2. Sai Bhaskar Trauma Emergency Hospital,

    Rep. by its Managing Director,

    Old Club Road, Kothapet,

    Guntur.

3. N.R.I. Hospital,

    Rep. by its Managing Director,

    Chinakakani,

    Mangalagiri Limits,

    Guntur district.

4. Manipal Hospital,

    Rep. by its Managing Director,

    NH-5, Near Kanakadurgamma varadhi,

    Tadepalli Village and Mandal,

    Guntur district.                                              … Opposite parties

      This complaint coming up before us for hearing on 22-07-11 in the presence of Sri P.V. Ramana, advocate for complainant and of                             Sri A.S. Reddy, advocate for 1^st opposite party, Sri Ch. Venu Kishore Babu, advocate for 2^nd opposite party, Sri Ch.S.P. Rao, advocate for 3^rd opposite party, 4^th opposite party remained absent and set exparte, upon perusing the material on record, after hearing both sides and having stood over till this day for consideration, this Forum made the following: 

O R D E R

Per Sri A. Hazarath Rao,  President:-         The complainant filed this complaint under section 12 of the Consumer Protection Act seeking Rs.19,50,000/- on account of death of her daughter C.P. Bhargavi @ Usha.  

2.      In brief the averments of the complaint are these:

        Smt C.P. Bhargavi (daughter of the complainant) was blessed with two children namely Manish Kumar Raju and Shashidhar Raju aged 3 ½ years and 1 ½ years respectively.   The said Bhargavi was admitted in the hospital of the 1st opposite party on 27-08-08 for tubectomy.   The 1^st opposite party conducted tubectomy without doing any investigations regarding her fitness.   The 1^st opposite party discharged the said Bhargavi on the same day.   Subsequently the said Bhargavi approached the 1^st opposite party for postoperative treatment on 06-09-08.   The 1^st opposite party without conducting any investigations simply removed the sutures on 06-09-08.   Again on 07-09-08 the 1^st opposite party prescribed medicines and administered saline to the said Bhargavi when complained of fever.   The 1^st opposite party advised the said Bhargavi to come on 08-09-08.   On the intervening night of 08/09-09-08 the said Bhargavi suffered from fever, severe pain in abdomen with vomitings and motions.   The 1^st opposite party admitted his daughter Bhargavi on 09-09-08 at about 8.30 am with the 1^st opposite party.  After investigations the said Bhargavi was referred to another Dr. Kusuma Gayathri for further diagnosis and treatment.   Dr. Kusuma Gayathri and Dr. Raveendra treated the said Bhargavi in the hospital of 2^nd opposite party and put her in ICU.  Dr. Kusuma Gayathri informed the condition of the said Bhargavi as O.K. when asked by the complainant and his sister.   After the doctors left the said Bhargavi complained abnormal abdomen pain and felt frequent unusual natural calls.  Then the complainant’s sister provided bedpan to the patient, since the night duty staff did not provide.   As the night duty staff of the 2^nd opposite party did not respond positively   Dr. Kusuma Gayathri sent Dr. Gade Raveendra at about 4.30 a.m. to know the condition of the said Bhargavi.   As the condition of the said Bhargavi worsened they advised the complainant to take her to St. Joseph’s Hospital, Guntur in writing.   Authorities of the St. Joseph’s Hospital, Guntur did not admit the said Bhargavi as they did not have enough beds in ICU.   The complainant took his daughter Bhargavi to the 3^rd opposite party at about 8.30 am on 10-09-08.   Dr. Gade Raveendra present then in the hospital of the 3^rd opposite party refused to admit her at that crucial juncture.  The complainant admitted her daughter Bhargavi in the hospital of the 4^th opposite party.   The authorities of the 4^th opposite party briskly attended, examined and studied the case sheet.   Doctors of the 4^th opposite party finally expressed that the patient Bhargavi was troubled with wrong laparoscopic surgery and was not having sufficient blood including platelets and is unable to receive medication.   During the treatment at 4^th opposite party’s hospital the said Bhargavi breathed her lost at about 12 pm due to Dengue shock syndrome.   The opposite parties treated the said Bhargavi without proper diagnosis.   Improper diagnosis of doctors and treatment amounted to deficiency of service.   The complainant claimed Rs.14, 00,000/- on account of death of his daughter Bhargavi, Rs.2,00,000/- towards love and affection, Rs.2,00,000/- towards loss of child care, Rs.1,00,000/- towards mental agony and Rs.50,000/- towards legal expenses. 

3.   The 4^th opposite party remained exparte.              

4.   The contention of the 1^st opposite party in brief is hereunder:

        The complainant is not the legal heir of the deceased                            C.P. Bhargavi @ Usha.  Husband and children of the said Bhargavi are alive and they are just and necessary parties to the complaint.   The complaint is therefore bad for mis-joinder and non-joinder of parties.   The said Bhargavi was an old patient of the hospital of the 1^st opposite party and she gave birth to her two children through cesarean operation.  Even though the said Bhargavi was permanent resident of Hyderabad came to Guntur to undergo laparoscopy tubectomy operation in the hospital of the 1^st opposite party due to her satisfaction of earlier services of the 1^st opposite party.  The 1^st opposite party in pursuance of investigation reports felt that the said Bhargavi was in fit condition to undergo laparoscopy tubectomy operation.   All lab technical reports will be handed over to the patients by entering the results in the case sheet and handover to the patients as per convenience.   Dr T. Vasu Kishore conducted laparoscopy tubectomy on the said Bhagavi and on the same day the hospital authorities of the 1^st opposite party discharged the said Bhargavi as she was quite healthy.   In laparoscopy operation there will be no cut or injury to any part of the body of a patient except injury to the skin trocar.   Therefore the question of application of sutures did not arise to the said trocar puncture, band-aid will be applied.   On the 3^rd postoperative day, the said Bhargavi visited the hospital for change of bandage.   The 1^st opposite party and his staff attended to the change of bandage.   On 02-09-08 the said Bhargavi came to the hospital and got bandage removed.   On the said two occasions the said Bhargavi was found normal and without any complications. The 1^st opposite party advised the said Bhargavi to visit the hospital one month later if necessary for checkup.   On 07-09-08 the said Bhargavi along with her parents came to the hospital complaining  loose motions, vomitings and fever and informed that she took stale food i.e., chicken puff on the previous day.   The said Bhargavi was treated for (food poisoning), gastro enteritis and applied IV fluids, antibiotics, antiemetics, styptics and after treatment the said Bhargavi was normal and left the hospital happily.   On 09-09-08 at about 11 a.m., the said Bhargavi came to the hospital again complaining fever, motions and vomitings stating that they were started on the intervening night of 08/09-09-08.   The 1^st opposite party immediately after investigations confirmed that the said Bhargavi was suffering from medical problem but not surgical problem.   It was brought to the notice of the said Bhargavi and her attendants.   On the advice of 1^st opposite party the said Bhargavi was shifted to  2^nd opposite party where Dr. Kusuma Gayathri is practicing for better     necessary medical treatment.   The 1^st opposite party thus discharged its duties successfully to the best of its ability.   The 1st opposite party came to know that at the time of discharge the said Bhargavi took investigation reports except the case sheet and joined the hospital of the 2^nd opposite party.   Subsequently the said Bhargavi did not turn up.   The 1^st opposite party came to know the subsequent events relating to the said Bhargavi through complainant’s notice.  The complainant approached this Forum by suppressing material averments with unclean hands.   The complaint therefore be dismissed.

5.    The contention of the 2^nd opposite party in brief is hereunder: -      

        The complainant is not legal heir of the C.P. Bhargavi @ Usha.   The complainant is not entitled to file this complaint as husband and children of the said C.P. Bhargavi @ Usha are alive.   The complaint is therefore bad for mis-joinder and non-joinder of parties.   On              09-09-08 at about 4 pm the patient was brought to the hospital of the 2^nd opposite party by her family members stating that she was discharged from the hospital of the 1^st opposite party.   Dr. Kusuma Gayathri had immediately gone through the reports including discharge summary and did technical examination and admitted her in ICU unit of the 2^nd opposite party.   As per case sheet the said C.P. Bhargavi @ Usha was suffering from loose motions, fever, vomitings from 07-09-08, dyspnea and abdominal pain since night of 08-09-08.   After going through investigations Dr. Kusuma Gayathri opined that the patient was suffering from viral fever with multiple organ involvement, sepsis secondary to food poisoning with multi organ involvement.   The 2^nd opposite party conducted a rapid test for detection of dengue fever by using a dengue kit.   The said patient was admitted in ICU and was treated with antibiotics, IV fluids, injection vitamin-K and other supportive treatment.   Dr. Kusuma Gayathri knew mother of the said patient well and as such informed the attendants of the patient about the involvement of the multiple systems and the prognosis of such multi organ involvement in the patient.   Dr Ravindra and other ICU staff have taken utmost care on the said patient.  BP, Pulse, respiratory rates of the patient were monitored 24 hours to the patients by most sophisticated Philips multipara monitors to avoid human errors.   At about 4.30 am the patient complained increase in the abdominal pain and dyspnea.   Dr. Ravindra attended the patient and advised ABG test.  The said ABG test showed metabolic acidosis in the patient.  Dr Ravindra had given the necessary treatment and necessary medicines for the correction of metabolic acidosis.   As the said patient is young lady with jaundice, anemia with Hepato Spleen Megalay with enlarged both kidneys, with free fluid abdomen with Metabolic acidosis with sepsis with pleural effusion, anticipating further renal complications with multi organ failure, Dr. Ravindra decided to shift the patient to a centre which has a facility of ventilator  and availability of nephrologists.   The patient was discharged from the hospital of the 2^nd opposite party at about 7.00 am and handed over all medical reports to the attendants with a referral letter to St. Joseph’s hospital, Guntur.   The said patient was in the hospital of 2^nd opposite party from 4.00 pm on 09-09-08 to 7.40 am on 10-09-08.   The 2^nd opposite party is not aware what happened subsequently.   The complainant filed this complaint with false and untenable allegations for a fancy compensation.   The so-called compensation claimed by the complainant itself shows the craziness of the complainant towards money of others and wants to loot the opposite parties in one way or the other.   The 2^nd opposite party never committed any wrong.   Rest of the allegations contra mentioned in the complaint are all false and are invented by the complainant to suit his case.

6.     The 3^rd opposite party filed memo contending that the patient was not at all admitted in the hospital and as such giving wrong treatment or treating in a negligent manner did not arise and sought for dismissal of the complaint.     

7.     Exs.A-1 to A-30 on behalf of complainant and Exs.B-1 to B-3 on behalf of opposite parties 1 and 2 were marked.

8.      Now the points that arose for consideration in this complaint are:

1. Whether the complainant is entitled to file this complaint?
2. Among the opposite parties who committed deficiency of service?
3. Whether the complainant is entitled to compensation and if so to what amount?
4. To what relief?

9.  POINT No. 2:-   The complainant in para 3 (h) averred contending that the opposite parties 1 to 4 have treated the patient without correct diagnosis.  The initial burden is on the complainant to make out a case of negligence on the part of the hospital or the doctor concerned, the onus then shifts on to the hospital or to the attending doctors and it is for the hospital to satisfy the court that there was no lack of care and diligence as held in Nizam Insittute of Medical Sciences vs. Prashanth S. Dhananka and others 2009 (2) CPJ 61 (SC).

10.  Now the Forum has to see whether the complainant has discharged his initial burden in making out a case of negligence against any of the opposite parties.  It is for the complainant to establish prima-facie who among the opposite parties made wrong diagnosis and gave wrong treatment, which led to the death of his daughter by adducing cogent evidence. 

11.   The complainant in para 3 (f) mentioned as detailed infra against the 3^rd opposite party

        “On this refusal to admit the patient the complainant took       the patient to NRI hospital, China Kakani, Mangalagiri at about 8.30 am where the same Dr. Gade Ravindra was      present in 3^rd opposite party and refused to admit her in the 3^rd opposite party’s hospital though it is a   comprehensive hospital”.

12.   The 3^rd opposite party in its version and affidavit contended it as a vague allegation.  The 3^rd opposite party in its version further mentioned that when the patient herself was not admitted in the hospital the question of giving treatment or acting in negligent manner did not arise.  Except the self-interested testimony of the complainant there is no other evidence to prove his contention.   The recitals in para 3 (f) of complaint revealed that no treatment was taken in the hospital of 3^rd opposite party.   In the absence of any cogent evidence the contention of the complainant about the 3^rd opposite party refusing to admit the deceased C.P. Bhargavi @ Usha cannot be believed.  Therefore we opine that there was neither negligence nor deficiency of service on behalf of 3^rd opposite party.     

13.   Regarding negligence or deficiency of service on behalf of the             4^th opposite party the complainant in para 3 (g) mentioned as detailed infra:

          “The complainant had no other go at that crucial time except admitting the patient in 4^th opposite party’s hospital.   Which is hereby the 4^th opposite party hospital doctors team briskly attended and thoroughly examined and studied the case sheet……………………..  Then on the basis of advise the complainant purchased several platelets blood packets and handed over to the doctors of the 4^th opposite party hospital.  While in treatment by the doctors of the 4^th opposite party hospital the patient died at about 12.00 p.m and the doctors declared the death was due to Dengue Shock Syndrome”. 

14.   Exs.A-14 to A-26 related to the investigations, treatment of the deceased C.P. Bhargavi @ Usha. Ex.A-26 is the copy of death summary issued by Dr. Ch. Manoj Kumar on behalf of the 4^th opposite party.  Ex.A-26 reads as follows:

        “Mrs. Bhargavi aged about 28 years, admitted with us on 10-09-08 with history of pain abdomen, losse stools, SOB, decreased urine output and altered sensorium for 2 days. No P/H/O/DM/HTN/CAD/Asthma. No H/o headache/Nausea/Vomitings.  H/o Fever + H/o Laparoscopic Tubectomy 15 days back present.

        O/E: Patient unconscious, dyspenic, Temparature – Normal

        No pedal edema, Pallor +, No Icteres, BP-90/70 mm Hg,

                        Pulse -68/min,

        CVS – S1 S2 +, RS – Clear, P/A – Distension +, Bowel                      sounds decreased, Potosis +, Restless+.

        CNS: Unconscious, respondent to painful stimuli.

        Pupil – Mid dilated and reactive. Power III/IV.

                A provisional diagnosis of Sepsis was made and admitted to ICU after explaining the prognosis to attenders.   Investigations sent and managed with medical management.   Surgeons opinion sought to rule out any surgical conditions.  Investigations revealed Dengue.  Diagnosed Dengue shock syndrome.  Managed with ventilatory support and inotropic support, Platelet transfusion + Blood transfusion, I.V. Fluids and other supportive measures.   Inspite at above management patient had cardio respiratory arrest on 11-09-08 at about 12.30 AM”. 

15.   Death of a patient in a nursing did not lead to an inference of negligence on behalf of either the nursing home or doctors who treated the patient.  It is for the complainant to prove that there was either wrong diagnosis or wrong treatment by cogent evidence.         Ex.A-26 revealed that the deceased C.P. Bhargavi @ Usha was suffering from ‘Dengue Shock Syndrome’.   The averments of the complaint revealed that the 4^th opposite party had briskly/thoroughly attended the case.   The complainant miserably failed in establishing that the 4^th opposite party treated the deceased Bhargavi negligently.   Therefore we hold that the 4^th opposite party is neither negligent nor committed any wrong/deficiency of service.   

16.   Exs.A-1 to A-6 related to the 1^st opposite party from                           07-09-08.   The complainant in para 3 (g) of his complaint mentioned that the doctors of the 4^th opposite party’s hospital finally expressed their opinion that the patient was troubled with wrong laparoscopic surgery and she is not having sufficient blood including platelets and she is unable to receive meditation.  But Ex.A-26 issued by the 4^th opposite party is otherwise.  

17. It is the contention of the complainant that the deceased                      C.P. Bhargavi @ Usha underwent tubectomy operation in the hospital of the 1^st opposite party on 27-08-08.   The same was not disputed by the 1^st opposite party.  The complainant did not file any document showing treatment at the hospital of the 1^st opposite party.  On the other hand, the 1^st opposite party filed case sheet relating to the deceased along with typed copy (Ex.B-1).

18.    Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, keyhole surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5–1.5 cm) as compared to the larger incisions needed in laparotomy.

19.   Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.

20.   There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include reduced pain due to smaller incisions and hemorrhaging, and shorter recovery time.

21.   The contention of the 1^st opposite party not involving any sutures in laparoscopic tubetcomy is having considerable force.  Likewise applying a band aid at the point of incision is having considerable force.  

22. Ex.B-1 revealed that the deceased C.P. Bhargavi @ Usha underwent tubectomy operation under double puncture laparoscopic tubectomy under GA and post operation was uneventful. Except Ex.B-1 there is no other document either from the complainant or opposite party to show that the 1^st opposite party did not conduct tubectomy properly. The deceased C.P. Bhargavi @ Usha took treatment as outpatient on 07-09-08 and 08-09-08 as seen from Exs.A-1 to A-3.  

23.   Ex.A-6 dated 09-09-08 issued by the 1^st opposite party hospital reads as follows:

      “A patient by name C.P. Usha aged 28 years came to out hospital at about 11.00 am h/o loose motions 5 times, vomitings 2 times & fever on & off since midnight.   H/o ingestion of stale food 3 days back.  O/E pulse 88/min, BP-110/80 mm ; Temp-100^o F,Abd-soft.  No distension, BS + Tongue – dry mid dehydration + passed urine twice at home.  On the advise of physician following investigations done and it given

      Investigations done:   Hb’s- 50%

                                     ESR-45 mm/1^st hr

                                     Widal - -ve

                                     S. Bilurubin- 2 mg%

                                     Platelet count-1,85,000 1 cm

                u/s report        Liver enlarged

                                     Spleen slightly enlarged

                                    Both kidneys enlarged slightly

        Treatment given      IV fluids – DNS –IL started

                                    Inj.    Magnex 1 gm given slow IV

                                    Inj.    Zofer   1 amp

                                    Inj.    Mol      1 amp.

                Patient shifted to physician for further management at about 2.30 pm.”                                                                        

24.   Ex.A-6 revealed that the deceased C.P. Bhargavi @ Usha took stale food either on 06-09-08 or 07-09-08.    It is not the contention of the complainant that the recitals of Ex.A-6 were false.   Exs.A-7 to              A-12 related to the 2nd opposite party.   The 2^nd opposite party did investigations as seen from Exs.A-7 to A-9.   On 10-09-08 the 2^nd opposite party addressed a letter to Dr. Uma Maheswara Rao,                        St. Joseph Hospital, Guntur and it reads as follows:

        “Please admit this case of (? Food poison, septicaemia,   ? hepatorenal syndrome, ? heptospi c metabolic acidosis. Please do the needful”.

25.   Ex.A-12 also revealed that the deceased C.P. Bhargavi @ Usha was suffering from food poisoning also.   It is also the case of the complainant that the authorities of St. Joseph’s hospital did not admit the deceased C.P. Bhargavi @ Usha for want of beds.    The complainant did not send the diagnosis and the treatment given by the opposite parties 1 to 4 to any independent authority make out who among them made wrong diagnosis and gave wrong treatment and committed deficiency of service.  By mere allegations it cannot be said that the opposite parties committed deficiency of service.  

26.   The complainant relied on the decisions reported in 2005 (3) CPJ  314 and 35 and 2005 (1) CPJ 33 and 2009 (2) CPJ 61.                        In Krishna Sarma vs. Raj Hospitals and others [2005 (3) CPJ 314] it was observed by Jharkhand State Consumer Disputes Redressal Commission, Ranchi that the deficiency in rendering medical services as negligence on the part of the respondent hospital are writ large on the face of it.   But it is not the case on hand and as such the above case has no application to the facts of this case.   

27.     In Dr. Ramdhuni Sahu vs. Dhulari Bhai [2005 (3) CPJ 35 (NC)]  the District Forum, the State Commission and the National Commission disbelieved the contention of the appellant about he not administering injection in left hand of the complainant as convicted under sections 269 and 337 IPC and sentenced to undergo three months imprisonment.   The fact of the above case are totally different from the facts of this case and as such is not applicable.

28.   In Meenakshi Mission hospital and Research Centre vs. Samuraj and another [2005 (1) CPJ 33 (NC)] the patient who was admitted for ‘cleft lip’ was taken for surgery around 9.30 am and was declared dead at 10.30 am and under those circumstances the Hon’ble National Commission observed

        “Both the lower Forums have fastened the responsibility on the petitioner hospital on the very cause of cardiac-rest within half an hour of the administering of anesthesia.  It is this which resulted death of the child.  It is not                  after-care which is important.   The whole case revolves around as to hat caused the cardiac-rest resulting in death”.

29.   In this case the patient survived for about 15 days after laparoscopic tubectomy as seen from Ex.A-26 and as such is distinguishable on facts.   The complainant miserably failed in discharging his initial burden.  It appears to us that the deceased taking stale food  created problems for her but not either for wrong diagnosis or wrong treatment. We therefore hold that even the opposite parties 1 and 2 did not commit any deficiency of service.   We therefore answer this point against the complainant.   

30.  POINT NO.1:-      In para 3(a) of the complaint the following was mentioned:

              “The complainant’s daughter by name C.P.Bhargavi @ Usha aged about 27 years who has got married and blessed with two minor children namely C.P. Manish Kumar Raju and C.P. Shashidhar Raju and their ages are 3 ½ years and 1 ½ years respectively”. 

31.   The contention of the opposite parties 1 and 2 is that the complainant does not come under the purview of consumer as defined under Section 2 (b) of the Consumer Protection Act.    The complainant filed this complaint after death of his daughter C.P. Bhargavi.   The above averments revealed that the said Bhargavi died leaving behind her husband and children.   It is not the case of the complainant that husband and children of the deceased Bhargavi are not co-operating with him in filing the complaint.   It is also not the case of the complainant that he filed the complaint on their behalf.  The complainant did not come under the purview of either legal heir or representative in the presence of husband and children of the deceased Bhargavi @ Usha.   The complaint was silent why husband and children of the deceased Bhaargavi @ Usha did not canvass the case.    The said contention of the opposite parties 1 and 2 is having considerable force.  We therefore opine that the complainant has no locus standi to file this case.  In view of the aforementioned discussion we answer this point against the complainant.

32.   POINT No.3:-   In view of above findings, the complainant is not entitled to any compensation under any head.   We therefore answer this point against the complainant.

33.  POINT No.4:-   In view of above findings in the result, the complaint is dismissed without costs. 

        Typed to my dictation by Junior Stenographer, corrected by me and pronounced in the open Forum dated this the 29th day of              July, 2011.

MEMBER                                             MEMBER                                             PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties 1 & 2:  

                                                                                              PRESIDENT