Punjab

StateCommission

A/11/788

The prime heart institute - Complainant(s)

Versus

Smt. Ranjit Kaur - Opp.Party(s)

Vaibhav Narang

05 Aug 2015

ORDER

                                                               FIRST ADDITIONAL BENCH

 

STATE  CONSUMER  DISPUTES  REDRESSAL  COMMISSION, PUNJAB

          SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.

                                     

 (1)                       First Appeal No.788 of 2011

 

 

                                                          Date of Institution: 16.05.2011  

                                                          Date of Decision:   05.08.2015

 

1.      The Prime Heart and Vasular Institute, Shivalik Hospital,          Sector 69, Mohali through its M.D Dr.U.B Singh @ Dr.U.P          Singh.

 

2.      Dr. U.B Singh @ Dr.U.P Singh, Managing Director, of the         Prime Heart Vasular Institute, Shivalik Hospital, Sector 69,         Mohali.

 

                                                                                                                        …..Appellants/Opposite party no.1 and 3.

 

                             Versus

 

1.      Smt. Ranjit Kaur wife of late Sh. Darshan Singh, resident of    village Ghumandgarh, Tehsil Bassi Pathana, District Fatehgarh          Sahib.

2.      Amandeep Kaur daughter of late Sh. Darshan Singh, wife of Sh. Kuldeep Singh, resident of VPO Barsalpur, District Ropar.

3.      Harmandeep Singh son of late Sh. Darshan Singh aged about        16 years through his natural guardian Smt. Ranjit Kaur,        resident of village Ghumandgarh, Tehsil Bassi Pathana,          District Fatehgarh Sahib.

 

                                                                                                                            …. Respondents/Complainant no.1 to 3

 

4.      Dr. Puneet K. Verma , the Prime Heart and Vascular Institute,           Shivalik Hospital, Sector 69 Mohali

5.      United India Insurance Company Ltd., 54 Janpath, Connaught         Place New Delhi

6.      United India Insurance Company Ltd, Regd., Head Office,      United India House , 24, White Road, Chennai.

 

                                                                                                                ..Performa respondents/Opposite Party no.2, 4 and 5

 

.                                                                 

                                               

 

         

First Appeal against order dated 29.03.2011 passed by the District Consumer Disputes Redressal Forum, Mohali

Quorum:-

 

          Shri J. S. Klar, Presiding Judicial Member.

          Shri Harcharan Singh Guram, Member.     

Present:-

 

          For the appellants                :  Sh.Vaibhav Narang Advocate    For the respondents no.1-3     : Sh.Kuldeep Singh, Advocate

          For the respondent no.4       : Ex-parte

          For the respondent no.5 & 6         : None.

 

                                                   AND

 

(2)               First Appeal No.727 of 2011

 

 

                                                          Date of Institution: 02.05.2011  

                                                          Date of Decision:  05.08.2015

 

1.      Smt. Ranjit Kaur wife of late Sh. Darshan Singh, resident of    village Ghumandgarh, Tehsil Bassi Pathana, District Fatehgarh          Sahib.

2.      Amandeep Kaur daughter of late Sh. Darshan Singh, wife of Sh. Kuldeep Singh, resident of VPO Barsalpur, District Ropar.

3.      Harmandeep Singh son of late Sh. Darshan Singh aged about        16 years through his natural guardian Smt. Ranjit Kaur,        resident of village Ghumandgarh, Tehsil Bassi Pathana,          District Fatehgarh Sahib.

 

                                                                                                     …. Appellants/Complainants no.1 to 3

 

                                      Versus

1.      Prime Heart and Vasular Institute, Shivalik Hospital, Sector 69,         Mohali through its M.D Dr.U.B Singh @ Dr.U.P Singh.

2.      Dr. Puneet K. Verma , the Prime Heart and Vascular Institute,           Shivalik Hospital, Sector 69 Mohali

 

3.      Dr. U.B Singh @ Dr.U.P Singh, Managing Director, of the         Prime Heart Vasular Institute, Shivalik Hospital, Sector 69,         Mohali.

4.      United India Insurance Company Ltd., 54 Janpath, Connaught         Place New Delhi

5.      United India Insurance Company Ltd, Regd., Head Office,      United India House , 24, White Road, Chennai.

 

                                                                                                        ..Respondents/Opposite Parties no.1 to. 5.

 

.                                              

First Appeals against order dated 29.03.2011 passed by the District Consumer Disputes Redressal Forum, Mohali

Quorum:-

 

          Shri J. S. Klar, Presiding Judicial Member.

          Shri Harcharan Singh Guram, Member.

         

Present:-

 

          For the appellants                 :  Sh.Kuldeep Singh, Advocate

          For the respondents no.1-3 :  Sh.Vaibhav Narang, Advocate

          Fro respondents no.4 & 5    :  None.

 

          . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

J. S. KLAR, PRESIDING JUDICIAL MEMBER:-

                                     

          By this common judgment, we intend to dispose of the above referred two First Appeals together, as they can be conveniently disposed of together, because they have arisen out of the same order dated 29.03.2011 of District Consumer Disputes Redressal Forum Mohali, vide which complaint filed by Rajinder Kaur and others was accepted and the OP no.1 to 3 were directed to refund the amount Rs.2,50,000/- with interest @ 9% per annum and further not to demand the impugned cheque no.271043 dated 05.02.2008 of the amount of Rs.2,40,000/- and further to pay compensation of Rs.50,000/- for mental harassment to complainant and Rs.5,000/- as costs of litigation to each of the complainants. First Appeal No.788 of 2011 has been filed by the appellants (the opposite party no.1 and 3 in the complaint) against the respondents of this appeal (the complainants no.1 to 3 in the complaint) and respondent nos.4 and 5 (the opposite parties no.4 and 5 in the complaint). Second connected First Appeal No.727 of 2011 has been preferred by the complainants against OPs for enhancement of compensation.

2.      The complainants have filed complaint U/s 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the OPs, on the averments that Darshan Singh husband of the complainant no.1 approached OP No.1 for medical check up on the advice of Dr.Gurpeet Singh Bawa Nursing Home situated at Bassi Pathana District Fatehgarh Sahib. The husband of the complainant Darshan Singh started vomiting and was having mild fever. He was checked up by OP No.2 and found that he was suffering from heart problem and was admitted in the hospital of OP No.1 for treatment on 5.1.2008 on the advice of OP No.2. OP No.2 disclosed the complainant that pacemaker was required to be installed immediately in order to save the life of the Darshan Singh. OP No.1 and 2 further stated to complainant that total expenditure of the pacemaker together with other treatment would be Rs.2,40,000/- till the recovery of patient Darshan Singh. Complainant no.1 stated to the OPs that she was not a position to pay the above amount forthwith. OP No.2 asked the complainant no.1 to issue cheque, as security and then they would start the treatment of her husband. OP No.2 advised the complainant to arrange for the cash amount in the meantime and assured that OP No.1 and 2 would return the cheque to her at the time of discharge of the patient from the hospital. On the assurance of OP No.2, Darshan Singh was admitted in the hospital of OP No.1 on 5.1.2008 and complainant no.2 namely Amandeep Kaur issued a cheque no.1217000100190259 drawn on Punjab National Bank Branch Bassi Pathana, amounting to Rs.2,40,000/- , as a security for the treatment of Darshan Singh. The complainant no.1 further deposited Rs.1 lac with OP No.1 on 5.1.2008, as per receipt of the same date. OP No.2 installed the temporary pacemaker on 5.1.2008 and thereafter OP No.2 installed a permanent pacemaker on 6.1.2008 on Darshan Singh. OP No.2 informed the complainant that operation remained successful and pacemaker was installed successfully and patient would be quite normal within a week. The condition of Darshan Singh patient further deteriorated. On enquiry by complainants, OPs told them not to worry about it. After installation of the pacemaker, the patient got developed stomach problem and left hemiparesis on 09.01.2008. The discharge summary of the patient showed that he had developed ulcer, liver problems and septicemia   on 10.1.2008. The development of said diseases was itself indicative of the above problems, as recorded in discharge summary issued by OP No.1. These diseases developed within four days in the hospital of OP No.1, it shows that these diseases occurred due to carelessness and negligence conduct of the OPs. The OPs have not exercised the due care in treating above Darshan Singh. The discharge summary given by OPs under the heading Key Clinical Events has revealed that there was no evidence of any RWMA (Regional Wall Motion Abnormality) or LV (Left Ventricular)/RV (Right Ventricular) dysfunction, which showed that the installation of the pacemaker was carried out without any requirement just to earn money. Darshan Singh was wrongly diagnosed by the OPs before installation of the pacemaker. The OPs directed the complainants to shift Darshan Singh patient to Cosmo Hospital for further treatment. Darshan Singh patient got discharged from the hospital of OP No.1 forcibly. On 25.1.2008, the complainant requested OP No.1 to return the cheque , which was initially given, as security to them, but it was not returned by them to the complainant no.1. Darshan Singh was taken to Fortis Hospital Mohali for further treatment on 25.1.2008 after discharge from the hospital of the OPs. He was checked up at Fortis Hospital and it was informed that all intestines of stomach of patient Darshan Singh have been infected and damaged badly due to ill treatment and negligence of the treating doctors. Dr. Atul Joshi operated the patient Darshan Singh at Fortis Hospital and stated that saving of life of patient was not possible at that critical juncture,  because all of his stomach intestines had been damaged. Darshan Singh patient was discharged from Fortis Hospital and he died on 27.1.2008. Darshan Singh patient was admitted on 05.1.2008 in the hospital of OP No.1 and was discharged therefrom on 25.1.2008 and he died on 27.1.2008. OPs had not properly diagnosed and examined Darshan Singh at the time of his admission and rather gave wrong treatment to him. OP No.1 had not returned the cheque, which was deposited by the complainant, as security with it. OPs wanted more money from the complainant. The complainants have, thus, filed the present complaint against OPs for medical negligence and unfair trade practice on the part of OPs seeking compensation of Rs.19,50,000/- along with interest @ 18% p.a, besides Rs.30,000/-, as costs of litigation.

3.      Upon notice, OP no.1 filed its separate written reply and contested the complaint of the complainant. It was averred that matter was referred for expert body's opinion and the Medical Board opined that no gross negligence was involved in the treatment of Darshan Singh by OPs. The allegations leveled in the complaint are vague and against the medical prescribed norms of the general practice. It was further averred in the written reply that patient Darshan Singh was diagnosed, as case of hypertension, NIDDM, Complete Heart Block, normal I.V. Function. The patient developed metabolic acidosis and respiratory distress and was examined by Dr. Lalitesh Garg (Physician Intensivist), patient electively intubated and started on Meropenem/Aztreonam/Metronidazole/renal dose of Dopamine and Norepinephrine. On 11.1.2008, patient was checked by Dr. Ladbans Kaur and repeat bed side and his ultrasound abdomen features were suggestive of adynamic intestinal obstruction/ 2nd unit of blood was leucocytosis improved and he was weaned off ventilator up to 16.1.2008. The conservative management continued in consultation with the GI Surgeon and the intensivist.  The patient had dry gangrene on left 2nd, 3rd, 4th toes and on right 3rd, 4th and 5th toes attributable to septicemia. The OP no.1 provided all necessary infrastructure, instrumentation and manpower of well qualified and skilled doctors to treat the patient in its hospital. Darshan Singh was taken to Fortis Hospital forcibly against the medical advice, as he was in further emergent need at that stage. He was under medical care of OP No.1. OP No.1 has always maintained highest standard of professional conduct and has not allowed itself to be influenced merely for the sake of profit. The husband of the complainant approached OPs in serious condition and treatment was given to him, as per the medical norms after due investigation under the prescribed line of treatment, prognosis, benefits and losses, known complications and essential direction to be followed were duly explained. The complaint was contested even on merits by OP No.1  alleging it  to be false and misconceived. This fact was admitted by OP no.1 that Darshan Singh was admitted in the hospital of OP No.1 on 5.1.2008 and he deposited Rs.1 lac on that day. It was further pleaded that Darshan Singh was suffering from heart problem, his broad QRS rhythm was 15/min and post TPI-I-I  ventricular pacing  @ 80bpm and Post - PPI- Normal  P wave tracking with normal ventricular pacing. It showed that patient was immediately improved just after implanting the pacemaker. It was denied by OP No.1 that complainant was assured that only Rs.2,40,000/- would be the total expenses of the entire treatment.  OP No.1 controverted the other averments of the complaint and it denied any medical negligence on its part vehemently and, thus,  prayed for dismissal of the present complaint.

4.      OP No.2 filed its separate written reply and contested the complainant of the complainant. Reply of OP No.2 is on the same lines, as pleaded by OP No.1. It further pleaded that best possible treatment consistent with standard medical practice prescribed world over was administered to the patient using reasonable skill to the best of abilities of OP No.2. Dr. Punit Kumar Verma is well recognized doctor with technical and professional expertise. The gastrointestinal bleeding and infection that the patient developed later on was not at all related to pacemaker insertion by the procedure performed by OP No.2. It was further submitted that two clinical problems are quite different and independent of each other and cannot be linked to one and another. The stomach infection developed later on by the patient and was not related to pacemaker during his stay in the hospital. The condition of Darshan Singh improved and he was discharged on the request of the patient against medical advice. OP No.2 is well equipped doctor holding degree of Medicine (DM) Cardiology from Delhi University. It was further pleaded on merits that operation of Darshan Singh was successfully performed on 06.01.2008 and patient responded well thereto. OP No.2 controverted the entire averments of the complaint and prayed for dismissal of the complaint.

5.      OP no.4 filed its separate written reply  and contested the complaint of the complainant. It was averred that OP No.2 was insured with it for the treatment of Darshan Singh, vide professional indemnity policy no.040100/46/07/35/00000932 valid from 19.6.2007 to 18.6.2008 and it also pleaded that written reply filed by OP No.2 may also be treated as its written reply and hence prayed for the dismissal of the present complaint.

6.      The complainant tendered in evidence affidavit of complainant Ex.CW-1/A along with copies of documents Ex.C-1 to Ex.C13. As against OP no.1 to 3 tendered in evidence affidavit of Dr. U.P Singh Ex.RW-1/A. OP No.2 tendered in evidence affidavit of Dr. Puneet Verma  of Prima Heart and Vascular Institute Shivalik Hospital  Ex.RW2/1 along with copies of documents Ex.R-1 to Ex.R-5. On conclusion of evidence and arguments, the District Forum Mohali accepted the complaint of the complainant and passed order against OP No.1 to 3, as recorded above. Aggrieved by the order of the District Forum Mohali dated 29.03.2011 two separate appeals  have been preferred against the same. First Appeal No.788 of 2011 has been preferred by OP no.1 and 3 against the order of District Forum Mohali and First Appeal No.727 of 2011 has been preferred by complainant for enhancement of compensation.

7.      We have heard learned counsel for the parties in the above referred two appeals and have also examined the record of the case.  We proceed to examine the controversy with the aid of evidence on the record after hearing the respective submissions of counsel for the parties. Ex.CW-1/1 is affidavit of Ranjit Kaur complainant wife of Darshan Singh reiterating the averments of the complaint on oath in this affidavit.  She stated in this affidavit that OPs assured to her that there would no other expenses except Rs.2,40,000/- for the package of entire treatment of Darshan Singh. She further stated that she deposited Rs.1 lac with OP no.1 on 5.1.2008 and on the insistence of OPs, cheque was given to OPs for the amount of Rs.2,40,000/- by complainant no.2/Amandeep Kaur mainly, as security amount to be returned, when the remaining amount is deposited by the complainant. She has stated that OPs wrongly diagnosed her husband, as heart patient and installed permanent pacemaker on 06.01.2008. Initially temporary pacemaker was installed on 5.1.2008 against the norms on Darshan Singh. She further stated that, as per discharge summary given by OPs,  there was no evidence of any RWMA (Regional Wall Motion Abnormality) or LV (Left Ventricular)/RV (Right Ventricular) dysfunction. She further deposed that OPs directed the complainant to shift the patient Darshan Singh to Cosmo Hospital for the treatment, which took place due to negligent act of the OPs. Ex.C-1 is receipt for deposit of Rs.1 lac on 05.01.2008 by complainant with the OPs. Ex.C-2 is discharge summary issued by OP no.1 to Darshan Singh. The Discharge Summary is reproduced as under :

Diagnosis :

Hypertension

NIDDM

Complete Heart Block

Normal I.V Function

Duodenal Ulcer Bleed

Intestinal Sepsis - Septicemia with MODS

Paralytic Ileus

Left Hemiparesis- Oligodendroglioma brain/Lacumar infarct

Procedure Done

Echocardiography on 05.01.2008, temporary pacemaker implantation on 05.01.2008, permanent pacemaker implantation on 06.01.2008, Electrical Parameters (DDDR, Vitatron C60DR), Atrial 2.6 mv/0.7V/493 ohms, Ventricular- dependent/O 6V/462 ohms.

Key Clinical Events

Admitted in state of bradycardia with shock, immediate TPI done via RFV , PPI done via left subclavian vein under LA on 06.01.2008. Detected to have deranged KFTs and high CK-MB 128.5 with 2D-echo showing no evidence of any RWMA or LV/RV dysfunction. Development left hemiparesis on 09.01.2008. Neuro consultation (Dr. H Tanjea) - watershed infarct ? Right MCA/ACA territory CT Head -Oligodendroglioma. In the evening on 09.01.2008 had malena and fresh lower GI bleed UGIE Large duodenal ulcer (2nd part) with severe reflux exaphagitis, colonoscopy normal. Transfused one unit of blood on 10.01.2008. Duodenal blopsies sent for histopathalogy evaluation- benign ulcer seen by Dr. Mudit Kumar (GI Surgeon) and advised conservative treatment. Became irritable with leucocytosis (septicemia) on 10.1.2008. Developed metabolic ocidosis and respiratory distress. Seen by Dr. Lalitest Garg (Physician intensivist). Patient electively intubated and started on Meropenem/Aztreonam/Metronidazole/renal dose of Dopamine and Norepinephrine. First episode of fever on 11.1.2008, max, temperature recorded 101.6 F. Repeat bed side ultrasound abdomen (Dr. Ladbans Kaur) features were suggestive of adynamic intextinal obstruction. Developed nonoliguric renal failure and continued to be febrile for next 72 hours i.v fluconazole added 2nd unit of blood transfused. Remained febrile but leucocytosis improved (TLC 11,500, Urea/Creatinine 245/2.36), Patient weaned off ventilator with a T-piece trial and extubated on 16.1.2008. CT Head (plain) showed evidence of small lacunar infarct on right side and multiple calcified areas on right side suggesting a possibility of oligodendroglioma. Patient continued to have low grade fever, with pain abdomen and high NG aspirate (bilious). CECT abdomen showed B/L/pleural effusion, Hepatomegaly, dilated fluid filled small bowel loops, coincidental finding of small angiomyodipoma at renal upper pole and kinking of celiac artery origin due to muscular diaphragmatic insertions. Conservative management continued in consultation with the GI surgeon and the intensivist. Patient continues to have low grade fever, significant pain abdomen on and off with tenderness in left umbilical and iliac region with sluggish bowel sounds. Has been reviewed gain by the GI team and advised diagnostic laparoscopy. His TLC is 10,800 and Urea/Creatinine are normal (36/1.17). He has dry gangrene on left 2nd, 3rd, 4th toes and on right 3rd, 4th , 5th toes attributable to septicemia.

Investigations ;

Attached

ECG           05.01.2008 - Broad QRS escape rhythm at 15/min. Post TPI : 1.1 ventricular pacing @ 80 bpm. Post PPI - Normal P ware tracking with normal ventricular pacing.

On Treatment

1. Inj. Tazact 4.5 g.i.v thrice a day 8 AM

2. Inj. Ciplox 400 mg i.v twice a day 8 AM-8 PM

3. Inj.Eptoin 200 mg i.v twice a day.

4. Inj. Calcium Gluconate one ampoule i.v once a day.

5. Inj.MVI one ampoule i.v. once a day.

6. Inj.Rabicip 40 mg i.v twice a day.

7. Tab. Syscan 150 mg once a day.

8. Tab Pletoz 100 mg twice a day

9. Tab Cyclopalm twice a day.

10. Steam inhalation 6 hourly

11. Maintenance i.v fluids( Neutralized 5% Dextrose) 13 oml/hour with K supplementation).

8.      It is, thus, evident from perusal of  discharge summary that Darshan Singh was admitted in State of Bradycardia with shock, immediate TPI done via RFV PPI done via left subclavian vein under LA on 06.01.2008. It was recorded in it that there was no evidence of any RWMA or LV/RV dysfunction. Ex.C-3 is the clinical summary issued by the OPs.  Ex.C-4 is LAMA Summary of the Fortis Hospital, in which it was recorded that patient Darshan Singh was admitted in Fortis Hospital with abdominal distension and sepsis and multi organ failure on 25th January and exploratory laparotomy was done and operative findings were massive small bowel gangrene with    faeculant ascities and jejunostomy with distal stump closure done on 26th January and patient was shifted to SPICU for postop management. By then, the patient was on full support of ventilator with high inotropic support. Patient's relatives wanted to take the patient against medical advice from hospital of OP No.1. Patient's condition  and consequences of discontinuation of medical care were explained to relatives in detail. So patient was shifted on AMBU, IV FLUIDS WITH IONOTROPES. Ex.C-5 is receipt dated 7.1.2008 regarding deposit the amount of Rs.40,000/- by complainant with OPs and Ex.C-6 is receipt dated 15.1.2008 regarding deposit of Rs.50,000/- by the complainant with OPs. Ex.C-7 is receipt dated 21.1.2008 regarding deposit the amount of Rs.57,000/- by the complainant with OPs. Ex.C-8 is legal notice sent by the complainant. Ex.C-12 is reply to legal notice. Ex.C-13 is statement of Dr. Punit Kumar recorded in some enquiry.

9.      The OPs mainly relied upon the affidavit of Dr. U.P Singh Managing Director Prime Heart and Vascular Institute  Ex.RW-1/1 on the record. He stated in his affidavit that expert Medical Board opinion was taken in this case and no gross negligence was found by PGI board of doctors on the part of OPs. He further stated that patient was diagnosed, as a case of hypertension, NIDDM, complete heart block, normal I.V function, duodenal ulcer bleed, intestinal sepsis-septicemia with mods, paralyticlleus, left hemiparesis-oligodendroglioma, brain/lacunar infarct.  This witness has further deposed that patient was admitted in state of bradycardia with shock. Immediate TPI done via RFV, PPI done via left subclavian vein under LA on 6.1.2008. It could not be reflected from the report of ECG i.e. 5.1.2008 broad QRS rhythm at 15/min and post TPI-I-I ventricular pacing @ 80bpm and post PPI Normal P were tracking with normal ventricular pacing. It showed that the patient was immediately improved just after implanting the pacemaker in him. This witness further deposed that on 08.01.2008 patient complained pain in right hypochondrium abdomen and was subjected for ultrasound abdomen at Prime Diagnostic, which revealed hepatomegaly with FATTY LIVER. The patient developed left hemiparesis on 09.01.2008, Neuro consultation Dr. H.Taneja - watershed infarct Right MCA/ACA territory CT Head-OLIGODENDROGLIOMA i.e. Brain Tumor. In the evening on 09.01.2008 patient had malena and fresh lower GI bleed. UGIE Large Duodenal Ulcer 2nd part with severe reflux and blood was transfused on 10.01.2008 and his duodenal biopsies sent for histopathology evaluation, which was ulcer, as seen by Dr.Mudit Kumar G.I Surgeon. This witness reiterated the version of the OPs, as stated in the written reply by denying any medical negligence on the part of OPs. The affidavit of Dr.Puneet Verma Ex.RW-2/1 is on the record. This witness has stated that complainant had not paid the requisite dues of the OP/hospital and complainant issued cheque of Rs. 2,40,000/- bearing no. 271043 dated 05.02.2008 to OPs hospital for treatment charges, which was dishonoured and proceedings have been pending before Competent Court of law about it. This witness further stated that OP No.2 treated the complainant diligently and strictly as per the Medical Standard Practice. Copy of complaint under Section 138 of N.I. Act is Ex.R-1. Textbook of Cardiovacular Medicine Ex.R-2. Ex.R-3 is copy of Discharge Summary of patient Darshan Singh. Dr. Puneet  Verma denied any medical negligence on the part of OP No.2 in this case vehemently. He further stated that after insertion of pacemaker, the condition of the complainant improved drastically. He further stated that Stomach Infection developed  in the patient later and it was not related to pacemaker during his stay in the hospital. He is qualified and reputed doctor and holds diploma of National Board, Doctorate of Medicine (DM Cardiology) and he has been insured with United India Insurance Company Ltd, vide Ex.R-2/5 policy document. He further stated that relatives of the patient Darshan Singh forcibly got him discharged him   against medical advice from their hospital.

10.    From evaluation of the above referred evidence on the record and hearing the respective submissions of counsel for the parties, we find that the matter was sent to PGI by the District Forum Mohali for expert opinion. Report of Expert Body's of PGI, which is part of the record is reproduced as  under :

"The patient Mr. Darshan Singh, a known , case of diabetes mellitus and hypertension was admitted at Prime Vascular Institute on 05.01.2008 with syncope and bradycardia. A temporary pacemaker was inserted, the same for complete heart block followed by permanent pacemaker insertion on 06.01.2008. On 09.01.2008, he developed left sided weakness of upper and lower limbs and abdominal pain with local tenderness. He also had rectal bleeding. He underwent upper GI endoscopy the same day, which showed large ulcerated lesion in 2nd part of duodenum with raised margins. Colonoscopy (also done the same day) showed melaenous stools. He had abdominal distension the next day i.e. 10.01.2008. He was also found to have respiratory distress for which he was intubated the same day and put on ventilator. Ultrasound showed dilated bowel loops. A diagnosis of adynamic paralytic ileus was made. He was given 2 units of blood. On 15.01.2008 he had melaena. On 16.1.2008 he was extubated. A CT Scan of abdomen on 18.1.2008 showed dilated fluid filled small bowel loops and ascites. On 21.1.2008, he had increase in distension of abdomen.

On 23.01.2008, he was started on jejuna feeds, but was found to have lump in right lower quadrant of abdomen. A possibility of ischemic bowel disease and localized perforation was considered by Dr. Mudit Kumar and exploratory laparotomy was suggested. The patient was again given Ryles tube feeding, but that was stopped a few hours later. On 25.1.2008, he was shifted to Fortis Hospital, where he underwent surgery which revealed gangrenous bowel.

Throughout the patient's sensorium remained subnormal and he required vaspressor agents and ventilator support. In the setting of diabetes mellitus and a recent cerebrovascular event and complete heart block, the above-mentioned features suggest that he was in a critical state throughout.

Conclusion :

The patient a known diabetic had presented with complete heart block for which a temporary, followed by a permanent pacemaker was put. He developed a cerebrovasular accident in the hospital and later abdominal symptoms appeared. He was in a critical state throughout requiring ventilator support, vasopressors and blood transfusion. His abdominal problems did not attract due attention probably because of his other serious illness.

We cannot find any gross fault with his overall management."

11.    It is, thus, evident that the Expert Body of Doctors of PGI concluded that patient was known case of Diabetes Mellitus and Hypertension  and was admitted at Prime Vascular Institute on 05.10.2008 with syncope and bradycardia. A temporary pacemaker was inserted on the same day  for complete heart block followed by permanent pacemaker insertion on 06.01.2008. On 09.01.2008, he developed left sided weakness of upper and lower limbs and abdominal pain with local tenderness. He developed a cerebrovascular accident in the hospital and later abdominal symptoms appeared in him. He was in a critical state throughout requiring ventilator support, vasopressors and blood transfusion. The Expert Body of PGI in report dated 16.07.2010 stated that abdominal problems did not attract due attention probably because of his other serious illness. Admission record of the patient was required to be placed by OPs to prove that patient Darshan Singh was suffering from abdominal problems even on that very day, when he was admitted in the hospital. No such record has been produced by the OPs in this case to prove any trace of abdominal problem suffered by the patient, when was admitted in the hospital of the OPs on 05.01.2008. Darshan Singh (since deceased) was discharged from the hospital of OP No.1 on 25.1.2008, as per discharge summary Ex.C-2. He was admitted on the same day i.e. 25.1.2008 in the Fortis Hospital, as per Lama Summary Ex.C-4 and was discharged therefrom on 27.1.2008. The diagnosis of the deceased was "Mesenteric Ischemia and Bowel Gangrene". Ex.C-4 further proved that deceased was admitted in the Fortis Hospital with abdominal distension and sepsis and multi organ failure on 25.01.2008. The patient had no such symptoms, when he was admitted in the hospital of OP No.1 on 05.01.2008. The development of the symptoms after admission of the complainant in the hospital of OPs is indicative of  this fact that OP No.1 was not fully equipped with the facilities to attend such problem of abdominal distension of patient and on account of this fact, no proper care to treat abdominal disorder of the deceased was taken by OP No.1 during his long stay of 20 days in the hospital of OP No.1. Vide discharge summary Ex.C-2, the deceased developed hemiparesis on 09.01.2008 and was given neuro consultation by Dr. H. Taneja. No such affidavit or statement of this witness is on the record to substantiate it. In the evening of 09.01.2008, Darshan Singh had malena and fresh lower GI bleed UGIE- Large duodenal ulcer (2nd part) with severe reflux esophagtis. Colonoscopy was allegedly normal. On 10.01.2008, Darshan Singh developed metabolic acidosis and respiratory distress, while remained admitted in the hospital of OPs. Statement of Dr. Lalitesh Garg is not on the record to prove this fact and hence it remained unsubstantiated. OPs detained the patient from 5.1.2008 to 25.1.2008 for 20 days length to inflate the bills, as rightly observed by District Forum. Eventually, he was discharged when the members of the family of the patient insisted upon his second opinion. The contention of the OPs is that patient was discharged against medical advice.

12.    The OPs version is that liability of expenses of Darshan Singh's treatment comes to Rs.5,25,123/- for 20 days period, which is exaggerated amount. The complainant paid Rs.2,50,000/- to OPs in cash, as proved on the record. The version of OPs remained un-rebutted that the total costs of pacemaker and other treatment would be Rs.2,40,000/- till recovery of the deceased Darshan Singh. Complainant's side has already paid Rs.2,50,000/- in cash to OPs, as proved on record by above referred receipts. We find weightage in the version of the complainant that OPs kept cheque with them as issued by complainant no.2, as security to be returned on deposit of balance amount of Rs.2,40,000/-. Generally, cash amount is deposited in the hospital in the routine manner by the attendants of the patient. It was incumbent upon OPs to produce the details of the expenses of the complainant till time of the stay of Darshan Singh in the hospital of OP No.1.

13.    The above circumstances indicate that OPs inflated the bill only by keeping the patient in the hospital for unwanted long period, when it was not fully equipped to deal with his above-said problems. It is not the case of the OPs that total cost was Rs.5,25,123/- and complainant paid the amount of Rs.2,50,000/- in cash and issued cheque for the remaining amount. The District Forum rightly observed that discount of Rs.35,060/- has been given so that amount is shown to be corresponding to Rs.2,40,000/- . We agree with the findings of the District Forum that this figure has been manipulated by the OPs to be in conformity with disputed cheque amount of Rs.2,40,000/-. The OPs have not alleged nor proved that amount of Rs. 2,40,000/- was due from the complainant for remaining treatment. OPs pleaded in the complaint Ex.R-1 that complainants issued a cheque bearing no.271043 dated 05.02.2008 amounting to Rs.2,40,000/-. This version of the OPs goes against OPs because after death of the patient, a person normally does not issue the cheque, as rightly observed by the District Forum in the order under challenge in this case. The only inference which we can safely draw from the above is that cheque was given as security by the complainant to be returned by the OPs to them later on, when complainant deposited the amount of Rs.2,40,000/- with the OPs. District Forum rightly has not relied upon the bill dated 25.1.2008 on the ground that it has been excessively charged to make it tally with the amount of Rs.2,50,000/- charged from the complainant in cash and amount deposited by cheque of Rs.2,40,000/-, as projected by the OPs.

14.    As a result of our above discussion, we hold that the complainants are entitled to the compensation of Rs.2,00,000/- from the OPs no.1 to 3 for deficiency in service and medical negligence and unfair trade practice on their part in not providing the abdominal treatment to the patient and regarding keeping the cheque with them, which was primarily given, as security only. It is further ordered that OPs shall not recover the disputed amount of Rs.2,40,000/- from the complainant, when it has been found that the above amount of Rs.2,40,000/- was not due to the OPs from the complainant, with regard to treatment of Darshan Singh in the hospital of OP No.1. The OPs shall pay the amount of Rs.2,00,000/- as compensation to complainant, besides compensation of Rs.35,000/- for mental harassment and Rs.15,000/- as costs of litigation within 45 days from the date of receipt of certified copy of order, failing which complainants shall be entitled to interest @ 9% p.a from the date of order till its actual payment.

15.    As a result of our above discussion, we dismiss the First Appeal No.727 of 2011 filed by complainants for enhancement of compensation and second First Appeal No. 788 of 2011  is ordered to be partly allowed, as ordered above.

16.    In First Appeal No.788 of 2011, the appellant had deposited the amount Rs.25,000/- in this Commission at the time of filing the appeal and they further deposited Rs.1,00,000/- vide receipt dated 24.6.2011 in compliance of the order of State Commission dated 25.5.2011. Both these amount with interest, if any, accrued thereon, be refunded by the registry to the complainants/respondents in equal shares by way of crossed cheque/demand draft after 45 days from receipt of copy of this order.

17.    Arguments in these appeals were heard on 03.08.2015 and the order was reserved. Now the order be communicated to the parties.

18.    The appeals could not be decided within the statutory period due to heavy pendency of court cases.

19.    Copy of this order be placed in FA No.727 of 2011.

 

                                                                     (J. S. KLAR)

                                                     PRESIDING JUDICIAL MEMBER

 

 

                                               

                                                           (HARCHARAN SINGH GURAM)                                                                          MEMBER

August 5,  2015.                                                                  

(ravi)