43-year-old man dies after pacemaker surgery ‘goes wrong’, wife gets Rs 33 lakh payout

On September 17, 2013, the woman’s husband was admitted to a super specialty hospital in Mohali with a history of prolonged chest pain. She claimed that the doctor recommended a biventricular (triple chamber) pacemaker and a four-day hospital package costing around Rs 5.5 lakh was discussed. It was further alleged that the doctor did not perform the surgery until the fourth day, that is, on September 20, 2013, after she deposited Rs 3 lakh.

Further, the wife claimed that the doctor, without the complete kit, implanted a cheap ‘double chamber pacemaker’ (costing Rs 45,000, as per the bill). It was also stated that the surgery remained incomplete, with the doctor citing unavailability of the third wire, and that on September 22, 2013, the doctor performed another surgery, implanting the actual biventricular pacemaker (costing Rs 4.47 lakh).

The bench observed contradictions in the hospital’s own records which were sufficient to hold it guilty of deficiency in service.

According to the records, the husband was quickly discharged on September 24, despite being in pain. On September 27, 2013, he suffered a severe heart attack and was brought back to the hospital, where he died. The wife then filed a complaint alleging gross medical negligence, cheating and unfair trade practice, seeking compensation of Rs 84 lakh. The state commission, on May 4, 2017, held the doctor guilty of medical negligence and held the hospital also liable. It ordered the hospital and the doctor to pay Rs 32.9 lakh to the wife.

Hospital blames ‘software glitch’

Senior Advocate Sanjeev Puri and advocate Abhinav Tyagi, representing the hospital and doctor, argued that implanting a biventricular pacemaker was often done in two stages. The counsel stated that on September 20, 2013, the husband was tired, and only two leads were implanted. The third lead and the pulse generator were implanted on September 22, which was an accepted standard practice, confirmed by the PGIMER expert committee, it was pointed out.

The counsel said that the bill entry of Rs 45,000 was for the first-stage procedure charges, which were labelled ‘Double Chamber Pacemaker because of a software glitch, and the same billing software anomaly was seen in other patients’ bills as well.

Advocate Bhavnik Mehta, appearing for the wife, argued that the state commission‘s order was well-reasoned and based on a “thorough” appreciation of evidence. It was also urged that the medical notes dated September 20, 2013, clearly stated “Patient CRT (Cardiac Resynchronization Therapy) done,” which meant that the full procedure was complete, which contradicted the two-stage theory.

‘Factually incorrect, misleading’

The national commission noted that CRT treatment specifically uses a biventricular pacemaker. Hence if only two leads were implanted and the pacemaker was to be installed later, then the nursing note “CRT done” would be factually incorrect and misleading.

According to the commission, the bill “unmistakably” listed a “Double Chamber Pacemaker” with a cost of Rs 45,000, and the explanation that it was a typographical error and actually represents the procedure charges for the first stage was not credible, as a “ hospital’s billing software is expected to maintain a standard chart of accounts. If the amount was for ‘Procedure Charges’, it should have been listed as such.”

The national commission held that the hospital and the doctor did not provide a consistent explanation for the discrepancies in the medical records and the bill, and upheld the state commission’s order, stating that the doctor was guilty of medical negligence and deficiency in service and the hospital was liable for his acts. According to the national commission, the payout of Rs 32.9 lakh, awarded to the wife, was just, fair and based on a reasoned assessment.

Takeaway

The ruling establishes the obligation of medical professionals to ensure proper treatment of their patients. It also emphasises that doctors must be prepared for foreseeable complications, and unsupported denials cannot defeat a medical negligence claim.

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