Andhra Pradesh

Chittoor-II at triputi

CC/28/2017

P.Venkata subbamma, W/o Late P.Ramamurthy, aged 65 years. - Complainant(s)

Versus

DBR and SK Super Specialty Hospital, Rep. by its Chairman - Opp.Party(s)

M.Vijay Sekhar, P.Narendra Kumar Reddy

26 Jul 2019

ORDER

Filing Date: 15.06.2017

Order Date:26.07.2019

 

 

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II,

CHITTOOR AT TIRUPATI

 

 

      PRESENT: Sri.T.Anand, President (FAC)

               Smt. T.Anitha, Member

 

 

 

FRIDAY THE TWENTY SIXTH DAY OF JULY, TWO THOUSAND AND NINTEEN

 

 

 

C.C.No.28/2017

 

 

Between

 

 

1.         P.Venkata Subbamma, W/o. late. P.Ramamurthy, aged about 65 years.

2.         P.Lakshmi Devi, W/o. late. P.Rajendra Prasad, aged about 27 years.

3.         P.Gagana Siri, minor, D/o. P.Rajendra Prasad, aged about 4 years.

4.         P.Joi Jaksha, minor, S/o. P.Rajendra Prasad, aged about 1^1/2 years.

 

Complainants 3 and 4 are minor, rep. by their

Next friend natural guardian mother 2^nd complainant

 

All are residing at

 

D.No.6-3-306, Manchala Street,

Tirupati,

Chittoor District.                                                                              … Complainants.

 

And

 

 

1.         DBR & SK Super Specialty Hospital,

            Rep. by its Chairman,

            D.No.20-7-37, DBR Hospital Road,

            Near TMC.,

            Tirupati Town,

            Chittoor District.

 

2.         Dr.P.Nagaraj,

            Aged about 40 years,

            Interventional Cardiologist,

            DBR & SK Super Specialty Hospital,

            D.No.20-7-37, DBR Hospital Road,

            Near TMC.,

            Tirupati Town,

            Chittoor District.                                                                  …  Opposite parties.

 

 

 

 

 

            This complaint coming on before us for final hearing on 22.03.19 and upon perusing the complaint and other relevant material papers on record and on hearing Sri.P.Narendrakumar Reddy, Sri.M.Vijaya Sekhar, counsel for the complainants, and Sri.T.M.Chayapathy, counsel for opposite parties,  and having stood over till this day for consideration, this Forum makes the following:-

 

ORDER

DELIVERED BY SRI. T.ANAND, PRESIDENT (FAC)

ON BEHALF OF THE BENCH

           

            This complaint is filed under Section –12  of C.P.Act 1986,  alleging as follows:-

2.  Complainant No.1 is the mother of deceased P.Rajendra Prasad. He died due to cardiac arrest, leaving behind his family. 1^st complainant is the mother,           2^nd complainant is his wife, and 3^rd and 4^th complainants are the minor children. On 11.06.2015 in the afternoon, deceased complained chest pain and was admitted in DBR & SK Super Specialty Hospital, Tirupati, by complainants 1 and 2 at about    2.30 p.m. He was admitted in ICU ward in opposite party No.1 hospital. Opposite party No.2 treated the deceased as inpatient vide IP No.67/73. It was informed to complainant No.1 that the deceased had cardiac minor stroke and that he needs ‘coronary angiogram test’. Complainant No.1 has Aarogyasri health card and on the basis of health card, treatment was given to the deceased in the hospital. The complainants told the doctor that they need not wait till the approval of Aarogyasri benefit, as they worried about the health of the deceased P.Rajendra Prasad. The doctor assured that there is no need to worry and that complainants can wait for a week or 10 days for the test. The approval was obtained on 13.06.2015 and coronary angiogram test was conducted on 15.06.2015. Complainant No.1 was informed that the deceased had cardiac problem, as one of the valves is blocked to a large extent. Complainants 1 and 2 are not worldly-wise and literates. The deceased practiced as an advocate in Tirupati courts and also worked as Law Officer of Indus Bank. All the members of his legal fraternity, friends and relatives were ready to support him to any extent both financially and morally to save his life. Though the complainants told the hospital authorities that they need not wait for the approval of Aarogyasri scheme benefit and start the treatment immediately, the opposite parties waited for the approval till 17.06.2015. On 18.06.2015 deceased was shifted to operation theatre for conducting coronary balloon angioplasty with drug eluting stent surgery. The 2^nd opposite party had conducted the surgery. On that day at about 8 p.m. complainant No.1, was informed that her son P.Rajendra Prasad, died due to cardiac arrest during the course of surgery. The deceased was the sole breadwinner of the family and due to his sudden death, his family members are suffering a lot financially. Further it is stated that generator was not provided during the course of surgery, and due to that there was power failure during the surgery. Complainants 1 and 2 were astonished to know that in the diagnosis report dt:16.06.2015 only one valve block was mentioned, but in the entire patient summary it is mentioned that three valves were blocked. They came to know that the reason for development of multiple blocks in valves is due to delay in doing surgery to the deceased and also due to lack of proper treatment to the deceased in the hospital. The deceased would not have developed complications, had there been proper treatment to patient. The hospital authorities refused to provide video recording of surgery to know what transpired during the course of surgery. They got the information from the hospital under RTI Act. The medical negligence by the opposite parties is briefly mentioned as follows – 1) The delay in conducting the stent surgery (one week delay), 2) Inaccurate and wrong angiogram test dt:16.06.2015, 3) Development of multiple blocks (three blocks) after the report dt:16.06.2015 is due to the lack of proper monitoring and total negligence in giving proper treatment, 4) Suppression of the fact that P.Rajendra Prasad had developed multiple blocks (i.e. three blocks) and proceeding with the surgery, 5) conducting surgery without generator and other proper mandatory facilities, and 6) other medical aspects, which the complainants 1 and 2 cannot assess due to lack of medical knowledge. The death of the deceased occurred purely due to negligence of opposite parties and the same amounts to deficiency in service on their part. The deceased would have earned an income of Rs.35,000/- per month as Law Officer (his monthly salary as on the date of death is Rs.20,000/-). He would have actively continued his career for next 30 to 40 years and would have provided sophisticated life to his family members, but due to his untimely death, complainant No.1 lost her son. More than everything, the complainants lost the love, affection and care, which the deceased P.Rajendra Prasad was giving to them. The 2^nd opposite party being professional doctor, did not take reasonable care and caution and treatment is not up to the medical standards.  

            3.  Opposite parties filed objections contending as follows – At the outset complaint allegations are denied. The specific denial is with regard to paras.3,4,5,6,7 and 8 of the complaint. The alleged complaint is barred by time. There is no deficiency in service on the part of opposite parties in discharging their duties. The hospital authorities sent entire CD and other materials to Aarogyasri unit and as such  opposite parties could not handover the same to complainants directly. Opposite party No.2, is a specialist in the field of cardiology. Opposite party No.1, is also a super specialty hospital with all equipment. The patient was provided Angiogram and Angioplasty treatment in cathlab. It consists of UPS with 120KV and no generator is necessary in providing treatment as UPS itself is providing sufficient energy. The said UPS also is online UPS with continuous power. As the complainant alleged that while conducting surgery opposite parties never provided generator and other mandatory facilities is false. Infact, opposite party No.1, also has 200 KV generator in addition to 120 KV UPS. The said UPS is the online electric equipment providing energy for 24 hours. The patient was admitted with acute AWMI (Anterior Wall Myocardiac Infaraction) with 1^1/2 hour window period on 11.06.2015 at 2.20 p.m. to casualty with Aarogyasri card. The patient was admitted and immediately provided with treatment Thrombolysed with Streptokinase Angina Subsided, but patient developed Left Ventricular failure. Because of moderate Left Ventricular Dysfunction the patient was stabilized in ICU and CAG (Angiogram) was done on 15.06.2015 at 1.30 p.m. The opposite party further stated that patient had left dominant circulation with LAD (Left Anterion Descending Artery) Osteoproximal total cutoff and was taken up for PTCA (Angioplasty) on 18.06.2015 at 3.08 p.m. to LAD (Left Anterion Descending Artery). During the procedure the patient developed complication of distal LMCA (Left Main Coronary Artery) and LCX (Left Circumflex Artery) occlusion with Thrombus and was bailed out with 2 DES to LCX (Left Circumflex Artery). But the patient developed cardiogenic shock and was kept in ventilator and inotropes and LAD procedure abandoned and the patient was shifted to ICU, but the patient succumbed in the follow up period. The opposite party further submits that patient came to hospital with Accute Myocardiac Infarction and provided with treatment of thrombolysis with STK as it is an accepted standard of care and within 3 hours of the window period is as good as primary PTCA. It is stated that as the patient had relief of pain and ST segment resolution in ECG, which indicated recanalisation of LAD (Left Anterior Descending Artery) and as patient had LVF, it is a good practice to stabilize the patient at the outset before taking up CAG (Coronary Angiogram) / PTCA (Percutaneous Transle Minor Coronary Angio Plast). CAG was done which is elective. But time gap between acute MI and CAG especially when the patient is in LVF, it is an acceptable standard of care which was taken by opposite parties in this case on hand. It is further stated that as only Osteproximal LAD (Left Anterior Descending Artery) is involved, the decision in going ahead with PTCA is acceptable standard of care. But during the procedure inspite of patient being on anti platelets and heparin, the patient had huge thrombus burden, as thrombus spilled in to distal LMCA (Left Main Coronary Artery) and LCX (Left Circumflex Artery) from the ostepromixal LAD (Left Anterion Descending Artery), which is an unfortunate complication, and may occur in some patients and all steps were taken to tide over crisis to restore the blood flow. While abandoning LAD stunting, the patient was kept on ventilator and inotropes as it was the only option left in the given circumstances. The cathlab is Innova 2100 IQ and comes with 120 KVA full system UPS and power fluctuations is not at all constraint for the procedure. Thus, to the knowledge of opposite parties there is no negligence on their part while attending the patient. Therefore, it is submitted that entire procedure that was followed by opposite parties is as per medical standards. There was no delay, and alleged delay mentioned in the complaint is baseless. Unless the patient is stabilized, the question of procedure of angiogram and angioplasty cannot be done. Hence, the patient was provided the treatment as per the medical procedure and inspite of their medicare, unfortunately the patient died. Hence, there is no substance in the complaint regarding deficiency in service on their part and as such it is prayed to dismiss the complaint.

            4.  On behalf of complainants P.Venkata Subbamma, filed chief affidavit as P.W.1 and marked Exs.A1 to A7. On behalf of opposite parties R.W.1 and R.W.2 filed their chief affidavits and marked Exs.B1 to B3.

            5.  The points for consideration are:-

            (i).  Whether the complaint is barred by limitation?

            (ii). Whether there is deficiency in service on the part of opposite parties? If so,  

                   to what extent the complainant is entitled to the reliefs sought in the

                   complaint?

            6.  Point No.(i):-  The opposite parties counsel contended that the complaint was filed on 06.07.2017 beyond the period of two years limitation and as such complaint ought not have been numbered, as barred by limitation. It is an admitted fact that the deceased Rajendra Prasad was admitted in the hospital of opposite party No.1 on 11.06.2015 as inpatient vide IP No.67/73 and underwent treatment in ICU ward till his death on 18.06.2015. The complaint was filed on 15.06.2017 vide S.R.No.429. It is therefore clear that the complaint was filed within two years period of limitation and hence the contention of opposite party counsel that the complaint is barred by limitation cannot be accepted. This point is answered accordingly.   

            7.  Point No.(ii):-  It is the argument of complainant counsel that medical records from opposite party No.1 hospital shows that on 11.06.2015, upon clinical examination and investigations, a provisional diagnosis of “Acute Anterior Wall Myocardial Infarction” was made classifying the CAD as “Killips Class II”, pending final diagnosis through Angiogram and the family of the deceased was informed on 11.06.2015 itself, that they were going to perform early Angiogram and if needed Angioplasty and the same can be corroborated from the medical records, including requisition to Arogyasri. But the Angiogram was postponed for 5 days until 15.06.2015 and the Angioplasty for 8 days until 18.06.2015 for unexplained reasons. He further argued that the care takers of the deceased inquired with opposite party No.2 about delay for the PCI and they were told that the doctor knows when to do PCI and they were providing best treatment. It is pointed out that in the written version filed by the opposite parties, it is stated that Thrombolysis is an accepted standard of care in the first 3 hours as defence to not providing early PCI. The guidelines 2, 3 and 4 clearly say that primary PCI should be the first line of treatment and Thrombolysis is acceptable only when primary PCI is not available. As opposite parties 1 and 2 have affirmed the availability of primary PCI, there is no explanation as to why PCI was not done within 24 hours of Thrombolysis. The opposite parties 1 and 2 did not give reasons for stabilizing the patient to perform PCI, as the reason to delay Coronary Angiogram and PCI. Opposite parties 1 and 2 infact stated that they deferred primary PCI to stabilize patient for PCI, self-assailing their first defense that deferring PCI wasn’t a factor as Thrombolysis was an equivalently acceptable standard of care in the first 3 hours of admission of the patient. But contrary to that opposite parities say, medical records actually show that the patient was stable from 11.06.2015 to 18.06.2015 and there was no condition that precluded primary PCI or even PCI in the first 24 hours. The opposite parties 1 and 2 failed to explain why they were waiting to stabilize the condition of the patient before PCI, as the patient was young, aged about 34 years and non-hypertensive, non-diabetic between 11.06.2015 to 18.06.2015. It is the argument of the complainant that obviously opposite parties waited for the Arogyasri approvals and due to that delay was caused in giving proper treatment to the deceased. Opposite party No.1 is statutorily not suppose to deviate from medical protocols, while they wait for approvals from benefit provider. He further contended that infact the deceased care takers were even ready to pay cash without waiting for Arogyasri approvals, to save the life of the deceased. It is the standard practice for hospitals including opposite party No.1 hospital to take authorization from patients, to make the patient responsible for any uncovered benefits from their benefit / insurance provider. The opposite party No.1 hospital took such consent from the patient’s care takers at the time of admission and also stated the same to them verbally, but they suppressed the same in the written version. It is argued that there is no record to show primary PCI was denied by the deceased or his care takers and the same is mentioned in the consent form to provide Thromnbolysis. But on the other hand, there is record to show primary PCI was warranted and required and was planned, and there is no record to show that patient refused to pay for primary PCI if warranted. If unwillingness or inability by the patient to pay for any services not covered or approved by their benefit provider (Aarogyasri) is really true, nothing prevented opposite party No.1 to state that is the reason to delay PCI. Instead opposite parties     1 and 2 first stated that Thrombolysis was provided as the acceptable standard of care in the first 3 hours and justified that PCI was delayed to stabilize the patient. Thus, opposite parties did not explain why thrombolysis was given, when PCI was planned for the patient in violation of Guideline No.5 (Salient points with reference to medical literature on angioplasty treatment filed on behalf of the complainant). Another gross unexplained negligence is, why after thrombolysis, the patient was not given PCI within 24 hours as mandated in Guideline No.6 (Salient points with reference to medical literature on angioplasty treatment filed on behalf of the complainant). As per the medical studies angioplasty is done to unclog an artery implicated in a heart attack, when performed more than 24 hours after a heart attack provides no tangible benefit to the patient, when the patient no longer had symptoms. It is agreed by complainant counsel that as early as 2007, the American College of Cardiology and the American Heart Association issued the guidelines that angioplasty is approved method to unclog an artery implicated in a heart attack, when performed more than   24 hours after the event, is not appropriate as long as the person is stable. This guideline was made to offset the risk to the patient when there is no tangible benefit to the patient, as by then the vascular system mediates the blood flow to adjust to the occlusion, and it can be dangerous to undo the mediation and new found stability. But in the instant case, 8 days after the heart attack on 11.06.2015 and while the patient was stable and asymptomatic during the 8 days, the opposite party No.1 hospital subjected the patient to the risk of angioplasty on 18.06.2015, which caused deterioration of health of the patient, resulting his death. The procedure adopted by the opposite parties is grossly outside the guidelines. Further, the opposite party hospital refused to share the video of the surgery with the family of the deceased and simply told them that they have submitted the video to the benefit provider (Aarogyasri). It can be seen from the medical records that the report for the angioplasty performed dt:18.06.2015 was not prepared till 20.06.2015, and it is improbable that they submitted the video before 20.06.2015 to Aarogyasri authorities. Thus, the opposite parties have suppressed the video giving credence to improper infrastructure provided in the operation theater. In the instant case on hand, the doctrine of ‘Res ispa Loquitor’ is applicable and there is no need for any expert opinion of cardiology, to show that there is medical negligence on the part of opposite parties. For that the complainant counsel placed reliance on 1) II (2013) CPJ 398 (NC), 2) I (2006) CPJ 16 (NC). The National Commission in S.C.Mathur and Ors. Vs. Director of AIIMS, New Delhi, clearly held “accepted medical literature clearly indicates that on failure of PCI procedure, it is mandatory to have Heart and Lung machine in the lab and to provide the same within 4 minutes of the cardiac arrest during the PCI procedure”. Admittedly, there is no Heart and Lung machine provided as per the medical records furnished by the opposite parties 1 and 2. Adding to that, the National Commission judgment reported in 2015 (1) ALD (Cons.) 5(NC), it was held “failure to take reasonable care amounts to medical negligence”. It was further held that opposite parties are guilty of overwriting and making corrections in the medical records. Hospital, though a corporate hospital, lacks infrastructure of cardiac alert system or rapid response team, hence negligence proved. It is therefore argued that facts narrated in the complaint and chief evidence of P.W.1 coupled with non-production of video of the operation conducted in the operation theater by opposite parties 1 and 2, clearly prove that there is negligence on the part of opposite parties 1 and 2.

            8.  On the other hand, opposite party counsel argued that there is no deficiency in service on the part of opposite parties in discharging their duties, as alleged by the complainant. It is the argument of opposite party counsel that the deceased was provided with medical treatment within ICU and later Angiogram and Angioplasty in Cathlab, and it consists of UPS with 120 KV and no generator is necessary for providing treatment, as UPS itself is providing sufficient energy and the said UPS is online UPS with continuous power supply. It is denied that generator was not provided in the operation theater while patient was undergoing treatment. The hospital is provided with 200 KV generator in addition to 120 KV UPS throughout 24 hours. It is argued that the deceased was admitted on 11.06.2015 at 2.20 p.m. in causality with Aarogyasri card. The patient was provided with treatment i.e. Thrombolysed with Streptokinese Angina subsided but patient developed left ventricular failure. Because of Left Ventricular Dysfunction the patient was stabilized in ICU and CAG (Angiogram) was done on 15.06.2015 at 1.30 p.m., and thereafter the patient has left dominant circulation with LAD (Left Anterior Descending Artery) Osteoproximal total cutoff and was taken up for PTCA (Angioplasty) on 18.06.2015 at 3.08 p.m. to LAD (Left Anterior Descending Artery). During the procedure the patient developed complication of distal LMCA (Left Main Coronary Artery) and LCX (Left Circumflex Artery) occlusion with Thrombus and was bailed out with 2 DES to LCX (Left Circumflex Artery). But the patient developed cardiogenic shock and was kept on ventilator and inotropes and LAD procedure was abandoned and the patient was shifted to ICU, but unfortunately the patient died in the follow up period. It is therefore contended that the opposite parties have taken utmost care and followed standard procedure while giving treatment to the deceased. It is vehemently argued that the patient was admitted with Acute Myocardiac Infarction and thrombolysis with STK as it is an accepted standard of care and within three hours of the window period and is as good as primary PTCA. Infact the patient had relief of pain and ST segment resolution in ECG which indicated recanalisation of LAD and as patient had LVF, it is a good practice to stabilize the patient at the outset before taking up CAG (Coronary Angiogram). It is pointed out that as only Osteproximal LAD is involved 100%, the decision in going ahead with PTCA is acceptable standard of care. But during the procedure, inspite of patient being on anti platelets and heparin, the patient had huge thrombus burden and thrombus spilled into distal LMCA (Left Main Coronary Artery) and LCX (Left Circumflex Artery) from the osteproximal LAD which is an unfortunate complication and which may occur in some patients and however for that opposite parties took all efforts to tide over crisis and restore the blood flow. Hence, it is argued that in the given circumstances, opposite parties  abandoned the LAD stunting and patient was kept on ventilator and inotropes. During the course of arguments, the counsel for opposite parties submitted that being a corporate hospital, they tried their level best to save the life of the patient, but due to complications developed during the operation, the patient died and it is not the fault of the doctors. The following citations were relied upon by the opposite parties –           (i) 1996 Consumer Cases Reporter, Page.389 of NCDRC between Dr.N.T.Subrahmanyam and Another vs. Dr.B.Krishna Rao and Another, wherein it is held that “Doctor cannot be found negligent merely because in the matter of opinion he made an error of judgment and can be held guilty of medical negligence only when the doctor falls short of the standard of reasonable medical care. (ii). 1997 Consumer Cases Reporter Page.39 of Kerala State Commission, Thiruvananthapuram between Joseph Alias Animon and Another vs. Dr.Elizabeth Zachariah and Others, wherein it is held that “No evidence to establish that there is any deficiency on the part of the opposite party in administering the medicines or conducting treatment of caesarian operation and hence complaint is dismissed”.  (iii).  1997 Consumer Cases Reporter Page.222 of Karnataka State Commission, Bangalore, between P.N.Sudhakar Gupta vs. Anugraha Vittala Nursing Home, wherein it is held that “deficiency in service in diagnosing and giving treatment not established and hence complaint is dismissed”.  (iv). 1997 Consumer Cases Reporter Page.330 of Tamil Nadu State Commission, Chennai, between T.Rama Rao vs. Vijaya Hospital and Another, wherein it is held “No vicarious liability for deficiency of service in treatment by second opposite party. Failure of second opposite party to give case sheets cannot be said to be deficiency in service – Deficiency in service is not proved against the opposite parties – Hence, complaint is dismissed. (v).  1997 Consumer Cases Reporter Page.339 of Gujarat State Commission, Ahmedabad, between Altaf Amin Bhagad vs. Dr.Dhansukh B.Shah, wherein it is held “Absolutely no evidence on record to show that opposite party not followed standard medical practice – Mere fact that deceased died in operation theater is not enough to establish negligence on the part of the doctor – Complaint dismissed”.   (vi). 2004 (1) CPR 24, Delhi State Commission between Ghisa Ram vs. Dr.P.K.Bansal and Another, wherein it is held “Onus to prove that there was negligence of service on part of the opposite parties while treating the complainant was on the complainant – neither in the complaint nor in the affidavit it has been stated as to in what manner the services provided by the opposite parties is lacking or deficient. No document was filed to prove that the treatment given by the opposite party is negligent. Complainant is not able to prove the negligence or deficiency within the meaning of Secton-2(1)(g) of the Act. Hence, complaint is liable to be dismissed”.  (vii). Civil Appeal No.1386 of 2001 SC between Ms.Ins.Malhotra vs. Dr.A.Kriplani and Others, that at Page.30 of the judgment, their Lordships made reference to Jacob Mathew vs. State of Punjab (2005) 6 SCC 1, wherein their Lordships held that “We are of the view that both on facts and in law, no case is made out by the appellant against the respondents. It is not the case of the appellant that the doctor is not qualified or specialized in their respective fields to treat the patient whom they agreed to treat. All the doctors who treated the patient are skilled and duly qualified specialists in their respective fields and they tried their best to save the life of Priya Malhotra. The appellant has not challenged the post mortem report.  Commission has properly and rightly appreciated the entire facts and legal aspects and found no merit and substance in any of the submissions made on behalf of the appellant – Complaint is dismissed”. Finally, the opposite party counsel basing on the legal principles and facts of the case, contended that from the date of admission of the patient, till the patient died on 18.06.2015, the hospital authorities have taken utmost care and the doctors gave treatment by following the standard procedure and hence question of  ‘Res ispa Loquitor’ will not apply in this case and complainant is bound to prove the negligence of opposite parties by adducing expert evidence, which is lacking in this case and therefore prayed to dismiss the complaint.

            9.  Coming to the documentary evidence, complainant marked Exs.A1 to A7. Ex.A1 is photocopy of Coronary Angiogram report of deceased P.Rajendra Prasad, dt:16.06.2015. Ex.A2 is photocopy of PTCA report of deceased P.Rajendra Prasad, dt:20.06.2015. Ex.A3 is photocopy of Dr.NTR Vaidya Seva Scheme, approval for cashless facility, dt:17.06.2015. Ex.A4 is photocopy of Death Summary of P.Rajendra Prasad. Ex.A5 is office copy of legal notice issued by the complainant to the opposite parties with postal receipts, dt:05.06.2017. Ex.A6 is served acknowledgement of      1^st opposite party, dt:06.06.2017 and Ex.A7 is letter addressed to the complainant’s son P.Ravi Sankar by Dr.NTR Vaidya Seva enclosing medical records of P.Rajendra Prasad, dt:20.08.2015. On behalf of opposite parties Exs.B1 to B3 are marked. Ex.B1 is served copy of legal notice issued by the petitioner counsel to the opposite parties, dt:05.06.2017. Ex.B2 is office copy of the reply notice with postal receipt and served acknowledgment, dt:14.06.2017. Ex.B3 is original copy of Discharge Summary.

            10. The chief affidavit filed by P.W.1 has highlighted certain points constituting medical negligence, they are (1). The delay in conducting the stent surgery (one week delay). (2). Inaccurate and wrong angiogram test dt:16.06.2015. (3). Development of multiple blocks (three blocks) after the report dt:16.06.2015, is due to the lack of proper monitoring and total negligence in giving proper treatment. (4). Suppression of the fact that P.Rajendra Prasad had developed multiple blocks (i.e. three blocks) and proceeding with the surgery. (5). Conducting surgery without the  generator and other proper mandatory facilities. (6). Other medical aspects, which the complainants 1 and 2 cannot assess due to lack of medical knowledge.

            11.  The sum and substance of the arguments advanced by complainant, as referred above is that though the deceased was admitted in the hospital on 11.06.2015  at 2.30 p.m. vide IP No.67/73, till 16.06.2015 nothing was done and the delay in commencing the treatment caused the death of the deceased and the same amounts to medical negligence on the part of opposite parties. Further P.W.1 stated that delay was caused by opposite parties not because of any health complications of the deceased but due to waiting for approval of Aarogyasri scheme. It is argued that they commenced the treatment only after getting approval from Aarogyasri scheme. As seen from the material on record, complainant has not examined any expert, in order to prove that the line of treatment followed by opposite parties is not standard as per guidelines. The complainant also failed to cross examine R.W.1 and R.W.2, who filed chief affidavits in support of their case, that there is no medical negligence on their part. The contention of complainant that ‘Res ispa Loquitor’ come into play in this case, as the record itself shows that there is negligence on the part of opposite parties and as such there is no need for examining expert doctor in this case, cannot be accepted. In view of the evidence of R.W.1 and R.W.2 that soon after the patient was admitted with Acute Myocardiac Infarction, Thrombolysis with STK treatment was provided as it is an accepted standard of care and within three hours of the window period is as good as primary PTCA. Further it is stated that the patient had relief of pain and ST segment resolution in ECG which indicated recanalisation of LAD (Left Anterior Descending Artery) and as patient had LVF, it is a good practice to stabilize the patient at the outset before taking up CAG (Coronary Angiogram). The complainant has to disprove the evidence of R.W.1 by contra medical evidence. It is no doubt true that voluminous literature was filed by the complainant relating to primary PCI treatment. As per the article on Actue Myocardial Infarction Management, it is stated that “any delay in primary PCI after a patient arrives at hospital is associated with higher mortality in hospital. Time for treatment should therefore be as short as possible. Door (or diagnosis) to treatment time should be less than 90 minutes or less than 60 minutes if PCI is ready in the hospital and symptoms started within 120 minutes.  Rescue PCI is defined as PCI performed on a coronary artery, which remains occluded despite fibrinolytic therapy. Rescue PCI is associated with a significant reduction in heart failure and re-infarction and a lower all-cause mortality and so should be considered when there is evidence of failed fibrinolysis based on clinical signs and insufficient ST-segment resolution, if there is clinical or ECG evidence of a large infarct and if the procedure can be performed less than        12 hours after the onset of symptoms”. Similarly, some literature is filed as to the treatment with regard to primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction. But, mere filing of literature containing medical treatment will not be of any help to the complainant in the absence of evidence on record. The complainant should have cross examined R.W.1 and R.W.2 with regard to medical literature filed by him and elicit answers from them. The Death Summary is marked as Ex.B3 and the extract of Death Summary is as follows – “Patient, a non-diabetic, non-hypertensive, initially presented on 11.06.2015 with acute AWMI with window period of 1^1/2 hour and thrombolized with STK. He had LVF and had moderate LV Dysfunction. After stabilization CAG was done on 15.06.2015 and revealed Left Dominant Circulation with LAD – Osteo proximal total cutoff. He was taken up for PTCA to LAD by Right FA approach. During the procedure, patient had sudden cardiac arrest due to LCX occlusion due to dissection / Thrombus in distal Left main and LCX and bail out PTCA done to LCX with 2 DES and then kept on ventilator and dual Inortropes and will all Supportive Drugs. Inspite of all efforts, patient could not be revived and was declared death at 7.50 p.m. on 18.06.2015”. From Ex.B3 it can be inferred that the deceased had sudden cardiac arrest while the procedure for PTCA was taken up and as such he was kept on ventilator and dual inotropes with supportive drugs, but patient died on 18.06.2015 at 7.50 p.m. From Ex.B3 it cannot be said that the doctors have not made any effort to save the life of the deceased. It is the contention of the complainant that the opposite party hospital has not furnished the video recorded in the operation theater, and had they supplied the video, it would have shown what exactly happened in the operation theater. Nothing prevented the complainant to cause production of the video from opposite party hospital during the pendency of the case, but the complainant had not taken any steps in this regard. R.W.1 in chief evidence deposed that they explained the situation and also shown the procedure followed as per video and after the procedure, it is unfortunate that the complainant came-up with false allegations that too after a period of 2 years, for the reasons best known to her. Further, at para.6 of the chief affidavit of R.W.2, it is explained how they followed the procedure to save the life of the patient and the same is extracted as follows – “I submit that the patient was admitted with Acute Myocardiac Infarction with Thrombolysis with STK is an accepted standard of care and within three hours of the window period is as good as primary PTCA. The patient had relief of pain and ST segment resolution in ECG which indicated recanalisation of LAD (Left Anterior Descending Artery) and as patient had LVF, it is a good practice to stabilize the patient at the outset before taking up CAG (Coronary Angiogram). CAG was done which is elective and not emergency and time gap between acute MI and CAG especially when the patient is in LVF is an acceptable standard of care, which was taken by us in the present case on hand. We took already care and provided treatment and thus there is no deficiency in our services. As only Osteproximal LAD (Left Anterior Descending Artery) is involved 100%, the decision in going ahead with PTCA is acceptable standard of care. But during the procedure inspite of patient being on anti platelets and heparin the patient had huge thrombus burden and thrombus spilled in to distal LMCA (Left Main Coronary Artery) and LCX (Left Circumflex Artery) from the osteproximal LAD (Left Anterior Descending Artery), which is an unfortunate complication which may occur in some patients and we took all the efforts to tide over crisis and restore the blood flow”. This evidence remains unchallenged since there is no cross examination by the complainant and also there is no independent medical evidence showing that the procedure adopted by opposite parties is contrary to the established standard of procedure. Hence, on the basis of citations submitted by opposite party counsel, as referred above and principles of law laid down with regard to medical negligence, we hold that the complainant is failed to prove that there is medical negligence on the part of opposite parties 1 and 2, and as such complaint is dismissed.

            12.  In the result, complaint is dismissed. No costs.                                                              

            Dictated to the stenographer, transcribed and typed by him, corrected and pronounced by me in the Open Forum this the 26^th day of July, 2019.

 

        Sd/-                                                                                                                     Sd/-                                       

Lady Member                                                                                                President (FAC)

 

 

APPENDIX OF EVIDENCE

 

 

 

Witnesses Examined on behalf of Complainant/s.

 

PW-1: P. Venkata Subbamma  (Chief Affidavit filed).

 

Witnesses Examined on behalf of Opposite PartY/S.

 

RW-1:  Dr. D. Gopi Krishna Reddy (Chief Affidavit filed).

RW-2:  Dr. P. Nagaraj (Chief Affidavit filed).

 

 

EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT/s

 

Exhibits (Ex.A)	Description of Documents
	Photo copy of Coronary Angiogram Report of deceased P.Rajendra Prasad. Dt; 16.06.2015.
	Photo copy of PTCA Report of deceased P.Rajendra Prasad. Dt: 20.06.2015.
	Photo copy of Dr. NTR VAIDYA SEVA SCHEME approval for cashless facility. Dt: 17.06.2015.
	Photo copy of Death Summary of P. Rajendra Prasad.
	Office copy of the Legal Notice issued by the complainant to the opposite parties with postal receipts. Dt: 05.06.2017.
	Served acknowledgement of 1st opposite party. Dt: 06.06.2017.
	Letter addressed to the complainant’s son P. Ravi Sankar by Dr. NTR Vaidya Seva enclosing medical records of P. Rajendra Prasad. Dt: 20.08.2015.

 

EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTY/s

 

Exhibits (Ex.B)	Description of Documents
	Served copy of legal notice issued by the petitioner counsel to the opposite parties. Dt: 05.06.2017.
	Office copy of the reply notice with postal receipt and served Acknowledgement. Dt: 14.06.2017.
	Original copy of Discharge Summary.

  

 

                                                                                                                         Sd/-      

                                                                                                                President (FAC)

   

                                   // TRUE COPY //

// BY ORDER //

 

Head Clerk/Sheristadar,

          Dist. Consumer Forum-II, Tirupati.

    

 

 Copies to:-    1.  The complainants.

                        2.  The opposite parties.