DISTRICT CONSUMER DISPUTES REDRESSAL FORUM II
Udyog Sadan C 22 & 23 Qutub Institutional Area
(Behind Qutub Hotel) New Delhi 110016.
Case No. 804/2005
1. Baby Garima Minocha
D/o Ashok Minocha
Minor Through
Her Father Shri Ashok Minocha
R/o Pocket B H/No. 278
Sarita Vihar New Delhi
2. Shri Ashok Minocha
S/o Amarnath Minocha
R/o Pocket B H/No. 278
Sarita Vihar New Delhi ...Complainants
Versus
1. Max Health Care
N 110 Panchsheel Park
New Delhi – 110017
2. Dr. Arvind Taneja
MD (Paediatrics) DABP FAAP
Director – Paediatric Service
Max Health Care
N 110 Panchsheel Park
New Delhi – 110017
3. Dr. Shruti Aggarwal ]
Clinical Associate Paediatrics ] (given up)
Max Health Care ]
N 110 Panchsheel Park ]
New Delhi – 110017 ] …Opposite Parties
Date of Institution 10.08.2005 Date of Order 15.09.2016
Coram
Sh. N.K. Goel President
Ms. Naina Bakshi
O R D E R
Briefly stated the case of the Complainant 1 (Baby Garima Minocha then aged 2 ½ years) and Complainant 2 (her father) is that Complainant 1 was ill and was admitted in the OP 1 hospital for fever and vomiting but owing to medical negligence and deficiency in service committed in the treatment by the OP 1 who is Max Health Care OP 2 who is senior Dr. Taneja and OP 3 who is Dr. Shruti Aggarwal Junior Doctor OPs are liable to compensate the complainants. It is stated that on 24.11.2004 the complainant 1 was admitted in the Hospital of OP 1 with the complaint of fever and vomiting. OP 1 & 2 started treatment and took some further tests and diagnosed her normal except for a palpable liver 2 cm below the costal margin that on the next day of admission complainant 1 developed loose motion and as the fever was running with high temperature she was reinvestigated with further tests etc. and the OPs changed the medicines on 25.11.04 but her condition was not under control that on 26.11.2004 the OPs again reinvestigated having again prescribing more tests that on 27.11.2004 the complainant 1 developed further complaint and complication in the evening with high fever she also developed fissuring of tongue and erythema of the lips. The liver was palpable soft 3 cm below the costal margin diarrhea and fever persisted and aggravated with complaint of abdominal pain intermittently but the OPs continued with the treatment of fever and diarrhea only and diagnosed typhoid finally and continued treatment of the same that on 28.11.2004 when there was no relief in the condition of complainant 1 the complainant 1’s uncle who is a doctor came to see her and he asked OPs to undergo the complainant 1 for CT abdomen. The OPs told the uncle of complainant 1 not to worry as the complainant 1 was only suffering from typhoid and her abdomen was soft and rest of the examination and tests they carried were normal that on advise of their relative Dr. Satish Arora and two other doctors Dr. Nitin Verma and Dr. Meera Luthra CT Scan was carried and it revealed a collection of fluid in the right side of the abdomen adjacent to the bladder just underneath the anterior abdominal wall thick reddish brown fluid around 0.5 ml was aspirated (the copies of the prescriptions medical charts medical history and receipts etc. are annexed as Annex. C 1 Colly). It is stated that on seeing lack of care in deciding what treatment was to be given and the complete negligence of the OPs complainant 1 was immediately shifted to Apollo Hospital for proper treatment. She was admitted there on 28.11.2004 and discharged on 6.12.2004 where she was treated by Dr. Anupam Sibal and her Laparoscopic drainage of right iliac was done on 29.11.2004 by Dr. Meera Luthra GA. The complainants further allege that OP 2 left the treatment in the mid and went abroad for his personal engagement leaving the serious patient to be attended by a Junior Doctor OP 3 who neither could diagnose nor having sufficient experience and knowledge to care the complainant No. 1 and to administer proper treatment to her which made the disease of the patient from bad to worse. The complainants further allege that Dr. Meera Luthra and Dr. Nitin Verma found that complainant 1 was not suffering from typhoid but that of abdominal and appendix problem having suggested CT scanning. The complainants specifically bring out in Para 22 of complaint that on CT scanning it was found that the complainant no. 1 had been suffering from appendix which is burst . It is stated that the OPs failed to spot the seriousness of the disease while the complainant No. 1 was crying with abdominal pain and having vomiting owing to appendicitis but the OPs wrongly diagnosed her and treated her for typhoid blatantly with wrong diagnose and approach with lack of care and caution. Feeling aggrieved with the treatment given by OPs and pleading deficiency in service and medical negligence on the part of the OPs the complainants have invoked jurisdiction of this forum to award the following amounts to them
1. AMOUNT SPENT AT MAX HEALTH CARE HOSPITAL
Bed Charges…………… Rs. 9900.00
Ward Consumables…… Rs. 466.00
Pharmacy……………….. Rs. 3070.00
CT Scan…………………. Rs. 4000.00
X Ray……………………. Rs. 250.00
Ultrasound……………… Rs. 1150.00
Pathology……………….. Rs. 2990.00+Rs.120.00=Rs.3110.00
Consultant fees……….. Rs. 3000.00
- AMOUNT SPENT AT APOLLO HOSPITAL
Bed Charges………….. Rs. 13 600.00
Bio Chemistry……….. Rs. 1 035.00
Blood Components Issue Rs. 1 785.00
Consultation………….. Rs. 11 300.00
Hematology……………. Rs. 2 120.00
Microbiology…………… Rs. 3 510.00
OT Consumables…….. Rs. 3 809.00
Other services………… Rs. 42 560.00
Pharmacy……………… Rs. 27 332.26
Radiology – X Ray……. Rs. 400.00
Transfusion Medicine.. Rs. 170.00
CT Scan on 22.12.04… Rs. 4 000.00
Follow up fees of Dr…. Rs. 2 000.00
TOTAL AMOUNT SPENT AT MAX HOSPITAL AND APOLLO HOSPITAL
(A+B) = Rs. 24 946.00
Rs. 1 14 231.22
- Amount claimed for mental torture
& sufferings of complainant No.1…………Rs. 2 00 000.00
- Amount for physical and mental torture
and sufferings of complainant No. 2
the parents and the family………………….Rs. 1 00 000.00
5. Amount for stress and strain……………… Rs. 60 000.00
6. Amount for work loss
of complainant No. 2………………………… Rs. 75 000.00
Total (C ) Rs. 4 35 000.00
Totalling to Rs. 5 74 177.22p
OP 1 & 2 have submitted their written statement denying all the allegations and have stated as follows
(a) That as per the history given to the respondents the patient complainant No. 1 was having recurrent fevers every 15 20 days in September 2004 i.e. prior to admission on 24.11.2004 because of high fever of 102°F and persistent vomiting. On the basis of a Widal Positive test she was earlier treated as a case of Typhoid fever in October 2004. Even 10 days prior to admission she had again started running a temperature since 14.11.2004.
Further as per the history disclosed to Respondent No. 2 she had earlier been treated in October 04 as a case of Typhoid fever with cefixime on the basis of a positive Widal Test for 14 days which caused the fever to subside. She had again started running a temperature 10 days prior to admission and had been treated with Cepodem (Cefpodoxime Antibiotic) followed by Amoxy clav (antibiotic drug) in the last 2 days before presentation to the O.Ps. with some relief. A report of a blood count showing the 18 100 with 73% Neutrophils on 21/11/04 was also presented to the physician.
- It is submitted that typhoid is a contagious infectious disease of the intestines that affects the whole body marked by high fever intestinal inflammation reddish skin rash and ulceration. Of the intestines Symptoms include high fever vomiting diarrhea Evanescent indefinite skin rash abdominal pain weakness and distorted sensorium. In the case of typhoid in children the liver (which has an important role in digestion) and located in upper right portion of the abdomen is commonly enlarged. On treatment the symptoms may take 1 2 weeks to go away.
- That any reasonable medico/specialist would under the circumstances consider (i) previous history of the patient (ii) her clinical presentations (iii) physical signs and symptoms and (iv) provisional diagnosis.
- That the attending doctors of Respondent No. 1 also considered all these factors vis à vis the patient when presented to inpatient wards on 24.11.2004 for admission.
- After admission a careful physical examination of the child patient on 24.11.2004 by Dr. Arvind Taneja (OP No. 2) showed a soft non tender abdomen with No Locational signs. There was no sensitiveness to pain when pressure was applied to skin. The physical examination was again unremarkable except that the child was very irritable.
The provisional diagnosis of the patient therefore was Relapsed typhoid fever with acute gastritis .
………………………………
- Respondents therefore continued the same antibiotics except giving her ofloxacin intravenously since the patient had some diarrhea also now (15 16 small stool) on 25/11/2004.
- Thirty nine hours after admission since the fever was still high Respondent No. 2 stopped Augmentin and Ofloxacin and instituted Intravenous Ceftrioxone and oral Azithromycin as his provisional diagnosis was still multi drug resistant Typhoid fever. The child had a high white blood cell (WBC) count of 26 100 with 80% neutrophils and normal platelet count. A chest X Ray obtained was normal as was a urine examination and liver enzymes (SGOT SGPT). It may be pertinent to clarify at this stage that though most cases of Typhoid have leucopenia (lowered WBC) an occasional child can present with leucocytosis (raised WBC) also.
- On 26/11/04 the fever and loose stools persisted but the abdomen was still soft and vital signs stable. An ultra sonography of abdomen on this day revealed no abnormality.
- Respondent No. 2 had to leave the city on 26/11/04 in the afternoon. Before leaving he had handed over the care of the patient to Dr. Anjali Saxena and Dr. Shruti Agarwal. Dr. Anjali Saxena and Dr. Shruti Agarwal were also told to consult Dr. Nitin Verma and or Dr. Meera Luthra in case of need. The Respondent No. 2 had further informed the parents of the patient of the temporary transfer of care since he would not be in town for the next 72 hours. At this stage it may be pertinent to state the qualification experience and standing of the physicians to whom the medical care of the patient was transferred.
It is submitted that the Respondent No. 1 follows a very strict credentialing policy for engaging Consultants and before the engagement of its physicians the Respondent No. 1 had examined their professional qualifications and professional skills (as evidenced by his working experience). Respondent No. 1 had engaged them only after fully satisfying itself that the physicians engaged by it held the required professional qualifications and also that they possessed the necessary skills and experience required for treating pediatric cases. ……………
- That on 27/11/04 76 hrs after admission in the morning hours at 8 45 AM for the first time some fissuring of lips was noted by the Resident Duty Medical officer & keeping the possibility of an adverse drug reaction the dermatology consultant was called in and antibiotics continued. The liver was noticed to be slightly enlarged as does commonly happen in Typhoid fever in children.
- In the morning of 28 11 2004 on physical examination for the first time a questionable lump was felt just above the Right inguinal crease Dr. Nitin Verma a Senior consultant was immediately called in by the respondents to review the patient and he examined the patient within 2 Hrs. The said Doctor prescribed a CT Scan Abdomen which was immediately carried out.
- The same morning the child was also seen by the Pediatric Surgeon Dr. Meera Luthra as per the reference of Dr. Nitin Verma and she also reinforced the impression of an intra abdominal abscess confirmed on CT Scan in the Right iliac fossa and supra pubic area.
- After such examination and during the course of medical counseling to the parents regarding the child’s condition Laparoscopic drainage was recommended as the course of treatment. But the parents decided to ignore the recommendation and instead wanted to transfer the child to Apollo Hospital.
OPs have stated that the complainants were specifically told that they were also free to consult and seek second medical opinion from any other medical practitioner of their choice for their satisfaction. They have denied that any doctor by the name of Dr. Satish Arora visited their hospital. Refuting allegations of not conducting CT Scan the OPs have stated that the child would have been un necessarily injected a dye and exposed to radiation at that stage when there was no indication for the same inter alia. After 100 hours of the admission a questionable lump was felt just above the right surgical crease. Accordingly Dr. Nitin Verma a senior consultant was immediately consulted by OP 1 & 3 who advised CT Scan. After knowing the report of CT Scan Dr. Meera Luthra Paediatric Surgeon was immediately requested to see the child. The Paediatric Surgeon planned for Laparoscopic drainage of the intra abdominal abscess. The OPs have further stated that at Apollo Hospital the patient (complainant 1) underwent Laparoscopic procedure identical to one recommended by the OPs and this procedure was performed by the same Paediatric Surgeon Dr. Meera Luthra who was also involved in OPs hospital. The OPs have blamed the complainants for declining to do the surgery and instead transfer the child to Apollo Hospital (left against medical advise). Summing up the complaint as vexatious and wrong to the own knowledge of the complainants it is prayed that the same is liable to be dismissed with special compensatory costs.
Vide order dated 15.3.2012 OP 3 was given up.
Complainants have filed rejoinder reiterating the averments made in the complaint.
Complainants have tendered evidence of Complainant No. 2 by way of affidavit. On the other hand affidavits of Dr. Dilpreet Brar M.S. Dr. Arvind Taneja (OP 2) Dr. Meera Luthra OP.W 4 and of Dr. (Col.) Nitin Verma OP.W 3 have been filed in evidence on behalf of the OPs. Complainant 2 has filed additional affidavit and OPs have filed counter affidavit to the additional affidavit filed by the complainant.
Since the case was involving serious allegations of negligence against the OP Hospital and the attending doctors the case was referred to Safdarjung Hospital for constituting the Medical Board and giving their opinion. Accordingly Safdarjung Hospital forwarded their medical opinion report on 18.1.2016 enclosing therein the medical opinion report of the Committee duly constituted by the Hospital. For the purposes of identification we mark it as Annex. I. Report of the experts is reproduced below
The Medical Board was held on 14.1.2016 under the Chairmanship of Dr. R.K. Anand Addl. M.S. & Chairman. Baby Garima Minocha’s medical records were evaluated. The Board is of the opinion that the patient Garima Minocha 2 Years Female Child admitted to Max Hospital on Nov. 24 2004 with fever and vomiting and palpable Liver. Following this developed loose stools the next day and reinvestigated on Nov. 26th During this period Antibiotics Oflox and Augmentin were given. Later on Monocef and Azithral were given. Ultrasound Abdomen on Nov. 26th showed Hepatomagacy. CT Abdomen on Nov. 28th showed burst appendix. The pediatrician was treating the child for non specific febrile illness (H/o typhoid in October).
However opinion of Pediatric Surgeon could have been taken as the child was not responding to treatment. Also feature of appendicitis in a 2 year old baby are often masked.
We must say at once that the report has not been written in specific words though it indicates that the treatment provided by the OPs to complainant No. 1 Baby Garima Minocha was not proper and the same was given and continued without the opinion of the Paediatric Surgeon. From the report it is also clear that the possibility of appendicitis in the patient (complainant No. 1) could not be ruled out as the features of the said disease in a 2 year child are often masked (not apparently visible).
Now we straightway come to the question whether the complainant is entitled for the relief prayed for?
We have carefully gone through all the documents and evidence adduced by the complainant the OPs and also the medical expert report of the Safdarjung Hospital.
We find that the child was admitted in hospital of OP 1 on 24.11.2004 and CT Scan was done after 4 days which ultimately led to finding of symptoms of Appendicitis. This could have been detected on the very first day or second day of admission had the Paediatric surgeon been associated from the day the child was non responsive to the treatment.
Though the Committee of Experts has not specifically and categorically pointed out negligence against the OPs but we find that the aforesaid report of the experts is couched in camouflaged manner wherein overtly or covertly it is established that the complainant 1 was treated for non specific febrile illness (Typhoid in October) whereas the complainant 1 indeed suffered from the Burst Appendix . We also find that owing to incorrect diagnoses of the child i.e. copmplainant 1 parents of the child decided to shift the patient to Apollo Hospital where she was operated for Appendix by the same doctor who was to operate for the same operation in the hospital of OP No. 1.
Admittedly OP 2 had left Delhi on 26.11.2004 in the afternoon for 72 hours. However according to the OPs before leaving he had handed over the patient (complainant 1) to Dr. Anjali Saxena and Dr. Shruti Agarwal who were also told to consult Dr. Nitin Verma and/or Dr. Meera Luthra in case of need. Photocopy of the medical treatment record in respect of complainant 1 at OP 1 hospital is Annex. O/P.1. The same runs into 64 pages. As per the endorsement made on it at page 33 the patient had left from the hospital at 4 p.m. on 27.11.04 though the case of the OPs is that the patient had left the hospital on 28.11.2004. There is absolutely no material on the record which may even suggest that Dr. Anjali Saxena and/or Dr. Shruti Agarwal had looked after the complainant 1 patient in the absence of OP 2. Their affidavits have not been filed in evidence on behalf of the OPs. Why? No answer . It shows that the said Dr. Anjali Saxena and Dr. Shruti Aggarwal had infact not provided any medical treatment/care to the complainant 1 patient in the absence of OP 2 and OP 2 had left OP 1 hospital and Delhi on 26.11.2004 in the afternoon leaving behind complainant 1 patient at her own fate. This in our considered opinion amounts to grave deficiency in service on the part of OP 2.
In his affidavit Dr. (Col) Nitin Verma has inter alia stated that he was called to see complainant 1 on 28.11.2004 at Max Medcentre Panchsheel Park on the reference of Dr. Shruti Agrawal and that he had referred the patient to Dr. Meera Luthra Paediatric Surgeon on call and the attendants explained the diagnosis and further line of management. He has given the opinion that the patient was being managed and investigated correctly the management protocol was correct and efforts were made to establish the diagnosis as per the investigations available. The said doctor had seen the patient only once. Therefore we are of the considered opinion that he was not in a position to opine that the patient was being managed and investigated correctly. Anyhow in her affidavit Dr. Meera Luthra has inter alia stated that on 28.11.04 at about 3.45 p.m. she had seen the patient complainant 1 at Max Panchsheel New Delhi on the reference of Dr. Nitin Verma that prior to her examination of the child the patient had already had a CT Scan on 28.11.2004 which diagnosed a right iliac fossa mass. According to her based on this diagnosis she had had planned Laparoscopic drainage for the patient but the parents of the child declined surgery and instead asked for discharge and LAMA (Left against medical advice). She has further stated that subsequently she was asked to see the same patient at Apollo Hospital New Delhi on the same evening by Dr. Anupam Sibal under whose care the parents had admitted the patient at Apollo Hospital that at Apollo Hospital on 29.11.2004 she operated on the patient and did laproscopic drainage of the abscess i.e. the same laparoscope’s procedure which was advised and planned at Max Hospital. It means that Dr. Meera Luthra had been called to OP 1 Hospital for the first time on 28.11.2004 at about 3.00 p.m. and by that time the parents of the complainant 1 decided to leave the OP 1 hospital.
Keeping in view the fact that OP 2 had left the complainant 1 patient at her own fate in the afternoon of 26.11.2004 there is no reason to disbelieve that the condition of the patient had deteriorated due to deficiency in service on his part. Dr. Meera Luthra has not specifically stated that the medical treatment being provided to complainant 1 at OP 1 hospital was according to the standard established treatment procedure and medical jurisprudence and that best type of medical treatment was being provided to her at OP 1 hospital. We are of the considered opinion that due to the medical negligence on the part of OP 2 the complainant 1 patient was not properly diagnosed despite OP 1 being a super speciality hospital and she was given the treatment in a very routine and careless manner.
We are of considered opinion that defective diagnosis in a super speciality hospital like that of Max which has all the tools for diagnosis at its command amounts to imperfection shortcoming on quality nature and manner of performance. We therefore hold OPs liable for deficiency in service under Section 2(1)(g) of the Consumer Protection Act 1986.
With above background we allow the complaint and direct OP No. 1 Hospital to compensate the complainants by paying an amount of Rs. 2.5 Lacs (Rupees Two Lacs Fifty Thousand only) in lumpsum towards medical expenses mental agony harassment and legal expenses within 30 days of receipt of copy of this order failing which OP 1 Hospital shall become liable to pay the said amount along with interest @ Rs. 8% per annum from the date of filing of the complaint till its realization.
Let a copy of this order be sent to the parties as per regulation 21 of the Consumer Protection Regulations. Thereafter file be consigned to record room.
Announced on 15.09.16.
(NAINA BAKSHI) (N.K. GOEL) MEMBER PRESIDENT
Case No. 804/05
15.9.2016
Present – None
Vide our separate order of even date pronounced the complaint is allowed. OP No. 1 Hospital is directed to compensate the complainants by paying an amount of Rs. 2.5 Lacs (Rupees Two Lacs Fifty Thousand only) in lumpsum towards medical expenses mental agony harassment and legal expenses within 30 days of receipt of copy of this order failing which OP 1 Hospital shall become liable to pay the said amount along with interest @ Rs. 8% per annum from the date of filing of the complaint till its realization. Let the file be consigned to record room.
(NAINA BAKSHI) (N.K. GOEL) MEMBER PRESIDENT
