DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,<br /> BATHINDA (PUNJAB)<br /> <br /> CC. No. 54 of 17-02-2009<br /> Decided on : 29-01-2010 <br /> <br /> 1.Santosh Rani aged about 49 years, widow of<br /> 2.Jawahar Lal aged about 27 years son of<br /> 3.Pardeep Kumar, aged about 25 years son of<br /> 4.Sunny, aged about 23 years son of<br /> Late Sh. Lal Chand S/o of Sh. Hukam Chand all residents of Tapa Mandi, District Barnala. <br /> .... Complainants<br /> Versus<br /> 1.Pregma Hospital, Bhatti Road, Bathinda, through its Managing Director/Partner/Manager/Proprietor<br /> 2.Dr. Surinder Kansala, Consultant Pregma Hospital, Bhatti Road, Bathinda.<br /> 3.United India Insurance Company Limited, 54 Janpath, Connauaght Place, New Delhi 110 001 through its Divisional Manager. <br /> ... Opposite parties<br /> <br /> Complaint under Section 12 of the Consumer Protection<br /> Act, 1986. <br /> QUORUM <br /> <br /> Ms. Vikramjit Kaur Soni, President<br /> Dr. Phulinder Preet, Member<br /> Sh. Amarjeet Paul, Member<br /> <br /> For the Complainant : Sh. K.S. Brar, counsel the complainant <br /> For the Opposite parties : Sh. Ajay Singla, counsel for<br /> the opposite parties. <br /> <br /> O R D E R<br /> <br /> VIKRAMJIT KAUR SONI, PRESIDENT <br /> <br /> 1. In brief the case of the complainants is that since Lal Chand, husband of complainant and father of complainants No. 2 to 4 was suffering from pneumonia and was also having some trouble in his kidney, they got admitted him with opposite party No. 1 on 23-10-2008 and deposited Rs. 20,000/- with him as advance money. The attending doctor after examining the patient put him on E.V. Fluid alongwith some medicines and dialysis was also done. The condition of the patient continued to improve till noon of 24-10-2008. Thereafter his condition started deteriorating and attending doctor incubated him and gave some medicines from the hospital of opposite party No.1. No medicine was purchased by the complainants from out side and all the medicines were given by opposite party No. 1 from their own hospital. At about 8 p.m. condition of the patient became serious and ultimately he died at about 9.00 p.m. in the hospital of the opposite parties.<br /> The complainants assert that in the discharge summary, the opposite parties have wrongly mentioned that patient was discharged at his own risk and responsibility and patient left at about 9.00 p.m. on 24-10-2008 against medical advice although he had died in the hospital of the opposite parties.<br /> From the medicines bills, it came to the notice of the complainants that the opposite parties have utilized expired medicines on the patient. Prazotel 40 M.G. Injection of Batch No. 30393 with expiry date 10-10-2008 and Butodol 2 M.G. Injection with batch No. 9503 with expiry date 08-01-2008 and many other expired medicines were administered to the deceased, due to which his condition deteriorated and he expired in the hospital of the opposite parties. <br /> Hence, this complaint for issuing directions to the opposite parties to pay Rs. 50,000/- with interest, charged from them, alongwith Rs. 6,00,000/- as compensation besides litigation expenses to the tune of Rs. 11,000/-.<br /> 2. The opposite parties filed their joint reply and submitted that patient Sh. Lal Chand, was referred to them by some local practitioner with respiratory distress. He was received by them at p.m. on 23-10-2009 in Emergency Department in a state of altered sensorium, mouth full of secretions and respiratory distress. So immediately, under direct laryngoscopy, oral suctioning was done and airway secured with endotracheal intubation and put on T-piece +02. The patient got stablized hemodynamically (vitals 160/100, HR 128, RER 26 1 SPO2 93%). He was shifted to ICU and he deposited total amount of Rs. 3500/-.<br /> From the previous records of the patient, it came to the notice of the opposite parties that recently he was diagnosed at PGI, Chandigarh, as a case of Wegeners granulomatosis with acute renal failure with suspicion of Carcinoma lung under valuation and underwent dialysis. Later the family of the patient informed that they refused Lung biopsy (Carcinoma Lung evaluation) and did not go for regular follow up.<br /> Lab investigations revealed Urea 360, Creatinine 7.2, K+ 6.97, TLC 12500/95%, Hb 7.8, severe metabolic acidosis. The opposite parties explained the seriousness of the patient's condition to his brother. The opposite parties advised urgent dialysis and referred him to nephrologist or higher Institute for further management. They shifted the patient at 7 a.m. on 24-10-2009 for dialysis to other hospital. The patient was brought back to opposite party No. 1 on 24-10-2008 at about 1.15 p.m. His condition was improved after one dialysis . The opposite party No. 2 explained to the family of the patient that he would require repeated dialysis, antibiotics, pulse thereapy and might need mechanical ventilator support but they wasted lot of time in discussions. Ultimately, they refused for any further treatment as they wanted to take the patient at their own risk and responsibility.<br /> 3. It has been further pleaded that it is a normal practice of the hospital that during emergency medicines are used from stock which are later on replaced by the patient and that is what happened in this case. The patient was treated diligently with due care and caution and no expiry date medicines were utilized. The opposite parties had never used expired medicine on the patient.<br /> It has also been pleaded that after enquiry, it was found that there was clerical mistake during computer batch selection of medicines in the sale bill. Regarding Prazotel injection, it was rechecked with VHB life Sciences Ltd and it was confirmed that Batch P-393 has an expiry date of 31-10-2009 not of 10-10-2009 as mentioned in their sale bill. The opposite parties have sold this medicine to the patient on 24-10-2008. Regarding Butodol injection, they purchased 60 Butodol injections of Batch 9503 in April, 2008. They sold out all these injections by 19-06-2008. On 24-10-2009, injection Butodol was sold out from another batch and by mistake from computer Batch 9503 was selected. The injection Butodol was given to the patient at 1.30 p.m. and as per complainants version, the condition of the patient worsened at 8.00 p.m. i.e. 6 and half hours after injection. There is neither negligence nor deficiency of service nor unfair trade practice on their part.<br /> 4. Parties have led evidence besides filing affidavits in support of their respective pleadings.<br /> 5. We have heard the learned counsel for the parties and have also gone through the record.<br /> 6. In para No. 1,2 & 3 of the complaint, it has been pleaded that deceased Lal Chand was suffering from Pneumonia and was also having some kidney problem on 23-10-2008 when he was got admitted to the hospital of opposite party Nos. 1 & 2. It has also been pleaded that deceased was administered some medicines besides putting him on E.V. Fluids. It has also been pleaded that he was also put on dialysis. His condition was stated to have been improved by way of above said initial treatment. His condition has been stated to have deteriorated in the after noon of 24-10-2008. These pleadings show that deceased was brought to the hospital of opposite party Nos. 1 & 2 in a precarious condition which improved, but again deteriorated after a few hours.<br /> 7. In their jointly reply, the opposite parties have pleaded that deceased was received in emergency at 9.00 p.m. on 23-10-2008 in a state of altered sensorium, mouth full of secretions and respiratory distress who was immediately subjected to oral suctioning under direct laryngoscopy. It is also alleged that airway was secured with endotracheal intubation and put on T-piece + 02, as a result of which he got stabilized hemodynamically. Their pleadings in the written reply have been corroborated by hospital and event notes annexed with Ex. R-20.<br /> 8. The written reply also shows that patient was brought to the hospital of opposite party Nos. 1 & 2 in a precarious condition. The opposite party Nos. 1 & 2 have also pleaded in para Nos. 22 & 23 of the written reply that patient had been recently diagnosed at P.G.I Chandigarh as a case of Wegeners granulomatosis with acute renal failure (RPGN) with suspicion of Carcinoma lung under evaluation & underwent dialysis. Later the patient's family refused Lung biopsy (Carcinoma Lung evaluation) & further investigations offered by PGI, Chandigarh and did not go for regular follow up. Lab investigations reveals Urea 360, Creatinine 7.2, K+ 6.97, TLC 12500/95%, Hb 7.8, Severe metabolic acidosis.<br /> 9. The opposite parties have pleaded that they have become aware of the above said facts on the basis of previous records of the illness of the patient. However, no such record has been placed on the file by either of the parties. No record has been sought for by the parties from PGI, Chandigarh, in this regard. Thus, the above said pleadings have been made by the opposite party without producing any evidence of the PGI. But at the same time, the above said pleadings cannot be termed to be without any basis. As already observed above, the deceased was brought in a precarious condition to the hospital of opposite party Nos. 1 & 2 and was immediately put on dialysis. He was also put on E.V. Fluid immediately thereafter. Therefore, there cannot be two opinions of the fact that a patient is put on dialysis immediately after he is brought to a hospital only in the case of kidney failure. Thus assertion of opposite party Nos. 1 & 2 appears to be correct that it was a case of kidney failure. Medical science also bears witness to the fact that kidneys did not fail within one or two days. Thus, further assertion of opposite party Nos. 1 & 2 appears to be correct that deceased was diagnosed at PGI as a case of Wegners granulomatosis with acute renal failure with suspicion of Carcinoma lung under evaluation where he had also under gone dialysis.<br /> 10. According to the pleadings of para Nos. 22 & 23 of written reply, the deceased had refused lung biopsy for further investigation by PGI and also did not go there for further investigation which appear to be correct in view of the above said findings recorded by this Fora.<br /> 11. According to a catena of rulings placed on record by both the parties, there are three stages of a treatment of the patient and they are :-<br /> i) Diagnosis<br /> ii) Treatment<br /> iii) Follow-up action<br /> In the instant case the diagnosis of the deceased by opposite party Nos. 1 & 2 was correct. There is also no dispute raised by the complainants that treatment of the deceased was incorrect. They have pleaded in para No. 10 of the complaint that opposite party Nos. 1 & 2 have used Prazotel 40 Mg injection of Batch No. 30393 with expiry date 10-10-2008 and Butodol 2 Mg injection Batch No. 9503 with expiry date 08-01-2008. They have also pleaded that many other expired medicines have been administered to the deceased. Therefore, their case is as to if deceased has been administered injections and medicines of proper potency, he would not have died.<br /> 12. Here the question arises as to whether the deceased could not over come his diseases due to the administration of above said injections and medicines ?<br /> 13. Names of the expired medicines allegedly administered to the deceased have not been mentioned either in the complaint or any other document relied upon by the complainants. Therefore, the controversy remains confined to the administration of expired injections of prazotel and Butodol.<br /> 14. Opposite party Nos. 1 & 2 have placed on record Ex. R-30 which is an Article written by Thomas A.M. Kramer, MD. Where he has tried to justify that a drug does not loose its 100% potency after the date of its expiry. His conclusion is that administration of an expired drug to a patient has the desired effect. The above said author has based his research on 'Asprin' date of which had expired. He had administered that drug to his mother. This Article states that a drug loses its potency to a considerable extent after its date of expiry.<br /> 15. Opposite party Nos. 1 & 2 have also pleaded that dates of expiry of the ampulses of the above said injections were wrongly mentioned as a result of mistake committed by the computer. They have specifically pleaded in para No. 27 that they never use expired medicines. They have further pleaded that they had inquired into the matter and had found that there was clerical mistake during computer batch selection of the medicines in the sale bills. It has been further pleaded that Prazotel injection was rechecked by VHB Life Sciences Ltd., and it was confirmed that Batch No. P-393 has an expiry date of 31-10-2008 and not 10-10-2009 as mentioned in the sale bill.<br /> 16. It has been further pleaded that Butodol injection Batch No. 9503 was purchased by opposite party Nos. 1 & 2 in April, 2008. They have sold out those injections by 19-06-2008. It has been further pleaded that Butodol injection was sold out from another Batch and by mistake computer selected Batch No. 9503. Their pleadings are a grouping in the wilderness as no cogent evidence has been produced that their computer often commits such mistakes. The mistake in this case has not been detected by opposite party Nos. 1 & 2, but by the complainants. Therefore, above said plea of the opposite parties is difficult to be subscribed to. No law has been produced by the opposite parties that administration of the expired drugs is not responsible for deteriorating the condition of a patient.<br /> 17. The drugs referred above were supplied by opposite party Nos. 1 & 2 from their own drug stores. Therefore, they are not only guilty of negligence in service but also of unfair trade practice.<br /> 18. Resultantly, it is held that after proper diagnoses of the patient, he was not administered proper medicines. The Hon'ble Supreme Court held in Post Graduate Institute of Medical Education & Research, Chandigarh Vs. Jaspal Singh & Others 2009(4) Civil court Cases 560 (S.C) that transfusion of mismatched blood is not only an error of professional judgment but also medical negligence. Therefore, a finding is recorded that administration of expired drugs was medical negligence as well as unfair trade practice.<br /> 19. Learned counsel for opposite party Nos. 1 & 2 have also contended that a doctor simply prescribed medicines which are administered by para medical staff of the Hospital. Therefore, the doctors of opposite party Nos. 1 & 2 were not liable for this negligence. The drug store which supplied the expired drugs belongs to opposite party Nos. 1 & 2. Therefore, deficiency in service squarely lies upon them as they were responsible for weeding out expired drugs from their medical store which they did not with a view to earn more money.<br /> 20. Now the question arises as to whether administration of expired drug cut short the life of the deceased ?<br /> 21. As also found in the preceding paras of this order, deceased was brought to the hospital of opposite party Nos. 1 & 2 in a very bad condition when renal failure had already taken place. The deceased was suspected by lung carcinoma in the PGI. They did not avail of best treatment in the PGI. Therefore the treatment by a second grade hospital would never save the life of such a patient. <br /> 22. Now let us also see as to whether it was a case of LAMA ?<br /> It is the case of opposite parties that opposite party No. 2 had explained to the patient and his family that he would require repeated dialysis, antibiotics, pulse therapy and might need mechanical ventilator support. Their case is also that they advised them to take the patient either to DMC, Ludhiana or PGI Chandigarh. Serious condition of the patient was so warranted. But the complainants did not agree.<br /> 23. In para Nos. 5 & 6 of the complaint, it has been mentioned that deceased died in the hospital of opposite party Nos. 1 & 2 at about 9.00 p.m. Opposite party Nos. 1 & 2 have pleaded that the family of the deceased had taken him from the hospital against medical advice. They have also prepared record in this respect.<br /> 24. It is correct that opposite party Nos. 1 & 2 had advised the family of the deceased to take him to some Super Speciality Hospital like PGI, Chandigarh or DMC, Ludhiana. It is also their case that family of the deceased did not comply with that advice. Therefore, when the condition of the deceased was precarious and deteriorating, there was no question for the family of the deceased to take him out from the Hospital to an unknown place against medical advice of opposite party Nos. 1 & 2. Family of the deceased appeared to be seriously concerned about his health. Therefore, they were not expected to take the deceased out from the Hospital without consent of opposite party Nos. 1 & 2 and that too for an unknown destination. Therefore, it appears that deceased breathed his last in the Hospital itself. Opposite party Nos. 1 & 2 fabricated a false report that deceased was taken away from their Hospital against their medical advice so as to escape a stigma that a patient had died in their Hospital. This is also an unfair trade practice.<br /> 25. The complainants have not produced any expert evidence so as to show that administration of time barred injections cut short the life of the deceased who was brought to the Hospital of opposite party Nos. 1 & 2 in a precarious condition with multiple diseases at advance stage.<br /> 26. The Hon'ble Supreme Court has held in INS. Malhotra Vs. Dr. A. Kriplani & Ors II(2009) CPJ 18 (SC) that :-<br /> “Medical Negligence – Treatment - Deceased brought to hospital in a very bad condition. Renal failure had already taken place. Died due to peritonitis with renal failure. Deficiency in service and medical negligence on part of treating doctors alleged. Complaint dismissed by National Commission as complainant has not been able to establish cash of medical negligence. Civil appeal filed. No difference/divergence of opinion between team of specialists and experts exists at any stage. Doctors informed patient and relatives that patient's condition was critical, kidney transplantation could not be done. Condition of patient started deteriorating day-by-day despite best care and attention of specialists in ICU. Complainant abruptly instructed doctors to stop haemodialysis treatment to patient, which resulted in ultimate death of patient. Doctors who treated patient are skilled and duly specialised in their respective fields. They tried their best to save life of deceased by joining their hands and heads together. Performed their professional duty as a team work. Post mortem report of deceased not challenged. No infirmity/perversity in findings recorded by National Commission found. No inference required in appeal. Negligence – Profession and occupational – Difference between. Result – Appeal dismissed.”<br /> 27. The opposite party Nos. 1 & 2 have produced on record post graduation degrees of the concerned doctors in the filed of medicines, cardiology, T.B. Chest and ICU's. Therefore, they were competent to attend to the deceased in the emergency. Therefore, in view of the law laid down in Ins. Malhotra Vs. Dr. A Kirplani & Ors. (Supra), it is held that administration of expired injections to the deceased by opposite party Nos. 1 & 2 did not cut short his life and as such, he died due to gravity of his diseases which were in an advanced stage.<br /> 28. In Post Graduate Institute of Medical Education & Research, Chandigarh Vs. Jaspal Singh & Others (Supra), the complainants were awarded compensation of Rs. 2,00,000/- on account of transfusion of mis-matched blood. Therefore, in the instant case, the complainants are entitled to compensation of Rs. 2,00,000/- on account of administration of time barred injections to the deceased and for preparing false record regarding the deceased leaving the Hospital against medical advice.<br /> 29. The drug store which supplied the expired injections is being run by opposite party Nos. 1 & 2. Therefore, a drug store which sells expired medicines for administration to the patients, is liable to be closed.<br /> 30. In view of the finding recorded above, this complaint is accepted with cost of Rs 5,000/- and the opposite parties are jointly and severally directed to pay a sum of Rs. 2,00,000/- to the complainants on account of deficiency in service and unfair trade practice in administering the expired injections to the deceased and for preparing false record regarding LAMA.<br /> 31. As already held above, opposite party Nos. 1 & 2 are not entitled to run a drug store for administration of expired medicines to the patients. Therefore, copy of this order be sent to Chief Drug Controller, Punjab, to cancel their licence of that Drug Store so that the said drug store should be closed. <br /> 32. Thus, the complaint is accepted against opposite party Nos. 1 & 2. Therefore, opposite party Nos. 1 & 2 are directed to pay a sum of Rs. 2,00,000/- as compensation and Rs. 5,000/- as cost for litigation, to the complainants in equal share, jointly and severally within a period of 45 days from the date of receipt of copy of this order.<br /> 33. Since no relief is claimed against opposite party No. 3, no direction can be given to it.<br /> 34. Copy of this order be sent to the parties concerned free of cost and the file be consigned to record.<br /> Pronounced :<br /> 29-01-2010 <br /> (Vikramjit Kaur Soni)<br /> President<br /> <br /> <br /> (Dr. Phulinder Preet)<br /> Member <br /> <br /> <br /> (Amarjeet Paul) *ik Member