1. This appeal arises out of judgement and order rendered by Karnataka State Consumer Disputes Redressal Commission, Bangalore (for short he State Commission in complaint case no. 1215 / 2001. By the impugned order, the complaint came to be dismissed. 2. Being aggrieved by the dismissal of her complaint, the original complainant has preferred this appeal. She is wife of deceased Gunasegaran, who allegedly died during course of surgical treatment in the hospital of respondents, namely, Manipal Hospital, Bangalore. 3. Briefly stated, the case of the appellant before the State Commission was that her husband Gunasegaran, aged about 58 years was employee of Hindustan Aeronautics Limited (HAL), Bangalore. He was suffering from unstable angina and diabetes mellitus. He was being treated for coronary heart disease for period between 29.05.2001 to 05.06.2001 in the HAL Hospital. He was referred by the HAL Hospital to Manipal Hospital on 5.06.2001. Though, there was no emergency yet he was operated on 13.06.2001. The bypass grafting of two valves was done during course of the said operation. The grafting had failed due to coronary spasm. On the same day, for second time he was subjected to another operation without his or relative consent. He was operated for the third time on the next day, i.e., 14.06.2001 and was kept in ITU without closing the chest for about 12 hours. He was moved to operation theatre on 15.06.2001 for alleged removal of blood clot without taking consent of the patient or his relatives. In the course of surgical procedure, it was ultimately found that there was low cardiac output due to acute renal failure. Though dialysis procedure was used yet on 17.06.2001, Gunasegaran died on account of renal failure. 4. The complainant alleges that surgeon who performed the operation as Chief Cardiac Surgeon at Manipal Hospital, was not duly qualified as a super-specialist. The consent for all the surgeries had not been obtained from the patient or his relatives. The concerned Doctors did not take proper and reasonable care while operating deceased Gunasegaran. Though, there was no history of renal impairment prior to the admission of deceased Gunasegaran in Manipal Hospital yet there was prognosis of renal failure / functioning during the surgical procedure. The multiple surgeries caused on the patient, without proper diagnosis and without due care, had resulted into low cardiac output and the kidney failure. Therefore, the Hospital and the Chief Surgeon of Manipal Hospital were liable to indemnify the appellant (complainant). She, therefore, sought compensation of Rs.20 lakh from the original opposite party nos. 1 & 2. She also sought compassionate appointment on establishment of the HAL. 5. The contesting respondents, original opposite party nos. 1 & 2, resisted the complaint. They denied that there was negligence while conducting the operations. They submitted that the husband of the appellant was already suffering from several ailments and was recommended to undergo the surgery before about 3 years after he had complained of chest pain. He had avoided such surgical procedure, with due knowledge that the surgery was necessary. He preferred to take only conservative treatment at HAL Hospital. He was suffering from severe diabetes. He was informed of the risk involved in coronary bypass surgery. The operations were conducted with informed consent of the patient. The respondent nos. 1 & 2 further submitted that on 15.06.2001 an expert Nephrologist was consulted for treatment of renal failure and peritoneal dialysis was started. They submitted that due precaution and care was taken while conducting the emergency operations. According to them, the death occurred as a result of low cardiac output leading to acute renal failure. The deceased also suffered from a rare but well-known complication of coronary spasm which caused failure to salvage him in spite of 5 days treatment in the I.T.U. In other words, the defence of the respondent nos. 1 & 2 was that the death was not result of any negligence on part of the Surgeons who conducted the surgical procedure. 6. It may be stated here that original OP Nos. 3 & 4, namely, Chief of Medical Services, HAL and the Chairman of HAL were deleted from array of OPs during pendency of the complaint proceedings. Obviously, they are not parties in the present appeal. 7. The State Commission heard learned counsel for both the parties and considered the material placed on record. The State Commission came to the conclusion that the appellant failed to establish her contention that multiple surgeries were conducted by the respondents without consent of the patient or his relatives. The State Commission further held that there was no medical negligence committed by the respondents which resulted into death of husband of the appellant (complainant). Consequently, the complaint was dismissed. 8. We have heard learned counsel for the parties. We have also perused the relevant documents and the medical literature placed on record. The questions which fall for our consideration may be articulated in following manner: i) Whether the appellant proved that the respondents conducted surgical procedures without informed consent of the patient and without his knowledge that risk factor was involved in such procedure/s? ii) Whether the appellant proved that her husband died as a result of medical negligence caused by the respondents while conducting the surgical procedure/s which had been done without taking due care by any act of commission or omission on part of the operating Surgeon/s? 9. Before adverting to the rival contentions, it may be stated that in case of alleged medical negligence, it is necessary to prove that the concerned medical practitioner was either incompetent to give the treatment to the patient or there was absence of due care and skill which is expected from a prudent practitioner. It is not necessary to reiterate the legal position which is duly set at rest. In acob Mathew Vs. State of Punjab [(2005) 6 SCC 1] We may take note of the fact that the test of medical negligence as laid down in olam Vs. Friern Hospital Management Committee[(1957) 1 WLR 582 : (1957) 2 All ER 118] is accepted by the Supreme Court in several judgements. The principle laid down in Bolam case is thus : .[A Doctor] is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.. It was further held that n the realm of diagnosis and treatment there is ample scope for genuine difference of opinion and a doctor is not negligent merely because his conclusion differs from that of other professional men. 10. In the fact situation of the present case, it is difficult to say that the attending doctors of the Manipal Hospital were not duly skilled. The medical record and the affidavits filed by the treating Doctors go to show that the Doctor K.S.S. Bhat was working as consultant cardiologist in Manipal Heart Foundation since its inception. He was also visiting consultant in cardiology for HAL Hospital. His affidavit shows that he had clinically examined deceased Gunasegaran at HAL Hospital in 1997 and also while the latter had been in HAL Hospital. His affidavit shows that Gunasegaran was admitted in HAL Hospital for about one week before he was referred to and admitted to Manipal Heart Foundation Hospital. The version of Dr. K.S.S. Bhatt, shows that he is well-experienced and highly qualified cardiologist. His version further shows that he has advised deceased Gunasegaran in 1997 to undergo CABG. His version reveals that Dr. Padmnabhan was attached to HAL Hospital as a physician but was not a cardiologist. What appears from the record is that though deceased Gunasegaran was advised to undergo cardiac surgery in 1997 yet, against such medical advice, he continued to be on conservative treatment. Needless to say that the patient was not unaware of the impending danger due to non-adherence to the medical advice. The affidavit of Dr. Raghuraman who is attached as a Doctor in HAL Hospital reveals that deceased Gunasegaran was suffering from nstable angina on effort His version shows that in 1997 Dr. Padmanabhan had attended Gunasegaran. Dr. Padmanabhan had prescribed certain drugs. It is true that Dr. Padmanabhan gave a remark on the prescription that there was no specific problem. The appellant alleges that deceased Gunasegaran was not suffering from any cardiac problem due to the medicines prescribed by Dr. Padmanabhan. The remark of Dr. Padmanabhan, however, does not show that the medical problem of nstable anginawas cured. Nor affidavit of Dr. Padmanabhan was filed by the appellant (complainant) in the course of proceedings before the State Commission. 11. We have gone through affidavit of Dr. Dev Anand which throws light on the emergency operations conducted in the Hospital of the respondent nos. 1 & 2. His version shows that from 5.06.2001 to 18.06.2001, in all, four surgical operations were performed. His version shows that diagnosis of subendocardial infarction was done by Dr. Bhat on basis of ECG report. Respondents adduced the evidence and also produced the relevant documents of medical treatment in order to show that the operations were essential in order to save life of the deceased. The medical record shows that initially consent of the deceased was obtained. The operation was not done without informing consequences and probability of complications arising out of such operations. The death summary issued on 18.06.2001 shows that deceased Gunasegaran was a known case of iabetes Mellitus He was admitted in the hospital of the respondents on reference by HAL Hospital. History recorded at the time of admission was of ffort angina NHYA class II The history further shows that the deceased had sustained Ishemic Heart Disease in 1997, Coronary angiogram showed Triple vessel impaired with Impaired LV function. The cause of death was low cardiac output due to acute renal failure following Ishemic Heart Disease. 12. Learned counsel for the appellant submits that prior to operation there was no renal failure of the complications arose because of lack of medical care. He would submit that there was no reason for the surgeon to keep the chest open for 12 hours. He contended that from 1997 till 2001 deceased Gunasegaran had not developed any serious heart problem and therefore, he had not selected to undergo the surgical procedure. He argued that surgical operations were not urgently required. He contended that in any case, the renal failure could be attributed to medical negligence of the treating Doctors of the respondent Hospital. 13. It is an admitted fact that no expert evidence was adduced by the appellant (complainant) before the State Commission. In this Commission, the matter was referred to committee of medical experts of the All India Institute of Medical Science (AIIMS), New Delhi. The medical board by letter dated 12.02.2011 gave opinion as stated below:- he medical board is of considered opinion that there is no evidence of any act of omission or commission on the part of the hospital and treating team to be labelled as medical negligence. This report of AIIMS cannot be lightly brushed aside. 14. In any case, there is no rebuttal evidence adduce by the appellant to show that the report of the expertscommittee is unacceptable though objection petition has been filed to show that the same is unacceptable. Learned counsel for the appellant invited our attention to . Kishan Rao Vs. Nikhil Super Speciality Hospital & Anr.[(2010) 5 SCC 513]. The Supreme Court held that the Consumer Forum can permit expert evidence but it is not bound by the view expressed by the expert because medical negligence is a mixed question of law and facts which is required to be resolved by the Forum. In our opinion, in the present case, the medical negligence cannot be inferred only on basis of the entries in the medical papers and on basis of affidavit of the appellant. Admittedly, the appellant is a housewife and has no necessary knowledge of medical science. The deceased was suffering from Diabetes Mellitus with history of ffort Anginain 1997. He had received chest pains and was diagnosed of having ishemic heart disease. His three vessels were impaired and, therefore, blood supply to the heart was irregular. It is well-known fact that diabetes is itself an impediment in conducting the surgical procedure. The medical record shows that the deceased was admitted in 1997 in HAL Hospital due to subendocardial infarction, meaning thereby that the blood supply to the heart was obstructed and, therefore, he was suffering from chest pains. With such a past medical history, when the problem was unmanageable at the HAL Hospital, the patient was referred to the Hospital of the respondent. It is obvious, therefore, that the Hospital of the respondents was considered to be well-equipped and there was expertise available to treat the patient. In such a complicated case, without support of any expert opinion, the complainant case of alleged medical negligence cannot be accepted only on basis of her affidavit or some entries in the medical record. The renal failure was result of less cardiac output. The medical record shows that a Nephrologist was consulted during the surgical procedures. No doubt, it was unfortunate death of the patient which could have caused much agony to the complainant. Still, however, in absence of any substantial evidence adduced by the appellant (complainant) to show that the death was result of carelessness or negligence of the attending Doctors, it is difficult to allow the claim for compensation. We are in general agreement with the reasoning and finding of the State Commission. 15. In a similar case in ethuraman Subramaniam Iyer Vs. Triveni Nursing Home & Anr.[I (1998) CPJ 110 (NC)], this Commission held that in absence of any expert evidence adduced on behalf of the complainant, a reasonable view taken by the State Commission is required to be maintained. In other words, the appeal cannot be allowed only because some other view is possible. 16. Taking over all view of the matter, we do not find any substance in the appeal, hence the appeal is dismissed. No costs. |