Chandigarh

StateCommission

CC/454/2018

Babita Devi Bhardwaj - Complainant(s)

Versus

Post Graduate Institute of Medical Education and Research - Opp.Party(s)

Sh Parkash Chand Bhardwaj

08 Jan 2019

ORDER

 

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

 

Complaint case No.	:	454 of 2018
Date of Institution	:	04.12.2018
Date of Decision	:	08.01.2019

 

1. Babita Devi Bhardwaj – Wife
2. Aditya Bhardwaj son & Shataksh Bhardwaj – daughter – minors through guardian – Babita Devi Bhardwaj – Mother.
3. Parkash Chand Bhardwaj son of Sh.Kanhya Lala – Father
4. Misro Bhardwaj wife of Parkash Chand Bhardwaj – Mother
5. Reena Bhardwaj d/o Parkash Chand Bhardwaj – Sister of Vinod Kumar Bhardwaj.

All residents of Village : Dandru, PO : Kaswar Tehsil Barsar, Distt. Harmirpur (HP) 174312.

(Mobile nos. for all : +91-9805530020 and 7650070020) (Email : parkash.bhardwaj@gmail.com).

 

……Complainants

V e r s u s

1. Post Graduate Institute of Medical Education and Research Chandigarh through its Director.
2. All concerned doctors and nursing staff of PGIMER, Chandigarh through its Director

                                                 .... Opposite Parties                   

BEFORE:         JUSTICE JASBIR SINGH (RETD.), PRESIDENT

                        MRS. PADMA PANDEY, MEMBER

                        MR. RAJESH K. ARYA, MEMBER

Argued by:       

 

Sh. Parkash Chand Bhardwaj, complainant No.3 in person

and on behalf of other complainants.

 

 

PER PADMA PANDEY, MEMBER

             

              The facts, in brief, are that Sh.Vinod Kumar Bhardwaj (now deceased) developed pain in lower jaw right side during the month of July, 2016. After consultation with dental surgeon, three of his teeth were removed and a lump of gum muscle rose at its place and he was advised to undergo certain tests to know the cause of complications. Accordingly, kin of the complainants approached HP Govt. Dental College and Hospital, Shimla and after clinical tests, he was diagnosed “Chondroid Tumor”(a type of bone cancer on lower right side jaw region – also known as lower Mandible). The doctors of the said hospital also advised to have consultation in HP Government Cancer Hospital, Shimla for removing the tumor, where certain tests were conducted and the test of Dr.Lal Path Lab also suggested Chondroid Tumor, due to which, the doctors of the said hospital orally advised for PET Scan of the whole body at PGIMER, Chandigarh. Therefore, the kin of the complainants visited PGIMER, Chandigarh on 03.11.2016 and after discussing the previous history, PET Scan of the body was conducted on 11.11.2016 and after other clinical tests, it was diagnosed as “Chondrosarcoma-Mandible” (a type of cancer of spreading nature). It was further stated that the dental surgeon decided to conduct the surgery to remove the affected portion of lower jaw (right side) and in the meanwhile the case was also referred to plastic surgeon. After conducting various tests, it was decided to operate on 19.11.2016. Therefore, the kin was admitted on 17.11.2016 for follow up but after seeing PET Scan report on 19.11.2016, the surgery was postponed as some abnormalities was detected and again advised to undergo PET Scan test to determine whether the cancerous cells spread to other parts of the body or remained in the area where it was detected, due to its spreading nature. After the second PET Scan, kin was cleared for the surgery by the dental and plastic surgery team. It was further stated that before the surgery, Pre-Anesthesia clearance from PAC Department was required, where, the kin was advised numerous tests, as one of the test was ECG for determining the condition of heart and the said test was conducted on 03.11.2016 and found abnormal. The said abnormality was ignored by the PAC Department and no further test was prescribed/advised. The said operation was conducted on 03.12.2016. After operation, the kin was shifted from the operation theatre to the plastic surgery ward at about 11.20 PM     on 03.12.2016 without oxygen and breathing balloon and suffered a shock due to lack of oxygen, as his eyes were wide opened until he was put on oxygen in the ward. It was further stated that the kin regained consciousness on next morning on 04.12.2016 after the anesthesia effect started reducing but complained of chest pain, palpitation and sweating and continued to be so till early morning of 07.12.2016. It was further stated that the monitor did not show stable reading of heart beat, BP, Oxygen intake and pulse etc. before putting kin on the ventilator, as condition started deteriorating further. The matter was regularly reported to the attending doctors but none of the doctors took it seriously and each time, they were told that in such type of cases these abnormalities keep happening. It was further stated that the blood transfusion was also started at about 9.00 AM on 05.12.2016 but stopped after an hour or so.  It was further stated that no sample of the blood was taken for matching before the blood transfusion whether it was fit for transfusion or not. On 04.12.2016, the complainants were also informed by the attending nursing staff that sugar level also had gone up considerably beyond normal limit and was being monitored and controlled. On 05.12.2016 the kin developed fever and the complainants were told to have started the treatment of fever besides other treatment but no record found for temperature in the information sought under RTI. It was further stated that waste blood pipe from the neck was removed on forenoon of 06.12.2016 but no record found in information under RTI. It was further stated that on 07.12.2016 at about 5.00 AM the condition of kin started deteriorating. As such, the nursing staff called Dr.Vipin-SR Psy. and after examination, the said doctor made the observation, which is mentioned in para No.13 of the complaint. It was further stated that after observing Acute Cardiac Event, the kin was put on ventilator by Dr.Vipin but was suggested against putting on ventilator by ENT/Cardio team of doctors, as there might be chances of lungs and kidney failure after the heart attack as parameters were not normal and vital organs of the patient may not respond with sudden pressure on them to return to normal state. It was further stated that no second opinion from the senior consultant of cardio was obtained. It was further stated that during the intervening period, Dr.Vipin also asked whether the patient was smoker. Dr. Vipin also informed the complainants on enquiry regarding the condition and said that there seems to be no supply of blood to lungs through pulmonary vein/nerve ; angiography is required to be done immediately to diagnose the clotting ; the patient after the operation should have been in ICU for special care and the lapse is on the part of one of the doctor for not doing so. After that, Dr. Vipin left and was not available for consultation.  It was further stated that the matter was also brought to the notice of HOD Dr.Sunil Gaba and later on, he told that the kin suffered massive heart attack in early hours on 07.12.2016 and could not be revived. It was further stated that the cardiologist was again called but very late and the said doctor wanted to conduct ECO test but the patient had already sunk and did not respond. The patient further suffered respiratory failure after the ECO test at around 10.15/10.30, which was informed to Dr.Rounik Shinde, who called another doctor from OT of plastic surgery, who tried to revive but all went in vain and the kin was declared dead at 11.00 AM on 07.12.2016 showing cause as “1.Cardio Respiratory Arrest 2. Chondrosarcoma Mandible Post Free Fibula Reconstruction”. Thereafter, the complainants wanted to know the cause of death and requested for post mortem, which was conducted and post mortem report was obtained under RTI Act (Annexure H), which is reproduced in page Nos.14 & 15 of the complaint file. It was further stated that the main cause was not diagnosed earlier by the medical staff and due to sheer negligency of the attending doctors and nursing staff, besides the doctors of PAC Department, who cleared the operation/surgery despite having the abnormal ECG, the patient could have been advised first the treatment of heart ailment. It was further stated that a letter dated 20.08.2018 sent through registered post to the Opposite Parties, which was received by them but no reply has been filed. Thereafter, a legal notice dated 05.09.2018 was sent to the Opposite Parties but to no avail. It was further stated that the aforesaid acts, on the part of the Opposite Parties, amounted to deficiency, in rendering service, and indulgence into unfair trade practice. When the grievance of the complainant, was not redressed, left with no alternative, a complaint under Section 17 of the Consumer Protection Act, 1986 (in short the ‘Act’ only), was filed.

2.           The complainants led evidence, in support of their case.

3.           We have heard Sh. Parkash Chand Bhardwaj, complainant No.3 in person and on behalf of other complainants. 

4.           The only point for consideration before us is as to whether there was any medical negligence on the part of the doctors. The answer to this question is in the negative. The complainant’s kin developed pain in lower jaw right side, pursuant of which, three of his teeth were removed and a lump of gum muscle rose at its place. After the clinical test, he was diagnosed with “Chondroid Tumor”(a type of bone cancer on lower right side jaw region – also known as lower Mandible). After consultation with HP Government Cancer Hospital, Shimla, he was advised for removal of the tumor by way of surgery. Thereafter, the kin approached PGIMER, Chandigarh on 03.11.2016, where the PET Scan and other tests were conducted and it was diagnosed as “Chondrosarcoma-Mandible” (a type of cancer of spreading nature). Before the operation/surgery, the kin was referred to Pre-Anesthesia Clearance from PAC Department (Pre-Anesthesia Department) of PGIMER, Chandigarh. The kin was advised numerous tests before clearing him for the operation, one of the test was for determining the condition of the heart, which was conducted on 03.11.2016 and found to be abnormal. After the report of other tests prescribed by PAC Department, the case was again reviewed on 09.11.2016 and cleared for surgery on 10.11.2016. In the chronology  of events, it is observed that the operation for the removal of the affected portion of the lower mandible (right) and its re-construction and removal of affected gum/skin of inner side of lip and its replacement was conducted on 03.12.2016. On 04.12.2016, he regained consciousness and complained of chest pain, palpitation & sweating. Such type of abnormalities happened in the next two days. Even the sugar level had increased and he developed fever on 05.12.2016. Thereafter, on 07.12.2016 the condition of the kin started deteriorating and he developed “Techycardia > 150, which means Fast heart beart & Tachypnoea > 30/min, which means Fast Breathing – 30/min and he was put on ventilator. From the aforesaid history of the patient, it is clear that the kin suffered massive heart attack on 07.12.2016 and could not be revived. He was declared dead at 11.00 AM on 07.12.2016, showing cause as “1.Cardio Respiratory Arrest 2. Chondrosarcoma Mandible Post Free Fibula Reconstruction”. Thereafter, the complainants wanted to know the cause of death and requested for post mortem, which was conducted and post mortem report was obtained under RTI Act (Annexure H), which is reproduced as under :-

“Autopsy Report : PM No.27849 : Vinod Bhardwaj Age 41 yrs. D.O. Adm : 1/12/16 D.O. Death : 7/12/2016 D.O. Autopsy : 7/12/16 “Prospectors : Dr. Shika and Sumit

“Clinical Diagnosis : K/C/O Chondrosarcoma mandible grade III >> (A type of cancer of Grade III (or High Grade) – These tumors are characterized by a higher cellularity, marked cellular and nuclear pleomorphism, nuclear hyperchromasia and increased mitosis and occasional presence of giant cells).

>> post operative day 4 demise ? Pulmonary thrombeombolism ? (Pulmonary Thromboembolism is the sudden occlusion of a lung artery due to a blood clot that was dislodged from somewhere else in the body, usually the legs. This leads to obstruction of the blood supply to the lung tissue, Clots can be of different sizes and more than one clot can break off over time. The larger the clot, the greater the risk of sudden death. If not treated aggressively, it can lead to respiratory and/or circulatory collapse and death).

*>> Acute coronary syndrome”

“Final Autopsy Diagnosis – In this 41 year old with K/C/O Chondrosarcoma mandible grade II day 4 post operative demise final autopsy diagnosis are :

“Billateral massive pulmonary thromboembolism-Saddle thrombus Bronchopneumonia, pleural effusion.

*Double vessel CAD – (LAD & RCA : 70-80% occlusion)\

* Old healed myocardial infarction, Foci of Acute MI.

* Meckel’s diverticulum

* Terminal necrosis in pancreas and mucosa of small intestine”

*(Meaning of terminology used is Attached Annexure ‘HH’

……Sd/- OS/KN/Prof Nandita Kakkar”

It is needless to say that the doctors had performed their duty, which was expected from them. The record shows that the kin was smoker. Smoking either active or passive, which is continuous or has been discontinued earlier has negative impact on the health of a person. The complainant has alleged that the operation was conducted without checking the condition of the heart of the person, whereas, there is clearance from the Department of Anesthesia during PAC for conducting the surgery. The complainant has alleged that the blood transfusion was not done properly and the waste blood pipe of neck out was not fully removed and bandaged, does not hold good because the doctors who were attending the patient have more knowledge and experience in conducting such like activities instead of common man. Prima facie it appears that such operation of removing the mandible is a very major surgery, which the complainant himself agreed that it went on for 13/14 hours and keeping in view already the frail ill health of the person, the post operative complications do occur in such serious cases.

5.           It is not out of place to mention here that the said surgery undergone by the kin was of a very serious nature and had it not been conducted by PGIMER, Chandigarh, after clearance of the abnormality observed in his ECG report by PAC Department of PGI, which was in fact one month prior to the operation, there were ample chances of patient having died due to the spreading nature of cancer. Therefore, in our eyes, there was no negligence on the part of the doctors of PGIMER, Chandigarh.

6.           In view of above, the complaint stands dismissed, at the preliminary stage, with no order as to costs.

7.           Certified Copies of this order be sent to the parties, free of charge.

8.           The file be consigned to Record Room, after completion.

Pronounced.

08.01.2019                                     

[JUSTICE JASBIR SINGH (RETD.)]

[PRESIDENT]

 

 

 [RAJESH K. ARYA]

MEMBER

 

 

 (PADMA PANDEY)

        MEMBER

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