ICU mandatory for nursing homes?

Operating upon a patient without having adequate infrastructure constitutes negligence

The Supreme Court’s (SC’s) recent judgment has created considerable confusion whether it is mandatory for all nursing homes to have an intensive care unit. Let’s study the case in detail. 

Bijoy Sinha Roy’s wife had a menstrual problem, for which gynaecologist Biswanath Das was consulted. He advised her to undergo hysterectomy. Initially she avoided it but after five months, she had to be operated due to severe bleeding. Her blood pressure was high and she became anaemic with low haemoglobin.  When Das was consulted again, he advised an emergency operation which was done at Ashutosh Nursing Home on December 1, 1993. 

When she did not regain consciousness after the surgery, since Ashutosh Nursing Home did not have a ICU facility, she was shifted to Repose Nursing Home, and then to SSKM Hospital where she died on January 17, 1994. 

Her husband, Bijoy Sinha Roy filed a complaint before the State Commission alleging negligence while performing the surgery by ignoring the high blood pressure and low haemoglobin and for having performed it in a setup without an ICU even though it was foreseeable that complications were likely to occur for which intensive care might be necessary. 

The complaint was contested. The gynaecologist contended that he had made the correct decision to perform emergency surgery to stop the bleeding. However, he did not comment on the allegation that the surgery was performed in an ill-equipped set up without adequate infrastructure to deal with complications.

The State Commission upheld the complaint and ruled that there was medical negligence. However, when both sides appealed to the National Commission, the order was set aside the order and complaint dismissed.

Roy approached the SC, which considered two issues. One, whether the decision to perform the surgery was correct; and two, choice of a nursing home without ICU facility to perform surgery. On the former, the SC held that the decision was medically correct and justified. On the second aspect, it observed that even the doctor had not disputed Roy’s contention that the patient's condition was such that it was foreseeable that ICU facility would be required. Yet, ignoring this aspect, the doctor chose to operate in a nursing home without ICU. The SC concluded that when the risk and complications could be anticipated and foreseen, no prudent or reasonable doctor would have risked performing the surgery in a nursing home without ICU facility. Hence, it held Das guilty to be negligent.

Accordingly, by its order of August 30, 2017 delivered by the Bench of Justice Adarsh Kumar Goel and Justice Uday Umesh Lalit, the Supreme Court held that Biswanath Das liable to pay Rs 5 lakh. Since Roy had died during the pendency of the litigation, the amount was ordered to be paid to his legal heirs within. The amount had to be paid within three months, or along with 12 per cent interest, if delayed.

The conclusion: It is not mandatory for every nursing home to have an ICU, but operating upon a patient without having adequate infrastructure to deal with foreseeable complications would constitute negligence. The necessary infrastructure would vary on a case-to-case basis, depending upon the ailment and the condition of each patient.

(The author is a consumer activist)