Tamil Nadu

StateCommission

CC/11/2007

Rani Samyuktha - Complainant(s)

Versus

The Chairman International Center for Cardiac Thoracic & Vascular - Opp.Party(s)

T.S.Sasi Kumar

10 Dec 2015

ORDER

 

BEFORE THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI

                           Present: Thiru J. Jayaram,                                PRESIDING JUDICIAL MEMBER

                                         Tmt.  P. Bakiyavathi                           MEMBER

 

C.C. No. 11 / 2007

                                                                         Dated this the  10^TH day of DECEMBER, 2015

Mrs. Y. Rani Samyuktha,                              ]

W/o Late Mr. Y. Venkata Rao,                       ]

MIG-347, P.M. Palam,                                  ]

Vishakapatnam,                                           ]  ..  Complainant

Andhra Pradesh                                           ]

 

                   Vs.

 

The Chairman,                                             ]

International Centre for                                 ]

Cardio-Thoracic and Vascular Diseases,       ]

A Unit of Frontier Life Line (P) Ltd,               ]

R.30-C, Ambattur Industrial Estate Road,      ]  ..  Opposite Party

Chennai – 600 101                              ]

   

This complaint coming up before us for final hearing on            16-10-2015 and on hearing the arguments of both sides and upon perusing the material records, this Commission made the following Order:

Counsel for Complainant:                    -        M/s T.S. Sasikumar

Counsel for Opposite Party                  -        M/s Subba Reddy

J. JAYARAM, PRESIDING JUDICIAL MEMBER

           The case of the complainant is as follows: The complainant came to Chennai with her husband Venkata Rao, Y. for treatment of his cardiac problems and consulted the opposite party in their capacity as expert heart surgeons in Chennai. On the advice of the heart surgeon at the International Centre for Cardiac-Thoracic and Vascular diseases, she admitted her husband in their hospital on 19-02-2005 for treatment of his cardiac problems. On the advice of the heart surgeon of the hospital, a Coronary Aortic By-Pass Surgery, two – grafts with Aortic valve replacement was conducted on 25-02-2015. At the time of the operation, the opposite party had told her that the entire operation would be recorded in the CD and will be given to her.

2.       Her husband underwent surgery on 25-02-2005, but following the operation he had profuse bleeding and the next day morning on 25-02-2005 the Surgeon informed her that her husband had passed away in spite of the operation being successful. The hospital authorities never informed that they withdrew the life supporting system from the patient, even though she was present at the time of withdrawal of the life supporting system. After the death of her husband, she requested the hospital authorities to provide the CD recorded at the time of the operation, but they informed her that there was no recording of the operation done, even though the opposite party had told the complainant that the entire process would be recorded and the CD would be given to her.

3.       She sent a letter in the month of May, 2005, requesting the authorities of the opposite party to send the authenticated copies of the case sheet and other related records of the patient and she received a reply from the opposite party; In response to which, the opposite party had sent her only the operation notes and the Coronary Angiogram Report. She actually asked for the entire case sheets with all the details of the operation clause 6 – injections and drugs administered and such other relevant information. On perusing the notes sent by the hospital, she was shocked to find that on several sheets, the hospital had mistakenly noted her late husband’s name as well as age and also several corrections even in the list of medication administered.

4.       The risk factor in the operation had increased because of the age factor. The opposite party did not take care to intimate the above fact to the complainant before conducting the surgery.

5.       Further, by way of reply, the opposite party has mentioned that they had conducted 5 operations on the day when her husband underwent operation and the operation involving high degree of risk in the case of her husband should not have been conducted in such careless negligent manner.

6.       Despite repeated requests, the CD recording of the operation and the original case sheets were not furnished to her. In the consent form, there was a clause which speaks about the photographs in the operation room for which they had given consent.

7.       In these circumstances, she sent a complaint dated 19-07-2006 to the Medical Council of India, against the opposite party for not furnishing the relevant case records and CD, which amounts to deficiency in service. The Medical Council of India forwarded the complaint to the Andhra Pradesh Medical Council, who in turn, forwarded the complaint to the Tamil Nadu Medical Council for further action which had jurisdiction over the opposite party as they reside in Tamil Nadu, for taking proper action, and there after the opposite party tried to convince her that they were not negligent or deficient in service. The complainant had telephonic conversation with the opposite party; but it was in vain. Her husband died only due to the negligence on the part of the opposite party and without undergoing the high risk surgery he might have survived for a few more years.

8.       The complainant had incurred expenses to the tune of Rs.2 Lac and also suffered mental agony and severe hardship trying to get the authenticated case records and the CD which were not furnished by the opposite party, amounting to deficiency in service on the part of the opposite party.  Hence the complaint is filed praying for direction to the opposite party to recompense for the expenditure incurred as hospital charges for the surgery to the tune of Rs.2 Lac and to pay a sum of Rs.5 Lac towards deficient and negligent service and another sum of Rs.5 Lac for mental agony and hardship suffered by her and to pay punitive damages to the tune of Rs.10 Lac, totally amounting to Rs.22 Lac, and to pay costs.  

9.       The opposite party filed version stating as follows:

The opposite party’s hospital is an internationally reputed heart care institute equipped with updated advanced technology of international standards. The complainant’s late husband Venkata Rao was a chronic rheumatic heart disease patient from his early childhood. On 19-02-2005, the complainant’s husband aged 69 years, who was a well known diabetic for over 20 years came to the outpatient department of the opposite party with a history of breathlessness during routine activities and chest discomfort and exhaustion for the past more than 1 year and he was a known case of Aortic Valve narrowing since birth for which he was already evaluated at Christian Medical College Hospital, Vellore and Apollo Hospital in 1986 and 1989 and he was investigated at Care Hospital, Hyderabad on 19-06-2004 where he was diagnosed to have severe aortic valve narrowing, coronary artery disease and advised to undergo coronary angiogram and immediate surgery. He came to the opposite party hospital for treatment almost 1 year later with severe symptoms. After expert evaluation, the outpatient department of the opposite party hospital, he was advised to have coronary angiogram and Right Heart Study followed by Aortic Valve Replacement and he was admitted for the same on 20-02-2005. After pre-Angio-screening, he was taken up for Coronary Angiogram on 21-02-2005. Angiogram revealed left main coronary artery disease with three vessel coronary artery disease, severe calcific aortic stenosis(narrowing), moderate aortic regurgitation(leak) moderate pulmonary artery hypertension and normal left ventricular function. Due to the underlying disease and its severity, he was advised to undergo Coronary Artery Bypass Surgery along with Aortic Valve Replacement. All necessary pre-operative procedures like dental consultation, anesthesia assessment and all other investigations were carried out in order to prepare the patient for surgery. The patient and his relatives were fully explained about the risk of surgery and complications. A full-informed written consent was taken from the patient and his wife Mrs. Rani Samyuktha Y. before the surgery. Patient underwent Coronary Artery Bypass Graft Surgery with two grafts and his diseased aortic valve was replaced with bioprosthetic valve on 25-02-2005. The aortic root was very narrow, hence aortic root enlargement using pericardium was also performed. After the main procedure was over, the heart was not beating initially, then with ventricular pacing the heart picked up. But severe bleeding with generalized oozing was noted which was controlled. Gradually, he came off bypass with supportive medications. His chest was kept open and only skin closure was done. He was shifted to ICU with all kinds of supports. During his post-operative period, he was having persistent low blood pressure and his kidney functions were deranged, for which he was on appropriate medications. His chest was closed after giving antibiotic wash to avoid infection. Relatives were allowed to visit the patient after the surgery in the ICU and were informed of his condition. His rhythm and heart rate was maintained. But at 1.15 PM on 26-02-2005 he suddenly had a Cardiac Arrest. In spite of all resuscitative measures the patient could not be revived and was declare dead at 3.20 PM on 26-02-2005. From the details given above, it is evident that the deceased Mr. Venkata Rao Y was admitted at Frontier Lifeline with severe aortic valve stenosis and triple vessel coronary artery disease which was a high risk case. The patient as well as the complainant herein and her relatives were clearly appraised by the Cardiologist and Cardiac Surgeons from time to time regarding the risk involved in carrying out the surgery. In spite of the best of pre-operative evaluation by competent and experienced Cardiologist, best possible surgical treatment by qualified, competent surgeons and the best possible post-operative care, the patient succumbed which was unfortunate and fatal. From the above information it is crystal clear that at no stage of the entire treatment process, there was any negligence or lack of proper care given to the deceased husband of the complainant. There was no promise made regarding the provision of CD by any one from the opposite party hospital since surgical procedure are not recorded in a routine manner. Only the Angiogram Report / CD is given, in which the complainant has misunderstood as surgery CD. Only rare surgeries performed during conferences, workshop and when foreign surgeons perform specialized surgeries are only video recorded in CD or photographs. The surgery performed in this case is only a routine cardiac surgery and more over, the Medical Council of India also does not have any regulations on the hospital for recording the operation procedure by a CD and this is purely left to the discretion of the hospital whether to record it or not depending upon their needs.

 

10.     Bleeding complications do happen during cardiac surgery due to use of anti-platelet agents, preoperative use of anticoagulants, which is subsequently reversed with protamine, use of foreign material in the blood vessel, with cardiopulmonary bypass equipment, bleeding is a distinct possibility which is explained in advance to patient and relatives. In fact, request is made to them to arrange blood donors and all hospitals performing open heart surgery need to have a well stocked blood bank. The Labs at the opposite party’s hospital are ISO certified and maintain the highest standards. There are several measures to try and arrest bleeding. These include extra protamine, use of blood products, transexaemic acid, and all of these have been done in Mr. Y. Venkata Rao. Keeping the chest open would lead to infection, where one of the accepted practices is packing the chest with gauze and closing the skin. This controls the bleeding, allows speedy access in ICU to the heart, if needed. This was done in Mr. Venkata Rao’s case. The very fact that post-operative ICU drainage was only 490 ml. testifies the efficacy of this system. While so, then the bleeding is the fact, it is evident that there has been no deficiency in service, in managing the same effectively.    

 

11.     The entire case records had been duly forwarded to the complainant as evidenced by letters. Mere spelling mistakes in the name of the diseased had no bearing at all in the details of patients operated on 22-02-2005 and 5 surgeries were carried out on that day and none of the other patients had similar to the complainant happened. Even though advanced age contributes to the risk of surgery, it is not the only risk factor. Apart from that, coronary artery bypass surgery with two grafts (CABG) and aortic valve replacement itself carries approximately 10% mortality, in addition to 5% morbidity in the presence of calcified valve diabetic mellitus and used all cardio pulmonary bypass.

 

12.     As regards the complainants allegation regarding 5 surgeries performed on the same day when a high risk surgery like the complainant’s husband was carried out in no way indicates deficiency in service. The hospital has 4 operation theatres fully equipped with porcelain operation rooms, the only one of its kind in India where simultaneously surgeries can be carried out. The hospital has 6 qualified Post M.Ch. Senior Consultant Cardiac Surgeons and 5 junior Cardiac Surgeons supported by 6 senior Consultant Cardiac Anesthesiologists performing surgery. It is not unusual or unknown to operate 5 patients per day.

 

13.     In addition, the consent form has a clause that in case of necessity, photographs can be taken on a special occasion. This in no way conforms with photographs have been taken or the procedures have been recorded by a CD. The consent obtained in this particular case was only a routine consent and it is included in the consent form so as to legalize the photographs done in case of unusual finding are recorded. None was present in this case.

 

14.     As already stated, photographing through CD is only intended for cardiac or research purposes and such CD recording is done when foreign surgeons perform specialized surgeries. The surgery performed in this case is a routine cardiac surgery. Recording by CD is the sole discretion of the hospital depending upon their needs for academic interest. The risk factors in a surgery are due to the condition of the patient, nature of disease and due to associated – co-morbid conditions which increase by age. These factors were clearly explained to the patient and his relatives prior to surgery. Thus while advanced age contributes to the risk, it is not the only one.

 

15.     The allegation that the complainant’s husband died due to the negligent act of the hospital is incorrect and baseless. The patient is a known case of heart disease and has been already evaluated at CMC, Vellore, Apollo Hospital, Chennai during 1986 and 1989, and subsequently he was also evaluated at Care Hospital in 2004, which proves beyond doubt that the patient had heart ailment which required immediate surgical treatment for which he came to Chennai for expert heart treatment. The coronary artery bypass surgery and aortic valve replacement carries a definable mortality prior to surgery.

 

16.     All case records and appropriate documents have been provided to the complainant and also has been contacted personally. There is no negligence or deficiency in service in the entire treatment of the complainant’s husband.

 

17.     The complainant filed proof affidavit and 29 documents, marked as Ex.A1 to A29 on the side of the complainant. The opposite party filed proof affidavit and 7 documents marked as Ex.B1 to B7 on the side of the opposite party.

18.     The points for consideration are:-

                      i)        Whether there is negligence or deficiency in service on the part of the opposite party as alleged in the complaint;

 

ii)       Whether the complainant is entitled to claim compensation from the opposite party; and

 

                       iii)      To what relief the complainant is entitled;

 

19.     Point Nos.1 to 3: The complainant has filed this complaint seeking compensation from the opposite party for the negligence and deficiency in service on the part of the opposite party in performing the surgery on the complainant’s husband resulting in his death.

20.     First, it is pertinent to note that there is no allegation in the complaint against the opposite party that the doctors / surgeons who treated the complainant’s husband and performed surgery are not duly qualified or reasonably skilled or not competent to treat and perform the surgery. The complainant has not specifically attributed any negligence or deficiency in service on the part of the opposite party in performing the surgery or the surgical procedure or the treatment, except a vague allegation that her husband died due to the negligence and the deficiency in service on the part of the opposite party.

21.     The Hon’ble Supreme Court has held in the case of Martin F.D’ Souza v. Mohd Ishfaq – I (2009) 32 (SC) 

        “Simply because patient not favourably responded to treatment given by doctor or surgery failed, doctor cannot be held straightaway liable for medical negligence”.

The Hon’ble National Commission in the case of V.K. Sharma v. Bharti Eye Foundation and another – II (2010) CPJ 94 (NC) has held -

“Just because the complainant not responded fvourably to treatment, no negligence can be attributed to the opposite party”.

22.     According to the complainant, there is negligence and deficiency in service on account of:

 

1) The operation procedure was not recorded and the recorded CD was not given to the complainant;

 

2) Original case sheets were not furnished to the complainant; and

 

3) Risk factor was not adequately explained to the complainant.

23.     It is relevant to note that no medical expert’s opinion is filed and no expert’s evidence is adduced.

24.     It is mainly contended by the complainant that the opposite party failed to record the process of surgery in CD and that the recorded CD was not furnished to her. Per contra, the opposite party would contend that surgical procedures are not recorded as a routine; only the Angiogram report / CD is given, and only in rare surgeries performed during conferences and workshops, academic purposes and only when foreign Surgeons perform specialized surgeries, are pre-recorded in CD or photographed. In this case, the surgery performed on the complainant’s husband was only a routine cardiac surgery and more over, the Medical Council of India does not have any regulations on the hospitals for recording the operation procedures by a CD and there was no promise made to the complainant that the surgery would be recorded and the CD would be given to the complainant. Therefore, the contention of the complainant that the opposite party did not record and furnish the CD to the complainant amounts to negligence and deficiency in service, is untenable.   

  

25.     The further contention of the complainant would be that the opposite party failed to furnish all the medical records wanted by the complainant; and the opposite party furnished only the operation notes and Coronary Angiogram report, and they did not furnish the entire original case sheets with all the details about the operation process; the name of injections and drugs administered to the patient.

26.     According to the opposite party, the entire case records had been sent to the complainant. The complainant is not at liberty to call for all the original case sheets or whatever documents she wants. On perusal of the records, we find that all the necessary records have been furnished to the complainant as stated herebelow, and the complainant cannot go on seeking to produce the originals of any documents as she pleases.

27.     From Ex.A2, A3, A5 and other exhibits filed by the complainant herself, we come to know that the following records have been furnished to the complainant by the opposite party:

1.       Admission and Discharge Record

2.       Patient’s Registration Form

3.       Outpatient clinical adult new case record

4.       Patient case record

5.       Angiogram Report

6.       Coronary Angiogram Report

7.       Micro Biology – Serology Report

8.       Micro Biology and Progress Report

9.       Cardio Surgical Summary

10.     Histopathology Report

11.     Micro Biology and Culture and Sensitivity

12.     Consent Form

13.     Operation Notes

14.     Medical Certificate of cause of death

15.     Death Summary

16.     Death Certificate

 

There is no material on record to establish that the documents were not furnished to the complainant. Therefore, the contention that the relevant medical records have not been supplied to the complainant is unsustainable.

28.     Another contention of the complainant would be that the opposite party did not take care to intimate to the complainant that in view of the age factor (69 years), the risk factor was more, and that the high risk operation was performed without adequate intimation to the complainant about the risk.

29.     In this context, we have to note that the complainant’s husband, admittedly, was a well known diabetic for over 20 years and he was a Chronic Rheumatic Heart disease patient from his childhood, and he approached the opposite party with history of breathlessness during routine activities and chest discomfort on exertion for the past more than one year and he was a well known case of aortic valve narrowing since birth, for which he was already evaluated at Christian Medical College, Vellore; and Apollo Hospital in 1986 and 1989, and he was also investigated at Care Hospital, Hyderabad on 19-6-2004. In these circumstances, we have to note that the complainant’s husband was a high-risk heart patient and the doctors have nothing to explain considering his age and his chronic health problems that he had to undergo the risk of surgery; and that age is also a contributing factor and the complainant’s allegation that the opposite party did not inform them that it is a high risk surgery; and that with advanced age, the risk factor was more; is without any substance, and in view of the above facts and circumstances, even a common man knows that it is a high risk surgery, left with no other option. Further, the complainant has given her consent for surgery.

30.     The further contention of the complainant is that five surgeries were conducted in the hospital and since too many surgeries have been performed per day, it would affect the quality of the treatment and surgery. The opposite party has furnished statistics of heart surgeries conducted in other reputed hospitals as follows:

 

“Narayana Hirudalaya, Bangalore conducts 15 – 20 surgeries / day;

 

Escorts, Delhi conducts 15 – 20 surgeries / day;

 

Railway Hospital, Perambur, Chennai conducts 4 surgeries / day;

 

All India Institute of Medical Sciences, Delhi conducts 10 to 12 surgeries / day;

 

Madras Medical Mission, Chennai conducts 7 – 8 surgeries / day;

Wockhardt, Bangalore conducts 4 – 5 surgeries / day”.

 

Hence, the complainant’s statement regarding 5 surgeries were carried out on the same day of her husband’s surgery does not have any sequence. There is no force in the contention of the complainant that too many surgeries were performed by the opposite party on that day resulting in negligence and deficiency in service on the part of the opposite party, causing her husband’s death.

31.     It is further contented by the complainant that the life support system was removed without her permission, which is denied by the opposite party, and according to the opposite party, the life support was withdrawn only after brain death of the patient and only after informing the complainant. Therefore there is no merit in the argument.

32.     Further, it is significant to note that the opposite party Dr. K.M. Cherian is a leading and very eminent and outstanding Heart Surgeon and the opposite party’s hospital is a very reputed and renowned hospital in Chennai. In this backdrop, we have to note that the complainant has alleged in para 32 of the compliant that the opposite party performed surgery on a patient of 69 years; but they failed to do their duty for greed of money. This statement of the complainant is meaningless and this remark against the opposite party is a baseless and unwarranted one, and it is deprecated by the Commission.  

33.     We have to note that the mere allegations leveled against the opposite party will not go to establish negligence or deficiency in service on the part of the opposite party. On considering the entire materials on record, we hold that the complainant has not established her case of negligence and deficiency in service against the opposite party.

34.     Therefore, we hold that there is no negligence or deficiency in service on the part of the opposite party, and that the complainant is not entitled to claim compensation from the opposite party and that the complainant is not entitled to any relief in the complaint, and the points are answered accordingly.

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

 

 

P. BAKIYAVATHI                                J. JAYARAM          

MEMBER                                      PRESIDING JUDICIAL MEMBER     

 

 

List of Documents filed by the Complainant

Ex.A1        May 2005       Letter by the complainant to opposite party

Ex.A2        25-05-2005     Letter from the opposite party with operation

                                      note and Angiogram Report

Ex.A3        08-07-2005     Letter by the complainant

Ex.A4        July 2005       Letter by the complainant

Ex.A5        27-07-2005     Letter by the opposite party with Xerox copies

                                      of the case file.

Ex.A6        31-01-2006     Letter by the complainant

Ex.A7        02-02-2006     Letter by the complainant

Ex.A8        07-02-2006     Letter from Dr. Cherian

Ex.A9        09-06-2006     Letter from the complainant

Ex.A10      09-06-2006     Letter from the complainant

Ex.A11      17-07-2006     Letter from the complainant to Medical

                                      Council of India

Ex.A12      17-07-2006     Letter from the complainant to the Chairman /

                                      opposite party asking CD.

Ex.A13      10-08-2006     Reply from the Chairman / opposite party to

                                      the complainant                       

Ex.A14      14-08-2006     Letter from the Medical Council of India and

                                      AP Medical Council CC complaint

Ex.A15      18-09-2006     Reply from Medical Superintendent / opposite

                                      Party

 

Ex.A16      03-10-2006     Letter from complainant to Medical Council of

                                      India

Ex.A17      10-10-2006     Letter from AP Medical Council  to Medical

                                      Council of India / CC complaint

Ex.A18       03-11-2006    Letter from the Medical Council of India / CC

                                      to Tamilnadu Medical Council.

 

Ex.A19       10-11-2006    Letter from Indian Medical Association to the

                                      Complainant

Ex.A20       19-02-2005    Patient’s Registration Form from International

                                      Centre for Cardio Thoracis Vascular diseases

Ex.A21       21-02-2005    Angiogram Report Micro Biology

Ex.A22       26-02-2005    Admission for discharge record of Mr. Venkata

                                      Rao.

Ex.A23       26-02-2005    Histopathology Report of Mr. Venkata Rao

Ex.A24       26-02-2005    Micro Biology Report of Mr. Venkata Rao

Ex.A25       26-02-2005    Death Certificate of Mr. Venkata Rao. Y

Ex.A26       19-02-2005    Bill amount Rs.300/-

Ex.A27       21-02-2005    Receipt for Rs.10,000/- from A. Venkata Rao

Ex.A28       24-02-2005    Bill for Rs.400/-

Ex.A29       26-02-2005    Inpatient bill Rs.2,07,121/-

List of Documents filed by the opposite party:  

 

Ex.B1     26-02-2005        Death Certificate

 

Ex.B2     25-05-2005        Letter from opposite party to complainant

 

Ex.B3     27-07-2005        Letter from opposite party to complainant

 

Ex.B4     25-02-2005        Extract from operation    

 

Ex.B5     07-02-2006        Letter from opposite party to complainant     

 

Ex.B6     10-08-2006        Letter from opposite party to complainant

 

Ex.B7     22-08-2006        Letter from Indian Medical Association (HQS)

                                      to opposite party

 

P. BAKIYAVATHI                                          J. JAYARAM          

         MEMBER                                    PRESIDING JUDICIAL MEMBER