This is an application u/s.12 of the C.P. Act, 1986.
Complainant by filing this complaint has submitted that the complainant is the son of Sandhya Charit and the mother of the complainant was in a religious fasting on 14th April, 2007 and on the following date she started vomiting several times and the said vomiting continued for next two days and as such a physician called on and she was being treated at her home by such local physician, but she developed confusion and disorientation on 17th April, 2007 and in such situation for better treatment she was admitted in Marwari Relief Society Hospital, (OP1) in general ward under attending doctor S.R. Baheti.
On admission of the mother of the complainant OP1 treated her and one CT Scan of Bran was also advised and it was done at Goutam Laboratories and CT Scan report resulted as normal and blood investigation revealed that there is severe Hyponatremia. Thereafter, neither the OP1 nor any doctor of the OP took any steps and advised for any treatment to the patient for which the condition of the mother was deteriorated and pursuant to advice of the then attending physician she was transferred to ITU since there is no alternative in the aid hospital and the reason behind the deterioration of the condition of mother was insufficiency of Sodium and Potassium in blood and for which the patient became partly comatosed and condition became serious.
Dr. Saroj Soni, the OP3 was at that time in ITU and Dr. Sony recommended for the better treatment of her mother and referred to Dr. S. K. Somani (OP4) herein, a renowned Neurologist and accordingly Dr. Soni engaged Dr. Somani for a considerable period when Dr. Somani was needed for consultation against consultation charges through the payment of which was payable to Dr. Somani by your complainant though Marwari Relief Society Hospital and, thereafter, Dr. Somani visited and diagnosed the disease of the patient and recommended for hypertonic saline and as per advice of Dr. S.K. Somani, the patient was intubated with hypertonic saline under the supervision of Dr. S.K. Somani, Dr. Maheswari and Dr. S. Son I for restoration of normal position of Sodium and Potassium in the blood of the patient. After application of hypertonic saline the condition of Sodium and Potassium was increased in the blood and developed from 100 and 2.20 to 142 and 2.9 respectively in the blood which is normal tolerable level in a human body.
After application of hypertonic saline in the blood of the patient through injection and medicine it was gradually started to become normal as on 17-04-2007, the patient was unable to identify anybody, could not talk even as she was partly comatosed but on 20-04-2007 Sodium and Potassium level became normal for using a hypertonic saline, the patient gradually became fit and talked with everyone of the family and on the same date Dr. Santosh Maheswari, Dr. S.K. Somani who were treating the patient along with Dr. Saroj Soni and three other doctors in ITU could not be ascertained and told to the complainant that her mother would be discharged within a week from the hospital as she was in good condition and rapidly improving her physical condition and for which the complainant and his family members were prepared to bring the patient back at home.
However, on 20-04-2007 when the mother of the complainant became well and talked with the family members because Sodium and Potassium were duly balanced in the blood as per laboratory report of blood of the mother of the complainant. Surprisingly due to negligence of the OP and for non-removal of the hypertonic saline from the morning of 21-04-2007 complainant’s mother became comatosed, breathless, hypotensive and it was revealed from the blood test report that the ratio of Sodium in the blood was increased by 158 i.e. exceeded limit of normal ratio due to non-removal of hypertonic saline and, as such the condition of the patient was deteriorated and Dr. Santosh Maheswari and Dr. S. Soni advised to remove the patient to any better hospital or nursing home. It is the duty and obligation on the part of the concerned doctor of the OP1 to provide proper advise treatment and service to the patients but in the instant case the act of the OP1 was apathetic, improper and negligent and for which the complainant’s mother was the worst sufferer and ultimately her condition become deteriorate and, in fact for negligent manner of treatment the condition of the mother become serious and practically it is reflected in the balance of Sodium and Potassium became normal yet as the hypertonic saline still applied t the mother of the complainant the limit of Sodium and Potassium in the blood of the mother of the complainant exceeded the normal limit and ultimately her condition became serious and in the above situation on 21-04-2007 mother of the complainant was removed to Woodland Nursing Home in a deep coma condition and she was treated there by Dr. Suresh Choraria, Dr. Sitangsu Sekhar Nandi and Dr. Sundar Naraya, who came to a conclusion that it was a case of Central Pointe Mayelinolysis which was caused due to inadequate, huge and abnormal application of hypertonic saline which was negligently applied by the concerned doctors of OP Hospital.
Thereafter, on 03-05-2007 complainant due to stringency of money was removed to Gamma Centuari Healthcare Pvt. Ltd. under Sabyasachi Sen and Dr. Sumanta Kumar and after careful observation the concerned doctors opined that the brain cell of the mother of the complainant was damaged due to excessive application of hypertonic saline and the mother of the complainant was under treatment of the above mentioned doctors till 10-08-2007 and ultimately complainant’s mother passed away.
In the above circumstances, complainant has prayed for compensation for causing serious condition of his mother by OPs Doctors for their negligent and deficient manner of treatment and for wrong treatment.
On the other hand OP3 Dr. Saroj Soni has submitted that Sandhya Charit was first brought to the emergency ward of the Marwari Relief Hospital, the OP1 on 17-04-2008 sometime around on 9:45 a.m. unconscious and as such her history was taken from the relatives who had accompanied her to the hospital. Thereafter, after thorough diagnosis and tests treatment was started conservatively and she was put in saline on her admission with the hospital. However, after sometime the patient developed convulsion and the condition became very serious and she was transferred to ITU of the OP1 hospital where the ITU parameters that were monitored showed that the Spa O2 was only 80percent whereas the normal range is 100percent. Accordingly the patient was advised to be intubated and was put on T piece for better oxygen management and thereafter, after considering all the reports it was found that patient’s Na was 100meq/L whereas the normal was 135-145, her K was 2.2 mgs whereas the normal was 3.5 – 4.5. Accordingly, the Na and K deficit was calculated and accordingly hypertonic saline with other medicine was started to increase the Na and K levels to normalcy. As per report of other tests and diagnosis it is found that she was a patient of neurological complications, Dr. S.R. Baheti was attended her and he also made all sorts of treatment properly. But Dr. Somani after examining the reports and the patient opined that the patient was a case of Coma lively due to severe hyponatremia. Dr. Somani advised to continue 3percent Nacl and anti convulsants and 1mg KCL which was started on that evening. On 18-04-2007 morning the patient was showing signs of gradual improvement. As a routine the Na+ and K= level examination was sent which confirmed that the Na level has increased from 100 meq/L and K from 2.2 to 2.3 meq/L and on the said date at evening Dr. Somani again came and visited the patient and noted that the condition of the patient has improved as the patient was responding to painful stimulus so, Dr. Somani advised to continue the same treatment. On that date Dr. S.R. Baheti was on leave for certain personal reason so, Dr. S. Maheswari reviewed the patient on his place. As per his advice the routine Na+ and K= levels were examined and advised treatment was properly given and subsequently, Dr. Somani came and reviewed Na+ level increased to 118 meq/L and K+ levels increased to 2.4 mgs. Upto 20-04-2007 Na+ was at 134 meq/L and K+ was 2.7 meq/L. As the Na+ levels already reached normalcy the 3percent Nacl saline was stopped but K+ infusion was continued which was still below normal and suspecting possibility of runaway hypernatramia, the Na+ was again advised and report was received in late evening which showed the Na+ level at 142 meq/L and at this point patient was examined by Dr. Somani and he found the patient in better position. Patient spontaneously opened the eye and had showed tongue. On 21st morning the patient developed respiratory distress and was having crepts and roschi in chest. It was suspected that the patient had developed ARDS/LVF. She was treated for LVF by administering appropriate medicines but in respect of improper medicine patient went into shock and her blood pressure was low and condition of the patient was administered Dopamin, Dytax, lasix etc. and while taking care of these complication patients attendants forced to administration to release the patient and accordingly as per their desire the patient was released and directed to give proper treatment from higher medical hospital and nursing home. Except there was no laches and negligence on the part of the OP and entire allegation as made by the complainant in view of the fact the normal process of treatment is duly given and in all respects improvement was OK so the allegation as made by the complainant is completely false.
OP5 Santosh Maheswari supported the fact reported and also submitted some version made by the OP3. OP2 Dr.S.R. Baheti confirmed that version of OPs3 and 5 and prayed for dismissal of the case.
Dr. Somani also filed written statement and supported the other OPs and prayed for dismissal of the complaint.
OP2 also filed written statement and confirmed the version of the other OPs and prayed for dismissal of the case.
Decision with Reasons
On indepth study of the complaint and the written version and also considering the material documents as filed by the complainant it is clear that undisputed fact that complainant’s mother was admitted to OP’s hospital on 17-04-2007. Thereafter treatment was started at Marwari Relief Society Hospital by the OP doctors and ultimately on 21-04-2007 patient was removed to Woodland Nursing Home where she was treated up to 3rd May, 2007. Thereafter, she was removed to Gama Centurian Healthcare Pvt. Ltd. and ultimately died there on 10-08-2007. So, it is clear that from 17-04-2007 to 10-08-2007 for long about 4 months at different nursing home the treatment was continued. After proper consideration of the reports it is found that from 22-04-2008 to 29-04-2008 at Woodland Nursing Home Sodium level was within the limit of 150.8 meq/L to 139.7 meq/L and Potassium level was 2.59 to 4.67 and this chart of sodium and potassium level is collected from the report of the Woodland Nursing Home but from the report of the OPs’ Hospital it is found that at OPs’ Hospital when she was admitted sodium level was 80 and potassium level was 2.1 but on the date of removal of the complainant’s mother from OPs’ hospital to Woodland Nursing Home the potassium level was 2.7 and sodium level was 134 and further considering the treatment sheet of the Woodland and Gama Centurian Healthcare Pvt. Ltd. it is found that both the hospitals adopted the same treatment for increasing the level of potassium and sodium but complainant has submitted very specifically that the OP Hospital and their doctors did not properly treated the lady and they did not consider that balance and sodium and potassium became normal but even then hypertonic saline was still applied and practically sodium and potassium level was increased upto the normal limit which caused sharp deterioration of the condition of the patient. Against this allegation we have considered the report of Woodland Nursing Home wherefrom it is found that from 22-04-2007 to 29-04-2007 level of sodium was 150.8 me/L to 139.7 meq/L and potassium level was from 2.59 to 4.67 but on the date of discharge from Marwari Relief Society Hospital it is found that the sodium level of the complainant’s mother was 156 meq/L and potassium level was 2.9. Pulse rate was 118 per minute, blood pressure was 90/160. But after comparing the said report of Marwari Relief Society Hospital and Woodland Hospital it is found that from 21-04-2007 to 29-04-2007 sodium level of the patient was gradually decreasing but potassium level was increasing but the process of treatment as adopted by the Woodland Hospital was same in nature as adopted by Marwari Relief Society Hospital. So, considering the treatment of the Marwari Relief Society Hospital we find that complainant mother’s potassium and sodium level were increased gradually from the date of admission on 17-04-2007 and till 21-04-2007 i.e. date of discharge.
Now, question is whether the OPs’ gave any extra dose even after improvement of the potassium and sodium level or not and whether the treatment procedure as adopted by the OP was accepted medical treatment procedure or not. In this regard we have already after considering the materials found apparently both the parties failed to give any positive answer before this Forum whether after improvement of the potassium and sodium level the treatment can be continued by giving same saline for stability of the patient or not and that is the vital question and for that purpose. Complainant put such questions to the expert doctors who already opined as same was referred by this Forum for getting the expert opinion in respect of the particular dispute.
Thereafter, as per complainant’s questionnaire same was referred to Office of the Medical Superintendent-cum-Vice Principal, Medical College and Hospitals, Kolkata for placing the matter before the Standing Board of Medical College Hospital for answering the questions as made by the complainant. accordingly, the Standing Medical Board, Government of West Bengal assisting of five doctors of different department answer all the questions and the doctors have specifically answered that the cause for said disease of the patient was due to mal nutrition after prolonoged diuretic use etc and it is associated with acute development of hyponatremia and it is specifically mentioned by the doctor against the question put by the complainant that it may occur with rapid correction of hyponatramia and even without it(ran away hypernatramia). Further it is answered after consulting all the papers the Board of Doctors came to a conclusion that serium sodium was less than 100 meg/L on 17-04-2007 and gradually rose to 158 meg/L on 21-04-2007 and in between figures in different days and sodium supplement was done by hypertonic saline at the beginning and changed to half normal saline when it started to rise abruptly. As it was found from the treatment sheet issued by the Marwari Relief Society Hospital and considering those the Board of Doctors have confirmed that the methodology of treatment and management as made by the doctors is medically acceptable but it is specifically mentioned even if there is a chance of development of hypernatramia. Further answered that consider the clinical condition and other factor and body condition as evident from the materials BHT there may be causative conditions one of which may be EPM and CT Brain shows symmetric demyelintion in different areas brain but that is no way specific for EPM (MRI Brain report is not available). Further doctor has submitted that central pontine myelinolysis is a clinical condition characterized by loss of myelin in pons (as well as extra pontine region-called EPM) characterized by coma, confusion, quadriplegia, pseudobalbar palsy and having characteristic radiological features in MRI. These answers were given by the Medical Board as made by the complainant and Medical Board after consulting entire materials record, reports of MRI opined that the sodium and potassium level had been increasing abruptly. Doctors of Marwari Relief Society Hospital changed the dose to half normal saline when it was detected the sodium and potassium level rose abruptly and this process and method as adopted by the OP was completely medically acceptable and that was the procedure but the Board of Doctors have opined even after adoption of such a treatment there was a development of hypernatramia and it is not possible to say when it shall be further fall or increase.
Anyhow, even after considering the report of the Medical Board of Doctors as per questionnaire made by the complainant we have also consulted the medical report of Marwari Relief Society Hospital and including the report of Woodland Nursing Home and after comparative study of the medical report we have gathered that during the stay at hospital the potassium and sodium level of the patient was increased gradually and on the date of release from OP’s Hospital for her shiftment to Woodland as per request of the complainant the actual level of potassium and sodium with the range of 2.4 (potassium level) and sodium level was 134 but when on 21-04-2007 patient was admitted to Woodland Nursing Home at that time at that date sodium level was 150.8 meq/L and potassium level was 2.9 but gradually sodium level was decreased and potassium level was increased and accordingly on 29-04-2007 sodium level was 139.7 meq/L and potassium level was 4.67. If we consider that fact in this case it is clear the treatment as adopted by the OP doctors was continued and improvement was found in the hospital of the OPs and also in the Woodland Nursing Home and ultimately on 29-04-2007 normal sodium and potassium level was found but even then Woodland Nursing Home doctors also fails to give the life to the mother of the complainant. So, considering very minutely all the medical reports including the opinion of the medical Board of Doctors as filed by the Medical Board of Doctors of Medical College and Hospital we are convinced same method of treatment was adopted by the Woodland Nursing Home as adopted by the OPs Hospital and doctors and that is the acceptable medical management of hypernatramia and considering all the above facts we are convinced to hold that there was no negligence or deficiency on the part of the Ops and the treatment and management and methodology as adopted for the treatment of the mother of the complainant was acceptable medical treatment and that treatment was continued by the Woodland Nursing Home doctors also and in fact, it is the opinion of the Medical science that even with medically acceptable supplementation there is a chance of hypernatramia which may cause even death also and considering the clinical condition and other comorbid condition there may be exceeding condition one of which may be EPM but EPM is a clinical condition characterized by loss of myelin in pons as well as extra pontine region which is called EPM for which one may be suffered from Coma confusion and other diseases which is evident from the advice of the MRI.
In the light of the above observation and also considering the entire materials on record including the medical treatment as done by the OPs and also subsequent treatment as given by the Woodland Nursing Home against whom complainant has no allegation and further after proper comparative study of the opinion of the Medical Board of Doctors including the present material BHT was confirmed that there was no negligence, deficiency on the part of the OPs in treating the matter of the complainant rather it is proved their treatment was acceptable methodological treatment as per medical science and that was the correct procedure and truth is that that procedure was also adopted by the Woodland Nursing Home and ultimately on 29-04-2007 the potassium level and sodium level of the complainant’s mother was regular. Thereafter, on further transfer of the complainant’s mother in the Gamma Centuari Healthcare Pvt. Ltd. on 3rd May, 2007 she was treated there and died on 10-08-2007 but anyhow the complainant has not filed any opinion of Gamma Centuari Healthcare Pvt. Ltd. or Woodland Nursing Home that they opined that the OPs treatment was erroneous but complainant has tried to say that the said two hospital reports reveal that treatment of the OP was erroneous but that is completely proved a false in view of the fact that documents filed by the complainant do not support that contention and at the same time the negligence and deficiency of the OP doctors as claimed by the complainant has been accepted by medical board of Government of West Bengal of Medical College and Hospital, Kolkata.
In the result, the complaint fails.
Hence,
Ordered
That the case be and the same is dismissed on contest against all the OPs but without any cost.
