IN THE MATTER OF

Smt Mithlesh Devi W/o Kalyan Singh age about 52 years R/o Village Narauli Tehsil Atrauli

(Through: Advocate Rakesh Kumar Singh)

                                                         V/s

1. Prathvi Raj Hospital AnnopShahr Road Chherath Aligarh through its Director Dr. Malkhan Singh

(Through: Advocate K.P, Misra)

2. JN Medical College Hospital AMU Aligarh through Head of the Department Medicine & Ophthalmology JN Medical College Hospital AMU Aligarh                                          
3. All India Institute of Medical Sciences New Delhi through Head of the Department, Ophthalmic Sciences Dr. Rajendra Prasad Center for Ophthalmic Sciences, AIIMS New Delhi

(Through: Advocate Farrukh Saied)

CORAM

 Present:

1. Shri Hasnain Qureshi, President
2. Shri Alok Upadhyaya, Member

PRONOUNCED by Shri Hasnain Qureshi, President

JUDGMENT

1. The present complaint has been filed by the complainant before this commission for  the following reliefs-

1.  The Op no.1 be directed to pay to the complainant compensation Rs.4000000/(Rs. Forty Lac only)
2. The Op no.1 be directed to pay to the complainant litigation expenses RS.25000/.

2. (a) Complainant stated that she suddenly got unwell having fever on 6.11.2021 and went to Op no.1 hospital for treatment where she was admitted. She was given treatment for dengue fever and she was told that she was in need of more platelets and transfusion of platelets was required. The platelets concentrate was purchased from Shanti Nursing Home Blood Bank, Aligarh on 6.11.2021, the platelets count of the complainant was found 46000lacs/mm3 and hemoglobin was 9.5 gm/dl. On 7.11.2021 the platelets count was found 74000lacs/mm3 and hemoglobin 10gm/dl. On 8.11.2021 complainant was transfused platelets concentrate and the platelet count increased to 850000lacs/mm3. Complainant suffered from dizziness and her eyes were filled by the blood and she lost her eyes vision. Complainant was not given further treatment to cure the disease and was referred to Medical College, Aligarh. The family members of the complainant were not made aware about this mis-happening. On 8.11.2021 complainant was shifted to Op no.2 Medical College Hospital where all the tests were conducted. It revealed from CT head report that the intravitreal hemorrhage was there involving right globe. The doctors were of the opinion that the complainant had 74000lacs/mm3 platelets count on 7.11.2021 before transfusion of platelets concentrate on 8.11.2021 and there was no need of transfusion of extra platelets. Complainant was referred to AIIMS on 10.11.2021 by the OP no.2 Hospital with the reference of having vitreous hemorrhage with raised IOP and Shallow AC. It was also mentioned that complainant had spontaneous rupture of globe ( right eye) with expulsive choroidal hemorrhage and in left eye, hazy cornea with shallow AC with raised DT. Complainant was diagnosed at Op no.3 hospital AIIMS on 11.11.2021 and was also diagnosed in the department of radio diagnosis and remained under treatment. Complainant suffered from total blindness and the certificate of disability was issued on 11.5.2022 by the Medical authority, Aligarh UP under the department of empowerment of the persons with disabilities, Ministry of Social and empowerment, Government of India. Complainant further stated  that the platelets count had itself  increased from 46000lacs/mm3 to 74000lacs/mm3 within a day and as per diagnosis in AIIMS complainant was found dengue related thrombocytopenia and bleeding occurs more often in patent with severe thrombocytopenia. Patent with 21-40000/cumm are in moderate risk and require platelets transfusions only if they have any hemorrhagic manifestations and other superadded conditions. The platelets transfusion is given in those patent who are either bleeding or having other hemorrhagic symptoms along with thrombocytopenia. In dengue patients those who have platelets count >40000 but <100000 have low risk. The low risk patients should not be given platelets transfusion and should be managed on intervenous fluids and supported therapy. About 80-90 % patient with dengue will have levels below 100000 while 20% patient will see critically low level of 20000 or less. Finding from the recent study show that most patient with critically low platelets count will recover by themselves after few days. It is clear that the complainant was not required transfusion of platelets count and transfusion leading to increase in platelets count caused vitreous hemorrhage to the complainant and she lost the eye sight and suffered from 100% permanent disability in relation to her both eyes. The director of the OP no.1 Dr. Malkhan Singh is a surgeon and not a physician. A skilled physician is required for giving treatment to the complainant. There was nothing in the treatment given to the complainant that there was any symptoms or indication whereby the doctor reached to the conclusion for transfusion of the platelets count to the complainant and in absence of any manifestation necessitating the transfusion, complainant should not have been transfused the platelets count. Dr. Malkhan Singh failed to discharge his obligation with up to date skill and knowledge. He must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. It was not only a simple case of negligence of the doctor to opt for transfusion of the platelets but is a gross negligence or recklessness which is a criminal liability with the civil liability of indemnifying  the complainant for the loss or injury caused to her by acts or omission and negligence of the doctors. Complainant is about  53 years old and she was enjoying good health to do her domestic duties as well as for extending help to farming and dairy. Her services have to be equated in terms of money at Rs.150000/ per annum. She is expected to survive 20 yeas more and therefore loss caused to her family would not be less than 30 lakh. She has been deprived from enjoyment of her life and the loss may be calculated at Rs.500000/. She has incurred Rs. 500000/ in her treatment. The total loss caused to her comes to Rs.4000000/.                    
3. Op no1 has stated in WS that on 6.11.2021 complainant was admitted in hospital for treatment and on testing the platelets count on 6.11.2021 was 46000. The complainant was having hemorrhaging tendency and she was advised for transfusion of platelets. On 7.11.2021 the platelets count was found 74000 on testing her blood. On 8.11.2021 platelets count was found 85000. On 6.11.2021 complainant was referred to Medical College, but she was not taken to Medical college by her family members and she was given treatment keeping in view humanity and she was taken to medical college where dengue fever found in tests. On 6.11.2021 platelets were transfused and thereafter on 8.11.2021 platelets were not transfused. The disability certificate dated 11.5.2022 is forged.  
4. Op no.2 submitted that the complainant had already lost her vision before coming to the J.N. Medical College, Aligarh and in good faith of the complainant with the belief of providing best possible care to the complainant all the tests were conducted and she was referred to AIIMS, Delhi in her interest. There is no reply on behalf of OP No.3.
5. Complainant has filed her affidavit and papers in support of her pleadings and Op no.1 has also filed their affidavits and papers.
6. We have perused the material available on record and heard the parties counsel.
7. The first question of consideration before us is whether there was negligence in providing medical treatment to the complainant at Op no.1 hospital? If so, its effect.
8. Complainant has claimed compensation against the Op no.1 and no grievance has been alleged by the complainant against the Op no.2 and 3 who have been improperly impleaded in the case. However, OP no.2 submitted in its reply that the complainant had already lost her vision before coming to Medical College hospital where all the tests were conducted in providing best possible treatment and was referred to OP No.3 in the interest of the complainant.
9. It is evident that the complainant had lost the eye sight of both the eyes while she was under treatment at op no.1 hospital. Complainant has referred to an article published by Wolters Kluwermedkno Publications in Asian Journal of Transfusion Science,2007 Jan-June wherein it is mentioned that the study suggests that bleeding occurs more often in patient with severe THROMBOCYTOPENIA and the patient having platelets count <20000 /cumm have the high risk of bleedings and require platelets transfusion. Patient with platelets count 21-40000/cumm are in moderate risk and require platelets transfusion only if they have any hemorrhagic manifestations and other superadded conditions. Complainant has also referred to another article SINGAPORE, March30, 2017 / channel New Asia wherein it is provided that all dengue patients with low platelets count do not need transfusion. It was found in a recent study that the dengue patient with critically low platelets count do not require platelets transfusion to get better, as long they do not have other complications and the findings from the study show that most patients with critically low platelets count will recover by themselves after a few days.
10. The Complainant was admitted at OP no.1 hospital on 6.11.2021 and it was found in test that she was having 46000lacs/mm3 as per test report annuexure3 and on 7.11.2021 she was found to have platelets count 74000lacs/mm3 as per test report annexure4. There was no indication of hemorrhage manifestations in the health condition of the complainant. Thus there was no necessity of platelets transfusion as reveals from the research studies discussed earlier. Complainant was transfused platelets concentrate on 8.11.2021 at op no.1 hospital as is evident from the report of Op no.2. There she was transfused platelets concentrate and platelets count increased to 850000lacs /mm3 as per report annexure 4 whereby her eye cavities were filled by the blood and she lost her eyes visions and she was found 100% blindness as per disability certificate annexure17.
11. It is clear that Dr. Malkhan Singh, the director of OP no.1 hospital who is not a physician did not have skill and knowledge in providing treatment to the complainant who have been suffering from dengue fever and he was not acquainted with the latest study and reached to the conclusion for transfusion of the platelets to the complainant without necessity of transfusion of platelets count. He did not discharge his obligation with up to date skill and knowledge with reasonable degree of care and caused loss and injury to the complainant by his acts or omissions and negligence. He is liable to compensate the complainant. Complainant was 53 years old women who was enjoying good health and was discharging her domestic duties and help to her farming and dairy work. Her services may be evaluated in terms of money at Rs. 100000/ per annum and loss for her life at Rs. 2000000/ (Twenty Lac). She was deprived from enjoyment of her life which cannot be compensated in terms of money and consolation may be given to her awarding the amount Rs 500000/. She had incurred expenses including all type of charges at Rs.500000/. Thus complainant is entitled for compensation at Rs.3000000/(Thirty Lakh) and litigation expenses Rs.10000/                   
12. The question formulated above is decided in favour of the complainant against the Ops no.1.
13. The law laid down in the ruling V. Kishan Rao V/s  Nikhil Super Specialty Hospital decided by Hon’ble  Supreme Court on 8.3.2010 is applicable to the present case. It has been held in this ruling that one of the duties of the doctor towards his patient is a duty of care in deciding what treatment is to be given and also a duty to take care in the administration of treatment. A breach of any of those duties may lead to an action for negligence by the patient.
14. We hereby direct to Op no 1 to pay to the complainant the amount of Rs.   3000000/ (Thirty Lac) with pendente lite and future interest at the rate 9% per annum and litigation expanses Rs.10000/. 
15. Op no 1 shall comply with the direction within 45 days failing which s shall be prosecuted for non-compliance in accordance with section 72 of the Act for awarding punishment against him.
16. A copy of this judgment be provided to all the parties as per rule as mandated by Consumer Protection Act, 2019. The judgment be uploaded forthwith on the website of the commission for the perusal of the parties.
17. File be consigned to record room along with a copy of this judgment.