Tamil Nadu
South Chennai
CC/643/2004
S.Gothamchand - Complainant(s)
Versus
S.Devambigai - Opp.Party(s)
M/s Ashok Menon
18 Dec 2019
ORDER
Date of filing : 28.09.2004
Date of Disposal : 18.12.2019
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (SOUTH)
@ 2ND Floor, T.N.P.S.C. Road, V.O.C. Nagar, Park Town, Chennai – 3.
PRESENT: THIRU. M. MONY, B.Sc., L.L.B, M.L. : PRESIDENT
TR. R. BASKARKUMARAVEL, B.Sc., L.L.M., BPT., PGDCLP. : MEMBER
C.C. No.643/2004
DATED THIS WEDNESDAY THE 18TH DAY OF DECEMBER 2019
S. Gothamchand,
S/o. Late A.S. Sugan Raj,
No.35/6, Main Road,
Alagiri Nagar,
Vadapalani,
Chennai – 600 026. .. Complainant.
..Versus..
1. Dr. S. Devambigai,
No.134, Greams Road,
Thousand Lights,
Chennai – 600 006.
2. Dr. Janakiraman,
No.15/1, 2nd Floor,
Chellammal Street,
(Opp. Hand’s Hospital),
Shenoy Nagar,
Chennai – 600 030. .. Opposite parties.
Counsel for the complainant : M/s. Ashok Menon
Counsel for the 1st opposite party : M/s. M.P. Mohandass & another
Counsel for the 2nd opposite party : M/s. M. Muthukumaran &
another
ORDER
THIRU. M. MONY, PRESIDENT
This complaint has been filed by the complainant against the opposite parties under section 12 of the Consumer Protection Act, 1986 prays to refund a sum of Rs.1,49,698.60/- towards hospital expenses and to pay a sum of Rs.20,00,000/- towards compensation for mental agony, anguish, loss, pain, sufferings and physical discomfort, gross negligence, carelessness, incompetence and deficiency in service with cost to the complainant.
1. The averments of the complaint in brief are as follows:-
The complainant submits that in the 2nd week of February 2000, the complainant’s wife Smt. Susheela felt some discomfort in her abdomen and found that there was an occasional vaginal bleeding and she consulted the 1st opposite party herein. The 1st opposite party examined and diagnosed that the complainant’s wife suffered from FIBROID UTERUS. The complainant submits that the 1st opposite party recommended that Smt. Susheela’s uterus to be totally removed. The surgery was explained to both complainant and his wife by the 1st opposite party that it is a routine surgery performed in the Government Hospital and Private Hospital and not complicated at all. Later on, the complainant’s wife was admitted in the Mercury Nursing Home, Pantheon Road, Egmore, Chennai by the 1st opposite party for surgery on 30.09.2000 at about 10.00 a.m. On the same day, Smt. Susheela was taken to the operation theatre by the 1st opposite party and surgery was commenced at about 03.40 p.m. According to the 1st opposite party, the 2nd opposite party was in-charge of administering Anaesthesia to Smt. Susheela. The complainant submits that he did not aware that when the 2nd opposite party examined his wife Smt. Susheela and given anaesthesia. At about 05.00 p.m. his wife was shifted from the operation theatre to ICU under instruction of the 1st opposite party with both her eyes covered by a pair of eye pads. The complainant’s wife was in an unconscious state when the complainant asked with the 1st opposite party that how his wife developed some sort of an allergy. The 1st opposite party told him that after anaesthesia had been administered by the 2nd opposite party, “resulting in reddishness and rashes all over the body with goose skin reaction and swelling of upper and lower lips of odema of her fingers, indicating some sort of a serious reaction to the drugs administered during Anaesthesia”.
2. The complainant submits that the 1st opposite party further told the complainant that she had gone ahead with the operation on the advice of the 2nd opposite party. The 1st opposite party has mentioned in the reply dated:24.11.2000 that the 2nd opposite party had been called to see Smt. Susheela for pre-anaesthetic assessment and he was informed that the surgery was to be posted that he was informed that the surgery was to be posted on 30.09.2000 at 03.00 p.m. and that the 2nd opposite party had examined Smt. Susheela in the morning and had given his report after examination then he had instructed the Duty Doctor to give “FORTWIN 30 mg IM and ATROPINE 15 mg IM, one hour before surgery” to quote from the reply of the 1st opposite party dated:24.11.2000. The complainant submits that the 1st opposite party further told him that she had no hand or role to play in the administration of Anaesthesia and that the same had been done totally by the 2nd opposite party. The complainant submits that his wife Smt. Susheela was kept in ICU in the Mercury Nursing Home from 30.09.2000 to 13.10.2000 with ventilator support. But she did not regain consciousness and she was under coma only at last on 13.10.2000, the doctors in the hospital pronounced her as dead. The complainant stated that he wrote a letter to the 1st opposite party on 12.11.2000 confirming the reason for death of complainant’s wife, the 2nd opposite party alone is responsible and to show cause why legal proceedings should not be initiated against her, for which, the 1st opposite party replied through letter dated:24.11.2000 with several untenable allegations. Further, the complainant denies that her wife signed in the letter of consent on 30.09.2000.
3. The complainant submits that his wife was not examined by the 2nd opposite party before administering Anaesthesia; pre-Anaesthetic assessment was not done because he was with his wife from her admission upto the surgery. Therefore, it is obvious that the 2nd opposite party recommended the medicines to Duty Doctor to give for TWIN 30 mg IM and ATROPINE 15 mg-IM one hour before surgery. But the 1st opposite party had put the blame on the 2nd opposite party. The complainant submits that the reply of the 1st opposite party stated that the 2nd opposite party concurred with Idiosyncratic reaction and immediately gave counter medicine to counter act and reverse Idiosyncratic reaction. The complainant submits that the 1st opposite party had asked for opinion of the complainant and his relatives to shift the complainant’s wife to biggest hospital where better facilities and investigations like CT scan and MRI are available under on “roof”, but it is denied by the complainant. The complainant submits that he received notice from the 1st opposite party’s Advocate on 05.12.2000 with all sorts of untenable contentions. Once again, the complainant sent a letter to the opposite parties 1 & 2 on 03.01.2001 but there is no reply. The complainant humbly reiterates that the death of his wife Smt. Susheela had occurred only on account of gross negligence, carelessness, incompetence and deficiency in service in the part of the opposite parties herein. The complainant had been spent for his wife treatment from 30.09.2000 to 13.10.2000 a total amount of Rs.1,49,698.60/-. The act of the opposite parties amounts to deficiency in service and unfair trade practice which caused great mental agony. Hence, the complaint is filed.
4. The brief averments in the written version filed by 1st opposite party is as follows:-
The 1st opposite party specifically denies each and every allegation made in the complaint and put the complainant to strict proof of the same. The 1st opposite party submits that she advised the complainant’s wife, Mrs. Susheela for removal of her uterus due to Fibroids with Menorrhagia. She consented for the same and letter of consent was signed by Mrs. Susheela on 30.09.2000. While signing the consent, she appraised of the procedure and the surgical risks involved in and she opted to undergo surgery where concession for the cost of surgery and therefore, Mercury Nursing Home was selected. After getting consent letter for surgery being Abdominal Hysteroctomy the 2nd opposite party Dr. Janakiraman, Anaesthesiologist was called to see the patient Mrs. Susheela for Pre-Anaesthetic assessment. The Anaesthesiologist examined the patient in the morning and has given Pre-Anaesthetic Assessment Report. Thereafter with the consent of the 2nd opposite party surgery was fixed by the 1st opposite party on 30.09.2000 itself at 03.00 p.m. The 2nd opposite party instructed the duty Doctor to give fort win 30 mg IM and Atropine 15 mg IM one hour before the surgery. But the complainant was not aware when the 2nd opposite party examined the party when Anaesthesia was administered. Normally, pre-medication is given in the ward as advised by the Anaesthetist and then, the patient will be shifted to theatre. In the operation theatre again, the patient examined and anaesthesia given.
5. The 1st opposite party states that no one announces the time of inducting anaesthesia to the patient’s relatives waiting outside including the complainant. After the anaesthetist examined all paraments and elicited history of allergy to food, drugs and asthma, the complainant’s wife was taken to the operation theatre on 30.09.2000 at 03.15 p.m. and connected with all vital equipments and she was connected to non-invasive cuff blood pressure monitor and recorded pre-operative blood pressure 130/70 on the table. The Anaesthesia was administered by the Anaesthetist and the surgery was started at 03.40 p.m. After about 30 minutes of starting surgery, the opposite party noticed allergic reaction, indicating some sort of Idiosyncratic reaction to some drugs used. It is noticed by the 2nd opposite party and immediate counter active measures were taken by the 2nd opposite party to reverse idiosyncratic reaction by giving drugs and fluctuating blood pressure was also counter acted by giving proper drug by the 2nd opposite party.
6. The 1st opposite party submits that as per 2nd opposite party’s advise immediately cut off the Nitrous Oxide administration to the complainant and 100% oxygenation was started. Due to fluctuating blood pressure Dopamine drip of 400 mg in 500 ml of 5% dextrose was started at the rate of 5 micrograms slow drip to maintain blood pressure and drugs to counter act the idiosyncratic reaction was given Efcorlin 200 mg I.V. Stratum Decadron 8 mg IV, Sodium Bicarbonate 10 ml each time, Isoprenaline 4 mg in 500 ml, Dextrose at 4 micrograms continuously infused Methyl Prednisolone 1 Vial IV given throughout pulse oxymetry was showing 98 to 100% oxygenation. Haemacel was started to maintain B.P. Meanwhile, a team of Doctors including the 1st opposite party with advice of the 2nd opposite party completed the surgery in view of the above situation encountered by Anaesthetist. Due to unfortunate idiosyncratic reaction, dressings were applied. The 1st opposite party states that the complainant’s wife tried to come out of anaesthesia and was restless. Then, the patient was shifted to ICU with the consent of Anaesthetist with Endotracheal tube to ICU and Ventilator support was given. All the vital parameters were monitored and maintained by the team of Doctors in ICU. Therefore, the 1st opposite party has not committed any deficiency in service and unfair trade practice and the complaint against the 1st opposite party is liable to be dismissed.
7. The brief averments in the written version filed by 2nd opposite party is as follows:-
The 2nd opposite party specifically denies each and every allegation made in the complaint and put the complainant to strict proof of the same. The 2nd opposite party states that the surgery was conducted by the 1st opposite party on the complainant’s wife and the 2nd opposite party was the anaesthetist during the surgery. But it is not correct to state that it was due to negligence in service on the part of the 2nd opposite party and the medicine that was administered on the complainant’s wife that she developed allergy. The 2nd opposite party states that after obtaining consent from the complainant’s wife, the surgery was performed by the 1st opposite party. Therefore, the averment in the complaint are false and fabricated. The 2nd opposite party states that the complainant has not produced any concrete and legally acceptable evidence to prove that the complainant’s wife expired due to negligent act of the 2nd opposite party. The position has been well explained in the reply notice dated:20.11.2000 sent by the 2nd opposite party as to the role of anaesthetist and all the necessary precautions have been taken before administering with anaesthetic drugs. An expert opinion from a Doctor on the same field would be in a position to appraise of the status of the patient and also if there was any medical negligence or not that had taken away the life of Mrs. Susheela. Therefore, the complaint has been filed with false and frivolous allegations against this opposite party. The 2nd opposite party stoutly denies the contentions. The complaint is devoid of merits and deficiency in service on the part of the 2nd opposite party and hence, the same is liable to be dismissed.
8. To prove the averments in the complaint, the complainant has filed proof affidavit as his evidence and documents Ex.A1 to Ex.A22 are marked. Proof affidavit of the 1st opposite party is filed and documents Ex.B1 to Ex.B15 are marked on the side of the 1st opposite party. Inspite of sufficient time is given, the 2nd opposite party has not filed any proof affidavit to prove the contentions raised in the written version and hence the proof affidavit of the 2nd opposite party is ‘closed’.
9. The points for consideration is:-
- Whether the complainant is entitled to get refund of a sum of Rs.1,49,698.60/- paid towards hospital expenses for his wife as prayed for?
- Whether the complainant is entitled to a sum of Rs.20,00,000/- towards compensation for mental agony, anguish, loss, pain, suffering, physical discomfort, gross negligence, carelessness, incompetence and deficiency in service with cost as prayed for?
10. On point:-
Inspite of sufficient time and opportunity given, the 2nd opposite party has not filed any proof affidavit to prove the contentions raised in the written version and hence the proof affidavit of the 2nd opposite party is ‘closed’. Both parties has not filed any written arguments. Heard the 1st opposite party’s Counsel. Perused the records namely; the complaint, written versions, proof affidavits and documents. The complainant pleaded in the complainant and contended that during the 2nd week of February 2000, the complainant’s wife Smt. Susheela felt some discomfort in her abdomen and found that there was an occasional vaginal bleeding. The complainant’s wife consulted the 1st opposite party herein. The 1st opposite party examined her and diagnosed that the complainant’s wife suffered from FIBROID UTERUS. But the complainant has not produced any medical records. On the other hand, it is admitted by the 1st opposite party through her reply letter to the complainant as per Ex.A19. Further the contention of the complainant is that the 1st opposite party recommended that Smt. Susheela’s uterus has to be totally removed. The nature of surgery was explained to both complainant and his wife by the 1st opposite party that it is a routine surgery performed in all the Government Hospitals and Private Hospitals and it is not complicated at all. Later on, the complainant’s wife was admitted in the Mercury Nursing Home, Pantheon Road, Egmore, Chennai by the 1st opposite party for surgery on 30.09.2000 at about 10.00 a.m. On the same day, Smt. Susheela was taken to the operation theatre by the 1st opposite party and surgery was conducted by the 1st opposite party after due administration of Anaesthesia by the 2nd opposite party.
11. Further the complainant contended that he did not aware that when the 2nd opposite party examined his wife Smt. Susheela and given Anaesthesia. At about 05.00 p.m. his wife was shifted from the operation theatre to ICU under instruction of the 1st opposite party with both her eyes covered by a pair of eye pads. The complainant’s wife was in an unconscious state when the complainant asked with the 1st opposite party that how his wife developed some sort of an allergy. The 1st opposite party replied him that after Anaesthesia had been administered by the 2nd opposite party, “resulted in reddishness and rashes all over the body with goose skin reaction and swelling of upper and lower lips of Odema of her fingers, indicating some sort of a serious reaction to the drugs administered during Anaesthesia occurred during surgery but on the advice of the 2nd opposite party, the 1st opposite party continued the surgery”. It was admitted by the 1st opposite party in her reply letter (page No.2), dated:24.11.2000 as per Ex.A19 to the complainant which reads as follows:
“Anaesthesia was administered by the Anaesthetist and the Surgery was started in 03.40 p.m. After about 30 mts. while the surgery was in progress and major pedicles were clamped we noticed suddenly reddishness and rashes all over the body with goose skin reaction with swelling of both upper and lower lip of oedema of her fingers, indicating some sort of idiosyncratic reaction to some drugs used” proves the negligence and deficiency in service.
12. Further the contention of the complainant is that the 1st opposite party further told him that she had no hand or role to play in the administration of Anaesthesia and that the same had been done totally by the 2nd opposite party but allergic reaction did not hamper the surgery in any manner. Further the contention of the complainant is that his wife Smt. Susheela was kept in ICU in the Mercury Nursing Home from 30.09.2000 to 13.10.2000 with ventilator support. But she did not regain consciousness and she was under coma only; at last on 13.10.2000, the doctors in the hospital declared her as dead. The Death Certificate was issued by one of the Doctors attached to the Mercury Nursing Home Dr. T.P. Abdul Shakoor as per Ex.A16 in which, it is clearly mentioned that death due to “CARDIAC ARREST”. But when the complainant’s wife was admitted for surgery for removal of her uterus, there was no symptom for cardiac disorder; on a careful perusal of Ex.B2, Case Sheet dated:30.09.2000 also not disclosed anything that the deceased was suffering from previous history of Cardiac problem proves that the cause of death of the complainant’s wife is only due to anaesthetic drugs reaction amounts to deficiency in service. Further the contention of the complainant is that at the time of death of the complainant’s wife, neither the 1st opposite party nor 2nd opposite party present in the above hospital proves lack of duty of care towards patient by the opposite parties 1 & 2 proves deficiency in service. Further the contention of the complainant is that he wrote a letter to the 1st opposite party on 12.11.2000 as per Ex.A17, to confirm / clear the reason for death of complainant’s wife the 2nd opposite party alone is responsible and to show cause why legal proceedings should not be initiated against her, for which, the 1st opposite party replied through letter dated:24.11.2000 as per Ex.A19 with several untenable allegations. Further the complainant denies that her wife signed in the letter of consent on 30.09.2000. But no document filed to prove the said averment by the complainant.
13. Further the complainant denies that his wife was examined by the 2nd opposite party before administering Anaesthesia (i.e.) pre-anaesthetic assessment was done, because he was with his wife from her admission upto the surgery. Therefore, it is obvious that the 2nd opposite party recommended the medicines to Duty Doctor to give for FORTWIN 30 mg IM and ATROPINE 15 mg-IM one hour before surgery. But no iota of evidence produced to prove on the complainant’s side. But the 1st opposite party put the blame on the 2nd opposite party to shift the burden on the 2nd opposite party is completely liable through Ex.A19 amounts to unfair trade practice and deficiency in service on the side of the 1st opposite party. Further the contention of the complainant is that the reply of the 1st opposite party stated that the 2nd opposite party concurred with idiosyncratic reaction and immediately gave counter medicine to counter act and reverse idiosyncratic reaction proves negligence of the opposite parties 1 & 2 amounts to unfair trade practice and deficiency in service. Further the contention of the complainant is that the 1st opposite party had asked for opinion of the complainant and his relatives to shift the complainant’s wife to biggest hospital where better facilities and investigations like CT scan and MRI are available under on “roof” is denied by the complainant. On the other hand, if indeed Mercury Nursing Home did not have the necessary facilities and equipments the 1st opposite party ought not to be admitted the complainant’s wife in that hospital also amounts to negligence of the 1st opposite party.
14. Further the contention of the complainant is that he received notice from the 1st opposite party’s Advocate on 05.12.2000 with all sorts of untenable contentions as per Ex.A20. The complainant gave reply dated:11.12.2000 to the opposite parties’ Advocate notice as per Ex.A21. Thereafter, the 1st opposite party spoke to the complainant telephone and requested him not to precipitate matters she was ready for settlement out of court; is not acceptable either on law or on facts. The 1st opposite party called the complainant to her counsel office for amicable settlement, but no records. Once again the complainant sent a letter to the opposite parties 1 & 2 on 03.01.2001 as per Ex.A22, but there is no reply. The complainant reiterates that the death of his wife Smt. Susheela had occurred only on account of the gross negligence, carelessness, incompetence and deficiency in service in the part of the opposite parties herein. The complainant had been spent for his wife treatment from 30.09.2000 to 13.10.2000 a total amount of Rs.1,49,698.60. Ex.A1 to Ex.A15 are the copy of bills for treatment. Therefore, the complainant has no choice except to approach this Hon’ble Forum for appropriate relief.
15. The learned Counsel appearing for the 1st opposite party would contend that she advised the complainant’s wife, Mrs. Susheela for removal of her uterus due to Fibroids with Menorrhagia as per Ex.B2. She consented for the same and letter of consent was signed by Mrs. Susheela on 30.09.2000 as per Ex.B1. While signing the consent, she was appraised of the procedure and the surgical risks involved in and she opted to undergo surgery where concession for the cost of surgery and therefore, Mercury Nursing Home was selected. After getting consent letter for surgery being Abdominal Hysteroctomy the 2nd opposite party Dr. Janakiraman Anaesthesiologist was called to see the patient Mrs. Susheela for Pre-Anaesthetic assessment. The Anaesthesiologist examined the patient in the morning and has given his report as per Ex.B3, Pre-Anaesthetic Assessment Report. But the Anaesthetists has not followed complete Pre-Anaesthetic assessment particularly blood investigation and the drug Suxamethonium was not tested Pre-Anaesthetically.
16. As per the Medical Literature General recommendations have been published in USA and in India a mnemonic has been suggested for pre-anaesthetic assessment to ensure that all aspects are covered. It runs alphabetically:
A – Affirmative history; Airway
B – Blood haemoglobin, blood loss estimation, and blood availability; Breathing
C – Clinical examination; Co-morbidities
D – Drugs being used by the patient; Details of previous anaesthesia and surgeries
E – Evaluate investigations; End point to take up the case for surgery
F – Fluid status; Fasting
G – Give physical status; Get consent
“Succinylcholine (also known as suxamethonium in the UK, New Zealand, Australia and other countries, “Celokurin” or “cello” for short in Europe)”.
proves the deficiency in service.
17. Further, from the Medical Literature of Tulane University Medical Center, New Orieans, Louisiana, U.S.A. which reads as follows:-
Anaesthesia in patients at risk of hypersensitivity reactions
In the United States 5% of the adult population has been estimated to be allergic to atleast one drug and up to 15% of the people believe that they have “medicine allergy” (1). Approximately 200,000 patients suffer a truly allergic reaction in the hospitals each year and probably another million people experience a milder reaction that may not require hospital treatment. (2) Fortunately truly allergic drug reactions make up only about 6% to 10% of all the adverse drug reactions. (3) The use of greater numbers of drugs in the perioperative period has resulted in an enhanced incidence of allergic drug reactions in anaesthesia. (4) In the United Kingdom 4.6% of deaths and 5.6% of cerebral damage following all the anaesthetic mishaps were attributed to drug sensitivity. (5) In Australia, the incidence of such reactions has risen from one for 20,000 anaesthesias indicated a severe reaction for every 4,500 cases. Despite appropriate treatment, 6% of the patients succumbed to these fatal allergic reactions. (7) Therefore, an identification of possible risk factors associated with hypersensitivity reactions is of importance in order to curtail the morbidity and mortality form hypersensitivity reactions during anaesthesia.
INDIVIDUAL RISK FACTORS FOR ALLERGIC REACTIONS
Sex: A higher preponderance of allergic drug reactions has been reported among the female gender. The incidence of allergic reactions among women is five times greater than in men following administration of muscle relaxants (8) Likewise, a female to male ration of 4:1 has been reported in drug allergy to thiopentone (9)”.
In the instance case, the 2nd opposite party neglected to take due care in administering muscle relaxants without testing the hypersensitivity reaction to the complainant’s wife amounts to deficiency in service. Thereafter with the consent of the 2nd opposite party, the surgery was fixed by the 1st opposite party on 30.09.2000 itself at 03.00 p.m. (Patient Examination done by the 1st opposite party) case sheet, Ex.B2. The 2nd opposite party instructed the duty Doctor to give FORTWIN 30 mg IM and Atropine 15 mg IM one hour before surgery as per Ex.B3. But in Ex.B3, it shows the Anaesthetic Doctor recommended only FORTWIN 30 mg Atropine 0.5 mg 1 hour before the surgery i.e. excess dosage of administration of Atropine proves the deficiency in service. But the complainant was not aware when the 2nd opposite party examined the complainant’s wife when anaesthesia was administered. Normally pre-medication is given in the ward as advised by the anaesthetist and then the patient will be shifted to theatre. There in the operation theatre again the patient examined and anaesthesia given.
18. Further the 1st opposite party contended that no one announces the time of inducting anaesthesia to the patient’s relatives waiting outside including the complainant. Further the contention of the 1st opposite party after the anaesthetist examined history of allergy to food, drugs and asthma gave his report. But failed to do other examination as per standard medical procedure above stated. Thereafter, the complainant’s wife was taken to the operation theatre on 30.09.2000 at 03.15 p.m. and connected with all vital equipments and she was connected to non-invasive cuff blood pressure monitor and recorded pre-operative blood pressure 130/70 on the table as per Ex.B4 and the surgery was started at 03.40 p.m. After about 30 minutes of starting surgery, the opposite party noticed allergic reaction, indicating some sort of Idiosyncratic reaction to some drugs used. It is noticed by the 2nd opposite party and immediate counter active measures were taken by the 2nd opposite party to reverse idiosyncratic reaction by giving drugs and fluctuating blood pressure was also counter acted by giving proper drug by the 2nd opposite party as per Ex.B4(S).
19. Further the contention of the 1st opposite party is that the 2nd opposite party advised to cut off immediately Nitrous Oxide and started 100% oxygenation. But as per the Medical Literature, NITROUS OXIDE should not be administered with muscle relaxant which reads as follows:-
Text Book of PHARMACOLOGY AND PHARMACOTHERAPEUTICS
By Mr. R.S. Satoskar & Mr. S.D. Bhandakar
NITROUS OXIDE : Nitrous Oxide is a colourless, inorganic, non-irritating gas with a sweet taste. It is non-inflammable and is marked in steel cylinders at a pressure of 650 to 800 lbs. per square inch. The oxygen in the nitrous oxide molecule is not available for tissue respiration as nitrous oxide does not undergo significant decomposition in the body.
Disadvantages:
(a) Nitrous oxide is not a potent anaesthetic by itself and has to be supplemented with either pre-anaesthetic medication or with other potent anaesthetic agents or muscle relaxants to achieve surgical anaesthesia and muscle relaxation.
(b) Excitement may be violent.
(c) Carbon-di-oxide accumulation and hypoxia may develop during prolonged nitrous oxide anaesthesia, especially when supplemented with skeletal muscle relaxants. This may precipitate cardiac irregularities during anaesthesia.
(d) A special form of apparatus is necessary to control its administration.
(e) Any closed gas-filled space tends to expand during administration of nitrous oxide. It is therefore, contraindicated in patients with collections of air in the pleural, pericardial or peritoneal cavities; intestinal obstruction; occlusion of the middle ear; chronic obstructive airway disease; or emphysema. It is also contraindicated in patients who have recently undergone pneumoencephalography.
PRE-ANAESTHETIC MEDICATION
Pre-anaesthetic medication is the term applied to the use of drugs prior to the administration of an anaesthetic agent, with the important object of making anaesthesia safer and more agreeable to the patient. The reasons for such medication are:
- For sedation, to reduce anxiety and apprehension without producing much drowsiness.
- To obtain an additive or synergistic effect so that induction could be smooth and rapid and the dose of the general anaesthetic could be reduced.
- To relieve preoperative and post-operative pain.
- To suppress respiratory secretions and to reduce reflex excitability.
- To counteract certain adverse effects of the anaesthetic drug used such as salivation, bradycardia and vomiting.
There is no single drug which can achieve all these objectives and hence usually a combination of drugs is used. It must be emphasized, however, that factors other than drugs can favourably affect preoperative psychological preparation and a preoperative visit by the anaesthesiologist and a sympathetic discussion with the patient about the events of the next day in itself have a high therapeutic value.
(3) Anticholinergic drug such as atropine or scopolamine is generally combined with morphine to block the vagal actions so as to reduce salivary and respiratory secretions and to prevent reflex parasympathetically induced hypotension and bradycardia. It may thus lessen the possibility of cardiac arrhythmias during the induction stage. Atropine stimulates the C.N.S. while scopolamine has a central depressant action. Due to blockade of cardiac vagal action, these drugs may produce tachycardia. One must remember that atropine causes initial vagal stimulation by its central action; use of atropine in combination with neostigmine to reverse the neuromuscular blockade by the muscle relaxant d-tubourarine, therefore, may sometimes cause cardiac arrest and death. Synthetic anticholinergics such as glycopyrrolate, a long acting quaternary amine, can be used instead of atropine for this purpose and are sometimes preferred because of their less central actions and less tendency to cause excessive tachycardia”.
Therefore, at the instance to administer oxygenation along muscle relaxant the anaesthetist wrongly administered Nitrous Oxide with muscle relaxant proves the deficiency in service.
20. Further the contention of the 1st opposite party is that in order to control fluctuating blood pressure, Dopamine drip of 400 mg in 500 ml of 5% dextrose was started at the rate of 5 microgram slow drip to maintain blood pressure and drugs to counter act the idiosyncratic reaction was given Efcorlin 200 mg I.V. stratum Decadron 8 mg IV, Sodium Bicarbonate 10 ml each time, Isoprenaline 4 mg in 500 ml Dextrose at 4 micrograms continuously infused Methyl Prednislolone 1 vial IV given throughout Pubeoxymetry was showing 98 to 100% oxygenation. Haemacel was started to maintain B.P. The 1st opposite party contended that in the mean time, a team of Doctors including the 1st opposite party completed the surgery due to unfortunate idiosyncratic reaction, dressings were applied proves the deficiency in administering anaesthetist drug and not taken due care of the complainant’s wife. Further the 1st opposite party contended that the complainant’s wife tried to come out of anaesthesia and was restless. Then, the patient was shifted to ICU with the consent of anaesthetist Endotracheal tube and ventilator support was given to the complainant’s wife proves that the complainant’s wife was in a serious condition in the ICU attributed to negligence of the opposite parties 1 & 2. Therefore, the opposite parties has committed deficiency in service and unfair trade practice.
21. The contention of the 2nd opposite party is that the surgery was conducted by the 1st opposite party on the complainant’s wife and the 2nd opposite party was the anaesthetist during the surgery. But it is incorrect to state that it was due to negligence in service on the part of the 2nd opposite party and the medicine that was administered on the complainant’s wife that she developed allergy. Further the 2nd opposite party contended that after obtaining consent from the complainant’s wife only the surgery performed by the 1st opposite party on the complainant’s wife. Therefore, the averment in the complaint are false and fabricated; is not acceptable. Further the contention of the 2nd opposite party is that the complainant has not produced any concrete and legally acceptable evidence to prove that the complainant’s wife expired due to negligent act of the 2nd opposite party. The position has been well explained in the reply notice dated:20.11.2000 sent by the 2nd opposite party as to the role of anaesthetist along written version of the 2nd opposite party all necessary precautions have been taken before administering with anaesthetic drugs. But after given sufficient opportunities, the 2nd opposite party has not filed proof affidavit to prove the contentions raised in written version filed on his side proves the negligence and deficiency in service on the part of the 2nd opposite party. Further the contention of the 2nd opposite party is that an expert opinion from a Doctor on the same field would be in a position to appraise of the status of the patient and also if there was any medical negligence or not that had taken away the life of Mrs. Susheela. It is a settled legal position by Appellate Courts all medical negligence case expert opinion is not necessary.
22. This Forum relied on the decision taken in the judgement follows:-
IN THE SUPREME COURT OF INDIA
CIVIL APPELLAE JURISDICTION
CIVIL APPEAL NO.2641/2010
(Arising out of SLP (C) No.15084/2009)
Bench : G.S. Singhvi, Asok Kumar Ganguly
Between
V. Krishan Rao
-Versus-
Nikhil Super Speciality Hospital & anr.
Held that
“13. In the opinion of this Court, before forming an opinion that expert evidence is necessary, the Fora under the Act must come to a conclusion that the case is complicated enough to require the opinion of an expert or that the facts of the case are such that it cannot be resolved by the members of the Fora without the assistance of expert opinion. This Court makes it clear that in these matters no mechanical approach can be followed by these Fora. Each case has to be judged on its own facts. If a decision is taken that in all cases medical negligence has to be proved on the basis of expert evidence, in that event the efficacy of the remedy provided under this Act will be unnecessarily burdened and in many cases such remedy would be illusory.
14. Apart from Lariago, several other injections were also administered on the patient. Lariago may be one injection for treating malaria but the finding of Yashoda Hospital which has been extracted above shows that smear for malarial parasite was positive. There is thus a definite indication of malaria, but so far as Widal test was conducted for Typhoid it was found negative. Even in such a situation, the patient was treated for Typhoid and not for malaria and when the condition of the patient worsened critically, she was sent to Yashoda Hospital in a very critical condition with no pulse, no BP and in an unconscious state with pupils dilated. As a result of which, the patient had to be put on a ventilator.
15. We do not think that in this case, expert evidence was necessary to prove medical negligence.
54. This Court however makes it clear that before the consumer Fora if any of the parties wants to adduce expert evidence, the members of the Fora by applying their mind to the facts and circumstances of the case and the material on record can allow the parties to adduce such evidence if it is appropriate to do so in the facts of the case. The discretion in this matter is left to the members of Fora especially when retired judges of Supreme Court and High Court are appointed to head National Commission and the State Commission respectively. Therefore, these questions are to be judged on the facts of each case and there cannot be a mechanical or strait jacket approach that each and every case must be referred to experts for evidence. When the Fora finds that expert evidence is required, the Fora must keep in mind that an expert witness in a given case normally discharges two functions. The first day of the expert is to explain the technical issues as clearly as possible so that it can be understood by a common man. The other function is to assist the Fora in deciding whether the acts or omissions of the medical practitioners or the hospital constitute negligence.
55. For the reasons discussed above, this Court holds that it is not bound by the general direction given in paragraph 106 in D’souza (supra). This Court further holds that in the facts and circumstances of the case expert evidence is not required and District Forum rightly did not ask the appellant to adduce expert evidence. Both State Commission and the National Commission fell into an error by opining to the contrary. This Court is constrained to set aside the orders passed by the State Commission and the National Commission and restores the order passed by the District Forum. The respondent No.1 is directed to pay the appellant the amount granted in his favour by the District Forum within ten weeks from date.
56. The appeal is thus allowed with cost assessed at Rs.10,000/- to be paid by the respondent No.1 to the appellant within ten weeks.
23. Considering the facts and circumstances of the case and on a careful perusal of the evidences filed on both sides and on the basis of the medical literature, the opposite parties 1 & 2 committed deficiency in treatment and lack of duty of care towards patient amounts to deficiency in service and unfair trade practice. Hence, this Forum is of the considered view that the opposite parties 1 & 2 are jointly and severally liable to refund a sum of Rs.1,49,698.60/- being the amount spent towards treatment for the complainant’s wife and to pay a sum of Rs.5,00,000/- towards compensation for mental agony with cost of Rs.5,000/- to the complainant.
In the result, this complaint is allowed in part. The opposite parties 1 & 2 are jointly and severally liable to refund a sum of Rs.1,49,698.60/- (Rupees One lakh forty nine thousand six hundred and ninety eight and sixty paise only) being the amount spent towards treatment for the complainant’s wife and to pay a sum of Rs.5,00,000/- (Rupees Five lakhs only) towards compensation for mental agony with cost of Rs.5,000/- (Rupees Five thousand only) to the complainant.
The above amounts shall be payable within six weeks from the date of receipt of the copy of this order, failing which, the said amounts shall carry interest at the rate of 9% p.a. to till the date of payment.
Dictated by the President to the Steno-typist, taken down, transcribed and computerized by her, corrected by the President and pronounced by us in the open Forum on this the 18th day of December 2019.
MEMBER PRESIDENT
COMPLAINANT SIDE DOCUMENTS:-
Ex.A1 | 13.02.2000 | Copy of receipt of Scan India to the complainant |
Ex.A2 | 28.09.2000 | Copy of cash bill of Vijaya Hospital Laboratory to the complainant |
Ex.A3 | From 30.09.2000 to 13.10.2000 | Copy of cash bills Bellona Medicals to the complainant (Cash bill series 28 bills) |
Ex.A4 |
| Copy of medical expenses voucher (Hand written) by the complainant |
Ex.A5 | 01.10.2000 | Copy of cash bill from Jeevan Blood Bank and Research Centre |
Ex.A6 | 01.10.2000 | Copy of cash bills from K.S. Hospital Pvt. Ltd. to the complainant (two bills dated:01.10.2000) |
Ex.A7 | 02.10.2000 | Copy of receipt of Lions Blood Bank and Research Foundations to the complainant |
Ex.A8 | 03.10.2000 | Copy of receipt from J.B.S. Mobile X-Ray Services to the complainant |
Ex.A9 | 03.10.2000 | Copy of cash bill of Suo Pharmaceutical Industries Ltd. to the complainant |
Ex.A10 | 03.10.2000 | Copy of cash bill Narayanappah Pharmaceutical Chemist to the complainant |
Ex.A11 | 04.10.2000 | Copy of receipt from Lister Laboratory to the complainant |
Ex.A12 | 09.10.2000 | Copy of cash bill from Sundaram Medical Foundation to the complainant |
Ex.A13 | 10.10.2000 | Copy of EM Sons Medicals to the complainant |
Ex.A14 | 13.10.2000 | Copy of receipt from Trauma Care Consortium to the complainant |
Ex.A15 | From 01.10.2000 to 09.10.2000 | Copy of cash bills of Apollo Hospital to the complainant |
Ex.A16 | 13.10.2000 | Copy of Death Certificate of Smt. Susheela issued by Mercury Nursing Home |
Ex.A17 | 12.11.2000 | Copy of letter from the complainant to 1st opposite party with copy to the 2nd opposite party and another |
Ex.A18 | 23.11.2000 | Copy of letter from the complainant to 1st opposite party with copy to the 2nd opposite party and another |
Ex.A19 | 24.11.2000 | Copy of letter from the 1st opposite party to complainant |
Ex.A20 | 05.12.2000 | Copy of letter from Shri. P. Balasubramanyam, Advocate to the complainant |
Ex.A21 | 11.12.2000 | Copy of reply from the complainant to Mr. P. Balasubramanyam |
Ex.A22 | 03.01.2001 | Copy of letter from the complainant to 1st opposite party with copy to the 2nd opposite party and another |
1ST OPPOSITE PARTY SIDE DOCUMENTS:-
Ex.B1 | 30.09.2000 | Copy of Consent for Surgery |
Ex.B2 | 30.09.2000 | Copy of Case Sheet |
Ex.B3 | 30.09.2000 | Copy of Anaesthetist Assessment |
Ex.B4 | 30.09.2000 | Copy of Operation Notes |
Ex.B5 | 30.09.2000 | Copy of Day today progress of the patient |
Ex.B6 |
| Copy of Shaw’s Textbook of Gynaecology |
Ex.B7 | 13.11.2000 | Copy of letter from the complainant |
Ex.B8 | 18.11.2000 | Copy of reply to the complainant by 1st opposite party |
Ex.B9 | 20.11.2000 | Copy of reply to the complainant by opposite parties 1 & 2 |
Ex.B10 | 23.11.2000 | Copy of letter from the complainant |
Ex.B11 | 30.11.2000 | Copy of reply from Mercury Nursing Home to the complainant |
Ex.B12 | 05.12.2000 | Copy of legal notice of the 1st opposite party to complainant |
Ex.B13 | 11.12.2000 | Copy of reply from the complainant |
Ex.B14 | 13.01.2001 | Copy of letter from the complainant to 1st opposite party |
Ex.B15 |
| Copy of Short Bio-Data of the 1st opposite party |
2ND OPPOSITE PARTY SIDE DOCUMENTS:- Proof Affidavit – ‘Closed’.
MEMBER PRESIDENT
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