DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD
Dated this the 30th day of September, 2024
Present : Sri. Vinay Menon V., President
: Smt. Vidya A., Member
: Sri. Krishnankutty N.K., Member Date of Filing: 22/08/2022
CC/153/2022
Sreenivasan R.,
S/o. Late M.Ramachandran,
Vellala Street,
Chittur, Palakkad – 678 101 - Complainant
(By Adv. Sooraj Krishnan K.V.)
Vs
- Dr.Jayagopal P.B.,
Cardiologist,
Director, Lakshmi Hospital,
Chittur Road, Palakkad – 678 013
- Dr.Rajaprabhakar,
R.M.O., Lakshmi Hospital,
Chittur Road, Palakkad – 678 013 - Opposite parties
(OPs by Adv. V.K. Venugopal)
O R D E R
By Sri. Vinay Menon V., President
- Complainant is the legal heir of one deceased Sakunthala who according to the complainant was admitted to the hospital with a slight discomfort in breathing. She underwent treatment for 6 days from 21/1/2022 till 28/1/2022. She was admitted due to the undertaking made by the 2nd OP that there are ample departments in Lakshmi Hospital for treatment of the complainant’s mother. But due to continuous negligence on the part of first opposite party in providing dialysis and other treatments, complainant’s mother developed a number of cardiac problems along with septicemia. Since the condition of the patient worsened, she was taken to Mother Hospital and thereafter to some other hospital. Subsequently the mother died. Complaint is aggrieved by a list of 16 counts of deficiency / negligence on the part of OP1, which are not reproduced herein, but discussed under Issue No. 3. Complainant seeks compensation and cost.
- Both OPs filed similar versions contending that the patient was provided treatment after being recommended by experts in their respective fields. Dialysis was provided under the guidelines of Dr. Jayaprakash, a leading nephrologist. Since the condition of the patient worsened, she was referred to centre with higher facilities. There is no deficiency in service on the part of OPs. They sought for dismissal of the complaint.
- The following issues were framed for consideration:
- Whether the opposite parties failed to diagnose and provide timely / proper medical assistance to the complainant’s mother?
- Whether the complainant’s mother’s condition aggravated owing to any treatment or lack thereof on the part of the OPs?
- Whether there is any deficiency in service on the part of OPs?
- Whether the complainant is entitled to any of the reliefs sought for?
- Any other reliefs?
4. (i) Documentary evidence of complainant comprised of proof affidavit and Exhibits
A1 to A13.
(ii) Marking of all documents are objected to as they are photocopies. Marking of Ext.A13 is specifically objected on the additional ground that it is a screen shot unaccompanied by Section 65B certification. Since this Commission is not bound by Indian Evidence Act, and that the opposite party has no case that the said documents are forged or fabricated, this objection is over-ruled.
(iii) OPs filed separate proof affidavits and marked Ext. B1. OPs 1 & 2 were examined
as DW1 & DW2 respectively.
5. Complainant belatedly filed 2 applications as I.A. 398/23 to implead Lakshmi Hospital, Palakkad, wherein the patient was admitted and had undergone treatment under O.P.s and I.A. 399/23 to amend the complaint after impleading the Hospital. As the said I.A.s were filed belatedly, both the I.A.s were dismissed.
6. At this juncture, it would be of interest to note that the 2nd O.P., who was examined as DW2 had filed detailed version and detailed proof-affidavit. He entered box and on oath submitted that he had merely admitted the patient and no further treatments were rendered by him. To any incidents past 22/01/2022, he pleaded ignorance.
But Ext. B1 and its contents, Doctors’ Notes and Nurses’ Notes, belie this deposition of the DW2. Said notes show that the DW1 had seen and treated the patient on all 6 days. It goes without saying that the DW1 has willfully lied before this Commission.
It is relevant to note that the sole allegation seen raised against the 2nd O.P. is in para 4 of the memorandum of the complaint. Per pleadings, when the complainant asked the 2nd O.P. whether he ought to take his mother elsewhere, O.P.2 answered in the negative and assured him that the hospital had all the facilities and it was based on this undertaking that mother was admitted in the hospital. Any further mention of O.P.2 arises only at a later stage, wherein he is roped in for claiming reliefs.
Since no grievous pleadings are raised against O.P.2, we do not deem it necessary that any adverse inference be raised as against O.P.2.
7. One aspect the complainant has not mentioned anywhere in the pleadings or evidence is the fact that the patient, Sakunthala, had two other children, other than the complainant – Uma Maheshwari and R. Rajesh. Their signature and active participation, while the patient was undergoing treatment can be seen on perusal of the contents of Ext. B1 document. Even after they being legal heirs of the patient, presently deceased, they are not parties to the complaint. They are not witnesses. Why such a fact was not revealed is not stated in the complainant
Issue Nos. 1 & 2
8. Even though the complainant has filed argument notes, we refuse to go by the same, since it does not address the issues and fails to guide us.
9. The 1st issue was framed so that this Commission could ascertain from evidence adduced by the parties whether the O.P.s had treated the complainant’s mother for diseases already suffered or whether there arose any fresh diseases that went unnoticed by the O.P.s owing to any negligence on the part of the O.P. The 2nd issue, to ascertain whether development of any fresh condition was consequent to any negligence on the part of the O.P.s.
10. Complainant’s pleadings are to the effect that (para 2 of the memorandum of complaint) the complainant’s mother succumbed to the continuous negligence by the 1st O.P. doctor. Thereafter in para 9, as aforesaid, 16 charges are raised.
11. Complaint admits that his mother was suffering from Type 2 Diabetes, Hypertension and CKD. She was taken to Lakshmi Hospital on 22.01.2022 as she suffered slight discomfort in breathing owing to pulmonary odema. At the time of admission, she was conscious and physically active. During discharge after 6 days, ie. 28/01/2022, she was bed-ridden, semi-conscious and suffered new health complications like Ischemic Heart Disease, Old Anterior Wall Myocardial Infarction, Acute Decompensated Heart Failure, Septecemia and Metabolic Encephalopathy. Theses conditions developed due to the negligence on the part of the 1st O.P.
12. Documentary evidences of the complaint are Ext. A1 to A13. Medical records maintained in the Lakshmi Hospital are marked as Ext. B1. Contents of none of the documents are in dispute. There is no case that the documents on either side is forged or fabricated. Hence reliance, as and when required, can be resorted to without any hesitation.
13. Page 3 of Ext. B1 is the Discharge Summary. Patient was admitted with history of acute onset of breathlessness and pulmonary edema. Patient was already on treatment for Diabetes Mellitus, Hyper tension and Chronic Kidney disease. It is the rest of the diseases in diagnosis ie. Ischemic Heart Disease, Old Anterior Wall Myocardial Infarction, Acute Decompensated Heart Failure, Septicemia and Metabolic Encephalopathy that the complainant claims to have arisen out of the treatment meted out to the patient by the 1st O.P.
14. To assay this position, the complainant cross examined O.P.s 1 and 2 as DW1 and 2. Relevant portion of the cross examination of DW1 is as follows:
Page 7 Line 13 to Page 8 Line 9 : “Admission സമയത്ത് symptom അല്ലാതെ എന്തെങ്കിലും അസുഖങ്ങള് ഉണ്ടെന്നു ബോധ്യപ്പെട്ടാല് അത് record ചെയ്യും. Ext.A6 പറയുന്നതാണോ patientന്റെ admission ചെയ്യുന്ന സമയത്തെ അവസ്ഥ എന്ന് പറഞ്ഞാല് ശരിയാണ്. Presented എന്ന് പറഞ്ഞു ആ സമയത്തെ അസുഖങ്ങള് ആണ് പറഞ്ഞിരിക്കുന്നത്. Patient വരുന്ന സമയം Ischemic Heart Disease, Old Anterior Wall Myocardial Infarction, Chronic kidney disease stage 5, Acute Decompensated Heart Failure, Septicemia Metabolic Encephalopathy എന്നിവ ഉണ്ടായിരുന്നോ എന്നു ചോദിച്ചാല് ഇത് discharge diagnosis ആണ്. ആദ്യ സമയം ഉണ്ടായ diagnosis അതില് താഴെ രേഖപ്പെടുത്തിയിട്ടുണ്ട്”.
Even though DW1 has stated that CKD was diagnosed post admission it goes without stating that the statement is a mistake since the complainant himself admits that the patient suffers from CKD.
15. But nothing could be brought out to show that Ischemic Heart Disease, Old Anterior Wall Myocardial Infarction, Acute Decompensated Heart Failure, Septicemia and Metabolic Encephalopathy as a direct concomitant of the treatment rendered to the patient by the O.P.1. As already stated supra, there is no pleading as against the treatment rendered by the 2nd O.P.
16. The complainant could have examined the doctors in Mother’s Hospital or any other expert in the field to drive in the nail that the patient contracted the aforesaid conditions as a result of the treatment rendered by O.P.1.
17. Merely because certain diseases were identified or diagnosed in the hospital of O.P.s would not make the said conditions a result of the treatment rendered to her.
18. Thus, we hold that
(1) the opposite parties have not failed to diagnose and provide timely / proper medical assistance to the complainant’s mother; and
(2) the complainant has failed to prove that the complainant’s mother’s condition
aggravated owing to any treatment or lack thereof on the part of the OPs.
Issue No.3
19. As already stated, grievances of the complainant are 16 in numbers. Focus of assailing has already been discussed and opinion arrived at. Rest of the 16 grievances can be assayed.
9(1) 1st OPs standing instruction to RMO for admitting patients in their emergency department during late night hours and not providing necessary medical care to the patient until he arrived for consultation caused irrecoverable loss to the patient.
20. There is nothing in evidence to show that there is a standing instruction to RMOs to admit patients in their emergency department during late night hours, irrespective of their condition.
9(2) No proper treatment for pulmonary edema given to the patient while admitted in ICU.
21. In order to reach a studied decision on this point, the complainant was bound to lead evidence to show that treatment rendered to the patient, as evidenced by the contents of Ext. B1, wherein the treatment given to the patient is recorded, are not the treatment that had to be rendered.
Ext. B1, Nurse’s note prepared at 1.30 AM on 22/01/2022 shows that O.P.2 had seen the patient and O2 was started and that Inj. Lasix 80 mg IV was given. Emergency intubation was done at 3.45 AM.
Complainant had failed to bring on record by cogent evidence what the treatment that ought to have been administered to a patient as that of the complainant’s mother and that the treatment rendered as is evidenced by the contents of Ext. B1 was not the treatment that ought to have been rendered.
22. Having failed to do so, we hold that the complainant has failed to prove his case on this ground.
9(3) Roles of pulmonologist and nephrologist carried out by 1st OP who is only an interventional cardiologist.
23. This grievance contains two elements, ie. (1) the role of pulmonologist; and (2) the role of nephrologist, both allegedly played by the 1st O.P.
24. Complainant’s grievance is that the patient was ventilated by the 1st O.P., who was an interventional cardiologist. He grieves that being a cardiologist, he had no expertise or competency to ventilate the patient.
Ventilation is the process of artificial supply of oxygen to the lungs, when the lungs is incapable of exertion. It is true that a pulmonologist is an expert in the field of diseases pertaining to the respiratory system. But the complainant ought to have proved that doctors having expertise in other fields are barred or prevented from ordering ventilation.
25. Second grievance is that the 1st O.P. assumed the role of a nephrologist. One consultation form (unnumbered sheet) dated 22/01/2022 shows the consulting doctor to be Dr. Jayaraj. Complainant has no case that this document is a forged one or one that is not prepared by a nephrologist. Further, 5 sheets of dialysis report forming part of Ext. B1 shows that the technician had informed the nephrologist. Complainant had not cared to assay the authenticity of these documents as well.
An informed consent form dated 22/01/2022 is seen executed by Uma Maheshwary, daughter of the patient. This form shows that Dr. Jayaraj, nephrologist is treating the patient. To the contents of this document also, the complaint has no objection.
26. Thus, the complaint has failed to prove that the 1st O.P., has acted as a pulmonologist and a nephrologist without availing the assistance the opinion of experts.
9(4) Failure to administer diuretics to patient to alleviate water pressure in lungs and avoid the chance of intubation.
27. As already stated supra, Ext. B1, in Nurse’s notes prepared at 1.30 AM on 22/01/2022 shows that O.P.2 had seen the patient and O2 was started and that Inj. Lasix 80 mg IV was given. Inj. Lasix is a diuretic. Thus, the contention of the complainant that the patient was not provided diuretics fails.
9(5) Unhygienic intubation even during Covid period.
28. No evidence is adduced by the complainant.
9(6) Cardiac disorder caused due to failure to start medication on time.
29. Complaint has not adduced any evidence to show that the patient developed Ischemic Heart Disease, Old Anterior Wall Myocardial Infarction and Acute Decompensated Heart Failure due to failure to initiate any sort of medication on time.
9(7) Forcefully kept patient in ventilator for more than 3 days and failed to administer proper antibiotics to avoid chance of ventilator associated / hospital acquired pneumonia and blood poisoning leading to patient contracting pneumonia and septicemia.
30. From a perusal of records, it is seen that the complainant and his sister has issued consent for continuation of ventilation on 26/01/2022, after her removal from ventilation on 25/01/2022. Thus, the complainant himself, along with his sister has granted consent for re-ventilating the patient.
31. Complainant has failed to prove that the O.P.s had failed to administer proper antibiotics to avoid chances of ventilator associated / hospital acquired pneumonia and blood poisoning leading to patient contracting pneumonia and septicemia by adducing evdence.
9(8) Patient’s hands were tied firmly with ICU cot leading to swelling and was sedated so that ICU technician were not disturbed by the patient.
32. No evidence is adduced to show that patient’s hands were tied to ICU cot. Eventhough the DW1 was put this question, no evidence corroborating the pleadings of the complainant could be brought forth. Even if her hands were tied, a burden is cast on the complainant to prove that such an action was resorted to with malice and is not advised in any medical protocol.
9(9) Since OP1 failed to look at the back of the patient, she developed bedsores.
33. No evidence is adduced to prove that there is any negligence on the part of the 1st O.P. in this regard.
9(10) Doctors of the hospital were coughing, sneezing and re-arranging their face mask with bare hands while entering the ICU.
34. No evidence is adduced.
9(11) Blood poisoning of the patient due to improper maintenance / sterilization of dialysis machine.
35. No evidence is adduced to prove that sepsis is caused as a result of improper maintenance / sterilization of dialysis machine.
9(12) Patient contracted Covid 19 due to poor infection-controlled standards.
36. No evidence is adduced.
9(13) Wrongful preparation of discharge summary to hide dialysis frequency, hospital acquired pneumonia and to alter post-hospitalization ailments as pre-hospitalization illness.
37. To this aspect also, the complainant had failed to adduce any cogent evidence except for some of the questions that were put to the O.P.s. at the time of cross examionation. The discharge summary contains two parts on the front page. One is ‘Diagnosis’, wherein 8 conditions are stated. Immediately below the 8 conditions, the conditions already suffered by the patient along with the presenting condition is stated.
Such a statement does not mean that except for Diabetes Mellitus, Hypertension and Chronic Kidney Disease and pulmonary edema, all other symptoms developed as a result of the treatment of O.P.1. It can only mean that they were diagnosed during the course of patient’s stay in hospital. It seems the complainant is confused with the terms “diagnosed” and “developed”.
38. Thus, complainant has failed to prove that the O.P.s had resorted to wrongful preparation of discharge summary.
9(14) Patient admitted with only single symptom but with discharge with half a dozen symptom due in efficiency of OP1.
39. Already discussed in 9(13).
9(15) Intubation of patient and increasing the frequency of dialysis without the consent from relatives concerned.
40. On 22/01/2022, it is seen in Ext. B1, that the patient was intubated as an emergency measure. On 26/01/2022, complainant and another daughter of patient had granted consent for ventilating the patient. An informed consent form dated 22/01/2022 is seen executed by one Uma Maheshwary, daughter of the patient for initiating dialysis. Two consents are seen executed by the daughter for receiving blood. Yet another son of the patient, R. Rajesh, is seen to have issued another consent for carrying out dialysis.
41. When a patient like that of the patient, who suffers from multiple morbidities, the doctors may have to resort to various methods for treatment. Sometimes it may call for some immediate action. This Commission cannot come to a conclusion, merely based on the pleadings of the complainant that no consent was sought for from the relatives of the patient. Even if we come to a conclusion that consent was not availed, what is to be considered is that whether such non-availing of consent or varying of frequency of dialysis was fatal to the case of the patient.
42. Complainant has not adduced any evidence to this end. This issue, accordingly, fails.
9(16) Providing false information in hospital website with regard to the departments and doctors to attract patients.
43. Complainant grieves that the website of the hospital contains false information. Had the complainant been serious about this allegation, they should have made the hospital a party to the dispute at the first instance. They have no case that the O.P.s were maintaining the web-sites personally. As already stated supra, they had filed belated applications as I.A. 398/2023 and 399/2023 to implead and amend the complainant, which were dismissed as being highly belated.
44. Present O.P.s, therefore, cannot be held liable for the maintenance of the web-site of the hospital.
Issue No.4
45. Based on the discussions above, we hold that the complainant is not entitled to any of the reliefs sought for.
Issue No.5
46. Accordingly, we hold that there is no negligence or deficiency in service on the part of the O.P.s. 1 and 2.
47. Complaint is accordingly dismissed.
48. Parties are directed to suffer their respective costs.
Pronounced in open court on this the 30th day of September, 2024.
Sd/-
Vinay Menon V
President
Sd/-
Vidya.A
Member
Sd/-
Krishnankutty N.K.
Member
APPENDIX
Exhibits marked on the side of the complainant
Ext.A1 - Copy of Covid 19 test report dated 22/1/22
Ext.A2 – Copy of microbiology report dated 22/1/22
Ext.A3 - Copy of serology report dated 22/1/22
Ext.A4 - Copy of troponin test dated 22/1/22
Ext.A5 - Copy of ECG dated 22/1/22
Ext.A6 - Copy of discharge bill 28/1/22
Ext.A7 - Copy of discharge summary dated 4/2/22 of Mother’s Hospital
Ext.A8 - Copy of bill dated 28/1/22
Ext.A9 - Copy of complaint before DPC
Ext.A10 - Copy of receipt dated 24/2/22 issued from Dist. Police office, Palakkad
Ext.A11 - Copy of final bill dated 4/2/2022
Ext.A12 – Copy of certificate issued from Karuna Medical College, Hospital
Ext.A13 – Print out of Lakshmi hospital website.
Exhibits marked on the side of the opposite party:
Ext.B1 – Copy of treatment records.
Court Exhibit: Nil
Third party documents: Nil
Witness examined on the side of the complainant: Nil
Witness examined on the side of the opposite parties:
DW1 – Dr.Jayagopal P.B. (OP1)
DW2 – Dr.Rajaprabhakar (OP2)
Court Witness: Nil
NB : Parties are directed to take back all extra set of documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.
