This C.C. is coming on before us for final hearing in the presence of Sri.Mukunda Rama Murthy, Advocate for complainant; and of                   Sri. K. Hanumantha Rao, Advocate for opposite parties No. 1 to 3; upon perusing the material papers on record and upon hearing and having stood over for consideration, this Forum passed the following order;

O  R  D  E  R

(Per Sri R.Kiran Kumar, Member)

          This complaint is filed u/s.12-A of Consumer Protection Act, 1986. 

2.      The averments made in the complaint are that the complainant belongs to scheduled tribe community and has been working as General Majdoor in 21 incline, Singareni Coallories, Yellandu, vide employee code No.0443999 and he is resident of Polampalli thanda (v), Singareni Mandal, Khammam District.  The complainant submitted that being an employee of Singareni Coallories company limited, he had registered names of his family members including him in the family medical attendance book and that if any illhealth caused to him or his family members, the opposite parties have to provide free medical facility to them.  On 10-06-2007, the wife of the complainant Smt Banoth Saji had suffered from ill health and bleeding and immediately she was taken to Singareni Coallories Hospital, Yellandu at about 9:00 AM, by showing family medical attendance book in the registration division and got registered the same vide registration No.5742, dt. 10-06-2007 and admitted in the hospital.  The complainant submitted that the doctor had sent the wife of the complainant to the laboratory for tests and in the laboratory they collected blood and urine samples of the wife of the complainant and asked the  complainant to get his wife to the hospital tomorrow.  The complainant also submitted that he requested the doctors to join his wife in the hospital, but the doctors advised the complainant to get his wife tomorrow, as per the advice of the doctors only he had taken his wife to the house and on 11-06-2007 the complainant had taken his wife to the hospital, as per the advice of the doctor.  The complainant further submitted that he collected the report of the blood and urine tests from the laboratory and submitted the same to the  doctor, after verifying the report the doctor referred the wife of the complainant to Singareni Coallories Main Hospital, Kothagudem vide letter No.Ref/YLD/D/009/1797/E, dt. 11-06-2007.  The complainant submitted that he requested the doctors to provide Hospital Ambulance as his wife condition was in critical, for shifting her to Kothagudem for immediate treatment but they refused to provide Ambulance and only permitted to pay Bus charges through accounts section of G.M. office and after getting Bus Charges from the accounts section, they travelled in Bus and went to Kothagudem immediately and reached Singareni Coallories Main Hospital, Kothagudem at 2:30 PM, meanwhile the health of the complainant’s wife has become very serious in condition.  Immediately, the complainant approached the Opposite party No.2 to join his wife, after waiting for one hour on several requests the duty doctor admitted the wife of the complainant vide IP No.2518, dt. 11-06-2007 in casual ward and started treatment and while undergoing treatment at about 4:00 PM, the doctor declared that the wife of the complainant died. 

The complainant further submitted that his wife was suffering from bleeding problem and the complainant had taken his wife to the opposite party No.2 hospital  Yellandu,  though the wife of the complainant was in serious condition, the doctors of opposite party No.2 hospital Yellandu failed to give emergency treatment, if doctors had responded immediately and started treatment, the wife of the complainant would survive, and also if the doctors provided Ambulance instead of permitting by Bus to shift the wife of the complainant to Kothagudem for immediate treatment, the Doctors of opposite party No.1 at Kothagudem would give proper treatment and wife of the complainant might have survived.  The complainant further submitted that due to the death of his wife, the complainant and his children suffered both mentally and physically, he lost his wife and conjugal happiness at his middle age and the children of the complainant also lost their mother and all of them lost love and affection and even now also the complainant is not digesting the death of his wife.     

The complainant further submitted that after death of his wife, he approached the opposite parties and requested for the payment of compensation, but they paid deaf ear.  Also submitted that since the opposite parties No.1 and 2 are responsible for recklessness and negligence act and the opposite party No.3 being the head of the institutions of opposite parties No.1 and 2 also responsible, they are jointly and severally liable for the claim of the complainant for the act of medical negligence and failure in rendering proper service and treatment on their part for that the complainant filed this complaint. 

3.      On behalf of the complainant, the following documents were filed and marked as Exhibits A1 to A4:-

Ex.A1:-Photocopy of Identity card of the complainant.

Ex.A2:-Photocopy of Family Treatment Attendant Book Abstract pages (No.3).

Ex.A3:-Photocopy of Death Certificate, issued by Dy. CMO/ Superintendent, Main Hospital, Kothagudem.

Ex.A4:-Photocopy of Bus fares facility certificate dt.11-06-2007, issued by Dy. CMO, Yellandu.

4.      On receipt of notices, the opposite parties No.1 to 3 appeared through their counsel and filed counter.   In their counter  opposite parties denied the allegations about deficiency in service, carelessness and negligent treatment and not providing Ambulance from Yellandu to Kothagudem requested by the complainant.  The opposite parties submitted that Smt. Saji was a known case of Chronic Secondary ITP with Fibroid Uterus with Grade-I internal Hemorrhoids and she was referred from Yellandu on 29-09-2005 with bleeding per rectum with gross anemia.  The opposite party No.1 submitted that the wife of the complainant was examined at Main Hospital, Kothagudem and necessary treatment was advised on 29-09-2005 in Main Hospital, Kothagudem and she was advised to review after one week.    The opposite parties further submitted that on 03-10-2005 the patient was admitted at 6:00 PM at Main Hospital, Kothagudem, and the hospital authorities have rendered necessary treatment till 08-10-2005 as inpatient and thereafter referred to NIMS, Hyderabad vide letter No.CRP/MEDKGM/D/002/8185, dt. 08-10-2005.  The opposite party No.1 further submitted that the patient was thoroughly investigated and found that she was suffering with Secondary ITP and she was undergone treatment at NIMS, Hyderabad and the SCCL had spent Rs.1,89,114/- and later she was attending at Area Hospital, Yellandu and Main Hospital, Kothagudem for treatment whenever she was sick.  The patient was brought to opposite party No.2 on 10-06-2007 with the complaint of Petechial Rash over the lower lip and all over the body, Dr. G.R. Vijayalaxmi examined the patient and opined that the patient’s condition necessitated for blood investigations and as the general condition was stable, patient was asked to come for review after investigations.  The patient had undergone the prescribed blood tests at Area hospital, Yellandu and reported back to Dr. G.R. Vijaya Laxmi on 11-06-2007 along with blood test reports as:

“The clotting time (CT) 3 ml ( 3 to 7)

The Bleeding time (BT) 2 min. (1 to 5)

Platelet Count– 1 Lakh (1.5 lakh - 3 lakhs)(Less than 50,000 internal bleeding).  

The opposite parties further submitted that Dr. G.R. VijayaLaxmi Examined the patient, as the general conditions of the patient was stable, the lab reports were normal and the patient did not complain of any bleeding except that of the Petechial Rashes, she was referred to opposite party No.1 on 11-06-2007 at 12:00 Noon for  the attention and opinion of General Physician for the Petechial Rashes over the lower lip and all over the body.  The patient was admitted in opposite party No.1 hospital, Kothagudem casualty ward about 3:40 PM on 11-06-2007 and the doctors and staff members of opposite party no.1 rendered the best services in giving treatment, but unfortunately while undergoing treatment the patient Smt. Banoth Saji died at 4:00 PM on 11-06-2007 due to “Cardio Respiratory Arrest”.  The opposite party No.1 further submitted that Secondary ITP is a rare case occurring one in one lakh people, sudden death can occur due to sudden intra crania hemorrhage, in most of the cases intra crania hemorrhage occurs in patient whose platelet count is less than 50,000, but in this case hemorrhage might have occurred beyond the expectations suddenly at any time resulting in death.  The opposite parties also submitted that there is no negligence, carelessness or deficiency in service in rendering the treatment to Smt. Banoth Saji, which resulted in her death, as such this complaint is not maintainable and prayed to dismiss the complaint.      

5.      Opposite party No.2 & 3 filed adoption memo, by adopting the counter filed by opposite party No.1. 

6.      On behalf of the opposite parties the following documents are filed and the same are marked as exhibits B-1 to B-7.

Ex.B-1:- Referral letter by Area hospital, Yellandu, dt.29-09-2005.

Ex.B-2:- Details of medical treatment of Smt. Banoth Saji, W/o. complainant, who got admitted at Main Hospital, Kothagudem on 03-10-2005, Certificate issued by Chief medical officer, S.C.Co. Ltd., Kothagudem.

Ex.B-3:- Case sheet from 3-10-2005 to 8-10-2005 issued by Chief Medical Officer, Main Hospital, S.C.Co. Ltd., Kothagudem.

Ex.B-4:- Referral letter addressed by Additional CMO (C) M.H., Kothagudem to the Director Nizam Institute of Medical Sciences, Punjagutta Hyderabad, dt. 08-10-2005.

Ex.B-5:- Referral letter addressed to Main Hospital, Kothagudem, by Deputy Chief Medical Officer, Yellandu, dt.11-6-2007.

Ex.B-6:- Copy of Case sheet issued by Chief Medical Officer, S.C.Co. Ltd, Kothagudem, dt. 11-6-2007.

Ex.B-7:- Death Certificate of Banoth Saji, dt.11-6-2007 issued by Deputy Chief Medical Officer, Main Hospital, Kothagudem.

7.      Complainant examined himself as PW-1

8.      Dr. G.R. Vijaya Laxmi examined as RW-1, and  Dr. V. Srinivasa Rao examined as RW-2. 

9.      Written Arguments of both parties filed.

10.    Heard oral arguments from both sides.

11.    Upon perusing the oral and documentary evidence on record, upon hearing the arguments, the points that arose for consideration are,

I) Whether there is any deficiency in service on the part of opposite parties in carelessness, negligent treatment and not providing hospital ambulance on seeing the serious conditions of the patient?

II) To What Relief?

Point No. I

The case of the complainant is that he is working as a General Majdoor in Singareni Coallories company, he and his family members registered their names in family medical attendance book, on 10-06-2007 the wife of the complainant suffered from ill health and bleeding and that immediately she was taken to Singareni Coallories Hospital, Yellandu, the doctor had sent the wife of the complainant to the laboratory for tests, the complainant had requested the doctors to join his wife in the hospital, but the doctors advised the complainant to get his wife tomorrow, on 11-06-2007 the complainant had taken his wife to the said hospital as per the advice of the doctor.  According to the complainant he collected the report of the blood and urine tests from the laboratory and submitted the same to the doctor, after verifying the report, the doctor referred the wife of the complainant to Singareni Coallories Main Hospital, Kothagudem vide letter No.Ref/YLD/D/009/1797/E, dt. 11-06-2007.  Accordingly the complainant requested the doctors to provide Hospital Ambulance as his wife condition was in critical, for shifting her to Kothagudem for emergency treatment but they refused to provide Ambulance and only permitted to pay Bus charges through accounts section of G.M. office, they travelled in Bus and went to Kothagudem immediately and reached Singareni Coallories Main Hospital, Kothagudem at 2:30 PM, meanwhile the health of the complainants wife have become very serious in condition.  Immediately, the complainant joined her wife vide IP No.2518, dt. 11-06-2007 in casual ward and the Medical Doctor started treatment and while undergoing treatment at about 4:00 PM, the doctor declared that the wife of the complainant died. 

According to the complainant, the wife of the complainant was suffering from bleeding problem and  the complainant had taken his wife to the hospital of opposite party No.2 at Yellandu, though the wife of the complainant was in serious condition, the doctors of opposite party No.2 hospital Yellandu failed to give proper treatment. If the doctors had responded immediately and the doctors provided Ambulance instead of permitting by Bus to shift the wife of the complainant to Kothagudem for emergency treatment, the Doctors of opposite party No.1 at Kothagudem would give immediate treatment, the wife of the complainant might have survived.    According to the complainant, the doctors of the opposite parties No.1 and 2 are responsible for recklessness and negligence act and the opposite party No.3 being the head of the institutions of opposite parties No.1 and 2 also responsible as such the complainant approached the Forum for redressal.

          From the documents and material available on record it is clear that the wife of the complainant was a known patient to the opposite parties, who was suffering with chronic secondary ITP with fibroid Uterus with grade-I internal hemorrhoids, she was referred from Yellandu on 29-09-2005, she was examined at Main Hospital, Kothagudem and referred to NIMS, Hyderabad and found that she was suffering with secondary ITP and was undergone treatment at NIMS at Hyderabad.  On 10-06-2007 the wife of the complainant brought to the Hospital of Opposite party No.2 with the complaint of petechial rash over the lower lip and all over the body, where the doctor G.R. Vijaya Laxmi examined the patient and opined that the patient’s condition necessitated for blood investigations and basing on blood reports, the wife of the complainant was referred to main Hospital on 11-06-2007 at 12:00 Noon vide referral letter No.YLD/MED/D/009/1797, dt. 11-06-2007, basing on their referral the wife of the complainant admitted in casualty ward at 3:40 PM as per Ex.B-6 and died at 4:00 PM due to cardio respiratory arrest.

          As per the version submitted by the opposite parties, secondary ITP is a rare case occur in one in one lakh people and sudden death can occur due to sudden crania hemorrhage and most cases of intra crania hemorrhage occurs in patient whose platelet count is less than 50,000, but hemorrhage might have occurred beyond the expectations suddenly at any time resulting in death. In this case on hand the opposite parties failed to take reasonable care even they are having knowledge about every chance of happening of sudden crania hemorrhage to the wife of the complainant who is a known case of Chronic Secondary ITP with fibroid uterus with grade-I Internal Hemorrhoids and they failed to refer the wife of the complainant to the higher centre i.e. Area Hospital, Kothagudem immediately on her approach and also failed to provide ambulance or any alternative support as alleged by the complainant.  Without taking proper care simply referred her by issuing Ex.B-5 referral letter which thrown her life into danger.  And also we observed that, as the patient presented with petechial rash over the lower lip and all over the body and also the complaint of bleeding, she should have been referred immediately to the higher center on the same day i.e. on 10-06-2007 inspite investigations done.  So, there is a time lapse in between the patient first visit to the hospital at opposite party No.1, on that of referral to the higher center which caused the deterioration in her general health condition.  And also the duty doctor of opposite party No.2 failed to admit the patient immediately in their hospital and on several requests made by the complainant only they admitted the patient and started treatment at 3:40 PM (as per Ex.B-6 discharge summary) and the patient condition was “pulse not palpable and no respiration” at that time.  

In our view, the opposite party No.1 owed certain duty towards the patient which she had failed.  On perusal of medical record, the patient was known case of Chronic Secondary ITP, the opposite party No. 1 Doctor simply sent the wife of the complainant to the laboratory for tests and on the next day referred the patient to go to a higher center for treatment.  As per the patient condition, it shall be considered as a medical emergency, as every complication can arise suddenly and the patients health may decline rapidly, it is the duty of the opposite party No.1 to attend the patient during emergency hours.  Thus, the opposite party No.2 had breached her duty of care towards the patient and failed to sent the patient by providing Ambulance and emergency care, which, thrown the life of the patient in to danger.  Thus, we are of considered view that, an appropriate standard of care had not been taken and the patient was simply referred to higher hospital by paying bus charges.  And the opposite party No.1 doctor also failed to attend the patient up to 3:40 PM which thrown the patient’s life into danger.

In Kalpana Vs. Dr. K. Rama Lakshmi and another I (2015) CPJ 79 (NC) wherein, the Hon’ble National Commission observed in para No.14, two land mark judgments of Hon’ble supreme court given in Jacob Mathew Vs. State of Punjab III (2005) CPJ 9 (Supreme Court)  and Kusum Sharma Vs. Batra Hospital I (2010) CPJ 29 (SC). In the above judgments, the Hon’ble National Commission observed that as Medical Professionals was expected to bring a reasonable degree of skill and knowledge and was expected to exercise a reasonable degree of care.   For the loss of life, i.e. death of the wife of the complainant, cannot be stated by any stretch of imagination that there is no degree of care was shown by the opposite party No.2 in referring for blood investigations and after that simply referred the patient to the opposite party No.1 hospital at Kothagudem, even though they are having knowledge about her ailment which is a rare and rarest one.  Hence this point is answered accordingly in favour of the complainant.

Regarding award of compensation, the complainant have prayed for Rs.20,00,000/- as compensation on the basis of personal loss, sufferance and mental agony.  In this context, the Hon’ble Supreme Court observed in Reshma Kumar & Others V/s. Madan Mohan and another I (2012) ACC 323 (SC), Nizam Institute of Medical Sciences V/s. Prashanth S. Dhananka & Ors. II (2009) CPJ 61 (SC) and in Balaram Prasad V/s. Kunal Shah & Ors. IV (2013) CPJ I (SC).  The Hon’ble Supreme Court emphasized that it is the duty of the tribunals, commissions and courts to consider relevant facts and circumstances of each and every case for awarding just and reasonable compensation.

In the instant case, we have observed that the cost of the treatment incurred at opposite parties hospital is at free of cost.  There are no details about earnings of the deceased and she was a housewife looking after the house hold responsibility.  Smt. Banoth Saji was a victim of medical negligence and she lost her life.  She died at the age of 44 years leaving behind her husband and children, therefore, considering her life expectancy and future prospects, we are of the considered view that, Rs.3,00,000/- will be just and proper compensation.  No doubt, we cannot compensate for the loss of her life, but the mental agony sustained by the family members is really a concern in this case.  Therefore, we award a further sum of Rs.2,00,000/- towards mental agony to the complainant. 

Point No.II

In the result the complainant is allowed in part directing the opposite parties No.1 to 3 to pay a total sum of Rs.5,00,000/- to the complainant, with interest @ 9% per annum from the date of filing of this complaint (i.e. from 10-06-2009), with in 30days from the date of receipt of this order, otherwise, it will carry further interest @9% per annum till its realization.

          Typed to dictation, corrected and pronounced by us in the open Forum, on this the  20^th day of January, 2017.

  Member                  FAC President             

District Consumer Forum,

Khammam.

APPENDIX OF EVIDENCE

WITNESSES EXAMINED

For Complainant                                                    For Opposite party

PW-1 : Banoth Lachi Ram                             RW-1 : Dr. G.R.Vijaya Laxmi

RW-2 : Dr. V. Srinivasa Rao

DOCUMENTS MARKED

For Complainant                                                    For Opposite party   

 Member                  FAC President             

District Consumer Forum,

Khammam