Tamil Nadu

StateCommission

FA/402/2013

UMA KUMAR HOSPITAL, DOCTOR - Complainant(s)

Versus

P. KARTHIKEYAN - Opp.Party(s)

ANAND ABDUL & VINOD ASSOCIATES

08 Mar 2022

ORDER

IN THE TAMIL NADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI.

 

Present: Hon’ble Thiru Justice R.SUBBIAH       ... PRESIDENT

            Tmt. Dr. S.M.LATHA MAHESWARI  ... MEMBER

 

F.A. No.402 of  2013

(Against the Order, dated 26.09.2013, passed in CC No.43/12,

on the file of  the DCDRF, Dharmapuri at Krishnagiri)

                                                    

                                    

                              Orders pronounced on:   08.03.2022

            

M/s. Uma Kumar Hospital,

rep. By its Doctor

1. Dr.Uma Kumar

2. L.K.Kumar

Maternity and Child Health

     Speciality Centre,

Bangalore Main Road,

Opp. to Anandha Bhavan Hotel,

Hosur 635 109.                        … Appellant / Opp. Party

 

vs.

 

1. Karthikeyan, P.

2. Minor Barkavi – rep. by

     NF/Father Karthikeyan,  

No.55, Thanigai Nagar,

Phase-II, Zuzuvadi,

Hosur Taluk,

Krishnagiri District.      …     Respondents/Complainants

 

             Counsel for Appellant         : M/s. Anand , Abdul &

                                     Vinodh Associates.

             Counsel for Respondent     : Mr.C.Prabhakaran

 

 

          This First Appeal came up for final hearing on 22.02.2022 and, after hearing the arguments of both sides and perusing the materials on record and having stood over for consideration till this day, this Commission passes the following:-

 

O R D E R

 

             The appellant herein/Hospital challenges the impugned Order, dated 26.09.2013, passed by the District Consumer Disputes Redressal Forum, Dharmapuri at Krishnagiri, in C.C. No.43 of 2012, whereby, the District Forum found that the Hospital has committed deficiency of service in prematurely discharging the wife of the 1^st complainant (R1)/mother of the 2^nd complainant (R2) without stabilizing the ailment, and ultimately directed the Hospital to pay Rs.1,00,000/-  as damages for deficiency in service and Rs.5,000/- towards litigation costs to the complainants.  

 

             2.  The appellant herein is the Opposite Party and Respondent Nos.1 and 2 herein are the complainants before the District Forum.

             The gist of the complaint filed before the District Forum is that, on 16.09.2009,  the wife of the 1^st complainant by name Sowmiyashree visited the  Opposite Party/Hospital with complaints of fever for one week and joint pain and, as advised by the Opposite Party, she was admitted as In-patient there; that her blood test report revealed TC count as 2900/cells instead of minimum 4500/cells and the platelet count  as 1.38 lakh/cu.mm instead of minimum 1.5 lakh, suggesting that she was suffering from Dengue/Malaria/viral fever; that, while so, without diagnosing properly and providing requisite treatment to the patient, the OP had simply discharged the patient on 19.09.2009 stating that the condition of the patient was good, but, the patient died on the same date on reaching home at 8 PM. after suffering wheezing and suffocation; and that her death is thus due to the deficiency in service on the part of the OP, who failed to diagnose properly and give the required treatment for the ailment, hence, the complaint, seeking for a direction to the OP to pay to the complainants a sum of Rs.19 lakh towards compensation, Rs.20,000/- each towards medical expenses and litigation costs.

 

             3. In the written version filed by them, the OP/Hospital would, inter alia, state thus:-

             It is true that the wife of the 1^st complainant was admitted in the Hospital on 16.09.2009 with complaints of fever since one week, joint pain, weakness/giddiness since 2 days and not able to walk since one day.   She was diagnosed to have pyrexia of unknown origin (in short PUO) and the cause of fever could not be detected despite systematic/comprehensive investigations.   All routine tests were done including HB, TC, DC, ESR, total RBC Count, HCT, MCV, MCH, MCHC, RDWCV, RDWSD, platelet count & MPV. She was treated symptomatically with antibiotics, analgesics and antipyretics.  In fact, she responded to the treatment and her stay in the Hospital from 16.09.2009 to 19.09.2009 was uneventful and her condition was good at the time of discharge. It is only the assumption and presumption of the 1^stcomplainant that she had dengue fever.  At the time of discharge, the patient was in good condition with no fever, which is evident from the discharge summary, dated 19.09.2009.  The 1^st complainant, having counter-signed the discharge summary of the patient to the effect that her condition was good at the time of discharge, is estopped from making any claim contrary to the facts mentioned in the said summary. Although the patient was asked to come back for review after 3 days, she never bothered to come back for a review. Thus, as there is no scope at all to allege deficiency in service, the complaint is liable to be dismissed.

 

             4.  Before the District Forum, both sides filed their respective proof affidavits and while, on the side of the complainant, 7 documents were marked as Exs.A1 to A7, the OP marked 6 documents as Exs.B1 to B6.  By the impugned order, dated 26.09.2013, the District Forum allowed the complaint, as mentioned supra, and aggrieved thereby, the Hospital has come up with the present First Appeal.

 

             5. Learned counsel for the appellant, by re-stating the stand taken by the Hospital in their written version, would submit that, when the patient was admitted in the Hospital, dengue was suspected as in that area, most of the people were affected by dengue, whereupon, the test for ascertaining the platelet count was repeatedly done between 17.09.2009 and 19.09.2009, and the reports indicated that the platelet count was increasing and it never went down.  Further, the fact that the patient was in good condition with no fever is evident from the discharge summary, dated 19.09.2009. Since the respondents did not choose to cross examine the appellant so as to dispute the discharge summary, they impliedly admitted the details therein; however, such core aspect has somehow escaped the consideration of the District Forum. The District Forum also failed to look into the fact that the patient had total cell count of 3900 cells/cu.mm on 16.09.2009 and that, as per the reports of the subsequent tests done on 17^th, 18^th and 19^th September, 2009, the total count was 4000 cells/cu.mm, which is not that much low to cause death.  At any rate, when the respondents/complainants failed to let in any expert evidence or adduce materials to attribute any negligence on the part of the Hospital, the contrary findings recorded by the District Forum based on assumptions and presumptions cannot be legally sustained.  Human body and its working pattern are nothing less than a highly complex machine.  Coupled with the complexities of medical science, the scope of impressions, misgivings and misplaced allegations against the operator, that is, the Doctor, cannot be ruled out.  One may have notions of best or ideal practice but that may differ from the reality of how medical practice is carried on or how in real life the doctors function.  Since, in the present case, absolutely unwarranted allegations have been levelled against the Hospital and, inasmuch as the impugned order is superfluous without any logic or legal basis, the same warrants absolute interference, he pleaded.     

 

             6. Per contra, learned counsel for the respondents would, at the first instance, submit that the premature discharge of the patient on 19.09.2009 was without any medical prescription or diet advice, especially when the patient did not even reach the minimum required count of vitals like TC and Platelet.  According to him, the Hospital failed to prove, as to under which medical protocol, the treatment given to the patient was strictly in accordance with the lines as pleaded in their version.  The negligence on the part of the Hospital in not giving drug prescription and diet advice at the time of hurried discharge would self-speak that they miserably failed to exercise minimum clinical care & skills in treating/handling the patient.  It is vehemently contended that mere counter-signing in the discharge summary by the 1^st respondent does not mean that the treatment given by the Hospital has been endorsed to be proper, since the same was done, believing the representation made by the Hospital that the condition of the patient was good then.   The documents filed by the Hospital themselves under Exs.B3 and B6 would clearly prove the deficiency of service on their part, hence, the impugned order passed by the District Forum is well-founded and thus, there is no scope for interference with the same, he pleaded.

 

               7.  In the light of the rival submissions advanced on either side, the only issue that arises for consideration is as to whether the appellant/Hospital is justified in claiming that there was no negligence/deficiency in service on their part vis-a-vis the allegation that they failed to exercise minimum clinical competence and ordinary professional skills in handling/treating the patient by discharging her prematurely that consequentially resulted in her death.

 

             8. In this regard, before proceeding further, it would be apt to point out that, in a case of this nature, where the allegation is that there was absolute lack of medical care at all stages, from the point of diagnosis upto the level of premature discharge, the Hospital must come up with entire medical records available with them about the nature of ailment and the course of medication coupled with the clinical notings-cum-advice, suggesting that the Doctors concerned performed their duties with usual care and had, in fact, taken all precautions.

               It is not disputed that the patient was admitted in the appellant/Hospital on 16.09.2009 as in-patient and that she underwent treatment there for 4 days till 19.09.2009, on which date, after discharge, on reaching the residence, she passed away.  According to the appellant, the patient/deceased was suffering from POU (unknown type of fever), which is said to be a ‘clinical challenge’ for many physicians. In other words, POU could be ascertained only by eliminating all possibilities except the final finding.  Thus, when the ailment itself is a diagnostic challenge, one would definitely expect the Hospital to clinically ensure that the patient in fact fully recovered from such unknown type of fever at the time of discharge.  To find out as to whether the appellant/Hospital, in fact, exercised reasonable medical competence in treating the patient said to be suffering from POU and also, in confirming her fitness upon complete recovery from illness, we have gone through the records, in particular, Exs.B2 and B6 marked by the Hospital as ‘CASE SHEET’ and ‘CASE REGISTER’ respectively.  On a bare perusal of the same, we find that both the documents are nothing but Pathology/Lab Reports and, as such, those documents do not contain any of the details that would be generally found in a regular ‘case history’ that would reflect vital details like the basis to conclude the ailment as POU, entries made for BP level/pulse rate/oxygen saturation level, etc.,  names of the drugs administered to the patient with timings, notings of the Doctors/nurses, who attended the patient in intervals and, above all, the clinical findings to conclude that the patient is fit for discharge.  The other material viz., so-called ‘Discharge Summary’ under Ex.B3, can only be termed a ‘blunt document’, which is bereft of material particulars except to describe the ailment as POU and to indicate that the patient was given antibiotics/analgesics/antipyretics and that her condition was good.  On the loud claims made by the appellant/Hospital that they were able to treat the patient suffering from pyrexia (the medical term for fever) of unknown origin and contained the ailment just in three to four days and thereby, she became fit for discharge, when they are required to produce the case history/details of treatment given for four days from 16.09.2009 to 19.09.2009, their act in marking the lab reports as ‘CASE SHEET’ and ‘CASE REGISTER’ is highly reprehensible.  The so-called discharge summary under Ex.A3, on the face of it, is only an empty pot without any detail about the body temperature of the patient, clinical advice on drugs/diet restrictions before review, etc., however, based on such obtuse summary, it is acclaimed by the appellant that the condition of the patient at the time of discharge was good.  To the dismay, the Lab Reports also run contrary to the claim of the Hospital, since those sheets indicate that the patient did not even have minimum required level of platelet count on the date of discharge; as such, she was not actually fit for discharge.   At any rate, none of the documents adduced by the Hospital takes us anywhere near the nature of diagnosis/line of treatment/clinical follow-up, etc, rather, those materials only discredit & destroy the defence of the Hospital and only suggests that the appellant/Hospital went astray from professional/medical ethics. When the patient unfortunately passed away on the very date of discharge itself, it is highly agonizing to see the very unusual stand taken by the Hospital at paragraph No.4 of the version to the effect ‘Infact the patient never even bothered to come back for a review, which again was against medical advise’.  Therefore, we have no hesitation to hold that negligence-cum-deficiency in service on the part of the Hospital is glaringly apparent throughout, from the initial stage of diagnosis upto the final level of premature discharge. As such, the appeal is absolutely devoid of any merit and thus, there is no scope at all for interference with the ultimate directions issued in the impugned order of the District Forum.

             9. In the result, the Appeal stands dismissed, by confirming the order, dated 26.09.2013, passed by the DCDRF, Dharmapuri at Krishnagiri, in C.C.No.43 of 2012.

 

S.M.LATHA MAHESWARI                             R.SUBBIAH, J.

MEMBER                                                      PRESIDENT.

ISM/TNSCDRC/Chennai/Orders/Mar/2022.