DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

(CENTRAL) ISBT KASHMERE GATE DELHI

CC No. 145/2007

No. DF/ Central/                                                                      Date

1.Yudhishtar Lal Chawla S/o Late Sh. Vasdev Chawla                                                                                                     

2.  Shilpa Chawla D/o Sh. Yudhishtar Lal Chawla

3.  Anuj Chawla S/o Sh. Yudhishatar Lal Chawla

All residents of  F – 99, Naraina Vihar, New Delhi – 28                        

                                                                                                  ......COMPLAINANT

VERSUS

1. Sir Ganga Ram Hospital

    Rajinder Nagar, New Delhi – 110 060

2. Dr. C.S. Aggarwal

    Senior Neuro Surgeon

3.  Dr. Gupta (Full name not known)

     Senior Neurologist

4.  Dr. Anshu Rohtagi

     Neurologist

5.  Dr. Rajesh Acharya

    Consulting Neurologist & Surgeon

    All C/o Sir Ganga Ram Hospital, Rajinder Nagar,

    New Delhi – 110 060

                                                                                          …..OPPOSITE PARTY

Ms. Rekha Rani President

Sh. Vikram Kumar Dabas, Member                                                                      Mrs. Manju Bala Sharma, Member

 ORDER                        Date:      .     .2018

Sh. Vikram Kumar Dabas

           The complainants have approached this Forum with the allegation that the OPs were guilty of medical negligence in the treatment of Smt. Sita Devi Chawla.  The brief facts alleged in the complaint are as under : -

           On 31/05/2004 at about 12 PM Smt. Sita Devi Chawla had a head fall.  She was admitted in the Neurology Deptt. of OP 1 Hospital, on the same day at about 3:00 PM.  The first CT scan of head of the patient did not disclose any brain haemorrhage.  It was found that there was a mild blood clot in the brain.  The doctors diagnosed the patient as case of MCA infarct.  On 4^th June 2004 the patient was examined and was pronounced as out of danger.  The patient was desperately asking for water but as per the advice of doctors the complainants were smearing plain water on her lips.  At about 12 Noon she stopped asked for water complainant which was brought to the notice of the attending nurses.  A request to the head nurse to immediately call the doctor did not bear any fruit and the complainants were told that the doctors were busy in their private OPD.  The patient was checked routinely at about 4 PM and an MRI scan was prescribed.  At about 9 PM a telephone call was given to complainant 1 that there was an emergency and a surgery was required to be performed on her.  Complainant one reached the OP 1 Hospital at about 11 PM.  He was taken to the Operation Theatre where he was told that the patient was in an unconscious state and there is 1% chances of her survival if she gains consciousness after the operation within 3 days.  No reason was given at to what has led to such state of affairs.  An operation was performed on the patient by OP 5.  However, the patient did not gain consciousness after the operation and on 11/06/2004 it was informed that she had gone into coma.  Eventually she breath new last on 25/07/2004. 

           In para 6 of the complaint the complainants have narrated the following facts which according to them establish medical negligence in the treatment of the patient.

1. That blood clot in the brain was quite mild.  The first CT Scan conducted on 31.05.2004 shows there was no brain hemorrhage.
2. That proper procedure of removing the clot by puncturing and

Making the flow of blood normal was not adopted as a firm step was not taken.

3. That lot of time was lost in admitting the patient in the hospital
4. Heavy doses of medicines were administered Continuously for three – four days.  Doctors found some blood in the urine and after seeing traces of blood doctors become aware of the disease and treatment was stopped.
5. That the deceased patient regain consciousness on 04/06/2004 and why she become unconscious on the same date at 12.00 P.M., no reasons

have been given.It is presumed that wrong treatment has been given and necessary steps and precautions were not taken.

6.  That in spite of repeated requests made by the complainants none of the doctors attended her from 12.00 P.M. till 4.30 P.M. as they were busy in private O.P.D.  and not caring for the regular patients who were admitted in the hospital for the last so many days. 
7. That Had the patient attended in between 12.00 PM to 4.30 PM, life of patient could have been saved.
8. That Dr. Rajesh Acharya, Opposite Party No. 5, the Consulting Neurologist and Surgeon who has conducted operation.  On 5^th June, 2004 uttered two times that he has been asked to operate the head at the terminal stage and had he been called earlier to operate the patient life of patient could have been saved.
9. That the MRI Report of Dr. Rajesh Acharya clearly shows that opposite party No. 1 to 4 kept the complainants in dark and have been negligent in treating the patient and have been careless in this matter. 
10. That the MRI report in one of the paras suggest that there was compression effect and this MRI was conducted on 11.06.04, which clearly suggest that the operation has failed but the opposite party have kept the complainants in dark and their assurance that the patient was out of danger was incorrect. 

The complainants have therefore prayed as follows :-

1.      Compensation of Rs. 52.00 Lakhs as prayed for may please be ordered   

To be awarded in favour of complainants against the opposite parties

Jointly and severally.

2.      Interest @ 18% per annum be also awarded on the said amount.
3.      Cost of the application be also awarded.
4.      Any other relief which this Hon’ble Commission may deem fit and

Proper in the circumstances of the case be also awarded.

The complaint has been contested by the OPs.  A written statement has been filed on behalf of OP No. 1, 2, 4 & 5.  It would be of benefit to reproduce preliminary     objections no. 1 to 4.

1.       The complainants have suppressed the fact that the deceased, Smt.  Sita Devi was suffering from a malignant MCA infarct.  Malignant MCA Infarct is a large ischemic infarction in the territory of middle cerebral artery that has severe postischemic edema leading to raised intracranial pressure, clinical deterioration, coma and death.  Because the moratality rate is as high as 80% in such patients.   The term malignant MCA infraction was coined.  This infarction behaves like a large space occupying lesion of brain.  And as per medical literature, the same has a high mortality rate and morbidity rate.  This fact coupled with the fact the deceased Smt. Sita Devi was suffering from pre-existing cardiac disease – mitral stenosis and atrial fibrillation, for which she had never taken any previous medical treatment, was the accelerating factor for her unfortunate demise and no negligence or deficiency in service can be attributed to the Answering Respondents as has been alleged in the Complaint.  Hence, it is submitted that the present complaint is liable to be rejected since the Complainants have suppressed the material facts before the Hon’ble Tribunal. 

2.       That the present complaint is otherwise also misconceived, groundless and unsustainable in view of the fact that the standard treatment, the world over for patients of infarction of brain which is conservative or without operation, i.e. treatment is done with antiplatelet, anti-coagulants and cerebral decongestants, was followed in the case of the deceased Smt. Sita Devi and when she did not respond to the said treatment, and rather her conditions deteriorated, she was immediately referred for surgical treatment to Respondent No. 5.  However, the Complainants would have the Hon’ble Forum believed that proper treatment was not given to the aforementioned Smt. Sita Devi which is an utterly misconceived plea in view of the fact that the treatment of cerebral – infarction is not by removing the clot by puncturing but by antiplatelet and anticoagulant therapy.   Therefore, standard definitive treatment was initiated immediately on diagnosing the case as acute embolic right middle cerebral artery infarction.  It is  submitted that only patients who still deteriorate inspite of conservative treatment are treated by surgery.  It is thus submitted that the present complaint being misconceived is liable to be rejected by the Hon’ble Forum. 

3.       That the Complainants are also guilty of suppression of facts in as much as they have intentionally failed to bring it to the notice of this Hon’ble Forum that the deceased Smt. Sita Devi was suffering from pre-existing cardiac disease – mitral stenosis and atrial fibrillation which leads to formation of clots in the left atrium of the heart.  These clots travelled to the blood vessels of the brain and caused the infarct (in the middle cerebral artery of brain).  As submitted earlier, in such cases of malignant middle cerebral artery infarct, high mortality rate of 80% exists despite optimal medical management.  It is submitted that the cause of the cerebral infarction in Smt. Sita Devi was the pre-existing cardiac disease for which she never took any previous medical treatment.  Therefore, it was the nature of the disease and further the negligence on the part of the deceased and her family members for not taking prior proper treatment for the said cardiac disease which resulted in her ultimate death rather than any negligence, wrong treatment or carelessness attributable to the Answering Respondents.  Therefore, it is submitted that the present complaint is liable to be dismissed since the Complainants are guilty of suppressing material facts from this Hon’ble Tribunal as also in view of the submissions made hereinabove. 

4.       That the present complaint is liable to be dismissed also since it is based on presumptions which are medically untenable and unacceptable.  The Complainants would have the Hon’ ble Forum believe that had the surgery been conducted on the deceased Smt. Sita Devi, earlier in point of time, she could have been saved.  In this regard it is submitted that since the said patient did not respond to optimal medical treatment in the first instance, and her condition deteriorated, she was referred for surgery.  It is submitted that the standard treatment the world over for patients such as the deceased is conservative with medicines only and when she did not respond and her condition deteriorated, surgery was recommended.  It is also submitted that the infracted brain is not punctured to make the flow of blood normal as has been averred by the Complainants.  It is stated that in the case of Smt. Sita Devi, she was suffering from large infarction of brain alongwith previous other diseases like hypertension, heart disease, mitral stenosis, atrial fibrillation and hypothyroidism.  It is submitted that chances of her survival post surgery was very poor and the said fact was explained to her attendants and thereafter written consent of her husband and borther-in-Law was obtained on the consent form.  It was explained that the surgery was to be done as a last option and that the patient may remain vegetative or may not survive inspite a successful operation.  Thereafter, decompressive craniotomy was done to relieve the pressure of the infracted brain inside the rigid skull.  It is submitted that the MRI conducted on the patient thereafter showed evidence of compression that did not respond despite cerebral decongestants and surgery.  It is therefore false on the part of the Complainants to allege that timely surgery was not done or that it was not done properly.  Hence, in view of the submissions made in the present para it is submitted that the Complaint is liable to rejected. 

The OPs have contested the complaint on merits.  They have reiterated that there was no medical negligence in the treatment given to the patients.  It would also be pertinent to reproduce para 4 (e) of the written statement on merits.  It reads s under.

‘’4 (e)          That the contents of  the para under reply as stated are denied.  It is submitted that since the patient Smt. Sita Devi was unconscious, due to her medical condition, she was not allowed oral intake.  It is denied that the patient was asking for water to drink since she was unconscious and was not in a condition to make such demands.  It is denied that the patient was unconscious due to the medicines administered to her.  It is further denied that the doctor attending to the patient were busy in private OPD and hence could not attend to the patient as alleged in the para under reply.  It is submitted that none of the treating doctors had OPD in the year 2004 from 12 pm to 4 pm.   It is submitted that Respondent No. 2 was in OPD from 8 am to 11 am and Respondent No. 4 was in OPD from 6 p.m. to 8 p.m. on the relevant date.  It is further submitted that the patient was in the high dependency unit where she was under constant supervision and care, hence, there was no question of her being left unattended as is being alleged in the para under reply.  All the allegations made qua the Answering Respondents in the para under reply are fabricated and hence vehemently denied. ‘’  

The OPs have prayed for the dismissal of the complaint. 

           The complainant has filed his affidavit of evidence wherein he has supported the contents of the complaint.  On behalf of OPs affidavits have been sworn by      Dr. V.K. Kapoor Director Medical (officiating), OP 1 Hospital, Dr. Anshu Rohtagi, (O P 4), Dr. Rajesh Acharya (OP 5), Dr. C.S. Aggarwal (O P 2) and by Dr. Kuljeet Singh.  All of them supported the defence taken in the reply to the complaint.

           It is pertinent to point out that this matter was referred to Delhi Medical Council for expert opinion.  The Delhi Medical Council through its execution committee had examined the reference has filed a report dated 23/02/2017 which inter alia reads as under :-

‘’The Executive Committee of the Delhi Medical Council Examined a reference no. DF(Central)/PF/2016/849 dated 03.06.2016 from President DCDRF (Central) in respect of case no. 145/2007 Yudhistar Lal Chawla v/s Ganga Ram Hospital.

The Executive Committee perused the reference from DCDRF (Central), complaint of Shri Yudhistar Lal Chawla, reply of Respondent No. 1, 2, 4 and 5, rejoinder of Shri Yudhistar Lal Chawla, copy of medical records of Sir Ganga Ram Hospital and other documents as provided by the Consumer Forum.

The Executive Committee notes that the patient Smt. Sita Devi was admitted at Sir Ganga Ram Hospital on 31^st May, 2004.  She had features suggestive of stroke. A C.T. scan was done which revealed no intracranial bleed.  She was treated with Heparin/Ecosprin on line of ischemic stroke.  Subsequently the size of infarct increased and patient deteriorated on 04^th June, 2004.  Therefore, she was operated on 05^th June, 2004 by the neurosurgeon with standard surgery after obtaining informed consent.  In addition she had Diabetes Mellitus, Hypertension, Mitral Senosis, Atrial fibrillation, Hypothyroidism and a bad chest.  She eventually did not survive and died later on.  All standard medical and surgical treatment were given to her. 

In view of the observation made hereinabove, it is, therefore, the decision of the Executive Committee that primafacie no case of medical negligence is made out on the part doctors of Sir Ganga Ram Hospital.

Complaint stands disposed.’’

Sd/:                                                   Sd/:                                Sd/:

(Dr. Arun Kumar Gupta)                  (Dr. Ajay Gambhir)       (Dr. Satendra Singh)

Chairman,                               Member,                        Member,

Executive Committee              Executive Committee     Executive Committee

Sd/:                                                   Sd/:

(Dr. Daljit Singh)                     (Dr. K.S. Anand)

Expert Member                       Expert Member

Executive Committee              Executive Committee

The Order of the Executive Committee dated 23^rd February, 2017 was confirmed by the Delhi Medical Council in its meeting held on 09^th March, 2017.

                                                                             By the Order & in the name of

                                                                             Delhi Medical Council

                                                                             (Dr. Girish Tyagi)

                                                                             Secretary

We have heard arguments advanced at the bar and have perused the record.  The complainants have not challenged the report of the execution committee  of the DMC and have also led no evidence to establish a case of medical negligence on the part of OPs except for a bald statement on oath by the complainant 1 alleging medical negligence on part of the Ops.  We therefore have nothing on record to disagree with the Delhi Medical Council report according to which the treatment of the disease was in accordance with the standard medical protocol and did not evolve any negligence. Even otherwise on facts we find ourselves in agreement with the aforesaid report.  This was a case where the diseased was suffering for a heart condition known as Mitral stenosis.   In such a condition there is formation of clots on the heart valves.  One of the clots appear to have disclosed and migrated to the MCA of the brain causing edema of the brain for which she was admitted in OP 1 Hospital.  In order to dissolve the clot conservative treatment such as coagulants   and blood thinners were given in order to dissolve the clot.  Since the deceased did not respond to the said treatment surgical intervention was needed and was undertaken.  This was also not of any help.  However, the OPs had followed the standard medical protocol required for treatment of the patient in this case.  We hold that there was no case of medical negligence in the case of the diseased.  Consequently the complaint is dismissed.  Copy of the order b e sent to the parties as per rules.    

File be consigned to record room.

Announced on this  _____  day of ________ 2018.