Date of Filing: 04-05-2015 Date of Final Order: 13-04-2017
Sri Gurupada Mondal, President.
This is an application under Section 12 of CP Act, 1986 filed by one Smt. Bani Das against Dr. D.K. Roy and the Manager, Roy Nursing Home, Tufanganj praying for Rs.2,00,000/- for medical negligence and deficiency of service, Rs.1,09,010/-for Nursing Home charges, Rs.10,000/- for litigation cost and Rs.1,25,000/- for mental pain, agony and harassment.
The case of the Complainant in short is that the OP No.1 is a Doctor (Gynaecologist) and OP No.2 is the Nursing Home carrying on business in the name and seal of Roy Nursing Home situated at Tufanganj under P.S. Tufanganj. The Complainant sustained pain on her abdomen and uterus and also sustained excessive bleeding from her uterus and as such, she consulted Dr. D.K. Roy (Gynaecologist) on 22.05.14. The Doctor prescribed some medicines and pathological tests but her condition started deteriorating and she further went to OP No.1 on 05.06.14 and on that date, the Doctor advised the Complainant for admission at Roy Nursing Home and stated that 4 to 6 bottles of blood would be required for transfusion. The OP No.2 supplied the blood as per instruction of Dr. D.K. Roy and transfusion of blood started on the Complainant and the Complainant complained of difficulty in breathing and shivering but on the next day, she could not urinate and her eyes were found to be deep yellow and a call was booked by the attending nurse. But, the Doctor did not pay any attention to the condition of the patient and there was no life saving equipments attached with her. The physical condition of the Complainant became critical because of transfusion of mismatch blood with the Complainant’s blood group which was O+ and her haemoglobin level fell down but her urea level went high. Then, the Complainant was taken to Subham Nursing Home at Cooch Behar on 09.06.14 and she was there from 09.06.14 to 12.06.14 as indoor patient but their efforts were also in vain and the Complainant was referred to higher centre for saving her life.
Further case of the Complainant is that on 12.06.14, she was taken to Mitra’s Clinic & Nursing Home, Siliguri and Senior Dr. N. Sanyal, DA,MD advised for admission in the Nursing Home as indoor patient. After pathological tests, Dr. N. Sanyal diagnosed that the patient was suffering from “Hemolytic transfusion reaction with multi organ failure”. The patient was treated day by day at Mitra’s Clinic & Nursing Home, Siliguri. She was discharged on 19.06.14 and she paid Rs.49,390/- as Nursing Home charges at Siliguri.
It is further alleged that due to lack of ordinary care and skill at the time of blood transfusion by OP No.2 without proper matching, the Complainant suffered “Hemolytic transfusion reaction with multi organ failure” and also suffered from various disorders. The OP No.1 and 2 did not maintain professional ethics, which tantamount to medical negligence and deficiency of service. It is the case of the Complainant that OP No.2 did not issue Nursing Home Bill of Rs.45,000/- and also did not issue any treatment sheets to the Complainant. In this connection, the Complainant sent a letter on 25.08.14 to the OP No.2 with a request to supply the treatment sheets including the test reports. The OP No.2 received the said letter on 28.08.14 but did not issue treatment sheets, medical bills etc. It is also stated in the complaint that due to such medical negligence, deficiency in service of the OP No.1 and 2, the Complainant suffered irreparable loss, mental pain and agony and also suffered huge monetary loss. Accordingly, the Complainant has filed the instant case for realization of Rs.2,00,000/- for medical negligence and deficiency of service, Rs.1,09,010/- for Nursing Home charges, Rs.10,000/- for litigation cost and Rs.1,25,000/- for mental pain, agony and harassment.
The OP No.1 and 2 after receiving of summons appeared before this Forum and filed separate w/v denying all material allegations contending inter-alia that the present case is not maintainable in its present form and in law. The case is bad for mis-joinder and non-joinder of necessary parties.
Specific case of the OP No.1 is that on 22.05.14, the Complainant came to him with a complaint of Abdomen pain, bleeding from uterus and after examining her, she was advised for Haemoglobin, Blood sugar, BTCT, Urea & Creatinine tests and also advised for USG of lower abdomen and prescribed some medicines for immediate control of bleeding from uterus. Thereafter, the patient came to him again on 05.06.14 with the USG report and after examining her, she was advised for admission for treatment and transfusion of blood. Accordingly, the patient was admitted to the Nursing Home of OP No.2.
Further case of the OP No.1 is that the patient had Blood Group of “O”, Rh factor-Positive “+” Ve and the patient party brought two bottles of blood O+ (Positive) from the Blood Bank of MJN Hospital, Cooch Behar on 05.06.14 and another 4 bottles of blood “O”+ (Positive) from the Blood Bank of Cooch Behar Municipality on 06.06.14. The said blood was supplied after cross-matching with the specimen blood of the patient. No Blood Bank issues or supply blood without cross-matching with the specimen blood of the recipient. The OP No.1 verified the cross-matching report issued by the Blood Bank, Group and Rh factor of the blood supplied by the Blood Bank being “O” + Ve with the blood report of the recipient patient “O” + Ve and thereafter, two bottles of blood was transfused to the patient on 05.06.14 and another two bottles of blood was transfused on 06.06.14.
It is the case of the OP No.1 that the OP No.1 strongly monitored the patient during transfusion of blood and no complaint was made by the patient during such transfusion. After the transfusion of blood, HB count was increased to 8.9 but her fever was not controlled and the OP No.1 took reasonable measures and care with utmost skill and experience. Due to better management, the patient was referred to a Physician on 08.06.14. Accordingly, the patient party took the patient to Subham Hospital & Diagnostic Centre, Cooch Behar and she was admitted and treated there from 09.06.14 to 12.06.14. It is also alleged by the OP No.1 that as per medical science, it cannot be ascertained prior to transfusion of blood upon a patient who may develop “Hemolytic Transfusion Reaction” in later stage if wrong Group or wrong Rh factor blood is transfused. During transfusion of blood of “O” + Ve upon the person of the Complainant, the OP No.1 did not notice any reaction. Accordingly, the OP No.1 has claimed that he is in no way responsible for delayed “Hemolytic Transfusion Reaction”. The OP No.1 had no negligence at all in rendering his service to the patient with utmost skill and experience. The delayed “Hemolytic Transfusion Reaction” is beyond the control of the OP No.1 as per medical science. It cannot be ascertained about the “Hemolytic Transfusion Reaction” by proper medical test.
Further case of the OP No.1 is that the Complainant suppressed some documents and she did not produce medical papers issued by Subham Hospital & Diagnostic Centre, Cooch Behar where the Complainant was treated from 09.06.14 to 12.06.14. On the basis of the aforesaid facts, the OP No.1 prayed for dismissal of the case with cost.
Specific case of the OP No.2 is that as per direction of the OP No.1, Blood Group and Rh factor of the patient were examined and found that the patient had Blood Group of “O”, Rh factor-Positive “+” Ve and the patient party brought two bottles of blood “O” Positive from the MJN Hospital, Cooch Behar Blood Bank on 05.06.14 and another 4 bottles of blood “O” Positive from the Cooch Behar Municipality Blood Bank on 06.06.14. The Blood Bank supplied the blood after cross-matching with the specimen blood of the patient and no Blood Bank issues or supply blood without cross-matching with the specimen blood of the recipient. The OP never supplied the blood to the patient party. The OP No.1 verified the cross-matching report issued by the Blood Bank, Group and Rh factor of the blood supplied by the Blood Bank with the Blood Report of the recipient.
Further case of the OP No.2 is that two bottles of blood was transfused on 05.06.14 and another two bottles of blood on 06.06.14. The OP No.1 and the nurses of the OP No.2 accordingly monitored the patient during transfusion of blood and no symptom or re-action was noticed at the time of transfusion and the Complainant did not complain anything during transfusion. After transfusion, HB count was increased to 8.9 but her fever was not controlled inspite of OP No.1 took all reasonable measures and care. For better management, the OP No.1 referred the patient to a Physician on 08.06.14. Accordingly, the patient party took the patient to Subham Hospital & Diagnostic Centre, Cooch Behar and admitted the patient on 09.06.14. The patient was treated there upto 12.06.14 on the ulterior motive and mala- fide intention. It is also alleged by the OP No.2 that the OP had no negligence at all on their part and rendered proper service to the patient. The delayed “Hemolytic Transfusion Reaction” is beyond control and as per medical science, it cannot be ascertained by proper test. The Complainant willfully withheld the medical papers issued by Subham Hospital, Cooch Behar. On the basis of the aforesaid facts, the OP No.2 prayed for dismissal of the case with cost.
In the light of the contention of the both parties, the following moot points are necessarily come up for consideration.
POINTS FOR CONSIDERATION
- Is the Complainant a Consumer as per Section 2(1)(d)(ii) of the C.P. Act, 1986?
- Has this Forum jurisdiction to entertain the instant complaint?
- Have the O.Ps any deficiency in service as alleged by the Complainant and are they liable in any way?
- Whether the Complainant is entitled to get relief/reliefs as prayed for?
DECISION WITH REASONS
The Complainant produced the prescriptions dated 22.05.14 and 05.06.14 issued by Dr. D.K. Roy, USG Report of lower abdomen of the Complainant , referred letter issued by OP No.1, Discharge Certificate of the Complainant issued by Mitra’s Nursing Home, Siliguri, and a letter written by the Complainant to OP No.2 alongwith Postal Money Receipt & A/D Card. The Complainant also produced In Patient Bills of the patient issued by Subham Hospital, Cooch Behar & Mitra’s Clinic & Nursing Home, Siliguri. On the other hand, the OPs have filed Patient Consent Form, Cross-Matching Report of the Blood issued by Cooch Behar Municipality Blood Bank and MJN Hospital, Cooch Behar, Two Treatment sheets of Bani Das of Roy’s Nursing Home, Pathological reports of Bani Das dated 22.05.14 and 06.06.14.
Point No.1
The Complainant is a patient, the OP No.1 is the Doctor and the OP No.2 is the Nursing Home, where the Complainant was admitted for her treatment. It is not the case of the OPs that OP No.1 treated the patient free of cost and OP No.2 rendered service free of charge. Hon’ble Apex Court held in a case Indian Medical Association vs UP Shantha, held “Service rendered to a patient by a Medical Practitioner by way of consultation, diagnosis and treatment both medical and surgical would fall within the ambit of “service” as defined u/s 2(1) (O) of the Act”.
Service rendered at a non-Govt. Hospital (Nursing Home where charges are required to be paid by the persons for availing such service falls within the purview of the expression of service. As such, we hold that the complainant is a consumer as per provision u/s 2(1) (d) (II) of C.P. Act, 1986.
Point No.2
The Complainant and the OP No.1 are the residents of Tufanganj in the district of Cooch Behar and the OP No.2 (Nursing Home) is situated at Tufanganj in the district of Cooch Behar and the claim amount is within the statutory limit of the District Forum. As such, this Forum has territorial and pecuniary jurisdiction to try this case. This point is decided in favour of the Complainant.
Point No.3 & 4.
Both the points are taken up together for the convenience of discussion as well as the points are related with each other.
The case of the Complainant is that the Complainant sustained pain on her abdomen and uterus and excessive bleeding from uterus and for that reason, she consulted with OP No.1 on 22.05.14 and Dr. D.K. Roy (Gynaecologist) prescribed medicines and pathological tests and USG and on 05.06.14 the Complainant further visited the OP No.1 and she was advised to admit at OP No.2 Nursing Home. Dr. D.K. Roy advised to give 4 to 6 bottles of blood. According to the Complainant, she was admitted at OP No.2 (Roy Nursing Home), Tufanganj. The OP No.2 supplied the blood and OP No.2 transfused the blood as per instruction of OP No.1. Soon after the blood transfusion, the patient started frothing from mouth and complained of difficulty in breathing and shivering and on next date, she (Complainant) could not urinate and her eyes were found deep yellow. The patient (Complainant) was referred and she was taken to Subham Nursing Home at Cooch Behar and she was admitted there from 09.06.14 to 12.06.14 but she was not recovered there and then she was taken to Siliguri at Mitra’s Clinic & Nursing Home and she was recovered from there. Dr. N. Sanyal, DA MD after pathological test diagnosed that the patient suffered “Hemolytic transfusion reaction with multi organ failure”.
On the other hand, the case of the OP No.1 & 2 is that the OP No.1 admitted that he treated the Complainant on 22.05.14 and admitted her at OP No.2 Nursing Home on 05.06.14 and the patient party collected the 2 bottles of Blood of O-positive Group from the Blood Bank of MJN Hospital, Cooch Behar and 4 bottles of blood “O-positive” from Cooch Behar Municipality Blood Bank. Blood Bank supplied the blood after cross-matching with the specimen blood of the patient. According to OP No.1, no Blood Bank supplies blood without cross-matching with the specimen blood of the recipient. The OP No.1 verified the cross-matching report issued by the Blood Bank, Group and RH factor of the blood supplied by the Blood Bank “O-positive” with the blood report of the recipient patient “O-positive” and thereafter, blood was transfused to the patient on 05.06.14 and two bottles of blood was transfused on 06.06.14 and OP No.1 carefully monitored the patient during transfusion of blood. According to OP No.1, there is no reaction during transfusion and her HB count was increased to 8.9 but her fever was not controlled. Accordingly, she was referred to the Physician on 08.06.14.
According to OP No.1, the patient developed “Hemolytic Transfusion Reaction” at later stage and only Acute Hemolytic reaction can be seen in a patient during transfusion of blood, not in later stage, if wrong group or RH factor group of blood is transfused. But during transfusion of blood O-Positive, the OP No.1 did not notice any reaction of the Complainant. According to OP No.1, he was in no way responsible for delayed Hemolytic Transfusion reaction as observed by the Doctor of Mitra’s Clinic & Nursing Home, which was beyond control of the OP No.1 and which (Delayed Hemolytic Transfusion Reaction) cannot be ascertained by Medical Test.
Admitted fact that the Complainant was admitted at OP No.2 Nursing Home on 05.06.14 under the care of Dr. D.K. Roy (O.P. No.1) and four bottles of blood were transfused on the person of the Complainant under the care of OP No.1. According to the Complainant, mismatched blood was transfused upon the body of the Complainant and as a result of such transfusion, Hemolytic Transfusion reaction with multi organ failure took place and OP No.1 and 2 are responsible for the same.
We find from the documents filed by the Complainant that the Complainant’s blood group O+ (Positive) and her H.B was 5032. One USG was done on the lower abdomen of the patient, which suggests Bulky uterus with thickened evdometrium. The patient (Complainant) was referred to the Physician along with two bottles of blood on 08.06.14. It is also evident from the documents filed by the Complainant that the patient was first taken to Subham Hospital & Diagnostic Centre (P) Ltd. on 09.06.14 and was admitted there till 12.06.14. But no treatment sheet of the victim (Complainant) issued by Subham Hospital is produced before this Forum. As per discharge certificate issued by Mitra’s Clinic and Nursing Home, the patient suffered Hemolytic Transfusion Reaction with multi organ failure.
Ld. Advocate for the Complainant submits that the documents produced by the OP No.,1 & 2 are all fabricated documents and the said documents should be disbelieved as the OP did not supply the treatment sheets of OP No.2 Nursing Home.
The patient (Complainant’s) blood group is O+ (positive) RH factor as it appears in the blood group report. The cross matching Blood report issued by the Cooch Behar Municipality Blood Bank and MJN Hospital are produced by the OP No.2. There is conflicting evidence who brought the Blood from the Blood Bank at Cooch Behar. Who brought the blood for the patient is not the bone of contention of this case. But from the cross matching report, it reveals to us that O+ (positive) blood was supplied to the patient for transfusion. As per cross matching report that matching between donors blood Red cells and recipient’s blood serum show no agglomeration in salme blood compatible. It is also noted that cross matching report and the bottle of the blood supplied must be verified before transfusion. The blood supplied by MJN Hospital was also cross matched and no agglomeration was found. The said blood was supplied on 05.06.14 and 06.06.14. In absence of any other blood, we hold that four bottles of O+ (positive) blood were transfused on the person of the patient (Complainant).
The Complainant suffered Hemolytic Transfusion Reaction with multi organ failure. The OP No.1 & 2 did not raise any objection that the patient did not suffer Hemolytic Transfusion Reaction.
Ld. Advocate for the Complainant and the Ld. Advocate for the OP cite Medical Literatures. It reveals from the Medical literatures supplied by the Complainant that a hemolytic Transfusion reaction is a serious complication that can occur after transfusion of blood. The red cells that were given in the transfusion are destroyed by the patient’s immune system. OP No.1 and 2 do differ with the above Hemolytic Reaction caused by Blood Transfusion.
According to Medical Literature supplied by the OPs, it reveals to us that there are two types of hemolytic transfusion caused by transfusion of blood. Acute hemolytic transfusion reaction and delayed hemolytic transfusion reaction.
An accurate hemolytic Transfusion reaction (AHTR) is a type of transfusion reaction that is associated with hemolysis. It occurs very soon after the Transfusion and within 24 hrs. of post transfusion. It can occur quickly upon transfusing a few mili-litres or 1-2 hours post transfusion. It is also known as immediate hemolytic transfusion reaction. This is a medical emergency as a result from rapid destruction of the donor red blood cells by host anti-bodies. The most common cause in clerical error i.e. wrong unit blood being given to the patient. Delayed Hemolytic Reactions commonly occurs about 4-8 hours after blood transfusion, but may develop to one month later. There may be also hemoglobin-urea and mild elevation of the serum bilirubin.
From the documents on record, it reveals to us that the patient (Complainant) suffered delayed Hemolytic Reaction. It is also evident to us that 4 bottles of O+ (positive) cross matched blood were brought to OP No.2 from Cooch Behar Municipality Blood Bank and on 06.06.14 and 2 bottles of cross matched blood of O+ (positive) were brought to the OPs from MJN Hospital Blood Bank. The blood Group of the Complainant was O+ (positive) as per report. The Blood Bank supplied the blood to the patient party or the OP No.2 after cross matching of the blood of the recipient. In absence of any contradictory evidence regarding the presence of other group or blood, we hold that O+ (positive) blood was transfused on the body of the Complainant. We do not find any medical negligence on the part of the OP No.1 and 2.
An Acute Hemolytic Transfusion reaction is usually related to A B O blood group incompatibility. The most severe of which often involves Group “A” red cells being given to a patient with group “O” Type blood. Proper diu then birds to complement C3 in the donor blood, facilitating the reaction through the alternate path way cascade. This acute Hemolytic Transfusion Reaction is a clerical error and my cause death. But in this case we do not find that the patient was given mismatched blood by the OPs at the time of transfusion of blood. Moreover, we further find that it is not a case of Acute Hemolytic Transfusion Reaction.
From the evidence on record, we find that it is a case of “Delayed Hemolytic Transfusion Reaction.” Let us see how far as Doctor is liable for Delayed Hemolytic reaction of a patient. In our earlier discussion, we have come to a conclusion that no mismatched blood was transfused in the body of the Complainant by the OP No.1 and 2.
Blood group of the patient (Complainant) was ascertained by laboratory test. The Complainant was instructed to ascertain blood group. The Sebayan Laboratory tested the blood of the Complainant and grouped O+ (positive). As per instruction of OP No.1, two bottles of O+ (positive) Blood was collected from MJN Hospital, Cooch Behar on 05.06.14 and 4 bottles of same group was collected from Cooch Behar Municipality Blood Bank. It appears from the blood supply Memo that the blood was cross-matched with the sample blood of the patient. Therefore, it is our considered opinion that “no cross-matched blood” was supplied to the patient (Complainant) on 05.06.14 and 06.06.14. Except oral evidence of the Complainant, there was nothing to show that the patient suffered Acute Hamolytic Reaction. The Delayed Hamolytic Transfusion takes place between 2 to 14 days after transfusion of red cell component sign and symptom are similar to an acute transfusion reaction but are less severe. Most delayed hemolytic reactions have a benign course, however, life threatening hemolytic with severe anemia and renal failure may occur.
As per medical science, it is not ascertainable prior to transfusion of blood upon a patient who may develop Hemolytic Transfusion reaction. As per medical science, the only acute Hemolytic Transfusion Reaction can be seen in a patient during transfusion of blood, not in later stage, if wrong blood group is transfused. As such, a doctor is not liable or responsible for delayed Hemolytic reaction. A patient has not favourably responded to a treatment given by a doctor or a surgery has failed, the doctor cannot be held straightway liable for medical negligence by applying the doctrine or Resipesa liquitor.
It must be remembered that something despite their best efforts the treatment of a doctor fails. Sometimes despite the best effort of surgeon the patient dies. That does not mean that the doctor or the surgeon must be held guilty of medical negligence, unless there is some strong evidence to suggest that he was negligent. It is evident from the evidence on record that the Complainant was admitted at Subham Hospital and Diagnostic Centre at Cooch Behar from 09.06.14 to 12.06.14 for her treatment. But Complainant did not produce the treatment sheets before this Forum in order to ascertain the fact of Acute hemolytic transfusion reaction. Non production of the said documents are fatal to the Complainant’s case and the benefit shall go to the OP.
Therefore, in our considered opinion, OP No.1 is not guilty of medical negligence and as such the Complainant is not entitled to get any relief.
Admitted fact is that the Complainant was admitted at OP No.2 Nursing Home at Tufanganj on 05.06.14 and was treated there till 08.09.14 and then the Complainant was moved to Subham Hospital on 09.06.14 for better management and was treated there till 12.06.14. According to the Complainant, at the time of discharge from OP No.2 Nursing Home bill of Rs.45,000/- after receiving the said amount from the Complainant and did not issue treatment sheet to the Complainant and in this regard, the Complainant sent a letter on 25.08.14 to the OP No.2 for obtaining whole treatment sheets, test reports or Complainant and OP No.2 received the said letter on 28.08.14 but did not issue any paper to the Complainant as per W.B. Medical Council Code of Medical Ethics.
On perusal from the evidence on record both oral and documentary, it reveals to us that the Complainant sent a Regd. Letter to the OP No.2 with request to supply the medical bills and treatment sheets but the OP No.2 did not issue the same.
As per Medical Ethics, every doctor registered under the W.B. Medical Council should maintain his medical records pertaining to his patient for a period of 3 years. If any request is made for medical records, either by the patient/Authorized attendant/WBMC or legal authorities involved, the same may be duly acknowledged and the documents shall be issued within 72 hrs.
Medical records i.e. Prescription, details of the treatment given, medicines, which are prescribed and the follow-up advice, if any should be made available to the patient at any time without any hue and cry. It is the duty of the doctor to state in the record all the details of the treatment given, medicine, which are prescribed and to follow up advice, if any and give it to the patient for his reference. Patient has a right to get the medical record pertaining to him and he cannot deny the same, when the patient paid the doctor/nursing home for treatment and hired the service. Therefore, the OP No.2 violates the medical ethics by non-supplying the copy of treatment sheets to the patient. Such conduct of OP No.2 amounts to deficiency of service and the OP No.2 shall be responsible to pay compensation for deficiency of service. But, we do not find any medical negligence of OP No.1.
Both the points are disposed of accordingly.
Accordingly,
Ordered,
That the case be and the same is dismissed on contest against the OP No.1 without cost and allowed in part against the OP No.2 with cost of Rs.10,000/- for deficiency of service.
Other reliefs against OP No.2 are declined. The OP No.2 is hereby directed to pay the aforesaid amount within 45 days from the date of passing the final order and in case of making default, the OP shall pay Rs.50/- for each day’s delay and the amount so accumulated be deposited in the Consumer Legal Aid Account.
Let a copy of the Final Order be supplied to the parties free of costs.
Dictated and corrected by me.
