Andhra Pradesh

Chittoor-II at triputi

CC/24/2014

T.Krishnamurthy S/o. T.Gurrappa - Complainant(s)

Versus

Sri Venkateswara Institute of Medical Sciences,Tirupati rep by Managing Director - Opp.Party(s)

A.Devendranath and Y.B.S.Bapujee ,Tirupati

13 Mar 2015

ORDER

Filing Date:17.02.2014

Order Date: 13.03.2015

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II,

TIRUPATI

 

      PRESENT: Sri.M.Ramakrishnaiah, President ,

        Smt. T.Anitha, Member

 

FRIDAY THE THIRTEENTH DAY OF MARCH, TWO THOUSAND AND FIFTEEN

 

C.C.No.24/2014

 

Between

 

Tamireddy Palli Krishnamurthy,

S/o. T.Gurrappa,

Hindu, aged about 50 years,

Coolie,

D.No.27-23/A, M.B.T.Road,

Punganur Town and Mandal,

Chittoor District.                                                                              … Complainant

 

 

And

 

Sri Venkateswara Institute of Medical Sciences (SVIMS),

Rep. by its Director,

Tirupati,

Chittoor District.                                                                              …  Opposite party.

 

 

            This complaint coming on before us for final hearing on 26.02.15 and upon perusing the complaint, written version and other relevant material papers on record and on hearing Sri.A.Devendranath, counsel for the complainant, and M.Subhashini, counsel for the opposite party, and  having stood over till this day for consideration, this Forum makes the following:-

 

ORDER

DELIVERYED BY SRI. M.RAMAKRISHNAIAH, PRESIDENT

ON BEHALF OF THE BENCH

 

            This complaint is filed under Section-12 of C.P.Act 1986, by the complainant against the opposite party for the following reliefs 1) to direct the opposite party to pay Rs.15,00,000/- towards compensation for deficiency of service, 2) to direct the opposite party to pay litigation expenses and pass such other reliefs, which the Forum deem fit and proper under the circumstances of the case.

            2.  The brief facts of the case are:- That Smt.T.Vijaya, wife of complainant, during the night of 28.02.2012 was not feeling well, as such she was shifted to the hospital of opposite party SVIMS on 29.02.2012 but the doctors at SVIMS did not admit the patient till 01.03.2012 morning and made the patient to wait for more than 24 hours at SVIMS. On 01.03.2012 during morning hours patient was admitted and necessary treatment was given, inspite of it the patient died on the same day i.e on 01.03.2012 at about 7.45 p.m. Had the patient was admitted in the hospital of opposite party and provided treatment on 29.02.2012 itself, she would have survived. Due to the negligence on the part of the doctors of the opposite party hospital, the patient died. Patient was hale and healthy prior to bringing her to the hospital of the opposite party. Hence the complaint.

            3.  The opposite party filed written version contending that on 01.03.2012 Smt.T.Vijaya, wife of complainant was brought to SVIMS hospital with a complaint of abdominal pain for 4 days, vomiting, menstrual bleeding for 2 days, for which she was taken treatment in local hospital at Punganur prior to referring the patient to the opposite party hospital, as they could not find any venous access on the patient. By the time the complainant’s wife was seen in opposite party hospital her condition was very serious on 01.03.2012. Appropriate investigations were done and the patient was severely anemic with both upper limb haematoma (collection of blood due to bleeding) with pulse 110/min and BP: 90/60 mm Hg. Patient soon developed increasing abdominal pain and restlessness for which she was shifted immediately from casualty to CT Post – Operative ICU ward. On further examination patient was found to have feeble peripheral pulse, multiple bruises over abdomen and swelling of both upper limbs. By same day patient had become severally restless dysphneic and shock like state. The patient was immediately intubated by anaesthesia team and necessary medications and inotropic support was started. INR ratio was repeated and found to be high (4.93) for which anti coagulation medicine was stopped. By late evening patient continued to deteriorate and despite all active and life supportive measures taken by C.T.Surgery and Anaesthesia doctors in C.T. Post – OP ICU ward, she deteriorated further and died at 8.40 p.m. on same day.

            4.  That all care and necessary treatment possible was given immedihately after admission on 01.03.2012 to the patient. The patient’s complains were of more than 4 days with treatment in outside local hospital and by the time she was brought to opposite party hospital on 01.03.2012, she was already in serious and grave condition. The complainant also made complaint against opposite party hospital to Government authorities and enquiries also conducted and a report was submitted to Government. The patient was not brought to the opposite party hospital on 29.02.2012 as alleged. The patient was not hale and healthy as stated in the complaint but she was admitted in opposite party hospital on 23.11.2011 bypass surgery was conducted on 02.12.2011 as per accepted surgical methodology world over under the circumstances of mitral  valve stenosis and the patient was implanted with 27 mm mitral ATS bileaflet mechanical valve under cardio pulmonary bypass and she was discharged on 09.12.2011 i.e. on 7^th post operative day. Admittedly there is no negligence or deficiency in service on the part of the doctors of opposite party hospital in providing treatment to the patient at any point of time and the complainant is not entitled to the reliefs sought for and prays the Forum to dismiss the complaint with costs.

            5.  In support of the case of the complainant, P.W.1(complainant) is examined and got marked Exs.A1 to A5. For opposite party R.W.1 is examined and got marked Exs.B1 to B5. Both parties have filed their respective chief affidavits as well as written arguments.

            6.  Now the points for consideration are:-

            (i).  Whether the patient Smt.T.Vijaya was brought to the opposite party

                  hospital on 29.02.2012 or on 01.03.2012?

            (ii).  Whether there is deficiency in service on the part of the opposite party

                   hospital?

            (iii).  Whether the complainant is entitled for the reliefs sought for?

            (iv).  To what relief?

            7.  Point No.(i):-  to answer this point, the burden lies on the complainant to prove that the patient was brought to the hospital of opposite party (SVIMS) on 29.02.2012 as contended. On perusal of the complaint, the complainant simply mentioned that the patient was brought to opposite party hospital on 29.02.2012 morning and the opposite party did not admit the patient till 01.03.2012 a.m. This contention was not substantiated by any sort of evidence. Nowhere in the complaint, chief affidavit, written arguments as well as Exs.A1 to A5 of the complainant it is mentioned - by what time the complainant brought his wife (patient) to the hospital of opposite party on 29.02.2012. Ex.B2 the representation made by the complainant to the Chief Secretary, Government of Andhra Pradesh and also the Governor of the State of Andhra Pradesh, it is specifically mentioned that P.W.1 took his wife when she complained of abdominal pain, to a local doctor Fakruddin at Punganur on 27.02.2012 evening for treatment. On 28.02.2012 Dr.Fakruddin attempted to administer glucose (fluids) to the patient but in vain as her hands were swollen. On 29.02.2012 the complainant along with his wife (patient) left to SVIMS, the hospital of opposite party and in the morning of 01.03.2012, he got his wife admitted in emergency ward. The doctors, who were there in the hospital secured the case sheet of the patient Smt.T.Vijaya, did investigations and shifted the patient to emergency post operative ICU. These contents of Ex.B2 were admitted as true in the evidence of P.W.1. Therefore, it is clear that patient was brought to the hospital of opposite party i.e. SVIMS only on 01.03.2012 but not on 29.02.2012. The complainant did not mention anywhere either in his complaint or in his chief affidavit that he has taken his wife Smt.T.Vijaya (patient) to Dr.Fakruddin at Punganur, so it amounts to suppression of facts. The doctor at  Punganur by name Dr.Fakruddin, could not trace out the venous (vains) of the patient to administer glucose, as her both the upper limbs found swollen. He advised the complainant to take the patient to the hospital, where she was underwent bypass surgery earlier. Then only the complainant brought the patient to SVIMS on 01.03.2012 morning. Thus the averments of the complaint were proved false by his own representation Ex.B2. Accordingly this point is answered holding that the patient was brought to the opposite party hospital SVIMS only on 01.03.2012 but not on 29.02.2012 and as such there is no negligence as alleged by the complainant on the part of the opposite party in admitting the patient on 29.02.2012.

            8. Point No.(ii):-  to answer this point also the complainant has to prove that his wife Smt.T.Vijaya, was made to wait for 24 hours without admission from 29.02.2012 morning till 01.03.2012 morning at SVIMS and to prove that there is negligence on the part of the opposite party in this regard. As already discussed in point No.1 since the complainant failed to prove that patient was brought to SVIMS on 29.02.2012, the alleged negligence on the part of the opposite party cannot be accepted. In the evidence of P.W.1 (complainant) and also in Ex.B2 he stated that on admission of the complainant’s wife on 01.03.2012, the doctors at opposite party hospital and some nurses attended on the patient, took the patient for X-rays but there was delay in providing treatment. In this regard Ex.B1 the discharge summary shows all the details from the time of admission of the patient till she passes away at 8.40 p.m. on 01.03.2012. Similarly, the medicines used, investigations done and all the precautions that were taken by the doctors of opposite party hospital were apparent and the same was deposed by R.W.1, the Director of SVIMS (opposite party) at para.14 of her deposition that the patient was brought to SVIMS casualty on 01.03.2012 with abdominal paid for 4 days, vomiting, menstrual bleeding for 2 days for which she has taken treatment in a local hospital at Punganur before being referred to opposite party hospital as they could hot find any venous access on the patient. By the time the complainant’s wife was seen in opposite party hospital her condition was very serious on 01.03.2012. appropriate investigations were done and the patient was severely anaemic with both upper limbs haematoma with pulse 110/min and BP 90/60 mm Hg. The patient soon developed increasing abdominal pain and restlessness for which she was shifted immediately from casualty to CT Post – Opposite Party ICU ward. On further examination patient was found to have feeble peripheral pulse, multiple bruises over abdomen and swelling of both upper limbs. On the same day patient had become severely restless dysphneic and shock like state. The patient was immediately intubated by anaesthesia team and necessary medications and inotropic support was started. INR ratio was repeated and found to be high (4.93) for which anti coagulation medicine was stopped. By late evening patient continued to deteriorate and despite all active and life supportive measures taken by C.T.Surgery and Anaesthesia Doctors in C.T.Post – operative ICU ward, she deteriorated further and died at 8.40 p.m on the same day in view of severe continuous irreversible shock since the time of admission. R.W.1 further deposed that even before admission, the patient had severe menstrual bleeding, bruises over body and severe pallor related to bleeding disorder due to anti-coagulants compounded by her possible liver disfunction due to Hbs Ag positive status (Hepatitis B infection), Arrhythmia, Cardiac and respiratory insufficiency.

            9.  Admittedly, the complainant’s wife (deceased T.Vijaya) underwent mitral heart valve prosthetic replacement on 02.12.2011 when she was admitted in SVIMS opposite party hospital on 23.11.2011 and 7 days after post operative period, she was discharged from the hospital on 09.12.2011 for which a sum of Rs.1,24,230/- was billed but under Arogyasree scheme, a sum of Rs.1,20,000/- was paid by the Government, the remaining amount of Rs.4,230/- was given concession to the complainant. After bypass surgery, the patient came to opposite party hospital on 22.12.2011 for follow-up treatment, for which a sum of Rs.366/- was also taken from Arogyasree Trust. On 01.03.2012, when the patient expired, the hospital billed under receipt No.1556724 dt:01.03.2012 for an amount of Rs.5,833/- settled by the patients attendants and the institute had given concession of Rs.1,822/- in the aforesaid bill. Thus, the opposite party has taken all precautions to save the life of the patient on earlier and on 01.03.2012 as well and also given concession in the fees.

            10.  As per Discharge Summary dt:01.03.2012 (Ex.B1), the patient came to hospital with abdominal pain since 4 days, vomiting, chest discomfort and also complaint of menstrual bleeding since 2 days. The observations and investigations were clearly noted in the Discharge Summary at pages 10, 11, 12, 13, 14 and 15 i.e. the last pages of Ex.B1. The medicines prescribed and other treatment, investigations etc. were also clearly noted from time to time and also noted. Inspite of all the precautions and providing necessary treatment right from the time of admission till 8.30 p.m. by the doctors of opposite party (SVIMS), unfortunately the patient passed away at 8.40 p.m. on 01.03.2012.

            11.  Generally the doctors will not have any enmity with the patients, they will try their level best to save the life of the patient. If wrong diagnosis is there and found that the medicines were wrongly prescribed, due to such cases of wrong prescription or wrong diagnosis, if the patient dies then the negligence or deficiency in service can be attributed to the doctors concern, likewise, if the doctors though very much available by the time the patient was brought to the hospital and having known the condition of the patient as serious, the doctors could not attend on the patient, then also one can attribute some negligence on the part of the doctors. Here in this case, by the time, the patient was brought to hospital of opposite party on 01.03.2012 morning, the condition of the patient was very serious.  Even according to the representation of the complainant under Ex.B2, the doctor at Punganur by name Dr.Fakruddin, could not administer fluids to the patient, as he could not found venous access on the patient, as her both upper limbs (hands) were found swollen, in such condition only they left to SVIMS on 29.02.2012 and brought the patient to the hospital of opposite party on 01.03.2012. Immediately after the patient was admitted in opposite party hospital, the doctors at opposite party hospital and nurses were attended on the patient, then investigations were started and treatment was continued and the doctors made best efforts with keen observation on the patient for every 30 minutes, the timings were also noted in the Discharge Summary referred to above under Ex.B1. Under those circumstances, one cannot attribute negligence or deficiency in service on the part of the opposite party.

            12.  Admittedly, the wife of complainant was earlier admitted in the opposite party hospital in the month of November 2011. At that time, the doctors have diagnosed that she is suffering from Rheumatic Heart Disease with “Mitral Valve Stenosis” with history of breathlessness grade III. The patient was advised to undergo surgery. After she was admitted in SVIMS appropriate investigations were done and patient was planned for “Mitral Heart Valve Prosthetic replacement” on 02.12.2011 after cardiology evaluation. The patient and her attendants including the complainant were explained of the risk involved in surgery including the associated risk of Hbs Ag positive status (risk of developing Hepatitis B infection) and surgery was conducted as per accepted surgical methodology under the circumstances of mitral valve stenosis. The patient was implanted with 27mm Mitral ATS bileaflet mechanical valve under Cardio Pulmonary Bypass. Post operative period was uneventful and she was discharged on 09.12.2011 i.e. on 7^th post operative day. During post operative period 2D echo was done and it showed acceptable gradients, no para vulvular leak and normal LV function. By the tie of discharge, the patient was explained the need to come for follow-up treatment and the need for using anti coagulants medications life long in view of implantation of mechanical prosthetic valve. All these facts were admitted by the complainant, inspite of it, the complainant contended that prior to bringing his wife to the hospital of the opposite party on 01.03.2012, she was hale and healthy, which is found to be false. Under those circumstances, whatever the contention raised by the complainant for attributing alleged negligence and deficiency in service on the part of the opposite party is not substantially proved by the complainant.

            13.  The learned counsel for the opposite party relied on number of citations of National Commission 1) 2007 (2) ALT 11 (NC); 2) 2007 (4) ALT (NC) CPA; 3) 2007 (4) ALT 26 (NC) CPA; 4) 2008 (5) ALT 25 (NC) CPA; 5) (2009) 7 SCC 130; 6) (2005) 6 SCC 1; 7) 2006 (4) ALT 28 (NC) (CPA) and 8) 2003 (4) ALT 57 (NC) (CPA).  

            In the decision reported in 2006 (2) ALT 17 (NC) (CPA) – K.Venkateshwarlu Vs. Managing Director, Nagarjuna Hospital, Vijayawada, the Hon’ble National Commission held that medical negligence of doctor – dismissal of complaint by State Commission on the ground of absence of cogent and reliable evidence in support of alleged negligence of doctor. The complainant not examined any expert in support of his case to prove doctor’s negligence, complainant has to lead adequate evidence with supportive medical text, this the complainant has not done clinical notes of the hospital indicating that sincere efforts made by the hospital authorities and the doctor to treat the patient, that though complainant suffered a serious set back after surgery, there is no reliable evidence to throw the blame on the doctor, complainant failed to make out a case of medical negligence of the doctor, appeal dismissed upholding the order of the State Commission.

            In the case on hand also, the complainant simply made some allegations in the complaint attributing negligence and deficiency in service on the part of the doctors, but there is no cogent or reliable evidence to prove the said allegations. On the other hand, the pleadings are contrary to his representation made to the Governor of the State of Andhra Pradesh under Ex.B2, whose contents were admitted by P.W.1(complainant) as true. 

            In the decision reported in (2009) 7 Supreme Court Cases 130 – C.P.Sreekumar (Dr.), MS (Ortho) Vs. S.Ramanujam, their Lordships Supreme Court held that in case of medical negligence pleading and particulars necessary to establish onus of proving medical negligence lies on the complainant, mere averment in the complaint is not evidence, complaint is to be proved b cogent evidence, complainant is obliged to provide facta probanda as well as facta probantia . Further held bald statement cannot be accepted, respondent neither producing contrary evidence nor rebutting doctor’s version that aggravation was due to muscular spasm, hence negligence cannot be attributed to hospital staff with certainty.

            In another decision reported in (2005) 6 SCC P.1 – Jacob Mathew Vs. State of Punjab, their Lordships Hon’ble Supreme Court have given guidelines for application of negligence, ingredients and actionability, definition and meaning of negligence as follows – the jurisprudential concept of negligence defies any precise definition. In current forensic speech, negligence has three meanings. They are: (i) a state of mind, in which it is opposed to intention (ii) careless conduct; and (iii) the breach of a duty to take care that is imposed by either common or statute law. All three meanings are applicable in different circumstances but any of them does not necessarily exclude the other meanings.

            Negligence is the breach of a duty caused by omission to do something which a reasonable man guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do. Negligence becomes actionable on account of injury resulting from the act or omission amounting to negligence attributable to the person sued. The essential components of negligence as recognized are three: “duty”, “breach” and “resulting damage” that is to say: (1) the existence of a duty to take care, which is owed by the defendant to the complainant; (2) the failure to attain that standard of care, prescribed by the law, thereby committing a breach of such duty;and (30 damage, which is both causally connected with such breach and recognized by the law, has been suffered by the complainant. If the claimant satisfies the court on the evidence that these three ingredients are made out, the defendant should be held liable in neglingence.

            In the case on hand, none of the above ingredients were either pleaded specifically or proved by adducing cogent and reliable evidence, except making a bald statement in the complaint.

            It is settled proposition of law that in the case of medical negligence, doctor is not negligent if he is acting in accordance with standard practice. Generally, if there is no cure, it is not negligence on the part of the doctor, if there is a mistake it is common tendency to blame doctor for negligence, the burden of proof in action for damages for negligence rests primarily on complainant to prove that there is breech of duty on the part of the doctor.

            The other citations given by the learned counsel for the opposite party are not applicable to the facts of the case on hand.                                       

            In view of the decisions of the Hon’ble Supreme Court and National Commission, we are of the opinion that the complainant failed to make out a case of medical negligence on the part of the opposite party and no allegation of medical negligence or deficiency in service can be attributed to the doctors, who treated the patient Smt.T.Vijaya, wife of the complainant in the hospital of opposite party and accordingly this point is answered.

            14.  Point No.(iii):-  In view of our holding on points 1 and 2 and as the complainant failed to establish the medical negligence or deficiency in service on the part of the opposite party hospital and in view of the sincere efforts and proper treatment and investigations done to the patient on 01.03.2012 as per the Discharge Summary under Ex.B1, we are of the opinion that the complainant is not entitled to the reliefs sought for. Accordingly this point is answered.

            15.  Point No.(iv):-  In view of our holding on points 1 to 3, we are of the opinion that the complainant failed to establish the case of medical negligence on the part of the opposite party or its doctors and therefore the complaint is liable to be dismissed.

            In the result, the complaint is dismissed. No order as to costs.

Typed to dictation by the stenographer, corrected by me and pronounced in the Open Forum this the 13^th day of March, 2015.   

 

       Sd/-                                                                                                                      Sd/-                                                                  

Lady Member                                                                                                      President

 

APPENDIX OF EVIDENCE

WITNESS EXAMINED ON BOTH SIDES

 

 

 

Witnesses Examined on behalf of Complainant.

PW-1: Tammireddypalli Krishnamurthy

 

Witnesses Examined on behalf of Opposite Party.

RW-1: Dr.  B.Vengamma DM(Neurology) (Affidavits filed).

 

EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT

 

Exhibits	Description of Documents
Ex.A1.	Original Death Certificate. Dt: 23.07.2012.
2.	A Photocopy of Discharge Summary. Dt: 09.12.2011.
3.	A Photocopy of Ration Card. Dt: 16.10.2005.
4.	A Photo copy of Asha worker Training confirmation Letter. Dt: 02.06.2008 to 01.07.2008.
5.	A Photo copy of Preliminary Admission Form. Dt: 23.11.2011.

 

EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTY

 

Exhibits	Description of Documents
Ex.B1.	Case sheet of the Patient T.Vijaya containing pages 1 to 134 and out patient record bearing pages 1 to 16. Dt: 21.11.2011.
2.	A Photo copy of Representation of complainant to the Principal Secretary to Government Health Medical an Family welfare Department, Hyderabad. Dt: 18.05.2012.
3.	A True copy of Approval for cashless facility of Rs.1,20,000/- given by Arogyasree authorities for medical treatment of complainants wife.          Dt: 23.11.2011.
4.	A True copy of Bill for Rs.1,24,230 issued by Opposite Party hospital in respect of medical treatment given to complainant wife. Dt: 08.12.2011.
5.	A True copy of Receipt Dt: 01.03.2012 for Rs. 3,011/- issued by Opposite Party hospital in respect of medical treatment given to complainant wife. Dt: 01.03.2012.

 

 

                                                                                                                                   Sd/-           

                                                                                                                President

// TRUE COPY //

// BY ORDER //

 

 

Head Clerk/Sheristadar,

             Dist. Consumer Forum-II, Tirupati.

 

 

 

Copies to:-     1. The Complainant.

                        2. The opposite party.