KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAD, THIRUVANANTHAPURAM
APPEAL 486/10
JUDGMENT DATED: 24..1..2012
PRESENT
JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT
SRI.S.CHANDRAMOHAN NAIR : MEMBER
1. The Proprietor, : APPELLANTS
MTM Hospital, Madan Nada,
Kollam – 12.
2. Dr.Rajagopal.S.R.,
-do-do-
(By Adv.Sajeevu Mathew)
Vs.
1. Jayakumari.A, : RESPONDENTS
W/o B.Radhakrishna Pillai,
Devikripa, MKRA 129,
Thirumullavaram, Kollam.
2. B.Radhakrishna Pillai,
-do-do-
(By Adv.B.K.Mohanan Pillai)
JUDGMENT
JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT
The appellants are the opposite parties the hospital and the doctor respectively who are under orders to pay compensation of Rs.4,00,000/- and cost of Rs.10000/- with interest at 12% in OP.304/04 in the file of CDRF, Kollam.
2. The case of the complainants/wife and husband is that the 1st complainant aged 42 and having 2 children consulted the 2nd opposite party doctor who is also the family doctor on 16.7.02 as outpatient she felt weakness of the body and that he advised her to get admitted on the following day ie on 17.7.02.. On the above date she was admitted as inpatient and after blood test etc it was advised to arrange O+ve blood for transfusion. On the next day that is on 18.7.02 a close relative of the 1st complainant one Sunil with the same blood group donated blood. At about 11AM blood transfusion started under the supervision of the 2nd opposite party. After sometime the patient had shivering and headache. The sister of the complainant informed the same to the duty doctor and the transfusion was stopped. After one or 2 hours transfusion was again started. Thereafter also the complainant had shivering and headache. Again the transfusion was stopped at about 2PM . Thereafter she felt that her left eye sight is diminishing and the same was communicated to the 2nd opposite party. The doctor told that it is only due to weakness of the body and lack of blood. Before 5PM again the blood transfusion was started and again she had severe headache and shivering and diminishing eye sight of the right eye. The matter was informed to the doctor through phone and to the duty doctor. At 5pm duty doctor stopped blood transfusion. The blood stains were seen on the left eye and the same was gradually increasing. Similar symptoms were seen on the right eye and the same also gradually increased. At about 9pm on 18.7.02 she lost her vision of both eyes. Some medicines were administered. She has became totally blind. At 9.30PM the 2nd opposite party come to the hospital and suggested to further treatment at Medical College Hospital, Thiruvananthapuram. In the early morning on 19.7.02 she was discharged with the reference letter. As there was a strike of house surgeons she was admitted at KIMS hospital, Thiurvananthapuram. She was inpatient therein upto 22.7.02. The attempts made by the experts to restore the eye sight was not successful. On 23.7.02 she was referred to RCC, Thiruvananthapuram suspecting blood cancer and admitted therein on 23.7.02 and discharged on 12.8.02. At RCC it was found that she is not having blood cancer. Thereafter she went for treatment at Sankar Nethralayam at Madras for restoration of eye sight. There was no improvement. Subsequently she underwent treatment at Sree Dhareeyam Ayurvedic Gaveshana Kendram, Koothatukulam from July 03 and she is still under treatment. She is totally blind. It is alleged that the loss of eye sight was on account of the negligent treatment by the 2nd opposite party while providing blood transfusion. It is alleged that the 2nd opposite party did not conduct any proper clinical tests to diagnose the disease before the treatment commenced. Altogether the complainant has spent a sum of Rs.2,39,250/- towards treatment expenses at various hospitals. She was also claimed a sum of Rs.600000/- as compensation and in addition a sum of Rs.1,00,000/- is claimed towards the future sufferings.
3. The first opposite party, Proprietor of the hospital has filed version totally denying the allegations. It is stated 2nd opposite party was serving as a consultant surgeon in the hospital . It is stated that the condition of the patient when she consulted the 2nd opposite party on 16.7.02 was severe anaemic. She was advised for admission and routine investigation. It was found that the hemoglobin level was 4.9gm% and she was advised to have blood transfusion immediately. As no donar was available she went home. The peripheral smear examination was done in Devi clinical laboratory which showed a low hemoglobin level. On the next day the donar was available and his blood was thoroughly examined and mandatory screening test and cross matching was done. Blood was collected under strict aseptic conditions on 17.1.02. After administering injections, of avil, dexona and lasix at 1.15PM blood transfusion commenced under the supervision of nurses and duty doctor. After one hour she developed vomiting sensation for which neomit injection was given. At about 3.30PM she developed slight shivering. Immediately transfusion was stopped temporarily and injection betnesol and lasix and paracetamol tablet was administered. At about 5PM temperature rose to 990 F and at 6PM 100.50 F. The temperature was controlled with paracetamol tablet and at 7.30 PM temperature became normal .At 7.30PM transfusion was again started. This time also the patient developed some shivering and temperature rose to 1000F. Hence the transfusion was stopped and paracetamol tablet and injection betnesol were administered. The 2nd opposite party was informed and he advised to stop transfusion. He came to the hospital and examine the patient. At 9PM she had no complaints except some joints pain. There was no dimness of vision or any bloody discoloration of the eyes. On 18.7.02 the physician examined the patient and noted normal temperature with some headache and blood pressure – 80/50 and pulse rate – 96/mt. On the evening of 18.7.02 at about 9.30PM the patient complained of dimness of vision of left eye. The 2nd opposite party immediately came to the hospital and advised early reference to the Medical College Hospital, Thiruvananthapuram. Instead of going to Medical College Hospital she was got admitted at KIMS hospital. The eye specialist at KIMS has noted that she was having endogenous Panuveitis of both eyes, a condition of inflammation of the eyeball, with glaucoma(increased intra ocular pressure). It seems that they also suspected thrombosis (blood clotting) of cavernous sinus, inside the skull. Subsequently she was referred to RCC and at RCC it was found that she had bilateral retinal hemorrhage with a diagnosis of myelodysplastic syndrome which is a precursor of leukemia. At the time of admission the condition of the complainant was severe anaemia requiring blood transfusion. When adverse symptoms were found she was immediately referred to Medical College hospital, Thiruvananthapuram. Detailed evaluation of the cause of anaemia which is time consuming was not the top priority at the time when the 2nd opposite party saw the complainant since she had severe anaemia of 4.5gms% constituting a medical emergency requiring correction by blood transfusion. According to the text book transfusion reactions are of two types mainly. First is the hemolytic transfusion reaction in which destruction of red blood cells occurs within the circulatory system. The clinical effects of an intravascular transfusion reaction are immediate, usually within minutes after starting transfusion, thus also called acute hemolytic reaction. This is most severe and life threatening reaction in which low blood pressure, shock and acute renal failure also occur. This reaction is caused by transfusion of incompatible blood groups. The 2nd type of transfusion reaction includes the febrile non-hemoglobin transfusion reaction, which are the most common and accounting for 90% of transfusion reactions. These are self limiting reactions and occurs immediately after starting transfusion, with fever, chills and malaise (Compendium of Transfusion Medicine by Dr.R.N.Makroo , 1999 page 247). It is also pointed out that every procedure however minor it may involve certain amount untoward happenings or simple reactions. The blood transfusion in a patient with a very low hemoglobin level is a life saving measure is done in good faith. The minor reactions has to be weighed against the possible complications of severe anaemia. The blood transfusions were given at KIMS and RCC hospitals also. Bleeding into various organs of the body is a feature of leukemia and pre leukemia conditions. Bleeding and subsequent inflammation of the eye structures has resulted in the loss of vision of the complainant. The opposite parties have not administered any other treatment except blood transfusion. The 2nd opposite party is a qualified Surgeon having 39 years of experience after passing masters degree in surgery at Medical College Hospital, Calicut. After his retirement from health services he was working in the 1st opposite party hospital as a consultant Surgeon. The hospital has ample infrastructure and facility to carry out surgical procedures and blood transfusion.
4. The 2nd opposite party doctor has also filed version containing the same averments as in the version of 1st opposite party. He also denied any negligence on the part of the opposite parties and has sought for dismissal of the complaint with a cost of Rs.10000/- to the 2nd opposite party as envisaged under Section 26 of the Consumer Protection Act.
5. The evidence adduced consisted of the testimony of PW1 to 4, DWs 1 to 3; Exts.P1 to P8 series and X1 and X2(b).
6. PW1 is the 1st complainant herself. PW2 is the 1st opposite party, the proprietor of the hospital. PW3 is the relative of the complainant who donated blood. PW4 is the Pathologist of District Hospital, Kollam. Opposite parties have examined DW1 the 2nd opposite party doctor and DW2 the Associated Professor of Medical Oncology, RCC, Thiruvananthapuram and DW3 Ophthalmologist at KIMS hospital.
7. As evident from the pleadings and evidence it is the case of the complainant who is a lady then aged 40 was having severe weakness and she consulted a lady doctor and as directed by her had blood test at Devi Clinic, a private laboratory and as the hemoglobin level was too low the above doctor directed to her to approach a hospital where there was blood transfusion facilities and that on16.7.02 she consulted the 2nd opposite party doctor who is a surgeon and family doctor and as advised by him got admitted in the 1st opposite party hospital and had blood transfusion of the blood taken from her sister’s son. The blood transfusion had to be stopped on account of reactions although repeatedly tried. She lost her sight of both eyes while she was an inpatient at the above hospital although opposite parties have contended that at the time of reference to the higher centre there was only diminution of eye sight of left eye. Subsequently she underwent treatment at KIMS hospital, Thiruvananthapuram and Regional Cancer Centre, Thriuvananthapuram but her eye sight could not be regained.
8. As to the date of blood transfusion the case of the complainants and that of the opposite parties is at variance. According to the complainant the blood transfusion was done on 18.7.02. According to the opposite parties the transfusion was done on 17.7.02. As to the episodes of transfusion also there is differences of opinion. According to the complainant the blood transfusion was started at 11AM and after sometime on account of shivering and acute headache and itching sensation the transfusion was stopped and after one or two hours blood transfusion was again started. Then she felt shivering and headache and itching sensation and at 2PM the transfusion was stopped and medicines were administered. At about 4PM transfusion restarted. Soon thereafter she had severe headache and shivering and loss of vision of the left eye. Then the transfusion was stopped and medicines were administered. As per the version of the complainant after the 2nd episode of blood transfusion her left eye sight was diminishing and after the 3rd episode of blood transfusion her right eye was also affected. By about 9PM she lost sight of both eyes.
9. On the other hand according to the opposite parties the blood transfusion was done on 17th. According to the opposite parties blood transfusion commenced at 1.15PM. After about one hour she was having vomiting sensation and medicines were administered. At 2.30PM she developed slight shivering and blood transfusion was stopped and medicines were administered. There was rising in temperature also by about 5PM. Everything was controlled after administering medicines blood transfusion again started at 7.30PM. After some time she developed shivering and temperature rose to 1000F and transfusion was stopped and medicines were administered. At 9PM she had only complaints of joint pain and the next day was uneventful. It was on the next day ie 18.7.02 at 9.30PM that she complained of diminishing of vision of the left eye and she was immediately referred to Medical College Hospital, Thiruvananthapuram. As noted above according to the opposite parties blood transfusion was attempted only twice. According to the complainant blood transfusion was attempted thrice. The Forum has proceeded on the assumption that the blood transfusion was done on 17th as contended by the opposite parties. The same is supported by Ext.P8 case sheet of the opposite party hospital. Although it is contended and put PW2 the 2nd opposite party doctor that P8 entries are fabricated we find that the version of the opposite parties in this regard has to be accepted as the blood donar who is nephew of the complainant was at the time working at FACT, Kochi and complainants could have produced documents with respect to his attendance or leave at his office on 18th.
10. As per ExtP8(d) the blood test report of Devi Clinic Laboratory, Kollam dated 15.7.02 the Hb level was only 4.5Gm%. All the doctors examined have testified the above is a very severe anaemic condition and the 1st step required is blood transfusion. The complainants have also no different opinion on the above point. As on 16.7.02 when the complainant consulted DW1/OP2 there was no donars available and hence the transfusion was done on the next day ie on the 17th July 2002. It was O+ve group and as it can be seen from Ext.P8(b) and (c) the blood of one Deepa a relative and that of Mr.Sunilkumar was cross matched. Both were found compatible and the blood of Sunilkumar was taken for transfusion. Altogether only about 150ml of blood could be transfused in toto as admitted by PW2 the Proprietor of the 1st opposite party hospital who is also a Physician with a post graduate degree. As noted by the Forum it is just half a pint that was transfused. The complainant was having only 4.5Mg% of Hb. As mentioned by PW4 the Pathologist of Kollam Government Hospital who is having the MD degree in Pathology the normal Hb % is from 11Mg onwards. Admittedly the transfusion done was not sufficient to raise Hb level of the complainant. As can be seen from Ext.P8 the Hb level subsequent to the transfusion is only 4.9%. It is admitted by DW1/OP1 that such a condition of low Hb level called for investigations including bone marrow test and that opposite party hospital was not having the facility to conduct the same . There is no explanation as to why PW1 was kept in the hospital till 9.30PM on the next day ie for 26 hours as noted by the Forum. The above aspect of evidence has not been explained by the opposite parties. Retaining PW1 who was severely anaemic and for whom investigations are required urgently to rule out leukemia is certainly a deficiency and negligence as held by the Forum.
11. According to the complainants on the next day morning ie 19.7.02 she was taken to the Medical College Hospital. On account of strike by house surgeons she was taken to KIMS Hospital wherein she was inpatient from 19.7.02 to 22.7.02. While an inpatient at KIMS hospital she was administered blood transfusion on the date of admission as well as on the next day. On 19th 3 pints of blood and 2oth 2 pints of blood were transfused. There was no reactions. As stated by DW3, Opthalmologist of KIMS hospital Ext.X2(a) case sheet of KIMS hospital would show that required investigations including bone marrow test, CT scan of various portions of the head etc were done and as Myelodysplastic Syndrome and leukemia was suspected she was referred to Regional Cancer Centre, Thiruvananthapuram wherein the illness was confirmed on bone marrow aspirations etc as Myelodysplastic Syndrome(herein after to be mentioned as MDS). She was under treatment therein from 23.7.02 to 12.8.02. MDS is a precursor to leukemia. According to DW2 the Associate Professor of RCC and as per records PW1 was found to be having bilateral retinal hemorrhage, vitreous hemorrhage ie bleeding into the retina and bleeding into vitreous . MRI scan revealed irregular thickening on the walls of both eyes and T2 hyper intense focus in the medulla and there was right transverse sigmoid sinus and jugular vein thrombosis. MDS can be caused idiopathically ie without a known cause also. He has also stated that subsequent to discharge she came for review on 7.11.2001 and 19.12.02 and thereafter she did not turn up. He has also stated that MDS can or not result in Leukemia.
12. According to PW1 she was not having leukemia . It is pointed out by the appellants that the complainant has suppressed the fact that she had MDS. Really the same is not mentioned in the complaint. Perhaps she has recovered.
13. It is seen from the case sheet that she underwent abdominal hysterectomy at KIMS hospital wherein she was inpatient subsequently from 4.8.03 to 12.8.03. Ofcourse the same is not relevant in the present case.
14. Another point stressed in the order of the Forum is that no blood test of the complainant was done at the opposite party hospital prior to blood transfusion. DW1 has admitted the same. It is his case that Devi Clinic wherein Ext.P8(d) test is done is a properly equipped Laboratory and hence fresh blood test was not required.
15. We find that the evidence of PW4, Pathologist would indicate that cross matching is a serious matter and it would take atleast 35 minutes time. PW2/Proprietor/Physician of OP1 hospital had stated that the time taken for cross matching will only be 5 to 10 minutes. It is to be noted that Ext.P1(d) blood test report is dated 15.7.02. According to the opposite parties cross matching and blood transfusion was done on 17.7.02. As per Ext.P1(d) the platelet count was not examined. Reliance placed on outside Laboratory and that too a test report of 2 days duration is alleged as deficiency.
16. It is also admitted by DW1 as well as by PW2 the doctors of the opposite party hospital that no rechecking was done after the blood transfusion had to be stopped on account of reactions. According to DW1 for minor reactions rechecking is not required. PW4 the Pathologist has stated that there is no such classifications as minor or major and that every time there is reaction there should be cross checking of the blood with respect to the mismatching. She has also stated that in case of reaction blood should be sent to the Laboratory and rechecked even in case of common reactions. Nothing was to be brought out to discredit the version of PW4 in this regard. The above constitute a serious deficiency in service and negligence on the part of the opposite parties.
17. We find that the point relied by the Forum below that PW2 has stated that he is not aware as to where the blood was kept after transfusion stopped and restarted and that PW4 has stated the blood is not to be kept in normal temperature for more than 4 hours and that in the instant case since the starting of the blood transfusion and the time blood transfusion restarted the time exceeded 4 hours and hence the blood would have been condaminated or clotted. DW1 has stated that if blood is clotted there will be bleeding. We find that the above findings are supported by proper evidence as such. We find that DW1 in the proof affidavit filed has stated that blood in the meantime was kept in the refrigerator. The same has not been challenged in the cross examination . Further there is no expert evidence or literature produced to the effect that the blood if kept more than 4 hours will get clotted. Hence we disagree with the finding of the Forum in this regard.
18. DW2 the doctor of RCC was not cross examined. He has stated that MDS can cause bleeding. The literature produced also support the same that bleeding is also a possibility in MDS patients. It was pointed out that there is no bleeding after the complainant was discharged from the opposite party hospital. DW2 has also not mentioned of any case at RCC wherein loss of eye sight was occasioned on account of MDS. All the same we find that there is deficiency and negligence on the opposite parties in not rechecking the blood after stopping transfusion on account of adverse reaction and restarting transfusion. There is also negligence on the part of the opposite parties in not conducting a detailed blood test of the complainant prior to commencing blood transfusion. There is also deficiency in service and negligence on the part of the opposite parties in retaining the complainant at the opposite party hospital subsequent to stopping of the blood transfusion and inspite of the fact that the complainant PW1 remained severely anaemic as only about 150ml blood could be transfused and after blood transfusion also the Hb level was only 4.9. As noted above she was retained at opposite party hospital for 26 hours instead of referring to a higher centre and inspite of the fact admittedly the opposite parties hospital was not having facilities for checking the severe anemic condition of PW1 including the facility for bone marrow test. For the above reasons we find that there is negligence and deficiency in service on the part of the opposite parties.
19. In the circumstances the order of the Forum directing to pay compensation of Rs.4,00,000/- is liable to be modified. The amount of compensation is confined to Rs.2.5 lakhs with interest at 9% from the date of complaint ie on 15.7.04. The order with respect to cost of Rs.10000/- is sustained. The opposite parties would be jointly and severally liable to pay the amount. The amount is to be paid within 3 months from the date of receipt of this order failing which the complainant will be entitled for interest at 12% per annum on the amount of compensation from 24..1..2012 the date of this order.
20. In the result the appeal is allowed in part as above.
The office will forward the LCR along with a copy of this order to the Forum.
JUSTICE K.R.UDAYABHANU : PRESIDENT
S.CHANDRAMOHAN NAIR : MEMBER
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