Before the District Consumer Dispute Redressal Commission [Central], 5th Floor ISBT Building, Kashmere Gate, Delhi
Complaint Case No.81/25.03.2015
C1: Mrs. Harbhajan Kaur Chadha w/o late Narender Pal Singh,
C2: Mr. Gurpreet Singh Chadha s/o late Narender Pal Singh,
Both resident of A-3/207, Janakpuri, New Delhi
C3: Mr. Raman Chadha s/o late Narender Pal Singh
[resident of A-3/207, Janakpuri, New Delhi]
Presently residing at- 77 A, Carlyle Avenue,
Southall UBI 2 BJ, U.K. ...Complainants
Versus
OP1: Sir Ganga Ram Hospital, through its Chairman,
Rajender Nagar, New Delhi-110060
OP2: Dr. TBS Buxi, c/o Sir Ganga Ram Hospital
Rajender Nagar, New Delhi-110060
OP3: Dr. Sumit Ray, c/o Sir Ganga Ram Hospital
Rajender Nagar, New Delhi-110060
OP4: Dr. Sumit Ray, c/o Sir Ganga Ram Hospital
Rajender Nagar, New Delhi-110060
OP5: Dr. Anil Arora, c/o Sir Ganga Ram Hospital
Rajender Nagar, New Delhi-110060
OP6: Dr. Aslam, c/o Sir Ganga Ram Hospital
Rajender Nagar, New Delhi-110060 ...Opposite Parties
Order Reserved on: 19.12.2022
Date of Order: 05.04.2023
Coram: Shri Inder Jeet Singh, President
Shri Vyas Muni Rai, Member
Ms. Shahina, Member -Female
Vyas Muni Rai
ORDER
1.1: The present compliant has been preferred by Mrs. Harbhajan Kaur Chadha, (complainant no.1), Mr. Gurpreet Singh Chadha (complainant no.2) and Mr. Raman Chadha (complainant no. 3) [ respectively legal heirs- wife and sons - of the patien- Narender Pal Singh , since deceased]. The complainants no. 2 and no.3 have given authority to their mother/complainant no. 1 to sign the complaint and to do other acts & deeds for and on their behalf (copy of authority letters are Annexure-A to A1). The complainants plead, that medical record of the deceased, is voluminous and runs into 100 of pages, however, relevant medical record and documents of the treatment are filled in order to show against OPs the deficiency of service and discrepancy in giving treatment to the patient. It is also requested to file other record with leave of Commission.
1.2: In the body of the complaint, the complainants allege discrepancy and deficiency in providing proper medical services (treatment and care) to the patient Narender Pal Singh, when he was in the hospital of OP1 for Adenocarcinoma stomach. OP1, its doctors and staff were negligent and careless in treating the deceased.
1.3: The deceased was admitted in the hospital of OP1 on 01.02.2013 for the purpose of CT scan, as he was complaining pain in abdomen and was under treatment of Dr. Sumit Ray [OP3, also arrayed as OP4]. The doctor wanted to ascertain spread of cancer tissue in abdomen area of patient (since dead). The admission of patient in hospital was on 01.02.2013, it is admitted fact by the OPs, even ICU initial evaluation report dated 01.02.2013 ( its copy is Annexure- B to B3).
1.4: The complainants also plead that the deceased underwent CT- scan and he got allergic reaction due to intravenous administration of radio opaque dye which is necessary to find out the spread of carcinoma, following which the patient got restless and unconscious (as per his attendants).
1.5: Further, when the patient was being taken to the CT scan room for test, he was not accompanied by any radiologist or doctor, even during the process of scan. During process of scan, the deceased felt discomfort in breathing and short of breath, but the technician in attendance paid no heed to the condition of patient and continued the procedure of scan. The hospital administration admits the fact that the patient got cardiac arrest (as per casualty card no. 294 dated 01.02.2013). The casualty card reads as ‘code blue attended’ which means that the deceased had suffered a cardiac arrest. The ICU Initial Evaluation Report dated 01.02.2013 evidences that deceased suffered cardiac arrest on the same day and the progress notes also shows that the deceased had come for scan, he became unconscious after administration of contrast, then shifted to casualty and intubation (Annexure B to B3). The casualty report dated 01.02.2013 also mentions that the CPR (or cardiopulmonary Resuscitation) was administered as per the AHA Protocol 2010. The casualty report also states that deceased never recovered from cardiac arrest. (Casualty card dated 01.02.2013 is Annexure C to C1).
1.6: In the aforesaid condition, the immediate treatment procedure recommended by Directorate of Health Services, Thiruvananthapuram with regard to providing quality assurance in the healthcare and guidelines for attending such medical emergency and management of patient should have been followed but it was not done so. The directions and guidelines of Secretary Health in SMO conference held on 31.01.2014 for the staff and doctors of the hospital is called Code Blue. (Code Blue is an event of utmost emergency, a mode of alerting all medical, nursing, para-medical and allied healthcare services and other personnel). The scope of Code Blue is to provide immediate life saving measures in case of life threatening emergencies like cardiac arrest, respiratory arrest, drugs allergy, poisoning etc. and surgical emergency like shock, etc. and every health care institutions were instructed to form a 'Code Blue Committee' which will form a Code Blue Team, which includes a doctor on duty, nurses on duty, doctors trained in Advanced Life Support, nurses trained in Advanced Life Support/ basic life support (copy of "Circular dated 24.02.2914, containing- Guidelines and recommendations of the conference on Code Blue held on 31.01.2014" -is Annexure-D to D3)
1.7: It is also stated in the complaint that when the said patient was being taken to ICU, he virtually collapsed on the CT scan table, as the deceased was left on the mercy of technician , he was not even accompanied by any doctor during the process of scan. It took 08 to 10 minutes in transporting the patient to the ICU on the trolley, the delay of 10 minutes has caused heavily in such state of emergency.
1.8: The patient-deceased was breathless after the scan process on 01.02.2013, but he was put on ventilator only on 02.02.2013, which shows the apathy of OPs and its staff (consultant visit chart dated 02.02.2013 is Annexure E to E1). The patient-deceased was not even afforded first aid in CT scan room and delay on the part of the hospital staff in responding to such medical exigency proved very fatal to him as it caused major hypoxic damage. The progress notes dated 06.02.2013 written by Dr. P. Sharma confirms that patient-deceased suffered from hypoxic damage (copy of progress report dated 06.02.2013 is Annexed as F to F1 to complaint).
1.9: The complainants allege that the medical literature of Cardiac Surgery India [downloaded from internet is Annexure- H to H2] leads that patient did not receive cardiopulmonary resuscitation for long and Code Blue Protocol was also not followed properly, which caused hypoxia leading to vegetative state because of which the deceased went into comma.
1.10: The complainants are feeling aggrieved and they allege that there is careless and negligent behavior of OP1 and its staff. The relatives of complainants also wrote complaint on 14.02.2013 to the administration of OP1/hospital about conditions of the patient-deceased. The was received by them, including OP1; it was followed by a reminder dated 23.03.2013 for urgent attention in the matter.
1.11: The patient finally succumbed to death on 27.03.2013 as OPs failed in providing effective medical care, they failed in practicing due care and diligence in treating him, they also failed to follow Code Blue and he was also not put on ventilator in time, which worsened his condition and resulted his death.
1.12: The deceased underwent treatment in the hospital of OP1 for 55 days and all the bills were waived off and dead body of the deceased was handed over to complainants. One of the bills issued (at page 50) by the OP1 appended a note “this is cumulative return slip for this prescription . This shows all the medicines returned so far as prescription no. 11303080041 and supersedes all the returned slip issued earlier”. This note has been written on all the bills further issued by OPs (copy admission/discharge note & pharmacy return slip are Annexure K to K2).
1.13: The complainants also pleaded that except initial advance payment of Rs.1,40,000/-, no other amount was ever demanded by the OP1 nor paid by the complainants and dead body of the deceased was released by OP1 without asking any further bill (advance statement of bill dated 07.02.2013 is Annexure-J). The bills amount was waived off by OPs because of complainants' complaint of negligence and deficiency in service to the management and the administration of OP1/hospital.
1.14: Last paragraph of the complaint is prayer clause, wherein, the complainants have prayed to direct OPs to refund of Rs. 1,40,000/- along with 18% interest pa from the date of payment made till the amount is realized by the complainants, they have also claimed Rs.18,00,000/- as compensation for loss of life of the deceased, for mental and physical agony and harassment suffered by complainants due to deficient services of OPs besides Rs. 51,000/- as litigation costs.
2.1: OPs have filed a composite/joint reply under the signature of Dr. Suchita Kathoch, Medical Superintendent (Officiating), Sir Ganga Ram Hospital on behalf of OP1, Dr. T.B.S. Buxi (OP2), Dr. Sumit Ray (OP3 and also OP4), Dr. Anil Arora (OP5), it is not authored by OP6 nor separate reply was filed by him, although all of them are being represented by Sh. Dinesh Chander, Executive Legal and by common Counsel. The reply is supported by affidavits of Dr. Suchita Kathoch, Medical Superintendent, Dr. TBS Buxi, (Managing Director), Dr. Sumit Ray, Vice Chairperson and Senior Consultant and of Dr. Anil Arora, Chairperson and the consultant of the OPs hospital. The reply of OPs have been filed under two heads i.e. (1) Preliminary Objections and (2) Reply on Merits. In the composite reply of OPs, they have denied each and every averments and allegations made in the complaint, save and extent to what is specifically admitted. The complaint is devoid of cause of action as the complainants have neither suffered any loss nor has been able to point out any deficiency in services of OPs. The complainants do not come under the purview of Consumer Protection Act. The complainants have not come to this Commission with clean hands and have deliberately concealed material facts to abuse the process of law.
2.2: The averments in the complaint are wrong, frivolous, vexatious and baseless. In para no. 8 of preliminary objections, of their reply, OPs have also cited Ms. Shantaben Mulji Bhai Patel and Ors. Vs Beach Candy Hospital and Research Center and Ors., 1 (2005) CPJ 10 (NC) “the doctors have performed their duties to the best of their ability and with due care and caution. It cannot be held that there is a deficiency in service, simply because something goes wrong, conclusion of deficiency cannot be drawn” and in Achutrao Haribhau Khodwa vs State of Maharashtra and others, 1 (1996) CLT 532 (SC) it was held, courts would indeed be slow in attributing negligence on the part or a doctor if he has performed his duties to the best of his ability and with due care and caution. Medical opinion may differ with regard to the course or action to be taken by a doctor treating a patient, but as long as a doctor acts in a manner, which is acceptable to the medical professional and the court finds that he has attended on the patient with due care, skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold doctors, guilty of negligence.
2.3: Further, the patient was known case of carcinoma stomach and OP4 referred the patient for CECT abdomen. The total scanning time for CECT test in such patients is between 10 to 14 seconds. The patient then complained of breathlessness and he was immediately shifted to Casualty on trolley. CMO on duty was informed and Code Blue was initiated and Senior Resident, (Critical Care Medicine) attended the Code Blue in less than three minutes. CPR was already being administered to the patient by the CMO on duty. Patient had already been intubated by the CMO on duty and put on mechanical ventilation. After the patient developed acute breathlessness after the CECT scan for which Code Blue was immediately attended by the critical care team, the patient was then admitted to ICU under Dr. Anil Arora on 02.02.2013 at 02:00 AM.
2.4: OPs denied that the patient got allergic reaction due to the intravenous administration of radio opaque dye or patient got restless and then unconscious. However, doctors remain on duty at all times in the radiology department. Although presence of a doctor at all times during scanning is not deemed necessary even by an institution as respected & reputable as Royal College of Radiologist. It has also been denied that patient was not revived, as alleged by the complainant, since the patient remained in ICU till 27.03.2013, after having the cardiac arrest on the night of 01.02.2013-02.02.2013.
2.5: The complainants were requested repeatedly to make the payment towards the treatment provided to the patient but the complainants failed to make the payment. The complainants met the Chairman, Board of Management and requested for waiving off the balance bills, as they were unable to make payment due to their financial constraints and on their request, Chairman, Board of Management waived off the balance bill amounting of Rs. 16,09,213/- as they were unable to make the balance payment. Although on 07.02.2013 the due bill amount was of Rs.1,88,330.95/- .The complainants were requested to make the payment of Rs. 54,000/- on running bill basis but it was not paid. OPs deny complainants' plea that hospital authority never demanded payments from complainants. OPs also deny receipt of legal notice. OPs request to dismiss complaint with heavy cost.
3. The complainants filed rejoinder to the reply of OPs, wherein, it has been submitted that OPs have not produced any documentary evidence to prove that Code Blue was attended in less than 3 minutes, no document has been filed by OPs as to how much time it took to shift the patient/ (since deceased) from CECT room to the casualty. The Code Blue should have been attended in the CECT room itself, when the patient had a cardiac arrest but the same was attended in the casualty being admitted fact by the OPs. The case law cited by OPs in reply have different facts and they are not applicable to the present case. It has also been submitted that the intubation and positive pressure ventilation should have been undertaken at the very place of occurrence of cardio arrest, which was not done and considerable precious time was wasted, as the patient was put on ventilator only on 02.02.2013. Rest of the contents of the rejoinder are reaffirmation of the contents of the complaint. The complainants also deny the contention of the OPs that the complainants met the Chairman of the Hospital Management for waiving off bills amount, the complainants were never called or met the Chairman for waive off the bills amount. The complainants reaffirm their plea of initial payment of Rs.1,40,000/- and then thereafter demand of Rs.54,000/- was but complaint was made against to the hospital authority.
4.1. Both the parties have filed their affidavits for evidence. The complainant no. 1 has filed evidence by way of affidavit for all the complainants, it is based on the contents of complaint and documents filed therewith.
4.2. On behalf of the OPs, evidence by way of four affidavits have been filed under the signatures of Dr. Sunita Sunda, Medical Superintendent (officiating), Sir Ganga Ram Hospital (OP1), Dr. TBS Buxi (OP2), Dr. Sumit Ray, Vice-Chairperson and Senior Consultant (OP3, also OP4) and of Dr. Anil Arora, Chairperson and Senior Consultant (OP5). The contents of affidavits are on the lines of reply of OPs. However, there are specific facts of dates and timing are also mentioned in the affidavits, which will be discussed at appropriate stage.
5: After evidence of parties, the complainants and the OPs have also filed their respective written arguments, besides oral submissions on their behalf.
6.1: We have considered the rival contentions and case of each party, their evidence and documents, in addition oral submissions by counsels on behalf of the parties. The complainants has also referred, a circular about the Blue Code with plea of its non-compliance by OPs, it will be referred and on the OPs have also equally emphasized about compliance/attendance of Blue Code. All the relevant points and contentions will be discussed at appropriate stage.
6.2.1. Moreover, this Commission by its proceedings dated 10.05.2016, followed by letter dated 16.05.2016, sought medical expert opinion from LNJP Hospital. The medical expert opinion of 23.08.2016, was received by letter dated 29.08.2016 [recorded in proceedings dated 13.10.2016] under the signature of Dr. Vikas Rampal, Deputy Medical Superintendent (OPD)/Chairperson Medical Board, LNJP Hospital, it concludes as under:-
"1. All the doctor involved in the treatment of the patient were qualified in their respective specialty.
2.As per the record received, the Committee did not find any evidence to suggest that wrong treatment was provided to the patient nor was there any negligence on the part of the treating doctors.
3.The documents provided in the petition and obtained from the hospital authorities don't reveal any evidence of negligence on the part of the opposite party."
However, the complainants filed objection to such report but OPs opted not to file reply to complainants' objection on expert opinion (as per proceedings dated 12.12.2017). The complainants' objections are that the expert opinion is based on extraneous documents, which are neither on record of the Forum nor in the knowledge of the complainants, therefore, the report. is vitiated and biased as the members of the medical committee have directly interacted with the OPs; if the medical Committee required some documents from the OPs, request should have been routed through the Hon'ble Commission. The complainants relies upon precedent C.A. no. 6619/2016 of Maharaja Agrasen Hospital & Ors. Vs Master Rishabh Sharma & Ors. with Civil Appeal No. 9461 of 2019 titled Pooja Sharma & Ors. vs Maharaja Agerasen Hospital & Ors., by referring paragraph 11.3.2, which is as under:
"It is well-settled that a court is not bound by the evidence of an expert, which is advisory in nature. The court must derive its own conclusions after carefully sifting through the medical records, and whether the standard protocol was followed in the treatment of the patient. The duty of an expert witness is to furnish the court with the necessary scientific criteria for testing the accuracy of the conclusions, so as to enable the Court to from an independent opinion by the application of this criteria to the facts proved by the evidence of the case. Whether such evidence could be accepted or how much weight should be attached to it is for the court to decide."
6.2.2. The medical expert opinion forwarded are just conclusions of the Board, but it does not mentions reasons, which convinced to make such conclusion. Apart from the material actually seen, assessed and considered by the Board is also not mentioned generally or specifically in that letter. What is reported and opined is based on such undisclosed papers and no name of an individual, either from complainants or staff of hospital or else is mention who was called, heard and inquired to explore the circumstance. Since, the report by expert is without reason as well as does not depict, what material was actually considered, therefore, the report cannot be considered for adjudication of this complaint either in favour or against of either side. This Commission will evaluate the material on record of this file independently.
6.3: Before discussing the factual matrix of cases on point of services or deficiency of services or other aspects, some allied issues are raised, let them be taken first. They are being taken.
At the outset plea taken by OPs in the preliminary objection is that complaint is devoid of cause of action as complainants has neither suffered any loss nor has been able to point out any deficiency in the service, complainants do not come under the purview of the Consumer Protection Act, the complainants have not come to this Commission with clean hands and have deliberately concealed material facts. This is opposed by complainants on the basis of narration of allegations in complaint.
In this regard bare perusal of the pleadings of complaint and documents filed with the complaint, it is admitted facts that patient reported to OP1/hospital for CECT test on 01.02.2013, then he was admitted & treated in the hospital, the complainants had their grievances about poor condition of patient and treatment being met out, the patient did not survive at end, he died on 27.03.2023 in ICU of the hospital. Thus complainants [being legal heirs/ LRs of deceased] are covered u/s 2(b)(v) of Consumer Protection Act, 1986, as the services of OPs were availed being consumer. OPs failed to establish as to what material facts have been concealed by the complainants or how it does not disclose cause of action for the complaint. It is competent complaint. The issue/objection raised stand answered.
7.1. First of all, it is relevant to mention about some terminologies or abbreviation appearing in the case of parties, it will make convenient to appreciate their respective plea.
(i) 'Causality or Emergency Department of hospital' - where all patients, require immediate attention and treatment, are brought in emergency, where doctors, medical staff remains available for prompt attention, treatment and necessary medical services, it remains open 24 hours, subject to exception. Generally, it is distinguished from OPD and IPD services.
(ii) "Intensive Care Unit (ICU)" is also a unit in the hospital, where critical sick, ill and injured patients are provided intensive care by especially trained medical personnel, having infrastructure of continuous monitoring and life support.
(iii) ' CT Scan/X-ray/MRI/ unit' is that place, where images of patient are taken under radiation protective cover, ordinarily it is also called 'Laboratory!
(iv) "CECT"- is abbreviation for Contrast Enhanced Computer Tomography" and CECT-abdomen is CT scan of the abdomen with contrast material, being a method for detecting abdominal pain, suspected cancer, kidney or gall bladder, stones etc. (v) "CPR"- stands for 'cardiopulmonary resuscitation', which is a life saving technique in emergent situations of heart-attack or when breathing or heart-beat is stopped.
(vi) "IPPV" Intermittent Positive Pressure Ventilation, is a technique to provide large breaths to patients (either manually or ventilating/mechanically), large respiratory pressure are administered, delivery of airflow is triggered.
(vii) "Intubation" - to insert and placing a breaking tube through mouth into trachea for ventilation.
(viii) 'Ventilator" - is a breathing machine that takes over the work of breathing and increases the oxygen level in the patient's blood.
(ix) "hypoxic "- hypoxic is low level of oxygen in body tissues. Its symptoms are restlessness, difficulty in breathing, rapid heart rate and bluish skin. In the absence of enough oxygen, the vitals brain, liver and other organs can be damaged.
7.2. The sequence of events are patient Narender Pal Singh was in the hospital of OP1 and he was taken to Laboratory for CECT abdomen test, then he was shifted to causality and lastly in ICU of the OP1/hospital. When the patient was being conducted CECT abdomen test, after the test was complete, he felt breathless in CT scan department, then he was taken to Causality, he was revived and then shifted to ICU.
7.3.1: However, parties have other rival plea, as complainants have grievances of negligence as well as deficiency of services, which are opposed by OPs. The complainants' grievances is that the patient was not put on ventilation immediately in CT scan room, which confirms in doctor's examination chart of 02.02.2013 [Annexure-E/page 22] showing instructions 'initiation of ventilation' but without mentioning the timings. This shows that patient put to ventilation first time on 02.02.2013, whereas he needed ventilation earlier on 01.02.2013 itself, when be become unconscious,. Thus, instead of putting patient on ventilation on 01.02.2013 for his critical care, he was shifted to Casualty (Annexure-B/pages16-17 and Annexure-E/pages 22-23). Had there been timely attendance of doctor during CECT test, medical attendant while patient became restlessness and breathlessness and the timely ventilator on 01.02.2013 by following the Blue Code, then patient would have survived, there were poor services. The complainants also refer circular dated 24.02.2014 issued by Directorate of Health Services, Thiruvananthapuram "Health Services Department- Quality Assurance in Health Care- Code Blue- Guidelines for the Emergency Management of Patient in Institutions under Health Services Department; the relevant part of the said circular is reproduced as under:-
"All health care institution should recognize the importance of managing the emergency situation in the hospital settings. "Code Blue" is generally used to indicate a patient requiring resuscitation or otherwise in need of immediate medical attention, most often as the result of a respiratory arrest or cardiac arrest. Code Blue is an event of utmost emergency, a mode of alerting all medical, nursing, paramedical and allied health care services and other personnel. The use of codes is intended to convey essential information quickly and with minimal misunderstanding to staff, while preventing stress and panic among visitors to the hospital.
2.xxx
3.xxx
4. A code blue committee shall be formed in all health care institutions. The members of the Code blue Committee in Small Health Care Institutions like PHC and CHC includes all staff involved in patient care. The member of the Code Blue Committee in higher hospitals includes Superintendent, Physician, Surgeon, Anesthesiologist, Gynecologist, Cardiologist, Pediatrician, Staff nurse etc. The superintendent or Medical Officer in charge of the institution will nominate one doctor as convener of the Code Blue Committee. The Code Blue Committee shall meet at least once in 3 months. Any requirement and deficiencies shall be communicated to District Medical Officer or appropriate authorities. The minutes of the committees shall be documented. The Code Blue Committee shall prepare Code Blue manual for the institution and shall be updated at least once in a year.
5. The institution shall have a code blue team. Code blue team members includes doctors on duty, nurses on duty, doctors trained in Advanced Life Support, Nurses trained in Advanced Life Support/ Basic life support. The code blue team shall be constituted by the Code blue Committee of the institution."
7.3.2: On other side, OPs' contention is that in their reply to complaint as well as in evidence of OPs with documents, it is clearly mentioned when patient complained of breathlessness in CT department, he was attended with all care, he was immediately shifted to Casualty and CMO on duty was accordingly informed to take care of the patient immediately and Code Blue was initiated; OP6 (Dr. Aslam), attended the patient in less than 3 minutes as per protocols. The patient was revived out of that episode.
7.3.3: Since, the core situations is confining to, whether or not the patient was given proper treatment or ventilator in time during his breathlessness, or is it result into further complications including heart attack on the same time on that day. For that purposes, the matter needs to be discussed.
The discussion is to be on three points viz (i) when it was place of (i) CT scan department, (ii) Causality and (iii) ICU. The record of Annexure-C [pages 16-17] are pertaining to Causality Department and Annexure-B [pages 12-15] are pertaining to ICU. Annexure-E (pages 22-23] are consultants visits record and Annexure-F [24-25] are progress note/post cardiac arrest, then patient suffered severe hypoxic damage.
8.1. On analysis of evidence and record, it is held that there is no proof of facts or evidence in favour of complainants and against OPs for not attending or giving the timely medical attention to the patient during breathlessness in CT Scan Department/CECT and in Causality, for the following reasons:-
(i). it is proved case of both the sides that patient's CECT was done completely. According to OPI's evidence, it took 10 to 14 seconds in conducting CECT. OP2 says the patient was conscious on completion of scan. Then, the patient complained of breathlessness and later he become unconscious;
(ii) according to complainant, ventilator was not provided then and there in CT scan room, whereas according to evidence of OP1 & OP2, the patient was immediately shifted on trolley from CT scan department to Causality as well as Code Blue was initiated;
Whereas per causality records, CPR was started by Causality Medical Officer on duty, Code Blue team, which include OP6, reached Causality within three minutes. Evidence of OP1 evidences that Blue Code call was attended by OP6 at about 10:30pm/1.02.2013, immediately he rushed to and reached the Casualty within three minutes, where CPR was already being administered to patient by CMO on duty, patient was put on IPPR, he was intubated by CMO on duty, patient was put on mechanical ventilator. OP6 took over from CMO to do chest compressions. The patient was successfully revived within two minutes. Patient was administered the drugs. OP6 also checked the endotracheal tube position and ventilator setting.
(iii). as per evidence of OPs and record of the Causality Card, it is mentioned specifically that 'Code Blue attended'. It also. mentions that 'CPR is being given according to AHA 2010 protocols. OPI's evidence is that the patient was put on IPPV as soon as the CPR was started, which is also mentioned in the Casualty Card. It worked and patient revived. The patient was intubation.
Evidence of OP1 also explains, that only one cycle of CPR had to be given (i.e. two minutes) before the patient had a 'return of spontaneous circulation,
(iv) The pleadings of OPs as well as evidence by OP1, the distance between the MRI/CT scan room and Casualty is 30 to 40 meters, where patient was on trolley immediately,
(v) OP5 also narrates that he had also seen the patient as well as his record of his case in causality on 01.02.2013 at 04:21pm, he was advised admission and investigations. OP5 also narrates for subsequent events that Blue Code was attended by OP6. Later, patient was admitted in ICU on 02.02.2013 at 2:02am under OP5, since patient required intensive care;
(vi) the version of evidence of OP4 is alike OP5. Although, OP6 has not filed affidavit of evidence, but version of other OPs is based on medical record;
(vii) there is no proof that patient suffered cardiac arrest in CT scan table nor the cardiac arrest was due to non-medical attendants;
(viii) the patient was also administered medicine in Causality and then he was shifted to ICU, where he was under other team of doctors including OP5,
(ix) the record, circumstances and evidence of parties referred (i) to (viii) above, do not prove plea of complainant but establish that whatever was required for care and treatment, it was done by OP1, its doctors and staff under the protocols and Code Blue. When OP1 and its doctors & staff followed the protocols, it is enough for standard compliance.
(x) in case any of complainants happens to have not seen the compliances, IPPR or CPR, it does not mean the patient was not taken care of it. It is relevant to mention that in Causality all infrastructure, doctor and staff, medicine remain available to meet the emergent requirements , whereas in CT scan place does not have all such men and material; the grievances of complainant are not tenable.
8.2 There is also no evidence in favour of complainants and against OPs in respect of treatment given to patient in ICU, for the following reasons:-
(a) the patient's admission was in ICU on 02.02.213 at 2:02am under the neurology team under Dr. C.S. Aggarwal,
(b) the ICU record describes the admission as well as patient was received from Causality being post CPR,
(c) as per evidence of OP1, the cardiac arrest happened between the night of 1.2.2013 and 2.2.2013 and there is no other evidence by the complainants. The complainants are drawing inference that for want of ventilator in CT room but CPR, it becomes the case of medical negligence or deficiency of service/ It is not so, since CPR was done and IPPV was put; then intubation;
(d) the patient was revived in Causality on 01.02.2013, then he was shifted to ICU, where he remained under treatment till 27.3.2013 [i.e. for 55 days] but succumb,
(e) the internal progress notes and investigation orders (Annexure-F/page 24-25) are in chronology showing the status of post cardiac arrest, thereafter at later stage of hypoxic damage and so on, and
(f) there is no evidence by complainants to establish the medical negligence or deficiency of service during this phase.
8.3. The complainants do not complains against OPs for deficiency in service or negligence during the phase, when patient was in Causality or in ICU but in the first phase when patient felt restlessness and breathlessness in CT scan room. However, by reading the events in chronologically along-with paragraphs 8.1. and 8.2 above, no case of deficiency in services or medical negligence is made out against OPs since they followed standard procedure and other protocols. The death summary (Annexure-G/page 26) of Narender Pal Singh, died in ICU-ward/bed, enumerates with history as well as the tests/ultra sounds/investigations apart from the status of vitals on the basis of such tests. The complainants could not establish any allegation specifically against any individual doctor arrayed as opposite parties in the complaint. The complainants had alleged that their relative made a complaint to Management on 14.2.2013, however, it has also not been proved by them.
8.4.1: There are rival plea on the point of medical bills, as complainant commands that because of medical negligence, the OPs waive off the huge medical bills but on the other side OPI's evidence explains that during the period when patient is on ventilator in Casualty, the ventilation charges are not billed but for ventilator in ICU are chargeable. The complainants were not having bills amount to pay on 27.03.2013, the bills were settled after discussion with Mr. John Mathew AO (billing) and it was assured by them to pay it on 28.3.2013. The dead body of patient was released to complainants. However, later because of requests of complainants of financial constraints, the balance bill was waive off by the Chairman.
8.4.2: In Admission/Discharge note [Annexure-K ,page-48], three set of noting are appearing. Firstly, the initially noting was over-written but a few words 'on' 'tomorrow' are still visible as they were omitted to be over-written to delete/suppress the original noting. Secondly, noting appearing is 'kindly release the body, bill settled, case discussed with Mr. John Mathew AO (billing). Thirdly, noting is 'Bill waived by Chairman, file may be accepted'. All such noting are without date.
It does not decipher what actually happened, since it does not depict reasons for settlement. No inference can be drawn in favour or against either side, however, admitted situation is .the balance bills were waived off. Moreover, the record of admission/discharge notes [Annexure-K1/pages 49] reflects noting of hospital staff that dead body of deceased was handed over on 28.01.2013 at 1:30am (i.e. mid-night) to relatives of patient.
8.5: The complaint is dismissed. No order as to costs.
9: Copy of this Order be sent/provided forthwith to the parties free of cost as per rules for necessary compliance.
10: It is appropriate to record that this Commission is facing very difficulty in day to day its functioning, for want of regular PA and stenographer, since only one stenographer Gr-III is posted for all work.
11: Announced on this 05th April, 2023.
[Vyas Muni Rai] [ Shahina] [Inder Jeet Singh]
Member Member (Female) President
