Kerala

StateCommission

CC/08/15

C.Viayakumar - Complainant(s)

Versus

Amrita Institute of Medical Science and Research Centre - Opp.Party(s)

Ajayakumar.B

06 Nov 2015

ORDER

    KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION SISUVIHARLANE VAZHUTHACADU THIRUVANANTHAPURAM

 

C.C.NO.15/08

JUDGMENT DATED :06/11/15

 

PRESENT

SRI.K.CHANDRADAS NADAR     : JUDICIAL MEMBER

SMT.A.RADHA                               : MEMBER

SMT.SANTHAMMA THOMAS      : MEMBER

 

COMPLAINANTS

 

1.   C. Vijayakumar,

          S/o. Chandrasekharan Nair,

          T.C. 28/1192,

          Sreekanteswaram, Fort. P.O.,

          Thiruvananathapuram

 

2.   Lathika  Devi. M.,

          W/o. C. Vijayakumar,

          T.C. 28/1192,

          Sreekanteswaram, Fort P.O.,

          Thiruvananthapuram

 

3.   Anil Kumar. B,

          S/o. Baskaran Nair,

          (through his power of attorney holder

          Smt.Lathika Devi, 2^nd complainant)

 

4.   Abhinand (minor)

          R/by the 3^rd complainant.

 

          (By Adv. Sri. S. Reghukumar)

 

                                                                                                Vs.

OPPOSITE PARTIES

 

1.   Amritha Institute of Medical Science

          and Research Centre,

          Eranakulam, P.O., Cochin – 26

          R/by its Managing Director

 

2.   M/s. National Insurance Company,

          2^nd Floor, Dhamodar Chambers, Statue Jn.,

          Thripunithura, Ernakulam.

 

          (By Adv. Sri. K.Srikumar & othrs for R1 &

            Adv. Sri. M. Nizarudeen for R2)

         

 

JUDGMENT

         

SRI.K.CHANDRADAS NADAR : JUDICIAL MEMBER

 

        This is a complaint filed under section 17of the consumer protection Act. The allegations in the complaint in brief are the following. Complainants 1 to 4 are respectively the father, mother, husband and son of Smt.Lekshmi Anil. Smt. Lekshmi Anil was an advocate by profession. During childhood, Smt.Lekshmi Anil was afflicted with severe viral fever and as a consequence of administration of drugs; she became diabetic in the childhood itself. She was undergoing treatment in the Medical College, Thiruvananthapuram for renal failure from 15.07.2004. X-ray taken at the Medical College revealed that she was also suffering from pericardial effusion. The nephrologists of the Medical College as well as the specialists in the Sree Chithra Institute of Medical Sciences, Thiruvananthapuram advised the patient to approach a higher centre. It was accordingly the patient got discharged from the Medical college hospital, Thiruvananthapuram and got admitted in the first opposite party hospital on 13.09.2004. Thorough medical checkup and tests confirmed that the patient was suffering from pericardial effusion. Accordingly, 20 continuous dialyses were performed. There after the patient was discharged from the first opposite party hospital on 05.10.2004. She was advised to undergo three haemo dialyses in a week. In order to facilitate treatment at the first opposite party hospital the patient and her family started to reside in a rented house near the first opposite party hospital. As pericardial effusion persisted after the prescribe course of treatment the patient was asked to get admitted in the first opposite party hospital. Accordingly, the patient was admitted there on 13.10.2004 and pericardiocentsis was performed to remove the pericardial effusion and the patient was discharged on 20.10.2004 with advice to continue haemodialysis on Tuesdays, Thursdays and Saturdays. Even after, continuous haemo dialysis pericardial effusion persisted. Hence several tests were performed and the doctors confirmed that the patient was suffering from tuberculosis.  Anti tuberculosis treatment was started on 11.11.2004. After two months treatment for tuberculosis the doctors found that the pericardial effusion of the patient had subsided. She was advised to continue two medicines for 4 months more.

        2.     The kidney of the mother of the patient was found suitable after clinical tests for transplantation.   Accordingly, the patient was admitted on 13.01.2005 in the first opposite party hospital for transplantation of kidney. Kidney was transplanted on her on 18.01.2005. She was discharged from the hospital on 27.01.2005. At the time of admission in the hospital on 13.01.2005 the complainants had enquired the doctors about the progress of treatment of TB and about the possible risks if any in conducting the operation as the evening fever had not subsided. In response, the doctors gave positive answers and the complainants were informed that the treatment for tuberculosis would not be an impediment to transplantation. They effected some changes in the course of medication after discharge from the hospital on 27.01.2005. The patient was admitted on 06.02.2005 as she felt general weakness including evening fever. She was discharged from the hospital after three days. The patient followed the prescription and advice of doctors strictly and went for periodical checkups. In April 2005 the doctors found that the condition of the patient was stable. Hence the patient and her family returned to Thiruvananthapuram. After check up in June 2005, on the reply of the doctors that the patient could do all things which a normal person can do, the patient went to Dubai. She was advised to follow medication and periodical check up. She was told to consult Dr.Poulose P Thomas a nephrologist attached to Belhoul Speciality Hospital, Dubai. She was advised to come back for annual checkup at the first opposite party hospital in January 2006. The patient followed the advice of the doctors. She returned from Dubai in December 2005 to undergo annual checkup at the first opposite party hospital in January 2006. After annual checkup some changes were effected in the medication. There after the patient went to Dubai. During that period the patient lost appetite and started to have irritation in stomach after eating solid foods.   Evening fever returned by July 2006. Her condition worsened. Hence she returned to Thiruvananthapuram on 08.07.2006. She was admitted in the KIMS hospital on10.07.2006 due to severe ache and vomiting. On 16.07.2006 she got discharged at request and went to the first opposite party hospital for check up. On the advice of the doctors she got admitted in the hospital but treatment was started without conducting any tests or diagnosing the disease. On 18.07.2006, the patient felt difficulty to breathe. Hence was shifted to ICU. There after she was put on ventilator and while under treatment Smt. Lekshmi Anil died on14.08.2006.

        3.     The doctors informed the cause of death of the patient as sepsis which was never informed to the complainants earlier. The first opposite party hospital committed gross negligence and deficiency in service by not following the accepted and standard protocol in their treatment of the patient. They committed gross negligence and deficiency in service by administering wrong combination of medicines as well as wrong diagnosis for tuberculosis. They committed unfair trade practice while not disclosing the actual disease. The grievance of the complainants were not redressed despite demands and notice issued through the lawyer of the complainants. Hence the complaints are seeking compensation of Rupees one crore.

        4.     Opposite parties 1 & 2 filed separate version. The contentions of the first opposite party hospital are that the patient Smt. Lekshmi Anil was diagnosed to have type 1 diabetes mellitus at the age of nine years. She was first seen at the first opposite party hospital on 13.09.2004. She was referred to the hospital with end stage kidney disease (on maintenance dialysis) for kidney transplantation. She underwent transplantation of kidney on 18.01.2005 and had been on immuno suppressive medications. Since then after about six months of follow up in the hospital she went abroad and was being followed up by a nephrologist there. Pericardial effusion (collection of fluid around the heart) in a patient with kidney failure can be due to accumulation of waste products in the body (uremia) or due to tuberculosis. The former usually disappears after intensive dialysis sessions where as the latter due to tuberculosis would persist.   Patients in India with kidney failure are having high risk of tuberculosis. The pericardial effusion in the patient responded to anti tuberculosis treatment. The patient was given medications that were absolutely essential to treat her illness. Her husband and her brother were regularly explained about the problems of the patient, all reports regarding investigations and treatment patient’s poor response to treatment and the likelihood of poor outcome. The allegations to the contrary are incorrect. When the patient expressed desire to go abroad, the first opposite party gave consent but advised periodical check up without fail. On enquiry regarding a good consultant available there, the name of the nephrologist Dr.Poulose P Thomas who had lot of experience in kidney transplantation was suggested. It is incorrect to say that the doctors at the first opposite party hospital started treatment without conducing tests or diagnosing the disease when admitted on 16.07.2006. They started treatment after conducing appropriate tests.  At the time of admission on 16.07.2006 the patient had history of chest and urinary infection for previous two months and had been under treatment elsewhere. She was admitted at the first opposite party hospital with high grade fever and breathlessness. She had to be shifted to ICU within 48 hours of admission. ICU care was needed as support for breathing and haemodynamic monitoring. She was not shifted out of ICU till her death on 14.08.2006 due to multi organ failure due to sepsis. Patients with diabetes mellitus are very susceptible to infections and their response to treatment is often inadequate. Kidney transplant recipients need to take immuno suppressive medication to maintain the functions of the transplanted kidney. These medicines impair the ability of the body's natural immunity against infections. These patients are always prone to serious infections. Since Lekshmi Anil had both the above factors she was pre disposed to infections. It is incorrect to say that the complainants were never informed that the patient was suffering from sepsis. It is also incorrect to say that gross negligence and deficiency in service were committed by not following accepted and standard protocol in the treatment of the patient. The patient’s husband and her brother were explained about her condition. Implant, investigation diagnosis and response to treatment every day. The doctors have followed only the protocol which is ordinarily followed in medical treatment. Sepsis means an infection which is otherwise known as a septicaemia. Such a patient is prone to develop many other serious complications. In the management of sepsis haemodynamic respiratory and metabolic support are very important. When organs like lungs, kidney, lever and brain are effected, intensive care support is the accepted therapy.

        5.     It is incorrect to say that wrong combination of medicines as well as wrong dosages were administered for the treatment of tuberculosis. She was advised to take appropriate combination of medication for tuberculosis. The doses of medication were adjusted appropriately according to the level of her kidney function. The opposite party sent detailed reply to the notice issued through the lawyer of the complainants. The treatment of the patient was decided by a team of highly qualified specialists including nephrologists transplant surgeons, Senior anesthesiologists and supportive departments. Kidney transplantation procedure was carried out on 18.05.205. But there was no complaint till 13.10.2006. The patient was given medical care comparable to renowned hospitals in our century and abroad.  Best possible medical care was provided to her by competent doctors during her stay in the hospital. There was no negligence or deficiency in service on the part of the doctors at the first opposite party hospital. The allegations to the contrary are false and the complaint is liable to be dismissed.

        6.     The additional second opposite party was impleaded on the contention of the first opposite party that the hospital was insured with the national insurance company. They have raised contentions identical to the contentions of the first opposite party. They have admitted that the first opposite party hospital is insured with them for an amount of Rs.one crore, but their liability for any one accident is limited to Rs.25,00,000/-.

          7.      On the allegations in the complaint and the contentions raised the following points arise for determination.

1. Whether the complainants have succeeded in establishing negligence or deficiency in service on the part of the first opposite party?

2. Whether the complainants are entitled to realize compensation if so what is the quantum?

          8.      The evidence consists of the deposition of the first complainant as PW1, Exts.A1 to A16 were marked on the side of the complainants, the oral evidence of two witnesses as DWs 1 & 2 on the side of the opposite parties and Exts.B1 to B5 marked on their side. After the evidence was recorded arguments were heard.

Point No.1

          9.      Even as per the allegations in the complaint Smt. Lekshmi Anil, the daughter of complainants 1 & 2 and the wife of complainant no.3 became diabetic during childhood itself. As per the version of the first opposite party she was diagnosed to have been afflicted with type 1 diabetes mellitus at the age of nine years. Obviously, deceased Lekshmi Anil was under treatment for diabetes ever since her childhood. It is alleged in the complaint itself that she was undergoing treatment in the Medical College Hospital, Thiruvananthapuram for renal failure.  On 15.07.2004, the x-ray taken at the Medical College Hospital, Thiruvananthapuram revealed that she was also suffering from pericardial effusion.  It is further admitted that nephrologists of the Medical College Hospital, Thiruvananthapauram as well as the specialists of the Sree Chithra Institute of Medical Sciences, Thiruvananthapuram advised the complainants to take the patient to a higher centre for management. it was accordingly Lekshmi Anil was got discharged from the Medical College hospital ,Thiruvananthapuram and got admitted in the first opposite party hospital on 13,09.2004. As per the version of the first opposite party Lekshmi Anil, the patient was seen at their hospital on 13.09.2004 as was referred with end stage kidney disease (on maintenance dialysis) for kidney transplantation. As per the allegations in the complaint itself the patient was subjected to thorough medical check up and tests and it was confirmed that she was suffering from pericardial effusion.    Twenty continuous dialyses were performed and thereafter three haemodialyses were performed in the succeeding week. That was done in the light of pericardial effusion which could have been due to two reasons. The possible first reason was due to kidney failure and consequent accumulation of waste products in the body ( a condition known as uremia) . The second reason for pericardial effusion (collection of fluid around the heart) could have been due to tuberculosis. It was with a view to rule out the first possible cause of pericardial effusion, that continuous haemodialyses were performed. It is admitted in the complaint itself that even after repeated dialyses pericardial effusion persisted. Pericardiocentsis performed also did not succeed in removing pericardial effusion. Therefore, several tests were performed at the first opposite party hospital and the doctors diagnosed that the patient was suffering from tuberculosis. The available evidence including the evidence of PW1 clearly show that the tests done for detecting tuberculosis were positive. Accordingly, anti tuberculosis treatment was started for the patient on 11.11.2004. It appears from the allegations in the complaint itself that after two months tuberculosis treatment the pericardial effusion in the patient subsided and the patient was advised to take two medicines for tuberculosis for a period of four more months. Since the permanent solution for renal failure was transplantation of kidney and the kidney of the second complainant mother was found suitable, kidney was transplanted in the patient on 18.01.2005. It is admitted in the complaint itself that few problems cropped up subsequently. But by April 2005, the patient was told that her condition was stable and accordingly she returned to Thiruvananthapuram and subsequently she was permitted to go abroad. On request the complainant was suggested to consult nephrologist Dr.Poulose P. Thomas abroad and attend annual check up in January 2006. After annual check up also the patient admittedly went abroad but by 2006 problems appeared and on 08.07.2006 she returned to Thiruvananthapuram. On 10.07.2006 she was admitted in the KIMS Hospital Thiruvananthapuram due to severe ache and vomiting. Ext.A9 is the discharge summary issued from the KIMS Hospital. It is seen that she was discharged from the hospital at request as she wanted to go to the transplant centre for further treatment. It is also seen that she was diagnosed to have klebsiella septicaemia diarrhoea one month duration, pyelonephritis, type 1 diabetes mellitus and hyper tension. It is seen from test results forming part of Ext.A9 that the transplanted kidney was normal. The patient was admitted in the first opposite party hospital on 16.07.2006. On 18.07.2006 she was shifted to ICU and later while on ventilator, she died on 14.08.2006 due to sepsis and consequent multi organ failure.

 

          In the background of the above admitted facts the only allegations of negligence and deficiency in service on the part of opposite party no.1 are that accepted and standard protocol was not followed by the first opposite party in treating the patient, wrong combinations of medicine as well as wrong dosages were prescribed for the treatment of tuberculosis and the actual disease namely sepsis was not disclosed to the complainants. In this regard, the complainants adduced no expert evidence PW1; the first complainant is not an expert to say anything about medical treatment. DW1 is the head of the team of doctors who treated the patient. DW2 was the nephrologist attached to the Ananthapuri Hospital.   He was formerly the Head of Department at the Medical Colleges of Kottayam and Thiruvananthapuram. It is sufficient to say that the cross examination of these witnesses particularly of DW2 was an exercise to gain medical knowledge. No attempt was made to bring out whether there was any prescription of wrong combination of medicines or inappropriate dosage while treating tuberculosis. In fact it appears that the protocol for tuberculosis treatment has changed over time as and when better medicines became available. In fact, there is national policy formulated for tuberculosis treatment.   Added to this after the transplant of kidney the patient was on immuno suppressive medicines which would affect her immune system and she was highly prone to infections. At the same time, if immuno suppressive medicines are stopped the transplanted kidney would fail to function. It is relevant that when she was admitted in the KIMS Hospital itself she was diagnosed to have been suffering from septicaemia. It is an advanced stage of infection. In the light of the said fact and the records meticulously kept by the first opposite party, it is difficult to presume that the complainants were not told about the actual illness and the progress of treatment. The said allegation appears to be without any basis.  As already mentioned there is nothing to indicate that wrong combination of medicines or wrong dosages were prescribed for treating tuberculosis .Such an inference cannot be taken because one of the symptoms namely evening fever allegedly returned after sometime. The tuberculosis germs can remain dormant as deposed to by DW2 and can infect the patient again when her immune system fails. The doctors who treated the patient can not be blamed for that.  As already pointed out, during the course of stay of the patient in the KIMS Hospital also the transplanted kidney of the patient was functioning in good condition. So from 18.01.2005 when the kidney was transplanted till 16.07.2006 at least the transplanted kidney functioned well. This shows that kidney transplantation in the patient was successful. Since there is nothing to support the allegations of negligence against the first opposite party, it is only to be held that the complainants have not succeeded in establishing deficiency in service or negligence on the part of the first opposite party in treating deceased Smt. Lekshmi Anil. The point is found accordingly.

Point No.2

          11.    In the light of the finding on point no.1 the complainants are not entitled to realise compensation from the first opposite party. Consequently, the second opposite party is also not liable.                                                                                                                                                                                                        

         

In the result, the complaint is dismissed but without costs.

 

K.CHANDRADAS NADAR   : JUDICIAL MEMBER

 

 

A.RADHA                               : MEMBER

 

 

SANTHAMMA THOMAS      : MEMBER

 

APPENDIX

List of witnesses for the complainant

PW1                    -   C. Vijayakumar

List of witnesses for the opposite parties

DW1                    -  Dr.Narayanan Unni

DW2                    -  Dr.Kasivisweswaran

List of Exhibits for the complainant

Ext.A1                 - The copy of the death certificate.

Ext.A2                 - The copy of the hemodialysis record.

Ext.A3                 - The copy of the ATT record.

                         

Ext.A4                 - The copy of the discharge summary issued on     5.10.2004.

Ext.A5                 - The copy of the discharge summary issued on 20.10.04.

Ext.A6                 - The copy of the discharge summary issued on 27.1.05.

Ext.A7                 - The copy of the discharge summary issued on 9.2.05.

Ext. A8                 - The copy of the medical report Belhoul Speciality

                                Hosputal, Dubai.

Ext.A9                 - The copy of the discharge summary issued by KIMS

                                Hospital dated 16.7.2006.

Ext.A10               - The copy of the pharmacy credit bill issued on 17.7.06.

Ext.A11               - The copy of the lawyers notice dated 3.10.06.

Ext.A12               - The copy of the reply notice dated 27.10.2006.

Ext.A13               - The copy of the reply to the reply notice dated 2.11.06.

Ext.A14(a)           - Provisional enrolment certificate dated 22.11.1998.

Ext.A14(b)           - Original identity card.

Ext.A15               - Original of the Medical Report issued by the Belhoul

                                Speciality Hospital, Dubai, UAE.        

Ext.A16               - Original of the Enrolment Certificate issued by the

                                Bar Council of Kerala dated 25.04.2000.

Exhibits for the opposite parties

Ext.B1                 - The copy of the authorisation  letter dated 7.7.2011.

Ext.B2                 - The copy of the medical records.

Ext.B3                 - The copy of medical journal.

Ext.B4                 - Copy of the Medical Establishment – Professional       Negligence Errors & Omissions Insurance Policy

Ext.B5                 - Copy of the policy schedule.

 

K.CHANDRADAS NADAR   : JUDICIAL MEMBER

 

A.RADHA                               : MEMBER

 

 

SANTHAMMA THOMAS      : MEMBER

 

 

 

 

 

 

 

 

KERALA STATE CONSUMER

DISPUTES REDRESSAL COMMISSION

 SISUVIHARLANE VAZHUTHACADU

THIRUVANANTHAPURAM

 

 

 

C.C.NO.15/08

JUDGMENT DATED: 06/11/15

 

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