1.       Heard Mr. Gaurav Gupta, Advocate, for the complainant, Mr. Sanjeev Puri, Sr. Advocate, assisted by Mr. Aditya Awasthi, Advocate, for opposite parties-1, 3, 4 & 6, Mr. Manoj Kumar Sahu, Advocate, for opposite party-2 and Mr. Manu Prabhakar, Advocate, for opposite party-5.

2.       Premdatt Chopra has filed above complaint for directing the opposite parties jointly and severally to pay (i) Rs.28117444/- with interest @18% per annum, as compensation; (ii) Rs.125000/- as litigation costs; and (iii) any other relief which is deemed fit and proper in the facts of the case.

3.       The complainant stated as follows:-

(a)     Mrs. Ish Chopra (the patient), aged 74 years, was the wife of the complainant. The patient suffered from cough and cold in April, 2014 and approached to Fortis FLT. LT. Rajan Dhall Hospital (OP-1). The patient was directed to consult with Dr. Hemant Tiwari (OP-5), who was a Pulmonary and Thoracic Surgery Consultant. The patient was admitted in the hospital on 02.04.2014 and discharged on 04.04.2014. Thereafter, the patient suffered with fracture in her left leg ankle on 08.04.2014 and was taken to Fortis FLT. LT. Rajan Dhall Hospital (OP-1), where she was attended by Dr. Gurvinder Bedi, Orthopaedic Surgeon (OP-6) but was admitted in supervision of Pulmonary Surgeon. OP-6 also advised to undergo right knee replacement. OP-6 again examined the patient on 09.04.2014 and informed that due to swelling in ankle area, knee replacement surgery had to be postponed for 5 days. The Anaesthetist evaluated the patient as a ‘high risk case’. However, the doctors of OP-1 conducted ‘right knee replacement surgery’ and ‘surgery of the ankle’ within two days. After surgery, the doctors obtained ‘blood test report’ dated 15.04.2014, which showed low calcium. But the doctor overlooked this report and did not take any remedial measure to improve the calcium. As a result the patient developed abnormal movement after 17 hours. Then the doctor administered a dose of calcium intravenously. The hospital discharged the patient on 22.04.2014 and charged total Rs.709920/-.

(b)     In spite of the assurances of the hospital, the patient could not walk properly due to severe pain and developed infections and complications after discharge. On the advice of Dr. Hemant Tiwari (OP-5), the patient was again admitted to Fortis Hospital (OP-1) on 02.06.2014 and discharged on 14.07.2014. During this period the complainant found that Dr. Hemant Tiwari (OP-5) was indulged in malpractices and actions. The complainant made a complaint to the hospital authorities. Hospital authorities found Dr. Hemant Tiwari (OP-5) as guilty, then he submitted his resignation. Despite 42 days of stay in the hospital, the patient went on batting with infections and complications, which was due to direct result of unnecessary right knee replacement surgery. The complainant filed a complaint with Mr. Shivender Singh, who worried due to the complaint and asked Mr. Udyan Dravin (OP-1) to get rid of from the patient and discharge her. Although the condition of the patient was very weak and she was not in position to walk but the hospital started to say that the patient would get more infection in the hospital and discharged her on 14.07.2014.  

(c)     Mr. Udyan Dravin (OP-1) admitted the faults in treatment of the patient by the team of its doctor and assured to give a discount in the bill. He also promised to provide all the required medical equipment at the home to sustain the patient, the doctor would attend the patient at home and two nurses of the hospital would be deputed round the clock free of charges. But after discharge neither required medical equipment was provided nor the nurses attended the patient at home. The doctor visited the home only to throw a cursory glance on the patient. The complainant had to purchase the medical equipment and hire the services of the nurse incurring Rs.800000/-. The complainant sent bills of medical equipment and the nurses, for reimbursement, then OP-1 did not settle it. Mr. Udyan Dravin told that finance department was not inclined to clear the bills for reimbursement and advised to adjust this bill, if the patient is admitted in hospital in future. Total bill of the hospital was of Rs.2668275/- and OP-2 gave discount of Rs.1118275/-.

(d)     The patient was again admitted in the hospital of OP-1 on 10.08.2014 and remained there till 02.09.2014. The hospital charged Rs.1054176/-. When the complainant asked to adjust Rs.800000/- as promised earlier, OP-2 and 3 refused and told that the hospital was not providing free treatment. The patient was again admitted in the hospital OP-1 on 01.12.2014, on the complaint of reduced right limb movement. CT scan revealed that there was an old infarction in the brain. This brain infarct was also noticed during August, 2014, wherein the doctors of OP-1 hospital prescribed that no blood thinner should be given to the patient as the bleeding in brain might be occur. The patient was discharged on 03.12.2014 and OP-1 charged Rs.66500/-.

(e)     The patient became violently ill due to stroke in the night of 25.01.2015. The complainant rushed to OP-1 hospital along with the patient. The doctors examined her and found that blood supply in her right leg had been reduced. The report revealed that there was blockage of blood vessels in the leg. The hospital referred the patient to Dr. Sanjay Gupta for treatment of blocked blood vessel, who advised the patient, not to opt for surgery of the blocked vessels of the right leg. Fortis Hospital (OP-1) represented Dr. Sanjay Gupta as a ‘vascular surgeon’, although, he was a ‘cardiac surgeon’. Not being a ‘vascular surgeon’, Dr. Sanjay Gupta was not qualified to give such opinion. Another cardiologist, Dr. Upendra Kaul prescribed blood thinner known as “Pradaxa”, ignoring the existing brain infarction. Dr. Renu Achtani (OP-9) also continued “Pradaxa”, ingoing the existing brain infarction. Due to use of “Pradaxa” bleeding from wounds and skin of the patient was started and her condition was deteriorated. The complainant searched about “Pradaxa” and found that it had strong side effects and is one among dangerous blood thinners and responsible for death of more than 500 patients in USA. When the complainant brought this shocking fact in the notice of the authorities of the hospital, then “Pradaxa” was stopped. Use of blood thinner led to bleeding in the brain, causing loss of speech of the patient. Eventually the patient succumbed to coma due to continued bleeding.       

(f)      The nurse Ms. Lamguali attempted to give double dose of insulin, which would have caused hypoglycaemia, which may cause death, but the complainant, owing to his alertness, stopped her in time. Ms. Lamguali tendered her apology in this respect. As the patient could not swallow on her own, she was put on by Ryle’s tube, feeding though it runs a potential risk of causing lung infection. To avoid such infection, the doctor planned to conduct  ‘Per Cutaneous Endoscopic Gastronomy’ (PEG). But it was found that due to administering “Pradaxa” previously, PEG could not be done. The patient was fed through Ryle’s tube for a long period of one and half month contrary to established medical principles.  

(g)     The team of the doctors of Fortis Hospital realized that they had played with the life of the patient and rendered her on the brink of death, so they created pressure on the complainant to get the patient discharged from hospital and take her to the home. The complainant told that the condition of patient was not stable and requested not to discharge her but ignoring the request of the complainant, the patient was discharged on 03.03.2015. In order to pacify the complainant, OP-1 hospital gave a discount of Rs.156000/- out of its total bill of Rs.1244829/- for her treatment for last 36 days.

(h)     The condition of the patient became worse on 14.03.2015. Around 9:30 hours on 14.03.2015, the complainant rushed to Dr Khanduja, who lives in his locality, who advised to call an ambulance immediately and admit the patient in hospital. The complainant called the ambulance and took the patient to Fortis Hospital (OP-1). The staff of the hospital out-rightly refused to take-out the patient from the ambulance. At that time the patient was writhing in pain and needed urgent admission in emergency medical care. The hospital staff informed that their superior have told them not to de-board the patient from the ambulance and not to admit her at any cost. Stunned by the behaviour of the staff, the complainant called Dr. Shalini Bhalla (OP-4) but she also bluntly refused to admit the patient. The complainant requested Dr. Shalini Bhalla (OP-4) that the patient had been in treatment of the hospital from last one year and admitted in the hospital during 26.01.2015 to 03.03.2015; all her medical record and history was lying in the hospital, however, Dr. Shalini Bhalla told that no bed was available in the hospital. The complainant was totally distraught with the behaviour of the administration. The complainant also called Mr. Shivender Singh (OP-3) but before saying anything by the complainant, he also told that no bed either in emergency ward or other ward was available in the hospital and cut the phone call. Dr. Anil Gandhi was accompanying the complainant, he also talked with Dr. Shalini Bhalla and tried to convince her to admit the patient in emergency condition but she rudely behaved with him also and cut his phone call.

(i)      Looking to the deteriorating condition of the patient, the complainant was left with no option but to take the patient to another hospital. The complainant took the ambulance to Max Hospital and admitted the patient there. The patient remained in ambulance for about 4 hours in severe pain due to apathy of OP-1 hospital. The doctors of Max Hospital were unaware of medical history, illness, reaction to the medicines, past treatment of the patient. They found themselves helpless to form proper opinion for line of treatment. After two days struggle with life, she ultimately died on 16.03.2015. (j)       Fortis Hospital exposed the patient to the risk of deep vein thrombosis and lung related issues like pneumonia. The knee replacement surgery initiated the cycle of infections, mistreatments, deliberate malpractices. Due to gross negligence of the doctors at Fortis Hospital, the condition of the patient was deteriorated day by day. In spite of expending about Rs.80/- lakhs in her treatment, she could not survive. She suffered lot of pain and trauma due to gross medical negligence committed by the opposite parties. After death of the patient, the complainant suffered with extreme mental and emotional distress. On these allegations, the complaint was filed on 07.09.2015. 

4.       Dr. Udyan Dravin (OP-2) filed written reply stating that he had no medical background. Entire allegations in the complaint are against the hospital OP-1 or against the treating doctors. Only some loose and vague allegations have been made against OP-2. Even in Affidavit of Evidence of the complainant, no allegation has been made nor any documentary evidence has been filed showing involvement of OP-2 in treatment of the patient. OP-2 was not involved in treatment of the patient at any time. OP-2 denied that Mr. Shivender Singh ever asked him to get rid of from the patient nor he took any action in this respect. He denied that the hospital OP-1 ever admitted its fault in treatment of the patient. If the complainant was not satisfied with the treatment of the patient from the hospital, he would have not admitted the patient again and again in the hospital OP-1. Discount in the bill was given on compassionate ground. Discharge slips show that the patient was discharge in stable condition at all the times. The complainant had a habit of name-dropping and trying to intimidate the hospital and the staff on false allegations. Exaggerated compensation has been claimed without any basis. Preliminary issues relating to maintainability of the complaint have been raised.

5.       Dr. Hemant Tiwari (OP-5) filed its written version stating that Mrs. Ish Chopra (the patient) had been under his treatment for about 5 years and had become a motherly figure for him. He regularly treated the patient and the complainant to the best of his ability, exercising due care and caution without expectation of monetary gain. He used to attend the patient at her home frequently as and when asked. Otherwise also, OP-5 used to visit, the house of the complainant for their regular check-up. The complainant and the patient were very much satisfied with his treatment, expertise and conduct, due to which they always availed his services. The patient was in fragile state of health prior to 2009. Her medical histories were (i) Open Cholecystectomy in 1984. (ii) Major accident resulting in fracture of mandible and severe dental trauma, following with plating of mandible in 2009. (iii) Pulmonary tuberculosis in 2009, required admission in ICU for 2 weeks. (iv) Severe reaction to anti tubercular medication, causing liver injury, required admission in ICU for 2 weeks. (v) Hypertension for over seven years. (vi) Diabetes Mellitus Type-2, for over seven years. (vi) Right knee osteoarthritis causing difficulty in ambulation since prior to 2009. (vii) Chronic kidney disease. (viii) Osteoporosis and (ix) Chronic obstructive airway disease. Due to right knee osteoarthritis, the patient was planning for right knee replacement from six months prior to her admission in hospital in April, 2014, as her limited mobility exacerbating her co-morbid condition and the excruciating pain. The patient travelled USA in 2014. On 02.04.2014, the patient was admitted to the hospital OP-1 for possible chest infection. After investigation, she was diagnosed to have exacerbation of her chronic lung and kidney disease. She was treated for the same and discharged on 04.04.2014. On 08.04.2014, she came to the hospital with complaint of dizziness for 2 days and fall wherein she twisted her left ankle, where swelling and pain developed. She was admitted under pulmonology as she needed to be investigated and managed for dizziness, which can have diverse aetiologies like low B.P., low blood sugar, infection and abnormal heart rhythms especially with underlying chronic medical conditions in an elderly people. As she was given treatment for chronic lung, heart and kidney diseases, there was possibility of recurrence of same problem. The complainant himself insisted for admission of the patient under Dr. Hemant Tiwari, as he was familiar with the medical history of the patient. The patient came from a long distance air travel, which can predispose the elderly to Deep Vein Thrombosis (DVT) (clots in the deep veins) which can also cause pain and swelling of the legs. Hence a differential diagnosis of DVT was made. Pending investigations treatment was also started for the same. Medication for DVT was stopped as soon as the results of other investigations ruled out DVT. The patient was also attended by orthopaedic team promptly. X-ray revealed fracture of left lower leg then orthopaedic team decided for surgical management. As right knee reeling under severe osteoarthritis, a non-surgical line of treatment would have left the patient immobile and severely vulnerable to life threatening exacerbation of her existing morbidities. Once the decision to treat the ankle fracture by surgery was taken, in their professional judgment, orthopaedic team advised for conducting both the procedures simultaneously as the patient and her husband were considering for right knee replacement. In view of multiple comorbidities, orthopaedic team and Anaesthetist decided to perform surgery under regional anaesthesia, which significantly minimises the risk with general anaesthesia like DVT, pneumonia, low B.P. The complainant and his family were counselled for that treatment and they gave ‘informed consent’ for that. During this period a usual combination of only 2 antibiotics were given at a time in succession. A combination of Tazact and Claribid was given from 08.4.2014 to 15.04.2014 to prevent infection. The patient developed fever in post-operative period. Urine test revealed urine infection, for which, a combination of Monocef and Metrogyl was given from 16.04.2014 to 21.04.2014. At no point of time four antibiotics were given simultaneously. After surgery, the patient recovered well and began to walk with walker support and then she was discharged on 22.04.2014.  In month of June, 2014, the complainant sent a complaint against OP-5 to Fortis Hospital. Feeling indigent, OP-5 took difficult decision to resign from the hospital on account of mental agony and resigned. OP-5 neither committed malpractices nor negligence in treatment of the patient. The complaint is liable to be dismissed.

6.       Dr. Shalini Bhalla and Dr. Gurvidner Bedi (OP-4 and 6) filed their joint written reply giving details of admission, discharge and speciality of treatment provided to Mrs. Ish Chopra (the patient) in the hospital as follows:-

(a)     As evident from the facts given above the patient had long medical history. At the time first admission in hospital on 26.10.2009, the patient was known case of diabetes on oral hypoglycaemic agent (OHA) for 6 years and on oral anti-tubercular treatment since one week. The patient was admitted with complaint of dry cough and progressive breathlessness for one week with low appetite and severe weakness. She was admitted in ICU and managed symptomatically. Her blood investigation revealed low hyponatraemia (Na-127) and Hb (11.1). The doctors in order to rule out the chances of PE or CT advised pulmonary angiography, which revealed minimal pulmonary embolism in segmental artery of posterior basal segment of right lower lobe of lung. Numerous well defined, modular lesions wide spread throughout B/L parenchyma, suggestive of Miliary (widespread) tuberculosis. Few discrete mediastinal lymph nodes also seen with hiatus hernia. Nodular thickening of B/L adrenal glands and small ill-defined hypodense area seen in left adrenal gland with calcification of coronary arteries. Various Doppler was normal. Faecal Occult Blood (FOB) was performed and Broncho-Alveolar Lavage (BAL) sent for investigations which was negative for Acid-fast Bacilli (AFB). Trans-bronchial biopsy showed gramulomatous inflammation. Bone marrow biopsy was also done which showed ill-defined granuloma. Her blood cultures, urine culture and bone marrow culture were negative. She was started on ATT. She improved with IV antibiotics, oxygen supplementation, IV steroids and other supportive medications. Histoplasmal antibodies were not detected. AFB culture was awaited. She developed ATT induced hepatitis for which ATT was modified. Urine culture grew Psuedomonas Aeuroginosa with insignificant colony count. She became afebrile and was discharged on 10.11.2009.

Diagnosis at Discharge: Disseminated Tuberculosis. Addison’s disease (Addison’s disease is a disorder that occurs when your body produces insufficient amounts of certain hormones from adrenal glands. In Addison’s disease adrenal glands produce too little cortisol and often insufficient levels of Aldosterone as well. Addison’s disease occurs in all age groups and affect both sexes and it can be life threatening.), Type-II Diabetes Mellitus. Anti Tubercular Treatment induced Hepatitis.

(b)  Second Admission on 04.12.2009. Indication for admission: low grade fever, nausea, vomiting, breathlessness and palpitations.

The patient was admitted and evaluated for fever. Blood test revealed elevated CRP (103.2), low TLC (1700), platelet count (9500), sodium (134), potassium (3.10), chloride (97). The lower limb venous colour Doppler was normal. Urine analysis showed glucosuria. Liver function and renal functions were normal. The blood & urine cultures & MP were negative. The procalcitone was high (0.5). The patient was given IV antibiotics, GM-CSF and supportive treatment. A PET-CT was negative of any FDC and metabolically active disease. A 7 mm pleural based nodule in medial segment of RML s/o begin etiology. The patient was discharged in stable condition.

Diagnosis at Discharge was Disseminated Tuberculosis. Addison’s Disease. Type II Diabetes Mellitus. ATT induced Hepatitis.

(c)  Third Admission on 02.04.2014. Indication for admission: Breathlessness, Pedal oedema (i.e. oedema in feet), cough with expectoration.

Investigations showed Hb 9.6, TLC 9400, creatinine 1.8, BbA1C is 6.6%. The patient also had AF at the time of admission and nephrology opinion taken for increased creatinine (2.0). 2 D echo showed EF of 60% with normal LV function. Stress thallium was negative. USG abdomen showed renal calculi, increased parenchymal echogenicity of bilateral kidneys.

Course through Hospital Stay: She was managed with IV diuretics, bronchodilator nebulisations, IV antibiotics, oxygen and other supportive medications. Creatinine started coming down, iron studies were low. She was discharged in stable condition on 04.04.2014.

Diagnosis at Discharge: Left Ventricular failure. HTN with Type II DM. Chronic kidney disease. Osteoporosis.

(d)     Fourth Admission on 08.04.2014. Indication on admission: Dizziness, Fall 2 times while walking, Pain and swelling of lower leg.

Investigations showed Hb 9.9, TLC 12700, platelets 179000. KFT showed serum creatinine 1.8, BUN 25, Mg 1.9, Ca+ 8.4, Phosphorus 2.5, Vit D 3 29.9, Na 141, K+ 4.6, PT 14.3, INR 1.12, CKP 41, CPKMB 25. The patient also had AF at the time of admission and cardiology opinion was taken and nephrology opinion was taken. Diabetology consultation was taken

Course through Hospital Stay:- Patient was operated for the tri-moleolar i.e. ankle fracture and right knee osteoarthritis for Total Knee Replacement. Left leg open reduction internal fixation done with right side. Patient was treated conservatively with IV antibiotics Ceftriaxome, metrogyl, clarithromycin, tazobactum, clavulanic acid. Left lower limb venous colour Doppler showed mild tissue swelling of left ankle region, no evidence of DVT. Chest and limb physiotherapy was done. Patient responded well to the treatment and was discharged in stable condition on 22.04.2014.

Diagnosis at Discharge: Trimalleolar fracture (left), osteoarthritis right knee, Fracture ankle, Diabetes Mellitus, Chronic Kidney disease, Hypertension.

(e)    Fifth Admission on 02.06.2014: Indication for admission: Fever on and off, cough, shortness of breath.

Investigation showed Hb 8.7, TLC 12.1, ESR 120, LFT normal, cardiac markers normal, creatinine 2.3, Blood Urea Nitrogen 34, Widal, MP smear & malarial antigen were negative. Coagulation profile & urinalysis were within normal limit. Pro Brain Natriuretic Peptide (BNP) 405, Procal 0.14. Bronchoscopy with BAL & TBB was done from right upper lobe. Thick secretions were aspirated from B/L lower lobes. BAL grew Aspergillus flavus. Trans-Bronchial Biopsy showed mild chronic inflammation. Cardiology & Nephrology opinion were sought. Creatinine & BNU showed a rising trend. S.TSH whole body T 99 scan, SPEP were normal.  

Course through Hospital Stay:- She was started on imipenem, teicoplanin, clarithromycin, fluconazole. mycafungin & voriconazole. Lasix infusion was started in view of fluid over load. CXR worsened & SOB (shortness of breath) increase. Repeat Pro BNP was 997, D-Dimer 2830. She showed no improvement. Then she was transferred under Dr. Vivek Nangia, on patient request. Treatment was modified to caspofungin polymyxin B, sulbactum & colistin nebulization. Voriconazole was continued. Her chest auscultation revealed bilateral crepitation. DVT Prophylaxis was started on 09.06.2014. All routine investigations were repeated. S Procal has risen to 0.58, Hb 10.3, TLC 13.1, S. Creatinine 2.2, BUN 75, Uric Acid 6.8. USG abdomen showed hepatomegaly (abnormal enlargement of liver) with simple cyst in the liver. Urine culture was negative. HRCT thorax done on 10.06.2014 showed nodular opacities in B/L lung parenchyma with tree in bud appearance. Feature s/o infective etiology with bronchoalveolar spread of disease.  Nephrology opinion was taken regularly & she was kept in even balance as per nephrologists advice. Blood Sugar was managed by endocrinologist Dr. Alka Jha. Brochoscopy was repeated to assess response to therapy on 11.06.2014. BAL showed branched septet hyphae in smear but much less in quantity than before. Gram’s stain showed gram positive cocci Tab. Linezolid was added to the treatment. Central venous catheter site was changed. Ptocl repeated on 16.06.2014 was 0.93, S. Galactomannan levels were negative (0.42). Her Hb level showed a falling trend, fragmin was stopped & one unit PRBC given. Stool for occult blood was negative. She was advised DVT pump application for prophylaxis of DVT. Her S. ACE level was 30.

HRCT Thorax repeated on 17.06.2014 showed improvement with decrease in cavitating nodules. NCCT PNS was s/o left maxillary sinusitis (?fungal). She improved clinically, antibiotics were de-escalated. Polymyxin B & Sulbactum were stopped. She started developing fever. Central Venous Pressure (CVP) tip c/s urine & blood c/s were done. HRCT chest done on 23.06.2014 was s/o infective etiology likely fungal with mild B/L pleural effusion. However, no progression of infection was noted. Fever subsided. Caspofungin received for 15 days & subsequently linezolid were stopped. CVP tip culture grew klebsiella pneumonia sensitive only to polymyxin B & colistin. IV colistin was started in renal adjusted doses. Her urine c/s also grew klebsiella. Blood c/s was negative. Cardiology consultation was done in view of persistent arrhythmia & Holter monitoring advised. Holter was s/o sick sinus syndrome. Hence cordarone was stopped. Her TSH levels were 6.64, Thyroxine 25 mcg was added to the treatment. Bronchial washing were again for micro biological evaluation. BAL showed aspergillus but only scanty in number & much less than before. S. creatinine level was checked regularly and were within range.

In evening of 27.06.2014, she developed acute breathlessness & de-saturation. Urine out-put decreased. She was shifted to MICU. ABG showed metabolic acidosis. Chest X-ray was s/o mild bilateral pleural effusion. Urgent ECG & cardiology opinion was done. ECG showed junctional rhythm, RBBB with secondary ST-T changes in V-1- V-3. CPK was 79, CKMB 27, Trop-I negative. Echo showed no RWMA with EF 55-60% unlikely to acute cardiac event. However, her D-Dimer was 4710 & pro BNP 2380. Procal was 0.83. 5000 units of LMWH was given stat & 2500 units added twice daily s/c.

Antibiotics were modified to doripenem, teicoplanin, polymyxin-B and colistin. Voriconazole was continued. She developed fall in BP non-responsive to fluids, so noradrenaline was started which was tapered of overnight & stopped in morning. In view of polymyxin B sensitive Klebsiella growing from CVP tip & urine, despite being on polymyxin B, she was started pentaglobulin infusion. All routine investigations were repeated. TLC was 15.7, Hb 7.7, S. creatinine 1.7, sodium 124. Repeat Pro BNP in morning was 4770. D-Dimer 4250. Echo showed RAP 35+ with no new changes. Nephrologist was attending regularly. She was on BiPAP support 16/6 with Fio2-30%. Haemodynamically stable. Her BAL culture also grew klebseilla. One unit PRBC was transfused. Her urine output continued to be low. ABG showed worsening of metabolic acidosis. Dr. Khanduja’s (Nephrologist) opinion was taken and she was started on Lasix infusion. Later in the night, she developed bradycardia (HR-49/min). Urgent EGC was done, which showed junctional bradycardia pre-emptively Temporary Pacemaker Insertion (TPI) was placed by cardiologist Dr. Ripen Gupta. Urine o/p picked up subsequently. She was also reviewed by Dr. Upendra Kaul (Director & H.O.D. of Cardiology), who advised to continue same treatment. Review was done by Dr. Anoop Mishra. Vasculitic profile was found to be negative. Eventually TPI was removed. She was evaluated by Brig. Ashok Rajput, HOD Pulmonology of RR Hospital, on the request of the family of the patient. Said fact has been documented in the doctors notes by Dr. Nangia. He was in agreement with the line of management.

In view of patient developing pressure ulcer over the sacrum reference was given to plastic surgeon Dr. Rashmi Taneja and advice incorporated into treatment. Gradually her clinical condition improved and she was shifted back to ward. She developed low grade fever. Considering possibility of drug fever all antibiotics were stopped and blood c/s and urine c/s sent which were negative. She had no thrombophlebitis (vein inflammation) ulcer was healing. She developed rash over groin and inframammary area. Reference was given to Dr. Deepak Vohra, dermatologist and fictional dermatitis. The patient was discharged in a satisfactory and stable condition on 14.07.2014.

Diagnosis at Discharge:- Aspergillus lung infection. Diabetes Mellitus. Sick sinus syndrome with Atrial Fibrillation with flutter with Intermittent Junctional Rhythm. An abnormal heart rhythm resulting from impulses, coming from a locus of tissue in the area of the atrioventricular node, the “junction” between atria and ventricles. Hypertension. Chronic Kidney Disease.

(f)      Sixth Admission on 10.08.2015: Indication for admission: Burning while passing urine; Breathlessness; Cough with minimal sputum; High Grade Fever

Course through hospital stay: She was started on IV polymixin B and sulbactum and other supportive medications. Urine routine report showed, large number of WBC's and protein (+++). Her TLC was 22.8 procal was 9.85 and widal was positive for H antigen (1:80), creatinine was 2.1, so polymixin dose was modified accordingly. ESR was 100. Her potassium was 5.9 which was controlled with k-bind sachet. Nephrologist opinion was taken and advice incorporated. Her HRCT chest showed resolution of fluid effusion and clearing of GGO's (Ground glass opacity) when compared to previous CT chest. By evening her blood pressure was 90/60 mmHg with low urinary output so she was shifted to ICU. IVF were given but BP did not rise. Noradrenaline Infusion started. Patient also complained of severe pain on right shoulder for which orthopedic opinion was taking and advice incorporated. Her Trop I was normal with other cardiac markers. Her blood pressure recovered with management. Her blood culture grew E.coli in two samples consecutive days sensitive to imipenem & cefoperazone & sulbactum, netilmycin, Meropenem and amikacin. Urine culture also grew E.coli (ESBL producing) with colony count of 100,000 sensitive to imipenem, Ertapenem, cefotaxime + sulbactum, ofloxacin. Echo showed LVEF 55-60%, Trace TR (RVSP-25+RAP). Antibiotics were stepped down to imipenem and salbactum. For her bedsores plastic surgeon opinion was taken and advice incorporated. She gradually improved haemodynamically. Her TLC and Potassium came down and creatinine also improved. On 15.08.2014 patient was shifted to the ward. On 18.08.2014 her urine R/M showed 3-5 pus cells and urine culture was later found to be negative for bacteria. However she developed severe left sided headache which was not subsiding on regular nephro-safe pain killers. There was no focal neurological deficit found, on examination. NCCT head was done which showed acute right PCA territory infract.

Despite patient being on Ecosprin and statins. She was shifted back to MICU. Neurologist (Dr. Vijay Chandra) advice incorporated. To look for haemorrhage transformation repeat NCCT was done which showed no interval changes. Heparin was avoided in view of large infarct because risk of haemorrhage. Clopidogrel was added. IV antibiotics were stopped on 21.08.2014. Patient had complaints of constipation and abdominal pain. Gastroenterologist opinion was taken and advice incorporated. Sr. Amylase and lipase were normal. She was afebrile. On 22.08.2014 her urine R/M showed 8-10 WBC's. She had spike of fever, her urine culture grew E.coli sensitive to amikacin, ertapenem, cefoperazone, sulbactum. Her Procal was negative, TLC -12,200. Her antibiotics Ertapenem and Nitrofurantoin restarted as per sensitivity. Her fever gradually subsided her sodium was slightly low which improved conservatively. On investigation recent TLC was 8,400, K-4.9, LFT was normal, except low albumin and urine R/M showed 3-5/ WBC's. She is being discharged on stable condition with advice to continue singal dose IV antibiotic at home.

Diagnosis on Discharge: Urosepsis with septic shock with mutli-organ failure

Right PCA infarct, Aspergillus chest infection on treatment, Hyperkalemia, Diabetes Mellitus, Chronic Kidney Disease.

(g)     Seventh admission on 01.12.2014: Indication for Admission: Difficulty in swallowing, Pain in back, Left limb weakness.

Course through hospital stay: Patient was brought to emergency she was accessed by neurologist (Dr. Vijay Chandra). NCCT head was done in view of reduced spontaneous right sided limb movement which showed no new infarct, old right PCA infarct. Neurologist's advice incorporated. She was started on IV Ampicillin, clavulanic acid, Inj. Fluconazone and her usual medication. Liquid diet was restricted as she had poor swallowing. Lab reports showed Hb-12.5, TLC-13000, ESR-80, Albumin-2.8, Creatinine 1.9, Potassium 5.3, Sodium 129. Urinalysis showed 40-50 pus cells, blood ++, protein +. Urine c/s report is awaited. Swab culture was sent for the gluteal ulcer and groin. The Urine c/s sent on 01.12.2014 and report dated 03.12.2014 showed 15-20 leukocytes and Klebsiella Pnuemoniae. The Wound Swab c/s report sent on 01.12.2014 and report dated 04.12.2014 showed Staphylococcus Aureus positive. Nephrologist and Urologist opinion was taken and advice followed. Patient was better and was discharged with following advice.

Diagnosis on Discharge: Transient Ischemic Attack (TIA): A brief episode of neurological dysfunction resulting from an interruption in the blood supply to the brain or the eye, sometimes as a precursor of a stroke Oral Thrush? Oesophageal Candidiasis: Diagnosis Esophageal candidiasis is an opportunistic infection of the esophagus by Candida albicans. The disease usually occurs in patients in immune-compromised states, Pyuria? Urinary Tract Infection”

(h) Eighth Admission on 26.01.2015: Indication for admission; abnormal behavior since 10:00 PM; Headache

Course through hospital stay: Patient was managed conservatively with IV fluids, IV anti- epileptic and other supportive medications. She responded well to the treatment and is being discharged in a stable condition. She had right femoral art embolism managed conservatively after discussion with CTU surgeon (Dr. S. Gupta). Cardiologist Dr. Upendra Kaul's opinion taken anticoagulant added but patient had recurrent bleed after predexa and clexane even at smaller doses. Loose motions improved after treatment and Gastroenterologist opinion, plastic surgeon (Dr. Rashmi Taneja's) opinion taken for the bed sore. MAS (Minimal Access Surgery) & Surgery opinion taken for PR Bleed. Dr. Khanduja Nephrologist managed her CKD as when needed. Pulmonology Dr. Nangia managed her in the ICU and later as a follow up case of pulmonary aspergillosis. Patient was afebrile, alert and comfortable at the time of discharge. Pulses in right lower limb had improved.

Diagnosis at discharge: Secondary aphasia right upper limb weakness, Left femoral embolism.

The patient earlier was under care and treatment of Dr. Hemant Tiwari, (OP 5) Sr. Consultant Pulmonology, who resigned from OP 1 Hospital on 24.06.2014. On request of the complainant, the patient was transferred to Dr. Vivek Nangia-Director, Pulmonology, when she was admitted in June, 2014. On 26.01.2015 the patient was admitted to OP 1 Hospital with history of drowsiness, inability to swallow and speak, inability to move Lt Upper and Lower Limb and excessive crying. The patient was a known case of Hypertension, Diabetes Mellitus, Hypothyroid, Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease, Atrial Fibrillation, Sick Sinus Syndrome, recent Aspergillus lung infection, recurrent Urinary Tract Infections and old Stroke (Rt. Posterior Cerebellar Artery) and Fibromyalgia. She also had a history of Right Total Knee Replacement. On 26.01.2015, the patient was admitted under Dr. Renu Achtani Sr. Consultant Neurology, with complaints as stated above. CT head was done and showed Lt recent Middle Cerebral Artery infarct. On clinical evaluation she was also detected to have right femoral artery thrombus which could be successfully treated conservatively with medicines, as per consultation of the CTVS Senior Consultant and Surgeon, Dr. Sanjay Gupta. The Patient was managed for Chronic Kidney Disease by the department of Nephrology and her Pulmonology morbidity by Dr. Vivek Nangia -Director Pulmonology. Dr. Upender Kaul Director Cardiology, was referred to for Cardiology complaints and management of anticoagulant for her stroke. Patient had stabilized, was doing well with multi-disciplinary care and was set for discharge on 08.02.2015. However, she developed bleeding per-rectally, for which the anti-coagulant Tab. Clopidrogrel that had been started for the stroke had to be stopped. Another anticoagulant was resumed again later to prevent risk of recurrence of stroke. The patient was again observed and had been doing well till she developed fever on 17.02.2015. Investigations were conducted for the same and it was suspected to be a urinary tract infection which the patient had history of and a protracted course of antibiotics had to be given as per her culture sensitivity reports. The patient remained afebrile from 27.02.2015 onwards. On 27.02.2015, she developed bleeding per rectally again, for which all injectable anti-coagulants were withdrawn. The complainant was explained that only anti-platelets would now be given to the patient due to bleeding. The cause of bleeding was found to be anal excoriation only and no internal bleed had occurred, as per both gastroenterologist and gastro-surgeon referrals. The patient was stabilized, did well and discharged on 03.03.2015 with stable vitals, as per consensus of the treating team. She was in the best condition that she could have been.

 In fact upon instance of the complainant, an internal Multi-Disciplinary Team (MDT) assessments and treatments were given to the patient, which was attended by various doctors of the OP 1 Hospital as well as the complainant and his 2 associates one of whom was a doctor. In the meeting, it was agreed that the course of treatment given was proper and same be continued, the said report was also signed by the complainant. It is wrong and malafide on part of the complainant to file the present complaint and go against his own admission in the said meeting. The complainant is stopped from taking contrary stands.

On 14.03.2015 the patient was never brought to the OP hospital but was politely informed that she could not be admitted due to high occupancy on the said date and non-availability of beds, which is documented from Hospital log showing occupancy on the said date and log depicting OT list. Furthermore, part of the ICU i.e. 6 beds for non- H1N1 patients and 4 beds for H1N1 patients, had been converted to H1N1 ward for that month. The said act of non-admission was neither deliberate nor intentional. It is further stated that OP hospital and doctors in fact made every possible endeavour to get the admission in Max Hospital. It is wrong on part of the complainant to state that doctors at Max Hospital were not aware of the medical condition of the patient as all the medical records of the patient were with them and the doctors at OP hospital had already intimated the doctors at Max Hospital about the medical condition of the patient. It is amply clear from the above averments wherein the details of the treatment given to the patient has been referred. The doctors at Hospital not only gave the best possible treatment to the patient but also cooperated with the complainant at every instance even though his behaviour was highhanded, rude and improper. The patient was admitted in OP hospital for 8 times and if thecomplainant/patient was not satisfied with the treatment given, she surely would not have come back to the hospital and this fact itself is sufficient to prove that complainant was happy and satisfied with the treatment given and was also well aware of critical and multiple medical conditions his wife suffered from.

7.       The complainant filed rejoinders to the written replies filed by the respective opposite parties. The complainants filed Affidavit of Evidence Prem Dutt Chopra, Rajesh Nayyar and Mrs. Anita Sethi and documentary evidence. Along with the complaint, an Affidavit of Dr. Anil Behl was filed. Dr. Hemant Tiwari (OP-5) has filed his Affidavit of Evidence and Affidavit of Evidence of Mr. Vijay Kumar and documentary evidence. Opposite Parties 1, 2, 4 & 6 have filed Affidavits of Evidence of Uddyan Dravid, Dr. Soumya Ahuja, Dr. Shalinli Bhalla and Dr. Gurvinder Bedi and documentary evidence. Dr. Soumya Ahuja, along with her Affidavit has attached copy of the order of Delhi Medical Council dated 18.03.2019, rejecting the complaint of the complainant against the doctors/opposite parties. All the parties have filed their written synopsis.

8.       Opposite party-1 filed IA/9043/2015 for deleting the name of Shivender Mohlan Singh (OP-3) from the array of the opposite parties. Shivender Mohan Singh is alleged to be Manager, Fortis FLT. LT. Rajan Dhall Hospital. Therefore, at this stage, we do not consider it appropriate to delete his name. Opposite parties-1 and 2 have filed RA/143/2017 for review of the order dated 14.02.2017 whereby the earlier order dated 17.03.2016 directing to delete opposite parties 1 & 2, has been recalled. There is no ground for review of the order dated 14.02.2017. RA/143/2017 is rejected. The complainant has filed IA/1979/2017 for permission to file additional documents which is in the nature of email communication between the parties. IA is allowed. Additional documents are taken on record.

9.       We have considered the arguments of the parties and examined the record. The complainant alleged that on 08.04.2014 the patient was admitted with the complaint of dinginess, fall two times while walking yesterday & today and pain & swelling in left lower leg since morning. None of these complaints were related to pulmonologist but the hospital admitted the patient in the care of Dr. Hemant Tiwari (OP-5) who was a Pulmonologist. Dr. Hemant Tiwari without diagnosing the ‘deep vein thrombosis’, started medicine pradaxa which was a blood thinner and caused complication to the patient later on.

          Dr. Hemant Tiwari in his written reply has stated that the patient was in his treatment from 1999 and she was admitted under him on 02.04.2014, was diagnosed with exacerbation of her chronic lung and kidney disease and he treated her. When the patient was admitted on 08.04.2014 then in the light of complaint of dizziness, fall two times while walking, ankle was twisted and developed pain and swelling, the complainant was advised for admission under an Orthopedician but the complainant and the patient insisted to admit under him. Therefore, she was admitted under him. In view of the fact that she had a long distance air journey few days before her admission and due to the swelling in ankle, he suspected deep vein thrombosis and started Pradaxa. However, X-ray as well as Doppler test were done, in which deep vein thrombosis was ruled out and medicine Pradaxa was stopped on next day. After test, DVT was not found as such, there was no question for informing the complainant in this respect. In X-ray report, fracture was revealed, therefore, it was decided to manage the fracture through operation. Since her right knee was also causing trouble, the patient and her husband were advised to go through total knee replacement surgery so that if operation of left ankle is done, it may remain safe. The complainant and the patient agreed for it and signed ‘informed consent’. After total knee replacement and ankle surgery the patient was discharged in stable condition. Although the patient was admitted under Dr. Hemant Tiwari but she was given treatment by Orthopedician.

10.     The complainant further alleged that in view of the swelling in ankle initially Orthopaedic Surgeon decided to postpone the surgery of the left leg for 5 days and Anaesthetist also evaluated the patient as a ‘high risk case’ but ignoring these facts, Dr. Gurvinder Bedi (OP-6) conducted surgery on the next day. The complainant has filed Affidavit of Dr. Anil Behl but he had not pointed out that what injury was caused to the patient due to surgery on the next day.

          So far as the Anaesthetist’s evaluation relating to high risk case is concerned, it was in respect of general anaesthesia, therefore, the procedure of general anaesthesia was not adopted rather local anaesthesia was adopted. Dr. Gurvinder Bedi (OP-6), in his Affidavit of Evidence, has stated that on 08.04.2014, he examined the patient with the complaint of pain and swelling in her ankle. Thereafter, the test like D-dimer, Doppler and X-ray were done. In the X-ray report, the fracture in ankle was diagnosed. Since patient had long standing right knee problem and non-operative technics and medicines were ineffective, she was proposed to knee replacement surgery along with the surgery of ankle as the mobility was getting restricted. She was a diabetic and had chronic chest problem. As there was no significant swelling, it was decided that her operation could be done. This was more of a subjective assessment. When the patient and her husband were counselled for it, they agreed for it and signed the ‘informed consent’. He has denied that he ever advised to postpone the surgery for 5 days. The surgeries of right knee replacement as well as ankle were performed under local anaesthesia on 10.04.2014. Instead of doing surgery at 2 times, the surgery at one occasion was done in the interest of the patient. The operation was successful and the patient started walking from 16.04.2014 with the help of walker. Under the clinical assessment, the surgery was performed on next day of admission. Therefore, no negligence has been committed by him.

11.     Although the counsel for the complainant has pointed out that Delhi Medical Council in its order dated 18.03.2019 found that no evidence of severe osteoarthritis was found but Delhi Medical Council discharged the doctors from charges, therefore, no reliance can be placed on this observation. The knee replacement was advised by the doctor and the complainant and the patient agreed for it. After giving ‘informed consent’ now the complainant is raising issue. At this stage it cannot be said by him that there was no need for right knee replacement at that time. In view of the problem in right knee, the surgery of left ankle was also risky inasmuch as more load/jerk can be caused after surgery in the left ankle. In any case, the surgery was successfully performed and no negligence can be attributed in this respect. It is incorrect to say that opinion of Anaesthetist was ignored. In view of the opinion of the Anaesthetist, instead of general anaesthesia, local anaesthesia was given. 

12.     The complainant further argued that the opposite party has committed delay of one day in administering calcium despite low level of calcium being diagnosed on 15.04.2014 and calcium tablet was given to the patient from 16.04.2014. The patient started walking from that very day, therefore, there was no injury to the patient for one day delay in administering the calcium. The allegation relating to intravenous calcium was given, has been denied by the opposite party. It is not verified from the discharge summary or any other record relating to the treatment during 08.04.2014 to 22.04.2014.

13.     The complainant further alleged that during her recovery the patient developed various post-surgery complications and infections. The patient was discharged on 22.04.2014 and was at her home for about 40 days. She was again admitted on 02.06.2014 with complaint of fever on and off for 4 days, cough, unable to expectoration sputum for 4 days and shortness of breath for 4 days. On the tests, she was diagnosed with aspergillus lung infection, diabetes mellitus, sick sinus syndrome with atrial fibrillation, flutter, intermittent junctional rhythm, hyper tension and chronic kidney disease. The patient had history of the lung disease, diabetes mellitus and hypertension. It cannot be said that it was due to post-operation complication. Thus, the above diseases are her medical history and not a new disease. In any case, she remained at her home for 40 days. These complications developed from last 4 days. 

14.     So far as the allegation against Dr. Hemant Tiwari that he was involved in mal-practices and mistreatment is concerned, no details in this respect are given. According to Dr. Hemant Tiwari he has been treating the patient and the complainant both for last 5 years and they were fully satisfied with his treatment as well as behaviour. Therefore, in April, 2014 and in June, 2014 they approached him with full faith. There was no reason for him to commit any mal-practice or mistreatment at this time and the allegation has been denied. Delhi Medical Council has not found any misconduct committed by Dr. Hemant Tiwari. The allegation in this respect is vague. There is no sufficient material to record any adverse finding against him.

15.     On her admission on 02.06.2014, her chest auscultation revealed bilateral crepitation. DVT Prophylaxis was started on 09.06.2014 as per guidelines published by American College of Chest Physician. Dr. Anil Behl was a family friend of the complainant. At that time he was in agreement with line of treatment. She was evaluated by Brig. Ashok Rajput, HOD Pulmonology of RR Hospital, on the request of the complainant on 30.06.2014 and he was also in agreement with the line of treatment. Gradually her clinical condition improved and she was shifted to ward. She developed low grade fever. Considering possibility of drug fever, all antibiotics were stopped and blood c/s and urine c/s were sent which were negative. She had no thrombophlebitis and ulcer was healing. She developed rash over groin and infra-mammary area. Reference was given to Dr. Deepak Vohra, Dermatologist. She was discharged on 14.07.2014 in stable condition. On 10.08.2014, the patient was admitted with the complaint of burning micturition for two days, breathlessness for one day, cough with minimal sputum for two days and high grade fever for one day. On test, she was diagnosed as eurosepsis with E.coli (ESBL producing) with septic shock and multi organ dysfunction aspergillus chest infection on treatment, hyperkalemia, diabetes mellitus, chronic kidney disease and hypothyroidism. According as per advice of specialists, the medicine was started. On 18.08.2014, she developed severe left sided headache. Then non contrast computed tomography (NCCT) head was done, which showed right PCA territory infract. Then heparine was stopped and clopidogrel was started. Repeat NCCT was done on 21.08.2014, which showed no interval changes. She was discharged on 02.09.2018.

16.     Cerebral Infarction is a pathological process that reduced blood flow to an area of the brain due to narrowing occlusion of a cerebral blood vessel due to hypotension. Medical literature on the side effect of Pradaxa shows that major bleeds occur in critical area or organs such as intraocular, intracranial, intra-spinal or intramuscular with compartment syndrome, retro-peritoneal, intra-articular or pericardial. It does not show that cerebral infarct is the side effect. The complainant has not adduced any evidence of visible bleeding from skin and wounds except affidavit of Dr. Anil Behl. This Commission has not issued notice to OP-7, 8 & 9. Discharge summary of 10.08.2014 to 02.09.2014 shows that the Director, HOD was Dr. Vivek Nangia, senior consultants was Dr. R.S. Chatterji and consultants were Dr. A.K. Singh, Dr. Shivani Swami and Dr. Naveen Dalal. None of these doctors have been impleaded has parties in the complaint nor complaint was filed against them before Delhi Medical Council.

17.     The patient was admitted on 26.01.2015, with drowsiness, inability to swallow and speak, inability to move Lt Upper and Lower Limb and excessive crying. The patient was a known case of Hypertension, Diabetes Mellitus, Hypothyroid, Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease, Atrial Fibrillation, Sick Sinus Syndrome, recent Aspergillus lung infection, recurrent Urinary Tract Infections and old Stroke (Rt. Posterior Cerebellar Artery) and Fibromyalgia. The patient was admitted under Dr. Renu Achtani Sr. Consultant Neurology. CT head was done and showed Lt recent Middle Cerebral Artery infarct. On clinical evaluation she was also diagnosed to have right femoral artery thrombus which could be successfully treated conservatively with medicines, as per consultation of Dr. Sanjay Gupta, CTVS Senior Consultant and Surgeon. Right femoral block was a complication of atrial fibrillation. Hence she needed a blood thinner and she was put on Pradaxa and Clexane. Dr. Sanjay Gupta found that collateral vessels were re-forming as the circulation to the limb, pulse were returning, temperature of the leg was getting warm and hence conservative management was done. The patient was managed for Chronic Kidney Disease by the department of Nephrology and her Pulmonology morbidity by Dr. Vivek Nangia -Director Pulmonology. Dr. Upender Kaul, Director Cardiology, was referred to for Cardiology complaints and management of anticoagulant for her stroke. The patient stabilized and was doing well with multi-disciplinary care and was set for discharge on 08.02.2015. However, she developed bleeding per-rectally, for which the anti-coagulant Tab. Clopidrogrel that had been started for the stroke had to be stopped. Another anticoagulant was resumed again later to prevent risk of recurrence of stroke. The patient was again observed and had been doing well till she developed fever on 17.02.2015. Investigations were conducted for the same and it was suspected to be a urinary tract infection which the patient had history of and a protracted course of antibiotics had to be given as per her culture sensitivity reports. The patient remained afebrile from 27.02.2015 onwards. On 27.02.2015, she developed bleeding per rectally again, for which all injectable anti-coagulants were withdrawn. The complainant was explained that only anti-platelets would now be given to the patient due to bleeding. The cause of bleeding was found to be anal excoriation and no internal bleed had occurred, as per both gastroenterologist and gastro-surgeon referrals. The patient did well and discharged on 03.03.2015 with stable vitals, as per consensus of the treating team.

18.     Ryle’s Tube was inserted to administer nutrition and medicine as the patient was unable to swallow and each for her own due to stroke. In regard to the allegation that the excess salt has been given in the diet to the patient, no pleading in this respect has been raised in the complaint, therefore, the opposite party had no opportunity to rebut it. Similarly, the attempt of administering double dose of insulin is concerned, admittedly double dose has not been administered nor any injury has been caused due to it.

19.     The allegation that the hospital has refused admission of the patient on 14.03.2015 has been explained by OP-4 & 6 in their written reply. They have stated that on that day their emergency ward was not vacant as due to H1N1, 5 Pulmonology ICU-10 beds had been converted to H1N1. Remaining beds were fully occupied therefore it was not feasible for them to admit a seriously ill patient. So far as arguments based burden of proof is concerned, the opposite parties have discharged their burden by adducing discharge summary, which is not controverted. Delhi Medical Council did not find medical negligence on the part of the opposite parties.   

20.     Supreme Court in Jacob Mathew v. State of Punjab (2005) 6 SCC 1, held that negligence is the breach of a duty caused by omission to do something which a reasonable man guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do. The definition of negligence as given in Law of Torts, Ratanlal & Dhirajlal (edited by Justice G.P. Singh), referred to hereinabove, holds good. Negligence becomes actionable on account of injury resulting from the act or omission amounting to negligence attributable to the person sued. The essential components of negligence are three: “duty”, “breach” and “resulting damage”. Negligence in the context of the medical profession necessarily calls for a treatment with a difference. To infer rashness or negligence on the part of a professional, in particular a doctor, additional considerations apply. A case of occupational negligence is different from one of professional negligence. A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of a medical professional. So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed. When it comes to the failure of taking precautions, what has to be seen is whether those precautions were taken which the ordinary experience of men has found to be sufficient; a failure to use special or extraordinary precautions which might have prevented the particular happening cannot be the standard for judging the alleged negligence. So also, the standard of care, while assessing the practice as adopted, is judged in the light of knowledge available at the time of the incident, and not at the date of trial. These principles were consistently applied in Kusum Sharma Vs. Batra Hospital & Medical Reserch Centre, (2010) 3 SCC 480, Arun Kumar Manglik Vs. Chirau Health & Medicare Private Ltd., (2019) 7 SCC 401, Maharaja Agrasen Hospital Vs. Master Rishabh Sharma (2020) 6 SCC 501 and Harish Kumar Khurana Vs. Joginder Singh, (2021) 10 SCC 291.  

O R D E R

In view of the aforesaid discussions, the complaint is dismissed.