8. Case was managed by a team of Physician, Cardiologist and Anaesthesiologist.  On 07.02.2007 patient was out on ventilation weaning mode and switched to ‘T’ piece with 10 liters of oxygen.  But after 3 hours, patient developed respiratory distress and oxygen desaturation and hence reconnected to SIMV mode and ventilation continued, to avoid hypoxic brain damage.  Condition of the patient explained to the relatives.  On 08.02.2007, patient’s relatives insisted for disconnecting the ventilator and removing the endodracheal tube.  The risk of doing so, without step down weaning was explained to the relatives.  But as per their written request, patient was extubated at 9-50 a.m. on 08.02.2007 and she was discharged at request against medical advice, as the relatives wanted to take her home.

                   9. They have done their best medically, in this matter, to the best of their knowledge and ability and only because of the competent and timely care given by the team of doctors consisting of Physician, Cardiologist and Anaesthesiologist, this patient could be tided over the medical emergency.

                   10. On the basis of the preliminary findings including C.T. chest done on 02.02.2007, the patient was advised to pleural biopsy done at R.C.C., Thiruvananthapuram.  Opposite parties denied the allegations that the complainants were not allowed to visit the patient in the ICU.  They were allowed to visit the patient according to the standard protocol followed in the ICU.  The patient’s condition was also informed whenever required.  The patient was intubated by the duty physician on 04.02.2007 and not by the third opposite party on 03.02.2007.  There is no medical negligence or improper management and the patient was given all required care the round clock.  Only required medicines were given and the bills were also normal.  The patient was discharged on request and against medical advice.  The patient was put on ventilatory support for the coronary artery heart diseases and as such removal from the hospital was risky.  But due to heavy pressure for discharge at their risk, she was discharged after obtaining due consent.  No signed blank papers were obtained from the relatives.  Opposite parties obtained only required papers.  The opposite party has not committed any medical negligence or defective service or any unfair trade practice.  The first opposite party was duly insured with ICICI Lombard General Insurance Company for the period of the treatment of the patient and the said insurance company is also a necessary party to this proceedings.  The District Medical Officer, Pathanamthitta, Dy. Supdt. of Police and the Circle Inspector of Police also conducted detailed enquiry in this matter on the basis of the complaint made by the complainants to the Government and the enquiry findings is in favour of the opposite parties.  With the above contentions, opposite parties 1 to 3 pray for the dismissal of the complaint with their cost. 

                   11. On the basis of the version of opposite parties 1 to 3, Dr. Devarajan, Cardiologist of the first opposite party’s hospital and ICICI Lombard General Insurance Company were impleaded as additional 4^th and 5^th opposite parties.

                   12. Additional 4^th opposite party entered appearance and filed his version.  The contentions raised by the additional 4th opposite party in his version is similar and same as that of the version of the opposite parties 1 to 3.  So we are not repeating the contentions of the additional 4^th opposite party.  Additional 4^th opposite party has also prays for the dismissal of the complaint as he had not committed any deficiency of service or negligence to the patient.

                   13. Additional 5^th opposite party is exparte.

                   14. On the basis of the pleadings of the parties, the only point to be considered is whether this complaint is allowable or not?

                   15. The evidence of this complaint consists of the oral evidence of PWs.1 to 5 and DW1 and Exts.A1 to A9 and Exts.B1 to B3.  Both sides were filed their argument notes.  After closure of evidence, both sides were heard.

                   16. The point:  The complainant’s allegation against the opposite parties is that deceased Sosamma Mathew, wife of the first complainant, was admitted at the first opposite party’s hospital on 01.02.2007 for complaints of pain in the neck and pleuritic pain on the right side of the chest and she was treated by opposite parties 2 and 3 and additional 4^th opposite party.  Because of the negligent treatment given by the opposite parties, the said Sosamma Mathew had developed other complications like oedema and respiratory and heart complications and she was put in ventilator support in the ICU and conducted various tests and administered various medicines.  The complainants were not allowed to see the patient and the opposite parties did not provide any information regarding the progress and condition of the patient.  Thereby the complainants are kept in the dark about the patient’s condition and treatment.  Further, the opposite parties issued exorbitant bills for the treatment, which is not affordable to the complainants.  According to the complainants, the procedures adopted by the opposite parties are unnecessary and are not warranted to a patient like Sosamma Mathew and the opposite parties acted in such a way only for squeezing money from the complainants.  Therefore, the complainants requested the opposite parties to discharge the patient for further treatment elsewhere affordable to the complainants.  But the opposite parties denied the demand of the complainants and at last on 08.02.2007 the patient was discharged against medical advice due to the pressure of the complainants.  The patient was taken to Fellowship Mission Hospital, Kumbanad and continued her treat there from 08.0.2.2007 15.02.2007 without ventilator support and other facilities unnecessarily provided by the opposite parties and her condition was improved.  The above said acts of the opposite parties is clear deficiency of service, negligence and unfair trade practice.  Thereby the complainants have sustained financial loss and mental agony and the opposite parties are liable to the complainants for the same.

                   17. In order to prove the complainants’ case, the third complainant filed a proof affidavit for and on behalf of the complainants.  On the basis of the proof affidavit, the third complainant was examined as PW1 and the documents produced were marked as Exts.A1 to A7.  Dr. N. Damodaran, Retired District Medical Officer, Dr. P. Raju. P. George of Fellowship Mission Hospital, Kumbanad, one Jacob Tharian, relative of the complainants and Dr. Annamma Daniel of Fellowship Mission Hospital, Kumbanad were examined as PWs. 2 to 5 and marked Exts.A8 and A9 also for the complainants. 

                   18. Exts.A1 is the Discharge Summary dated 08.02.2007 issued by the second opposite party in respect of the treatment of the patient at the first opposite party’s hospital.  Ext.A2 series are the medical bills issued from the first opposite party’s hospital in connection with the treatment of the patient.  Ext.A3 is the Discharge Summary issued from Fellowship Mission Hospital, Kumbanad in respect of the treatment of the patient from 08.02.2007 to 15.02.2007.  Ext.A3(a) is the Medical Certificate dated 15.02.2007 issued from Fellowship Mission Hospital, Kumbanad in respect of the treatment of the patient.  Ext.A4 is the copy of notice-dated 05.03.2007 issued by the patient Sosamma Mathew to opposite parties 1 to 3.  Exts.A4(a), A4(b) and A4(c) are the postal receipts of Ext.A4 notice and Exts.A4(d) to Ext.A4(f) are the postal acknowledgment cards of Ext.A4 notice.  Ext. A5 is the reply issued by the Chief Medical Officer of the first opposite party to Sosamma Mathew in reply to Ext.A4 notice.  Ext.A6 is the copy of the certificate issued from Mylapra Grama Panchayat in respect of the death of Sosamma Mathew.  Ext.A7 is the enquiry report dated 11.04.2007 of District Medical Officer, Pathanamthitta in respect of the allegations of the complainants against the opposite parties on the basis of the complainants’ complaint to the Chief Minister of Kerala.  Exts.A8 and A9 respectively are the certified copy of the front cover of the outpatient file and discharge summary of Fellowship Mission Hospital, Kumbanad in respect of the treatment of the patient.

                   19.  On the other hand, the contentions of opposite parties is that the patient was admitted on 01.02.2007 in the ICU as she was sick and had complaints dyspnoea and pain in chest and neck.  She was examined by the Physician and Cardiologist and she had given proper treatment and medicines on the basis of the investigations and she was also found suspected cancer.  So the relatives are advised to get pleural biopsy done at R.C.C. Thiruvananthapuram.  While so on 04.02.2007, patient developed sudden cardio respiratory arrest and hence she was put on ventilator with informed written consent from her son and this position continued till her discharge against medical advice.  During these days she was given proper care and treatment.  But in the meantime, the relatives insisted for the discharge of the patient by saying that the bills issued are not affordable to them.  But the patient’s condition was serious and critical, the discharge of the patient is dangerous and risky and this was also informed to the relatives.  But they are not prepared to accept the same.  So at last on 08.02.2007, after having discussions with the concerned doctors, opposite parties discharged the patient against medical advice.  The treatments and other informations regarding the patient after discharge from the opposite parties’ hospital is not known to the opposite parties.  According to the opposite parties, what all treatments, medicines, tests and other procedures adopted by the opposite parties are correct and as per medical ethics and are also warranted in the case of the patient.  The bills were also normal.  So they argued that they have not committed any negligence, deficiency of service and unfair trade practice as alleged by the complainants.  A notice received from the patient was also replied.  On the basis of the complaints of the complainants before the Chief Minister of Kerala, the District Medical Officer also conducted an enquiry in this regard and his enquiry report also justifies the contentions of the opposite parties.

                   20. In order to prove the contentions of the opposite parties, the second opposite party filed a proof affidavit for the opposite parties.  On the basis of the proof affidavit, second opposite party was examined as DW1 and the documents produced were marked as Exts.B1 to B3.  Ext.B1 is the medical records pertaining to the treatment of the patient at the first opposite party’s hospital from 01.02.2007 to 08.02.2007.  Ext.B2 is the Outpatient record pertaining to the treatment of the patient at the first opposite party’s hospital.  Ext.B3 is the ECG observations of the patient taken on 07.02.2007 at 06-40 a.m. 

                   21. On the basis of the contentions and arguments of the parties, we have perused the entire materials on record and found that there is no dispute regarding the admission and discharge of the patient from the hospital.  But according to the complainants, opposite parties conducted unnecessary tests and the patient was put to ventilator support unnecessarily.  The patient’s condition from her admission to her discharge was not properly brought to the notice of the complainants and her health conditions during that period did not warranted for putting her to ventilator support and the bills issued were also exorbitant and not affordable to the complainants.  So the complainants requested for the discharge of the patient, which was not yielded by the opposite parties by saying that the patient was not in a position to discharge due to the critical condition of the patient.  Actually, the patient was not in a critical condition and all the above said acts of the opposite parties are for extracting money from the complainants. 

                   22. But the opposite parties’ argument is that the patient was in a critical condition and whatever treatments and medicines including ventilator support are warranted in the circumstances of the patient and thus they have not committed any deficiency of service or unfair trade practice. 

           23. In the absence of any expert evidence from the side of the complainants, and on the basis of the available evidence, we could not find any negligent treatment from the side of the opposite parties or they have conducted unnecessary tests and they have prescribed unnecessary medicines.  But it is seen from Ext.A7 enquiry report and from the deposition of PW2, the complainants have requested the opposite parties for the discharge of the patient on 06.02.2007 and the patient’s condition was fit for discharge on that day.  But PW2 immediately denied this aspect when a leading question was put to the witness by the counsel for the complainants for getting more clarifiaction.  PW2 adds extubation of an intubated person depends on various factors and such factors are not found in the medical records examined by him.  The relevant portions of the deposition of PW2 is as follows:- “At\zjW¯n lÀPn¡mcnbpsS amXmhns\ hospital bill affordable AÃm¯XpsIm­v asähnsSsb¦nepw sIm­pt]mIp¶Xn\v discharge sN¿Wsa¶v opposite party 2-hnt\mSv 6.2.07þ Bhiys¸«Xmbn a\Ênembn«p­v.............6.2.07þ  patientþs\ discharge sN¿m³ ]äm¯ AhØbnembncp¶psh¶v Dr. Susan Tharian ]dªn«pÅXmbn AhcpsS samgnbn tcJs¸Sp¯nbn«p­v.................. 6.2.07þ  patientþs\ discharge sN¿m³ ]äm¯ AhØbnembncp¶psh¶v Hcp tUmIvSdpw samgn \ÂInbn«nÃ. 6.2.07þ  patientþs\ discharge sN¿m³ ]äm¯ AhØbnembncp¶psh¶v tUmIvSÀamÀ ]dbpItbm hospital recordþIÄ {]Imcw t_m²ys¸SpItbm sNbvXn«nÃ.  Cu kmlNcy¯n patientþs\ discharge sN¿p¶XpsIm­v bmsXmcp Ipg¸hpw D­mhpIbnÃmbncp¶p F¶v hmZnIÄ ]dbp¶p? (Q) icnbÃ. (A).  He adds Hcn¡Â ventilator \evIn Ignªm AXv remove sN¿Wsa¦n patientþ\v ]e Imcy§fnepw improvements (Recovery) D­mhWw.  6.2.07þ Cu patient B Hcp AhØbn F¯nbncp¶nsöv Rm³ ]cntim[n¨ medical records sIm­v a\Ênembn«pÅXmWv.  AXpsIm­mWv discharge sN¿m³ Ignbm¯ AhØbnembncp¶psh¶v ]dbm³ ImcWw”.

                   24. At the same time, DW1 in cross examination deposed that at the time of discharge of the patient on 08.02.2007, the patient’s condition was not fit for extubation, but the patient was extubated and discharged on the compulsion of the relatives and on 07.02.2007 as per the request of the relatives, opposite parties extubated the patient, but intubated immediately as intubation is required for the patient.  The relevant portion of the deposition of DW1 is as follows: “patientþs\ 8þmw XobXn discharge sN¿p¶ kabw intubation Bhiyambncp¶p.  F¶m _Ôp¡fpsS \nÀ_Ô{]Imcw extubation \S¯nbmWv discharge sNbvXXv.  ventilatorþ \n¶pw tcmKnsb amäWsa¶v 7þmw XobXn _Ôp¡Ä Bhiys¸«p.  AX\pkcn¨v disconnect sNbvXpsh¦nepw ventilator Bhiyaps­¶p ImWpIbpw ho­pw reconnect sN¿pIbpw sNbvXn«p­v”. 

                      25. One part of the deposition of PW2 shows that the statements of opposite parties recorded by PW2 in the course of his enquiry, the patient’s condition was fit for discharge on 06.02.2007 whereas the other part of the deposition of PW2 and the deposition of DW1 shows that the patient’s condition was not fit for extubation and discharge and the discharge was made under compulsion and was against medical advice.  But there is no evidence to show that the patient was intubated at her admission at Fellowship Mission Hospital, Kumbanad immediately after the discharge from the opposite parties’ hospital on 08.02.2007.  It is very clear from Exts. A3 and A3(a) and the deposition of PW5.  The relevant portion of the deposition of PW5 is as follows: -“patientþs\ NnInÂkn¨ncp¶ Imebfhn Fs´Ãmw NnInÂkIÄ \evInbncp¶psh¶v Ext. A3þ hniZambn ]dªn«p­v.  Artificial intubation \ÂInbncp¶Xmbn Ext. A3 tcJbn ImWp¶nÔ.    

                   26. All the above facts show that the claim of the opposite parties regarding the condition of the patient is beyond realities and is an exaggeration.  The opposite parties also failed to prove that the patient was intubated immediately after the discharge.  The patient was discharged by the opposite parties on 08.02.2007 at 10-50 a.m.  As per Ext.A3, the patient was admitted at Fellowship Mission Hospital, Kumbanad on 08.02.2007 at 3-25 p.m. and discharged on 15.02.2007 at 5-00 p.m.  As per Exts.A3 and A3(a) during the patient’s treatment at Fellowship Mission Hospital, Kumband, she was without ventilator support.  In the circumstances, we find that the opposite parties acted against medical ethics, which is no doubt, a clear deficiency in service and is an unfair trade practice and the said unwarranted treatments and procedures adopted in this case by the opposite parties is for squeezing money from the complainants and the opposite parties are liable to the complainants to that extent.  Therefore, this complaint is allowable with modification.  However, opposite parties 2 to 4 are the employees of the first opposite party, the first opposite party is vicariously liable to the complainants. 

                   27. In the result, this complaint is allowed in part, thereby the first opposite party is directed to return the 50% of the treatment expenses as per Ext. A2 medical bills along with compensation of ` 25,000 (Rupees Twenty five thousand only) and cost of ` 3,000 (Rupees Three thousand only) to the complainants within 30 days from the date of receipt of this order, failing which the complainants are allowed to realise the whole amount from the first opposite party with 10% interest per annum from today till the whole realisation.  The first opposite party is at liberty to realise the decreed amount from the additional 5^th opposite party after making payments to the complainants, if there is a valid insurance policy as claimed by the first opposite party.  

                   Declared in the Open Forum on this the 16^th day of August, 2011.

                                                                                                       (Sd/-)

                                                                                                Jacob Stephen,

                                                                                                   (President)

Sri. N. Premkumar (Member)                 :         (Sd/-)

Appendix:

Witness examined on the side of the complainants:

PW1  :         Mathew Varghese.

PW2  :         Dr. N. Damodaran.

PW3  :         Dr. Raju. P. Geroge.

PW4  :         Jacob Thariyan.

PW5  :         Dr. Annamma Daniel.

Exhibits marked on the side of the complainants:

A1     :         Discharge Summary dated 08.02.2007 issued by the second

                     opposite party. 

A2     :         Medical bills issued from the first opposite party’s hospital in

                     connection with the treatment of the patient.

A3     :         Discharge Summary issued from Fellowship Mission Hospital,

                     Kumbanad from 08.02.2007 to 15.02.2007.

A3(a)          :         Medical Certificate dated 15.02.2007 issued from Fellowship

                      Mission Hospital, Kumbanad in respect of the treatment of the

                      patient.

A4     :         Copy of notice-dated 05.03.2007 issued by Sosamma Mathew to

                      opposite parties 1 to 3.

A4(a), A4(b) and A4(c) :  Postal receipts of Ext.A4 notice.

A4(d) to Ext.A4(f)  :   Postal acknowledgment cards of Ext.A4 notice.

A5     :         Reply notice issued by the Chief Medical Officer of the first

                     opposite party to Sosamma Mathew in reply to Ext.A4 notice.

A6     :         Copy of the certificate issued from Mylapra Grama Panchayat in

                      respect of the death of Sosamma Mathew.

A7     :         Enquiry report dated 11.04.2007 of District Medical Officer,

                      Pathanamthitta on the basis of the complainants’ complaint to the

                      Chief Minister of Kerala.

A8 and A9 :  Certified copy of the front cover of the outpatient file and

                      discharge summary of Fellowship Mission Hospital, Kumbanad

                       in respect of the treatment of the patient.

Witness examined on the side of the opposite parties:

DW1 :         Dr. Jolly. V. Mathew.

Exhibits marked on the side of the opposite parties:

B1     :         Medical records pertaining to the treatment of the patient at the

                     first opposite party’s hospital from 01.02.2007 to 08.02.2007.

B2     :         Outpatient record pertaining to the treatment of the patient at the

                     first opposite party’s hospital. 

B3     :         ECG observations of the patient on 07.02.2007 at 06-40 a.m.

                                                                                                (By Order)

                                                                                          Senior Superintendent

Copy to:- (1) Skariah Mathai, Puthenchirayil House, Mekozhoor P.O.,            

                       Pathanamthitta.

       (2) Medical Officer/Managing Director, Mar Gregorios Memorial   

             Muthoot Medical Centre, College Road, Kozhencherry – 689 641

(3)  Dr. Jolly. V. Mathew, MGM Muthoot Medical Centre, College     

      Road, Kozhencherry – 689 641.

(4)  Dr. Susan Tharian, MGM Muthoot Medical Centre, Kozhencherry – 689 641.

(5) Dr. Devarajan, Cardiologist, MGM Muthoot Medical Centre,

                       College Road, Kozhencherry.

        (6)  ICICI Lombard General Insurance, ICICI Bank Towers,

                        Bandra Kurla Complex, Mumbai – 400 051.

                  (7) The Stock File.