Tamil Nadu
South Chennai
161/2007
M.Rami Reddy - Complainant(s)
Versus
The General Manager,Vijaya Heart Foundation& other - Opp.Party(s)
Dharmarajan
30 Oct 2019
ORDER
Complaint presented on : 11.04.2007
Date of Disposal : 30.10.2019
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (SOUTH)
@ 2ND Floor, T.N.P.S.C. Road, V.O.C. Nagar, Park Town, Chennai – 3.
PRESENT: THIRU. M. MONY, B.Sc., L.L.B, M.L. : PRESIDENT
TR. R. BASKARKUMARAVEL, B.Sc., L.L.M., BPT., PGDCLP. : MEMBER
C.C. No.161/2007
DATED THIS THURSDAY THE 30TH DAY OF OCTOBER 2019
Mr. M. Rami Reddy,
S/o. Mr. Subbarama Reddy,
No.7, Nehru Street,
Tirupathi. .. Complainant.
..Versus..
1. The General Manager,
Vijaya Heart Foundation,
(Vijaya Medical & Educational Trust),
No.180, N.S.K. Road,
Chennai – 600 026.
2. Dr. M. Vijayakumar, M.D., D.M.,
Senior Consultant Cardiologist,
Vijaya Heart Foundation,
(Vijaya Medical & Educational Trust),
No.180, N.S.K. Road,
Chennai – 600 026. .. Opposite parties.
Counsel for the complainant : M/s. V. Balaji
Counsel for the opposite parties : M/s. N.L. Rajah & another
ORDER
THIRU. M. MONY, PRESIDENT
This complaint has been filed by the complainant against the opposite parties 1 & 2 under section 12 of the Consumer Protection Act, 1986 prays to pay a sum of Rs.2,07,259.85/- towards hospitalization, medicines, doctors fees, lab tests and other connected expenses, a sum of Rs.1,00,000/- towards compensation for negligence and deficiency in service of the opposite parties hurriedly performing Percutaneous Transluminal Coronary Angioplasty (PTCA) with stent which resulted in failure and necessitated the second surgery of CABG and to pay a sum of Rs.2,00,000/- towards compensation for mental agony, pain etc with cost of Rs.15,000/- to the complainant.
1. The averments of the complaint in brief are as follows:-
The complainant submits that on 07.05.2004, the complainant was admitted in the 1st opposite hospital for his heart ailment and he was referred to the 2nd opposite party by the 1st opposite party for diagnose and treatment. The 2nd opposite party diagnosed the complainant ailment through Angiogram that the complainant is suffering from Coronary Heart Disease (Single Vessel Disease). The 2nd opposite party advised the complainant for treatment of his problem by way adhoc Percutaneous Translauminal Coronary Angioplasty (PTA) with stent. The complainant and his relatives opted for CABG treatment only. The complainant submits that the 2nd opposite party informed the complainant and his relatives that the PTCA with stent would work for another 20 years without any further problem. Only based on such assurance so given by the 2nd opposite party, the complainant agreed and underwent treatment. On discharge, the complainant paid Rs.81,770.85/- hospital charges vide bill dated:13.05.2004 and the 2nd opposite party’s professional charges Rs.22,500/- vide receipt dated:10.05.2004. The complainant later developed recurring heart pain and contacted the 2nd opposite party on 09.04.2005 & 24.03.2005. The complainant was referred to Dr. Y.V.C. Reddy who after conducted examination and tests diagnosed that the complainant was suffering from severe instent restenosis of Left Anterior Descending Artery (LAD) and advised Coronary Artery Bypass Graft (CABG). The complainant underwent CABG on 01.04.2005 was later discharged on 11.04.2005 on payment of Rs.1,02,989/- towards hospitalization and other charges as well.
2. The complainant submits that he underwent severe instent restenosis contrary to the great assurances given by the 2nd opposite party. The complainant reliably understands that failure and use of poor quality of stent led to the 2nd surgery. The complainant and his relatives were not given details of the surgery and there was no consent taken setting forth in specific terms about the alleged 20-30% restenosis and also no mention about the existence of drug coated stents in vogue which bears less risks compared to ordinary ones. The complainant narrating his ordeal gave a notice on 01.05.2005 which was replied on 12.05.2005. Later on, the complainant sent a legal notice on 23.06.2005 which was replied on 15.07.2005 denying negligence, stating that the complainant was made fully aware of the details about PTCA and the various options available obtaining of free consent and other aspects. It is pertinent to point out that at no point of time was the complainant informed of the fact that all stents have 20-30% restenosis. The failure to reveal such facts and hurriedly performing Percutaneous Transluminal Coronary Angioplasty (PTCA) with stent resulted in failure and necessitated the second surgery of CABG which amounts to deficiency in service by the 2nd opposite party. The act of the opposite parties 1 & 2 amount to deficiency in service and unfair trade practice which caused great mental agony. Hence, the complaint is filed.
3. The brief averments in the written version filed by opposite parties 1 & 2 is as follows:
The opposite parties 1 & 2 specifically deny each and every allegations made in the complaint and put the complainant to strict proof of the same. The opposite parties 1 & 2 state that the complainant (patient) aged 68 years old approached their hospital on 07.05.2004 and was suffering from Myocardial Infarction (Heart Attack) from 11.04.2004 and he had Post Myocardial Infarction Agina, Hypertensive and had mild LV Dysfunction. Based on clinical status, the complainant was advised to undergo angiogram. He preferred to admit in the general ward and on the same day Angiogram done and revealed single vessel disease with 95% block. The opposite parties state that the complainant was treated by the 2nd opposite party on the same day i.e. 07.05.2004 who is a specialist in Cardiology M.B.B.S., M.D.D.M. having 19 years experience in his field and he is one of the competent Cardiologist in the city. The opposite parties state that the 2nd opposite party explained in detail about the disease to the complainant and his relatives and the complainant is suffering from recent attack of heart attack and considering his age he preferred to treat the complainant by PTCA (Percutaneous Transluminal Coronary Angioplasty) after obtaining Express Consent from the complainant and his relatives. The opposite parties state that the 2nd opposite party explained to the complainant and his relative about the by-pass surgery carried higher risk. In single vessel disease PTCA only the treatment of choice and also informed about the risk of 20-30% restenosis and it can be reduced to 10% if drug coated stent used because it is costlier, the complainant opted for non-drug coated.
4. The opposite parties state that the PTCA procedure with stent was successfully completed on 07.05.2004 and the post-operative period was uneventful. No assurance was given that the PTCA procedure with stent will work without any problem for atleast 20 years. The complainant and his relatives had been clearly informed by the 2nd opposite party that there was 20-30% of Restonosis in the case of PTCA procedure with stent. It is pertinent to state that again on the grounds of affordability, the complainant got himself admitted in the general ward. The complainant was discharged with appropriate advice and medication. The allegation that no consent was obtained for the PTCA procedure with stent is false to the knowledge of the complainant. The complainant was discharged on 13.05.2004 with appropriate advice and medication.
5. The opposite parties state that again the complainant came and contacted Dr. Y.V.C. Reddy on 24.03.2005 in the 1st opposite party’s hospital with the referral letter dated:17.03.2005 from Dr. (Mrs.) P. Krishna Prasanthi, Tirupati. The opposite parties state that when the complainant contacted Dr. Y.V.C. Reddy on 24.03.2005 at the 1st opposite party’s hospital with recurrence of angina. He had already been evaluated by a local cardiologist at Tirupathi. Tread Mill Trust done there was positive for inducible myocardial ischemia. The patient was diagnosed to be having stent restenosis and came to the 1st opposite party hospital for further management. The opposite parties state that Dr. Y.V.C. Reddy also gave two options treating restenosis by (1) CABG Surgery (2) Repeat PTCA with stenting by Proximal LAD but the complainant and relatives insisted CABG surgery, he has performed the same. The restonosis that occurred was something that the complainant and his relatives had been clearly informed prior to the surgery as a possible outcome of the surgery. As stated above, the complainant chosen the non-drug coated stent on the grounds of affordability. By no stretch of imagination can the 2nd opposite party be held liable or responsible for the restonosis as there is a possibility of the same occurring in 20-30% of the cases. There is no question of any negligence, carelessness or deficiency in service on the part of the opposite parties. Hence, the complaint is liable to be dismissed.
6. To prove the averments in the complaint, the complainant has filed proof affidavit as his evidence and documents Ex.A1 to Ex.A14 are marked. Proof affidavit of the opposite parties 1 & 2 is filed and documents Ex.B1 & Ex.B15 filed and marked on the side of the opposite parties 1 & 2.
7. The points for consideration is:-
- Whether the complainant is entitled to a sum of Rs.2,07,259.85/- towards hospitalization, medicines, Doctors Fees, Lab Tests and other expenses as prayed for?
- Whether the complainant is entitled to a sum of Rs.3,00,000/- towards negligence, mental agony and deficiency in service as compensation from the opposite parties 1 & 2 with cost of Rs.15,000/- as prayed for?
8. On point:-
Both complainant and opposite parties filed their respective written arguments. Heard their respective Counsels also. Perused the records namely; the complaint, written versions, proof affidavits and documents. The learned Counsel for the complainant would contend that on 07.05.2004, the complainant was admitted in the 1st opposite hospital for his heart ailment and he was referred to the 2nd opposite party by the 1st opposite party for diagnose and treatment. The 2nd opposite party diagnosed the complainant’s ailment through Angiogram and found that the complainant is suffering from Coronary Heart Disease (Single Vessel Disease) as per Ex.A2, Report of Coronary Angiography dated:07.05.2004. The 2nd opposite party advised the complainant for treatment of his problem by way adhoc Percutaneous Translauminal Coronary Angioplasty (PTA) with stent. The complainant and his relatives came to the 1st opposite party hospital for CABG treatment. Further the contention of the complainant is that the 2nd opposite party informed the complainant and his relatives that the PTCA with stent would work for another 20 years without any further problem. But the complainant has not produced any document to prove the above said assurance of the opposite party and also admitted during his cross examination dated:08.07.2010 before this Hon’ble Forum that “it is only the oral assurance was given by the 2nd opposite party no alleged written advise given to me”; which amounts to imaginary and is not acceptable either in law or on facts proves that the 2nd opposite party has not given any such assurance to the complainant.
9. Further the contention of the complainant is that he has not given his consent for PTCA treatment in his cross examination dated:08.07.2010. On the contrary, he has admitted in the complaint and in his proof affidavit and also executed consent form Ex.B9 proves that the complainant and his relatives has been explained about the PTCA with stent procedure only line of treatment for the patient recently suffered heart attack with single vessel disease and also has been explained by the 2nd opposite party the highest risk of by-pass surgery in the complainant like aged patient proves that the 2nd opposite party has not obtained consent from the complainant; and the false allegation has been made against the opposite parties by the complainant is apparently proved. Further, on perusal of records including Ex.A3, Discharge Summary, the complainant was admitted on 07.05.2004 and after PTCA stenting treatment with excellent result discharged on 13.05.2004 with prescribed medicine to be followed at home and proper medical advice by the 2nd opposite party and to come for review with the 2nd opposite party after one month. But the complainant has not pleaded anything about whether he has come for review with the 2nd opposite party and taken further advice and treatment. No documents produced on his side proves negligence on the part of the complainant and also suppression of material facts. In spite of that the complainant pleaded and contended that he developed recurring heart pain contacted the 2nd opposite party on 09.01.2005 after seven months, the 2nd opposite party examined the complainant and prescribed further medicine as per Ex.A5 and due advice given; thereafter the complainant returned home this fact also has been suppressed by the complainant proves that the complainant has not come forward with clean hands.
10. Further the contention of the complainant is that he has again contacted the 2nd opposite party for treatment; is false because he has been referred to Dr. Y. Vijaya Chandra Reddy by Dr. Krishna Prasanthi, Tirupati as per Ex.B15 through reference letter dated:17.03.2005. The complainant consulted Dr. Y.V.C. Reddy on 23.03.2005 who diagnosed that the complainant was suffered from severe instant restenosis of left Anterior Decending Artery (LAD) and advised for Coronary Artery By-pass Graft (CABG). The complainant was admitted on 30.03.2005, surgery was done on 01.04.2005 and discharged on 11.04.2005 as per Ex.A6, Ex.A7 & Ex.A8. Further the contention of the complainant is that severe instant restenosis is due to the negligence and false assurance given by the 2nd opposite party; the 2nd opposite party used poor quality of stent, but the complainant has not produced any documentary evidence to prove the alleged assurance and that the stent used is of poor quality. On the other hand, during his cross examination dated:08.07.2010, the complainant questioned the opposite party, Doctor which reads as follows:
12. Qn. Are you aware which company manufacturers these stents?
Ans. I am not aware.
13. Qn. Have you taken steps to send similar stents manufactured by the company for any tests?
Ans. The question is irrelevant to this case. Hence, I cannot answer this question.
proves the above said allegation of poor quality stent is false. Further the contention of the complainant is that 2nd opposite party has not told any detail about surgery, no consent obtained from the complainant and not informed about 20-30% of restenosis after PTCA are all false and imaginary. Further, the contention of the complainant is that a notice to the opposite party on 01.05.2005 as per Ex.A9 was given. The opposite parties replied for the same on 12.05.2005 as per Ex.A10. Further the complainant issued legal notice on 23.06.2005 as per Ex.A11 for which, the opposite party replied on 15.07.2005 as per Ex.A12 with untenable allegation denying negligence which caused great mental agony, extended hospital stay and unnecessary expenses incurred there on. Hence, the complainant filed this case on medical negligence and deficiency in service of the opposite parties and claiming compensation and cost.
11. The contention of the opposite parties 1 & 2 is that the complainant (patient) is aged 68 years old approached their hospital on 07.05.2004 and was suffering from Myocardial Infarction (Heart Attack) from 11.04.2004 and he had Post Myocardial Infarction Agina, Hypertensive and had mild LV Dysfunction. Based on clinical status, the complainant was duly explained and was advised to undergo angiogram and was accepted. The complainant himself preferred to admit in the general ward and on the same day Angiogram done with consent and the report revealed single vessel disease with 95% block as per Ex.B8 (S) (Report of Coronary Angiography). Further the contention of the opposite parties 1 & 2 is that the complainant was treated by the 2nd opposite party on the same day i.e. 07.05.2004 who is a specialist in Cardiology M.B.B.S., M.D.D.M. having 19 years experience in his field and he is one of the competent Cardiologist in the city which is not denied by the complainant. Further the contention of the opposite parties is that the 2nd opposite party explained in detail about the disease to the complainant and his relatives and the complainant is suffering from recent attack of heart attack and considering his age he preferred to treat the complainant by PTCA (Percutaneous Transluminal Coronary Angioplasty) after obtaining Express Consent from the complainant and his relatives as per Ex.B9 and the complainant also admitted in his complaint and proof affidavit proves no deficiency in service on the part of the opposite parties. Further the contention of the opposite parties is that the 2nd opposite party explained to the complainant and his relative about the by-pass surgery which carries higher risk. In a single vessel disease PTCA only the treatment of choice and also informed about the risk of 20-30% restenosis and it can be reduced to 10% if drug coated stent used but it is costlier, the complainant opted for non-drug coated stent because drug coated stent is costlier. It is recommended that as per the Medical Literature that is the reason that the 2nd opposite party opted for proper and standard treatment. In the case of the complainant, it is proved by the following medical literature which reads as follows:
Section 2, Ischemic Heart Disease: Non–Pharmacologic Treatment of IHD
In Chapter 20, Catheter-based Techniques to Treat Ischemic Heart Disease
Introduction
Catheter-based techniques to treat coronary artery narrowing or occlusion have revolutionized the management of patients who have chronic or acute ischemic heart disease. The percutaneous catheter technique was found widespread acceptance and nowadays constitutes a viable strong option among the available medical and surgical options in the treatment of ischemic heart disease. Over the years, significant improvement in interventional equipment and technique have been accomplished, so that today we have low-profile, highly steerable and trackable balloon catheters and a wide variety of guidewires that are able to negotiate complex calcific lesions or chronic total occlusions. All these technical advances, and increased operator experience, have made catheter-based coronary therapy relative safe and effective. Major remaining problems are:
- The occurrence of major adverse coronary events during the procedure.
- The treatment of long lesions or lesions in small vessels.
- The occurrence of restenosis at 6 months and
- The opening of chronic totally occluded vessels.
These limitations have prompted the many current studies that aim to make the technique safer and more acceptable as a first-choice option to treat coronary obstructions.
12. Further the contention of the opposite parties is that the PTCA procedure with stent was successfully completed on 07.05.2004 and the post-operative period was uneventful. The complainant was discharged on 13.05.2004 as per Ex.B8(S) with appropriate advice and medication. Therefore, the 2nd opposite party treated the complainant with due care and adopting recommended medical procedure as per the Standard Norms. The medical literature filed by the opposite parties proves as follows:
Complications after balloon angioplasty
Procedure-related complications
“From the very beginning of use of PTCA, standard treatment with heparin and aspirin has been given to reduce major complications. Because coronary thrombosis does play a part in abrupt occlusion, a logical approach was to test whether adjunctive therapy with thrombolytic treatment was beneficial”.
Therefore, proves that the opposite parties applied absolute standard care medically and no question of any carelessness, negligence or deficiency in service on the part of the opposite parties arise. The 2nd opposite party shown due care, caution and diligence diagnosed and performed the surgery and the surgery itself was performed with after fully explaining all the material facts medically to the complainant and his relatives. Excellent pre-operative and post-operative care was extended to the complainant proves that there is no deficiency in service by the opposite party. Further the contention of the opposite parties that the 2nd opposite party advised the complainant to come for review after one month. But the complainant did not turn up as per Ex.A3. The complainant came to the hospital on 09.01.2005 i.e. after 6 months of surgery with recurring of heart pain contacted the 2nd opposite party, he was examined by the 2nd opposite party treated and prescribed medicines as per Ex.A5, the complainant went back home proves no treatment deficiency on the part of the 2nd opposite party.
13. Further the contention of the opposite parties is that again the complainant came and contacted Dr. Y.V.C. Reddy on 24.03.2005 in the 1st opposite party’s hospital with the referral letter dated:17.03.2005 from Dr. (Mrs.) P. Krishna Prasanthi, Tirupati as per Ex.B15, Dr. Y.V.C. Reddy examined the complainant and diagnosed as severe Instant Restenosis of LAD and the complainant was admitted in the 1st opposite party’s hospital on 30.03.2005. He underwent off-pump CABG surgery on 01.04.2005 with grafts: LIMA to LAD, SVG to major diagonal and discharged on 11.04.2005 with medicine and advice. The opposite parties contended that this itself proves the 1st opposite party’s hospital rendered perfect service to the complainant. Further the contention of the opposite parties is that when the complainant contacted Dr. Y.V.C. Reddy on 24.03.2005, he has not told anything wrong committed in the earlier treatment by the 2nd opposite party which is impliedly admitted by the complainant from his answer to the question during his cross examination dated:02.12.2010 which reads as follows:
3. Dr. Y.V.C. Reddy said to be a best Doctor by you has not conveyed any remarks about the quality of Stem cell or the performance of the surgery and treatment by Dr. Vijaya Kumar?
I do not need to make any complaints against him. I want only best possible treatment.
4. You are not firm in making allegations against Dr. Vijaya Kumar?
I have never said at any time that I am not making strong complaint against Dr. Vijaya Kumar.
5. Whey did you file Mercy petition instead of demand?
For considering my matter sympathetically by the hospital authorities
proves no negligence on the part of the 2nd opposite party in performing PTCA procedure. The stent Duraflex used by the 2nd opposite party is also proved high-performance stent system as per Ex.B15(S) as per medical literature restenosis will occur at 6 months which reads as follows:
“The Duraflex Coronary Stent System consists of a stainless steel stent that is cut from a tube and pre-mounted on a rapid exchange delivery system. This high-performance stent system is compatible with 5 F guiding catheters”.
14. Further the contention of the opposite parties that Dr. Y.V.C. Reddy also gave two options treating restenosis by (1) CABG Surgery (2) Repeat PTCA with stenting by Proximal LAD but the complainant and relatives insisted CABG surgery, he has performed the same.
15. As per the decision cited in:
2016(4) CPR 190 (NC)
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Dr. Shrikant V. Mukewar
-Versus-
Vimal & Ors.
Revision Petition No.781/2016
In the context of medical negligence, they relied upon the Hon’ble Supreme Court’s decision in
1996(2) SCC 634
Between
Achutrao Hari Bhavu Khodwa Vs. State of Maharashtra
Held that
“The skill of medical practitioners differs from Doctor to Doctor. The very nature of the profession in such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be slow in attributing Negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. Medical opinion may differ with regard to the course of action to be taken by a Doctor treating a patient, but as long as a Doctor acts in a manner which is acceptable to the Medical Profession, that has attended on the patient with due care, skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the Doctor to be guilty of Negligence”.
Considering the facts and circumstances of the case, evidences filed, cross examination done on both sides and other medical records, literatures, this Hon’ble Forum came to a conclusion that the opposite parties 1 & 2 were not committed any deficiency in service. Hence, this Forum is of the considered view that this complaint has to be dismissed.
In the result, this complaint is dismissed. No costs.
Dictated by the President to the Steno-typist, taken down, transcribed and computerized by her, corrected by the President and pronounced by us in the open Forum on this the 30th day of October 2019.
MEMBER PRESIDENT
COMPLAINANT SIDE DOCUMENTS:-
Ex.A1 | 24.04.2004 | Copy of report |
Ex.A2 | 07.05.2004 | Copy of reports of Coronary Angiography |
Ex.A3 | 07.05.2004 | Copy of Adhoc PTCA and stenting to LAD |
Ex.A4 | 03.01.2005 | Copy of Discharge Summary |
Ex.A5 | 09.01.2005 | Copy of Stress Summary Report |
Ex.A6 | 23.03.2005 | Copy of Prescription |
Ex.A7 | 30.03.2005 | Copy of Discharge Summary |
Ex.A8 | 01.04.2005 | Copy of Discharge Summary |
Ex.A9 | 01.05.2005 | Copy of Operation notes |
Ex.A10 | 12.05.2005 | Copy of notice |
Ex.A11 | 23.06.2005 | Copy of reply of the 1st opposite party |
Ex.A12 | 15.07.2005 | Copy of reply |
Ex.A13 |
| Copy of bill / receipts |
Ex.A14 |
| Copy of medical bills |
OPPOSITE PARTIES 1 & 2 SIDE DOCUMENTS:-
Ex.B1 | 05.07.2005 | Copy of reply notice by the opposite parties |
Ex.B2 | 15.07.2005 | Copy of reply notice by the opposite parties |
Ex.B3 | 07.05.2004 | Copy of report of Coronary Angiography |
Ex.B4 | 07.05.2004 | Copy of Orders for PTCA issued |
Ex.B5 | 07.05.2004 | Copy of consent for Cardiac Catheterization/ Balloon Angioplasty |
Ex.B6 |
| Copy of Progress Sheet and Doctor’s Orders |
Ex.B7 |
| Copy of Medical Literature |
Ex.B8 | 07.05.2004 | Copy of IP Case Sheet |
Ex.B9 | 07.05.2004 | Copy of consent for Cardiac Catheterization Balloon Angioplasty |
Ex.B10 |
| Copy of clinical chart |
Ex.B11 | 07.05.2004 | Copy of Progress Sheet |
Ex.B12 | 07.05.2004 | Copy of results of investigation |
Ex.B13 | 13.05.2004 | Copy of treatment chart |
Ex.B14 | 08.05.2004 | Copy of nurses report /chart/ report |
Ex.B15(S) |
| Copy of Duraflex Coronary Stent, system Product Specifications, History & Course in Hospital, letter of Mrs. Dr. P. Krishna Prasanthi |
MEMBER PRESIDENT
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