BEFORE THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT PUDUCHERRY
TUESDAY, the 23rd day of December, 2014
CONSUMER COMPLAIANT NO.3/2006
G.Subramanian, S/o Govindarasu,
Residing at No.17, 12th East Cross Street,
Co-Operative Nagar, S.S.Nallur Post,
Mayiladuthurai Taluk, Tamilnadu. ………………. Complainant
Vs.
1. Pondicherry Institute of Medical Sciences,
Rep. by its Director, Kanagachettikulam,
Kalapet, Puducherry - 14
2. The Principal, The Pondicherry Institute
of Medical Sciences, Kanagachettikulam,
Kalapet, Puducherry – 14
3. Dr. Jayanth Mathew,
Pondicherry Institute of Medical Sciences,
Kanachettikulam, Kalapet,
Puducherry – 14.
4. Dr.Vivekanandan, The Pondicherry Institute
of Medical Sciences, Kanagachettikulam,
Kalapet, Puducherry – 14.
5. Dr.Annamani, The Pondicherry Institute of
Medical Sciences, Kanagachettikulam,
Kalapet, Puducherry – 14.
6. Dr.Nandakumar, The Pondicherry Institute of
Medical Sciences, Kanagachettikulam,
Kalapet, Puducherry -14.
7. Dr. Gunavathi, The Pondicherry Institute of
Medical Sciences, Kanagachettikulam,
Kalapet, Puducherry -14.
8. Dr. Nagesh, The Pondicherry Institute of
Medical Sciences, Kanagachettikulam,
Kalapet, Puducherry -14.
9. Dr. Kalyan Singh, The Pondicherry Institute of
Medical Sciences, Kanagachettikulam,
Kalapet, Puducherry -14. …………. Opposite Parties
BEFORE:
HON’BLE THIRU JUSTICE K.VENKATARAMAN
PRESIDENT
TMT. K.K.RITHA,
MEMBER
FOR THE COMPLAINANT:
Tvl. Muthu Venkataraman, S.Sathish Chandrasekaran
and M.N.Bharathi Advocates, Chennai
FOR THE OPPOSITE PARTIES:
Tvl. L.Sathish, S.Doraiswamy,
and C.Kalyanasoundaram, Advocates, Puducherry
O R D E R
(By Tmt. K.K.Ritha, Member)
This complaint was filed on 17.05.2006 by one Mr.G.Subramanian alleging medical negligence in treatment and deficiency in service by the Opposite Parties causing the death of his daughter Ms. G.Sumithra, aged 25 years who was working as Lecturer in an Engineering College.
2. The case of the complaint, in brief, is as follows:
On 29.11.2005, his daughter (hereinafter referred to as the patient/deceased) was infected by common cold. She was treated by one Dr.Prasad at Chidambaram, who suspected 'pleural effusion' and then referred her to Opposite Party No1's Hospital. He also suggested that she would be normal in two days to resume her duty. Again, on 29.11.2005 the patient was treated by Dr.Pandian, who advised to take E.C.G. and Chest X-ray and found her chest was infected with cold and prescribed medicines. The Doctor opined that tablets and injection would completely cure her.
3. As advised by Dr.Prasad, the patient was taken to 1st Opposite Party's hospital on 30.11.2005 at 7.00 p.m. and admitted in emergency ward. She was prescribed medicines and the complainant paid a sum of Rs.18,000/- as advance. The Opposite Parties, who had treated her refused to shift her from the emergency ward where she was unable to bear the AC, to a separate cabin, since the complainant failed to make payments in time. After paying a sum of Rs.10,000/- on 16.02.2005 at 11.00 p.m., the patient was shifted to a general ward. The complainant had no confidence in the treatment given by the Opposite Parties. They were constantly demanding money by giving treatment by inexperienced Doctors. Dr.Vivekanandan (O.P.No.4) and Dr.Jayanth Mathew(O.P.No.3) had performed dialysis on several occasions which resulted in worsening her health condition. Also they charged exorbitant amount for the dialysis. The patient was shifted from the general ward to the special ward and again admitted to the general ward due to his failure to pay further advance amount. She was administered an intravenous injection through her neck twice by an inexperienced staff. The syringe was not sterilized and so it highly infected resulting in the wound becoming septic.
4. Dr.Vivekanandan (O.P.No.4) stopped treatment and went to the extent of removing the intravenous injection from the patient's neck, as the complainant failed to deposit a further amount of Rs.55,169/-. The Doctor also prevented the patient from being shifted to hospital in Chennai by giving assurance of rendering the best treatment. The complainant was unable to communicate his grievances to Dr.Annamani (O.P.No.5), the Chief Doctor, who could not comprehend Tamil. Further, the Doctor prescribed medicines at random and was put to hardship by prescribing the medicines by name 'voraze- 200 mg' costing Rs.2,700/- per tablet. For this, the reason given by the Opposite Parties was that the skin of the patient blackened since she was allergic to certain medicines and to save her from dire situation. The complainant became panic when ENT Doctor informed him to buy 40 tablets costing Rs.750/- each to prevent blood clot, which was available only in Chennai.
5. The complainant spent Rs.38,974.50 for medicines, Rs.65,980/- haemodialysis, scan, X-ray and other expenses and the total expenses incurred was Rs. 1,04,892.50. The complainant was pressurized to buy medicines without giving any proper reason. Further, from the date of admission on 30.11.2005 to 26.12.2005, the patient was in good spirit because of the personal care given by her attenders.
6. On 27.12.2005 at 10.00 p.m., the patient suffered breathing problem.. The Opposite Parties performed dialysis at 11.00 p.m., only after the complainant had deposited Rs.1,500/- towards the charges. Further, Dr.Vivekanandan (O.P.No.4) reprimanded the complainant that the delay was due to his failure to deposit the demanded amount on the previous day. On 28.12.2005, the patient had become pale and blood was pumped, since there was no proper blood flow. The condition of the patient worsened and she was shifted to emergency ward. The Opposite Party No.3 suspected brain fever and had drilled holes in the head which was a futile attempt. On 30.12.2005 she was put on ventilator. A Senior Doctor on 01.01.2006 informed that the chances of saving the patient was bleak and on 04.01.2006 at 8.25 a.m., the patient breathed her last. The physical and mental struggle undergone by the complainant and the deceased cannot be expressed in words. He issued notice to the Opposite Parties for medical negligence and deficiency in service and prays to pay a sum of Rs.1,04,892.50 towards medical expenses incurred; Rs.90,00,000/- for mental agony and Rs.10,000/- for costs.
7. Per contra, the Opposite Parties filed the reply version with the following averments:
The Opposite Parties denied all the allegations made by the complainant against the Institution and individual Doctors. These allegations did not find place in the notice issued by the complainant which are only an afterthought. After filing the complaint before this Commission, the complainant had called for a press meet to malign the reputation of the Opposite Parties in public. The one-sided version of the complainant was published in New Indian Express and in Tamil edition Dhinakaran on 26.07.2006.
8. Dr. Prasad, Professor and Head of Department, Dermatology had referred the patient to Opposite Party No.1's hospital. In his letter, dt.29.11.2005 the Doctor had clearly mentioned that the patient was a known case of Systemic Lupus Erythematocis (SLE) and she was taking oral steroids. Also she had chest pain and dyspnoea for two days and suspected pleural effusion. The findings of the Doctor was an indication that the patient was critical and required treatment from a Super Specialty Hospital. The complainant instead of bringing the patient to Opposite Parties hospital, had taken her to Dr.Pandian, Chest Specialist on 29.11.2005. The Doctor suggested that the patient would be completely cured with tablets and injection and mentioned that she had CCF (Congestive Cardiac Failure) and acute pulmonary edema, collection of fluid in lungs. The E.C.G. taken by the Doctor indicates that the heart of the patient was under severe stress and it showed a heart rate of 150 instead of the normal rate of 70 – 80.
9. The patient had undergone ANA blood test on 01.09.2004 and on 08.09.2005 at HITECH Diagnostic Centre, Chennai which confirmed SLE, which is an incurable and life threatening disease. The complainant suppressed the medical report of the patient who had elevated urea, albuminuria, leucocyturia and anemia, which are strong indications of damage to kidney and projected the patient's sickness as common cold.
10. On 30.11.2005 at 7.00 p.m., the patient was brought to casualty in a critical condition with severe breathlessness , vomiting, loose stool and oliguria for four days. Though Dr.Prasad referred the patient on 29.11.2005 to O.P.No.1's hospital, the complainant brought her after a crucial delay of 24 hours. Cardiologist, Nephrologist, Urologist and Ophthalmologist were pressed into service and necessary medications started after obtaining consent from the patient's sister, who accompanied her. All necessary tests and investigations were done, which revealed that the patient had severe renal failure. She also had myocarditis with congestive cardiac failure and abnormal blood pressure, pulse rate and respiratory rate.
11. The Opposite Parties further submitted that they had given counselling to the complainant's family members about the incurable disease, the critical condition and the bleak chances of survival of the patient. It required specialized treatment which cost high. The patient required frequent dialysis because of acute renal failure. For conducting dialysis, consent was obtained from the close relatives of the patient. The complainant was aware of the fact that the patient's kidneys were already damaged due to SLE, because of high level of urea and serum creatinine in the blood. The Opposite Parties condemned the accusation levelled by the complainant that for extracting money from him repeated dialysis were done unnecessarily. After the treatment, though the patient showed some signs of improvement, but on 07.12.2005, the 7th day of her admission, she developed gangrene in her right index finger and dis-colouration because of SLE which was immediately attended by the Opposite Parties. In the third week of her admission, she developed pain in the nose and blocked sensation. The ENT surgeon detected aspergillus, a serious condition and prescribed Voraze 200 mg. which is the recommended treatment for such complaint. Though the complainant was appraised of the condition, he alleges that he was forced to buy expensive medicines without any reason.
12. The patient was shifted to ICU on 27.12.2005 since she developed vomiting, high fever and became drowsy. The CT scan revealed hydrocephalus and intra ventricular bleeding. So, external drainage was done by Neurosurgeon, a high risk surgery which was explained to the complainant and obtained consent from him and his son. The patient then developed breathing difficulty requiring mechanical ventilation. In spite of the best efforts, the patient did not survive and breathed her last on 04.01.2006.
13. Treatment was given to the patient for 35 days of which 25 days in ICU and 10 days in the general ward. During her treatment, expensive diagnostic tests, hi-tech and advanced treatment were given. The complainant had paid a sum of Rs.43,500/- and not Rs.65,918/-, which he had stated in his complaint. The complainant is yet to pay a sum of Rs.1,22,787/-. At no point of time, the patient was left unattended for want of payment for treatment and never pressurized the complainant for the same rather provided the best possible treatment by experienced Doctors out of compassion for the patient. The Opposite Parties provided proper treatment and never pressurized the complainant to pay the bills out of compassion towards the patient. The patient was brought in a precarious condition and she survived for 35 days because of the care and treatment given by them. Apart from monetary loss and damage to the reputation caused to the Opposite Parties, they also lost precious time in defending the case which could have been used for their professional service. Hence, the Opposite Parties prayed for the dismissal of the complaint with exemplary costs and to render justice.
14. To substantiate the case, the complainant herein, filed his proof-affidavit, examined himself as CW1, marked documents Exs.C1 to C34 and also filed written arguments. The 4th opposite party has filed his proof-affidavit, examined himself as RW1, marked documents Exs.R1 to R4 and filed written arguments and also citations and authorities filed by both the parties. This Commission after hearing the arguments of complainant had framed issues for consideration. On 14.09.2012, the Opposite Parties filed a memo requesting this Commission to re-draft and recast the issues in respect of the complaint which are enumerated below:
- wrong diagnosis of kidney failure
- failure to treat the patient/deceased for the actual ailment
- failure to treat the patient/deceased on ground of non-payment of fees
- ill-treatment meted out to the patient
- treatment given by non-professional, untrained and non-technical staff
- failure to obtain consent from the patient/relative for conducting various medical
procedures
- Non-maintenance of proper case sheets and records in respect of the
patient/deceased
- random prescription of medicines
- Frequent shifting of patient from ward to ward with disregard to patient's deteriorating
health conditions
- use of non-sterilised equipments/apparatus/instruments to the patient resulting in
infection & deterioration of her health condition
15. The complainant alleged the opposite parties for wrong diagnosis of kidney failure by conducting dialysis several times without confirming it through proper tests. By reading the high level of serum creatinine and urea, the opposite parties concluded that the patient suffered from ‘acute renal failure’ (ARF). Such findings are totally erroneous since serum creatinine and urea are not the sole determining parameters to come to such conclusion. While so, the normal creatinine rate in adult females is between 0.5 and 1.1. There may be increased values due to high B.P., indigestion of large amount of dietary meat and muscle damage. Blood urea, nitrogen can also be elevated due to dehydration and heart failure. On the date of admission, the creatinine level of the patient was only 2.8 mg/dl which is not alarmingly high. Further, the blood urea nitrogen was bound to be high since the patient had congestive heart failure at the time of admission into O.P.1's hospital.
16. The opposite parties opposed the above allegations levelled against them by the complainant for diagnosis of kidney failure as false and stated that the latter completely relied upon Exs.C1 and C2, being the prescriptions of Dr.Prasad and Dr.Pandian, whom the patient consulted prior to admitting in O.P.1's hospital. The stand taken by the complainant is that there is no reference of renal failure in Ex.C1 and C2 and therefore, the opposite parties had wrongly diagnosed as kidney failure. The fact is Dr.Prasad, a Dermatologist and Dr.Pandian, a General Physician had done only clinical examinations, the visible aspects of the patient and recorded their observations, which could not be taken as a conclusive finding. Whereas, the opposite parties had confirmed ‘acute renal failure’ (ARF) only after conducting crucial tests which are more authentic and reliable than the clinical examinations done by the said two Doctors. This shows the ignorance of the complainant in Medical Literature and his self-assessment of the subject based on unconfirmed and unsubstantiated information downloaded from the websites.
17. The complainant’s next allegation was that the failure of the opposite parties to treat the patient for the actual ailment, i.e. pleural effusion (accumulation of fluid in the lungs). According to the complainant, Dr.Prasad, Ex.C1, suggested that the patient was infected with common cold and suspected pleural effusion and Dr.Pandian concluded that she was ailing from congestive cardiac failure (CCF), Ex.C2. The Impression of both the Doctors Exs.C1 and C2 were not taken into consideration by the opposite party Doctors but proceeded to give treatment for acute renal failure which was not confirmed by conducting proper tests. Moreover, the opposite parties could have conducted tests to confirm the level of excess fluid in the pleura by classifying pleural effusion as exudate/transudate. Only on 27.12.2005 when the condition of the patient was at the final stage, a ventricular drainage was done for the first time by the Opposite Parties and failed to treat the patient from the actual disease.
18. The complainant's contention is that the Opposite Parties had failed to conduct GFR test which determines the stage of kidney failure and 24 hours urine test to calculate the level of kidney function. Confirmation of 'Oliguria', insufficiency in the amount of urine produced is mandatory to determine kidney failure. Though the Opposite Parties had done the creatinine and urea test, that alone will not confirm kidney failure. The normal creatinine rate in adult females is between 0.5 and 1.1 mg/dl and the level of 2.8 mg/dl in the patient is not alarming. The Opposite Parties should have conducted all these tests to confirm acute renal failure which they failed to do.
19. The opposite parties admitted that Dr.Prasad, who had referred the patient to O.P.1 hospital had only suspected pleural effusion and did not confirm the same and Dr.Pandian by seeing the X-ray, had concluded Congestive Cardiac Failure (CCF) and Acute Pulmonary Edema (APO). The findings of both the Doctors (Exs.C1 and C2) are not one and the same and so, it is not a conclusive finding. So, the allegation of the complainant that the patient suffered from pleural effusion and admitted for the particular treatment is absolutely baseless. Moreover, the complainant was willing to believe an undiagnosed and unconfirmed suspicion of Dr.Prasad and also Dr.Pandian to be the final than the number of tests and investigations done by the opposite parties. This shows that the complainant is trying to presume and assume negligence without concrete evidence.
20. On 30.11.2005, when the patient was admitted, the investigations showed the following results:
“The blood urea was abnormally high 127 mg/dl as against the normal range of 7 – 20 mg/dl. The serum creatinine level was also very high at 2.8 mg/dl as against the normal range of 0.6 to 0.9 mg/dl for females and serum potassium level was also abnormally high at 6.9 mEq/per litre as against the normal range of 3.5 to 5 mEq/per litre. The texts produced by the complainant clearly indicates that the two most common methods of testing the kidney function is the blood test and the urine test and in both the tests, the significant presence of urea, creatinine and potassium determines kidney abnormalities”
21. These tests by itself were full proof and complete tests to confirm kidney failure. Thus, the opposite parties confirmed that there was absolutely no necessity for them to have conducted all the tests available to confirm kidney failure when the same was established by blood test analysis of the patient.
22. Another allegation levelled by the complainant was the treatment given by non-professional, untrained and non-technical staff of the opposite parties. The paramedicals were not trained to handle emergency situation and lack basic training. The patient was seen by one Doctor and observations were signed by another.
23. The opposite parties stated that since the hospital is a Multi-Speciality Hospital with Medical College attached to it, students, interns assist the Experts/ Doctors and on their instructions and guidance make records of the patients in the case-sheets, which is a normal procedure.
24. Failure to obtain consent from the patient/relatives/attenders for various medical procedures, was another accusation made by the complainant against the opposite parties. At no point of time consent was obtained from the patient/relative/ attenders for the treatment. The signature said to have obtained by the opposite parties from the patient’s sister did not tally with her specimen signature and added that other signatures are created by the O.P.s to escape from legal consequences.
“7.16 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics), Regulation 2002 clearly states as follows:
“Before performing an operation, the physician should obtain, in writing, the consent from the husband or wife, parent or guardian in the case of minor or the patient himself as the case may be”
25. The opposite parties refuted such allegations when the complainant and other close relatives signed in the consent forms in Tamil vernacular. Moreover, the Doctors explained in detail about the condition of the patient, the proposed treatment, consequences and prognosis of such treatment to the complainant and his relatives and only after that, signatures were obtained in the consent forms, Page No.63 to 66 – Ex.R2 – Volume-I.
26. Non-maintenance of proper case-sheets and records of the patient was another allegation made by the complainant, which according to him, was hurriedly made in haphazard manner without signatures of Doctors/Nurses. O.P.No.4 (RW1), deposed that “ M.C.I. (Indian Medical Council) Regulation 2002 in respect of Professional Conduct, Etiquette and Ethics does not mandate signing of case-sheets, records, etc. maintained by the hospital concerning to the patients ”, which the complainant considered as non-reliable and non-admissible reports when produced before the court of law and the relevant clause is extracted below:
7.7 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation 2002 clearly states as follows:
“Registered Medical Practitioners are, in certain cases, bound by law to give, or may from time to time be called upon or required to give certificates, notifications, reports and other documents of similar character signed by them in their professional capacity for subsequent use in the courts or for administrative purposes, etc”
27. Thus, the complainant reiterated that it was mandatory for the Doctors to put their signatures in case-sheets and records of the hospital.
28. The opposite parties objected the above allegations of the complainant and termed it as fictitious, as they had produced all the records which are duly and properly maintained by them with the help of the trained personnel.
For complainant’s question:
“After each report have the concerned Doctors signed?”
O.P.No.4, RW1 deposed “in most cases the records have been signed periodically. However, during the same shift when the Doctor makes several entries, he may not sign every single statement. However, periodic signature is maintained.”
Also opposite parties stated that the complainant intentionally avoided Appendix 4 of 7.7 which enumerates only Certificates, Reports, Notifications, etc. issued by Doctors for the purposes of various Acts/Administrative Requirements and the said Regulation is extracted hereunder:
“a. Under the Act relating to birth, death or disposal of the dead.
b. Under the Acts relating to Lunacy and mental deficiency and Mental
Illness Act and the Rules made there under
c. Under the Vaccination Act and the Regulations made there under.
d. Under the Factory Acts and the Regulations made there under
e. Under the Education Acts
f. Under the Public Health Acts and Orders made there under.
g. Under the Workmen’s Compensation Act and Persons with Disability
Act.
h. Under the Acts and Orders relating to the Notification of Infectious
Diseases.
i. Under the Employees State Insurance Act.
j. In connection with Sick Benefit Insurance and Friendly Societies Act.
k. Under the Merchant Shipping Act
l. For Procuring/Issuing of Passports
m. Excusing the Attendance in Courts of Justices, Public Services, in
Public Offices in ordinary employment.
n. In connection with Civil & Military Matters.
o. In connection with Matters under the Control of Department of
Pensions.
p. In connection with Quarantine Rules.
q. For Procuring Driving Licence”.
29. The signatures of Doctors are mandatory in matters relating to Appendix 4 of 7.7 of the Regulation and not the day-to-day case-sheets, nursing sheets, urine output charts, anaesthetic charts, etc. As such, the complainant had deliberately misrepresented and misinterpreted the Rules to suit his convenience. As such, reliance on STPL (CL) 1439 (NC) reported in 2007 – NC D.Rama Rajyam (Dr.) Vs. P.K.Vasudeva Rao & Others cannot not be applied in this case.
30. Use of non-sterilised equipments/apparatus/instruments resulting in infection and causing further deterioration of patient’s health is another accusation of the complainant against the opposite parties. The patient was always treated using non-sterilised equipments due to which, her skin turned black and also infected the index finger. The variation in mentioning about the right index finger for left index finger was due to inattentiveness of the Doctors and Nurses. An intravenous injection was administered on the neck of the patient by a novice who was unable to detect the vein and pierced the patient's neck for the second time. This had caused gangrene which was never cured, led to septicemia and ultimately she succumbed to it. In this connection, RW1 in his cross-examination had stated the following:
“ Q: Whether the right index finger was infected at any point of time?”
“A: The patient had involvement of right index finger It was mentioned on Page No.84 as left index finger. On Page No.85 and on several other pages in the document written by various Doctors, mentions it as “ right index finger only
Q: Whether the patient’s right or left index finger was affected?
Ans: After reading the records written by me, I said that right index finger was affected.
Q: Whether without the records, you recollect whether the right index finger or left index finger was affected?
Ans: I cannot be certain about the exact side from my memory alone.
Q: In page No.102 in Volume-I, the two diagrams pertain to the same hand or different hands?
Ans: They pertain to the same hand. They show the right hand.
Q: Was there any mention about the said diagrams about right or left hand?
Ans: On that page, it is not mentioned. It is mentioned in the previous page 101. (Witness is exceeding his limit perused the records and is saying that the same is mentioned in the preceding page)
Q: In page No.101 Volume-I, left column time 10.35 p.m. mentions “C/S” by Dr.Vivek. When the rest of the page is in your handwriting?
Ans: The record was written by Resident Medical Officer. The continuation of the same record in the next page (page No.102, the diagram and the description of the diagram) were written by me.
Q: Beginning from Page No.101 Volume-I in the column 11.12.2005 10.35 p.m. till page No.102 Volume-I is there any signature of the Resident Medical Officer or your signature.
Ans: I had not signed. My handwriting is there. Resident Medical Officer had not signed.
Q: I suggest that the entire case-sheet had been prepared only after the death of the patient only for the purpose of this case and that is why relevant signatures are not found in the appropriate places in the case-sheet.
Ans: I deny the suggestion.
Q: I suggest that the entire case-sheet has been prepared only after the death of the patient only for the purpose of this case and that is why the right index finger and left index finger had been wrongly entered in different places.
Ans: I deny the suggestion.”
31. Thus, the RW1 deposed that the right index finger of the patient was infected and the diagram of the hand was drawn by him at Page No.102 – Ex.R2 –Volume-I.
32. Shifting of the patient for want of money is one of the main accusations levelled by the complainant against the opposite parties and alleged that the patient was frequently shifted on several occasions, viz. 16.12.2005, 17.12.2005, 18.12.2005, 19.12.2005, 20.12.2005, 23.12.2005, 27.12.2005. The patient was kept in emergency ward and refused to shift her to a separate cabin for want of payment. Since the patient could not bear the AC in the emergency ward, the complainant had no other means but to pay Rs.10,000/- and assured to pay the balance amount of Rs.8,000/-. Then, finally she was shifted from Emergency Ward on 16.12.2005 at 11.00 p.m. to Female Medical Ward. On 20.12.2005, the patient was shifted again to Emergency Ward stating the reason for shifting for effecting " transfusion and observation ”. Within four hours, the patient was again shifted to Special Ward. It is common in medical history that patients to be observed would be kept in a particular ward for at least 24 hours, whereas the patient was shifted within four hours, contrast to the practice in vogue. Thus, shifting from Emergency Ward to Special Ward and to Female Ward had deteriorated the health and caused breathing difficulties to the patient.
33. According to the opposite parties, shifting had no adverse impact on the treatment given to the patient. In fact, they had given all the necessary treatment to the patient from 30.11.2005 to 16.12.2005 in the Emergency Ward irrespective of the payments made by the complainant. When the condition of the patient showed some signs of improvement, she was shifted to Female Medical Ward. Moreover, no hospital can afford to keep a patient longer period in emergency ward unless the condition of the patient so warrants. The O.P.No.1 hospital is a trauma care centre and emergency ward is always needed for critical cases. Shifting to Emergency Ward was done for transfusion of FFP (Fresh Frozen Plasma). The shifting was done for a specific purpose to perform a specific procedure and after the procedure in the emergency ward the patient was shifted back to the present ward after recording all her vital parameters. The complainant had misinterpreted the recordings made by the Doctors – “ presently patient shifted to ward ” only meant that the patient was at the point of time in a special ward who was actually shifted from emergency ward on 18.12.2005, Similarly, on all occasions, shifting was done with a purpose for conducting different medical procedures and in no circumstances the opposite parties had stopped giving treatment to the patient, inspite of pending payment of bills by the complainant.
34. Another grievance of the complainant is that Doctors used to prescribe medicines at random taking advantage of his ignorance, when he was asked to purchase a medicine by name “Voraze – 200 mg” costing Rs.2,700/- per tablet, to treat blackening of skin of the patient. He was panic when ENT Doctor prescribed 40 tablets which costs Rs.750/- each to prevent blood-clot. The medicines cost the complainant Rs.38,974.50, C.T.Scan, X-ray and hemodialysis Rs.65,918/- and Dialysis Rs.15,000/-. Added to this, he was pressurized to buy medicines without giving any proper reasons for the same.
35. The opposite parties strongly objected to the above contentions of the complainant and stated that the latter had paid only the pharmacy bills towards the purchase of medicines and medical equipments which the complainant was supposed to purchase and the same could not be given free of costs by the opposite parties. In total, six receipts from 01.12.2005 to 28.12.2005 amounting to Rs.43,000/- paid by the complainant are towards the patient’s treatment and the cost of the medicines and medical supplies comes to lesser amount. The patient’s stay in ICU, usage of various equipments, tests and investigations, specialised procedures like, endoscopy are all included in the hospital bills. Since the O.P.No.1's hospital is a private one, it is legally entitled to collect the payments for the treatment and hence the complainant is bound to pay the hospital charges. At the same time, the opposite parties, neither delayed nor stopped treatment to the patient even though there was delay in settling bills by the complainant.
36. The other accusations of the complainant are the ill-treatment meted out to him and the patient by the opposite parties for non-payment of the bills and the O.P.No.4 prevented the complainant from getting the patient discharged and taking her to a hospital in Chennai for treatment and his difficulties to interact in Tamil with the Chief Doctor (O.P.5), who could not comprehend the language.
37. Discussions & Findings:
We have perused the entire medical records like case-records, clinical laboratory reports, nursing notes placed on file and Medical Literature and citations filed by the complainant and the Opposite Parties
38. Before admitting the patient in the Opposite Party No.1's hospital, she was taking treatment for SLE which was diagnosed by Hi-Tech Diagnostic Centre, Chennai, (Ex.R4, dt.08.09.2005) and it is a dreaded and incurable disease. At the same time, the complainant projected his daughter/patient as hale and health and was suffering from common cold and also she would recover from it in two days. But, in reality, she had a serious health problem of SLE. Prior to admitting in the O.P.1's Hospital, she was taking treatment continuously from Dr.P.V.S.Prasad and was taking oral steroids.
39. The complainant solely relied upon the findings of the two Doctors, whom the patient had consulted in their private clinics. The two Doctors had given two different findings, i.e. Dr.Prasad diagnosed as ‘pleural effusion’ and Dr.Pandian as Congestive Cardiac Failure (CCF) and Pulmonary Edema, as per Exs.C1 and C2. Though the Doctors had contradicted with each other in their opinion, the patient reposed faith in the findings of the two Doctors, who had not conducted any tests or investigations for kidney problem of the patient. The complainant could have examined those Doctors to ascertain their diagnosis. Thus, the findings of the two Doctors were not conclusive and final. Whereas, the O.P.No.1's Hospital is a Super Speciality Hospital, wherein various tests and investigations were done, availed the experiences and knowledge of qualified Doctors in different Medical Fields and come to the conclusion that, the patient had ARF, because her blood urea was abnormally high viz. 127 mg/dl as against the normal range of 7 – 20 mg/dl; serum creatinine level was very high at 2.8 mg/dl as against the normal range of 0.6 to 0.9 mg/dl for females and also serum potassium level was abnormally high at 6.9 mEq/per litre as against 3.5 to 5.00 mEq/per litre.
40. The Progressive Report of Intensive Care Unit at page No.68 (Ex.R2 – Volume-I), dated 31.11.2005, at 8.00 p.m., when the patient was admitted in Emergency Ward, it was recorded as:
The finding was " No evidence of peri-cardial effusion ".
On 01.12.2005 at 10.00 a.m. at Page 70 (Ex.R2 – Volume – I recorded " SLE acute renal failure, myo-carditis, pulomanary edema "
41. In this connection, the O.P.No.4 (RW1) deposed the findings as follows:
" We have taken chest X-ray to rule out " pleural effusion ".
To confirm our suspicion of heart-failure, we did chest X-ray which showed pulmonary edema and echo-heart which shown very poor heart functioning. ( at Page No.4 of RW1).
" We have done X.ray, E.C.G and Echo-Scan for the heart at the time of admission itself. So all necessary evaluations were done before dialysis." (Page 8 of RW1).
" The urea and creatinine values were sent daily and these are recorded at Page 393 to 402 (Ex.R2 – Volume-I) under the heading 'Investigation Sheet'
42. From the above medical report, it is evident that the opposite parties had done chest X-ray, Echo and blood-test and found no evidence of peri-cardial effusion, but, the patient was suffering from acute renal failure. The report shows that though the Opposite Parties had diagnosed Acute Renal Failure on 01.12.2005 itself, they had not hurried to treat the patient with dialysis, but with medicines. Only after a week of the said findings, dialysis was started by following medical procedures.
43. We have completely verified the quantum of amount paid by the complainant through Exs. C3 and C4 series bills (Pages 9 to 263), in order to come to a clear understanding whether the opposite parties had fleeced the complainant as alleged by him for the treatment of the patient are exhibited below:
Six receipts of payment: Rs.43,500/-
Drugs & Disposables : Rs. 7,908/-
Dialysis : Rs.11,300/- (approximately)
Medicines : Rs.35,000/-
Total : Rs.97,708/-
44. From Exs.C3 and C4 series bills (Pages 9 to 263), it can be observed that the complainant had paid Rs.97,708/- approximately towards the treatment. Also the complainant has stated that the Doctor had prescribed 40 tablets each costing Rs.750/-, but, there is no document/bills to prove the same.
45. We can feel the agony, anguish and pain of a father and other family members who had struggled to meet out the expenses of his daughter, the patient in order to save her life. At the same time, the treating Doctors are not responsible for the financial difficulties of the complainant because he was expected to make payments for the treatments in O.P.1's hospital, which is a private hospital. In this case, we can observe that the opposite parties were very generous towards the patient since in many private hospitals, payments have to be made beforehand or immediately after the treatment of the patient. Here, the treatment was continuously given when payment was due from the complainant as exhibited in the course of treatment in the emergency ward from 30.11.2005 to 16.12.2005. During this span of time, the patient was given treatment in the emergency ward with expensive diagnostic tests hi-tech and advanced treatment without getting full payments towards it.
46. The medical records produced by the Opposite Party No.1's Hospital are maintained properly and they do not seem to be created one as alleged by the complainant. Frequent signatures of Doctors are also present in the records. The learned counsel for the complainant pointed out that each and every page of the medical record is not signed by the Doctors, the notings are made by one person and signatures of another person. The learned counsel for the Opposite Parties replied that it is not practical to expect Experts/Doctors to make the notings in their own handwriting and sign each and every page. Moreover, they are not school children to follow such procedure. Also Opposite Party No.1's hospital is a Super Specialty Hospital where students, interns and junior Doctors accompany Senior Doctors and on their guidance, the latter make notings in the case sheets and such procedures are followed in most of the hospitals. We have to see the authenticity of the medical records which are found to be genuine.
47. The complainant also alleged that his daughter/patient was made as a case study by the Opposite Parties to the students of O.P.No.1's Institution which had hurt his feelings deeply. Since the O.P.No.1's Institution is a Super Specialty Hospital and Medical College attached to it, the medical students have access to the patients and the treatment for their case study. This is not an unusual procedure followed by O.P.No.1's Hospital but the same system is followed irrespective of all the medical colleges, as it is a part of their curriculum.
48. Regarding consent, the documents at pages 63 to 66 in Ex.R2 - Volume-I exhibit that the opposite parties had received consent from the complainant and his close relatives. The complainant, in his written arguments, had challenged the signature of patient’s sister as false and all the consent letters were fabricated documents. When the complainant was challenging the signature of patient’s sister, he had not made any attempt to prove it beyond doubt by examining the patient’s sister, the signatory of the consent form. The stand taken by the complainant that the Opposite Parties had given treatment without obtaining the consent and also, the consequences and prognosis of the treatment. This cannot be accepted because as per documents at Page No.63 to 66 in Ex.R2 – Volume-I, which shows that consent was obtained from the complainant and close relatives and that various tests and investigations were done with their due knowledge during the treatment period of 35 days.
49. The complainant filed the following citations to highlight his case:
i) " Samira Kohli Vs.Dr.Praba Manchanda & Another (2008 STPL (LE) 39 585 (SC)
Principles relating to consent – a Doctor has to get the consent of the patient before commencing a treatment – it would be real and valid – consent should be voluntary – to give adequate information – disclose nature and procedure of treatment and its purpose, benefit and effect – consequences.
In the present case, the Opposite Parties had explained to the complainant and the close relatives about the consequences and prognosis of the treatment. Hence, the Opposite Parties had obtained consent from the complainant and close relatives as exhibited in documents Page No.63 to 66 of Ex.R2 – Volume – I.
ii) Sushma & Others Vs. Dr.G.D.Goel & Another (2010 STPL (CL) 2238 (NC)
There is nothing on record to show the exact nature of risk – explained either to the deceased or relations. The consent is perfunctory in nature.
In the above citation, there is no record to show that the Opposite Parties had explained the risk involved in the course of treatment and also no proper consent had been obtained. Thus, this citation cannot be applicable to the case on hand wherein, the Opposite Parties had clearly explained the course of treatment and the consequences and duly obtained consent from the complainant and close relatives.
iii) H.S.Tuli Vs. Post-Graduate Institute of Medical Education & Research & Others (2008 STPL (CL) 1245 (NC)
Express written consent has to be obtained in all diagnostic procedures – the concept of informed consent has come to force in recent years and many patients did not understand the nature of medical procedures to which they give consent. All information must be explained in comprehensible – non medical terms preferably in local language about the diagnosis, nature of treatment, risks involved and prospects of success.
In the case on hand, consent was obtained in Tamil vernacular which is the local language and the Opposite Parties had explained the seriousness of the disease to the patient's family members, as seen from the records produced by the Opposite Parties (Ex.R2 – Volume-I).
iv) 2008 STPL (CL) 1245 (SC) Stresses the necessity to obtain consent while performing surgery. This does not apply in the present case where consent was obtained by the Opposite Parties for treating the patient.
v) Dr.Navdeep Singh Khaira & Another Vs. Sheela Gupta and Another ( 2010- STPL (CL) 59 (NC)
In this case, prolonged ailments of patient – chronic renal failure – suffered from dilated cardiac arrest – "before transfusing blood, Opposite Parties should have done cross-matching of blood instead straightaway opting to transfix the blood – Opposite Parties cannot wriggle out of their responsibility by simply taking the plea that the deceased was suffering from chronic renal failure."
In the complaint on hand, the Opposite Parties had done necessary tests and diagnosed ARF and continued treatment for the patient and thus the above findings will not apply.
vi) Dinesh Jaishal (Deceased) through L.Rs & others Vs. Bombay Hospital & Medical Research Centre & Another ( 2010 STPL (CL) 512 (NC)
Medical negligence case made out – the case of res ipsa loquiter – treating surgeons had not informed the risks involved in surgeries and chances of success and failure – hospital held liable for deficiency in service
The above findings of the National Commission will not fit in the present case since the treating Doctors explained to the complainant and family members about the course of treatment, i.e. dialysis to the patient and thus the facts and circumstances of the case does not come in to the purview of the dictum " res ipsa loquiter ".
vii) Savitha Garg Vs. Director, National Heart Institute (A.I.R. 2004- SC – 5088 (2004-8 SCC 56)
In this case, the doctrine of ' res ipsa loquiter ' applied and the onus lay on the hospital authority to prove that there had been no negligence on its part or on the part of anyone for whose acts and omissions, it was liable and that onus had not been discharged.
The doctrine of ' res ipsa locquiter ' does not apply in the present case, since there was no lack of care or diligence on the part of the Opposite Parties.
Expert opinion is not required when medical negligence is glaring and on the surface level wherein the principle ' res ipsa loquiter ' would apply. But, in the present case, there is no such glaring mistake or negligence committed by the treating Doctors since they have taken care of the patient for 35 days and given proper treatment for her medical problem.
viii) D.Ramarajyam (Dr) Vs. P.K.Vasudeva Rao & Others (2007 STPL (CL) 1439 (NC)
This was a case wherein – hysterectomy – death within three days of operation – unexpected complication arose, not disclosed – M.B.B.S. Doctor preferred major surgery without taking assistance of an anesthetist or even another Doctor even at critical stage till the death of the patient – There was no signature of the Doctor or Nurses on any of the sheets - compensation awarded.
This case will not come into the ambit of the present case wherein systematic entries were made from the date of admission of the patient till the last day in the hospital and signatures of Doctors/Nurses were very much available in the case sheets
ix) V.Kishan Rao Vs.Nikhil Super Specialty Hospital & Another (2010 STPL (LE) 53597 (SC)
In medical negligence, whether expert opinion is necessary to prove the case or not – whether the principle of res ipsa loquiter had been made applicable in the case of medical negligence – the complainant does not have to prove anything as the thing proves itself. Requirement of expert opinion depends upon facts and circumstances of each case and the materials on record, it cannot be mechanical or straight-jacket approach that each and every case must be referred to an expert.
The above citation is filed by the complainant to prove his case without examining an expert since he attempted to prove his case by the facts and circumstances and documents of the case.
The objects and reasons of the Act to provide speedy and simple redressal of consumer disputes. Expert evidence in all cases of medical negligence should not be imposed which will dilute and defeat the very purpose of the Act. The efficacy of the Act will be curtailed and the remedy will become illusory to the common man.
50 .The Opposite Parties' side filed the following authorities to prove their case:
Oxford Textbook of Medicine: Systemic Lupus Erytheromatosis and Related Disorders: SLE is an auto-immune rheumatic disorder that can present with systems in almost any organ or the system of the body. It can kill (mortality 10% at 10 years from diagnosis)
51. We have not considered the materials downloaded from the internet and filed before this Commission since there is no authenticity in the particular subject.
52. To prove the merits/status of the complaint, the legal notice, dt. 25 02.2006, Ex.C5 issued by the complainant's Advocate Mr.N.Kannan at Para 3 is reproduced below:
" Meanwhile, on 27.12.2005 my client's daughter's condition deteriorated and was urgently required to be put on dialysis. But, Dr.Jain who was doing dialysis refused to put her on dialysis on the ground that no money was paid. Dr.Vivekanandan telephoned Dr.Jain, who was away from Pondicherry to permit him to put her on dialysis stating all the treatment so far done would be become futile, if she was not put on dialysis. Even then, Dr.Jain refused to put her on dialysis for want of money. My client made all efforts to have her life saved and remitted a sum of Rs.1,000/- only on 27.12.2005 at 10.00 p.m. to persuade you to continue the treatment and save the life. "
53. In the complaint, the complainant complained that Dr.Vivekanandan, O.P.No.4, ill-treated him but in the notice issued by the complainant's Advocate revealed that only Dr.Jain refused to put the patient on dialysis and not Dr.Vivekanandan, who tried to convince Dr.Jain to continue the treatment. This legal notice is the axis through which the complainant initially ventilated his grievances against the Opposite Parties, wherein he had not found fault with Dr.Vivekanandan, O.P.No.4. In the complaint placed before this Commission, he had impleaded the Doctor in a different manner and there is no redressal sought for against Dr. Jain. This amply proves that the complainant had not come before this Commission with a genuine complaint against the Opposite Parties.
54. A consumer knocking at the door of redressal agencies under the Act for relief in a consumer dispute must do so with clean hands as observed in " SagliRam Vs. General Manager, United India Insurance Company Limited (II- 1984 C.P.J. 444: 1984 (I) C.P.R. 434)
55. The test of medical negligence which was laid down in " Bolam Vs. Friern Hospital Management Committee " (Reported in (1957) 2 All E.L.R. 118) has been accepted by the Hon'ble Supreme Court as laying down correct tests in cases of medical negligence and the following principles have been laid down:
56. A Doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art. It is also held that in the realm of diagnosis and treatment there is ample scope for genuine difference of opinion and a Doctor is not negligent merely because his conclusion differs from that of other professional men. It was also made clear that the true test for establishing negligence in diagnosis or treatment on the part of the Doctor is whether he has been proved to be guilty of such failure as no Doctor of ordinary skill would be guilty of, if acting with ordinary care.
57. Merely because a Doctor chooses one course of action in preference to other one available, he would not be liable if course of action chosen by him was acceptable to medical profession as observed in " Dr.K.K.Kakk & Another Vs. Smt.Neetu Singh through Smt. Mithlesh Singh & Others 2014 (3) C.P.R. 513(NC)"
58. To conclude, a Medical Practitioner must act with reasonable degree of skill and knowledge and must exercise a reasonable degree of care. From the above findings, it is conspicuous that the Opposite Parties had treated the patient with reasonable care, knowledge and skill. From the facts and circumstances of the case and the documents produced by both the parties, it is found that there is no dereliction of duty on the part of O.P.No.1's Hospital and the treating Doctors. There is no default in discharge of their duties towards the patient. They had bestowed, reasonable care and skill that is expected from them, appropriate to the qualification, knowledge and experience. In view of the above discussions, the allegations of the complainant against the Opposite Parties for wrong diagnosis of kidney failure, treatment given not for the actual disease, consent not obtained, created medical records, charged exorbitant amount, shifting of the patient for want of money had not been proved beyond doubt, since the allegations are speculative in nature. There is no substance and cogent evidence to support any of the allegations of the complainant against the Opposite Parties. Hence, there is no deficiency in service and medical negligence on the part of the O.P.No.1's Hospital and other Opposite Parties. Hence, there is no merit in the complaint and the complaint is dismissed.
59. Our profound sympathies are with the complainant for the loss of his daughter at an early age.
60. We place on record our appreciation for the efforts taken by the learned counsel Mr.S. Sathish Chandrasekaran, who appeared for the complainant and learned Counsel Mr.L.Sathish, who appeared for the all the Opposite Parties in handling the present case of medical negligence with depth and versatality.
61. In the result, the complaint stands dismissed. Both the parties have to bear their respective costs.
Dated this the 23rd day of December, 2014
(Justice K.VENKATARAMAN)
PRESIDENT
(K.K.RITHA)
MEMBER
COMPLAINANT'S WITNESSES:
CW1 – G.Subramanian, Complainant, proof-affidavit filed on 12.06.2008, cross-
examined on 26.06.2009
COMPLAINANT'S EXHIBITS:
Ex.C1 – Xerox copy of Prescription by Dr.Pandian, Physician and Chest Specialist,
Chidambaram, marked through CW1
Ex.C2 – xerox copy of Request form for Ultrasonogram/Echo Cardiogram by O.P.1 in
respect of patient sumitra, dt.30.04.2008, marked through CW1
Ex.C3 – Xerox copy of cash receipt for Rs.2,900/-, dt. 21.12.2005, issued by M/s
Medihauxe International, Chennai in the name of Ms.Sumithra, marked
through CW1
Ex.C4 – 64 Copies of prescriptions by O.P.1 hospital for Ms.S.Sumithra for the period
from 30.11.2003 to 17.12.2005, marked through CW1
Ex.C5 – Copy of complainant's lawyer notice, dt.25.02.2006 and reminder, dt.
20.03.2006, issued to O.P.1 Hospital, marked through CW1.
Ex.C6 – Copy of reply notice by O.P.1's counsel dated 21.03.2006 to complainant's
counsel, marked through CW1.
Ex.C7 – Xerox copy of returned cover addressed to one Mr.Kannan, Advocate,
marked through CW1.
Ex.C8 – Copy of reply to reminder notice, dt.01.04.2006 by O.P.1's counsel to
complainant's counsel, marked through CW1.
Ex.C9 – Copy of Case Summary of Ms.S.Sumithra, issued by O.P.1 Hospital, marked
through CW1.
Ex.C10- Copy of Identity Card issued to Patient Ms.S.Sumithra by O.P.1 Hospital,
marked through CW1.
Ex.C11- Copy of advance remittance slip, dt.26.12.2005 for Rs.55,196, issued by
O.P.1 hospital to Ms.S.Sumithra, marked through CW1.
Ex.C12- Copy of Death Certificate of Ms.S.Sumithra, issued by O.P.1 Hospital,
marked through CW1
Ex.C13- Copy of covering letter by Rajiv Gandhi – Vazapady K.Ramamurthy
Charitable Trust, enclosing a D.D. for Rs.25,000, marked through CW1.
Ex.C14- Copy of housing plot allotment order in favour of one Chandra by Mayuram
Co-Op Building Society, marked through CW1.
Ex.C15- Copy of Driving Licence issued to one s.Senthil by Licensing Authority,
Mayiladuthurai, marked through CW1.
Ex.C16- Copy of Identity Card issued to one Ms.S.Sumathi by Annamalai University,
marked through CW1.
Ex.C17- Copy of Hall-Ticket issued to one Ms.S.Sumathi by Annamalai University for
the examinations held in 20013, marked through CW1.
Ex.C18- Copy of study material for Nephrology, issued by O.P.1 Hospital, marked
through CW1.
Ex.C19- Copy of appointment order, dt.08.06.2005 to Ms.S.Sumithra by
Adhiparasakthi Engineering College, Melmaruvathur, marked through CW1.
Ex.C20- Copy of Consultant's report, dt.22.05.2004 in respect of Ms.S.Sumithra by
Apollo Hospitals, Chennai with inspection report 5 in number, marked
through CW1.
Ex.C21- Copy of identity card issued to Ms.S.Sumithra, by Adhiparasakthi Engineering
College, Melmaruvathur, marked through CW1.
Ex.C22- Prescriptions by Dr.P.V.S.Prasad, M.D. (Skin), Annamalai University to Ms.
To S.Sumithra, on different dates from 2004 to 2005 marked through CW1
Ex.C32
Ex.C33- Copy of Report of Serum Electrolytes, issued by Neela Diagnostic Centre, in
respect of Ms.S.Sumitra, marked through CW1.
Ex.C34- Copy of Blood test report, dt. 08.09.2004 issued by Neela Diagnostic Centre
in respect of Ms S.Sumitra, marked through CW1
LIST OF OPPOSITE PARTIES' WITNESSES:
RW1 – Dr.Vivekanandan, Proof Affidavit filed on 26.02.2010 and cross-examined on
25.02.2011, 21.10.2011, 08.03.2012 and 23.03.2012
LIST OF EXHIBITS MARKED BY OPPOSITE PARTIES:
Ex.R1 – Letter of Authorisation issued to RW1 by O.P.1 Hospital, marked through
RW1
Ex.R2 – Copy of in-patient case records maintained by O.P.1 Hospital in respect of
patient Ms.S.Sumithra (Sl.No.14 to 410 (Vol.No.I) and from Sl.No.1 to 171
(Vol.No.II), marked through RW1.
Ex.R3 – Copy of Clinical Lab Report, dt.09.09.2005, issued by Neela Diagnostic
Centre, Chidambaram in respect Ms.S.Sumithra (3 pages), marked through
RW1.
Ex.R4 – Copy of Lab Report, dt.08.09.2005, issued by Hi-Tech diagnostic Centre,
Chennai in respect of Ms.S.Sumithra (3 pages), marked through RW1.
(Justice K.VENKATARAMAN)
PRESIDENT
(K.K.RITHA)
MEMBER
