DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,<br /> BATHINDA (PUNJAB)<br /> <br /> CC No. 160 of 21-07-2009<br /> Decided on : 18-03-2010 <br /> <br /> 1.Manjit Kaur aged about 50 years W/o Late Sh. Darshan Singh Kainth<br /> 2.Harjinder Singh aged about 25 years S/o Late Sh. Darshan Singh Kainth<br /> 3.Kulwinder Singh aged about 29 years S/o Late Sh. Darshan Singh Kainth<br /> - All residents of H. No. 15527, Street No. 1, Hazura Kapura Colony, Bathinda.<br /> ..... Complainants<br /> Versus<br /> <br /> 1.M/s. Pragma Hospital, Bhatti Road, Bathinda, through its Manager. <br /> 2.Dr. Surinder Kansal, Pragma Hospital, Bhatti Road, Bathinda.<br /> 3.Dr. Akhilesh, R.M.O. Pragma Hospital, Bhatti Road, Bathinda.<br /> 4.Sh. Sanjeev, Pragma Hospital, Bhatti Road, Bathinda.<br /> 5.United India Insurance Co. Ltd., through its Divisional Manager, 54 Janpath, Connuaght Place, New Delhi 110 001.<br /> .. ... Opposite parties<br /> <br /> Complaint under Section 12 of the Consumer Protection<br /> Act, 1986.<br /> <br /> QUORUM <br /> <br /> Ms. Vikramjit Kaur Soni, President<br /> Dr. Phulinder Preet, Member<br /> Sh. Amarjeet Paul, Member<br /> <br /> For the Complainant : Sh. N.K. Jeet, counsel for the complainants <br /> For the Opposite parties : Sh. Ajay Singla, counsel for <br /> opposite party Nos. 1, 2 & 5. <br /> Sh. Vikas Singla, counsel for opposite<br /> party No. 3.<br /> Opposite party No. 4 exparte. <br /> <br /> O R D E R<br /> <br /> VIKRAMJIT KAUR SONI, PRESIDENT <br /> <br /> 1. Briefly stated the case of the complainants are that complainant No. 1 is the wife and complainant Nos 2 & 3 are the sons of Darshan Singh Kainth, who fell ill and was admitted with opposite party No. 1 on 14-11-2008. Opposite party No. 2 after checking him diagnosed as suffering from dengue. On 15-11-2008, condition of Darshan Singh Kainth deteriorated while under treatment. The opposite party No. 2 asked the complainants to arrange two units of blood which they arranged from Blood Bank, Civil Hospital, Bathinda. Opposite party Nos. 3 & 4 started transfusing blood to the patient on the instructions of opposite party No. 2 who was not personally present to supervise the blood transfusion. Shortly afterwards, condition of Darshan Singh Kainth deteriorated further and he started shivering, writhing in pain and gasping for breath. At about 12 p.m. in the night, opposite party No. 2 sent the patient who was on ventilator for CT Scan at Omega Scan Centre, Bathinda, by putting him on Ambu-bag. After coming back from Omega Scan Centre, the patient was taken to ICU of opposite party No. 1 where he was declared dead. Complainants alleged that when after blood transfusion, condition of patient deteriorated, opposite party No. 2 did not attend him for nearly one and a half hour which was an extremely critical and important period to save his life.<br /> 2. Aggrieved at this, the complainant No. 1 submitted complaint against the opposite parties to the Deputy Commissioner, Bathinda, who forwarded it to the Civil Surgeon, Bathinda for Inquiry. The Civil Surgeon, Bathinda, constituted a three member committee to inquire in to the complaint which concluded that negligence on the part of Dr. Surinder Kansal, Dr. Akhilesh and staff Sanjeev has caused the death of the patient. The complainants allege deficiency in service on the part of the opposite parties. Hence, this complaint for issuing directions to the opposite parties to pay them compensation to the tune of Rs. 10,00,000/-.<br /> 3. Opposite party Nos. 1 & 2 filed joint written reply taking preliminary objections that Inquiry report by the Board of doctors at Civil Hospital, Bathinda is without deeply probing into the real facts and medical evidence rather based on their own assumptions and presumptions; complaint is bad for non-joinder of necessary party and opposite party Nos. 1 & 2 being treating doctors have tried their best to avoid all complications and no warranty or guarantee was ever given by opposite party Nos. 1 & 2 to the complainant about result of treatment.<br /> 4. On merits, it has been submitted that patient was diagnosed as a case of Dengue Fever on the basis of clinical investigations and epidemiological grounds. The patient was advised to be taken to higher Institute but patient's family got the patient admitted on request. It was clearly told to the patient's family that opposite party No. 2 is a critical care diploma holder and managing critically sick patients in collaboration with other concerned specialists. After examination and diagnosing the patient, the patient's family was advised to arrange two units of platelets rich plasma (PRP) and accordingly, they arranged blood from Civil Hospital, Bathinda and handed over to opposite party No. 3. on 15-11-2008. It has been admitted that opposite party No. 3 started blood transfusion under direct supervision/ instructions of opposite party No. 2. Opposite party No. 3 was working under opposite party No. 2 and have carried out the instructions issued by opposite party No. 2 but it stands denied that opposite party Nos. 3 & 4 are incompetent and unqualified to handle this job.<br /> 5. It has been submitted that immediately after blood (PRP) transfusion was started, the patient developed severe reaction in the form of shivering, sweating and restlessness. Opposite party No. 2 advised opposite party No. 3 to give required injections who followed the instructions given to him on telephone. Opposite party No. 2 reached hospital within 10-15 minutes and as per advice of Neurologist, patient was sent for CT Scan Brain on endotracheal tube with ambu bag respiration which revealed normal study. After coming back, the patient was hemo-dynamically stable and put on mechanical ventilator support. After some time, he started having hypotension and resuscitated further I/V fluid & Inotropes. Patient had bradycardiac arrest at about 1.10 am on 16-11-2008 and was declared dead at 1.45 am. Thrombocytopenia and acute febrile illness was certified as a cause of death.<br /> 6. Opposite party No 3 filed written version and submitted that he is qualified BAMS doctor and practice under registration with the Board of Ayurvedic & Unani Systems of Medicines, Punjab. He worked in a Charitable Hospital, observed and done many blood transfusion under supervision. He alleges that he has adequate experience in handling blood transfusion and its complications, if any.<br /> 7. Despite receiving notice dasti, none appeared on behalf of opposite party No. 4 and as such, exparte proceedings were taken against him.<br /> 8. Opposite party No. 5 in its reply submitted that Proprietor of Opposite party No. 1 i.e. Hospital is insured with United India Insurance Co. Ltd., New Delhi, during the period the patient Sh. Darshan Singh Kainth was treated by opposite party No. 1.<br /> 9. Parties have led evidence besides filing affidavits in support of their respective pleadings.<br /> 10. We have heard learned counsel for the parties and have gone through the record.<br /> 11. In para Nos. 3 & 4 of the complaint, the complainants alleged that Sh. Darshan Singh was brought to the hospital of opposite party No. 1, who was suffering from Dengue fever. The patient was admitted on 14-11-2008 and his condition deteriorated on 15-11-2008. The opposite party No. 2 asked the attendants of the patient to arrange two units of blood. They arranged two units of blood from civil hospital, Bathinda and handed over to opposite party No. 2. On the instructions of opposite party No. 2, opposite party Nos. 3 & 4 started transfusing blood to the deceased. At that time, opposite party No. 2 was not present. Shortly after transfusion of blood, the condition of patient deteriorated. He started shivering, writhing in pain and gasping for breath. Resultantly, he died.<br /> 12. The main questions arise in the complaint are as under :-<br /> i) Firstly the doctor i.e. opposite party No. 2 was not competent to treat the patient suffering from such type of disease ? <br /> ii) Secondly, were opposite party Nos. 3 & 4 incompetent to transfuse the blood ? <br /> iii) Thirdly, when the blood was being transfused and complication arose, opposite party Nos. 3 & 4 failed to manage the condition of the patient as opposite party No. 2 after contacting repeatedly, failed to reach in time and attend the patient as he reached after delay of 1-1/2 hours ?<br /> 13. Here the version of the complainants is that the opposite party No. 2 did not attend the patient for nearly 1-1/2 hours, which was an extremely critical and important period to save the patient's life.<br /> 14. The opposite party Nos. 1 & 2 pleaded that allegations of the complainants are based on non-specific and unscientific and laymen conjunctures. They further denied all the allegations levelled by the complainant against them.<br /> 15. In this case after the death of Darshan Singh, the complainants moved an application before Deputy Commissioner, Bathinda, who has marked Inquiry to the Civil Surgeon vide Ex. C-6. Civil Surgeon constituted the Board of three members namely Dr Ajit Pal Singh, Dr. Inderdeep Singh Sran and Dr. Harinder Pal Singh, who submitted their report Ex. C-5 in which it has been concluded that negligence on the part of Dr. Surinder Kansal, Dr. Akhilesh and staff Sanjeev has caused death and has also recommended to take legal action against opposite party No. 2 and his incompetent staff. On the recommendation of said committee, an FIR bearing No. 473 dated 06-07-2009 Annexure -I was also lodged under Section 304-A of IPC against opposite party Nos. 2 to 4. To controvert this Inquiry report, opposite parties have submitted another Inquiry report conducted by Bathinda Branch of IMA vide Ex. R-28 in which doctors have concluded that patient died because of the disease and related complications (Acute febrile illness, thrombocytopenia and anaphylaxis reaction of blood (PRP) and not because of medical negligence of doctors and staff of Pragma Hospital. In this report much stress has been given to establish that the Board of Medical Officers which was constituted on the recommendation of Deputy Commissioner, was incompetent to give this report but it has not been brought on record that on whose approach Bathinda Branch of IMA conducted an Inquiry.<br /> 16. Now the following are the answers to the above mentioned questions :<br /> 17. In answer to question No. 1 – Opposite party No. 2 is fully competent to treat the patient who is suffering from any type of fever including dengue and no such specific qualification/expertness is required to treat such patient. Even a general physician having MBBS (degree) is fully competent to treat such patient. In the case in hand, opposite party No. 2 is M.D (Tuberculosis & Respiratory Diseases) and is holding Diploma in Critical Care. Therefore, there remains no question regarding the competency of opposite party No. 2.<br /> 18. Now we turn to question No. 2 regarding competency of opposite party Nos. 3 & 4. Opposite party No. 3 i.e. Dr. Akhilesh , being BAMS as alleged by the complainants was incompetent to transfuse the blood. Opposite party No. 3 denied this allegation in para No. 4 of parawise reply of the written reply that notification to this effect has already been issued to Director, Heath & Family Welfare, Punjab, Chandigarh, in which it was made clear that the BAMS doctors are qualified doctors and are eligible to practice modern medicine. Opposite party No. 3 has further pleaded that he has done institutional based teaching and training regarding blood transfusion and management of related complication and emergency drug treatment as a part of syllabus of BAMS course. He further pleaded that he worked in a Charitable Hospital under supervision of medicine department and done many blood transfusions. He also did many transfusion under the supervision and observations of opposite party no. 2. To prove his this assertion, he has placed on file syllabus of BAMS vide Ex. C-23 page 196, which proves that while doing BAMS, modern medicines alongwith transfusion of blood was also taught to him. Moreover, he has experience of doing blood transfusion. Therefore, there is no doubt that he is not qualified to transfuse the blood. So, this assertion of the complainant is false.<br /> 19. Complainants alleged that opposite party No. 4 who administered blood to the patient was not legally as well as medically competent and qualified for this job as he was having diploma in Electro – Homeopathy which is not a recognised system of medicine. Since opposite party No. 4 has proceeded against exparte, no written version is filed on his part to controvert the allegations of the complainants.<br /> 20. From the perusal of record, it revealed that opposite party No. 4 is the staff member who carried/followed the order of his employer i.e. opposite party Nos. 1 & 2. He did nothing in his independent capacity. He cannot be held guilty for being not qualified to transfuse the blood as he is puppet in the hands of his master. Therefore, no deficiency in service is proved against him.<br /> 21. Now the 3rd question which arose is that at the time of blood transfusion the complication arose, opposite party Nos. 3 & 4 failed to manage the condition of patient. The complainants alleged that when opposite party Nos. 3 & 4 started transfusing blood to the patient on the instructions of opposite party No. 2, who himself was not present at that time to supervise the blood transfusion. Thereafter within few minutes, the condition of the patient deteriorated and he started shivering, writhing in pain and gasping for breath. Opposite party No. 2 reached late by 1-1/2 hours and told the attendants of the patient that blood has caused reaction and patient was sent for CT Scan while opposite party No. 2 has pleaded that when opposite party No. 3 saw that patient's condition has deteriorated, he immediately stopped PRP transfusion and informed opposite party No. 2 who advised opposite party No. 3 to give required injections and monitor patient's vitals. All these instructions were given by opposite party No. 2 to opposite party No. 3 on telephone. Patient was shifted to ICU. Opposite party No. 2 further pleaded that he reached hospital within 10-15 minutes to attend the patient. Thereafter he also consulted Neurologist. On the advice of Neurologist, opposite party No. 2 sent the patient for CT scan Brain on endotracheal tube with ambu bag respiration. The report of CT Scan revealed normal study. When the patient was received back in ICU, he was hemo-dynamically stable and put on mechanical ventilator support but after sometime, patient started having hypotension and resuscitated further with I/V fluid and Inotropes. Patient had bradycardiac arrest at about 1.10 a.m. on 16-11-2008. Thrombocytopenia and acute febrile illness was certified as a cause of death.<br /> 22. From the above version of opposite party No. 2, it is not understandable when platelets count before PRP was 15000 as per Ex. C-3 then after blood transfusion how these can shoot upto 36000 when the blood transfusion was immediately stopped after few minutes of its start as stated by opposite party Nos. 3 & 4. Instead of giving immediate treatment, opposite party No. 3 called up opposite party No. 2 for further instructions. During that interval, blood transfusion was not stopped. Opposite party No. 2 took 30 to 40 minutes to reach hospital as per Ex. C-5 (Inquiry report) and by that time, the condition of the patient deteriorated. He was shifted to ICU and then as per advice of Dr. Gaurav Singla, Neurologist, patient was sent for CT Scan. <br /> 23. No report of CT Scan has been placed on file. As blood was brought by the attendants of the patient from Civil Hospital, Bathinda, it was properly checked but when it was given to the doctors concerned for transfusion, they were duty bound to doubly match the blood before transfusion which they have not done so. The blood which was left after transfusion was handed over to the attendants of the patient whereas the opposite parties should have to get that blood tested from the competent laboratory. Here also, the opposite party No. 2 has failed to do so. Moreover, the complete record Bed Head Ticket has not been produced before this Forum which was in the custody of opposite party Nos. 1 to 4.<br /> 24. In view of the above discussion, we are of the considered view that opposite party Nos. 1 & 2 have failed to give proper treatment to the patient. From the act and conduct of opposite party Nos. 1 & 2, it is clear that they were negligent while transfusing blood to the deceased. Hence, there is gross deficiency in service on the part of opposite party Nos. 1 & 2. In this view of the matter, we get support from the observations of The Hon'ble Supreme Court wherein it has been held in Post Graduate Institute of Medical Education & Research, Chandigarh Vs. Jaspal Singh & Others 2009(4) Civil Court Cases 560 (S.C) that transfusion of mismatched blood is not only an error of professional judgment but also medical negligence. .<br /> 25. The deceased was of 54 years of age. He was tailor by profession and his monthly income was Rs. 15,000/-. Normal age expectency is 57 years in India.. The complainants have claimed compensation on higher side. <br /> 26. In view of what has been discussed above, this complaint is accepted against opposite party Nos. 1, 2 & 5 and dismissed qua opposite party Nos. 3 & 4. As opposite party Nos. 3 & 4 are employees of opposite party Nos. 1 & 2 and accordingly master is liable for the acts of his servants. The opposite party Nos. 1, 2 & 5 are directed to pay Rs. 1,50,000/- as compensation and Rs. 5,000/- as litigation expenses to the complainants in equal share, jointly and severally within 45 days from the date of receipt of copy of this order.<br /> 27. Copy of this order be sent to the parties concerned free of cost and the file be consigned to record.<br /> Pronounced :<br /> 18-03-2010 <br /> (Vikramjit Kaur Soni)<br /> President<br /> <br /> <br /> (Dr. Phulinder Preet)<br /> Member <br /> <br /> <br /> (Amarjeet Paul) *ik Member