Tamil Nadu

South Chennai

CC/94/2016

R.Ashock Kumar - Complainant(s)

Versus

M/s.Apollo Hospital Enterprise Ltd - Opp.Party(s)

M/s.V.Balaji

05 Mar 2020

ORDER

                                                                             Date of filing      : 23.03.2016

                                                                               Date of disposal : 05.03.2020

                                                                                  

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (SOUTH)

@ 2^ND Floor, T.N.P.S.C. Road, V.O.C. Nagar, Park Town, Chennai – 3.

 

PRESENT: THIRU. M. MONY, B.Sc., L.L.B, M.L.                    : PRESIDENT

TR. R. BASKARKUMARAVEL, B.Sc., L.L.M., BPT., PGDCLP.  : MEMBER

 

C.C. No.94/2016

DATED THIS THURSDAY THE 05^TH DAY OF MARCH 2020

                                 

R. Ashok Kumar,

S/o. Late P. Raghavelu,

No.14/7, Thiruvalluvar First Street,

Periyar Nagar,

Tiruninravur – 602 024.                                                  .. Complainant.                        

..Versus..

 

1. APOLLO HOSPITALS ENTERPRISES LTD.,

M/s. APOLLO HOSPITALS,

No.21, Greams Lane,

Office Greams Road,

Chennai – 600 006.    

 

2. Dr. L.F. Sridhar,

Consultant Cardio Vascular & Thoracic Surgeon,

Apollo Hospitals,

Chennai – 600 006.                                                 ..  Opposite parties.

 

Counsel for the complainant       : M/s. V. Balaji & others

Counsel for the opposite parties : M/s. Maimoona Badsha

 

ORDER

THIRU. M. MONY, PRESIDENT

       This complaint has been filed by the complainant against the opposite parties 1 & 2 under section 12 of the Consumer Protection Act, 1986 prays to pay a sum of Rs.8,03,182/- towards hospital charges and to pay a sum of Rs.10,00,000/- towards compensation for mental agony with cost of Rs.50,000/- to the complainant.

1.    The averments of the complaint in brief are as follows:-

         The complainant submits that on 28.07.2014, the complainant had a chest pain and approached the 1^st opposite party hospital for treatment and consulted Dr. Vijayachandra Reddy, Cardiologist at the 1^st opposite party hospital who has advised the complainant to undergo angiogram test.   As per the advice of the Doctor, the complainant had undergone angiogram on 29.07.2014. As per the final diagnosis arrived by the 1^st opposite party, the complainant suffered Coronary Artery Disease.  Further, the cardiologist recommended the complainant to undergo Coronary artery bypass.  The complainant submits that he was admitted into the 1^st opposite party hospital on 29.07.2014 for Coronary artery bypass.  The 2^nd opposite party performed bypass surgery to the complainant on 01.08.2014 and was discharged on 08.08.2014.   On discharge, the complainant strictly followed the post operative instructions and medication prescribed by the 2^nd opposite party.  The complainant submits that on 24.11.2014, the complainant had the symptoms of breathlessness and chest pain.  Hence, the complainant approached the 1^st opposite party, hospital wherein, the complainant was advised to take 320 Slice CT-Coronary Angiogram which revealed 80% of stenosis and the conclusion of the report is as follows:

• CT findings reveal patent LIMA t LAD & SVG to PDA
• 80% stenosis of SVG to OM.

2.     The complainant submits that he consulted the two Cardiologist for second opinion.   “Both the cardiologist informed that “One of the blocks had not been attended to”. The complainant was very much upset and undergone mental agony his attender, one Mr. T.R. Nanda Kumar lodged a complaint before the 1^st opposite party on 09.12.2014 seeking explanation. The complainant submits that on 21.01.2015, the 2^nd opposite party sent explanation letter to the 1^st opposite party dated:09.12.2014 mentioning that “the second opposite party admits that he has not attended one block since the branch diagonal was small at surgery”.  Since every after the surgery miserable failed and neglected to carry out the proper care taken to remove all the blocks.   Hence, the complainant was compelled to undergo another surgery by expending a huge amount of Rs.5,00,000/- and already the complainant has expended a sum of Rs.3,03,182/-.  However in the early part and last part of the explanation, the 2^nd opposite party states that recurrence had occurred.  In common man understanding the recurrence will occur only earlier block is grafted.  Having not grafted block, how recurrence might have occurred that too with the 80%.   The complainant submits that the 2^nd opposite party has not attended one block.  Hence, the doctrine of Res ipsa loquitor is applicable.  The complainant submits that because of the negligence of the 2^nd opposite party, the complainant had to undergo once again bypass surgery or undergo angiogram with stent.   This procedure will costs Rs.2,50,000/-.   The opposite parties are liable to pay Rs.10,00,000/- as compensation for pain and sufferings and to refund the medical expenses incurred by the complainant for earlier surgery and subsequent surgery to be undergone and cost.   Hence, the complaint is filed.

3.      The brief averments in the written version filed by opposite parties 1 & 2 is as follows:-

The opposite parties 1 & 2 specifically deny each and every allegations made in the complaint and put the complainant to strict proof of the same.   The 1^st opposite party has an unblemished track record of high quality medical care adhering to international standards in the practice of medicine.  The 2^nd opposite party is a highly qualified, experienced and well respected medical professional, who has been working in the profession for more than 28 years.   The complainant received treatment from the 2^nd opposite party between 29.07.2014 & 08.08.2014 at the 1^st opposite party’s medical facilities at Apollo Hospitals, Chennai – 6.   The complainant first consulted Dr. Vijay Chandra Reddy, Cardiologist in the 1^st opposite party’s hospital.   The complainant complained of history of chest pain on exertion and informed the Doctor that he had been admitted and treated locally at K.M. Hospital.  At the 1^st opposite party’s hospital, the complainant was diagnosed with severe Coronary Artery Disease (CAD) and the Doctor advised him to undergo a Coronary Angioplasty.  The complainant was evaluated by Cardiac Catheterization and Coronary Angiography, which revealed severe left main with triple vessel disease with normal Left Ventricular function (by Echo), and he was advised a coronary artery bypass graft surgery (CABG Surgery).  The complainant underwent the CABG Surgery performed by the 2^nd opposite party at the 1^st opposite party’s hospital on 01.08.2014. 

4.     The opposite parties state that that after explaining the complainant regarding the risk involved in the surgery, a General Consent, Consent for Anaesthesia, Consent for Angiography, Consent Form for Transfusion of Blood / Blood Components, Consent for Coronary Artery Bypass Surgery, and Consent sent for HIV testing were obtained from the complainant on 29.07.2014, 31.07.2014, 29.07.2014, 31.07.2014, 31.07.2014 & 30.07.2014 respectively.  The opposite parties state the complainant without stating the appropriate date of symptom of breathlessness, chest pain as claimed by him.   The complainant consulted the Doctor, 1^st opposite party on 24.11.2014 and the Doctor and diagnosis recommended for further surgery which shall not be a deficiency in service because the symptom occurred more than three months after the CABG surgery.   The said history is typically suggestive of saphenous vein graft (“SVG”) which is developing in the first year after a coronary artery bypass graft surgery from 5% to 26% according to various medical literature.   The opposite parties state that it is universally accepted and quoted in all medical literature that LIMA to LAD is the gold standard graft which shown the survival and benefits to the patients and same literature advises to avoid grafting separately with a small D1 with SVG  for fear of competitive flow affecting LIMA – LAD graft.    As stated above in the letter dated:22.01.2015 issued to the complainant, the 2^nd opposite party clarified that it is only vessels of reasonable quality and reasonable size that are grafted.  

5.     The opposite parties state that coronary angiogram was taken to the complainant on 29.07.2014 and revealed that the First Diagonal of the Heart (D1) was small with disease and that during the CABG Surgery, the D1 was found to be too small to be grafted.   Moreover, grafting over this small diagonal branch would have compromised the Left Internal Mammary Artery (LIMA) to Left Anterior Descending Coronary Artery (LAD) graft due to competitive flow and this LIMA – LAD graft is more important that a small diagonal graft.    The LIMA to LAD graft alone increases the long term survival benefit for the patient.   Therefore, for these reasons, the D1 was not grafted.   The complainant has misconstrued the medical facts.   It was D1 that was not grafted and the SVG disease arises in the SVG to OMA which is a totally different vessel.   Therefore, it is incorrect to state that the non-grafting had anything to do with the SVG disease.   The 2^nd opposite party used the word “recurrence” in the context of explaining that recurrence of symptoms occurred after two and half months of the CABG Surgery; therefore, had  no relation to the CABG Surgery itself but the development of a new disease.    The CABG Surgery was successful as noted by the total disappearance of symptoms and good cardiac and general health status of the complainant at his discharge.   All these are clear indicators that the CABG Surgery was performed without causing any harm or damage to the complainant.   Therefore, the allegation of negligence of the 2^nd opposite party is unfounded and unsubstantiated.   The complainant fails to prove any negligence on the part of the opposite parties.   Hence, the opposite parties are not liable to pay for any subsequent surgery as has been claimed by the complainant and hence, the complaint is liable to be dismissed.

6.     To prove the averments in the complaint, the complainant has filed proof affidavit as his evidence and documents Ex.A1 to Ex.A7 are marked.  Proof affidavit of the opposite parties 1 & 2 is filed and documents Ex.B1 to Ex.B15 are marked on the side of the opposite parties 1 & 2.

7.      The points for consideration is:-

1. Whether the complainant is entitled to a sum of Rs.8,03,182/- expended towards medical expenses and hospital charges as prayed for?
2. Whether the complainant is entitled to a sum of Rs.10,00,000/- towards compensation for mental agony, deficiency in service with cost of Rs.50,000/- as prayed for?

8.      On point:-

Both parties filed their respective written arguments.  Heard both sides.  Perused the records namely; the complaint, written version, proof affidavits and documents.   The complainant pleaded and contended that on 28.07.2014, the complainant had a chest pain and approached the 1^st opposite party hospital for treatment.  The 1^st opposite party suggested the 2^nd opposite party Doctor for due clinical diagnosis.  The 2^nd opposite party Doctor Suggested Angiogram.  

9.     Accordingly on 29.07.2014, Angiogram was taken and Ex.A1 is the copy of Angiogram Report which reveals Coronary Artery Disease and it reads as follows:-

CORONARY ANGIOGRAM

Clinical Diagnosis                : Dyslipidemia

                                                  F/H/O coronary artery disease

                                                  CAD: Acute IWMI (6/7/2014)

                                                 Troponin positive

                                                 Echo : RWMA with normal LV function

                                                 Normal TSH

                                                CT-CAG: 40-50% proximal LAD stenosis             

                                                80-90% proximal R-PDA stenosis

Haemodynamics

Cham                                             Chamber	Pre-angio (mm Hg)	O2 Saturation %
AO	120/80m 90	100%

 

LMCA                                     : Distal 50% stenosis

LAD                                        : Type III proximal eccentric 70% stenosis

                                                 D1 ostial 70% stenosis

LCX                                        : Non-document

OM Branches                      : Normal

RCA                                       : Dominant proximal RCA eccentric 70% Stenosis

PDA                                       : Subtotal occlusion filled by collaterals  from left system

Final Diagnosis                   : CORONARY ARTERY DISEASE

CORONARY ANGIOGRAM

SEVERE LMCA DISEASE

SEVERE LAD AND RCA

SUBTOTAL OCCLUSION OF PDA

Recommendation               : CABG WITH GRAFTS TO

• LAD
• D1
• OM
• PDA

  As per the advice of the doctor, 2^nd opposite party on 01.08.2014, due surgery was performed and the complainant was discharged on 08.08.2014.  Ex.A2 is the copy of Discharge Summary. 

In Ex.A2, copy of Discharge Summary under SURGERY INFORMATION it reads as follows:-

Date of Surgery              - 01/08/2014

Through a limited median sternotomy on a beating heart without conventional cardio pulmonary bypass aorto coronary saphenous vein grafting to.

- Posterior descending artery

- Major obtuse marginal artery

- The left internal mammary artery was grafted to

- Left anterior descending artery

Accordingly, the after the surgery, administered medication.   Further the contention of the complainant is that on 24.11.2014, the complainant had severe chest pain.  Hence, the complainant approached the 1^st opposite party, hospital wherein, the complainant was advised to take Angiogram as per Ex.A4 which reveals 80% of the block is in existing which reads as follows:-

CONCLUSION:- 

- CT findings reveal patent LIMA t LAD & SVG to PDA

- 80% stenosis of SVG to OM.

Since the 2^nd opposite party during the surgery has not attended one block.   

10.    Further the contention of the complainant is that on 22.01.2015, the 2^nd opposite party sent a reply letter to the 1^st opposite party dated:09.12.2014 and admitted that one block was not attended.   The reason is the said block is small and it is due to recurrence proves the deficiency in service as well as unfair trade practice.   Since even after the surgery miserably failed and neglected to carry out the proper care taken to remove all the blocks.   Hence, the complainant was constrained to undergo another surgery expending a huge amount of Rs.5,00,000/- already the complainant has expended a sum of Rs.3,03,182/- as per Ex.A7.   Further the contention of the complainant is that the 2^nd opposite party in his written explanation dated:21.01.2015 which is marked as Ex.A6 he admitted the following:-

        “Regarding one block not attended to, all vessels of reasonable quality and reasonable size would be grafted.   If the branch diagonal was small at surgery, it would not be grafted.  Moreover grafting this small branch would have compromised the LIMA to LAD graft due to competitive flow and this LIMA-LAD graft is more important that small diagonal graft.  The initial absence of symptoms and recurrence after two and a half months suggests disease developing in the SVG to OMA is the cause of the symptoms”.

The opposite party has not obtained the proper consent not to remove the blocks and not disclose without grafting during surgery.  The complainant is claiming Rs.10,00,000/- towards compensation and refund of the medical expenses incurred by the complainant for earlier surgery and subsequent surgery to be undergone and cost.

11.    The learned Counsel for the opposite parties would contend that as per Ex.B1 to Ex.B4 Series due surgery was performed by the experts.   The complainant underwent CABG Surgery through the 2^nd opposite party.  Ex.B6 is the copy of Operation Notes.   Further the contention of the opposite parties is that after explaining the complainant regarding the risk involved in the surgery, a General Consent, Consent for Anaesthesia, Consent for Angiography, Consent Form for Transfusion of Blood / Blood Components, Consent for Coronary Artery Bypass Surgery, and Consent sent for HIV test were obtained.   Ex.B7 Series are the Consent Forms.  Ex.B8 is the copy of Discharge Summary.   Further the contention of the opposite parties  the complainant without stating the appropriate date of symptom of breathlessness chest pain and discomfort consulted the Doctor, 1^st opposite party on 24.11.2014 and the Doctor and diagnosis recommended for further surgery as per Ex.B9 which shall not be a deficiency in service because the symptom occurred more than three months after the CABG surgery.   The said history is typically suggestive of saphenous vein graft (“SVG”) which is developing in the first year after a coronary artery bypass graft surgery.   The opposite parties has not explained the reason for not grafting of a vain even after obtaining consent for appropriate surgery amounts to deficiency in service. 

12.    Further the contention of the opposite parties is that it is universally accepted and quoted in all medical literature that LIMA to LAD is the gold standard graft which shown the survival and benefits to the patients and same literature advises to avoid grafting separately with a small D1 with SVG  for fear of competitive flow affecting LIMA – LAD graft.   But in this case, on a careful perusal of the surgery report and Discharge Summary, Ex.A2 it reads as follows:

“Through a limited median sternotomy on a beating heart without conventional cardio pulmonary bypass aorto coronary saphenous vein grafting to.

- Posterior descending artery

- Major obtuse marginal artery

- The left internal mammary artery was grafted to

- Left anterior descending artery”

proves utter negligence in surgery.  Considering the facts and circumstances of the case, this Forum is of the considered view that the opposite parties 1 & 2 are jointly and severally liable to pay a sum of Rs.3,03,182/- being the hospital charges paid and to pay a sum of Rs.2,00,000/- towards compensation for mental agony with cost of Rs.10,000/- to the complainant.

In the result, this complaint is allowed in part.  The opposite parties 1 & 2 are jointly and severally liable to pay a sum of Rs.3,03,182/- (Rupees Three lakhs three thousand one hundred and eighty two only) being the hospital charges paid and to pay a sum of Rs.2,00,000/- (Rupees Two lakhs only) towards compensation for mental agony with cost of Rs.10,000/- (Rupees Ten thousand only) to the complainant.

The above amounts shall be payable within six weeks from the date of receipt of the copy of this order, failing which, the said amounts shall carry interest at the rate of 9% p.a. to till the date of payment.

Dictated  by the President to the Steno-typist, taken down, transcribed and computerized by her, corrected by the President and pronounced by us in the open Forum on this the 05^th day  March 2020. 

 

MEMBER                                                                                                                                                                                               PRESIDENT

COMPLAINANT SIDE DOCUMENTS:-

Ex.A1	29.07.2014	Copy of Angiogram Report
Ex.A2	08.08.2014	Copy of Discharge Summary
Ex.A3	08.08.2014	Copy of Operation Notes
Ex.A4	24.11.2014	Copy of Angiogram Report
Ex.A5	09.12.2014	Copy of Protest letter
Ex.A6	22.01.2015	Copy of Explanation by the 2nd opposite party
Ex.A7		Copy of Final Bill

 

OPPOSITE PARTIES SIDE DOCUMENTS:-  

Ex.B1 (S)		Copy of Dr. L.F. Sridhar’s Degree and Medical Registration Certificates
Ex.B2		Copy of Dr. L.F. Sridhar’s Curriculum Vitae
Ex.B3 (S)		Copy of Registration Form, patient Registration Record, Admission Slip and Admission Form
Ex.B4		Copy of Cardiac Catheterization
Ex.B5	24.11.2014	Copy of Coronary Angiogram Evaluation Report
Ex.B6	01.08.2014	Copy of Operation Notes
Ex.B7 (S)		Copy of Consent Forms
Ex.B8	08.08.2014	Copy of Discharge Summary
Ex.B9	24.11.2014	Copy of OP – Diagnosis & Recommendations
Ex.B10		Copy of Primary Coronary Artery Bypass Surgery by G.D. Rushing and David D. Yuh
Ex.B11 (S)		(1) Bypass Conduit Options by Hendrick B. Barner (2) Stenotic Arteriosclerotic Coronary Artery Disease in Kirklin/Barratt-Boyes Cardiac Surgery (Volume 1, Fourth Edition) by Nicholas T. Kouchoukos, Eugene H.  Blackstone, Frank L. Hanley and James K. Kirklin
Ex.B12	09.12.2014	Copy of letter from Mr. T.R. NandaKumar
Ex.B13	22.01.2015	Copy of letter from Dr. R.K. Venkatasalam
Ex.B14 (S)		(1) “Competitive flow between a vein and an arterial graft at transit-time flow measurement” by Michele Rossi, Federica Jiritano, Emanuele Malta and Attilio Renzulli (2) “Impact of Competitive Flow on Hemodynamics in Coronary Surgery: Numerical Study of ITA-LAD Model” by Jinli Ding Youjun Liu, Feng Wang and Fan Bai (3) “Patency rate of internal thoracic artery to the left anterior descending artery bypass is reduced by competitive flow from the concomitant saphenous venin graft in the left coronary artery” by Masashii Kawamura, Hiroyuki Nakajima, JunjiroCobayshi, Toshihiro Funatsu, Yoritaka Otsuka, Toshikatsu Yagihara and Soichiro Kitamura (4) “The impact of competive flow on distal coronary flow and on a graft flow during coronary artery bypass surgery” by Nikoloas TsirikosKarapanos, Scott H. Suddenorf, Zhuo Li, Marianne Huebner, Lyle D. Joyce and Soon J. Park
Ex.B15 (S)		Copy of Hospital bills

 

 

 

MEMBER                                                                                                                                                                                              PRESIDENT