A. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION : AT HYDERABAD
CC 93/2011
Between :
01. G. Ramesh Kumar, s/o G. Gundu Rao
Aged about 57 years, occ:Service
02. G. Rajni Kanth, s/o G. Ramesh Kumar
Aged about 30 years, occ : Service
03. G. V. Ramakanth, S/o G. Ramesh Kumar
Aged about 29 years, Occ : Service
04. G. V. Rahul Kanth, S/o G. Ramesh Kumar
Aged about 26 years, Occ : Business,
All R/o H. No. 14-2-134/24, Gosha Mahal,
Chandanwadi, Hyderabad – 500012 ,, Complainants
And.
01. Care Hospitals, Nampally, Hyderabad
Rep. by Medical Director,
Dr. D. N. Kumar, S/o not known to the complainant
Aged : Major, occ : Medical Practitioner.
02. Dr. Sridhar, S/o not known to the complainant
Aged : Major, Occ : Interventional Neuro Radiologist
Care Hospitals,. Banjara Hills, Hyderabad.
03. Dr. J. M. K. Murthy, S/o not known to the complainant
Aged : Major, occ : Head, Dept of Neurology
Care Hospital, Nampally, Hyderabad.
04. Dr. T. V. R. K. Murthy, S/o not known to the complainant
Aged : Major, occ : Neuro surgeon
Care Hospital, Nampally, Hyderabad
Address for all : Care Hospitals, Nampally,
Hyderabad .. Opposite Parties
Counsel for the Complainants : Mr. A. K. Muheed
Counsel for the Respondents : M/s. A. Srinath
Coram ;
Sri R. Lakshminarasimha Rao… Hon’ble Member
And
Sri T. Ashok Kumar .. Hon’ble Member
Friday, the Twenty Fifth Day of October
Two Thousand Thirteen
Oral Order : ( As per Sri T. Ashok Kumar , Hon’ble Member )
****
01. This is a complaint filed U/s. 17 (1)(a) of C. P. Act by the complainants against the opposite parties claiming compensation of Rs. 25 lakhs together with interest @ 18% PA from 09.06,.2011 till realization and also to direct the Director of AP medical council to revoke the licenses of Ops 2 to 4 and remove their names from the roles of practicing doctors and debar them from practicing medicine alleging that death of one Smt. Krishnaveni who is the wife of the first complainant and mother of the other complainants died on account of Medical negligence on the part of the opposite parties.
02. The brief facts of the complaint are as under :
Smt. Krishnaveni,. Wife of the first complainant and mother of the other complainants was admitted in Gosha Mahal hospital, Hyderabad on 5.6.2011 with a complaint of vomiting and severe headache and that she was treated there for three days and Dr. Janardhan suspected that she was suffering from food poison and he suggested for CT scan which was conducted at Kamineni Hospital, King Koti, Hyderabad. After going through the said CT scan report the said Dr. doctor instructed the said complainant and her family members to take brain Angiogram of the said patient at Medwin hospitals. Accordingly it was so done and after going through the report Dr. Venkateswarlu and Dr. Janardhan suspected that the said patient is suffering from Basilar Artery Top aneurysm and for better treatment the said patient was admitted in OP. 1 hospital on 09.06.2011 at 2.30 PM in the emergency ward. Later she was suggested to be taken to OP. 2 Dr. Sridhar at Care Hospital, Banjara Hills, Hyderabad. Accordingly it was so done and the said doctor was requested to treat the said patient who was hale and healthy aged 47 years. The deceased was diagnosed as ‘Basilar Artery Top Aneurysm’ and care hospitals had given assurance of her recovery and suggested operation on 09.06.2011 but OP. 2 doctor had been to Bombay to attend a conference knowing well that there is emergency patient and her condition was serious. In the mean while since condition of the said patient became serious on 10.06.2011 Care hospital authorities called Dr. Venkateswarlu from Medwin hospitals and preparations were done for coiling and the operation was fixed on 11.7.2011 at 2.00 PM , Dr. Venkateswarlu visited the patient, discussed with opposite parties hospital authorities and thereafter without disclosing substantial reasons left the hospital. It was informed that OP. 2 Dr. Sridhar would return on 12.6.2011 and treat her. Dr. Sridhar ( OP 2 ) came to Hyderabad on 12.6.2011 but conducted operation on 13.6.2011. On account of negligence on the part of the Ops, including OP. 2 the said patient namely Krishnaveni died on 16.6.2011 but the opposite party declared that she died on 18.6.2011. A criminal case vide FIR 184/2011 was registered against the Ops by Abids Police for the offence U/s. 304 A IPC. Even though the said patient was joined in the hospital on 9.6.2011 and survived for ten days, on account of negligent treatment on the part of the opposite parties she died and on account of her death the complainants 1 to 4 were subjected to mental agony, loss of service, affection and further the first complainant lost right of consortium. In spite of legal notice Ops did not oblige with the claim of the complainants and hence the complaint.
03. OP. 2 filed written version on his behalf and on behalf of the other Ops resisting the claim of the complainants and denying the allegations made in the complaint and the brief facts are as under :
There is no medical negligence in treating the Smt. Krishnaveni at all. Prior to her admission in the hospital of Ops she took treatment in another hospital and on advice there she was brought to Care Hospital, Nampally on 9.6.2011 and after reviewing the medical reports of the patients at the hospital of Ops she was diagnosed with Basilar artery top aneurysm and it was so informed to the attendants of the patient. Since OP 2 had to attend a pre scheduled conference at Mumbai, he left for Mumbai and returned late night on 12.6.2011. In the meanwhile, the patient was referred to another Neuro Radiologist, Viz Dr. Venkateswarlu of Medwin hospital and he agreed to conduct the required operation on 11.6.2011. the procedure was an elective one and was not an emergency one. Even though, the operation was planned on 11.6.2011, Dr. Venkateswarlu, could not conduct the same on account of technical problem which is very common. The attendants were informed to shift the patient to some other hospital but they insisted that the operation has to be conducted by the Care Hospital doctor himself. The operation was again scheduled on 13.6.2011 and the same was informed to the patient and attendants and the risks involved in the procedure was also explained to them. No assurance that nothing will happen to the patient was given by the Ops. The operation was conducted as scheduled on 13.6.2011 by following due procedure and thereafter also the attendants of the patient were informed of the condition of the patient. During the operation, the Aneurysm was ruptured and it was one of the possible complications of the procedure. The entire family of the patient was informed about the complications, seriousness of the situation and the likely out come and after surgery patient was taken to Neurology Intensive Care unit on the ventilator and she was showing minimal motor response and was triggering ventilator. But was maintaining normal sinusrhythm and blood pressure. On 18.6.2011, the patient stopped triggering ventilator in the morning and had cardiac arrest at 12.30 PM and declared dead. At no stage of the treatment of the patient, there was any negligence and death is one of the possible consequences of a medical procedure and it did not occur on account of alleged delay in conducting the operation. The Ops tried their best as per their professional abilities but unfortunately on account of such a known complication. Police , Abids registered the crime in connection with the death of the said patient but the Ops have taken appropriate steps against it. There is no professional negligence on the part of Ops in treating the patient and therefore the claim of the complainant is not sustainable either in law or on facts and thus prayed to dismiss the complaint.
04. PW.1/First complainant filed evidence affidavit reiterating the case as set out in the complaint and marked Ex. A1 to A10 documents.
05. RW.1 ( OP.2 ) filed evidence affidavit deposing the defences set out in the written version and on commission he and RW.2 were cross examined. fRW.2 , Sri JMK Murthy was also cross examined. Further RW/ 3. Dr. J. Venkateswarlu was examined. Ex. B1 to B`1 2 were marked on behalf of the opposite parties. Heard both side counsel and they also submitted written arguments in support of their respective contentions.
06. Now the points for consideration are
(i) Whether there is any professional negligence on the part of the Opposite parties in treating Smt. Krishnaveni for her ailment and rendered any deficient service ?
(ii) Whether the complainants are entitled for compensation and if so what would be the reasonable amount ?
(iii) Whether the complainants are entitled for other relief claimed ? to what relief ?’
07. POINT NO 1 and 2 : since points 1 and 2 made common discussion they are taken up to answer together.
THERE IS no dispute that Smt. Krishnaveni aged 47 years. who is hereinafter referred to as deceased, is the wife of the first complainant and mother of complainants 2 to 4 and was admitted initially on 5.6.2011 in Gosha Mahal hospital, with complaint of vomiting and headache and that undergone CT scan and Brain Angiogram and that later on she was admitted in OP. 1 hospital at Nampally on 09.06.2011 at 3.40 PM and that she was diagnosed as ‘Basilar Artery Top Aneurysm’ i.e,. nerves and brain have become thinner at some places and coiling or clipping was advised to her at the said hospital. The complainants contended that OP hospital had given assurance for her recovery but the same could not be appreciated because nobody would give such an assurance in the medical field. The grievance of the complainants is that OP. 2 surgeon had been to Mumbai on 10.06.2011, to attend conference knowing well that there is emergency patient and her condition was serious and that since condition of the said patient became so serious OP hospital authorities called Dr.Venkateswarlu from Medwin hospital on 10.06.2007 and he prepared for procedure for coiling and that on 11.6.2011 at 2.00 PM operation was fixed and thereafter the said Dr. Venkateswarlu came to the patient and discussed with hospital authorities went away without disclosing any substantial reason and did not conducted any such coiling procedure and that even though OP. 2 doctor turned up on 12.06.2011 no operation was conducted on the said date and it was so conducted leisurely on 13.06.2011 and thus the delay in conducting surgical procedure resulted in the death of the deceased and therefore the Ops are guilty of professional/medical negligence. It is also contended by the complainants that though the deceased died on 16.06.2011 it was not revealed to them and declared dead on 18.06.2011.
08. The contention of the Ops is that there is no medical negligence on their part in treating the deceased and that initially she took treatment in another hospital and upon advice she was brought to Care Hospital, Nampally on 09.06.2011 and that after perusal of reports of the deceased it was diagnosed that she was suffering from Basilar Artery Top Aneurysm, and coiling was advised and that the said procedure was an elective one as opposed to an emergency one and that since OP. 2 surgeon had a prescheduled conference at Mumbai it was suggested to the attendants of the deceased patient to take treatment with another interventional Neuro Radiologist Dr. Venkateswarlu of Medwin hospitals, Hyderabad and that though the same was planned on 11.6.2011,Dr. Venkateswarlu he could not conduct the said surgical procedure on the said date due to technical problem which is very common and that though option of shifting the patient to some other hospital was clearly explained to the attendants they insisted that the same has to be done by OP. 2 Doctor himself and that the said OP. 2 Dr.Sridhar returned to Hyderabad late in the night on 12.06.2011 and that after taking required consents on 12.06.2011 night at 9.00 PM the said surgical procedure of coiling was done on 13.06.2011 duly explaining the complications and risks to the attendants of the patient and that no assurance was given saying that nothing will happen to the patient and that after patient was shifted to Neurology Intensive care on the ventilator and the patient was showing minimal motor response and was triggering ventilator but was maintaining normal sinusrhythm and blood pressure and that on 18.06.2011 morning she stopped triggering ventilator and had cardiac arrest at 12.30 PM and was declared dead and that during the operation the aneurysm was ruptured and that it was one of the possibilities and complications of the procedure and it was informed to the family members of the patient duly so also the likely outcome and that there was no medical negligence on the part of the Ops in treating the patient and that for extracting money a false complaint was filed so also to tarnish the image of the hospital.
09. It is not the case of the complainant that OP. 2 doctor is a not qualified doctor and on the other hand on the advice of Gosha Mahal hospital for better treatment the said patient was taken by her family members to the OP hospital and it is on record that OP. 2 Dr. Sridhar is only the surgeon in particular branch for all the Care hospitals and thus his efficiency to treat the patient cannot be questioned. Merely because something went wrong and patient died it is not desirable to hold him guilty of negligence. A charge of medical professional negligence is serious when compared with the negligence on the part of driver of a motor vehicle because such a charge against a medical practitioner not only effects his profession but also the reputation therefore burden of proof is heavy in such cases than that of the cases filed against the driver of the motor vehicles. The negligence cannot be resumed but it has to be established with dependable evidence of an expert in the field. One of the tests of medical negligence is that something which is required under Medical practice to be done was not done or what was done was contra. If the person/persons who alleged medical negligence establish the case with required ingredients aforesaid then only, a finding to the effect that the medical practitioner is guilty of professional negligence can be given. A Medical practitioner must possess a reasonable skill and knowledge and it is neither very highest nor a very low degree of care. Error of Judgment if any cannot be based to say that the doctor was negligent in discharging duties and no compensation can be awarded in such cases.
10. The complainants alleged that the deceased died on 16.06.2011 itself and that it was not disclosed to them by OP hospital and that on 18.06.2011 it was so informed and certainly it is a grave allegation. Ex. A5 Post mortem report filed by the complainants itself discloses that the approximate time of death of the deceased is 18.06.2011 at 12.30 PM at Care Hospital, Hyderabad and it is also mentioned in the said PME report that rigormortis was present in the dead body when it was brought to the Osmania General Hospital on 18.06.2011 at 5.30 PM and the said aspect also disproves the contention of the complainants that the deceased died on 16.06.2011 and with such an instance it can be said that the complainants are the persons who can go to any extent in making allegations against the opposite parties. ‘
11. It is true that as seen from Ex. A3 copy of FIR a case in Cr No. 184/2011 for the offence U/s. 420 IPC was registered at P.S., Abids, Hyderabad on 18.6.2011 against OP. 1 Care Hospital and in the said FIR also no provision U/s. 304 A IPC is mentioned. In Ex. A4 inquest it was observed that the deceased died on account of negligence of Care Hospital doctors and staff but the same cannot be accepted as the scope of section 174 Cr.P C proceedings is limited to say the apparent cause of death of the deceased. There is no evidence on record to say that police filed any charge sheet against Ops in the said crime alleging professional negligence against them. Further, the Ops contended that quash proceedings were initiated in respect of the said FIR in the Hon’ble High Court of A.P. Hence it is not desirable to discuss about the said FIR , inquest etc. in detail in this case.
12. OP.2 testified that before he left for Mumbai to attend prefixed conference it was informed to the attendants of the patient and also advised them to take treatment with Dr. Venkateswarlu, Neuro Radiologist of Medwin hospitals, his programme at Mumbai was pre fixed and as a faculty he had to attend the said programme and therefore we cannot find fault with OP. 2 in the said context. Even though, the complainants contended that OP.2 Dr. Sridhar returned to Hyderabad and was available on 12.06.2011 there is no dependable evidence from their side in the said context. Had really he was available at Hyderabad on 12.6.2011 in day time there was no reason for him not to conduct the operation on the said patient. Consistently, his plea is that he returned to Hyderabad from Mumbai on late night on 12.06.2011 and therefore he conducted such surgical procedure on the said patient on 13.06.2011 and there is acceptable force in the said contention.
13. It is borne by the record from the evidence of Ops that the complainants insisted that surgical procedure has to be conducted by the Op. 2 and therefore they did not evince interest in getting conducted such a surgical procedure through Dr. Venkateswarlu of Medwin Hospitals. It is true that in the absence of OP. 2 Dr. Sridhar on 11.6.2011 Dr. Venkateswarlu intended to conduct operation at 2.00 PM and came to the hospital of the Ops. Ex A2 progress note of Care Hospital pertaining to the deceased patient discloses that from time to time necessary steps were taken in connection with the treatment of the patient by administering the medicines. Even though four coils were deployed there was possibility of using of one coil and it cannot be over ruled and therefore contention of the complainants that as per post mortem report discloses that only one coil spring is recovered from the patient’s brain is also not helpful for them. Ex. A6 letter dated 30.06.2011 marked by the complainants themselves addressed to Dr. Ramakrishna, advisor to Administrative Staff College of India where first complainant is working by Dr. D. N. Kumar, Medical Director, Care Hospital, Nampally discloses that on 11.06.2011 at 2.30 PM Dr. Venkateswarlu came to the OP hospital to do the procedure and shifted the patient to Cathelab where the procedure was to be performed and he had a discussion with the anesthetist who felt that since it is a major and complex procedure it would require that he would be able to do the procedure in the evening on 12th June. Probably in such circumstances the said surgical procedure could not be undertaken on 11.6.2011 and the Ops explained the reason for such postponement saying that for technical reasons it was not so conducted on 11.6.2011 and we cannot find fault with the Ops in the said context for not mentioning the said details in the written version or evidence because the documents filed by the complainants itself speaks the same. In such circumstances suggestion to RW. 2 Dr, JMK Murthy, that he did not allow Dr. Venkateswarlu to conduct the coiling operation because of Dr. Sridhar was not available at Hyderabad could not be appreciated in favour of the complainant and on the other hand it strengthen the contention of the Ops that Op 2 was not available at Hyderabad on that day as he was pre occupied at Mumbai. Ex. B-5 High risk consent dated 12.06.2011 at 9.00 PM given by one G. V. Rahulkanth, son of the deceased patient, discloses that the nature and purpose of surgical procedure coiling was explained so also the possible complications like risk to life etc during and after surgery and that the said son of the patient gave unreserved consent for surgery anesthesia and transfusion if any and therefore there is no substance in the contention of the complainants that required consent was not taken and that the possible complications were not explained to them. Very specifically, OP. 2 testified that the rupture of the aneurysm during the operation is one of the possibilities/complications of the procedure and the same was duly informed to the family members of the patient and also seriousness of the situation and the likely outcome and in spite of explaining so the complainants gave consent for such surgical procedure. The complainants did not establish with any clinching and dependable evidence that such a rupture is not one of the possible complications of the procedure by examining an expert and that the delay in conducting the procedure resulted in death of the patient. So also to prove that OP. 2 did not follow the due procedure in conducting such an operation on the patient and that did not take pre or post care and that he negligently conducted such a surgical procedure resulting in the death of the deceased. No incriminating circumstances are available on record to connect the Ops with the alleged negligence. Ex. A5 PME report discloses that cause of death of the deceased to the best knowledge and belief of the doctor who conducted autopsy was cerebral hemorrhage (?) rupture berry aneurysm and the said rupture is one of the possible complications described by the Ops and thus the PME report also supports the case of the Ops in the said context. Suspicion however strong cannot take the place of proof and therefore the suspicion of the complainants that on account of delay in conducting such surgical procedure the deceased died is no way helpful for them in this case. The complainants did not state as to what acts of doctors either omitted when needed are done in contravention of established medical protocol resulting in death of the patient and therefore in view of the decision reported in AIR (SC) 1996 -0-550- Shantha Vs. Medical council of India it is difficult to hold that Ops rendered deficient service. In view of the decision reported in AIR 1969 SC 128 if the doctor had fallen short of standard of reasonable medical care, he can be held guilty of professional negligence and in this case since the complainants failed to establish the said aspect with dependable evidence or circumstances we are of the considered view that this is not a fit case to hold that Ops rendered deficient service. Even though RW.1 Dr. Sridhar from RW.2 Dr. JMK Murthy and RW.3 Dr. Venkateswarlu were examined/cross examined by the Ops nothing important was elicited from them in their favour to hold that Ops rendered deficient service. Dr. Venkateswarlu testified that he cannot say there has any negligence on the part of Ops hospital in treating the patient and it also goes against the complainants. In such circumstances, self-serving evidence of PW.1 first complainant is not useful for the complainants to seek relief against the Ops though he was not cross examined by the opposite parties. Being a central Government employee the first complainant was reimbursed Rs.4 lakhs medical bill and probably for the said reason, the said medical expenses were not included in the relief portion of the complaint. Wife and major children cannot be considered as dependents of the deceased, however, on account of her death they lost her services so also right of consortium by the 1st complainant husband but when there is no dependable evidence from their side that Ops rendered deficient service they are not entitled for any compensation. In view of the above discussion the decision reported in AIR 2011 SC 249 between Minor Margesh K Parik Vs Dr. Mayur H. Mehtha, AIR (SC) 1996 -0-550- between Indian Medical Association Vs. V P Shantha and the list of decisions enclosed to Indian Medical Associations case are not helpful to the complainants as with legal and dependable evidence or circumstances they failed to establish their case that the Ops rendered deficient service. It is much more so when the facts of the said case quite different with the facts of the case on hand. The complaint is devoid of merit and is liable to be dismissed. Thus points 1 and 2 are answered accordingly against the complainants.
14. POINT NO. 3 :
IN view of the findings in points 1 and 2 against the complainants, they are not entitled for the other relief i.e. a direction to the to direct the Director of AP medical council to revoke the licences of Ops 2 to 4 and remove their names from the roles of practicing doctors and debar them from practicing medicine also . Parties shall bear their own costs.
15. In the result, the complaint is dismissed. Parties shall bear their own costs.
MEMBER MEMBER
DATED : 25.10.2013.
APPENDIX OF EVIDENCE
Documents Marked
For the complainants :
Ex. A-1 : 09.06.2011 : case sheet
Ex. A-2; 12.06.2011 ; consent forum
Ex.A-3: 18.06.2011 : FIR
Ex. A-4; 18.06.2011 : Panchanama
Ex.A-5; 18.06.2011 ; Postmortem report
Ex. A-6: 01.07.2011 : Letter from OP
Ex. A-7; 02.08.2011 : Settlement of IP Bills
Ex.A-8: 11.08.2011 : Legal notice of complainant
Ex. A-9: 11.08.2011 : postal receipt with acknowledgement
Ex.A-10: 28.08.2011 : reply notice
For the opposite parties :
Ex. B-1: 09.06.2011 : Registration Data
Ex. B-2; - : Undertaking letter
Ex.B-3: 09.06.2011 : Checklist for inpatient admission
Ex.B-4; - : consent forms three in no,.
Ex.B-5; 12.06.2011 : High Risk consent
Ex.B-6; 10.06.2011 : Consent for Anesthesia/Analgesia/sedation
Ex.B-7; 09.06.2011 ; Check List
Ex.B-8: 10.06.2011 ; Nutritional Assessment form
Ex.B-9: - ; Post Anaesthesia Care Unit Record
Ex.B-10: 09.06.2011 : Progress Notes
Ex. B-11; - : Nurses Record
Ex.B-12; - ; Dietary progress notes
MEMBER MEMBER
DATED : 25.10.013.
