DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
(CENTRAL) ISBT KASHMERE GATE DELHI
CC No. 531/2007
No. DF/ Central/ Date
Sh. Rajiv Bansal,
S/o Sh. R.V. Bansal,
R/o C -2/1213, First Floor,
Sector – 16, Rohini,
New Delhi
......COMPLAINANT
VERSUS
Sir Ganga Ram Hospital
Through
Dr. Nalini Kaul
Director Medical
Sir Ganga Ram Hospital,
Sir Ganga Ram Hospital Marg,
Rajinder Nagar, New Delhi – 110 060
…..OPPOSITE PARTIES
Ms. Rekha Rani President
Sh. Vikram Kumar Dabas, Member Mrs. Manju Bala Sharma, Member
ORDER Date: . .2018
Sh. Vikram Kumar Dabas
On 24/05/2007 the complainant was admitted to OP 1 hospital with the complaint of leg pain due to thrombotic arterial disease. It is alleged that the complainant was advised that a minor surgery will be done on him for which 3 -4 units of blood was required to be arranged. He was further told that the expenses on his treatment would be around Rs. 1,00,000/- to 1,25,000/-. It is alleged that the doctors were negligent in post operative care as a result of which he suffered a bleed for which another operation was carried out. The complainant decided to shift to AIIMS but was not allowed to do so until he deposited Rs. 4,69,070/- the extra expenditure on his treatment. Police had to be called in where after he was allowed to leave the hospital. He was admitted in AIIMS on 21/05/2007 and was discharged on 13/06/2007. The complainant has approached the forum for refund of amount of Rs. 1,25,000/- deposited by him at the time of his admission and has further claimed various other sums under different heads.
The complaint has been contested and a reply has been filed on behalf of the OPs, under the head brief facts it reads :
That the complainant was admitted in the casualty of Sir Ganga Ram Hospital on 29.04.2007 at 11:30 a.m. with complaints of sudden onset of pain in lower limbs and calf, followed by weakness of both lower limbs with numbness, in ability to move both lower limbs and no sensation in both the legs upto knee joint since last one day. The patient had a past history of bilateral deep vein thrombosis two years back. He had been advised anticoagulation medicines but he had been taking them irregularly making his blood vulnerable to clotting at any time. The patient also had a history of chronic smoking and chronic alcoholism. The casualty medical officer referred the patient to Neurosurgeon who in turn refereed him to vascular surgical unit. The patient was seen by vascular surgery unit and diagnosed on clinical grounds as “acute thrombosis of femoral arteries”. Patient was administered‘ heparin in the casualty itself. And after initial treatment the patient was admitted in the hospital under 'vascular surgery unit. After stabilizing the patient on the same day evening bilateral embolectomy with left leg fasciotomy to reduce the tension in the muscles of the leg after which the wound is left unstitched so as to decompress the muscles otherwise they would undergo further neurosis. The procedure was done with the consent of the patient and as well as his attendants after duly explaining the course of treatment, the nature of medicine and the risks involved to them. The patient and his attendants were duly explained about the advantages and disadvantages of the procedure which included risks of gangrene of both lower limbs, rhabdomyolysis leading to renal failure. The patient as well as his attendants were informed about approximate expenses of the arterial procedure (Bilateral embolectomy would be Rs. 1,25,000/- and approximate stay in the hospital, if all went without any complication, would be 5-6 days. However it was clearly and specifically told that in case of any complications such as renal failure the duration of the stay in the hospital as well as the expenses would increase considerably. Only after taking the consent the patient was taken up for the surgery. Post operatively there was gradual improvement of perfusion in both the legs, patient had palpable pulses in both the legs. Daily dressing of the unstitched left leg fasciotmoy wound was done as is usual practice and standard of care, which revealed healthy muscles with no hematoma.
Naphrology consultation was sought for reperfusion injury and a diagnosis of ‘’RHABDOMYOLYSIS WITH ACUTE RENAL FAILURE AND HYPERKALEMIA’’ was made. The patient was treated conservatively for HYPERKALMEIA and an attempt was made to maintain urine output with I.V. Fluids and Diuretics. Patient however developed non-oliguric acute renal failure, resulting from infection in the operative fasciotamy wound in the muscle area. The patients renal function continued to deteriorate and he was given heparin free hemodialysis through double lumen subclavian catheter. Patient had uneventful hemodialysis though he had been oozing from fasciotomy wound without any increase during hemodialysis.
On 05.05.2007 the patient developed shock? Septic and was immediately shifted to ICU where he continued to get heparin free slow low efficiency dialysis (SLED). He received hemodialysis on 08.09.2007, and on various occasions as per treatment requirement. The patient however, left against medical advice and absconded from the hospital on 21.05.2007 without permission/information from the doctors or staff of the hospital and without paying the bill amounting to Rs. 4,69,070/- to the hospital.
That during the period the patient remained admitted in the hospital he received various broad spectrum antibiotics, antifungal treatment, anticoagulant and Antiplatelet drugs. The patient had hyper coagulability state as his double lumen catheter got clotted and the AV shunt was repeatedly got clotted and had to be revised once and de-clotted twice, inspite of his being on I.V. heparin for bilateral Ilio-femoral embolectomy. Patient was still oliguric on the day he left the hospital (Urine output of 300 ml/ 24 Hr.). He was advised to continue alternate day hemodialysis. During hospital stay patient received total of 13 hemodialysis, 9 blood transfusion and two units of fresh frozen plasma.
There was gradual improvement in both lower limb movements and sensation. Patient had bilateral palpable pedal pulses. Check arterial dopler revealed good flows in both lower limb vessels. On 13.05.2007 the groin stitches were removed and there was no wound gaping in the groin wounds.
On 11.05.2007, once patient was fully conscious, it was noticed that he was having no movement of right foot. For this neurology consultation was sought and they advised MRI of dorso lumbar spine and nerve conduction studies. However MRI was normal it was diagnosed to be sequlae of thrombosis of ilio-femoral arteries (Ischemic Neuropathy).
The OPs have taken preliminary objections that the complainant has not come to this Forum with clean hands and has suppressed material facts. It has stated that complainant had left the hospital against medical advice when he was still under the treatment without paying the charges of the hospital to the tune of Rs. 4,69,070/-. The OP has claimed that there is no deficiency of service on its part and the complainant was treated as per the standard medical protocol. It has denied any medical negligence on its part in the treatment of the complainant. The OP have contested the complaint on merits and has prayed for dismissal of the complaint.
The complainant has filed his own affidavit dated 01/04/2008 in support of the complaint. On behalf of the OPs affidavit were filed by Dr. D.S. Rana, Dr. A.K. Bhalla, Dr. Nalini Kaul and by Dr. Rajiv Parikh.
We have heard arguments advanced at the bar and have perused the record. It appears from the record that the complainant has lodged a complaint against the OPs with Delhi Medical Council who had passed an order dated 3/12/2008 which inter alia reads as under :
‘’In light of the above, the Delhi Medical Council observes that the patient had B/L lower limb arterial thrombosis and had acute renal failure at the onset of his illness was seen by Nephrologist on 30.04.2007 and regularly following this and managed conservatively till 3rd May, 2007 and as his condition deteriorated with deterioration renal function, he was given haemodialysis on 4th and 5th. He did not receive heparin during dialysis as per records as well as per Dr. A. K. Bhalla. Patient did bleed and had hypotension, oliguria and required large number of units of blood. This most likely was due to sepsis also confirmed by the discharged summary of AIIMS. There has been no negligence on the part of doctors of Sir Ganga Ram Hospital, may be they needed to communicate with the family, better.’’
During the pendency of the complaint this matter was referred to Medical Superintendent Lok Nayak Hospital New Delhi for ex-pert opinion. The Medical Superintendent Lok Nayak Hospital had constituted a board who after examining the medical record had opined as under :-
- The doctors who treated the patient, Mr. Rajiv Bansal were qualified to do so.
- All the management done and treatment given to Mr. Rajiv Bansal during his stay in Sir Ganga Ram Hospital was as per the standard protocol in cases of Thrombotic Arterial Disease (Bilateral ilio- femoral Thrombo- embolism) with Compartment Syndrome in the leg (left leg). Wrong treatment was never given to him.
No act of negligence on part of treating doctor could be found out from the available medical records.
- No record of negligence on part of other OP could be made out.
The perusal of the order passed by Delhi Medical Council and the expert
opinion rendered by a board of doctors of Lok Nayak Hospital as extracted above rules out any case of medical negligence on the part of the treating doctors. The complainant on his part has not examined any medical expert and has also not placed on record any document to prove the allegation of medical negligence. A perusal of the medical treatment record also does not show medical negligence on the part of the treating doctors.
The complainant was admitted on 29.04.2007 with a complaint of pain in both calf and thigh, numbness and weakness in both legs at Sir Ganga Ram Hospital, New Delhi and was diagnosed as a case of Bilateral ileo-femoral embolus with left leg compartment syndrome and Bilateral embolectomy with left leg fasciotomy was performed on him on 29.04.2007 itself. The complainant developed rhabdomyolsis induced ARF. Therefore multiple sessions of hemodialysis, was carried on him and left AV shunt was made to facilitate dialysis. The complainant also received various broad spectrum antibiotics and anti fungal treatment as he developed shock due to speticemia. This was in accordance with standard medical protocol. Thereafter the patient left against medical advice on 21/05/2007. The OPs had followed the standard medical protocol required for treatment of the
patient in this case. We therefore hold that there was no case of medical negligence in the case of the diseased. We are therefore of the considered opinion that this case has no merits. Consequently the complaint is dismissed. Copy of the order be sent to the parties as per rules.
File be consigned to record room.
Announced on this 10th day of May 2018.
