HYDERABAD

                                                            C.D.No. 8/2005

Between :

G.Rajashree,

w/o.late G.Nageshwar Rao,

aged 40 years, Household R/o.1-9-12/3/1,

 Kishan Nagar Colony, Medak-502  110, AP.                                    …Complainant

               And

1.The Managing Director, Mediciti Hospitals,

   5-9-22,  Secretariate Road, Hyderabad-63.

2.Dr.Sumeet Sinha, MD, DM, Cardiologist,

    C/o.Global Hospital, Khairatabad,

     Hyderabad -500 004.

                                                                               … Opp.parties

Counsel for the complainant                        :            M/s.K.Shyam  Kumar

Counsel for the respondents                        :            M/s.A.Sudarshan Reddy

CORAM :THE  HON’BLE .JUSTICE  SRI  D. APPA RAO , PRESIDENT

                              SMT. M.SHREESHA, HON’BLE MEMBER

                                                                  AND

                           SRI G.BHOOPATHI REDDY, HON’BLE MEMBER

       THURSDAY, THE TWENTY  FIRST  DAY OF    AUGUST

TWO THOUSAND EIGHT. 

Oral Order :  (Per Sri G.Bhoopathi Reddy , Hon’ble Member)

                                                               ***

       This is a complaint filed under Section 17(a) (i) of Consumer Protection Act,1986  to direct the  opposite parties to pay the complainant Rs.50 lakhs with bank interest from 27.2.2003 and costs .

         The case of the complainant is as follows:

 The husband of the complainant  served Indian Army for 17 years and after retirement he started a garment business  under the name  Balaji Dresses at Medak town.   He was  neither   a diabetic nor hypertensive.   In the year 1992 he had  Coronory  By-pass Surgery CABG  at Appolo Hospital, Hyderabad   and  since then he had no complaints  and no chest pains etc.   and he used to have regular check ups at Appolo Hospital, Hyderabad with Dr.Tripti Deb, MD DM Cardiologist  and daily he used to walk 14 kms. and to work and live normally.   On 17.2.2003 her husband complained  of some chest pain and he was immediately taken to local doctor who gave the best emergency treatment   and his chest pain was relieved completely  .     As  the  said doctor advised to go for a check up at Mediciti Hospital , Hyderabad  the complainant and her husband went to the Mediciti hospital on  18.2.2003  at 8 a.m.   The husband of the complainant found to be normal and  stable with good LV function. . The opp.parties kept the husband of the complainant in ICU though he had no chest pain , shortness of breath or any significant danger.   The opp.parties attempted for angiography, stenting or intervention greedily to extract and grab more money   They did not arrange proper facilities and for any cardio thorasic surgeon’s team.  The opp.parties kept  the husband of the complainant  in their hospital from 18.2.2003  till 27.2.03  to inflate their bills, without any actual medical necessity.   He had a complete normal life at admission, walking , talking , drinking and eating as any other hale and healthy person and continued  as such till his death on 27.2.2003 .  On 27.2.2003 at  09.30 a.m.   the complainant’s husband  was taken into the operation theatre , probably for coronary artery by-pass grafting as claimed by Dr.Sumeeth Sinha.  . At his instance,  the complainant  paid Rs.90,000/-  to a person introduced by him as the marketing executive of Arcom Medical Devices (P) Ltd., Nampally, Hyderabad.  On demand of a receipt,  Dr.Sumeet Sinha   told that she had to pay Rs.10,000/- extra, hence she declined to obtain it.   At 10.30 a.m. the colleagues of  Dr.Sumeet Sinha  came out of the theatre speaking that her husband died due to the attempts to fix stent of unequal size,  because of mistake, misestimation  and misjudgement at the angiography.   At about 11 am. the dead body was brought out covered with  linen and kept in ICU without any manual or artificial attention and the Billing Manager TV Naidu demanded Rs.2,10,000/-  to receive the dead body   and he snatched  the two identity cards issued under  Army Group Insurance Fund,  jointly to the deceased and to her  and atlast they gave the dead body  at around 10 p.m. after much struggle.   The complainant got issued a legal notice through  her brother in law G.Shiv Kumar  to the opp.parties to furnish all the relevant records  and details of medicines administered and procedures adopted .,  cardiothorasic surgeon’s  file and notes, referring doctor’s file etc. by making a photocopy and to return the snatched identity cards.   The opp.party no.1  gave reply  and sent copies of some records by forging to suit him in defence . The opp.party no.2 did not give any reply   . The complainant became a widow and her children orphans  and seeing all this mother of the complainant expired and mother in law got paralysed with bed rest totally.   On 17.2.2004  she consumed sleeping pills in huge quantity  to commit suicide , yet she was initially treated  at BBR hospital Balanagar, Hyderabad and then admitted as an inpatient in Nizams Institute of Medical Sciences , Hyderabad   for about 10 days.   The complainant approached  District Forum to direct the opp.parties to pay Rs.50,00,000/-  towards loss of affection,  loss of income  loss of company and control in family etc.    together  with bank interest from 27.2.2003  and costs .

          The opposite party no.2 filed counter denying the allegations made in the complaint.  The opp.party no.1 filed memo adopting the counter of opp.party no.2 . The opp.party no.2 stated that the   patient   Mr.G.Nageswara Rao was alcoholic  and case history of the patient recorded goes to show that the patient was a known heart patient who had undergone the coronary by pass surgery in the November,1992 at Appollo hospital,   The husband of the complainant had preexisting severe heart disease 11 years ago  at an young age of 37 years.      The patient  received an injection Streptokinase  at 1.30 a.m. on 18.2.2003 which is given to dissolve clots formed in blood vessels.    The patient   received the best possible and appropriate treatment.  He was continuing to have increasing chest pain for which the dose of infusion and medicines were adjusted appropriately.   Finally on 24.2.2003 the angiogram was performed   which  revealed severe triple vessel disease in a native vessel s., two critical lesions in the SVG Graft to LAD , MILD disease in graft to RCA.   Since the patient was having recurrent Angina and risk of getting repeat heart attack, the option of coronary angioplasty and stent placement were discussed  along with family members of the  patient.      A fully informed high risk consent was obtained from the patient and his wife i.e. the complainant for carrying out the angioplasty.  The patient was taken  to the Cath Lab on 27.2.2003  for  angioplasty and not surgery or operation theatre as alleged by the complainant . During the procedure, after the lesion (diseased segment) was crossed with the wire, the INJ REOPRO was administered to dissolve the clots  and decrease the thrombus burden   and then the covered stent (symbiot)  was successfully deployed across  the diseased segment.   Following    the stent deployment there was a distal migration of the thrombus material resulting to NO FLOW PHENOMENON.   It is  a known complication which occurs in   5 to 15% of vein graft PTCA”s  following  this event patient develop ECG changes of a fresh attack , fall in blood pressure and heart rates and had a cardiac arrest.   The team of doctors in Cath Lab immediately started resuscitative measures, patient was intubated and put on ventilator, intracardiac pacing was done to improve  the heart rates , an INTRA AORTIC BALLOON  PUMP (IABP)  was inserted to improve the circulation and blood pressure.   Multiple I.V. infusions were started to improve the B.P.  The patient was shifted to ICCU at 11.30 a.m. with all the supportive equipment and infusions . Inspite of all the best efforts of the doctors , the patient ultimately  succumbed and died at 1.30 p.m. in ICCU and not in the  theatre as alleged  . The opp.party  submits that the bill for the services rendered  to the patient amounted to Rs.2,10,000/-   and since the relatives of the patient expressed financial problems to settle the same the relatives of the patient suggested the opp.party  no.1 to lodge a claim with the AGIF and assured to  sign  any papers required and  therefore  handed over the identity cards for lodging the claim with AGIF  .   The opp.party no.1 was informed   that maximum limit of amount entitled to the above claim is only Rs.1,50,000/-  and on humanitarian grounds the   opp.party no.1 accepted the same.    In order to recover atleast  part of the bill amount wrote to the AGIF who refused to entertain the claim and infact the said outstanding amount is still due . The opp.party states that the allegations made by the complainant  are absolutely false and called for the strict proof of the same.  The opp.party prayed for dismissal of the complaint with costs.   

        Exs. A1 to A4 documents are marked on behalf of the complainant  and Exs.B1 to B7 documents are marked on behalf of the opp.parties .  The opp.parties  filed written arguments.  The  complainant is examined as PW.1,   the brother of the husband of the complainant  G.Shiv Kumar  is examined as PW.2,  and friend of the husband  of the complainant  Nimbagiri Ashok Kumar  is  examined as PW.3 .   The opp.party no.2 Dr. Sumeet  Sinha  is examined as RW.1

 The points for determination arises in this complaint are

1.Whether there was any medical negligence  on the part of the opp.parties ?.

2. Whether the complainant is entitled to any relief?

       The complainant submits that she  brought her husband to Mediciti hospital on 18.2.2004 and  at the time of admission in the hospital her husband was normal, stable with good LV function,   but her husband was kept in intensive care unit   and  the opp.parties attempted for    angiography , stenting      to extract and grab more money .  The complainant also submits  that  on account of negligence , deficiency in service on the part of the opp.parties and  unnecessary attempts for CABG without presence of any Cardio  Thorasic surgeons team , unwarranted and un indicated attempts  of stenting without proper stent , her husband died  The opp.parties resisted the plea that there was no medical negligence on their part , the patient was taken to the Cath Lab on 27.2.2003 for angioplasty and not  surgery or operation theatre as alleged , during the procedure  after the lesion diseased segment  was crossed with the wire, the INJ REOPRO was administered to dissolve the clots and decrease the thrombus burden, then the covered stent (SYMBIOT) was successfully deployed across the diseased segment  and  following the stent deployment, there was a distal migration of the thrombus  material resulting to NO FLOW PHENOMENON.   The opp.parties further submits  that   the team of doctors in Cath Lab immediately started  resuscitative measures, patient was intubated and put on ventilator, intracardiac pacing was done to improve the heart rates , an INTRA AORTIC BALLOON PUMP (IABP )   was inserted to improve the circulation and blood pressure,   multiple I.V. infusions were started to improve the B.P  .   The opp.parties  further stated   that   high risk consent of the complainant’s husband and complainant was taken  and  there was no medical negligence  on their part. .

           To prove the medical negligence aspect is concerned  three witnesses are examined on behalf of the complainant.  PW.1  i.e.  complainant stated in her evidence that  on 17.2.2003   her husband  complained   chest pain and he was taken to local doctor  who gave best emergency treatment  and on his advise he was taken to the opp.party no.1  hospital and    the opp.parties attempted for angiography, stenting  carelessly and very negligently.  It is also stated that she has paid fee of Rs.90,000/-  and on account of the negligence in giving the treatment her husband died.    PW.2  G.Shiv Kumar who is brother of the deceased  and PW.3 N.Ashok Kumar friend of the deceased   have also  deposed  the same facts as stated by the PW.1. To rebut the evidence  of the complainant, RW.1 Dr.Sumeet Sinha who is opp.party no.2    deposed in his evidence that  on 17.2.2003 the complainant admitted her husband  in   the  opp.party no.1 hospital for the problem of chest pain   and all the tests were conducted , the patient had gum  bleeding as a result of clot    dissolving    injection  he had  received at the Medak,   surgical opinion  was obtained regarding  repeat by- pass surgery from  Sri Dr.Gokhale, C.T.Surgeon  who opined that it was highly risky and it could be done only after 3 weeks in view of recent heart attacks. He further  stated that    since the patient was having recurrent angina  and risk of getting repeat Heart Attack , the option of Coronary Angioplasty and  stent placement were discussed along with the family members of the patient and the family members of the patient were explained the high risk likely complications that could occur subsequently were also explained and a fully informed  high risk consent was obtained from the complainant and his husband   and thereafter  the said operation was conducted  and  there is no medical negligence .

To prove the medical negligence aspect is concerned the   burden lies on the complainant .      The complainant  filed   documentary evidence Exs.A1 to A4 .   Ex..A1    is the legal notice issued on behalf of the complainant to the  opp.parties calling upon to furnish  the  names of the doctors, their team companions, assistants and staff who are involved in attending  the patient at the hospital  with their role time /date-wise, item wise bill with time and date of expenditure, medicines administered and procedures adopted  and also to return the back the ID cards which were forcibly snatched from  them and the papers containing their TIs and signatures .     Ex.A2 is the  reply  dt. 21.3.2003  issued by the opp.parties  denying the allegations made in the complaint.  Ex.  A3 is the acknowledgement  card.   Ex.A4 is  the In- Patient Discharge bill  for Rs.2,29,975.05 .

    Ex.B1 is the  case sheet/progress notes dt. 18.2.2003 of the  husband of the complainant issued by the Mediciti hospital. Ex.B2    is the letter of consent  dt. 24.2.2003  given by the complainant’s husband and complainant.  Ex.B3 is the reply  letter    dt.21.3.2003  issued by the opp.parties  to the complainant.   Ex.B4 is  the  Army Group Insurance Fund    Supplementary Medical Benefit   Scheme Identity cards .    Ex.B5   is the copy of the letter  dt. 28.2.2003  issued by the   office  of Army Group Insurance Fund, New Delhi to the opp.party no.1  stating that no liability    has been  issued by AGIF and no payment can be made in  respect of  claim of  wife  of G.Nageshwar Rao.     Ex.B6 is the  investigation   report dt.26.2.2003.  Ex.B7 is the  extract from the text book of International Cardiology.   

            Ex.B1  case sheet of  Mediciti hospitals discloses that the patient has already undergone by pass surgery in the Appolo hospital and all the details of the treatment given to the complainant’s husband was mentioned. Even before conducting the required operations investigation was conducted.   Ex.B6 investigation report discloses  that liver function test, Haematology test  pathology tests were conducted .   Before  conducting  second by pass surgery high risk consent was also taken from the complainant    and her  husband which  discloses  that the hospital authorities    have explained in detail about the  risk  involved in the operation and the complainant and her husband  agreed for the said operation and they have conducted the operation.  The  opposite party has taken a specific plea  that  ECG  taken for husband of the complainant  at Medak   discloses that   the patient  had a  major heart attack and  Streptokinase injection was given  to dissolve clots formed in blood vessels and the said fact was also mentioned in the case sheet and ECG     RW.1 in the cross examination  also clarified that immediately after the complainant’s husband was brought to the hospital    all necessary  required   tests were conducted and  high risk consent was also obtained  from the complainant and her husband.       

        The complainant has complained that they are not allowed to take second opinion of the doctor.  The submission made by the complainants is not sustainable.     G.Shiv Kumar  the brother of the complainant’s husband was examined as PW.2.    He  deposed that he did not give any report to the police when two army group insurance cards  of the deceased were snatched   by the hospital authorities.    The complainant has not examined any expert doctor  to prove that there was medical negligence  on the part of the opposite party in the treatment given to the husband of the  complainant.   Even the complainant has not examined  the  doctor    who has first  gave treatment  to the deceased at Medak.  The opposite party no.2 who is examined as RW.1 in his evidence stated that on 27.2.2003  the patient was taken to the Cath Lab for angioplasty and not surgery or operation theatre  and during the procedure , after the lesion (diseased segment was crossed with the wire , the INJ REOPRO   was administered to dissolve the clots and decrease the thrombus  burden   and then   the covered stent (SYMBIOT) was successfully deployed across the diseased segment .   RW.1  has also clarified that  following the stent deployment there was a distal migration of the thrombus material resulting  to “ NO FLOW PHENOMENON “  and it is known complication which occurs in 5-15%  of  vein graft PTCA’s  following this event patient develop ECG changes of a fresh attack , fall in blood pressure and heart rates and had a cardiac arrest.  The RW.1 further stated that   the patient had major heart attack , severe disease in his heart blood vessels and a high risk   procedures were done to save his life in good faith    with all possible precautions and best available material.    For the aforesaid reasons mentioned  we are of the opinion that there was no medical negligence on the part of the opp.parties .   The  medical negligence is not proved by the complainant .

     In the result complaint is dismissed . In the circumstances without costs.

                              PRESIDENT              LADY MEMBER        MALE MEMBER

                                                                        Dt.

                                         APPENDIX OF EVIDENCE

                                                 Witnesses  Examined

For the complainant :                                                For the opp.party :

PW.1:  Smt. G.Rajasree (Complainant )             Dr.Sumeet Sinha : RW.1

PW.2 :  G.Shiv Kumar

PW.3 :  N.Ashok  Kumar                                                                            

Exhibits marked on behalf of the complainant:

Ex..A1 : legal notice  dt.12.3.2003 issued by  the complt to the  O.Ps.   

 Ex.A2 :  reply  dt. 21.3.2003  issued by the opp.parties 

 Ex.  A3: acknowledgement  card. 

 Ex.A4  : In- Patient Discharge bill  for Rs.2,29,975.05  issued by the Ops. .

Exhibits marked on behalf of the  opp.parties ::

 Ex.B1 : case sheet/progress notes dt. 18.2.2003 of the  husband of the complainant issued by the Mediciti Hospital.

Ex.B2  : letter of consent  dt. 24.2.2003  given by the complainant’s husband and complainant. 

Ex.B3 : reply  lr    dt.21.3.2003  issued by the opp.parties  to the complainant.   Ex.B4  :  Army Group Insurance Fund    supplementary Medical Benefit   Scheme Identity cards .   

Ex.B5   : copy of the letter  dt. 28.2.2003  issued by the  office of Army Group Insurance Fund, New Delhi to the opp.party no.1    

Ex.B6  :  Investigation   report dt.26.2.2003. 

Ex.B7  :  Extract from the Text  book of International Cardiology.

                              PRESIDENT          LADY MEMBER        MALE MEMBER    

                                                                  DT.

PM*