BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD.
C.C.No.54 OF 2007
Between:
1. Medi Sushanth (Since died)
2. M.Purushotham Rao, S/o.M.Hanumaiah
Aged 63 years, Occ:Retd.Government Employee.
3. M.Swarnalatha, W/o.M.Purushotham Rao,
Aged about 50 years, Occ:Housewife,
Nos. 2 and 3 are resident of H.No.69,
Tarbund X road, Secunderabad. Complainants
And
1. The Managing Director, Care Hospital,
Near Clock Tower, Market Street,
Secunderabad.
2. Dr.Bishampath, Dy.Care Hospital,
Exhibition Ground, Nampally,
Hyderabad.
3. Dr.P.C.Gupta, Care Hospital, Exhibition
Ground, Nampally, Hyderabad.
4. Dr.Gopal Rao, Registrar, Division of
Cardiothoracic Surgery, Exhibition
Grounds, Nampally, Hyderabad. Opposite Parties.
Counsel for the Complainants: Mr.N.V.Ramakrishna
Counsel for the Opposite parties: M/s.A.Srinath-O.Ps.1, 3 and 4.
O.P. No.2 served by way of paper
Publication.
QUORUM: SRI SYED ABDULLAH, MEMBER.
AND
SRI R.LAKSHMINARASIMHA RAO MEMBER
.
TUESDAY, THE TWENTY EIGHTH DAY OF DECEMBER,
TWO THOUSAND TEN
Oral Order (As per Sri R.Lakshminarasimha Rao, Hon’ble Member)
***
1. The complaint is filed U/s.17(1)(a)(i) against the Managing Director, CARE Hospital and 3 others seeking compensation of Rs.30,00,000/- with interest @ 24% p.a. thereon.
2. The averments of the complaint are that the complainant No.1 (since deceased) suffered pain in his left leg whereon the complainant No.2 had taken him to the opposite party No.1 hospital on 13-10-2005 at 11.30 p.m. A doctor attended to him and administered injection by assuring him that he would be alright within an hour. The pain did not heal and the doctor informed the complainant No.2 that they would shift the complainant No.1 to CARE Hospital, Nampally and prior to the shifting of the patient, his urine was tested and its colour changed to black. At CARE hospital, Nampally no doctor attended to the patient from 5.00 a.m. to 3.00 p.m. After subjecting the patient to ultrasound treatment, the doctors therein informed the complainant No.2 that they had consulted Dr.P.C.Gupta and Dr.Madhavi. Dr.Madhavi informed the complainants 2 and 3 that the legs of the complainant No.1 had been damaged and she had compelled the complainant No.2 to give his consent else his son would loose his life as also they would not give any guarantee to the functioning of the right leg of the patient and his life.
3. The complainant No.1 is the only son of complainants 2 and 3. It is submitted that there was much delay in assessment and treatment in the emergency department. Identification of cause of delay and treatment amount to deficiency in service and delayed the improvement of condition of the patient. The standard health CARE recommends that all emergency departments should provide thrombolytic therapy, thrombolytic drugs should be made readily available on 24 hour basis and the nurses and physicians and other members of the Health CARE team should co-operate, develop a plan for the diagnosis, treatment and delivery of CARE to the patients with suspected emergency. The surgery was conducted at 3.30 p.m. on 15-10-2005 without making pre-operative notes.
4. Due to the negligence of the doctors in making delayed diagnosis led to the amputation of the leg of the complainant No.1 as also the non-rendering thrombolytic treatment which could have saved the limb of the patient. The opposite parties have not taken the consent of complainants 2 and 3 except obtaining their signature on dotted lines in a blank paper. The complainant No.1 used to earn Rs.50,000/- per month and he was aged 25 years. The complainants 2 and 3 claimed Rs.20,00,000/- towards loss of earnings, Rs.5,00,000/- under the head of pain and mental agony, Rs.3,00,000/- towards continuous medical expenditure and Rs.2,00,000/- medical attendant, bed charges and transportation charges etc.
5. The opposite party No.2 has not chosen to contest the case inspite of service of notice on him by way of paper publication.
6. The opposite party No.3 has filed his affidavit styled as counter on behalf of the opposite parties 1 and 4 wherein it is stated that the complainant No.1 presented in the first opposite party hospital with complaint of sudden onset of pain in both lower limbs and lower back which rapidly progressed to weakness of both lower limbs on 13-10-2005 and at that time the patient was conscious, had trachycardia (114 per minute) presented with BP 130/70). He was an ex-smoker and suffered from diabetes Mellitus with further history of coronary artery disease. He was shifted to CARE hospital, Nampally. The change of colour of urine of the patient was due to loss of protein in the urine and not due to administration of any injection. He was attended to, from 8.00 p.m. and the tests such as Doppler venus and artery were conducted and he was kept under neurological CARE. On 14-10-2005, he was diagnosed as a case of acute aortic occlusion which is also known as a blood clot as a result of previous history of coronary artery disease.
7. Due to the acute aortic occlusion protein was being lost in the urine and in the process, the kidneys of the complainant No.1 were getting affected. Acute aortic occlusion is a live and limb threatening disease that carries a mortality of 50%, of those patients who survive more than 20% end up with major amputation of one or both lower limbs.
8. Immediately after the diagnosis was made, vascular surgeons were informed and after conducting the tests, it was explained to the attendants of the complainant No.1 that the patient’s left limb was non viable and the right lower limb exhibited symptoms of doubtful viability. After explaining the symptoms, prognosis the patient was taken for undergoing surgery and he was not in a position to respond properly or communicate coherently with the doctors. Emergency surgery was planned under spinal anaesthesia. The consent of the complainant No.2 was taken. In view of the heart condition of the patient, diabetes Mellitus and kidney dis-function and also nature of the disease, the surgery was a high risk surgery meant to save life. The particulars of the treatment are noted and in the opinion of the doctors, thrombolytic treatment was unnecessary for the first surgery conducted on 14-10-2005, the complainant No.2 has signed the consent form as the complainant No.1 was not in a position to give his consent and for the second operation, for debridement under spinal anesthesia on 29-10-2005, the complainant No.1 has given his consent. There was no deficiency in service on the part of the opposite parties and as such requested for dismissal of the complaint.
9. The complainant No.2 has filed his affidavit and got marked the documents initially Exs.A1 to A7 and subsequently got marked Exs.A8 and A9 by filing the same as additional documents. The opposite party No.3 has filed his affidavit. Ex. B1 marked which included copies of consent form, registration of patient and investigation report and operative procedure etc.
10. The complainant No.2 and opposite parties 1, 3 and 4 have filed written arguments.
The points for consideration are:
1. Whether non rendering of thrombolytic treatment amounts to deficiency in service on the part of opposite parties 1 to 4?
2. Whether there was any medical negligence on the part of the opposite parties in treating the complainant no.1?
3. To what relief?
11. POINTS NO.1 & 2: The complainant No.1 was admitted in the opposite party No.1 hospital on 13-10-2005 with the complaint of sudden onset of pain in both his lower limbs. The doctors at the opposite party No.1 hospital conducted tests and were of the opinion that complainant No.1 was suffering from paraphlegia. The doctors of the opposite party no1. hospital had decided to shift the complainant No.1 to CARE hospital, Nampally for accurate and proper diagnosis of the disease that the complainant No.1 was suffering from. Just before the patient was shifted to the CARE hospital, Nampally, the doctors at opposite party no.1 hospital had observed that complainant No.1 passing urine in black colour. The complainants 2 and 3 had contended that due to administration of the medicine by the doctors at opposite party no.1 hospital, the complainant No.1 had suffered affect of functioning of his kidneys and in those circumstances, the urine he passed was of black colour. The complainants also filed reply written arguments in which they denied the allegation made by opposite parties 1, 3 and 4 that their deceased son was addicted to alcohol or smoking and he was a diabetic. They submitted that their son was a case of CAD, and he was diagnosed as a Neurology case and that there was considerable delay in diagnosing the same by Doppler tests which le to catastrophe.
12. The complainants 2 and 3 had not examined any witness or filed any documents in support of their contention that the administration of medicine at the opposite party No.1 hospital resulted in the patient passing urine in black colour. It appears more probable the contention of the opposite parties 1, 3 and 4 that the patient suffered Coronary Artery Disease, a year prior to his admission in the opposite party no.1 hospital which resulted in acute aortic occlusion which is also termed as blood clot that came to be formed in the abdominal area due to which the muscle protein was being lost in the urine and in the process the kidneys of the complainant No.1 were getting effected. It is not disputed that the complainant No.1 had suffered cardiac problem a year prior to the date of his admission at the opposite party no.1 hospital and the sudden onset of pain in his lower limbs attributed to the acute aortic occlusion in the abdominal area of the patient cannot be ruled out as the cause for dis-functioning of kidneys of the complainant No.1 which resulted in loss of muscle protein and in its turn the loss of muscle protein led to blackening of the urine of the complainant No.1. These facts does not reflect any deficiency in service in rendering the treatment at the opposite party No.1 hospital till he was shifted to the CARE hospital, Nampally.
13. After the complainant No.1 was shifted to CARE hospital, Nampally, he was subjected to tests such as MRI/CT scan including Doppler venus and artery tests. He was diagnosed as a case of acute aortic occlusion and the details of the treatment have been progressively noted in the progress notes marked as Ex.B1. In view of the deteriorating health condition of complainant No.1, the doctors at CARE hospital decided to perform surgery on the patient and obtained the signature of complainant No.2. The complainant No.2 has not denied or disputed his signature in the consent form. Opposite party No.1 has cited the reason of the incoherence of the complainant No.1 for obtaining the signature of complainant No.2 in the consent form in so far as the first operation that was performed on 14-10-2005. The signature of the complainant No.1 was obtained in the consent form for the operation that was conducted on 29-10-2005. Therefore, the question of not giving consent either by the complainant No.1 or by complainant No.2 for conducting both the operations on the complainant No.1 by the doctors of the opposite party no.1 hospital does not arise. The contention of the complainants 2 and 3 that they had not given consent is not sustainable.
14. It is contended that the opposite parties had failed to thromoblytic treatment to the complainant No.1 which according to the complainants 2 and 3 had led to the loss of limb of the complainant No.1. It is submitted by the opposite parties that the thromoblytic treatment was not felt necessary by them in the circumstances the complainant No.1 was placed in. The opposite parties 1, 3 and 4 contended that complainants 2 and 3 had not adduced any evidence to show that thromoblytic treatment was necessarily to be rendered to the complainant No.1 nor the complainants 2 and 3 had chosen to cross-examine the opposite party no.3 in this regard. In so far as the amputation of left limb of the complainant No.1 is concerned, the opposite parties 1, 3 and 4 had stressed on the acute aortic occlusion as the sole and whole cause for the loss of limb of the patient. They contended that acute aortic occlusion is a life and limb threatening disease which carries a mortality of 50% and according to the opposite parties even the patient’s who survive from acute aortic occlusion would end up to the extent of 20% with major amputation of one or both lower limbs. Therefore, the cause for amputation of left limb of the complainant No.1 is acute aortic occlusion. The complainant No.2 and 3 had not adduced any evidence to show that the non rendering of thrombolytic treatment resulted in amputation of left limb of the patient.
15. The documents, diagnostic report and consent form, discharge summary, emergency certificate etc. filed by the complainant does not support their case in positive manner. The copy of the letter addressed by the complainant No.2 to doctor Rajendra is not supported by any complaint of medical negligence on the part of the opposite party no.1 hospital. The list of medicines with the amount spent there for to an extent of Rs.1,07,600/- is not supported by the Medical bills and prescriptions and in any case the question of compensation comes into picture only when any negligence or deficiency in service is found on the part of the opposite parties. We do not find any such negligence as alleged by the complainants 2 and 3 in rendering treatment to complainant No.1 particularly in the circumstances as noted in the discharge summary that the complainant No.1 was diagnosed a case of CAD, diabetes mellitus prior to his admission at the opposite arty no.1 hospital with the complaint of sudden onset of pain in his lower limbs which was diagnosed to be acute aortic occlusion.
16. In 1998 (2) CLT 399 in SMT.GURMIT MAHAL v. CHAUHAN NURSING HOME AND ANOTHER it was held by Punjab State Consumer Commission that while performing Laproscopic cholecystectomy accidentally CBD was cut causing biliary peritonitis later requiring multiple drainage and another surgery of hepatico jejunostomy at PGIMER. The facts in the instant case are different and hence has no application.
17. In (1997) CPJ 103 in DEVENDRA KANTILAL NAYAK AND ORS. v. DR.KALANIBEN DHRUV SHAH & ANR. it was held by Gujarat State Consumer Commission that in a case of cesarean section done for placenta previa during which massive hemorrhage was encountered and despite numerous blood transfusions, the patient exanguinated and died later at another hospital. Postmortem done showed hematoma intraperitoneally with antemortem cuts on ulterior artery branches and hematoma around sutures and statements of obstetrician and anesthetist gave varied accounts. The facts in the instant case are different and hence has no application.
18. In AIR 1990 207 in DR.PINNAMANENI NARASIMHA RAO v. GUNDAVARAPU JAYAPRAKASU AND ANOTHER in which the Hon’ble High Court of Andhra Pradesh found negligence on the part of the doctor who performed tonsillectomy operation on the patient in a careless and negligent manner in Government hospital and during surgery the patient had respiratory and cardiac arrest from which he was revived but did not regain consciousness for 2-3days, physician, ophthalmologist and psychiatric consultations were sought. Later it was found that the patient had cerebral damage due to anoxia. The facts in the instant case are different and hence has no application.
19. In 1998(1) CPR 1 (SC) in M/s.SPRING MEADOWS HOSPITAL (NOIDA) & ANR. v. HARJOT AHLUWALIA THROUGH K.S.AHLUWALIA & ANR. in which the National Commission awarded compensation of Rs.12.5 lacs and further awarded compensation of Rs.5 lacs to the parents for actue mental agony as the injection of Chloroquin was given intravenously causing cardiac arrest by an unqualified nurse and the Supreme Court on appeal limited the award to Rs.5.00 lacs. The facts in the instant case are different and hence has no application.
20. In the result the complaint is dismissed.
Sd/-
MEMBER.
Sd/-
MEMBER.
JM Dt.28-12-2010
//APPENDIX OF EVIDENCE//
For complainants For Opp.parties
Affidavit of 2nd complainant. Affidavit of Dr.P.C.Gupta filed
Filed.
Witnesses examined
For complainants For Opp.parties
NIL NIL
Exhibits marked on behalf of complainants:
Ex.A1-Copy of investigation report dated 14-10-2005.
Ex.A2-General Authorization treatment dated 14-10-2005.
Ex.A3-Discharge summary dated 08-11-2005.
Ex.A4-Emergency Certificate dt.8-2-2006.
Ex.A5-Complaint to Medical Consumer Association dated nil.
Ex.A6-Statement of medicines cost
Ex.A7-Salary Certificate.
Ex.A8-copy of Death Certificate
Ex.A9-Photo.
Exhibits marked on behalf of Opp.parties:
Ex.B1-Copies of consent form, registration of patient and investigation
report and operative procedure etc.
Sd/-
MEMBER.
Sd/-
MEMBER.
