Tamil Nadu
North Chennai
206/2011
Sujatha, - Complainant(s)
Versus
Narayana Hospital, - Opp.Party(s)
V.Balaji
26 Dec 2017
ORDER
Complaint presented on: 25.11.2011
Order pronounced on: 26.12.2017
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)
2nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3
PRESENT: THIRU.K.JAYABALAN, B.Sc., B.L., PRESIDENT
THIRU. M.UYIRROLI KANNAN B.B.A., B.L., MEMBER - I
TUESDAY THE 26th DAY OF DECEMBER 2017
C.C.NO.206/2011
Sujatha,
W/o.Umapathy,
No.16/2, Kandappa Gramani Street,
Purasawalkam,
Chennai – 600 007.
….. Complainant
..Vs..
1. Narayana Hospital,
No.18, Tana Street,
Purasawalkam,
Chennai – 600 007.
2.Dr.P.Varalakshmi,
Narayana Hospital,
No.18, Tana Street,
Purasawalkam,
Chennai – 600 007.
3.Apollo Hospital,
21, Greams Lane,
Chennai – 600 006.
4.M/s Oriental Insurance Company Limited,
Rep by its General Manager,
Having its Office at “Dwarka” second floor, (impleaded as per order in
No.79, Uttamar Gandhi Salai, CMP.No.135/2012)
(Nungambakkam High Road)
Chennai – 600 034.
| .....Opposite Parties
|
|
Date of complaint : 02.12.2011
Counsel for Complainant : M/s. V.Balaji, A.Sermaraj
Counsel for 1st & 2nd Opposite Parties : V.Ramakrishnan, K.Ganesan
Counsel for 3rd Opposite Party : M/s. C. Manishankar,
K.Krishnamoorthy,
J.Vasu & S.Arun prasad
Counsel for 4th Opposite Party : N. Vijayaraghavan
O R D E R
BY PRESIDENT THIRU. K.JAYABALAN B.Sc., B.L.,
This complaint is filed by the complainant to refund hospital expenses and compensation for mental agony with cost of the complaint u/s 12 of the Consumer Protection Act.1986.
1.THE COMPLAINT IN BRIEF:
The complainant conceived for the second time and she consulted the 2nd opposite party AT the 1st opposite party/hospital on 19.01.2011. Her last menstrual period was on 23.11.2010 and expected date of delivery was on 30.08.2011. From the date of first examination by the 2nd opposite party and she was admitted with the 1st opposite party for delivery, she was keeping good health. Her hemoglobin is 11.48 gms %. On 19.01.2011 her BP was 110/70, on 19.02.2011 her BP was 120/80, on 19.03.2011 her BP was 110/70 and on 13.05.2011 her BP was 120/80. On 14.06.2011 her hemoglobin was 9.2 gm% and BP was 120/80.
2. The complainant consulted the 2nd opposite party on 14.07.2011, the 2nd opposite party suggested elective LSCS between 21.08.2011 to 27.08 2011. Again she consulted the 2nd opposite party on 17.08.2011 and she directed her to admit on 24.08.2011 at 08.00 a.m for elective LSCS.
3. The complainant developed labour pain and she was admitted on 18.08.2011 in the 1st opposite party /hospital. The 1st & 2nd opposite parties have not obtained informed consent from the complainant for performance of surgery or the consent of her husband for sterilization. The 2nd opposite party performed LSCS and the complainant delivered female baby at 9.50 a.m. The Heart beat between 110 to 160 is normal in fetus. Nowhere the 2nd opposite party recorded the fetal heart rate. In the report of surgical procedure the manipulation was done thereby elective was corrected as emergency. Even in the surgical report the BP of the complainant is 120/80. There is no abnormality in the mother and child health. The 2nd opposite party suggested elective LSCS only. So the performance of emergency LSCS without attending circumstances perse amounts to deficiency in service and negligent in performing the surgery.
4. The complainant is not an hypertensive patient and she never took anti hypertensive drugs and the 2nd opposite party also not prescribed such drug. At the time of admission for delivery the complainant was informed that her BP was 110/70 and there was no fetal distress. The 2nd opposite party has performed the LSCS as the indication is fetal distress. The FH rate ranging from 110 to 160 is normal compared to distressed baby. The fetal heart rate was not recorded by the second opposite party. However in the discharge summary itself, it has been categorically stated that fetal heart was good. The discharge summary was not signed by the doctor concerned. It was not in the printed format. Name of the hospital was not mentioned. It is computer generated discharge summary and hence the doubt over the genuineness of the record submitted to the complainant.
5. The complainant was discharged on 22.08.2011. In the discharge summary, the 2nd opposite party has advised iron and calcium for three months only. The complainant is having hypertension of 140/80 at the time of discharge, the 2nd opposite party is duty bound to prescribe the drugs to control the hypertension. Failure to prescribe such a drug amounts to deficiency in service. In fact T Aldomet- 250 was not at all prescribed by the second opposite party and the said tablet was inserted in the discharge summary to show the complainant has hypertension. On 22.08.2011 around 7.30 pm the complainant vomited in the house. On 23.08.2011 she developed giddiness, vomiting in the morning. Immediately she was admitted in the 1st opposite party hospital at 8.00 a.m. The complainant was not at all attended by the 2nd opposite party till 11.40 a.m. The complainant husband went to the 2nd opposite party room and shouted and thereafter only the 2nd opposite party came and examined the complainant and the BP was not recorded every half an hour. The BP chart shows that at 8.30 a.m 170/100, at 11.30 a.m 160/90, at 12.45 p.m 170/90 am, at 1.15 p.m 200/100. There
is variation in record of the BP. The discharge summary projected that the complainant is having Accelerated Hypertension. It means very high blood pressure that comes on suddenly, quickly. The lower (diastolic) pressure is often above 130 mm Hg where normal value is 80 mm Hg. The BP chart does not disclose that the complainant was having diastolic pressure of 130 on 23.08.2011.
6. The treatment for accelerated hypertension is to do the test of ABG, Creatine and Urine analysis. This basic test was not done. The chest X-ray was not done. The chest X-ray will reveal congestion in lungs and enlarged heart. BUN test was not done. Accelerated hypertension that is left untreated; it can lead to hypertensive emergency and potential serious consequences including bleeding in brain. This has exactly happened in the complainant case. Hence the principle of Resipsa liquidator is applicable. The complainant was prescribed PANTOCID TABLET. This tablet is contra indication to the lactation woman. Tablet EMESET effectively control the vomiting. But this drug passes into the Brest milk. Inj. Nitroglycerine is meant for unstable angina, hypertensive during cardiac surgery. Tablet Vertin meant for Vertico and it is contra indication to lactation woman. The tablet stemetil is a potent phenothia zina neorulepsis. This tablet should not be used to lactation woman. The tablet Calcigard is a Calcium channel blacker and it is unsafe for lactation woman. All the drugs will have drug interaction and will deterroid health of the complainant. The aforesaid prescription of drugs clearly establishes the negligent manner of treating the complainant.
7. The complainant was transferred to third opposite party hospital for further management. During the transit from 1st opposite party hospital complainant Scan was done and it showed pontine Hemorrhage. The complainant sustained brain damages which resulted the paralysis and it is irreversible and permanent one. The complainant incurred Rs.4.50 lakhs in the Apollo Hospital for treating the complications arisen due to the negligent treatment of the 2nd opposite party hospital. The complainant life was saved but the ailment was not cured. The first and 2nd opposite party are duty bound to issue the case sheet within 72 hours from the date of demand. In this complainant case, only after the intervention of Assistant Commissioner of Police, Vepery, Chennai-7, Xerox copies was given that too after the seven days from the instruction of the Assistant Commissioner of Police. The complainant incurred Rs.40,000/- for the delivery and Rs.17,500/- for second admission in the 1st opposite party hospital. Besides she incurred a sum of Rs.4,84,471.76/- in the 3rd opposite party hospital. Thus she has incurred a total sum of Rs.5,41,971.76/-. She is in very pathetic situation and unable to feed milk to her child and lifelong she required assistance from 3rd persons. Hence the complainant filed this complaint to refund hospital expenses and compensation for mental agony with cost of the complaint.
8. WRITTEN VERSION OF THE 1st OPPOSITE PARTY IN BRIEF:
The complainant was admitted in the 1st opposite party hospital on 18.08.2011 for delivery and the 2nd opposite party did LSCS and delivered female baby further MPT was also done to the complainant and she was discharged on 22.08.2011. This opposite party runs the hospital by name Narayana Hospital which, admitted the complainant at the instance of the 2nd opposite party. The complainant was taking treatment with the 2nd opposite party in respect of her pregnancy and for the safe delivery which is a special filed of medicine called obstetrics. The complainant had included this opposite party in the complaint only for including the hospital in administering the treatment has made by the 2nd opposite party and her experts. Therefore there is no allegation in respect of this opposite party either in manner of this administration of the treatment as advised by the doctors and the one and only allegation that has been narrated against the hospital is about the not signing of discharge summary.
9. On 22nd of August of 2011 she had giddiness and vomiting, on the next day the other things being severe and she was admitted in the hospital for further management. On the opinion of Cardiologist she was transferred to scan centre in the ambulance which is fully equipped for transferring the patient. She was advised to move to a hospital having sophisticated facility of management where the complainant preferred the place to be Apollo Hospital as decided by her near and dear for which she was transferred in the same ambulance from centre without returning to the 1st opposite party’s hospital. At Apollo Hospital she have undergone treatment from 23rd of August of 2011 and discharged on 22nd of September of 2011 as she said.
10. The complainant was taking treatment with the 2nd opposite party in respect of her pregnancy and for the safe delivery which is a special filed of medicine called obstetrics. The 2nd opposite party being an expert in that field of medicine who has a post graduate diploma namely, D.G.O., this opposite party did not take part in any of the treatment given to the complainant except to give the directions to carry out the treatment. Therefore there is no allegation in respect of this opposite party either in manner of this administration of the treatment as advised by the doctors and the one and only allegation that has been narrated against the hospital is about the not signing of discharge summary. The Complainant scan had shown Pontine Haemorrhage allegedly leading to brain damage allegedly stating that it resulted in paralysis which is alleged to be irreversible. It is admitted fact that according to the complainant the Pontine Haemorrhage is due to the elevated hypertension.
11. The symptom of Nausea, Vomiting, and Headache which is a clear clinical presentation that is always associated with some happenings in the brain. Further at the time of admission it is diagnosed to be accelerated hypertension. Hence when the accelerated hypertension was present at the time of admission and the tests having been taken after admission the test cannot be the initial or causative factor of the accelerated hypertension. Thus there is no casual connection between the allegation made against this opposite party and the alleged Pontine Haemorrhage.
12. There is not even a single word of whisper in pleading that what was the breach of duty owed by this opposite party resulted in the Pontine Haemorrhage. In the absence of any pleading of the alleged breach of duty, the damage and the relationship to make the breach of duty is the cause which resulted in the effect of the Pontine Haemorrhage which has not been pleaded in the complaint, which is the humble submission of this opposite party. Hence it is humbly submitted that the complainant has not made out any case against this opposite party and prays to dismiss the complaint with costs.
13. WRITTEN VERSION OF THE 2nd OPPOSITE PARTY IN BRIEF:
This opposite party admits that the complainant came to this opposite party for antenatal check up on 19.01.2011. The complainant earlier underwent LSCS at Sowcarpet. The complainant accepted to undergo elective LSCS in the month of June 2011. The date was fixed as on 24.08.2011. The complainant herself has admitted that she came to this doctor with her labour pain on 18th of August 2011 for the very purpose of the delivery of the child. Due to threatened rupture emergency LSCS was done. The consent of the complainant and her mother was also obtained.
14. The fetus also was under stress is also fortified by the presence of meconium found in the amniotic fluid at the time of delivery confirms that this doctor made the right decision to have delivery conducted emergently by LSCS. Thus the patient with previous LSCS with Labour is to be classified as “Threatened Rupture” is the right classification made by this opposite party, and being a doctor this opposite party believes that the decision cannot be found fault with. Therefore the decision of conducting emergent caesarean section cannot be attributed to willful malice and when the same is done with the accepted school of medical thought that is proved by the above data given.
15. In respect of the sterilization surgery, it is not the case of the complainant that she has not consented and also it is not the case that her husband has not consented, but it was the case specifically that the complainant wants to plead that it was not in writing. The decision to do sterilization was informed and the consent being given by them, it was done. The patient underwent emergency lower segment caesarean section which in short form called LSCS delivered a live female baby and also underwent family planning operation by a method called Modified Pomeroy’s Technique which is shortly called as “MPT”. Further surgery was done by the 2nd opposite party who has got requisite expertise and education which she did along with Dr.Jawahar who has got a Post Graduate degree in surgery and the Anaesthesia was administered by Dr.Alaguvel who has got the necessary expertise, qualification and experience to administer the anesthesia. Thus the procedure was performed in a manner known to medical jurisprudence and accepted by the complainant, its family members and the manner of prudent performance of the procedures is not disputed except to the allegations of doing it emergently and the alleged performance of surgery without consent, which is not really true as has been explained supra.
16. The complainant came to the 1st opposite party’s hospital and got admitted on 23rd of August of 2011 at 8.30 hours and was admitted in the hospital as per the advice of this doctor. The patient was seen by this doctor at about 9.30 hours and her blood pressure as measured by this doctor revealed as 170/100 and 170/90 mm of Mercury shortly denoted as Hg as per the chemical symbol used in chemistry, where she was diagnosed as Accelerated hypertension. The very statement that the complainant was not treated till her husband created a scene at 11.30 a.m hours is a concocted story.
17. As decided by this doctor the cardiologist opinion was sought and the cardiologist gave the opinion which is as per the records available. The cardiologist also made the same diagnosis as made by this doctor accepted the treatment started by this doctor and rate the Blood Pressure of the patient hourly and to get Neurologist opinion. The cardiologist had also sought the blood test to be done. Further, as the cardiologist has sought for the emergent complainant of the Brain show was transferred in the Ambulance to the complainant Scan Centre from where the complainant took a decision that she will opt for treatment at the third opposite party hospital.
18. WRITTEN VERSION OF THE 3rd OPPOSITE PARTY IN BRIEF:
The complaint against this opposite party is not maintainable. A perusal of the complaint would show that the entire allegations in the complaint are directed only against the 1st & 2nd opposite parties. Hence, this opposite party is not traversing the various allegations made in the complaint against the 1st & 2nd opposite parties but he has restricted this version only to the treatment given to the complainant by this opposite party. The medical records available it appears that the complainant was admitted on 23.08.2011 in an emergency. She previously underwent lower segment cesarean section and she was given anti hypertension drugs for the past one month and discharges from the 1st and 2nd opposite parties on 22.08.2011. Following that she developed drowsiness, vomiting for which Complainant brain scan was done outside, which shows pontine hemorrhage. She was incubated for low GCS and shifted to CCU. Various examinations were done by this opposite party which revealed right gaze palsy, V nerve weakness, striprose, right facial weakness and left hemiparesis. She was put on RT feed and catheterized. Tracheotomy was done for prolonged ventilation on 16.09.2011, right gaze palsy and right facial palsy, V nerve weakness improved. The complainant was discharged on 22.09.2011 in a conscious and oriented state with advice for review after two weeks. No reliefs have been claimed against this opposite party, hence the complaint may be dismissed as against this opposite party.
19. WRITTEN VERSION OF THE 4th OPPOSITE PARTY IN BRIEF:
This opposite party has issued Professional Indemnity policy No.412000/48/2012/541 to the Second Respondent/ Dr.P.Varalakshmi, to cover her individual Professional Negligence. The Insurer is liable only to the extent of Professional Negligence of 2nd opposite party, provided the 2nd opposite party was the treating/attending Gynecologist of the complainant. The Discharge Summary and the medical records of complainant were not signed by the 2nd opposite party. The complainant is called upon to prove the service rendered by the second opposite party in order to substantiate the claim as against the insurer. As far as M/s. Narayana Hospital, 1st opposite party is concerned, the insurer has no contractual relations and no policy has been taken in its name and for the Professional Negligence of other Doctors and for the errors and Omissions of M/s. Narayana Hospital/ 1st opposite party herein, this 4th opposite party not liable. Strictly without prejudice to the above, the maximum liability of the insurer under the policy is Rs.10,00,000/- in respect of any one accident. In any event the liability of the insurer is only to the extent of the said sum and is not liable to indemnify anything more than the agreed sum.
20. The medical records do not contain the signature of the 2nd opposite party to substantiate that she was the consulting Doctor of the complainant. The further allegations in para 6 and 7 that the 2nd opposite party has manipulated the Surgical procedure report and performed emergency LSCS without compelling necessity is false and without any basis. The onus is on the complainant to prove that the discharge summary was issued by the 2nd opposite party herein. The discharge summary no where contains the signature of 2nd opposite party. It does not even contain the name of the hospital. As such the liability of Insurer arises if and only the professional negligence of the 2nd opposite party is proved. The further allegation that hypertension tablet was not prescribed by the 2nd opposite party but was inserted in discharge summary to show complainant has hypertension is false and misleading.
21. The medical reports reveal that she was properly treated and was found to develop sudden deterioration in consciousness and performed Complainant Brain scan which revealed hemorrhage and was thereafter referred to Apollo Hospital for further evaluation. Even otherwise the insured the 2nd opposite party was not found to have treated the complainant. The claim is excessive and hence this opposite party prays to dismiss the complaint with costs.
22. POINTS FOR CONSIDERATION:
1. Whether there is deficiency in service on the part of the opposite parties?
2. Whether the complainant is entitled to any relief? If so to what extent?
23. POINT NO :1
The admitted case of the complainant and the opposite parties 1 & 2 are that the complainant had undergone LSCS for the delivery of the 1st child. After conceived for the 2nd time, the complainant went to the 2nd opposite party / doctor attached with the 1st opposite party. The 2nd opposite party examined her on 19.01.2011. Her last menstrual period was on 23.11.2010 and expected delivery was on 30.08.2011. Throughout the antenatal period, the complainant consulted the 2nd opposite party and she prescribed medicine and her findings in Ex.A1 to ExA3 prescriptions. On 14.07.2011 itself the 2nd opposite party suggested for elective LSCS between 21st to 27th in writing in ExA2 prescription. Further in ExA3, on 17.08.2011 the doctor suggested the elective LSCS on 24.08.2011 and complainant to get admitted on 23.08.2011.
24. On18.08.2011she developed into labour pain and got admitted at 09.38am in the 1st opposite party hospital. The 2nd opposite party done emergency LSCS. The complainant delivered male baby on the day at 09.50am. After LSCS procedure, her BP was 120/80 and she was discharged on 22.08.2011. After discharge on same day evening, the complainant developed to giddiness and vomiting and informed the 2nd opposite party. She advised her to admit in the 1st opposite party hospital and however she got readmitted in the 1st opposite party hospital on 23.08.2011 morning 08.00am.
25. The complainant alleged deficiencies against the opposite parties 1 &2 are that
- On 23.08.2011 at 08.00am the complainant was admitted in the 1st opposite party hospital and she was not at all attended by the 2nd opposite party/doctor till 11.40am is negligence on the part of the opposite parties 1 &2,
- The opposite parties 1 &2 have not obtained informed consent from the complainant or from her husband to do the LSCS and sterilization,
- The 1st opposite party has manipulated the medical records,
- The opposite parties 1 & 2 have violated the code of medical ethics,
- The 2nd opposite party prescribed contra indicated drugs and
Due to negligent treatment of the opposite parties 1 & 2 resulted the complainant brain has been damaged
26. According to the complainant she had giddiness and vomiting in the morning on 23.08.2011and she went to the 1st opposite party /hospital at 08.00am and the complainant was not attended by the 2nd opposite party till 11.40am and the complainant husband shouted in front of the 2nd opposite party /doctor room, then only she came out and attended the complainant. The 2nd opposite party would reply that she had attended the complainant on 09.30am as per ExA8 progress notes and thereafter all her monitoring on the complainant was recorded in the said notes and therefore the contention of the complainant that she had attended her only at 11.40am is false.
27. As per the ExA8 progress notes at page 11, the 2nd opposite party admitted the complainant at 09.30am on 23.08.2011 and started treatment. As per further notes nitroglycerine drip was started and tablets were prescribed and the complainant become drowsy at 01.00pm and at 1.30pm she was shifted to the scan centre. However in ExA8 at page 16 drugs & medical record, the medicines prescribed at 08.30 am on 23.08.2011 and drips started at 9.30am on the same day. When the complainant admitted as per ExA8 at page 11 at 9.30am, how can the 2nd opposite party prescribe medicines at about 08.30am in page 16 of Ex.A8. Likewise as per record ExA8 at page13 nitroglycerine drip started after 1.00pm when the patient become drowsy and in the very same document at page 16 drip started at 09.30am. The same medicine and drip were prescribed in different timings in the progress notes and drugs and medical records proves that the 2nd opposite party negligently omitted to Check or to treat the complainant, on reaching the hospital at 08.00am. Since the 2nd opposite party has not visited the complainant, her husband shouted in front of her room and thereafter only at 11.40am, the 2nd opposite party the doctor came and started treatment to the complainant and that’s why the different timings were recorded by the 2nd opposite party on later timings for prescribing medicines and drips in ExA8 as said above. The doctor has not filed any proof to establish that she had started treatment to the complainant at 08.00 or 08.30am. Therefore, the above discussion proves that the 2nd opposite party committed negligent in treating the complainant in time.
28. Though the 1st opposite party staff were recorded the drugs and medicines record, the same was done only at the instructions of the 2nd opposite party. Therefore the 1st opposite party has not committed any deficiency in this regard.
29. The case of the complainant is that the opposite parties 1 & 2 have not obtained consent either from her or from her husband much less informed consent. The opposite party replied that the complainant mother who was present in the hospital has signed in ExA4 consent and ExA6 patient registration record. The ExA4 is for permission for surgical procedure that is the doctor who has to do surgery has to obtain the consent of the patient or from the close relative or attendee. In ExA4 consent form undisputedly the complainant mother had signed. The complainant husband was very well available with the patient before taking her to do the procedure. The complainant husband is only very dear and near to his wife than the mother of the complainant. Absolutely there is no explanation on the part of the 2nd opposite party, why she had not obtained the consent of the husband. Further followed by LSCS the doctor had done the sterilization procedure.
30. The Complainant contended that the 2nd opposite party referred a Supreme Court judgment of, Samira kohli vs Dr.Prabha Manchanda (2008 (1) scale 442) elaborated about the various aspects of consent. In the said judgement the Hon’ble supreme court held in para 44(32) (iii) extracted at page 25 of written version that the “consent given for one treatment will not be a valid for conducting some other treatment procedure”. Further in paragraph 44 (34) it is held as follows.
The term ‘informed consent’ is often used, but there is no such concept in English law. The consent must be real; that is to say, the patient must have been given sufficient information for her to understand the nature of the operation, its likely effects, and any complications which may arise and which the surgeon in exercise of is duty to the patient considers she should be made aware of; only then can she reach a proper decision.
The above ratio clearly says that the consent given for one procedure cannot be taken for other procedure. Further the doctor who conducts surgery has to inform the patient to understand the nature of the operation and its effects and complication. It is not the case of the 2nd opposite party that she had explained about the sterilization procedure to the complainant and obtained her consent to do the same. Further she had not even obtained the consent of her husband for the 2nd procedure. The consent obtained in the ExA4 is not a valid consent from the complainant or her husband and hence it is held that the 2nd opposite party has not obtained the informed consent from the complainant to perform LSCS and therefore we hold that the 2nd opposite party committed deficiency in obtaining the consent.
31. The Hon’ble supreme court specifically held that it is the duty of the surgeon to inform the patient to understand the nature and complication of the procedure and surgeon fail to do the same to obtain the consent and such deficiency can’t be fastened liability on the hospital and therefore we hold that the 1st opposite party / Hospital has not committed deficiency in getting the consent from the complainant.
32. According to the complainant ExA5 report of surgical procedure is manipulated by the 1st opposite party by correcting the term LSCS as emergency and there by the 1 opposite party has committed deficiency in creating that record. The alleged consent obtained in ExA4, it was clearly written as emergency LSCS and also in ExA6 written as emergency LSCS. Therefore by writing emergency by way of correction in ExA5 cannot be termed as manipulation of record and therefore we hold that the 1st opposite party has not committed any deficiency in this regard.
33. The Complainant alleged that the opposite parties 1 &2 have violated the code of medical ethics by not issuing the medical records within 72 hours from the date of demand. It is common practice that even at the time of discharge itself the discharge summary was issued to the patient. To issue such a discharge summary the doctor who was treating the patient has to furnish the treatment particulars done by the doctor to the hospital and then only the hospital able to issue the records. Admittedly in this case the records were not furnished to the complainant immediately on demand and only on making complaint to the police the same was issued to her. In ExA8 at page 11 & 16 the admission time differs and in this respect we already held that such records were prepared subsequently on information furnished by the treating doctor. Therefore in such circumstances we hold that the hospital / 1st opposite party has not committed any deficiency and on the other hand the doctor who had furnished information belatedly to prepare records and also attended the complainant belatedly only at 11.40am, though she reached the hospital at 08.00am established that the 2nd opposite party violated the code of medical ethics.
34. The 2nd opposite party prescribed contra indicated drugs to the complainant and there by committed deficiency in service to the complainant pleaded in para 15 of the complaint that basic test was not done and further in para 16 she was prescribed PANTOCID tablets is contra indicating drug to the lactating woman and she also prescribed EMESET to control the vomiting which passes into the breast milk and tablet VERTIN prescribed meant for vertigo and it is contra indication to lactating woman, tablets STEMETIL also should not be used by lactating woman and tablet CALCIGARD is a calcium channel blacker and it is unsafe for lactating woman and further nitroglycerine is meant for unstable angina, hypertensive during cardiac surgery and therefore the prescription of above drugs clearly establishes the negligent manner of treating the complainant by the 2nd opposite party. No doubt the 2nd opposite party prescribed the above tablets and drip to the complainant. In this respect excepting the statement of the complainant, no expert evidence is available to support the case of the complainant that the said tablets are the contra indicating drugs to the complainant. The complainant herself is not an expert in the medical field and therefore, her statement alone is not sufficient to hold that the tablets prescribed by the 2nd opposite party are a contra indicated drugs. To speak about the effects and consequences of the tablets, the competent person would be an expert in the medical field. Therefore in such circumstances, it is held that the complainant has not proved that the 2nd opposite party has prescribed contra indicated drugs and thereby we hold that the 2nd opposite party has not committed any deficiency in this regard.
35. The complainant would content that due to the negligent treatment of the opposite parties 1 & 2, resulting that he had suffered with brain damage, resulting pontine hemorrhage. As per ExA7 discharge summary at the time of discharge the complainant had BP 140/80 on 22.08.2011. very next day on 23.08.2011 she was admitted in the hospital and the BP noted in ExA8 at page 19 BP chart shows that at 08.30am 170/100, at 11.30am 160/90, at 12.45pm 170/90 and at 01.15pm 200/100. This proves the variation of BP to the complainant and on higher side. This BP was not recorded in the BP chart. The above BP recording shows that the complainant was having high BP. Though the complainant reached the hospital on 23.08.2011 at 08.00am the 2nd opposite party had seen the complainant and started treatment only at 11.40am. If the 2nd opposite party /doctor had seen the complainant on reaching the hospital 08 or 08.30am she could have started the treatment to stabilize the BP, the things may be different. Due to belated treatment of the 2nd opposite party and at 01.30pm after consulting the cardiologist over phone the complainant was referred to C.T brain centre. After taking the C.T scan the report revealed that the brain was damaged. Hence the 2nd opposite party referred the patient to the 3rd opposite party/hospital for further management and after treatment she was also discharged by the 3rd opposite party as per ExA10 discharge summary.
36. According to the complainant she had paid the charges for taking C.T scan outside the 1st opposite party/hospital. The said C.T scan report was not filed by the 2nd opposite party as a document to know whether the complainant brain was damaged or not. Failure to produce the scan report proves that the complainant brain was damaged due to high BP as contented by the complainant. Therefore, the 2nd opposite party negligently omitted to treat the complainant on reaching the hospital at 08 or 08.30am is deficiency on her part. However the 2nd opposite party omitted to treat the patient, the 1st opposite party cannot be liable for such an omission and therefore the 1st opposite party has not committed any deficiency in this regard.
37. Therefore from the forgoing discussion we hold that the 2nd opposite party committed deficiency in service and whereas the 1st opposite party has not committed any deficiency committed. As far as the opposite parties 3&4 are concerned no relief sought against them in the complaint.
38. POINT NO :2
We have held that the 2nd opposite party only committed professional negligence and thereby committed deficiency in service and due to the same the complainant forced to take treatment at the 3rd opposite party/hospital and spent a sum of Rs.4,84,471/- as per ExA12. She further spent at the 1st opposite party /hospital a sum of Rs.40,000/- and thus totally she spent an amount of Rs.5,24,471/- towards medical expenses and for such amount the complainant is entitled from the 2nd opposite party due to her negligent act. Due to negligent act of the 2nd opposite party the complainant suffered with mental agony is accepted and for the same, it would be appropriate to order to pay a sum of Rs.3,00,000/-towards compensation from her.
39. The 4th opposite party had issued professional indemnity policy No.412000/48/2012/541 to the 2nd opposite party /Dr.P.Varalakshmi, to cover her individual professional Negligence. The said policy is marked as ExB25. The maximum liability of the insurer under the policy is Rs.10,00,000/- in respect of any one accident and to that extend the 4th opposite party is liable to indemnify the 2nd opposite party/doctor.
40. We concluded above that the complainant is entitle for a Sum of Rs.300,000/- as compensation and Rs.5,24,471/- towards medical expenses, in total Rs.8,24,471/- from the 2nd opposite party for the medical negligence committed by her. The 4th opposite party issued professional indemnity policy to cover the professional negligence committed by the 2nd opposite party. Therefore , the 4th opposite party /insurer owes a duty by virtue of ExB25 policy issued by him for the 2nd opposite party to pay the said amount of Rs.8,24,471/- to the complainant on behalf of the 2nd opposite party. Hence we may order that the 4th opposite party shall pay the above said amount of Rs.8,24,471/- to the complainant by virtue. Further we may order that the 2nd opposite party shall pay a sum of Rs.5000/- towards litigation expenses to the complainant.
41. Since we held in point No.1 that the 1st opposite party had not committed deficiency in service and the complaint in respect of him is liable to be dismissed. No order is need to be passed as against the 3rd opposite party as no relief sought against him in the complaint.
In the result the complaint is partly allowed. The 4th opposite party is ordered to pay a sum of Rs.8,24,471/- (Rupees Eight Lakhs twenty four thousand four hundred and seventy one Only) to the complainant to indemnify the 2nd opposite party’s professional negligent act. Further the 2nd opposite party is ordered to pay a sum of Rs.5,000/-(Rupees Five Thousand only) towards litigation expenses. The complaint in respect of the 1st opposite party is dismissed. No order is passed against the 3rd opposite party.
The above amount shall be paid to the complaint within 6 weeks from the date of receipt of the copy of the order failing which the above said amount shall carry 9% interest till the date of payment.
Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 26th day of December 2017.
MEMBER – I PRESIDENT
LIST OF DOCUMENTS FILED BY THE COMPLAINANT:
Ex.A1 dated 19.01.2011 Antenatal Prescription
Ex.A2 dated 14.06.2011 Antenatal Prescription
Ex.A3 dated 17.08.2011 Antenatal Prescription
Ex.A4 dated 18.08.2011 Consent Form
Ex.A5 dated 18.08.2011 Report of Surgical Procedure
Ex.A6 dated 18.08.2011 Patient Registration Record
Ex.A7 dated 22.08.2011 Discharge summary issued by the first and second
Opposite Parties
Ex.A8 dated 23.08.2011 Progress notes
Ex.A9 dated 23.08.2011 Discharge summary issued by the 1st & 2nd
Opposite Parties
Ex.A10 dated 22.09.2011 Discharge summary issued by the 3rd Opposite
Party
Ex.A11 dated 22.08.2011 Final Bill
Ex.A12 dated 22.09.2011 Inpatient bill issued by the 3rd Opposite Party
LIST OF DOCUMENTS FILED BY THE 1st & 2nd OPPOSITE PARTIES :
Ex.B1 dated Insurance claim by Complainant & Discharge
Summary handed over by M/s. Star Health
Ex.B2 dated Insurance Company
Ex.B3 dated Bill
Ex.B4 dated Professional Indemnity
Ex.B5 dated | www.american pregnancy.org/prenataltesting/tripletest.html
|
Ex.B6 dated | Second trimester maternal dimeric inhibin – A in the multiple-marker screening test for Down’s syndrome by Martin A.Renier1,3,Annie Vereecken.Erik Van Herck, Danny Straetmans, Palu Ramaekers and philippe Buytaert
|
Ex.B7 dated | Booklet issued by Down’s syndrome society of Langdon Down centre, 2a Langdon park, Teddington, Middleses
|
Ex.B8 dated | The new England Journal of Medicine VOLUME 335 SEPTEMBER 5, 1996 NUMBER 10 UNDER THE CAPTION, ‘COMPARISON OF A TRIAL OF LABOR WITH AN ELECTIVE SECOND CASAREAN SECTION’, BY MICHAEL J.MCMAHON M.D., M.P.H., EDWIN R.LUTHER, M.D., WATSON A. BOWES, J.R., M.D., AND ANDREW F. OLSHAN, P.H.D
|
Ex.B9 dated | Role of Emergency Hysterectomy in Modern Obstetrics” by Jyotsana Lamba, Shashi Gupta from the post Graduate Department of Obst and Gyane, Govt Medical College, Jammu – J & K – India, published in Vol. 14 No.1, January – March 2012
|
Ex.B10 dated | Three Dimentional Ultrasound Assessment of CS Scar: A Cross Sectional Study”. By Amal Hanfy, M.D, Khaled Abdel Malek Department of Obstetrics & Gynaecology, Cairo University KAJOG: a journal of Kasr Al-Aini, sourced from of Obstetrics & Gynaecology www.kajog.net, from the journal vol. 2, issue 2, August 2011
|
Ex.A11 dated | Chapter 65 – Vaginal Birth After Caesarean”. By Bruce L. Flamm, from the book of the six-volume series, GYNECOLOGY AND OBSTETRICS
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Ex.A12 dated | “Uterine Rupture in Pregnancy”. Author: Gerard G Nahum, MD, FACOG, Facs: chief Editor: David Chelmow, MD published and available from the net emedicine.medscape.com/article/275854- overview
|
Ex.B13 dated | Williams OBSTETRICS in 23rd edition at page 94 under the heading “Maternal and Fetal Anatomy and Physiology” Williams OBSTETRICS in 23rd edition at page at page 340 under section Antepartum, Williams OBSTETRICS in 23rd edition at page at page page 581 under the heading, “Abnormalities of the placenta, Umbilical Cord, and Membranes”. “Active management of labour, care of the foctus” by KIERAN O DRISCOLL, MALACHI COUGHLAN, VINCENT FENTON, MAIRE SKELLY from BRITISH MEDICAL JOURNAL 3 DECEMBER 1977 in an article appearing at page 1451 Meconium passage by premature infants JA Henry et al published in Journal of Perinatology (2006) 26 J Obstet Gynecol India Vol.57, No.6: November/December 2007 pg 501-504 “Fetal and neonatal outcome of babies in meconium stained amniotic fluid and meconium aspiration syndrome” by pushpa Bhatia, Neelam Ela of the Department of Obstetrics and Gynaecology, Kasturba Hospital, Delhi.
|
Ex.B14 dated | International Journal of Obstetrics and Gynaecology in July 2002, Vol. 109, pp. 733-736, under the heading. “The management of postpartum hypertension”.
| |
Ex.B15 dated | Current Diagnosis and Management of Hypertensive Emergency by Andrew R.Haas and Paul E. Marik Division of Critical Care, pulmonary, Allergy and Immunologic Disease, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Ex.B16 dated | World Health Organisation Guide line Book
| |
Ex.B17 dated | Melignant Hypertension by John D Bisognano, MD, Phd, FACP, FACC, Professor of Medicine, Director of Outpatient Cardiology, Department of Medicine, Cardiology Division, University of Rochester Medical Center published in Medscape | The Lab reports
|
Ex.B19 dated NIL | Arterial Blood Gas (ABG) Test where the author Benjamin Daniel Liess, MD: Chief Editor: Vincent Lopez Rowe, MD
|
Ex.B20 dated NIL | Oxford Handbook of Clinical Medicine by Murray Longmore Ian Wilkinson Edward Davidson Alexander Foulkers Ahmed Mafi page No.181
|
Ex.B21 dated NIL | Step by setp Approach to Arterial Blood Gases by Ssunanda pages 4 and 5
|
Ex.B22 dated NIL | Merck Manual for health care professionals under the heading Hypertensive emergencies
|
| Ex.B23 dated NIL | Drugs profile IV parenteral Nitroglycerine, the AMERICAN REGENT, INC. SHIRLEY, NY 11967, which has published WARNINGS, AND DOSAGE AND ADMINISTRATION SECTIONS is marked as my exhibit, tells the use of this drug for pregnant woman and lactating mothers. Stemetil is Prochlorperazine, for its use in lactating mother as per the brouchure given by the stemetil manufacturer. Pantocid Generic Name, pantoprazole sodium, Data Sheet, Drug Therapy ONDANSETRON by Vasantha Thavraj & L.S. Arya, both from the Department of Pacdiatrics. All India Institute of Medical Sciences, New Delhi 110 029 published in INDIAN PEDIATRICS VOLUME 32 – AUGUST 1995 use in Pregnant and Nursing Mothers, as Exhibit Hypertensive Crises: Recognition and Management by Jeseph varon, M.D.,F.A.C.P., Assistant Professor, Anaesthesiology, Critical Care & Medicine, Assistant Director, Surgical Intensive Care Unit and Post anaesthesia Care Unit of the Department of Anaesthesiology and critical care, The University of Texas M.D Anderson Cancer Centre Houston, Texas & Maura Polansky, M.S., P.A.-C physician Assistant, Surgical Intensive Care Unit and Post Anaesthesia Care Unit Department of Anaesthesiology and Critical Care. The University of Texas M.D.Anderson Cancer Centre Houston, Texas., Nifedipine use while Breastfeeding Source: “Prescribing in Pregancy”, Fourth edition, Edited by Peter Rubin, Nottingham University Hospitals, Queen’s Medical Centre Campus, Nottingham, UK., Margeret Ramsay, Nottingham University Hospitals, Queen’s Medical Centre Campus, Nottingham, UK 2008 by Blackwell publishing page number 222 |
Ex.B24 dated NIL
LIST OF DOCUMENTS
Ex.B25 dated NIL
LIST OF DOCUMENTS Y THE 3rd OPPOSITE PARTY | Professional Indemnity with M/s. Oriental Insurance Company Limited.
FILED BY THE 4th OPPOSITE PARTY:
Professional Indemnity policy issued to second Respondent with terms and conditions
FILED BY THE 3rd OPPOSITE PARTY:
|
Ex.B26 dated NIL | Registration Form
|
Ex.B27 dated NIL | Patient Registration Record
|
Ex.B28 dated NIL | Admission Slip
|
Ex.B29 dated NIL | Admission Form
|
Ex.B30 dated NIL | Department of Bio-Chemistry
|
Ex.B31 dated NIL | Initial patient Assessment Record
|
Ex.B32 dated NIL
| Opposite Party Summary |
Ex.B33 dated NIL | Initial Patient Assessment Record
|
Ex.B34 dated NIL | Prescription
|
Ex.B35 dated NIL | Follow up Sheet
|
Ex.B36 dated NIL | Case Sheet
|
Ex.B37 dated NIL | Progress Report
|
Ex.B38 dated NIL | IP Consultation Request |
Ex.B39 dated NIL | Doctor Instruction Sheet
|
Ex.B40 dated NIL | Drug & Diet Chart
|
Ex.B41 dated NIL | Clinial Chart
|
Ex.B42 dated NIL | Nursing Assessment – Emergency
|
Ex.B43 dated NIL | Nursing Admission Assessment
|
Ex.B44 dated NIL | Fall Risk Assessment Form
|
Ex.B45 dated NIL | Nursing Daily Record
|
Ex.B46 dated NIL | Nurse’s Notes
|
Ex.B47 dated NIL | Intake/out Record
|
Ex.B48 dated NIL | Flow Chart
|
Ex.B49 dated NIL | CCU Master Chart
|
Ex.B50 dated NIL | Admission Check list
|
Ex.B51 dated NIL | Care Team Rounds
|
Ex.B52 dated NIL | Physiotherapy Department
|
Ex.B53 dated NIL | General Consent
|
Ex.B54 dated NIL | Investigation Chart
|
Ex.B55 dated NIL | Neuro-observation chart
|
Ex.B56 dated NIL | Continuous Intra Venous Infusion Order
|
Ex.B57 dated NIL | Transfer Information Sheet
|
Ex.B58 dated NIL | Pressure Ulcer Risk Assessment Staging and Treatment Chart |
Ex.B59 dated NIL | Posting Chart
|
Ex.B60 dated NIL | Food & Fluid chart
|
Ex.B61 dated NIL | Department of Dietetics
|
Ex.B62 dated NIL | Insurance Pre-Authorization Request Form
|
Ex.B63 dated NIL | Investigation Report
|
Ex.B64 dated NIL | Discharge Summary |
MEMBER – I PRESIDENT
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