Pronounced on: 4th July 2022 ORDER DR. S. M. KANTIKAR, MEMBER 1. The present Appeals have been filed against judgment/order dated 01.10.2012 passed by the Chandigarh State Consumer Disputes Redressal Commission (hereinafter referred to as the ‘State Commission’) in Complaint Case No. 26 of 2011, whereby the Complaint was allowed, directing the Post Graduate Institute of Medical Education and Research (hereinafter referred to as the ‘PGI’) at Chandigarh to pay compensation of Rs. 1,00,000/- along with costs of Rs. 10,000/-. 2. Brief facts are that on 04.06.2008, Mr. Naresh Kataria (since deceased - patient) met with an accident and was firstly taken to Govt. Hospital, Sector 32, Chandigarh. After First-Aid, he was shifted to emergency ward of the Opposite Party - PGI, Chandigarh at about 12.30 noon. At the time of admission, he was complaining of acute abdominal pain and breathing problem. In the evening, Ultra-Sonography (USG) of abdomen was conducted which showed extensive surgical emphysema i.e. air under the skin over right side of abdomen and epigastrium. It was alleged that the attending doctors in emergency ward did not pay attention, but they continued to assure not to worry, saying that there was no serious injury and the patient would be discharged on the next day i.e. on 05.06.2008. Medicines like sedatives and pain killers (analgesics) were administered and the patient slept throughout the night. On the next morning (05.06.2008), the patient’s abdomen was distended and he started laboured respiration. At 9.30 a.m., the abdominal pain was unbearable, an emergency call was sent to Specialist Prof. G. Singh, to examine him, but he came late at 4.00 p.m. and examined the patient. He advised for immediate operation and put the patient on ventilator, but the ventilator was defective. Therefore, the patient could not be ventilated and alternatively, manual ventilation with a pump was given, but the condition of patient deteriorated and patient became unconscious. After 10 days, the patient expired on 16.06.2008 at 2.20 a.m. Being aggrieved by the negligent treatment at each step of treatment and deficiency in service, the Complainants filed the complaint before the Commission seeking Rs. 95,00,000/- as compensation . 3. The Opposite Party filed the written statement along with relevant documents and medical literature and denied any negligence during the treatment. It was submitted that the lack of ventilator was temporary and after the operation, the patient stayed in the ICU for 10 days (06.06.2008 to 16.06.2008) on ventilator and also availed services of the PGI as available for critically ill patients. It was further submitted that AMBU bag is manual resuscitator, a hand held devise, commonly used for patients with inadequate breathing, it provides positive pressure ventilation. It was commonly used in emergency rooms as part of standard equipment in, critical care settings in the hospitals. 4. The State Commission, after hearing the parties, did not find medical negligence of PGI during treatment, but it held the PGI liable for certain administrative lapses and deficiency in service for not providing ventilator The Complaint was partly allowed and it was directed to the PGI to pay compensation of Rs. 1,00,000/- along with costs of Rs. 10,000/-. 5. Being aggrieved, both the Parties filed cross Appeals before this Commission. 6. We have heard the learned Counsel for both the sides. Perused the material on record. There was 58 days delay in filing FA/9/2013 and 8 days delay in filing FA/697/2012. For the reasons stated in the applications, the delay is condoned. 7. We note that, on 04.06.2008, the patient was taken to GMCH and after First Aid, on the same day, he was referred to PGI with a tube inserted in the right side of the chest which was draining blood stained fluid. At PGI, the doctors attended the emergency. USG of abdomen showed extensive surgical emphysema over right side and in the epigastric region. However, the liver, gall bladder and pancreas were found obscured. The CT Scan of head was seen by neuro-surgeon, it was normal. The USG was repeated after 10 hours, but the abdominal features were same, there was no abdominal injury, but patient had breathing problem. The first X-ray dated 04.06.2008 did not show air under diaphragm whereas the second X-ray taken on next day morning air under diaphragm which was first time noted by the senior resident. Therefore, the patient was referred to general surgery for urgent need of laparotomy. The Professor, Dr. G. Singh, examined the patient at 4 p.m. and diagnosed air under diaphragm and right lung contusion and emergency operation was conducted on the same day. 8. The Complainant’s main grouse was that there was delay in performing surgery. As per the medical record of PGI, on the day of incident, Dr. G. Singh was operating another critical patient. As he being a senior doctor, it was not possible for him to remain present in the emergency for 24 hours. The patient was properly attended by his senior residents and investigations were performed. From the medical literature, due to blunt abdominal trauma, the colonic injury was a very rare phenomenon and such injuries frequently remained undetected, but diagnosed at delayed stage and the patient would present with severe abdominal tenderness. Despite instructions of specialist doctor, the patient could not be ventilated and therefore manual ventilation by pump was given. The condition of patient deteriorated further and he became unconscious. After the laparotomy (surgery) the patient stayed in ICU for 10 days with all facilities available. 9. We are aware that PGI is a reputed research institute in the country and most of the patients visit there for its quality of care. It was a fair admission of the Opposite Party about non availability of ventilator because it was defective. However, no steps were taken to repair such defective ventilators certainly amounts to deficiency and failure of duty care towards the emergency patients. The hospital authority was responsible for regular maintenance and servicing of the life-saving equipments. About the allegation of wrong date mentioned in the death summary, PM report and the death certificate as 15th or 16th April, 2011. Such erroneous entries in the crucial documents create lot of doubts, but the Complainants struggled more and got the mistake rectified by the Opposite Party on 23.07.2008. Thus, in the instant case, the lapses and casual approach of the PGI authorities are visible. 10. The government institutes like AIIMS, Safdarjung and PGI etc. are flooded with huge patient workload. The expected duty of care and responsibility towards the critical patients were more, but practically it is more difficult to cope up with situation. In the instant case it was temporary failure of ventilator, but timely alternative arrangements were made and mechanical manual pump was provided. In the emergency ward round O’ clock Junior /Senior Residents are available to look after the patients and time to time update the condition to the senior consultant. From the record is evident that he patient was reviewed and investigated from time to time, he was also examined by the cardiothoracic surgeons on 05.06.2008. Thus, negligence in the treatment was not evident. It should be borne in mind that it is not possible to provide ventilator to each patient in any Govt. or Private hospitals/medical institutes. There is always a shortage especially in research institutes like PGI, AIIMS etc. 11. The State Commission which did not hold PGI for medical negligence, but awarded the lump sum compensation of Rs.1,00,000/- for deficiency in service for not repairing the defective ventilators and for wrong date mentioned in record. The medical negligence was not proved and there is no ground for enhancement of the award. Based on the foregoing discussion, there is no need to interfere with the Order of the State Commission. We affirm the compensation awarded by the State Commission, which is just and proper in the instant case. We expect systemic improvement in the patient’s care and more accountability of erring staff at PGI. Both the Appeals are dismissed. There shall be no order as to costs. |
