Haryana

Ambala

CC/180/2015

Sukhdev Singh - Complainant(s)

Versus

Sant Hospital - Opp.Party(s)

P.S. Sharma

11 Dec 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMBALA.

Complaint Case No.      : 180 of 2015.

Date of Institution         : 03.07.2015.

Date of Decision            : 11.12.2017

 

1.Sukhdev Singh s/o late Sh.Mehar Singh aged 67 years r/o House No.7536/4 new No.1432/4, Shukul Kund Road, Ambala City.

2.Gagan Deep Singh s/o Sh.Sukhdev Singh, aged 27 years, r/o House No.7536/4 new No.1432/4, Shukul Kund Road, Ambala City.

……Complainants.

Versus

 

1. Sant Hospital (Heart & Multi Specialty) through Dr.Sant Ram Arora, 14 Civil Lines, Near Arya School Chowk, Ambala City.
2. Dr.Sant Ram Arora, Prop. Sant Hospital (Heart & Multi Specialty), 14 Civil Lines, Near Arya School Chowk, Ambala City.
3. The New India Assurance Co. Ltd. Ambala City through its Branch Manager (with whom Op Nos. 1 & 2 are insured vide policy No.35350236140400000006 for the period from 05.06.2014 to 04.06.2015).

                                                                   ……Opposite Parties.

 

Complaint Under Section 12 of the Consumer Protection Act.

 

BEFORE:   SH. D.N. ARORA, PRESIDENT.

                   SH. PUSHPENDER KUMAR, MEMBER.

                   MS. ANAMIKA GUPTA, MEMBER.

                  

Present:       Sh. P.S.Sharma, counsel for complainant.

                   Sh. Tarun Mehta, counsel for OP Nos.1 & 2.

                   Sh. Narender Sharma, counsel for OP No.3.  

ORDER

 

                   Brief facts of the present complaint are that on 14.02.2015 at 11.25 P.M. the complainants had taken Smt.Bhupinder Kaur (wife of complainant No.1 and mother of complainant No.2) to the OP Nos.1 & 2 due to chest pain for treatment where she was got admitted on the advice of Op No.2 and ECG was conducted at around 11.30 P.M. besides several other tests to ascertain the problem.  Thereafter, OP No.2 told that it was cardiac arrest and she needed medication with assurance that the hospital is fully equipped with all facilities to deal with such like cases. The Op No.2 started treatment of Smt.Bhupinder Kumar at 11.40 P.M. and gave injection of streptokinase at about 11.45 P.M. and thereafter left the hospital premises within 5 minutes by saying that she would be OK. The patient felt uneasiness   and the complainants brought this fact to the staff of the hospital but the staff only did ECG 2/3 times and the doctor did not visit the hospital. Blood started oozing out from her mouth and she also suffered vomiting followed by hypertension. The staff and doctor were intimated about the deteriorating condition of the patient but the Op No.2 did not visit the hospital, however, the staff had given two injections to the patient but her condition could not improve. The Op no.2 visited the hospital at 7.30 A.M. of 15.02.2015 and told that the condition of the patient is not normal and she requires to be referred to MAX Hospital, Mohali. At the request of the complainants the patient was referred to FORTIS Hospital but OP No. 2 could not disclose that she had a chat with Dr.Saxena of MAX Hospital Mohali. The OP No.2 asked for arranging the ambulance, therefore, complainant No.1 asked the driver of ambulance but he refused by saying that he was booked by OP No.2 for visiting MAX Hospital, Mohali. The patient was taken to MAX Hospital, Mohali where she was admitted at 12.55 PM after her discharge from the hospital of OP No.2.She was diagnosed to have pericardial Temponade. Pig Tail catheter was placed and about 3.5 litter of blood stained fluid was drained. She was put on IAPB support besides ventilator support but she failed to revive and ultimately died on 15.02.2015 to 6.15 P.M. due to acute AWMI thrombolyzed with streptokinase in OP No.1 i.e. hospital of OP No.2. The Op No.2 was in touch with doctor of MAX hospital and even thereafter her discharge he was in constant touch with the said doctor as he was well aware about his carelessness, negligent and deficient act and due to his unprofessional attitude Smt.Bhupinder Kaur lost her life.  Had there been full facilities in the hospital alongwith experienced staff then the life of patient could have been saved but the Op No.2 did not bother to  attend the patient properly for 10 hours despite time and again requests made by the complainants and thereafter advised to take the patient for treatment at MAX hospital on 15.02.2015 . The complainants got served legal notice upon the OPs for unprofessional misconduct/ negligence for making compensation on account of death of Smt.Bhupinder Kaur but to no avail. In evidence, the complainants have tendered joint affidavit Annexure CA and documents Annexure C1 to Annexure C15 (6/1 to C-6/2, C7- to C-7/3, C8 to C11,C12/1 to Annexure C12/7).

2.                Upon notice OPs appeared and contested the complaint by filing separate replies. OP Nos.1 & 2 in their joint reply have submitted that the present complaint is clear case of exploitation by an unscrupulous person against the medical practitioner who have spent years in building his reputation. The complainants have not come to this Forum with clean hands. The patient was brought in hospital in emergency with complaint of chest pain & profuse sweating for last about ½ hours. She was attended immediately being suspect impending heart trouble and accordingly 12 lead ECG was done which confirmed the diagnosis & the attendants were intimated about her heart-attack. Simultaneously with admission investigations viz. Hb, TLC, DLC, Blood Sugar, Blood urea, Serum Creatnine etc. were done and the patient was given Tab-Disprin, S/L Sorbitrate 5 mg.  Treatment was started immediately after admission and she had episode of sustained VT (i.e. Ventricular Tachycardia) which was managed with I/V Cardorone-150 mg stat. and as per standard medical protocol she was put on monitoring with oxygen and I/V line. If VT is allowed to continue it may lead to VF (Ventricular Fibrillation) & cardiac arrest. The hospital of Op No.2 is newly built having well equipped facilities with trained technicians with neat and tidy atmosphere. The Op No.1 is a qualified medical practitioner. It has been further submitted that since the patient’s chest pain did not subside with the treatment coupled with life threatening VT, the patient was thrombolysied after about 45 minutes of her admission with inj.Streptokinase infusion in about 60 minutes of I/V infusion so that blocked artery can open and complication of MI could reduce. The patient remained in stable condition till morning and during this period she was constantly monitored and her vital were checked at regular intervals under supervision of OP No.2. There was no bleeding from any side much less profuse bleeding or haemtemesis i.e. blood in vomit. Necessary check-up and medications were provided to the patient as and when required and there was no complication noticed except for which the patient had suffered and the treatment was given to reduce the trauma. The patient was bound to have an episode of sinus tachycardia with hypotension and the ECG showed ST re-elevation suggestive of re-infarct (i.e. second heart attack), therefore, the attendants were advised for urgent coronary angiography from Tertiary Care Hospital.  The case was discussed with Dr.Sudhir Saxena, DM cardiology and for further management; the patient was referred to MAX Super Specialty hospital having CAG facility after managing low blood pressure of the patient with I/V fluid, supportive care & even arranging the ambulance considering safety of patient & time constraint. It were the attendants who took the patient to MAX hospital and it was their sweet will if they wanted they could have taken her to any other hospital. As per record of MAX Super Specialty hospital the ECG done in said after admission at 12.20 P.M. and the same reveals HR-106/m regular, BP 98/60, oxygen 93 % which shows that the patient had reached in the hospital in stable condition. As per record, diagnosis of pericardial temponade was made at Max Super Specialty Hospital after investigation and fluid from pericardial cavity was also drained. Pericardial tamponade is an type of pericardial effusion in which   fluid, blood, clots, accumulates in the pericardium (i.e. the double walled sac in which the heart is enclosed fills up with fluid faster than the pericardial sac stretch). The MSSH record shows that the patient was treated as per standard line of treatment but unfortunately despite best efforts the patient died in evening. The death of the patient was on account of above stated problem and not due to negligent medical treatment during her short stay in the hospital before referral. The loss of blood was pericardial cavity as about 3.5 ltrs of blood was drained from the pericardial cavity which has collected over a short period of time. The record of MSSH does not indicate any kind of negligence or deficient medical service given to the deceased. There is unprofessional misconduct, deficiency in service and carelessness on the part of Op Nos. 1 & 2. Other contentions made in the complaint have been controverted and prayer for dismissal of the complaint has been made.

3.                Op No.3 in its reply has taken preliminary objections such as cause of action, maintainability, concealment of material facts etc. The complainants by way of this complaint are trying to malign the reputation of a reasonably competent medical expert of his field.  The complainants have failed to get the post mortem of patient Smt.Bhupinder Kaur and no FIR has been lodged with police regarding the alleged negligence of OP No.2. There was no negligence or professional misconduct on the part of OP Nos.1 & 2 and the patient did not loss her life due to carelessness, negligence or deficiency in service and unprofessional attitude. Other contentions made in the complaint have been contorverted and prayer for dismissal of the complaint has been made. In evidence, the OPs have tendered affidavits Annexure RA, Annexure RX and documents Annexure R1 to Annexure R10 and Annexure R3/1.

3.                We have heard learned counsel for the parties besides going through the material available on the case file very carefully.

4.                It is admitted fact that the patient was apparently well till 14.02.2015 and at about 11.25 p.m. she developed chest pain and she visited nearby hospital i.e. OP No.1 for treatment where she was examined and immediately necessary blood investigation and ECG was done and as per ECG and on clinical examination patient was diagnosed as a case of anterior wall extensive myocardial infraction (Ext AWMI) and some medicines were  was given and patient was thrombolised with injection streptokinase as first line of treatment & patient remained in the hospital till next morning upto 11 A.M.

5.                Counsel for the complainant argued that as per the treatment record Annexure C1 to Annexure C3  patient during the stay in the hospital was not taken care properly after initial treatment and was taken care by Para-medical staff only, as per record repeat ECG were done and  doctor/OP No.1 did not attend the patient throughout night and was attended next day morning i.e. on 15.02.2015. Patient was not well and had blood stain vomiting and she remained in distress during stay in the hospital of OP No.1. Next day morning OP No.1 examined her and found her in serious condition and referred the patient to MAX Hospital and counsel further argued that it is clear from the record as Annexure C1 during her stay no cardic ECHO was done neither the attendants were advised for angiography after thrombolisation nor they were advised to shift the patient to higher institute immediately after initial treatment. Even OP No.1 was very well aware that the facility such like Angiography is not available in his hospital and even no facility to deal with the complication of injection streptokinase. It is also clear from the treatment record that Dr.Sudhir Saxena is having tie up with the OP No.1 and his name is also mentioned on  the OPD card Annexure C1 and it is also clear from the above said record patient was referred to the said Doctor who was having consulting transaction with OP No.1. Record of MAX Hospital shows that the patient was diagnosed as a case of hyptertension Altered Sensorium and Acute AWMI thrombolysed  with Streptokinase, pericardial tamponade (Annexure C6/1)  and necessary treatment was given at MAX Hospital as per Annexure C6/1 and Annexure C6/2.  As per the  above said record patient was persistently  draining blood stained fluid in the Pericardial drain above about 3.5 liters of fluid was drained but patient could not survive and died at 6.35 P.M. on 15.02.2015. Learned counsel for the complainant has relied upon case law titled as A.Nageswara Rao Care of S.Appa Rao Vs. E.S.I.Hospital & Anr. 2016 (4) C.P.J. 633 (NC) wherein Hon’ble National Commission has held that  Medical Negligence- Heart ailments- Proper monitoring not done-Patient died- Claim for- alleged deficiency in service- Reimbursement and compensation- Alleged deficiency in service- complaint filed- Partly allowed by District Forum- State Commission allowed appeal- Hence, revision petition before National Commission- Admittedly, patient was suffering from hypertension and heart ailment when she was brought to hospital- Hospital should  have referred her to super specialty hospital where she could be given proper treatment under the care of some specialist in cardiology- On the other hand, they kept the patient admitted in general ward of their own hospital.  He further relied upon case law titled as Chief Medical Officer, Yashoda Hospital Vs. D.Uma Devi & 3 Ors. 2016 (2) C.P.R. 559  wherein Hon’ble National Commission has held that Medical services-patient died after long suffering- Alleged deficiency in service and medical negligence- Propofol  has a narrow therpapeutic window and a small increase in dosage may cause a patient to progress from deep sedation to a state of general anaesthesia- It was an unethical act of OP- In the present case, doctors at OP hospital, area qualified but failed in their duty of care during ERCP procedure as per standard guidelines, propofol was administered without  monitoring an caution- Cardic arrest was not managed properly and patient suffered coma- It is a clear case of medical negligence- Compensation cannot be calculated in a perfect mathematical sense, cannot be precise and accurate, but has to be within certain broad guidelines and within certain broad parameters - Amount of compensation enhanced from Rs.10 lakhs to 47 lakhs.  In case titled as B.R.Saini Vs. Lions Hospital & Research Centre 2017 (2) C.P.J. 98 Hon’ble Delhi State Commission  has held that Medical Services negligence- Brain surgery- Lack of facilities in hospital- Death of patient due to excessive bleeding- Deficiency in service alleged- It is alleged that hospital did not have facility of CT scan- Hospital  should not have conducted the surgery on the head of the deceased- Held, hospital is liable for negligence and deficiency in services.

                   On the other hand, learned counsel for the Op No.1 has argued that OP-hospital has done proper treatment on the patient and they have even referred her to Max Super Specialty Hospital, Mohali where she was examined by a qualified cardiologist and she was given further treatment. It has been further argued that  as per record of Max Super Specialty Hospital submitted by the complainant before this Forum Annexure C-5, Annexure C-6/1 to C-6/2, C7- to C-7/3, C8 to C11,C12/1 to Annexure C12/7, ECG done in the said hospital after admission at 12.20 P.M. reveals HR-106/m regular, BP 98/60,Oxygen 93 % show that the patient had reached in the hospital in a clinically stable condition and was treated for pericardial temponade and fluid from pericardial cavity was also drained but unfortunately despite best efforts, the patient died at Max Hospital in evening.   The doctors did their duty at the best ability but they cannot change the destiny.  The death of patient was on account of pericardial temponade i.e. collection of fluids etc. in pericardium due to rupture in LV cavity which consequently leads to anemia (low Hb), cardiogenic shock & cardiac arrest but was not for any wrong or negligent medical treatment during her short stay in the hospital of the O.P. No.2 before referral was mentioned in reply Annexure C-13. It has been further argued that there is no expert evidence to prove negligence and deficient service provided to the patient by the OP No.2. In support of these arguments learned counsel for the Ops have placed reliance of case laws titled as Agarulakshmi Rajyam Vs. K.Sudhakara Rao (Dr.) II (2007) CPJ 240 (NC),  Upasana Hospital Vs. S.Farooq II (2007) CPJ 235 (NC), Swati Parkash Patil Vs. Kiran Raja Ram Vanarse (Dr.) II(2007) CPJ 403 and Kusum Sharma Vs. Batra Hospital & Medical Reserch Centre 2010 (1) CPJ 29 (SC).

From the above said record we found that OP No.1 should have refer the patient to higher institute after thrombolisation since the patient was not well and ECHO and angiography should have been done but such facilities were not available in his hospital. If it is presumed that all the facilities were available in the hospital even then the treatment record itself depicts that the treating doctor has not taken care in looking after the patient by using the available facilities in the hospital.

It was the duty of the OP No.1 to refer the patient at the nearby place having such type of facilities or to refer the higher institute for better management. Had he attended the patient regularly and referred the patient in time to the higher institute where such type of facilities are existing, life of the patient could have been saved such type  of complications i.e. Pericardial tamponade with severe anemia would not have developed. Due to excessive blood loss her hemoglobin had fallen to the level of 3.7 gm as mentioned in the Annexure C6/2 (i.e. treatment record of MAX Hospital). The counsel for the complainant had drawn our attention towards the literature regarding side effect of the Streptokinase-injection. We have pursued the literature, it is clearly mentioned that after injecting the above said injection, treating doctor  should have notice the effect of the above said injection.

                    Counsel for the complainant relied upon  the law laid by  by Hon’ble National Commission in case title as Tarun Thakore vs. Dr. Noshir M. Shroff (OOP No. 2015/2000 dated 24-09-2002) wherein the National Commission made some observation about the duties of doctor towards his patient. From those observations it is clear 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 the treatment.

                    We have also gone through the judgment delivered by Hon’ble Apex Court in case titled as “V. Kishan Rao vs. Nikhil Super Speciality Hospital& Another” 2010 (2) RCR Civil 161, Whereby in para No. 47, Hon’ble Supreme Court is held that in a case where negligence is evident, the principle of res ipsa loquitur operates and the complainant does not have to prove anything as the thing (res) proves itself”. In such a case it is for the respondent to prove that he has taken care and done his duty to repel the charge of negligence.

                              Law laid down by the Hon’ble Apex Court in case titled as “V. Kishan Rao vs. Nikhil Super Specialty Hospital& Another” 2010 (2) RCR Civil 161, wherein claim of the complainant cannot be rejected on the ground that the expert witness not examined to prove negligence of doctor –it is not required to have expert evidence in all cases of medical negligence. In the present case res ipsa loquitur principle is applied.

7.                          In view of the above discussion, we are of the considered view that OP No. 2 i.e Dr.Sant Ram Arora was in negligent to perform his duty as he has failed to take care in the administration of the treatment of the patient.

                             Now we are coming on the point of quantum

8.                          As far as compensation part is concerned, wife of complainant No.1 and mother of complainant No.2 died due to the negligence on the part of the treating doctor. Counsel for the complainant has relied upon the judgment of the Hon’ble Supreme Court of India in case titled as Lata Wadhwa Vs. State of Bihar ii (2001) ACC 316 (SC) SLT 826.

                             It is true that the claimants who ought to have given data for determination of compensation, did not assist in any manner by providing the data for estimating the value of services rendered by such housewives. But even in the absence of such data and taking into consideration the multifarious services rendered by housewives for managing the entire family, even on a modest estimation, should be Rs.6,000/- per month and Rs.72,000/- per annum.

                             It is admitted fact that the deceased lady was 61 years old as per the treatment record Annexure C1. The complainant Sukhdev Singh has lost his life partner in the age when he was in need of assistance of his partner and his life in the absence of life partner become solitary. Although there is no any reliable evidence with regard to income of the deceased value of the gratuitous services rendered by the deceased were taken Rs.6,000/- per month and applying the multiplier as per the  Motor Vehicle Act, 1988 as per the judgment passed by Hon’ble Supreme Court of India in case titled as Sarla Verma and others Vs. Delhi Transport Corporation, Civil Appeal No.3482 of 2008 decided on 15.04.2009. Accordingly, we accept the complaint of the complainants with cost which is assessed at Rs.5,000/- and loss of the dependency in this case as Rs.2,40,000/-  (Rs.4,000 x 12 x 5) on account of service being rendered by the deceased to the complainants alongwith sum of Rs.10,000/- on account of love and affection and addition a sum of Rs.20,000/- to complainant No.1 on account of loss of consortium. Besides an amount Rs.1,38,711/- (As per annexure C-10, Annexure C11 and Annexure C12/1 to Annexure C12/7) spent on the treatment of the patient at MAX Hospital alongwith interest @ 9 % per annum from the date of filing of the complaint till its realization. Thus, the complaint of the complainant is accepted and admittedly OP Nos. 1 & 2 are insured with the OP No. 3 as per Professional Indemnity Insurance Policy (Doctor) as Annexure R3/1, therefore, OP No.3, being insurer, is directed to pay the awarded amount and to comply with the following directions within a period of 30 days from the date of receipt of copy of this order:-

1. To pay an amount of Rs.1,38,711/- along with interest @ 9 % per annum from the date of filing of complaint till its realization.
2. To pay Rs.2,40,000/-  (Rs.4,000 x 12 x 5) service being rendered by the deceased to the complainants alongwith sum of Rs.10,000/- on account of love and affection and addition a sum of Rs.20,000/- to complainant No.1 on account of loss of consortium within 30 days failing which this amount would carry 9 % interest for default period till realization.

 

It is made clear that all the relief except the relief qua Rs.20,000/- on account of loss of consortium would be shared by both the complainants in equal share. Copy of this order be supplied to both the parties free of costs.  File be consigned after due compliance.

 

ANNOUNCED ON:      11.12.2017

                        

                           

(PUSHPENDER KUMAR)     (ANAMIKA GUPTA)      (D.N.ARORA)

MEMBER                                MEMBER                      PRESIDENT