DISTRICT CONSUMER DISPUTES REDRESSAL FORUM PALAKKAD
Dated this the 30th day of March 2012
Present : Smt.Seena H, President
: Smt. Preetha.G. Nair, Member
: Smt. Bhanumathi.A.K, Member Date of filing : 01/01/2011
C.C.No.3/2011
Sreenivasan,
S/o. Devan,
Kalathilveedu,
Thenur Post,
Parali 678 616
Palakkd - Complainant
(By Adv.Reena)
Vs
1. Managing Director,
Karuna Hospital,
Melamuri, Palakkad - 6
(By Adv.V.K.Venugopalan)
2. Dr.Jayaprakash,
Child Specialist, Karuna Hospital,
Melamuri, Palakkad - 6
(By Adv.V.K.Venugopalan)
3.Dr.Sudarsanan,
Karuna Hospital,
Melamuri, Palakkad – 6 - Opposite parties
(By Adv.V.K.Venugopalan)
O R D E R
By Smt. SEENA.H. PRESIDENT.
In a nut shell, the case of the complainant is as follows:
Complainant’s wife was admitted to the opposite party hospital for delivery and a girl child was born on 4/8/2010 following a normal delivery. The child was having a birth weight of 2.35kg. On 6/8/10 the child was not drinking the mother’s milk and it was informed to the doctor. On 7/08/10 yellow colour was noticed on the baby. Though it was informed to the doctors, they refused to take the matter seriously and told everything was okay. It was only on the 7th day the child was taken to NICU. No information regarding the child’s condition was intimated to the complainant. On 9/08/10 complainant got the child forcibly discharged and was taken to Jubilee Mission Hospital. The doctor at the Jubilee Mission Hospital advised for an immediate blood transfusion and it was also informed that the bilirubin has exceeded the dangerous level and there is likelihood of damages to the minor child affecting her healthy life like a normal individual. Now the child is diagnosed with severe hearing impairment. The child neck is also not steady. According to the complainant, the life long disablement of the minor child was due to the negligence on the part of the opposite parties. Hence prays for exemplary damages.
All opposite parties resisted the allegations of the complainant by the following contentions. According to opposite parties it is true that the complainant’s wife had a normal delivery on 4/8/10. The baby was normal in all respects. Baby was sucking well and routine blood grouping done. On 6/8/10. baby was noted to have jaundice. Necessary investigations were done. Apart from mild jaundice baby was active and feeding well. Serum bilirubin was 10mg%. Child was diagnosed to have physiological jaundice which usually subsides spontaneously. The results were promptly informed to the bystanders. There was no need for concern as most babies develop jaundice by 3rd day of life. Photo Therapy which is the standard treatment for jaundice was instituted. On 7/8/2010 also baby was seen by the 2nd opposite party. Except for mild jaundice baby was normal. Serum bilirubin was 12.5 mg% and was within acceptable limits. Double photo therapy was instituted. On 7/8/10, 2nd opposite party wanted to leave station due to unavoidable circumstances, 3rd opposite party, child specialist was entrusted to look after the patient. On 8/8/10, 3rd opposite party has attended the patient. The child was active, but clinically jaundice was increasing and hence repeat bilirubin was done. As it was increased to 26mg% double surface photo therapy, IV fluids, antibiotics etc. were administered. 2nd opposite party attended the patient on 9/8/2010. The patient was active but icterus was still persisting. The relatives were informed that if the repeat bilirubin showed increase, then the child has to referred to higher centre for exchange transfusion. The repeat bilirubin was 33mg% and hence the patient was referred to Jubilee Medical Mission Hospital, Thrissur for expert management.
Opposite parties 1 &2 further stated that the American academy of pediatricians guideline for neonatal jaundice will shows that there is no negligence on the part of opposite parties. The treatment methods adopted were of standard practice followed in similar cases. Opposite parties denies the say of the complainant that the child refused to feed on 6/8/10. The child was active and was feeding well and had passed urine adequately. Mild dehydration was there as photo therapy was instituted. Opposite parties also denied the say of the complainant that the child was referred to Jubilee Mission Hospital at the request of the complainant. According to opposite parties 1 & 2, there is no deficiency in service on their part. 3rd opposite party admits that he has treated the child in the absence of 2nd opposite party doctor on 7/8/10 and 8/8/10. The child was carefully attended and repeat bilirubin test was advised. IV drips and antibiotic injection was administered on 8/8/10. As it was in raising trend, double surface photo therapy was also done. As the level of bilirubin was not dangerously high and the baby was active, 3rd opposite party did not referred the patient to a higher centre. On the very next day the treated doctor has attended the baby. Hence there is no deficiency in service on the part of 3rd opposite party.
The evidence adduced by the parties consists of their respective chief affidavits. Ext.A1 to A32 , Ext.B1 and the testimony of PW1 & DW1.
Now the issues that arise for consideration are
1.Whether there is any deficiency in service on the part of opposite
parties?
2. If so, what the relief and cost ?
Issue No.1
On going through the complaint and affidavit we find that the instances of medical negligence leveled against the opposite parties are as follows:
1. Even though it was informed to the doctors on 6/8/10 that the child was not drinking milk, it was not taken seriously. Further, when the colour change was informed on the 4th day, doctors and nurses told that every thing was okay.
2. It was only on the 7th day the child was taken to NICU, though the child was looking worse prior to that date.
3. The life long disablement caused to the child is due to the negligence of the opposite parties.
As far as point No.1 and 2, the contention of opposite parties is that child was sucking well and was active. Ext.B1, recordings in the case sheet of the child shows that from 5/8/10 to 9/8/10, the baby was sucking well and active. Hence we find that the say of the complainant turn out to be false.
It is the say of the complainant that the child was taken to NICU only on the 7th day though the child was looking worse prior to that. It is born out from Ext.B1 that the child developed jaundice on the 3rd day i.e. on 6/8/10. According to opposite parties, it is usual that the children develops jaundice on the third day, which will get subside spontaneously also. Opposite parties has deposed that necessary investigations were done and photo therapy was also started. On the next day when the serum bilirubin was found at little high level, double photo therapy was started. Ext.B1 case sheet supports the say of the 2nd opposite party. It is seen that in the complaint, complainant has not specifically pointed out what acts of the opposite parties constitutes medical negligence, rather has stated that the life long disablement of the minor child was due to the negligence on the part of opposite parties. The question to be decided is whether opposite parties has followed the standard practice followed by the professionals in the same field. The treated doctor at Karuna Hospital was examined as DW1 and the Doctor who has done the subsequent treatment at Jubilee Mission Hospital was examined as PW1. The relevant portion of the deposition of DW1 is noted below”
6/8/10\mWv jaundice IXv. Normally 60% babies develop jaundice serum bilirubin test sNbvXp. 6/8/10 \v Xs¶ Phototherapy start sNbXp. Usually 15mg Bhpt¼mgmWv start sN¿pI. A§ns\ clear cut Bbn procedure CÃ. _m¡n factors infection, blood group incompatibility etc. IqSn t\m¡nbmWv start sN¿pI. 10mg Bbt¸mÄ phototherapy start sNbvXp. 6/8/10\v medicines start sNbvXn«nÃ.
For physiological jaundice medicines BhiyanÃ. Phototherapy sImv amdpw.
7/8/10\v bilirubin 12.5 mg. That is within the normal limits and the baby was active and hence continued phototherapy. There is no clear cut off level of bilirubin that is treated as dangerous. Even 5 mg can be dangerous where as 50mg may not be dangerous. Bilirubin along with other factors determine the risk.
8/8/10\v 3rd opposite party Fs¶ hnfn¸n¨v Ip«nbpsS Imcy§Ä kwkmcn¨ncp¶p. Doctor everything was normal F¶mWv ]dªXv. 8/8/10\v bilirubin level 26 mg Bbncp¶p. Except for the rise in bilirubin everything was normal. Medication started on 8/8/10. Ip«nbpsS clinical condition worse Bbncp¶nÃ. Bilirubin level has nothing to do with the general condition and activity of the baby.
9/8/10\v 33mgBbncp¶p bilirubin level. When phototherapy fail next option is exchange transfusion. There was no facility to do it in the hospital so referred. Hike in the bilirubin level can be genetic. It may be due to the hyper sensitivity of the blood brain barrier which is genetically constituted. Since in this case, other factors are ruled out, this is the only reason for the hike.
It is also relevant to note what PW1 has to say on the matter. PW1 deposed as follows:
10/8/10emWv Rm³ Ip«nsb ]cntim[n¨Xv. Hypertonic. F¶ condition Ip«n hfsc stiff Bbncp¶p. _ew ]nSp¯wt]mse ImWn¨p. Lethargy F¶ condition Ipd¨v Djmdv Ipdhmbncp¶p. ]mev IpSn¡m³ hnk½Xn¨ncp¶p.
9/8/10 tUm.kRvPohv BWv Ip«nsb ]cntim[n¨Xv. B Znhks¯ sdt¡mÀUv Rm³ ]cntim[n¨ncp¶p. 9/8/10 serum bilirubin 49 Bbncp¶p. stated in Ext.A9. Neonatal Icterus. F¶p ]dªm P\n¨ DS³ Ip«nIÄ¡v DmIp¶ aª¸n¯amWv. Kern icterus F¶Xv aª¸n¯w IqSnbn«v brain tebv¡v hym]n¡p¶XmWv. 15 IqSnbmse aª¸n¯w treat sN¿mdpÅp. Phototherapy start. sN¿pw. 20mg BIpt¼mgmWv medicines sImSp¡mdpÅXv. Double phototherapbn apIfnepw Xmsgbpw Ip«nsb InS¯nbn«v light shbv¡mdpv. F{X AfhmsW¦nepw, phototherapy sN¿mdpv. Bilirubin 49mg BbXn\memWv Ip«nbpsS blood apgph\pwamÁn ]pXnb blood sImSpt¡nh¶Xv. 25...30 BsW¦n phototherapy sNbvXv Ipdhnsæn blood amÁn sImSp¡pw. Above 30 BsW¦n braintebv¡v _m[n¡m³ km[yXbpv. A\ymb¯n ]dªncn¡p¶ Ip«nbv¡v braintebv¡v _m[n¨ncp¶p.
P\n¨v aq¶maXv ZnhkamWv jaundice IpSm³ XpS§p¶Xv. ]n¶oSv 7 Znhkw BIpt¼mÄ km[mcW Ipdbmdpv. 14 Znhkw hsc Nne Ip«nIÄ¡v jaundice ImWmdpv. Normally 33,49 F¶n§s\ fast Bbn«v IqSm³ {]tXyIn¨v ImcWw H¶pw InÃ.
Manual of neonatal care F¶Xv authenticated book BWv. icnbmb bilirubin level ]dªn«nÃ. GXp range emWv dangerous F¶pw, Ft¸mgmWv safe F¶pw]dªn«nÃ. Nne Ip«nIÄ¡v sNdnb AfhnemWv brain tebv¡v _m[n¡p¶Xv. Nnet¸mÄ henb Afhnepw _m[n¡p¶Xmbn ImWmdpv. CXnsâ ImcWw blood brain barrier different BbXv sImmWv. One of the factors is genetics. Premature babies is another factor, infections, hypoxia are the another factors. Cu hI factors. H¶pw Cu baby¡v Dmbncp¶nÃ.
Nne tIkn F{X \à treatment sImSp¯mepw Ip«nIfn _m[n¡mdpv. IqSpXembn premature babiesemWv kw`hn¡mdpÅXv. Ususally 4 aWn¡qÀ CShn«mWv bilirubin check sN¿mdpÅXv. 33 Bbt¸mgmWv R§fpsS hospital F¯p¶Xv 8/8/\v 26 Dmbncp¶p. (referring Ext.B1) between 25 – 30 phototherapy acceptable BWv. Ipdbp¶nsænemWv blood amÁnshbv¡p¶Xv. Ext.B1 {]Imcw medicinesDw double side phototherapybpw sImSp¯n«pv. 26mg bpw active Bbncp¶XpsImpw phototherapy aXn. 4 – 6 hours t\m¡nbn«v 26 \n¶pw Ipdbp¶nsæn blood amÁnshbv¡pw. Bilirubin level.Dw blood brian barrier brains\ _m[n¡mdpÅ factorsBWv. Blood brain barriersâ resistance genetic BWv.
Difficult to say that there is negligence on the part of opposite parties. Fs´Ãmw treatment sImSp¯mepw Nne babies\v C§s\ kw`hn¡mw.
In the authoritative book, manual of neo-natal care it is stated as follows:
The neuropathologic changes seen in preterm infants with kernicterus may be due to the prior nonspecific damage and not to the bilirubin. It has been shown that when the blood-brain- barrier is altered albumin-bound bilirubin will enter the brain. These new data indicate that there is no specific bilirubin level that is definitely ‘safe’ or ‘toxic’ for all infants.
On going through the above depositions and authoritative test, we are of the view that the opposite parties has not deviated from the standard practice followed by the persons of the same profession. Even though we have sympathy towards the child, we are not in a position to attribute medical negligence without cogent and convincing evidence. Complainant miserably failed to prove case of medical negligence against opposite parties.
In the result complaint dismissed.
Pronounced in the open court on the 30th day of March 2012
Sd/-
Seena.H
President
Sd/-
Preetha G Nair
Member
Sd/-
Bhanumathi.A.K.
Member
APPENDIX
Exhibits marked on the side of the complainant
1.Ext. A1 – Blood Report and Urine Analysis report dtd.10/5/10
2.Ext. A2 – Ultra sound and Doppler requisition test dt.10/6/10
3.Ext.A3 – Karuna Hospital bill for Rs.575/-dated 10/5/10
4. Ext A4 – Urine analysis report dated 24/7/10
5. Ext A5 – Doppler report dated 14/7/10
6. Ext A6 – Test report dated 7/8/10 of Karuna Hospital
7. Ext A7 – Test report dated 8/8/10 of Karuna Hospital
8. Ext A8 – Test bill dated 9/8/10
9. Ext A9 –Discharge summary dated 14/8/10 of JM Medical College Hospital, Thrissur.
10. Ext A10 – Pharmacy bill dated 9/8/10 of JMMC Hospital
11. Ext A11 – Pharmacy bill dated 12/8/10 of JMMC Hospital
12. Ext A12 – Pharmacy bill dated 13/8/10 of JMMC Hospital
13. Ext A13 – Pharmacy bill dated 14/8/10 of JMMC Hospital
14. Ext A14 – OP ticket dated 28/9/10 of JMMC Hospital
15. Ext A15 – OP ticket dated 8/11/10 of JMMC Hospital
16. Ext A16 – Copy of Hospital bill dated 8/11/10 of JMMC
17. Ext A17 – Copy of OP ticket dated 30/11/10 of JMMC
18. Ext A18 - Pharmacy bill dated 30/11/10 of JMMC Hospital
19. Ext A19 – Pharmacy bill dated 28/12/10 of JMMC Hospital
20. Ext A20 – Electrophysiological study report dated 31/1/11
21. Ext A21 – Taxi rent receipt dated 9/8/10
22. Ext A22 – OP receipt dated 9/8/10 of JMMC
23. Ext A23 – Train ticket dated 14/8/10
24. Ext A24 – OP receipt dated 28/1/11 of JMMC
25. Ext A25 – Pharmacy bill dated 3/2/11 of JMMC
26. Ext A26 – Pharmacy bill dated 4/3/11 of JMMC
27. Ext A27 – OP bill dated 6/1/11
28. Ext A28 –Train ticket dated 31/1/11
29. Ext A29 – Train ticket dated 3/2/11
30. Ext A30 – OP bill dated 6/5/11
31. Ext A31 – Pharmacy bill dated 6/5/11 of JMMC
32. Ext A32 – Hearing test cash bill dated 28/5/11
Witness examined on the side of the complainant
PW1 – Dr.Aparna Namboothiripad
Exhibits marked on the side of the Opposite Party
1.Ext.B1 - Case Record of Karuna Hospital
Witness examined on the side of the Opposite party
DW1 – Dr.Jayaprakash
Cost (allowed)
No cost allowed
