BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD.
FA.No.1783/2007 AGAINST C.C.No.1082/2005 DISTRICT FORUM-I, HYDERABAD
Between:
1. M.Sathyanarayana, S/o.Raju,
Aged about 46 years,
Occ:Agriculture, R/o.Basanna Camp,
Tq Sindhanur, District Raichur,
Karnataka.
2. Smt.Dhanalakshmi W/o.M.Satyanarayana,
Aged about 43 years, Occ:Agriculture,
R/o.Basanna Camp, Taluk:Sindhanur,
District Raichur. Appellants/
Complainants
And
1. Apollo Hospitals, near Old MLA Quarters,
Hyderguda, Hyderabad.
2. Apollo Hospitals Enterprises Ltd., Apollo
Pharmachy, Jubilee Hills, Hyderabad.
3. Apollo hospitals, Jubilee Hills,
Hyderabad.
4. United Insurance Company Ltd., 2-4-1/4,
M.G.Road, Secunderabad. Respondents/
Opp.parties
Counsel for the Appellants: M/s.C.K.Rao
Counsel for the Respondents:M/s.Indus Law Firm. R1 to R3.
QUORUM: THE HON’BLE JUSTICE SRI D.APPA RAO, PRESIDENT.
SMT.M.SHREESHA, MEMBER
&
SRI K.SATYANAND, MEMBER
.
TUESDAY, THE SIXTH DAY OF APRIL,
TWO THOUSAND TEN
Oral order:(Per Smt.M.Shreesha, Hon’ble Member)
***
Aggrieved by the order in C.C.No.1082/2005 on the file of District Forum-I, Hyderabad the complainants preferred this appeal.
The brief facts as set out in the complaint are that the complainants are the parents of the deceased M.Ramakrishna who had a crush injury to his left arm on 19-12-2003 at 9.30 a.m. at Raichur district, Karnataka while he was handling paddy harvesting machine. He was immediately brought to opposite party No.1 hospital and got admitted on the same day at 8.00 p.m. On 20-12-2003 Dr.Sudhakar Prasad conducted an operation and assured recovery. On 23-12-2003, the said doctor informed that the condition of the patient became serious and that the patient had to be shifted to their main hospital. On 27-12-2003 the patient was declared dead due to cardiac arrest secondary to sepsis leading septicemia, respiratory failure, renal failure etc., It is the case of the complainant that opposite party No.1 did not give proper post operative treatment and did not anticipate the infection and due to lack of proper care, the patient died during infection. The complainants got issued a legal notice and approached the District Forum to award compensation of Rs.8,80,000/-.
Counter was filed on behalf of opposite parties 1 to 3 admitting that the patient was attended to by Dr.Sudhakar Prasad for the crush injury with laceration over the antero-lateral aspect of the left arm with compound fracture of left humerus with vascular compromise of left upper limb and ‘Frgmin’ injection was given to improve blood circulation. They submitted that the patient was operated under general anaesthesia on 20-12-2003 for wound debridment, interlocking nailing of left humerous besides brachial artery and basic vein repair was done. The wound was explored and the surgery was uneventful. Post surgery, radial pulse and capillary filling of left hand was good and was shifted to ICU on 20-12-2003 at 1.45 p.m. and continuously monitored. The patient complained inability to move fingers and lower limbs etc. so potassium supplements were given. Dr.Sanjay Maitra, Nephrologist, a competent doctor attended and diagnosed hypokolemia and appropriate treatment was given to increase urine output. On 22-12-2003 the renal parameters were found high and urine output was 20 to 30 ml per hour which was due to renal insufficiency. Respiratory distress started on 22-12-2003 and hence he was intubated and sedated connecting to ventilator. Dopamine and Dobutamine drip was fixed and later the patient went into Acute respiratory syndrome with respiratory failure and due to sepsis, he suffered multi organ disfunction and monitored daily in SICU. However, on 27-12-2003, B.P. started falling followed by cardiac arrest and as such he was declared dead at 7.55 p.m. on 27-12-2003. They submitted that due to sepsis, several complications occurred and submitted that there was no negligence on their behalf and prayed for dismissal of the complaint.
Based on the evidence adduced i.e. Exs.A1 to A16 and the pleadings put forward, the District Forum dismissed the complaint.
Aggrieved by the said order, the complainants preferred this appeal. The facts not in dispute are that the complainant’s son aged 22 years sustained a non bleeding crush injury on his left upper arm on 19-12-2003 at about 9.30 a.m. at his village in Raichur district, Karnataka while he was handling paddy harvesting machine. He was immediately brought to opposite party No.1 hospital and got admitted on the same day at 8.00 p.m. The next day i.e. on 20-12-2003 Dr.Sudhakar Prasad of opposite party No.1 conducted a surgery on the left arm of the appellant’s son and the patient was recovering. His condition became serious from 23-12-2003 and he was shifted to their subsidiary hospital at Jubilee hills and the patient was in sepsis condition with consequent renal failure, low blood pressure, abnormal level of serum creatinine etc., The patient was confined from 23-12-2003 to 27-12-2003 at opposite party No.3 hospital. It is the case of the complainant that opposite party No.3 gave the case sheet and treatment record pertaining to the treatment period from 23-12-2003 to 27-12-2003 but did not give the hospital record from 20-12-2003 to 23-12-2003. It is only after the patient suffered multi organ failure that opposite party No.1 shifted the patient to opposite party No.3 hospital and did not even reply to the legal notice sent by the complainant. It is the further case of the complainant that the opposite parties 1 to 3 have admitted that the medical record pertaining to the period from 19-12-2003 to 23-12-2003 was misplaced. The learned counsel for the appellant/complainant in his written arguments further stated as per regulation No.1.3 of the Indian Medical Council (Profession, conduct, Etiquette and Ethics) Regulations, 2002, the maintenance of medical records is stated as follows:
1.3.1 Every physician shall maintain medical records pertaining to his/her indoor patient for a period of 3 years from the commencement of the treatment in a standard proforma laid down by the Medical Council of Indian and attached as appendix 3.
1.3.2 if any request is made for medical records either by the patient authorized attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours.
1.34. Efforts shall be made to computerized Medical record for quick retrieval.
It is the further case of the complainant that after the on set of septicemia, no immediate laboratory investigations such as blood culture report were done to know the source of microbes that invaded the blood stream. The medication also does not show the use of broad spectrum of antibiotics used appropriate to the particular type of infection. He also relied on medical literature of Septicemia and Endocarditic by DC shown in Oxford University pres at Page No.49 (Septicemia : Clinical Features) which stated as follows:
“Every recognition of the clinical features of bold stream invasion and its complications is essential. This requires careful attention to epidemiological, microbiology and path physiological clues which in turn dictate therapeutic response”.
At page 50 “Until rapid laboratory identification of invading micro organisms because possible it would appear sensible to describe clinical blood stream invasion as Septicemia and when complicated by cardiovascular collapse as septicemic shock”
At page-66: DIC is a serious consequences of Septicemia.
Renal function is commonly impaired in septicemia, urine flow begins to fall until oliguria.
8. Microbiological investigations:
“It is important that microbiological investigations of the septicemia patient be carried count promptly, before antimicrobial chemotherapy is prescribed. If microbiological sampling is carried out promptly and efficiently. There is minimal delay in patient management. This provides the greatest
opportunity to establish a definitive microbiological diagnosis which, in turn makes the selection of specific chemotherapy easier. Blood cultures are essential investigation and are described in chapter 4”.
9. At page No.76 in Chapter No.4.
Modern blood culture techniques and other methods for detecting microbes in the blood.
The rapid and reliable detection of organisms in the blood of the patient is important to help guide the optimal treatment of septicemia.
Blood cultures remain the mainstay of the methods available, but in addition, immunological and other non cultural methods have been introduced to assist with rapid diagnosis.
It is the case of the opposite parties who also filed their written arguments that the patient was operated under general anaesthesia on 20-12-2003 for wound debridment interlocking nailing of left humerous besides brachial artery and basic vein repair. The wound over the antero lateral aspect of left arm was explored. It was noticed that the skin flap of the patient was degloved over the cubital fissa and the biceps and bruchiolis were totally cut and devascularised. The flexor group of muscles were found crushed and devascularised at the site of the origin near medical epicondyle. The extensor group of muscles was also crushed near lateral epicondyle region. The devascularised biceps and brachialis were excised and all the devitalized muscles of flexor and extensor group of forearm muscles were excised. Median nerve and radial nerve were found to be intact. Brachial arteries and basilica veins were found thrombosed. The fracture humerus was stabilized with interlocking nail and external fixator was applied to keep the elbow in flexion. Brachial artery and basical vein thrombosed segment was excised and end-to-end anastomosis was done with 8.0 ethylon. After the said procedure, the wound was thoroughly washed with normal saline. The skin margins were sutured together with 3.0 ethylon. SSG (Split skin Graft) was harvested from right thigh and was stored to be applied over the wound. The surgery was uneventful, post surgery, radial pulses and capillary filling of left hand was good. Thereafter the patient was shifted to ICU on 2012-2003 and was continuously monitored. A Nephrologist has also attended when hypokalemia was found and suggested treatment. As urine output started falling, lasic injection was given and fluid supplement started on the advise of the Nephrologist. As the patient developed respiratory distress on 22-12-2003, he was intubated and sedated and connected to ventilator and was put on Dopamine and Dobutamine drip. On the advise of Nephrologist, the patient was shifted to SICU of the third opposite party hospital for dialysis and patient was diagnosed to have DIC with sepsis and he was subjected to haemodialysis on 24-12-2003 and all possible care was taken and the patient went into ARDS and due to sepsis syndrome, he suffered multi organ failure and died on 27-12-2003.
The complainants never denied that apart from Dr.Sudhakar Prasad who conducted the operation, Dr.Sanjay Maitra, Nephrologist also treated the patient. It is the contention of the complainant that proper post operative care was taken and that this can be known from the medical record given by opposite parties 1 and 3. It is an admitted fact that opposite parties 1 and 2 have sent the medical record to opposite party no.3 hospital but was misplaced there.
We rely on the judgement of the apex court in It is held by the Apex Court in (2004) 8 SUPREME COURT CASES 56 in SAVITA GARG (SMT) v. DIRECTOR, NATIONAL HEART INSTITUTE that
‘when a prima facie case is established, it is the duty of the opposite parties to prove their case, since it is only the opposite parties who are aware of the exact line of treatment that has been given to the patient. It was also held by the Apex Court that once a claim petition is filed and the complainant has successfully discharged the initial burden that the hospital/clinic/doctor was negligent and that as a result of such negligence, the patient died, then in that case, the burden lies on the hospital and the doctor concerned, who treated the patient, to show that there was no negligence involved in the treatment.
In the instant case, it is an admitted fact that opposite party No.3 i.e. Apollo Hospital, Jubilee Hills, did not have the case sheet of opposite party no.1 with them at the time of admission of the patient on 23-12-2003. In their discharge summary i.e. Ex.A5 in which it is clearly stated that the date of admission is 23-12-2003 and the date of discharge is 27-12-2003, they have discussed the line of treatment given by opposite party No.1 and in the absence of any discharge summary or hospital treatment record/case sheet given by opposite party No.1. It is pertinent to note that in Ex.A6 i.e. progress sheet of opposite party No.3, Apollo Hospital, Jubilee Hills, dated 23-12-2003, 12.15 p.m. it is clearly stated as follows:
“case of crush injury-left hand
with vascular injury on left humorous
repaired on 20-12-2003 on going Sepsis-
It is clear from this at the time of admission on 23-12-2003 in opposite party No.3 hospital, the patient was in a condition of sepsis. Even opposite party No.3 discharge summary, opposite party No.3 stated that the patient of total renal failure and hence was shifted for better management to opposite party No.3 hospital. When a 22 year old patient was admittedly operated upon on 20-12-2003 by opposite party No.1 hospital and within 3 days ended in a condition of sepsis and total renal failure, we are of the considered view that there is a prima case and the burden of proof shifts on the opposite party. Keeping in view the aforementioned judgement of the apex court, the duty to prove that the line of treatment given in opposite party no.1 hospital from 19-12-2003 till the morning of 23-12-2003 is as per the standards of medical parlance is on the opposite parties which they have failed to establish. In the absence of medical record from 19-12-2003 to 23-12-2003 either the complainant or even this Commission does not have any documentary evidence to even peruse the line of treatment accorded by opposite party No.1 hospital. Hence we are of the considered view that there is deficiency of service on behalf of the opposite party Nos.1 and 3. Since it is the case of opposite party No.1 that opposite party No.3 has misplaced the case sheet and opposite party No.1 did not produce any doctor to prove that they have taken reasonable and standard care as per the norms of medical practice. However, we observe from the record that opposite party No.2 is only a Pharmacy of opposite party No.3 hospital, so we are of the considered view that opposite parties 1 and 3 are only liable and case against opposite party No.2 is dismissed without costs. It is pertinent to note that the complainant got issues three legal notices, Exs.A13 to A15 dated 8-11-2004, 3-5-2005 and 28-5-2005 calling for the records of opposite party No.1 from 19-12-2003 to 23-12-2003. The complainant has prayed for an amount of Rs.2,50,000/- towards pecuniary loss. It is an admitted fact that the complainant was 22 years old and sustained this injury while working in the agricultural fields. We feel it is a fit case to take into consideration the calculation as per the Motor Vehicles Act and calculate his earnings at Rs.20,000/- p.a. less 1/3rd which is approximately Rs.13,000/- per annum x 17 years = Rs.2,21,000/- as against his claim of Rs.2,50,000/- towards pecuniary loss. We are of the considered view that the complainant is entitled to this reasonable amount of Rs.2,21,000/- in addition to Rs.15,000/- towards loss of consortium and Rs.15,000/- towards loss of estate. We observe from the prayer in the main complaint that the complainant had asked for refund of the excess price of Rs.30,000/- charged by the opposite parties for medicines and other consumables. This is being disallowed in the absence of any evidence that the price charged on the medicines is excessive. Apart from this we observe from the record that though the complainant submitted that he spent an amount of Rs.1,00,000/- under various heads towards medical treatment in his main complaint, he did not pray for any refund of medical expenditure in his prayer. However, we are of the considered view that the complainant is entitled to compensation of Rs.1,00,000/- for mental agony that he had undergone on account of death of his young son who was aged only 22 years. It is also pertinent to note that the insurance company was impleaded as opposite party No.4. Neither the policy number nor the terms and conditions of the insurance policy has been put forth in either the complainant’s affidavit or that of the opposite parties. We do not know the terms and conditions of the policy between the hospital and the insurance company and since this has not been stated even by the opposite parties 1 and 3 either in their counter, affidavit or written arguments, we cannot direct the insurance company to jointly and severally pay these amounts. Hence the case against opposite party No.4 is dismissed.
In the result this appeal is allowed in part and the order of the District Forum is set aside and consequently the complaint is allowed in part directing opposite parties 1 and 3 to pay an amount of Rs.2,21,000/- towards pecuniary loss, Rs.15,000/- towards consortium, Rs.15,000/- towards loss of estate. We also award a compensation of Rs.1,00,000/- towards mental agony and costs of Rs.3,000/- to be paid within four weeks from the date of receipt of this order.
Sd/-PRESIDENT.
Sd/-MEMBER.
Sd/-MEMBER.
JM Dt.06-4-2010
