BEFORE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD
C.C.NO.105 OF 2010
Between:
Smt W/o Sri Complainant
1. Yashoda Hospital, rep. by its Director
Sri
2. Yashoda Hospital, rep. by its Director
Sri
3. Yashoda Hospital, rep. by its Director
Sri
4. Dr.Y.Radhika
aged Major, Consultant Obstetrician &
Gynaecologist,
5. Dr.M.Venkateswara
6. Dr.AVS Suresh
aged major Consultant Oncologist,
7. Dr.D.Chandrashekhara Reddy
aged Major, Consultant Gastroenterologist
8. The New India Assurance Company Ltd.,
# 6-3-862/A/B, 2nd Floor, Green Lands, its Senior Divisional Manager, covered under
Policy No.611900/36/07/32/00000003 to
opposite parties no.1 to 3 (Impleaded as per
the orders dated 24.1.2012 in I.A.No.210/2011)
9. The United India Insurance rd Floor, authorized Signatory covered under Policy
No.050100/46/07/35/00000/190 to
Opposite party no.4, (Impleaded as per the
orders dated 24.01.2012 in I.a.No.211/2011)
10. The New Oriental Insurance DO-2, Western Wing, 3rd Floor, Lands Road, Hyderabad rep. by its authorized signatory
covered under Policy No.431200/48/2008/2004 to
opposite arty no.5, ( dated 24.01.2012 in I.A.No.212/2011)
11. The National Insurance company Limited
Ground Floor, 1-2-274/1, 100, Opposite Minerva Complex
Policy No.551802/46/08/87/00000069 to opposite party
No.7 (Impleaded as per the orders dated 24.01.2012
in I.ANo.213/2011)
Opposite parties
Counsel for the Complainant M/s Counsel for the Opposite parties M/s M/s
NO.1 to 5 & 7)
M/s
M/s M/s M/s
QUORUM: SRI R.LAKSHMINARASIMHA RAO, HON’BLE MEMBER
AND
SRI THOTA ASHOK KUMAR, HON’BLE MEMBER
TUESDAY THE ELEVANTH DAY OF DECEMBER
TWO THOUSAND TWELVE
Oral Order (As per Sri
***
1. The complaint is filed seeking direction to the opposite parties to pay a sum of `40 lakh with interest towards medical expenses and treatment, `5 lakh with interest towards compensation for mental agony and `25,000/- towards costs
2. The averments of the complaint are that on 11.3.2008 she was admitted in the opposite party no.1 hospital for treatment of gum bleeding and she was treated for a period for 22 days and blood was transfused to her where after her condition was further deteriorated. After her condition become normal, she was discharged on 2.4.2008 and the complainant incurred an amount of `1 On 18.7.2008 she was again admitted as inpatient in the opposite party no.1 hospital during the time of her admission for the first time she was treated by the opposite parties no.4 to 6 and when she was admitted for the second time the opposite parties no.4 and 6 administered treatment to her and discharged her on 19.7.2008 and the complainant incurred an amount of `10,000/- towards consultation fees and medicine.
3. On 2.8.2008 the complainant was admitted for delivery in the opposite party no.1 hospital and she had undergone LSCS and she gave birth to a female child. The opposite parties conducted various tests and diagnosed the complainant suffering from hepatitis-B. The blood donors who donated blood to the complainant are not infected with On 6.8.2008 the complainant was discharged from the opposite party no.1 hospital and she incurred a sum of Rs.60 On 21.8.2008 the complainant was again admitted to the opposite party no.1 hospital and she was subjected to serum test, liver function test, urine test and complete blood picture test. The opposite parties no.4 to 7 treated the complainant and on 30.8.2008 she was discharged with an advise to go for liver transplantation. The complainant incurred a sum of `1
4. On 31.1.2008 the complainant was admitted in Indraprastha Apollo Hospital at New Delhi where she had undergone liver transplantation and The complainant visited Indraprastha Apollo Hospital for periodical check-up for three times till 10.10.2008. The complainant incurred an amount of `22`7 lakhs towards charges for medicine, tests and transportation and she had spent a sum of `29,50,000/-. Due to improper and negligent treatment and due to transfusion of the blood without due verification health condition of the complainant resulted into acute liver failure (HVV and HAV related). The complainant incurred a sumo of `2
5. The complainant got issued notice on 31.12.2008 to the opposite parties demanding for a sum of Rs.40 lakh towards medical expenses, Rs.5 lakh towards compensation for suffering from mental agony and on 9.2.2009 the opposite parties no.1 to 3 gave reply for which the complainant got issued rejoinder demanding for the amount mentioned in notice that she got issued on 31.12.2008.
6. The opposite parties no.1 to 5 7 resisted the claim by filing written version and contended that they are not necessary parties to the complaint and that the complainant was admitted into the opposite parties no.1 to 3 hospital on 11.3.2008 with complaint of amenorrhea of four months duration, gum bleeding, headache of 10 days duration and blurring vision of one day duration. Provisionally she was diagnosed as a case of Evan’s Syndrome, severe anaemia with haemoglobin 4.2 mgs/dl, with severe thrombocytopenia with retinal haemorrhage and platelet count of life threatening 12000 in view of her serious condition which sometimes may lead bleeding in the brain, she was given immediate platelet transfusion as lifesaving procedure. She was referred to ophthalmologist, general physician, medical oncologist for optimal management and she was treated according to standard protocol and she had recovered well and was discharged on 2.4.2008 and during her stay in the hospital she was charged `1,88,256/-.
7. The complainant was again admitted to the opposite parties no.1 to 3 hospital on 18.7.2008 with complaint of swelling all over her body and she was directed to undergo tests such as urine routine and microscopic, blood sugar level, platelet count etc., and in view of improvement in her condition she was discharged on 19.7.2008. The complainant was discharged on 19.7.2008 and she was charged `8,656/-. Again on 2.8.2008 she was admitted for delivery and she was discharged on 6.8.2008. She had undergone LSCS and in view of adequate platelet count she was advised to taper of steroids as standard ITP guidelines and during this period she was tested positive for Opinion of the gastroenterologist and herpetologist was taken. Further investigations which will ABV investigation replicative state were sought for to plan further management of the patient.
8. The complainant in her notice dated 9.1.2009 suppressed her admission for delivery to the opposite partyno.1 hospital on 2.8.2008. The hospital has transfused the blood from its blood bank which follows standard national guidelines and the hospital would screen all the blood for hepatitis B hepatitis C, malaria and syphilis. There was no chance for transmission of any disease due to blood transfusion and the complainant had not followed the regular follow up treatment after she was discharged from the opposite parties no.1 to 3 hospital. She was admitted again on 21.8.2008 in the opposite party no.1 hospital with complaint of high grade fever with chills, vomiting, generalised weakness and itching. She was admitted in the intensive care unit and diagnosed with hepatitis (A &B) with fulminant hepatic failure. Opinion of gastroenterologist was taken.
9. The complainant was given antiviral therapy for hepatitis-B. She was found to be As the patient was not improving by conservative therapy, she was given an option for liver transplantation and she was discharged at her request in The opposite parties had no knowledge of the treatment undergone by the complainant at Indraprastha Apollo Hospital New Delhi or the expenditure stated to have been incurred by her at the hospital. There was no negligence or deficiency in service on the part of the opposite parties no.1 to 3 5 and 7 and prayed for dismissal of the complaint.
10. The opposite party no.8 has filed written version stating that the opposite party no.8 has no knowledge of the treatment administered to the complainant at the opposite parties no.1 to 3 It is contended that there is no consumer service provider relationship between the complainant and the opposite party no.8 and that there is no deficiency in service on the part of the opposite party no.8. It is contended that the complaint is not filed within the period of limitation and the amount claimed by the complainant is excessive and exorbitant.
11. The opposite party no.9 resisted the case contending that the complaint is not maintainable for non-joinder of M/s Indraprastha Apollo Hospital New Delhi and not impleading the doctors who conducted liver transplantation to the complainant. There was no negligence on the part of the opposite party no.4 in whose favour the opposite party no.9 has issued the insurance policy. The liability of the opposite party no.9 under professional indemnity insurance policy issued for the period 14.2.2008 to 13.2.2009 is limited to `5 lakh. The opposite parties no.4 and 9 have no knowledge of the treatment administered to the complainant at Indraprastha Apollo Hospital New Delhi. Hence, prayed for dismissal of the complaint against the opposite parties no.4 and 9.
12. In support of her claim, the complainant has filed her affidavit and the documents Exs.A1 to A17. On behalf of the opposite parties, the fifth opposite party and the Senior Divisional Manager of the 9th opposite party insurance company have filed their affidavits and the documents Exs.B1 to B4.
13. The counsel for the opposite parties no.1 to 5 and 7 and the counsel for the opposite no.9 have filed their written arguments.
14. The points for consideration are:
1. Whether the opposite parties no.1 to 6 rendered deficiency in service while administering treatment to the complainant?
2. To what relief?
15. POINT NO.1: The complainant visited the hospital of the opposite parties no.1 to 3 for treatment of gum bleeding and was admitted on 11.3.2008. Several tests were conducted in the opposite parties no.1 to 3 hospital and she was discharged after a period of 22 days and during the course of the treatment she was transfused with blood. It is not disputed that the opposite parties no.4 to 6 administered The admission record of the complainant would show that she was undergoing regular check-up for confirmed pregnancy and she was suffering from It is noted in the progress sheet that the complainant was asymptomatic and suffered from gum bleeding 10 days prior to the date of her admission in the opposite party 1 hospital. She was diagnosed with Evans Syndrome with severe anaemia with haemoglobin 4.2 She was discharged on 2.4.2008 and as on the date of discharge she was normal and fit to be discharged.
16. The complainant was again admitted to the opposite partyno.1 hospital on 18.7.2008 and the opposite parties no.4 and 6 administered treatment to her. She was admitted with the complaint of pedal oedema (bilateral) and her platelet count was monitored, TT Betamethasone injections were prescribed at 6 p.m. and 9.45 p.m. on 18.7.2008 and she was discharged on the next day i.e., on 19.7.2008.
17. She was discharged on 6.8.2008 and at the time of conducting LSCS, she had undergone various investigations and they had shown her The learned counsel for the opposite parties no.1 to 5 and 7 has contended that as the complainant is a potential carrier to transmit The opposite parties no.1 to 3 discharged the complainant on 6.8.2008 in a stable clinical condition.
18. On 21.08.2008 the complainant was admitted with complaint of high grade fever with chills, vomiting, generalized weakness and itching. She was diagnosed with suffering from acute hepatitis (A & B) with Fulminant Hepatic Failure. The learned counsel for the opposite parties 1 to 3 has contended that after obtaining the opinion of Gastroenterologist and infection and the learned counsel for the opposite parties no.1 to 5 and 7 has submitted that the transfusion of blood is not the cause of transmission of infection. He has submitted that the blood which was transfused was already tested for
19. It is not known whether the complainant was treated in any other hospital before getting admitted in the opposite party no.1-hospital on 11.03.2008. She was admitted to the opposite party no.1-hospital for about four times and the blood was transfused to her during the period she was treated from 11.03.2008 till 2.04.2008. Except this time there was no transfusion of blood was made at any time she was subsequently treated from 18.07.2008 till 19.07.2008, from 21.08.2008 till 30.08.2008, from 22.09.2008 till 29.08.2008.
20. The opposite parties no.1 to 5 and 7 have referred to annexure-I to explain the process of collection of blood and its verification and preservation by its blood bank. It is mentioned in the Annexure-I that the name of the blood donor is registered and his blood sample is collected which would be rejected if haemoglobin percentage is lower than the prescribed value. The haemoglobin percentage is 13 on requisition would be supplied to the patient after conducting cross matching test.
21. The other annexures, i.e., annexure-
Mrs It is not clear when she contacted this infection. During pregnancy her platelet counts had decreased and for this transfusion were given. Apparently prior to this transfusion she had no evidence of hepatitis B. Post transplantation she will require regular medication.
22. The learned counsel for the opposite parties no.1 to 5 and 7 would contend that Dr Gupta has not specifically mentioned that the liver dysfunction and transmission of HAV infection is due to the sole cause of transmission of blood. ‘ Pregnancy opens up and filed by the complainant does not support in absolute terms of what he had mentioned in the certificate. Some of excerpts of the Article are extracted hereunder:
DOCTOR SPEAK
HOW PREGNANCY COULD AFFECT YOUR LIVER
Dr.Subash Gupta, senior consultant, liver transplant, Apollo Hospital, explains what happened to It could be that the Hepatitis B virus was present in her body as a result of a previous infection. The virus could also have been during the blood transfusions given to increase her platelet count. Her pregnancy suppressed the infection initially, but after she delivered, the virus multiplied rapidly, “he says.
Pregnancy also may have unexplained adverse effects on the liver. Most pregnant women are Apart from this, there are three other ways that the liver can be affected.
Acute Fatty Liver
During pregnancy the liver enlarged and becomes – physiological changes happen to accommodate the growing baby. The liver cells fill up with fat globules which eventually cause liver failure. Nausea, vomiting and jaundice are the symptoms of this condition which doesn’t have any known cause.
HELLP Syndrome
In this condition, a number of cellular changes take place. The red cells in the liver breaks down, and the liver can soften to such an extent that it fractures.
Liver Dysfunction caused by Eclampsia is Again,
Obstructive cholestasis
This is a pregnancy-related liver disorder in which there are abnormalities in the flow of bile, leading to a build-up of bile acids in the mother’s blood.
23. What doctor Gupta told the author is that the exact cause for the complainant’s condition is uncertain and Hepatitis B Virus could be present in the complainant’s body as a result of previous infection or the virus could have been transmitted due to blood transfusion made in order to increase the platelet count of the complainant. The opposite parties would contend that Hepatitis A can be caused by means other than blood transfusion such as due acute liver failure, contaminated food and water, hair cutting saloons, beauty parlours, intercourse etc.,
24. The learned counsel for the opposite parties no.1 to 5 and 7 has relied upon the decision of the In that case, the complainant had undergone coronary bypass surgery on 23.08.1995 and during the post-operative stage it was found that he contracted Hepatitis and the level of infection was very high and it was also found that he had an attack of serum Hepatitis B. It was argued on behalf of the complainant that he had no past history of Hepatitis and prior to surgery it was found negative and that he was not admitted to any other hospital nor any treatment was administered to him for any other illness and he contracted infection when blood was transfused to him by the hospital. It was contended on behalf of the hospital that the complainant had undergone tooth extraction and he did not submit the reports prior to his admission and after he was discharged from the hospital. The National Commission held that the complainant had not proved that he contracted the infection while undergoing operation and not due to a) use of infected needles whilst administering injection, b) blood transfusion-exposure to infected blood products; c) sexual intercourse; d) undergoing a surgical procedure or operation and e) by dental extraction.
25. Recently, the National Commission had dealt with a case in “Escort Heart Institute & Research Centre `50,000/- passed by the State Commission. The National Commission held that:
We agree with the findings of the State Commission that there is adequate evidence on record to establish that there is clear nexus between the blood transfusion on the Respondent No.1 during the course of her cardiac surgery at the Appellant/Institute and her contracting Hepatitis B, 60 days later especially since Respondent No.1 had not undergone any other blood transfusion except at the Appellant/Institute. The report from P.G.I. Hospital, Chandigarh which is a highly reputed independent institution with specialized healthcare facilities has confirmed this fact in writing. We note that the Appellant/Institute has in its
26. The following points can be culled from the aforementioned decisions:
i) Incubation period for Hepatitis B virus is 40 days to 180
ii) Even after testing blood, the overall frequency of hepatitis in patients receiving
iii) Radio Immunoassay test is considered more sensitive and specific for screening blood compared to ELISA test.
iv) ELISA test is not considered conclusive in detecting HIV virus.
v) Hepatitis B could be contracted by a) a) use of infected needles whilst administering injection; b) blood transfusion – exposure to infected blood products ; c) sexual intercourse; d) undergoing a surgical procedure or operation and e) by dental extraction
27. In Escorts Heart Institute (supra) the complainant had undergone coronary artery bypass grafting and during the time of surgery, blood was transfused to her The PGI Hospital Chandigarh in its Discharge summary has reported that the complainant was a case of post transfusion Hepatitis B with Grade-I and she was treated therefor.
28. In the case on hand, in the Screening Register and Issue names of persons who had donated blood and the screening tests conducted are clearly mentioned. The complainant was not treated in any other hospital since the date of her admission for the first time in the opposite party hospital on 11.3.2008 till she was discharged with advise for liver transplantation on 29.8.2008, no blood was transfused to her except the one made on 11.3.2008 at opposite party no.1 hospital. The certificate issued by
29. The complainant’s pregnancy suppressed the virus which reactivated and multiplied and was detect just two days prior to her delivery. The screening procedure described at clause 7 of annexure 1 would indicate that the blood bank of the opposite party no.1 hospital adopted ELISA test which is not approved by the The screening stated in Annexure-1 read as under:
7. SCREENING PROCEDURE
7.1 4TH
a. Hepatitis –B surface Antigen
b. Hepatitis – C Virus
7.2 All the donor samples are properly labelled and centrifuged for ½ an hour at 5000 RPM
7.3
7.4. Check the inventory of
7.5 Solution is checked for
7.6 Wastage box is checked, if full the machine will not run. It is emptied first.
7.7. The samples are loaded after checking the labels and labels are entered in to the system.
7.8. Run request is given
7.9. After 45 minutes check the results.
7.10 Take out the print out from the printer attached to the instrument.
7.11 Controls are run once in 24 hours
7.12 Probe cleaning is done in 48 hours
7.13 Three tests are run on each donor sample for HIV, and HCV
7.14 Screening Negative or
7.15 Before running the test calibration is done for each kit of 100
30. Even after, the collected blood is screened by conducting Elisa The complainant’s pregnancy may have, in the words of The Hepatitis caused to the complainant’s liver which was replaced and transplanted at Indraprastha Apollo The complainant stated to have incurred an expenditure of `40 lakhs from the time she was admitted to the opposite party hospital on 11.3.2008 till she was treated in Indraprastha Apollo Hospital. In Escorts Heart Institute Case, the National Commission confirmed the award passed by the State Commission for `50,000/- towards compensation. In that case, the complainant’s liver was not extensively damaged and there was no need for transplantation of liver. The complainant claimed for an amount of `6`50,000/- in favour of the complainant. As the order of the State Commission confirmed by the National Commission, the ratio laid therein is squarely applicable to the facts of the case on hand. The complainant claimed an amount of `40 lakhs. The complainant has stated that she has incurred an amount of `1`60,000/- and `1,00,000/- at the opposite partyno.1 hospital and `29,50,000/- lakhs at Indraprastha Hospital.
31. It is to be considered while quantifying the compensation to be awarded that the opposite party no.1 hospital and its blood bank had taken every care while screening the blood which was transfused to the complainant. Insofar as the negligence of the opposite parties no.1 to 3 hospital is concerned, the Radio Immunoassay Test could have been preferred to Elisa Test and the lack of fool proof precautions can be pressed into service to award an amount of Rs.6 lakhs which is payable jointly and severally by the opposite parties no.1 to 11. The opposite parties no.8 to 11 by virtue of issuing the insurance policies in favour of the opposite parties no.1 to 7 are liable to pay the amount to the complainant.
32. In the result the complaint is allowed directing the opposite parties no.1 to 11 to pay the amount of `6 lakhs to the complainant together with costs of `5,000/-.
MEMBER
MEMBER
Dt.11.12.2012
KMK*
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
For complainant for opposite parties
NIL EXHIBITS MARKED
For complainant
Ex. A1 Discharge summary, date 02.04.2008
Ex. A2 Discharge summary, date 19.07.2008
Ex. A3 Discharge summary, date 06.08.2008
Ex. A4 Discharge summary, date 30.08.2008
Ex. A5 Test Reports, date 11.03.2008 & 06.08.2008
Ex. A6 Prescription Letters, date 05.04.2008 & 19.08.2008
Ex. A7 Bills, date 11.03.2008 & 30.08.2008
Ex. A8 Discharge summary, date 22.09.2008
Ex.A9 Bills, date 22.09.2008
Ex.A10 Air Tickets, date 30.08.2008
Ex.A11 Original receipts, date 30.08.2008 & 25.04.2012
Ex.A12 Notice, date 31.12.2008
Ex.A13 Notice, date 31.12.2008
Ex.A14 Reply to Reply
Ex.A15
Ex.A16 Symptoms issued by
Ex.A17 Paper publication, date 30.09.2008
For opposite parties
Ex.B1 Admission Record Hospital
Ex.B2 Admission Record Hospital
Ex.B3 Admission Record Hospital.
Ex.B4 Admission Record
MEMBER
MEMBER
