Dengue death: Haryana probe indicts Fortis Hospital for medical negligence

In his complaint to the police, the father of the girl, Jayanth Singh, had alleged that the treating doctor switched off the ventilator and ambu bag when she was taken in the private ambulance. (Express Photo: Manoj Kumar)

The expert committee, set up by Haryana to probe the allegation of medical negligence in the dengue death of a seven-year-old girl at Fortis Hospital in Gurgaon, has concluded that “withdrawal of life support by the hospital in the ambulance amounts to negligence and is against law…”

In its report submitted to the Haryana health ministry on December 5, the committee, headed by Principal Secretary, Health, Amit Jha, has said that “under the garb of LAMA (leave against medical advice) process, the hospital disposes of the patients in an unethical manner when attendants no longer want to continue the treatment.”

The girl succumbed to dengue shock syndrome on September 15, after a 15-day stay at Fortis, Gurgaon. Her family had alleged overcharging, to the tune of Rs 16 lakh, and medical negligence.

Pointing out that it’s the “treating doctor’s responsibility to ensure that the discharge is as safe and appropriate as possible under the circumstances,” the report says, “this responsibility includes helping the patient to follow up after discharge. Maintaining the therapeutic alliance does not end with an against medical advice discharge (AMA); it only transfers the alliance to another setting. So by taking off oxygen and other life supporting treatment, the doctors have not kept the patient on the same treatment line. This is lapse/ negligence/ unethical conduct also… Hence the case is recommended to be sent to Medical Council of India for action… under this, all senior doctors treating case… should be held accountable.”

In his complaint to the police, the father of the girl, Jayanth Singh, had alleged that the treating doctor switched off the ventilator and ambu bag when she was taken in the private ambulance. He also alleged that the management refused to provide a Fortis ambulance if she was taken to another hospital.

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“The medical experts, Paediatrics, have submitted in their report that the withdrawal of life support by the hospital in the ambulance amounts to negligence and is against law of the land… The report of Dr Jitender Kumar Jhakhar, Forensic Medicine Expert, PGIMS, Rohtak, has observed that it was unethical for the doctor to stop the assisted ventilation without handing over to other specialists or directing the relative to ventilate the child by means of ambu bag,” says the report.

It says the treating doctor “should have raised the issue of ill-equipped ambulance with his own hospital and alerted the parent also immediately”.

The report adds that “instead of disposing of patient like this, hospital should counsel the parents and inform them about the complications of taking off life support system and further advice to shift the patient to another hospital and provide necessary ALS (Advance Life Support) ambulance with support staff who can continue to manage such patient during transfer.”

Earlier, the Fortis Hospital authorities, had said, that “as the attendants of the child wanted to take the child LAMA, an outsourced ambulance was arranged which could transport the child back home as per hospital LAMA protocol. As per the hospital policy (followed by most private hospitals), LAMA patients are not offered hospital’s ambulances, but the family is assisted to arrange an ambulance, which was done in this case. This outsourced service vendor’s ambulances/ hearse vans are always parked inside our premises.”

The hospital maintained that the family was briefed on “the critical condition of the child, after which they took the decision to… Leave Against Medical Advice (LAMA)”.

“After going through the statements of doctors and father, it appears prima facie that the parents were guided by the doctor opinion to take the child home. The patient was neither brain dead nor in a vegetative state, but was alive as per statement of (treating doctor)… The LAMA in this case is shrouded in ambiguity. Under these circumstances, it appears that prima facie, under garb of LAMA process, the hospital disposes of the patients in an unethical manner when attendants no longer want to continue the treatment,” the expert committee has said.

But the report adds that “this option of LAMA exercised by the parents (in spite of hospital explaining consequences like death to attendants) does not seem right as it involves the decision of taking off life support system from critically ill patient.”

“However, it is pertinent to mention here that patient was not only dependent on oxygen for survival. Many other drugs and therapies to support vital organs, as detailed in the treatment record, were being given to keep her alive. It is unlikely that with the withdrawal of all other supportive therapy, the patient would have survived for long on oxygen alone, but taking off all other supportive treatment too which would have caused the death of the patient,” adds the report.

When contacted, a spokesperson for Fortis Healthcare said, “A member of the inquiry team concluded that in his opinion, the father… Mr Jayanth Singh was well informed about the consequence of LAMA. He also concluded that on the part of the parents, it was against morality to leave the hospital against medical advice in such a critical case.”

The spokesperson added: “The committee members reaffirmed that the family had to spend Rs 15 lakh for emergency ICU treatment for dengue shock syndrome for 15 days, not for normal dengue fever. The committee also stated that mortality is high, ranging from 6-30% and most deaths occur in children. The committee confirmed that the patient was managed adequately and appropriately. There is prima facie no evidence of negligence in the management of the child during her stay in the PICU.”