IN THE CONSUMER DISPUTES REDRESSAL  COMMISSION, KOLLAM

Dated this the    15^th      Day of  September  2021

  Present: -  Sri. E.M.Muhammed Ibrahim, B.A, LL.M. President

        Smt.S.Sandhya Rani, Bsc, L.L.B,Member

   CC.26/15

1. Mr.Jesudasan Joseph                         :         Complainants

        S/o Joseph

      Residing at Denver Dale

      Thamarakulam

      Kollam-691001.

2. Agnes Sydna Jesudasan

         W/o Jesudasan Joseph

       Residing at Denver Dale

       Thamarakulam

       Kollam-691001.

     [By Adv.M I Alexander Panicker& Adv.Manu Jayaprakash]

V/s

1. Dr.Jayakumaran                            :         Opposite parties

Consultant Neuro Surgeon

Bishop Benziger Hospital

Beach Road, Kollam-691001

[By Adv.A.Nisar&Adv.Saju George]

2. The Director

Bishop Benziger Hospital

Beach Road, Kollam-691001.

[By Adv.George Mathew, Adv.S.Riyas&Adv.Johnson Jacob]

FINAL  ORDER

E.M.MUHAMMED IBRAHIM , B.A, LL.M,President

          1. This is a case based on a consumer complaint filed u/s 12 of the Consumer Protection Act 1986 alleging medical negligence, deficiency in service and unfair trade practice against Dr.Jayakumaran and the Director of Bishop Benziger Hospital, Kollam.

2. The averments in the complaint in short are as follows:-

The 1^st complainant is the husband of the 2^nd complainant who is a teacher by profession.  The 1^st complainant was working in a private firm.  Now the 1^st complainant is bedridden and hence 2^nd complainant has been impleaded in the complaint to prosecute the complaint.

          3. The 1^st opposite party is a Consultant Neuro Surgeon attached to Bishop Benziger Hospital, Kollam.  The 2^nd opposite party is the Director of the said hospital.  The 1^st complainant was referred to the 2^nd opposite party by KIMS hospital, Thiruvananthapuram and was admitted in the said hospital as IP NO.15/1370  at 8.45 pm on 05.05.2014.  On finding that the patient sympotomatically better and afebrile he was referred to Bishop Benziger Hospital for better nursing care since the patient had tracheostomy and had Ryles Tube for feeding and suction.  The 1^st complainant was admitted in the said hospital by believing that the said hospital would ensure nursing patient with competent trained nurses and treat him with competent doctors. Experience in the said hospital and the trauma suffered by complainants is well explained by the 2^nd complainant in her complaint lodged before the 2^nd opposite party on 24.06.2014.  All the allegations in the said complaint would constitute criminal medical negligence and breach of  trust and also would amount to deficiency in service and unfair trade practice.

          4. After so much trauma and criminal negligence from the side of 1^st opposite party and the nurses of the said hospital, the 1^st complainant was again taken to KIMS Hospital, Thiruvananthapuram on 11.05.2014 only because of noticing high degree of fever and the said hospital staffs including 1^st opposite party cold not manage it and no proper explanations given to the 2^nd  complainant.  When the 1^st complainant was admitted in KIMS Hospital and on investigations of ET Secretions were conducted and it was found that there was heavy growth of Klebsiella Pneumonia which is infection obtained when a person is in the hospital for some other treatment.  Feces are the most significant source of patient’s infection, followed by contact with contaminated instruments.  This can be only because of poor nursing of the patient in the hospital of opposite parties. 

          5. Again Tracheostamy Swab on investigation was found to have Klebsiella Pneumonia and Acinetobacter.  Acinetobacter is widely distributed genus of bacteria found in most hospital environments, which may establish itself in the respiratory flora and on the skin of patients after prolonged hospitalizations, often via contaminated medical instruments, eg. Catheters and IV lines, which introduce Acinetobacter to normally sterile sites.

          6. On 15.05.2014 it was noticed that there is Moderate Growth of Staphylococcus Aureus(MRSA in ET Secretion.  All such infections are caused only from the hospital of opposite parties, due to negligent nursing, poor  hygienic standards and use of non sterile instruments.  The patient when got discharged from the hospital of opposite parties, had Sepsis that means systemic infection by pathogenic microorganisms, especially bacteria, that have invaded the bloodstream, usually from a local source.  Sepsis is characterized by fever, increased number of which blood cells, increased heart rate, and other signs of widespread infection.  It is suspicious why the 1^st opposite party was so criminally negligent in not administering medicines to contain fever or not referred the patient to KIMS hospital for better treatment on noticing so much high degree of fever and started pneumonia congesting lungs and showed many symptoms of trouble in breathing and a stage of collapse by the patient.  The opposite parties had charged more than Rs.10,000/- for nursing the patient from 05.05.2014 to 11.05.2014 in the said hospital.  Trauma caused to the complainants, is caused only due to the negligence of 1^st opposite party and the nurses.  The mismanagement and professional  incompetence of the 1^st opposite party is exposed.  If 1^st opposite party was incapable of diagnosis and managing fever due to serious infections, he should have sought help of physicians of that hospital which he deliberately avoided for reasons best known to him at the risk of the life of the patient and hence he deserve no leniency from the complainants. 

          7. In KIMS hospital, the 1^st complainant was further treated from 11.05.2014 to 14.06.2014 as an inpatient and was discharged again with tracheostomy tube and CBD insitu and is advised to follow up. Now the patient is nursed at the residence itself  with a male home nurse.  Due to criminal negligence and mismanagement of treatment and nursing of the opposite parties, the patient’s health conditions was deteriorated and his life itself was in danger and could be saved only of timely treatment he received at KIMS hospital, Thiruvananthapuram.  Total bill amount for treatment of the 1^st complainant from 11.05.2014 to 14.06.2014 at KIMS Hospital came to 3,86,094.71/-.  Bystanders expenses, travelling expenses and other loss caused in the salary of the 2^nd complainant and transportation expenses etc. are above one lakh of rupees.  The 1^st complainant had to face lot of pain and suffering and money cannot compensate it.

          8. The 1^st opposite party who had treated the 1^st complainant is personally liable for the negligence and mismanagement and the 2^nd opposite party as the head of Bishop Benziger Hospital is vicariously liable to compensate for the negligence of its staffs including 1^st opposite party.  Both the opposite parties are liable to compensate the 1^st complainant jointly and severally for the above loss and injury.  For litigation purpose it is fixed to the tune of Rs.5,00,000/-.

          9. On 09.12.2014, the complainants had issued a notice and requested the opposite parties to pay Rs.5,00,000/- by way  of compensation for the damages caused to the 1^st complainant.  The opposite parties had issued a reply notice raising all sorts of scandalous allegations and aspersions against the 2^nd complainant.  Hence the  complaint.

          10. The 1^st and 2^nd opposite party filed separate version by denying all the allegations and averments regarding medical negligence, deficiency in service and unfair trade practice.  The contentions of both the opposite parties are more or less same which are as follows.  According to the both the opposite parties there is absolutely no latches, negligence or deficiency in service on the side of the opposite parties.  Therefore the complainants are not entitled to receive any relief claimed for.  Both the opposite parties would deny the allegation that the 1^st complainant was not referred to Bishop Benziger Hospital by the KIMS hospital, Thiruvananathapuram.  The 1^st complainant was admitted in KIMS hospital, Thiruvananthapuram for 26 days from 09.04.2014 till 05.05.2014.  He was admitted there with serious bleedings inside the brain.  The 1^st complainant was admitted in the 2^nd opposite party hospital only on 05.05.2014 and it is further contented that Mr.Sydney  a close relative of the 1^st complainant  informed the 1^st opposite party that the prolonged treatment of his relative in KIMS Hospital would be a financial liability and other inconvenience to them and hence enquired as to whether the 1^st complainant could be admitted in the 2^nd opposite party hospital as if they got discharged from KIMS hospital.  The  1^st opposite party replied that he shall try his maximum to save the patient.  Thereafter the 1^st complainant was discharged from KIMS hospital at the request of the bystanders and brought to the emergency room of the 2^nd opposite party hospital at about 8.45 pm on 05.05.2014.  The 2^nd opposite party had received a complaint dated 24.06.2014 from the 2^nd complainant and the said complaint was referred to the ethics committee for a detailed enquiry.  After detailed investigation, through the ethics committee had found that there was no negligence or latches on the part of the 1^st opposite party in treating the 1^st complainant.  When the 1^st complainant was brought to the 2^nd opposite party hospital he required trachoestomy tube for helping in his breathing, a feeding tube for his food and water intake and urinary catheter for passing urine.  He has also unable to speak or communicate.  His right side was totally paralyzed requiring help from others for even to move his limbs and perform other primary needs.  Fungal infections were present.  He was admitted in a room as requested by the bystanders and was shifted to Neuro Surgery IC unit within one hour as he developed serious breathing difficulty.  Suction was given and the saturation level of oxygen of blood was 94%.  His condition was stabilized by intensive treatment in the Neuro Surgery IC unit and was again shifted to the room after 24 hours.  The seriousness of disease possible complications and outcome were explained to the bystanders including the 2^nd complainant.  They were also informed that unlike in the Neuro Surgery ICU, where the nursing staff would take care of him in all aspects whereas while in the room bystanders were also expected and needed to help the nursing staff since the staff could not remain inside the room of the patient all the full 24 hours. 

          11. On 06.05.2014 at about 9 AM  opposite party came for ICU rounds and advised the 1^st complainant to continue the medication prescribed by KIMS hospital and start physiotherapy and cardiology consultation.  Thereafter ECHO was taken and CT brain was repeated.  At about 11 AM 1^st opposite party reviewed the case and discussed with the bystanders and advised to change portable tracheotomy tube to a better tube since that can be easily managed by the bystanders in case of blockage.  Bystanders were also shown and explained how to remove and insert the tube.  Thereafter the 1^st opposite party reviewed the case at 2 PM. Tracheostomy tube was changed to shiley’s tube and advised observation of the patient closely.  Tracheostomy suction was done every hour and as and when required.  Since the disease may take many months or years to recover they were advised to learn the nursing care from the staff so that they could look after him at home and could be shifted to home at the earliest.  If it was not possible for the bystanders to do so they were given options to hire home nurses.  Bystanders including the wife agreed to take care of the patient  and continue  the treatment prescribed by the doctor.  On 07.05.2014 the 1^st complainant was referred to the cardiac physician and his directions were also carried out.  He was also shown to Neuro Physician on 08.05.2014 and the Neuro Physician advised to continue with the same management.  On 09.05.2014 at about 1.15 AM bystanders complained that the patient was having noisy breathing and not able to sleep.  Immediately the emergency medicine doctor attended the patient.  Accordingly mobilization was given and discussed the matter with this opposite party.  At about 5 AM on the same day the patient had pulled out the ryles tube due to the negligence of the bystanders.  In the beginning itself the bystanders were informed that it was not easy to put the feeding tube in such patient and as such constant vigil is highly necessary.  When the matter was reminded, the 2^nd complainant refused to give consent for putting the feeding tube again.  She was informed about the other options of gastrostomy tube insertion and parenteral nutrition which would result in much more complication and cost.  Even then the 2^nd complainant refused to give consent for putting the feeding tube again.  Hence the 1^st complainant was given intravenous fluids as an alternative.  Tracheotomy care were also given regularly.  On 10.05.2014 morning 1^st opposite party came for rounds.  Even at that time the bystanders were not willing for putting ryles tube.  On the same day evening at about 7 PM the 1^st complainant had noisy breathing.  Thereupon duty doctor attended the patient and necessary treatment given.  At about 8 PM as the patient developed small bleeding from the trachestomy site the duty doctor at that time changed dressing and stopped the bleeding and advised to give careful suction of tube to prevent further bleeding.  At that time bystanders expressed willingness to put the feeding tube which thought the emergency medicine doctor tried he could not succeed.  On the same day at about midnight the 1^st complainant had slight temperature of 102⁰ F for which medications were given and thereby fever was brought under control immediately.  Thereafter he did not have fever till he was discharged from the hospital.  On 11.05.2014 morning itself feeding tube was put by the 1^st opposite party and he was referred to KIMS hospital, Thiruvananthapuram as per the request of the bystanders including the 2^nd complainant and it was against the medical advice of the 1^st opposite party.  The respiratory infection in unconscious patients with tracheostomy is not infrequent.  The germs which is said to have caused infection in the patient are Klebsiella Pneumonia has an incubation period of 1 to 10 days, acinetobacter up to 7 days and staphylococcus aureus up to 10 days.  Since the incubation period which is the time between the entry of organism in the body and presentation of symptoms of the disease can be more than 7 days for these germs.  The 1^st complainant obviously stayed in the 2^nd opposite party hospital technically only for 5 ½ days, and hence it can be seen that the source of infection could be very well from somewhere else and it can be possibly from the KIMS hospital also.  As per the discharge summary produced by the complainant it can be clearly seen that the 1^st complainant had sepsis and hypothyroidism even while the 1^st complainant was admitted in KIMS hospital, Thiruvananthapuram, prior to his arrival in the 2^nd  opposite party’s hospital.  That is clearly revealed from the discharge summary dated 05.05.2014 issued by the KIMS hospital, Thiruvananthapuram.  Hence the contention in the complaint that the 1^st complainant was affected with infection due to the poor nursing of the patient in the hospital of the 2^nd opposite party is absolutely false.  During the period when the 1^st complainant was admitted in the hospital no other patient in ICU or ward had developed any infection of the said/alleged germs in the 2^nd opposite party hospital.  The 2^nd opposite party is monitoring the records of keeping sterility of the hospital ICU by regular fumigation and frequent verifications of it by regular micro biological culture and sensitivity from ICU samples.  It is pertinent to note that National Accreditation Board has certified Bishop Benziger Hospital as a SAFE I certified hospital of India which was given to 2^nd opposite party hospital after rigorous and repeated verification by the national inspectors.  SAFE I certification is a program that enables the health care organization in upgrading their infection control practices thereby ensuring quality care for their patients.  It is increasingly being recognized by health care fraternity that a vibrant and functional infection control programme is the corner stone for ensuring safety and quality.  The 2^nd opposite party hospital is the 14^th hospital in India getting this prestigious certification. Hence the allegation that all such infections are caused only from the 2^nd opposite party hospital due to negligent nursing, poor hygienic standards and non sterile instruments etc. are all absolutely false, totally baseless and stated with malafide intention.  On 10.05.2014 at about midnight the 1^st complainant was noticed to have raised body temperature of 102 F.  Therefore medications were given promptly and the temperature was brought under control immediately.  Thereafter he had never had any fever till be was discharged.  He was seen by neuro physician, cardiac physician and emergency medicine doctors during his short stay in the hospital.  On 11.05.2014 morning itself the 1^st complainant was sent to KIMS hospital as per the request of the bystanders,  At the time when the 1^st complainant was shifted to KIMS hospital, his temperature was normal and his condition was stable.  Moreover the culture and sensitivity report yielded only normal oropharyngal flora.  All these facts reveal that many physicians were consulted necessary investigations were carried out, prompt treatments were given and timely reference was also done.  Basal ganglia hematoma is treated mainly by neuro surgeons all over the world.  The averments that the 1^st  opposite party was criminally negligent in not administering medicines to contain fever or not referring the patient to KIMS for better treatment, etc are all false and hence denied.  The 1^st opposite party had discharged his duties towards the 1^st complainant promptly and without any latches on his part.

          12. The 2^nd opposite party hospital is a tertiary care centre and neurosurgery department is being run successfully since 1995.  The 2^nd opposite party hospital is having all facilities and man power to treat  respiratory infections.  The hospital being a mission hospital the treatment cost is very much less when compared with other corporate hospitals.  The 2^nd complainant always very arrogant, argumentative and interfering unnecessarily with the accepted treatment of protocols rather than co-operating with the staff of the hospital.  Nursing staff in the hospital are well qualified.  The 2^nd complainant was never willing to take personal care of the 1^st complainant.  Ethics committee cooperated with the 2^nd opposite party had conducted a fact finding enquiry on the basis of the complaint received from the 2^nd complainant and found that there was no negligence on the part of the doctor or the hospital.  The said fact was informed the 2^nd complainant orally and she was also aware of the enquiry and therefore no formal reply was sent to the 2^nd complainant.  The 2^nd  complainant filed the present complaint on experimental basis so as to extract money illegally from the opposite parties.  Opposite parties are not liable or responsible for the amount of Rs.3,80,094.71/- collected by the KIMS hospital for their treatment charges.  The 1^st opposite party is not liable since there is no negligence or mismanagement of the 1^st complainant.  The opposite parties had given proper treatment and prompt service to the 1^st complainant during his stay in the 2^nd opposite party hospital on their own option or recommendation after fully being convinced about the name and fame of the opposite parties in the field of nursing and medical treatment.  In fact the health of the 1^st complainant had substantially improved while he was undergoing treatment in the 2^nd opposite party hospital.  The allegations raised in the letter dated 24.06.2014 are absolutely false.  The opposite parties had given the best possible treatment in the hospital.  All the allegations raised by the 2^nd complainant are absolutely false and it was raised with the oblique motive of undue monitorial considerations by tarnishing the reputation and image of the opposite parties.  There is no deficiency in service or unfair trade practice on the part of the opposite parties.  The 1^st complainant who was already physically weak and affected with sepsis was admitted in the 2^nd opposite party hospital on 05.05.2014 only.  Even at the initial stage when the 1^st complainant was admitted in the KIMS hospital, he was affected with sepsis and hence the allegation contrary to the above are absolutely false.  The 2^nd opposite party had charged only a very nominal amount for the treatment done by them.  The 1^st complainant was brought to the 2^nd opposite party hospital for continuing the treatment which was done in KIMS hospital.  Hence the allegation that the 1^st opposite party was incapable of diagnosis and managing fever etc. are all absolutely false.  The 1^st complainant was suffering from various diseases even prior to the admission in the 2^nd opposite party hospital.  There is no negligence or latches on the part of the opposite parties.  Hence they are neither jointly nor severally or vicariously liable to pay any amount claimed by the complainants.  Opposite parties further pray to dismiss the complaint with their costs and compensatory costs. 

13. In view of the above pleadings the points that arise for consideration are:-

1. Whether the condition of the 1^st complainant was worsened due to the negligence and poor unhygienic nursing care and treatment of the 1^st opposite party doctor at the 2^nd opposite party hospital?
2. Whether there is any  deficiency in service or any unfair trade practice on the part of the opposite parties No.1&2?
3. Relief and costs.

14. Evidence on the side of the complainant consists of the oral evidence of  PW1&2 and Ext.P1 to P9, Ext.X1&X2 documents.  Evidence on the side of the opposite parties consists of the oral evidence of DW1 to DW3 and Ext.D1 to D4 documents.

15. Both sides have filed separate notes of argument.

16. Heard both sides.

Point No.1&2

          17. For avoiding repetition of discussion of materials these 2 points are considered together.  The specific case of the complainants is that the 1^st complainant had sustained stroke on 09.04.2014 and got admitted at the KIMS hospital on that day and continued treatment till 05.05.2014 on which day the 1^st complainant was discharged by finding that the patient symptomatically better and afebrile and the 1^st complainant was referred to Bishop Benziger Hospital, Kollam for  nursing care.  According to the learned counsel for the complainant the pleadings and evidence available on record would indicate that the patient was stable at the time of admitting him in the 2^nd opposite party hospital on 05.05.2014 and subsequent development was solely due to deficiency in service of 1^st opposite party who treated the patient and lack of nursing care and non use of hygienic equipments.  We shall examine the above allegations in the light of oral and documentary evidence available on record.

          18. Ext.P1 is the discharge summary dated 05.05.2014 issued by KIMS hospital, Thiruvananthapuram wherein it is stated under the head discharge diagnosis that the patient has been suffering from systemic hypertension, Type 2 diabetes mellitus, hypothyroidism and sepsis even when he was first admitted in KIMS hospital which was much before the admission of  the 1^st complainant in the 2^nd opposite party hospital.  In the circumstances the allegation that the complainant was affected with infection due to prolonged hospitalization and poor nursing care given at that hospital cannot be accepted as such.  As per Ext.P1 discharge summary it is clear that the 1^st  complainant had infection caused by Escheria coli, streptococcus and pseudomonas while treating at the KIMS hospital.  Patient was ventilated and later trachoestomy was done, pulmonologist consulted in view of thick tracheal secretion and nephrology consulted for worsening the renal function.  It was also recommended a review after 2 weeks on 19.05.14 in nephrology  OPD with TCRBS results.  In the circumstances it is clear that the patient’s multiple organs were affected and in the time of discharging trachostomy tube was not removed. 

19.     It is also clear from Ext.P1 discharge summary that the patient was not referred to 2^nd opposite party hospital by KIMS hospital as claimed in para 3 of the complaint.  PW1 herself would admit that as suggested by the 2^nd complainant and her relatives the 1^st complainant brought to 2^nd opposite party hospital.  The above materials would indicate that the 1^st complainant was not referred to the 2^nd opposite party by the KIMS hospital as claimed in the complaint.  It is also brought out in evidence that the patient was brought to the emergency room of the 2^nd opposite party hospital during night hours if the patient was stable there is no need to bring the patient to the emergency room during night hours.  The above conduct itself would indicate that he was not stable when got admitted at the hospital on 05.05.14.  In the circumstances the allegation that the patient was affected with infection due to the poor nursing of the patient at the 2^nd opposite party hospital is not believable and convincing. 

20.     It is also clear from the available materials that during the period when the 1^st complainant was admitted in the hospital no other patient who was in ICU or ward had developed any illness due to the alleged germs in the Benziger hospital.  It is also brought out in evidence that the Benziger hospital monitoring the records of keeping sterility of the said hospital ICU by regular fumigation and frequent verification by regular micro biological culture and sensitivity from ICU samples and that is why National Accreditation Board has certified Bishop Benziger Hospital as a SAFE I certified hospital in India.  In the light of the materials available on record it is clear that the National Accreditation  Board has certified the 2^nd opposite party as SAFE I certified hospital after rigorous and repeated verification.  It is also brought out in evidence that 2^nd opposite party hospital is the 14^th hospital in the entire nation getting the prestigious SAFE I certification.  In the circumstance the allegation that infection  which caused only from the 2^nd opposite party hospital due to negligent nursing, poor hygienic standards etc appears to be baseless.

21. It is also brought out in evidence that the 1^st opposite party doctor who treated the complainant is a competent certified doctor.   He has been examined as DW1.  It is brought out in evidence through DW1 that he has obtained super specialty qualification from Government Medical College, Thiruvananthapuram and having more than 25 years experience  in prestigious hospital including Indian Defence service.  He has also served as consultant neuro surgeon in KIMS hospital, Thiruvananthapuram.  He obtained training in Cleveland clinics in USA during the year 2008 and Froedtert and University hospital in Wisconsin in USA during the year 2010 for intervention of neurovascular diseases and training in Basal ganglia haematoma.  In the circumstances we have no doubt about the professional competency of the 1^st opposite party doctor in treating the complainant.

22.  It is also brought out in evidence that on receipt of Ext.P2 complaint the 2^nd opposite party caused to conduct a fact finding enquiry through the ethics committee and it was found that  neither the doctor nor the hospital was negligent in treating the complainant. Learned counsel for the complainant would argue that Ext.D4 report of the Ethics Committee is not reliable as the complainant was not questioned during enquiry.  We find no merit in the above argument.  In a discrete enquiry or fact finding enquiry the complainant need not always be questioned as his grievance(Ext.P2 complaint) is available before the Ethics Committee.  It is only a preliminary departmental enquiry.  Of course in a detailed enquiry the complainant/grievance petitioner’s statement has to be recorded. 

23.   Ext.D1 case sheet of the 1^st complainant would clearly show that correct mode of treatment was given to the 1^st complainant.  In this connection it is to be pointed out the evidence of PW2 who is none other than the Neurologist working at KIMS hospital, Thiruvananthapuram that the 1^st complainant was discharged on 05.05.2014.  According to PW2 at the time of discharge he was improved and stable but he requires nursing care and supporting care.  He was bed ridden also.  He required prolonged nursing care and at the time of discharge he was having tracheostomy insitu.  PW2 has further answered to a suggestive question put by the learned counsel for the complainant that Klebsiella Pneumonia affected to the complainant was not due to unhygienic nursing care.  PW2 has further added that even if it is properly nursed the said disease may occur.  It is pertinent to point out the reply to suggestive question put by the learned counsel for the complainant that  “I suggest that it is only case of culpable negligence in the treatment at the Bishop Benziger Hospital the condition of the patient become worse” Answer is ‘No’ PW2 further added  previous doctor had done maximum effort to save the life of the patient.  It is also brought out in evidence through PW2 that those who had undergone  tracheostomy are prone to develop Klensiella pneumonia and sepsis and all other bacterial diseases.  PW2 has given a negative answer to the suggestion made by the learned counsel for the complainant that a patient who is having illness or disease is admitted in a hospital to get the disease cured, if the illness of the patient admitted aggravated is not mismanagement of the patient by the doctor who treated?(Q) No(A).  Towards the  end of re-examination PW2 has opined that as per Ext.D1series treatment record of the 1^st complainant, opposite party No.1 has treated all initial treatment.  In view of the above  evidence tendered by PW2 we are unable to agree with the case of the complainant that it was due to mismanagement of the opposite parties illness of the 1^st complainant was aggravated. 

          24. DW2 Dr.Anilkumar is an expert who was the HOD of  Neuro surgery in Thiruvananthapuram Medical College.  The oral evidence of DW2 Dr.Anilkumar would show that ICH can cause significant deficit and even death.  After perusing Ext.P4 documents the witness deposed  that there was evidence of infection which is recorded in Ext.P4 itself.  DW2 has further deposed that  usually patients admitted in ICU prolong period when catheter and trachostomy  are prone for infection.  It is further to be pointed out that DW2 after perusing Ext.D1 series file opined that there is evidence of cross consultation with the Neuro Physician.  He has further deposed that the very same medicine prescribed by the doctor who had discharged the patient at the KIMS hospital was continued in  OP2 hospital.  It is pertinent to point out the answer to a question whether the condition of 1^st complainant worsened because of the negligent treatment of OP1&2.  The answer to the question is not  likely as an open wound like trechostomy always attract infection anywhere. 

25. Ext.P6 document also would indicate that there was infection in blood, urine and in secretion during the treatment at KIMS.  In the 2^nd discharge summary the culture of ET secretion shows heavy growth of  Klebsiella Pneumonia. The oral evidence of DW2 would indicate that patient has undergone treatment for sepsis 1 month in KIMS hospital and was discharged so  recurrence of infection within 1 week of stopping antibiotic is not a surprise. According to the learned counsel for the complainant all infections are caused only from the 2^nd opposite party hospital due to negligent nursing, poor hygiene standards and use of non sterile instruments.  But in the light of the evidence of DW2 quoted above we find no merit in the above allegations. 

26.  Both the expert doctors (who are PW2 and DW2) examined in this case has specifically opined that those infection are prone to such patients.  The  learned counsel  for the 1^st opposite party has pointed out that after discharging from KIMS hospital the patient was brought to the 2^nd opposite party hospital and he was admitted in ICU because of heavy wheezing and that itself would indicate that the patient was not discharged in a stable condition.  But in order to avoid heavy expenses at the KIMS hospital relative of the 1^st complainant  requested for discharge and brought the patient to the 2^nd opposite party hospital.  The learned counsel for the 1^st opposite party has further argued that the 2^nd  complainant has got allegation that the 1^st complainant was admitted in a dirty room, but she was no such case during treatment period and subsequently developed such allegations as afterthought to maintain a false case.  In view of the facts and circumstances of the case we find force in the above contention.

          27. The learned counsel for the complainant has argued that PW2 and DW2 are 2 expert witnessed and the evidence given by the above 2 witnessed is sufficient enough to conclude there was negligence and deficiency in service of the opposite parties in treatment and nursing of the 1^st complainant.  On evaluating the entire evidence of these 2 witnessed we disagree with the above argument of the learned counsel for the complainant. According to the learned counsel for the complainant the patient was brought in a stable condition from KIMS hospital.  But it is brought out in evidence that immediately on arrival of the 1^st complainant/patient he was shifted to Neuro surgery ICU which would indicate that the patient was not brought in a stable condition as claimed by the complainants. It is also brought out in evidence that the patient requires suction which is an indication that he had excessive secretion due to chest infection.  When frequent suction is done which can result in mucosal injury and bleedings and it was not due to any negligence of the treated doctor or due to the negligent handling of the patient by the 2^nd opposite party hospital.  It is also clear from the available materials that the  Ryles tubes are changed as and when it is blocked and not when the tube is discolored due to the passing of various medicine through it. In view of the materials pointed out above it is clear that 2 expert witnesses examined in this case as PW2 and DW2 has unanimously expressed satisfaction in the mode of medical treatment and nursing care provided by the 1^st and 2^nd opposite parties.  In the circumstances it cannot be inferred that there is deficiency in service or any unfair trade practice on the part of the opposite party No.1&2 or the nursing staffs of 1^st opposite party hospital.  The points answered accordingly.

          Point No.3

          In view of the finding of point no.1&2 we find no merit in the complaint and the same is only to be dismissed.  In the result the complaint stands dismissed.  Parties are directed to suffer their respective costs.

     Dictated to the Confidential Assistant  Smt. Deepa.S transcribed and typed by her corrected by me and pronounced in the  Open Commission this the  15^th   day of  September   2021.

E.M.Muhammed Ibrahim:Sd/-

S.Sandhya Rani:Sd/-

Forwarded/by Order

                                                                                     Senior Superintendent

INDEX

Witnesses Examined for the Complainant:-

PW1    :           Agnes sydna Jesudasan

PW2    :           Dr.Syamlal

Documents marked for the  complainant

Ext.P1 :  Copy of discharge summary issued from KIMS hospital dated   05.05.14

Ext.P2  :   Bill of  Bishop Benziger Hospital dated 11.05.14

Ext.P3 :   Discharge summary issued by Bishop Benziger Hospital dated 11.05.14

Ext.P4 :   Bill of Bishop Benziger Hospital dated 07.05.14

Ext.P5:               Discharge summary issued from KIMS dated 14.06.14

Ext.P6 :  Copy of bill issued from KIMS dated 14.06.14

Ext.P7 : Copy of complaint issued to the 2^nd opposite party by the 2^nd complainant dated 24.06.14.

Ext.P8 :Lawyer notice dated 09.12.14.

Ext.P9 series   : Acknowledgment card

Witnesses Examined for the opposite party:-

DW1   :   Dr.Jayakumaran

DW2   :  Anilkumar.P

DW3:  Remyl Jesudas

Documents marked for opposite party:-

Ext.D1 series: Case sheet of the patient (Bishop Benziger Hospital)

Ext.D2:  Power of attorney

Ext.D3: NABH SAFE-I certificate

Ext.D4: Copy of preliminary enquiry report.

Ext.X1 series: Discharge summary  KIMS Hospital

Ext.X2 series: Discharge summary KIMS Hospital

E.M.Muhammed Ibrahim:Sd/-

S.Sandhya Rani:Sd/-

                                                                                    Forwarded/by Order

                                                                                    Senior Superintendent