Order-15.
Date-14/09/2015.
This is an application u/s.12 of the C.P. Act, 1986.
Complainant by filing this complaint has submitted that her husband had a very small business of Ayurvedic Roots etc. of which he used to maintain his family with meager income and at the age of 67 years he attached by a serious disease of Brain Stem Haemorrhage Pneumonia and Sepsis which resulted in renal failure as is appearing in the death certificate.
Prior to its death all along in past days throughout their life they had financial crisis and he was the sole earning member of his family and there was no other family members to look after or to stand by him.
OP Dr. Prosenjit Chakraborty OP3 took the responsibility of treating the patient i.e. complainant’s husband and after short treatment referred the matter to OP1, North City Hospital for further treatment.
Complainant has serious shortage of fund and almost begging from the friends, relatives in total she could collect Rs.1,50,000/- and before taking admission in the respondent hospital had discussed with the matter with Dr. Prosenjit Chakraborty who assured on repeated queries that the expenses would be within Rs.1.5 lacs.
Complainant came to know from one of their relative Surajit Kumar Das who is an employee of Punjab National Bank (PNB) that the OP hospital by virtue of a tie-up arrangement with PNB Sramik Union admits the patient cashless and only to avail such facilities the complainant contracted with the said Surajit Kumar Das and admitted the patient at the OP’s hospital. Complainant being aggrieves states that since the members and the relatives of the PNB Sramik Union pays the bill of the medical expenses through that Union, the OP’s hospital misutilised that system of the tie up arrangement deliberately makes intransparent high bill.
Said Surajit Kumar Das is an employee of PNB and the relative of the complainant’s family received the said bill which came through the said PNB Sramik Union and complainant is a semi illiterate lady, she was perplexed with grief and sorrow and is also really helpless upon the demise of her husband who was the only earning member of the family.
Complainant on or about 21st October, 2014 met with Surajit Das to find the details of the purported bill and with utter surprise found the following irregularities :
- Despite having previous understanding with the said hospital, the complainant was not given day to day bill as a result of whereof bill got exceeded to huge length and the complainant under forceful circumstances, also could not shift her husband to any Government Hospital.
- Rs.2,76,638-00 has been charged on account of medicines whereas no batch number is quoted against supply of items of the medicines as shown in patient Transaction Details.and the fishy activities of the hospital naturally created which about actual use of medicine.
- The fees of doctors as appeared in the bill are abnormally high in comparison to any standard and fees structure was not disclosed to the patient party prior to engagement of the doctors.
- It is appeared that Dr. Prosenjit Chakraborty was absent from 20-08-2014 to 24-08-2014 when one Dr. Anupam Chakraborty attended the patient from 21-08-2014 to 22-08-2014, this change was not intimated to the patient party at that material point of time. Further Dr. Prosenjit Chakraborty attended the patient on 25-08-2014 and advised urgent trachestomy operation and such operation was performed by Dr. J.N. Kundu on 26-08-2014. Such operation was a life saving measure but after the operation the patient condition was more deteriorated and ultimately succumbed to death on 29-08-2014.
- For the sudden absent of Dr. Prosenjit Chakra borty as aforesaid such vitally important operation was delayed for at least five days, therefore, it can be specifically alleged that if the said operation had been done four days ago in that case life of the patient could have been saved who died on 29-08-2014 and it is no doubt a serious cause of medical negligence on the part of Dr. Prosenjit Chakraborty and also the hospital authority and it is the contributory negligence in nature.
In fact for the negligence manner of treatment and service as rendered by the OPs complainant suffered mental pain and agony and at the same time the life of her husband for which complainant has filed this complaint praying for compensation against the OPs.
On the other hand OP3 Dr. Prosenjit Chakraborty by filing written version submitted that OP3 as a prudent medical man took all such positive steps for his treatment and question of medical negligence in the instant case does not arise at all and for that for some purpose make out some vexatious claim and allegation without relying upon the medical documents, relevant record and truth is that complainant has failed to prove any sort of medical negligence on the part of the OPs by any means. Further OP3 has alleged that about cost of treatment of the patient he did not committed that it shall be completed within any specified amount and all the doctors who attended the complainant’s husband attended with due diligence and care adopting all medical norms.
Fact remains Tracheostomy which is a surgical procedure to create an opening through the neck into the trachea (windpipe) wherein a tube is usually placed through this opening to provide an airway and to remove secretions from the lungs, is not a life saving operation per se especially when the patient was already on endotrachial tube and such tracheostomy was done on patients who are usually on endotrachial tube for a prolonged period and the role and function of both intubation and tracheostomy are one and the same. The former proceeds the later when there is prolonged obstruction in the airway hence the question of negligence does not arise.
Moreover, the patient had come to OP1’s hospital and was already on endotrachial tube. Question is how, where and when did the patient, since deceased get intubated. Nowhere in the four corners of the complaint of petition there is any whisper of the same and the complainant very conveniently suppressed the ‘treatment’ patient received prior to the present hospital. Further it is submitted that the entire allegation is baseless without any expert’s opinion or anything. So, the complaint should be dismissed against the OP3.
On the other hand, OPs1 and 2 by filing written statement submitted the medical negligence is not a matter of participation but a matter of settled principle of law and truth is that the OPs gave them proper treatment with proper care adopting all medical norms and truth is that OP1 serve required papers for hospitalization of the complainant’s husband, since deceased along with the total bill amounting to Rs.4,32,715/- to the concerned authority of PNB Sramik Union vide letter dated 17-09-2014 and at the same time there is no allegation against hospital authority about their any negligence and deficiency.
In fact, complainant prayed for considering the bill and to reduce the amount and humanitarian and/or sympathetic ground. Nowhere did she mention of any deficiency in rendering medical service to her husband, since deceased during his stay at the OP Hospital. In fact the instant complaint case is an afterthought and further the bill was never sent to the complainant but it was sent to the Sramik Union and that is the norms and everything was done as per requirement of the medicine etc. and that was noted in detail and complainant’s husband since deceased was admitted to the OP Hospital with cashless benefit of PNB Sramik Union. Under such circumstances, why and with what intentions would the Hosptal authority give threatening calls to the complainant and sent unknown rowdy people to her for realization of the bill when on the contrary it is an undisputed fact that the bill shall be paid by the said Sramik Union. So, the allegation of the complainant against the OPs is completely false and fabricated and in reality the entire complaint is false for which the complaint should be dismissed.
Decision with Reasons
On an indepth study of the complaint and the written version and also hearing the Ld. Lawyers of both the parties and further assessment of the medical certificate and other materials as produced by the complainant it is found that Dilip Dutta aged about 67 years was admitted to North City Hospital on 14-05-2014 on 06.45 p.m. and expired on 29-08-2014 at 8.10 p.m. and he was in the treatment of Dr. Prosenjit Chakraborty in bed No.315 and primary cause of death is noted Brain Stem Haemorrhage Pneumonia Sepsis, secondary cause Renal Failure and that death certificate was issued on 30-08-2014 at 12.49 a.m. by the hospital authority. In fact, complainant was admitted to present hospital on 14-08-2014 after examined by Dr. M.J. Rooni with a history of sudden onset disorientation, vomiting and squeezing of speech. Form complainant’s own document it is found that bill was sent by North City Hospital to Punjab National Bank (PNB) Shramik Union of PNB and it was received by the member of Shramik Union of PNB on 29-08-2014.
From the document that is the case history regarding treatment of the patient Dilip Dutta (since deceased) it is found that history is noted to the effect known hypertensive on irregular medication and the patient previously admitted in the Zenith Hospital and treated conservatively from 12-08-2014 to 14-08-2014 and diagnosed to a case of CVA/AF/HTN/Left lung consolidation pt on ET tube and that is the case history issued on 14-08-2014 when he was under intubation and he was referred to this hospital from Zenith Hospital where the patient was treated from 12-08-2014 to 14-08-2014. So, it is clear that intubation was made on the body of the husband of the complainant that is Dilip Dutta by Zenith Hospital not by this Hospital. Thereafter, treatment was continued and from the medical continuation sheet of the treatment and progress note it is clear that he was suffering from several complications and diseases and several doctors were deputed by the OP for his treatment to give relief but in fact, the complainant husband did not respond well and sepsis started when he was admitted being removed from Zenith Hospital to present hospital along with intubation and several tests were made and it was detected that the condition on the date of admission was drowsy disbanded condition with several complications and renal failures. On x-ray lung was found inflated and aerated and he also suffered from nephratis and some other disease and ultimately when the situation was found beyond control intubation was there but in place of that tracheostomy was done but even then the position was not improved and he also suffered from nephropathy and from the treatment sheets it is found patient was treated by several doctors and specialists to control the situation but ultimately treatment did not respond and he died and he was also in ventilation but all the attempts failed and anyhow on 29-08-2014 the patient died at about 8.10 p.m. Practically at the time of advancement of the argument Ld. Lawyer for the complainant submitted that the tracheostomy was not done in time for which death was caused but considering the research work done in the field of tracheostomy by different doctors and authors of European Society of Intensive Care Medicine and from their faculty report it is clear that in case of many patient it is difficult to predict how long they will require the artificial airway and in these cases, the patient should be reassessed on a daily basis to determine whether tracheostomy is required and as per their author’s research work it is undisputed that artificial airway is needed for less than 10 days, an endotracheal tube via the translaryngeal route is preferred and if it is accepted that patient is still required an artificial airway for greater than 21 days then a trachestomy is preferred but in their conclusion they have admitted that it is only for the purpose of giving marginal respiratory mechanics and may lead to quicker discontinuation of mechanical ventilation but that is not sufficient to save the life if patient is found not stable. It is an adopted procedure to give artificial airway and only by giving artificial airway patient cannot be saved if the patient suffers from different types of diseases. This procedure is only required for the artificial airway so that the treatment can be done but only by applying the tracheostomy patient cannot be saved but it is the last effort for saving the patient what is already decided by the authors and it is difficult to predict how long they will require the artificial airway but artificial airway is required for the purpose of giving a chance for further treatment etc. In fact, early tracheostomy can improve mobility and may enhance the patient’s psychological problem well-being which may help to take over medical treatment but it is not a process to save the patient always when the patient has no stability or to respond against medication or other treatment.
It is also known fact that generally it is used in respect of critically ill patient only to give them a certain relief and in the meantime to treat the patient properly but tracheostomy cannot save a patient if that patient if that patient suffers from other complicated diseases and if such a patient does not respond against proper medication also. Only it is a procedure to give some relief to the patient but same may not give proper relief to a patient who is not stable. But in this case it is found that this patient was admitted to this hospital along with translaryngeal intubation that means another procedure which has been attempted by the Zenith Hospital which is substitute to tracheostomy. So, it is clear that the patient was not in stable condition and he suffered from air hunger for which Zenith Hospital adopted translaryngeal intubation which is called a ventilator support or airway protection for some period and it was given with a hope that the patient will respond against proper treatment and medication but considering the entire medical treatment it is clear that even after treatment and after giving proper medication and placing on ventilations as per medical science patient condition was deteriorating complainant’s entire body system failed and particularly he suffered from renal failure at the relevant time ad ultimately patient did not respond against proper treatment then it is clear that his entire system failed and for which even after continuous treatment and medication the patient did not revive and died but the allegation as made by the complainant that tracheostomy was not done immediately is found a baseless allegation because already that patient was under intubation and it was done at Zenith Hospital and practically that intubation was found repeatedly changed for which the tracheostomy was done. Then it is clear all efforts were made by Zenith Hospital to give artificial air to save him from continuous air hunger and it is alternative path of tracheostomy so, only for tracheostomy operation after lapse of 5 days cannot be treated as the cause of death of the complainant’s husband but the cause of death was renal failure and complainant’s husband suffered from it for which he was admitted in the Zenith Hospital and after that he admitted in this hospital. We have gathered from treatment sheet and all prescriptions that medical method and procedure for saving the life of such a patient as taken by the OPs were all at par medical method but whose condition was not stable at the time of admission into this hospital.
Moreover in this case it is proved that at Zenith Hospital translaryngeal intubation was made and in the present OP’s hospital ultimately that was removed and tracheostomy was made for support or air protection for a prolonged period and that was needed in emergent situation during airway obstruction and considering need for an artificial airway, the application of tracheostomy was preferred and that was the correct approach but difficult issue is how long it shall give such relief. It is specifically opined by Dr. Heffner, Dr. Gracey and A. Estaben of European Society of Intensive Care Medicine, Barcelona that this procedure is only to give preoperative or short term post operative complications and practically it is at least as safe as standard procedure when it is required but same is not a long term relief and if the body system does not naturally cure from such other diseases and in fact tracheostomy is done in critically ill persons to give proper relief for the time being. But it is not a long term medical relief when tracheostomy is made on duration of medical ventilation and after tracheostomy if the general position is not ultimately restored and other body system does not work properly in that case even after tracheostomy recovery of the patient is not found that is not the cause of tracheostomy. Further it is already opined by those doctors in case of renal failure, pneumonia, congested lung and other associated physical problem of a patient generally laryngeal intubation and tracheostomy is done but it is nothing but a temporary relief in case of a critical patient and in the present case no doubt complainant’s husband was a critically ill patient who was transferred from Zenith Hospital in intubation and condition was serious. There was a history of renal failure. So, considering the critical situation of the patient present OP ultimately removed laryngeal intubation and applied tracheostomy and even then the condition of the patient was not improved as he was a critically ill patient and ultimately died due to several diseases which is evident from the discharge summary. No doubt medical negligence is not a matter of perception but a matter of proof.
Considering the entire materials on record including authenticated opinion of doctors it is found that tracheostomy is generally done for critically ill patient to give relief from air-hunger but there is no such connecting medical authorization that as soon as tracheostomy is made, the patient shall be saved from air-hunger and improvement of the critically ill patient may be found but truth is that all other system of the body must have to respond on medication or treatment. If the general body system does not respond against treatment of a critically ill patient in that case generally mortality of the patient is decreased within 30 days and all over the world in different hospital application of tracheostomy was assessed and it was detected that if after applying mechanical evaluation the condition of the patient is not developed generally tracheostomy is applied but chance of recovery cannot be ascertained. After proper study of the book written by those doctors and also considering their decision in respect of the effect of tracheostomy in respect of critically ill patient we have gathered that tracheostomy is widely used for intervention in adult, in critically care units and it is generally required for the purpose of surgical operation which is immediately required and also for some other cases but tracheostomy is not such a treatment for improving the general system of the body if patient itself suffers from different type of disease and chance of recovery is very poor but only to give relief from air-hunger symptoms it is applied only to give psychological relief to the patient but tracheostomy is not a treatment for removing air-hunger of a patient for ever.
In this context, we have studied some portion of the writings of those doctors referred we have gathered that if a person is found a patient of asthma, by tracheostomy his such sort of problem cannot be cured but if it is found such a patient is needed some urgent operation in that case tracheostomy is applied only for the purpose of that operation but after operation there is no chance to cure from such asthma and that is the authorization of medical science. So, we have gathered that there was no medical error on the part of the OPs for removing the laryngeal intubation by adopting tracheostomy and when the doctors found that laryngeal intubation shall not give him much relief this procedure was taken as last chance to give the critical relief for that patient but ultimately on medication her husband did not respond as renal failure caused and at the same time there was brain hemorrhage and those are not the effect of tracheostomy but before the application of tracheostomy the patient was in drowsiness and at the relevant time he suffered from brain damages renal failure and he was in critical physical condition when he was removed from Zenith Hospital to present OP’s hospital. So, considering the situation of the patient we are confirmed that the treatment was not started from very beginning by the OPs but that fellow was treated at Zenith Hospital after considering his ailment and Zenith Hospital failed to give any proper relief even after continuous treatment when complainant removed his husband to this hospital under intubation. Anyhow, OPs also adopted some other improved theorization of medication and other procedure but as because the patient did not respond against such medication he ultimately died. But the complainant’s claim that due to late decision of adopting tracheostomy death was caused but it is completely baseless without any foundation having no medical authority’s support in this regard. Truth is that he was under laryngeal intubation and as per the authoritative doctor’s opinion if laryngeal intubation fails in that case by adopting tracheostomy the general condition of the patient cannot be developed. So, considering all the above medical authorization we are confirmed the treatment as done by the OPs and also procedure as adopted by the OPs and their skill in this regard to save the life of the husband of the present complainant was at par medical norms and authorization when that is the fact as per the settled law of medical it is to be alleged as to which occasion of the doctor was not as per accepted medical practice and what was done should not have been done or what was not done should have been done that is to be supported of accepting evidence or available medical letter or approach relying upon this theorization of the Hon’ble Supreme Court as already discussed in Mathews Jacob and other judgements we have gathered that in the present case complainant failed to prove any sort of medical negligence by showing any authoritative books that particular type of treatment ought to have been taken and that has not been taken. On the contrary we have studied the medical authoritative books in this regard. Particularly, in respect of the application of tracheostomy in case of a critically ill person wherefrom we have gathered after studying the basic authorization tracheostomy its implement, application and effect after operation with the present documents that is the medical discharge certificate application of the said procedure by the OPs we are confirmed at par accepted medical practice and improved method of treatment as maintained all over the world OPs applied everything to save the life of the complainant’s husband and failure is not for tracheostomy but it was the failure of entire body system of the patient who have not responded against all prospective treatment and application of all medical sciences to save him. That is the settled principle of law if a body system fails and does not respond against medication in that case it shall be treated as total failure of the function of the system of the body and in this case not only her husband suffered from brain hemorrhage but also with renal failure and died.
In the light of the above observation and findings we are to conclude without any hesitation that there is no deficiency, negligence on the part of the OP’s doctor in discharging their duties as doctors during the treatment of the patient at their hospital and complainant has miserably failed to prove any sort of negligence deficiency on the part of the OPs except their allegation in so many lines in the compliant but that has not been substantiated by any authoritative medical opinion or literature. So, the complaint fails.
Hence,
Ordered
That the case be and the same is dismissed on contest but without any cost against the OPs.
