on the part of the Hospital also touches upon the negligence with due to the patient appears to have suffered.” While the hospital argued that Dr. Kamawat was adequately qualified through his residency experience, the commission remained unconvinced that his qualifications met the threshold required to diagnose and manage a life-threatening embolic event. By leaving the patient’s care solely to a doctor lacking higher specialization in cardiology or pulmonology, the hospital abdicated its responsibility to provide a standard of care commensurate with the patient's deteriorating condition.

Financial Redress for a Preventable Tragedy

In determining the compensation, the commission adopted a balanced approach, acknowledging the surgeon’s competence in performing the actual hernia repair while holding the hospital and the attending staff accountable for the failed post-operative management. The tribunal noted that the surgeon, Dr. B.D. Pathak, had acted within the accepted scope of surgical practice, and therefore, no negligence could be attributed to the surgery itself.

However, the failure to diagnose pulmonary embolism when the first symptoms appeared was deemed a direct breach of the duty of care. Consequently, the commission apportioned the liability, directing the Metro Heart Institute to bear ₹15 lakh of the total award, while Dr. Kamawat was held liable for the remaining ₹5 lakh. The commission stipulated that this amount must be paid within three months, with an interest rate of 6% per annum applicable in the event of default.

The judgment serves as a stern reminder to healthcare providers that the duty of care extends far beyond the successful completion of a procedure. Proper monitoring, timely escalation to specialists, and the accurate maintenance of clinical records are indispensable components of medical services. By failing to detect and manage a recognized post-operative complication, the respondents deprived the patient of a chance at life, necessitating the court’s intervention to provide financial relief to the grieving family. The commission concluded that the hospital's failure to provide adequate specialist support and the attending doctor’s failure to act on clinical red flags collectively constituted a deficiency in service that could not be overlooked.