Chandigarh

StateCommission

A/25/2018

Darshan Lal - Complainant(s)

Versus

Director, Post Graduate Institute of Medical Education & Research - Opp.Party(s)

Prem Chand Dhiman, Authorised Person

11 Jul 2018

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

Appeal No.	:	25 of 2018
Date of Institution	:	27.02.2018
Date of Decision	:	11.07.2018

 

Darshan Lal husband of Late Smt. Asha Surjan, resident of House No.16, Type-V, Power Colony, Roopnagar (Pb.)

……Appellant/Complainant

 

V e r s u s

 

1. Director, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh.
2. Head of the Department of Advanced Cardiovascular (CVC), PGIMER, Sector 12, Chandigarh.
3. Dr. Rohit Manoj K. department of Advanced Cardiovascular (CVC) PGIMER, Sec.12, Chandigarh.

….…..Respondents/Opposite parties

 

BEFORE:         MR. DEV RAJ, PRESIDING MEMBER.

                        MRS. PADMA PANDEY, MEMBER

 

Argued by:-       Sh.Prem Chand Dhiman, Authorized Representative of the appellant alongwith applicant/appellant in person.

                         Sh.Gaurav Bhardwaj, Advocate proxy for Sh.Paras Money Goyal, Advocate for the respondents.

 

PER PADMA PANDEY, MEMBER

                This appeal has been filed against the order dated 18.01.2018, passed by the District Consumer Disputes Redressal Forum-I, U.T., Chandigarh (in short the Forum), vide which consumer complaint bearing No.422 of 2017 filed by the appellant/complainant, was dismissed.

2.         The facts in brief are that on 10.2.2016 the complainant took his wife to PGIMER, U.T., Chandigarh, for medical consultation. They revisited the said hospital on 24.2.2016, where the doctors recommended CRT-D implantation to the wife of the complainant. She was admitted in the hospital on 26.4.2016. Opposite party no.3 performed the procedure on 27.4.2016 and she was discharged on 2.5.2016 in a satisfactory condition. She was advised to revisit the hospital on 6.5.2016 for follow up. Four stitches were removed on different dates but while removing the fifth one on 28.5.2016, a small amount of pus came out from the wound and she was re-admitted in the hospital, on the same day. She remained in the hospital till 13.6.2016 (4.13 a.m.) on which date, she was declared dead.  As per the complainant, neither the patient was suffering from any kidney injury/disease nor she had any blood/urine sugar problem and also she was not a patient of diabetes mellitus of any grade at all. It has been contended that the death of the patient was caused due to medical negligence on the part of the doctors in not performing the implantation of CRT-D (Pacemaker) in her body, correctly on 27.4.2016, which caused infection, in the wound. Alleging that the aforesaid acts amounted to medical negligence, deficiency in service and unfair trade practice on the part of opposite parties, the complainant had filed consumer complaint aforesaid, before the Forum
3.         The opposite parties, in their joint written statement pleaded that even though CRT-D implantation was recommended to the patient, the possible complications were also communicated to her family, as noted in the separate consent form.  It was stated that the pacemaker infection/sepsis is  well-documented. There are no features from which it can be predicted that which pacemaker patient will develop infection beforehand. The surgical procedures are not fool-proof and there exist occasions, where complications developed even after doctors have provided high standard of care. It was further stated that there was no negligence on the part of the doctors and the death of the patient occurred due to the complications that arose, as a result of CRT-D implantation and multifactorial acute kidney injury. The patient was diabetic and there was an error in the death certificate prepared by the Junior Resident.  Pleading that there is no medical negligence, deficiency in service or unfair trade practice on their part,  prayer was made for dismissal of the complaint.
4.         Rejoinder was filed by the complainant denying all the averments contained in the written reply of the opposite parties and reiterating those in his complaint.
5.         After hearing the contesting parties and on going through the evidence and record of the case, the Forum dismissed the complaint, while holding as under:-

 “A perusal of the complaint itself reveals that the complainant is taking contradictory stand.  In para 2 (ii) it has been contended by the complainant that the patient was discharged from the hospital on 2.5.2016 in a satisfactory condition and was advised to revisit the hospital on 6.5.2016 for follow up action.  It has also been contended that four stitches were removed on different dates by the doctors, but, while removing the fifth one, when a small amount of pus was noticed, the patient was immediately re-admitted in the hospital on 28.5.2016. Notably, as per the contention of the complainant himself, the patient after giving full treatment i.e. implantation of CRT-D was discharged in a satisfactory condition and thereafter during last follow up, as soon as the treating doctor noticed the pus in the stitch, the patient was immediately re-admitted.  We feel that had the treating doctor been negligent, he could certainly ignore the existence of pus in the stitch as the patient was in a satisfactory condition during the previous follow ups. However, the doctor, being responsible and vigilant, re-admitted the patient immediately on the same day to provide her the utmost care under the supervision of the efficient and capable hospital staff instead of sending her home after the dressing of the stitch or prescribing some treatment for the same. 

We are of the opinion that certainly surgical procedures are not foolproof and there exist occasions where complications develop even after doctors have provided high-standard care. Human body is complex and it would be unwise to expect that doctors can always foresee and control how it would react to a surgery.  In the present case, the services provided by the doctors were to the best of their abilities and the complications that arose were the ones which were considered to be a part of the risk that a pacemaker implantation carries.”

6.         Hence this appeal.
7.         We have heard the contesting parties and have also gone through the record of the case, including written arguments, filed in miscellaneous application bearing no.255 of 2018 and the reply filed thereto, by the respondents.
8.         We are of the considered opinion that the findings given by the Forum, are fully justified. The appellant has failed to produce on record, even a single document, to prove that the treating doctor was negligent, at any point of time, while treating his wife. The appellant himself has stated in his complaint filed before the Forum that CRT-D (pacemaker) was implanted successfully in the body of his wife on 27.04.2016 and the patient was discharged from the hospital on 02.05.2016, in a satisfactory condition and that she was declared perfectly fit. As such, it is an admitted fact that the treating doctor performed his duties, to the utmost satisfaction i.e. with reasonable degree of skill, knowledge and care. Thereafter, it has been alleged by the appellant that after successful implantation of CRT-D (pacemaker), he took his wife for removing the stitches, on several occasions. However, on 28.05.2016, when fifth stitch was removed, a small amount of pus came out from the wound, as a result whereof,  his wife was readmitted and CRT-D (pacemaker) was removed by the doctors on 28.05.2016, resulting into death of the patient, as the CRT-D (pacemaker) was not implanted again by the doctors, which was required to be done within 14 days, as per the medical literature.
9.         At the time of arguments before this Commission, the sole argument raised by the appellant against the respondents are that, it was only on account of the reason that CRT-D (pacemaker), which was removed by the doctors on 28.05.2016 was to be implanted within 14 days therefrom i.e. latest by 11.06.2016, whereas, on the other hand, the same became ready for implantation only on 16.06.2016 i.e. after a delay of 5 days, as such, it was the main cause of death of his wife, which occurred on 13.06.2016, by which time, the pace maker could not be implanted. Had the said CRT-D (pacemaker) which was removed on 28.05.2016 been implanted by 11.06.2016, the patient would have survived.

                On the other hand, a specific stand has been taken by the respondents, that CRT-D (pacemaker) was removed from the body of the patient only on 02.06.2016 and not on 28.05.2016, as such, the same could not have been implanted again, before 16.06.2016, however, since the patient suffered refractory cardiogenic shock and acute kidney injury, during the period intervening followed by antecedent cause i.e. delated cardiomyopathy with severe Lv dysfunction, she expired on 13.06.2016 i.e. three days prior to that date (16.06.2016).    

10.         Now the question arises, as to on which date, CRT-D (pacemaker) was removed from the body of the patient. It may be stated here that progress sheet dated 02.06.2016 Annexure-4 at page 147 of the Forum file clearly reveals that the CRT-D (pacemaker) was explanted/removed from the body of the patient, on 02.06.2016 and not on 28.05.2016, as was alleged by the appellant. The appellant has failed to produce on record, any document, to the contrary. Under these circumstances, it is held that the appellant tried to mislead the Forum, by saying that the CRT-D (pacemaker) was removed from the body of his wife on 28.05.2016, so that he is able to justify his stand, that death of the patient took place on account of negligence of the doctors, as they failed to implant CRT-D (pacemaker) within the prescribed period of 14 days i.e. latest by 11.06.2016. Though we have mercy with the appellant, as he has lost his wife, but his said action to prove the respondents deficient, is not appreciable.
11.         Furthermore, medical literature placed on record by the respondents, which has gone unrebutted by the appellant, clearly says that pacemaker infection/sepsis is a complication, which can be fatal in some cases, as has been in the present case. There are no features, from which it can be predicted, which patient will develop infection beforehand. It was also made clear by the respondents, that since discharge from the wound did not reduce from pacemaker pocket site of the body of the patient, despite frequent dressing and injectables antibiotics, CRT-D (pacemaker) was explanted on 02.06.2016, as per guidelines of the American Heart Association. The patient continued to show local wound site infection, and as per American Heart Association, new transvenous lead placement should be delayed atleast for 14 days, after the infected device is removed, especially, when there is evidence of infection, yet, the patient died during the period intervening, for the reasons aforementioned.

                It is pertinent to mention here that the appellant failed to produce any contrary record, against the medical literature, reliance whereupon has been placed by the respondents, which clearly proves that they (respondents) performed their duty with reasonable degree of skill, knowledge and care. Not even a single document has been placed on record, proving that the doctors concerned were negligent while performing their duties, as far as the present case is concerned. Furthermore, the complications related to the said treatment were brought to the notice of the appellant and his son, for which, admittedly, they also gave their consent. Just because the appellant had suffered a bad outcome from the medical treatment given to his wife, does not mean that the doctors concerned, did not take reasonable care in treating her. Negligence is an essential ingredient of the offence and it must be culpable or gross and that too must be proved. The doctors can be held liable, only where their conduct falls below the standards of a reasonably competent practitioners in their field.

12.         Sequence of events narrated above, clearly goes to prove that the Forum was right in holding that the doctors concerned were not negligent in treating the wife of the appellant, however, despite that fact, she could not be saved, because of the complications, referred to above. The consumer complaint was rightly dismissed by the Forum, while relying upon the medical literature; various judgments of the Supreme Court of India and also the National Commission, as such, it calls no interference of this Commission, to give any contrary findings.  
13.         For the reasons recorded above, this appeal being devoid of merit, is dismissed, with no order as to costs. 
14.         Certified copies of this order be supplied to the parties, free of cost.
15.         The file be consigned to Record Room, after completion.

Pronounced.

11.07.2018_

Sd/-

(DEV RAJ)

PRESIDING MEMBER

 

 

Sd/-

 (PADMA PANDEY)

        MEMBER

 

 

Rg.

 

 

 

 

STATE COMMISSION

(M.A. No.255 of 2018 in Appeal No. 25 of 2018)

Darshan Lal Vs. PGIMER and another

Argued by:        Sh.Prem Chand Dhiman, Authorized Representative of the applicant/appellant alongwith applicant/appellant in person.

                         Sh.Gaurav Bhardwaj, Advocate proxy for Sh.Paras Money Goyal, Advocate for the non-applicants/respondents.

 

Dated the  11^th  day of July  2018

ORDER

                By way of moving this application, the applicant has sought directions to the respondents, to return the CRT-D device, which could not be implanted in the body of his wife, on account of her death, and also to pay him additional compensation, on this act of the respondents. However, on 19.06.2018 by way of filing written arguments, it has been admitted by the applicant that the said device has been returned to him, by the respondents, on 29.05.2018, yet, without some accessories. It may be stated here that there is nothing on record, to say that when the said device was received by the applicant from the respondents, he raised any issue, in that regard. On letter dated 14.05.2018, whereupon, the applicant has acknowledged the receipt of said device, nothing is found to be mentioned that the same was received by him, under protest, on the ground that complete accessories have not been returned alongwith it. As such, under these circumstances, the applicant cannot raise, such an issue, at this stage.

                In view of above, this application is dismissed, with no order as to costs and is disposed of, accordingly.

                Certified copies of this order alongwith main order passed in Appeal No. 25 of 2018, be supplied to the parties, free of cost.

                This file be tagged with the appeal file and be consigned to Record Room, after completion.

 

 

                                Sd/-                                 Sd/-

(DEV RAJ) PRESIDING MEMBER

(PADMA PANDEY) MEMBER

 

Rg.