BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, VELLORE DISTRICT AT VELLORE. PRESENT:THIRU. A. SAMPATH, B.A., B.L., PRESIDENT TMT. G. MALARVIZHI, B.E. MEMBER – I THIRU. K. DHAYALAMURTHI,B.SC. MEMBER – II CC. 34 / 2005 TUESDAY THE 22ND DAY OF FEBRUARY 2011. Smt. P. Devi, W/o. Sarath, Eguva Mathyam Village, Thavanampalle Mandal, Chittoor District , A.P. … Complainant. - Vs – 1. The Professor and Head Medicine Unit II Dr. Kurian Thomas, 2. Dr. Thomas David, 3. Dr Zoya Vasuki, 4. Dr. Samual George Hansnak, 5. Dr. John Mahew, 6. Dr. George M. Vargheesee, 7. The Medical Superintendent, All are residing at Christian Medical College Hospital, Vellore. … Opposite party. . . . . This petition coming on for final hearing before us on 7.2.2011, in the presence of Thiru. M.s.Achari & Thiru.T.M. Sivakumar for the complainant and Thiru. M.R.Ramanan, Advocate for the opposite parties 1 to 7 , and having stood over for consideration till this day, the Forum made the following: O R D E R Pronounced by Thiru. A. Sampath, President of the District Consumer Disputes Redressal Forum, Vellore District. 1. The brief facts of the case of the complainant is as follows: The complainant was conceived and joined at C.M.C. Hospital, Vellore by obtaining Membership bearing No.286151-6 on 3rd April 2003 for pre delivery care treatment and she used to take treatment regularly as per the direction of the opposite parties and she has paid necessary bills. On 24.8.03 she gave birth to a female under normal delivery. Thereafter the opposite parties had given treatment and discharged immediate of two weeks, after discharged she developed fever, head ache and become unable to walk. Then she was attacked with the giddiness and used to speak irrelevantly then her husband Sarth and her father N.Subramanyam Reddy took her and admitted in the opposite party institution for treatment. After the admission the opposite parties have done irrelevant tests and caused a bill Rs.72,000/- and at last failed to regain her health. The opposite parties have collected the bill and discharged the complainant and failed to extend their services properly. Thereafter the complainant admitted at Sri Sathiya Sai Medical Institute of Science at Bangalore with great difficulty and spent a small amount of Rs.9000/- and the complainant recovered her health within a week and directed to attend monthly. Though the opposite parties collected bills at high rate and fail to render services properly resulted much in convenience to the complainant and to her family members, like expenses, mental agony and torture. The complainant has issued legal notice on 22.12.03 claiming and demanding the opposite parties to pay the loss incurred by her and her family members. But the opposite parties received the said notice and failed to reply so far. Particulars of damages. 1. Medical bills for free delivery care treatment Rs. 32,000.00 2. Transport and other from 3rd April 2003 to 24.8.03 Rs. 10,000.00 3. Medicals bills from 8.9.03 to 29.9.03 Rs. 72,000.00 4. Transport and other expenses from 8.9.03 to 29.9.03 Rs. 25,000.00 5. Mental agony and suffering of the family members is estimated at Rs.2,75,00.00 ------------------------ Total Rs.4,89,000.00 ------------------------- Therefore directing the opposite parties to pay a sum of Rs.4,89,000/- with costs. 2. The counter filed by the opposite party No.7 and adopted by the other opposite parties are as follows: The opposite parties does not admit any of the allegations made in the complaint except those that are expressly admitted herein and puts the complaint to strict proof of the allegations not so admitted hereunder. The complainant with Hospital No.286151-C was seen OGI Unit of the hospital for antenatal care on 3.4.03. It was her first pregnancy. The complainant was reported to have had two episodes of Vaginal bleedings and is reported to have received antenatal care elsewhere, had undergone an ultrasound examination by Dr. Bhuvaneswari of Chittoor, Andhra Pradesh Hospital on 2.3.03 and the test had revealed a retroplaecntal clot. On her visit to the Hospital on 3.4.03, she had undergone another ultrasound examination and it revealed that she was normal. She was advised to undergo routine antenatal blood tests. The blood test revealed that she was anemic and therefore advised to increase her iron intake and prescribed medication for deforming and to take iron capsules twice a day. On her subsequent visits to the Hospital, no abnormalities were found. On 24.8.03, the complainant was admitted in spontaneous labour. The course of labour was uneventful and she was delivered of a live girl baby. The immediate post-partum period was uneventful and Doctor advised her to be discharged on 25.8.03 as she was a febrile, had normal lochia and was breast feeding satisfactorily. Mother and child were noted to be healthy at the time of discharge. On the 6th day, sutures were removed. There was no report of any discomfort of any sort. 3. More than two weeks after the normal delivery, she was brought to casualty department of the opposite party on 8.9.03. She had features of altered consciousness, and seizures (fits) of 4 days duration associated with fever, vomiting reduced urinary output and head-ache. She was treated in a private hospital at her home town before coming to CMC Hospital, She was found to have the following syndromes during the course of the illness at admission and evaluation in causality. a. Septic Syndrome (infection which had spread to the blood system and is considered serious disease with potential bad outcome. ) b. Puperal Sepsis (infection of the uterine cavity after delivery) c. Severe Hyper natremia (abnormally high sodium in the blood – Norma is between 135-140. But she had 179 at admission This is a life threatening condition) d. Acute Respiratory Pneumonia affecting sides of the lungs seen often Distress Syndrome with severe diseases like sepsis. In these cases The lung is unable to adequately oxygenate the Blood, so oxygenation of the rest of the body is Compromised and needed ventilatory support e. Meningo-Encephalitis (Infection which is primarily in the brain which produces loss of consciousness, fits and neurological deficits) f. Demyelization (damage to the nerve fiberes with loss of covering membrance) g. Central Pontine Myelinolysis (damage to a part of brain (Pons) often due to abnormal sodium levels in the blood.) h. Generalized Tonic (called fits where there is involuntary muscular clonic Seizures activity often associated with loss of consciousness). Such Symptoms were unconnected to the delivery or post-natal care, which took place is this Hospital. In such cases of severe infection, the normal function of lung, heart and brain are impaired. The patient could be managed more effectively in the Intensive Card Unit where ventilatory support and more intensive and medical care is possible. The complainant was therefore admitted in the Intensive Care Unit and was put under Ventilator to help in the maintenance of adequate oxygenation of the blood until her lungs returned to normalcy. She was kept under frequent monitoring and her blood pressure, pulse rate and oxygenation were monitored and recorded. The sever sodium imbalance in the blood was rectified and brought to normalcy. The patient was administered the following: a)Inj. Crystalline penicillin given intra venous 20 lacks every 2 hours for 14 days This is the recommended does of meningitis. b). Inj. Cefotaxime Intravenous 2 gm IV every 8 hours for 14 days for puperal sepsis. c) Inj. Gentamicin 200 mg. IV once daily 14 days for puperal sepsis. d) Inj. Flgyl 500 mg. IV once in 8 hours. 14 days puperal sepsis. e) Cap. Doxycycline 100 mg. Twice daily for suspected other infection. 4. The Patient’s infection was brought under good control and she did not have fever. Her blood sodium was brought down to normal level. Her lung functions had returned to normal and she was able to breath without ventilator support. Blood pressure returned to normal. Her fits were brought under control with medicines. After proper treatment, she was improving and she and her relatives decided to continue nursing and rehabilitation at home and she was therefore discharged medically on 29.9.03 but left the hospital on 4.10.03 after completing discharge procedures. She had reportedly had fever for 4 days, reduced urinary output and vomiting for 3-4 days before she came to the Hospital on 8.9.03. While antenatal, intra natal and immediate post natal care were satisfactory in this Hospital, the response of the patient and her family to seek proper care when she took ill in the 3rd week post partum was delayed. The delay led the patient arriving in the Hospital in such critical condition and after treatment she was discharged in good condition. It is because of the best treatment she had at this Hospital, she recovered and was discharged, and her further recovery allegedly at Sri Sathyasaibaba Hospital was the natural course of the recovery after infection was controlled at this Hospital. It is absolutely false and unfounded to allege that there was any deficiency of service at this Hospital either in the matter of diagnosis or treatment. Hence this complaint is to be dismissed. 5. Now the points for consideration are: a) Whether there is any deficiency in service, on the part of the opposite parties? b) Whether the complainant is entitled to the reliefs asked for?. 6. Ex.A1 to Ex.A7 were marked on the side of the complainant and Ex.B1 to Ex.B3 were marked on the side of the opposite parties. Proof affidavit of the complainant and Proof affidavit of the opposite parties have been filed. No oral evidence let in on the side of opposite parties. 7. POINT NO. (a) It is admitted facts of the parties that the complainant was seen OGI Unit of the opposite parties hospital for antenatal care on 3.4.03 and she had under gone an ultrasound examination and blood test and prescribed iron capsules twice a day. On 24.8.03 the complainant was admitted in spontaneous labour and she was delivered of a live girl baby and Doctor advised her to be discharged on 25.8.03 as she was a febrile had normal lochia and was breast feeding satisfactorily and on the 6th day sutures were removed. Mother and child were noted to be healthy at the time of discharge. 8. The complainant contended that two weeks after discharged from the hospital she developed fever, head ache and become unable to walk. She was admitted in the opposite party institution for treatment on 8.9.03. After admission the opposite parties have done irrelevant tests and caused a bill Rs.72,000/- and at last failed to regain her health. Even at the 2nd test the opposite parties could not completing to treat the complainant with caution and care and they failed to render services properly resulted much in convenience to the complainant and to her family members, like expenses, mental agony and torture. 9. The opposite parties contended that more than two weeks after the normal delivery she was brought to casualty department on 8.9.03. During the course of the illness at admission and evaluation in causality, she was found to have the a. Septic Syndrome b. Puperal Sepsis c. Severe Hyper natremia d. Acute Respiratory distress Syndrome e. Meningo-Encephalitis f. Demyelization g. Central Pontine Myelinolysis h. Generalized Tonic clonic Seizures Such symptoms were unconnected to the delivery or post-natal care, which took place is this Hospital. The complainant was therefore admitted in the Intensive Care Unit and was put under Ventilator to help in the maintenance of adequate oxygenation of the blood until her lungs returned to normalcy. The sever sodium imbalance in the blood was rectified and brought to normalcy. The patient was administered the proper medicines maintained in the Ex.B1 series records of the opposite party hospital. After proper treatment she was improving and she and her relatives decided to continue nursing and rehabilitation at home and she was therefore discharged medically on 29.9.03 but left the hospital on 4.10.03 after completing discharge procedures. Therefore absolutely false and unfounded to allege that there was any deficiency of service at this hospital either in the matter of diagnosis or treatment. 10. From the perusal of Ex.B1 series page No.2 to 12 of medical records and discharge summary of the complainant issued by the opposite party hospital it is mentioned that the complainant was seen OGI Unit of the opposite party’s hospital for antenatal care on 3.4.03 and she was reported to have received antenatal care elsewhere, had undergone an ultrasound examination by Dr.Bhuvaneswari of Chittoor, Andhra Pradesh and the test had revealed a retroplaecntal clot. She had undergone another ultra-sound examination and blood test on 3.4.03. The blood test revealed that she has anemic and therefore advised to increase her iron intake and prescribed medication for deforming and to take iron capsules twice a day. It is further mentioned in the said medical records that on 24.8.03 the complainant was admitted in spontaneous labour and she was delivered of a live girl baby. The immediate post-partum period was uneventful and doctor advised her to be discharged on 25.8.03 as she was a febrile, had normal lochia and was breast feeding satisfactorily. From the perusal of discharge summary it is mentioned that she was discharged with the following advice: excusive demand breast feeding for baby for 4 months. Immunizations to be given as advised. Contraception to be discussed at six week checkup. Calcium Carbonate and Cap Autrin 1 daily for 6 weeks. Suture removal on 29.8.2003. Repeat visit on 13.10.2003. The complainant has also not made any allegation about the treatment for delivery. 11. From the perusal of Ex.A1 discharge summary of the complainant issued by the opposite party hospital it is seen that two weeks after the normal delivery she was brought to the hospital and she was reported to have that she had a normal vaginal delivery on 24.8.2003, two weeks following which she developed fever for the last seven days, headache for seven days and inability to walk for two days. The fever was high grade, intermittent, with no chills and rigors. The headache was holocranial, severe and associated with giddiness. She has 2-3 episodes of non-projectile vomiting per day for two days. She also began speaking irrelevantly. There were no history of seizures, cranial nerve involvement, weaknes of upper limbs, sensory defecits or bowel/bladder incontinence. There is no past history of tuberculosis. She was treated outside with IV antibiotics before being brought to C.M.C. Hospital. It is further mentioned that On investigation she was found to have the following syndromes during the course of the illness at admission dt. 8.9.03 and evaluation in causality: a. Septic Syndrome b. Puperal Sepsis c. Severe Hyper natremia d. Acute Respiratory distress Syndrome e. Meningo-Encephalitis f. Demyelization g. Central Pontine Myelinolysis h. Generalized Tonic clonic Seizures 12. The complainant was admitted in the Intensive Care Unit and was put under Ventilator to help in the maintenance of adequate oxygenation of the blood. The patient was administered the following: a)Inj. Crystalline penicillin given intra venous 20 lacks every 2 hours for 14 days This is the recommended does of meningitis. b). Inj. Cefotaxime Intravenous 2 gm IV every 8 hours for 14 days for puperal sepsis. c) Inj. Gentamicin 200 mg. IV once daily 14 days for puperal sepsis. d) Inj. Flgyl 500 mg. IV once in 8 hours. 14 days puperal sepsis. e) Cap. Doxycycline 100 mg. Twice daily for suspected other infection After several tests and treatment the doctors have opined that she was found to have a hypernatremia at admission, that was gradually corrected. She was admitted in MICU after being intubated for an aspiration pneumonia. After successful extubation she remained noncommunicative and had evidence of a spastic quadriparesis. This was considered to be a sequelae of hypoxia or central pontine myelinolysis. An MRI scan confirmed the presence of lesions in the brainstem consistent with hypoxic damage. She was advised further rehabilitation under PMR and she was discharged from the hospital on 29.9.03 with the recommendations of Nasogastric tube feeds 2 litres / day – 2000kcal diet. T. Eptoin 100 mg thrice a day. T. Rantac 150 mg twice a day. Persol local application to the face. Prickly heat cream local application Twice a day. Physiotherapy as advised. 13. According to the complainant that after admission the opposite parties have done irrelevant tests and caused a bill Rs.72,000/- at last failed to region her health, so opposite parties have failed to extend their services properly. Therefore, she admitted in Sri Sathiya Sai Medical Institute of Science at Bangalore with great difficulty and spent a small amount of Rs.9000/- and the complainant recovered her health within a week. Hence the opposite parties could not completing to treat the complainant with caution care and they failed to render services properly resulted much inconvenience to the complainant like expenses mental agony and torture. The learned counsel for the opposite parties have argued that bare allegations in the complaint would not establish charge of negligence on the part of the opposite parties. The burden of proof on the medical negligence lies on the complaint, but in this case, the complainant has not proved the allegation made in the complaint against the opposite parties through medical records or expert evidence. In this connection the learned counsel for the opposite party is relying upon the following Judgments of Hon’ble Supreme Court and National Consumer Disputes Redressal Commission, New Delhi. I. (2009) 7 Supreme Court Cases 130 C.P. SREEKUMAR (DR.), MS (ORTHO) ..Vs.. S.RAMANUJAM Wherein the Hon’ble Supreme Court is held that “ As already observed in Jacob Mathew case the onus to prove medical negligence lies largely on the claimant and that this onus can be discharged by leading cogent evidence. A mere averment in a complaint which is denied by the other side can, by no stretch of imagination, be said to be evidence by which the case of the complainant can be said to be proved. It is the obligation of the complainant to provide the facta probanda as well as the facta probantia. In Jacob Mathew case it has been observed as under: (SCC pp.32-33, para-48) “(1) Negligence is the breach of a duty caused by omission to do something which a reasonable man guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do. The definition of negligence as given in Law of Torts, Ratantal 7 Dhirajlal (edited by Justice G.P.Singh), referred to hereinabove, holds good. Negligence becomes actionable on account of injury resulting from the act or omission amounting to negligence attributable to the person sued. The essential components of negligence are three: ‘duty’ , ‘breach’ and ‘resulting damage’ (2) Negligence in the context of the medical profession necessarily calls for a treatment with a difference. To infer rashness or negligence on the part of a professional, in particular a doctor, additional considerations apply. A case of occupational negligence is different from one of professional negligence. A simple lack of care, an error of judgment or an accident, is not proof of negligence on the par of a medical professional. II. 2007 (2) CPR 260 (NC) N. Krishna Reddy ..Vs.. Christian Medical College and Hospital Rep. by its Medical Superintendent & Anr. Wherein the Hon’ble National Commission, New Delhi is held that, “ Consumer Protection Act, 1986 – Sections 21(a)(i) – and 2 (1) (g) – Complaints about medical negligence – Medical negligence must be established and not presumed. In the absence of expert evidence on behalf of the complainant, no negligence or deficiency in service could be found against the affidavits filed by Hospital and doctors. “ In the present case, from the perusal of Ex.A1 discharge summary and Ex.B1 series medical records of the complainant issued by the opposite parties hospital would show that the doctors of the opposite parties hospital have taken the proper test investigation and administer proper medicine and treatment with at most care and skill. During the treatment she was closely monitor by the nurse and doctors. 14. The nature of the medical profession is such that there are many courses of treatment in each disease. The diagnostic procedure may by vary, and the approach by each doctor will be different and the treatment given to a patient differs from man to man. It is for the doctor treating the patient to decide the best course of action and if he has done the job exercising due diligence with such standard of care that is required of him. Unless it is shown that the Doctor or Nurse has failed to opt a particular precaution or failed to follow the procedure and such failure has called to the ultimate result or complication. In the present case, except the complaint there is no medical record or expert evidence to prove that the opposite parties have done irrelevant test and they failed to render services properly while treating the patient. The ruling cited by the learned counsel for the opposite parties are squarely applicable to facts and circumstances of this case. 15. Hence, taking all the above facts into consideration from the contention in the complaint and the counter, as well as proof affidavit of the both the parties, and from the documents Ex.A1 to A7 and Ex.B1 to Ex.B3, we have come to the conclusion that the complainant herein has not clearly proved the deficiency in service on the part of the opposite parties herein. Hence we answer this point (a) as against the complainants herein. 16. POINT NO : (b ) In view of our findings on points (a), since, we have come to the conclusion that the complainant herein has not clearly proved the deficiency in service on the part of the opposite parties herein. We have also come to the conclusion that the complainant is not at all entitled to any relief asked for by him in this complaint. Hence we answer this point (b ) also as against the complainant herein. 17. In the result, this complaint is dismissed. No costs. Dictated to the Steno-typist and transcribed by her, corrected and pronounced by the President, in Open Forum, this the 22nd day of February, 2011. MEMBER-I MEMBER-II PRESIDENT. List of Documents: Complainant’s Exhibits: Ex.A1 – 27.9.03 - X-copy of Discharge summary. Ex.A2 - -- - X-copy of Medical Prescription & bills. Ex.A3- 8.9.03 to 14.9.03 - X-copy of Medical Bills. Ex.A4- 12.9.03 & 6.10.03 - Medical bill & Out patient card. Ex.A5- 22.12.03 - X-copy of legal notice. Ex.A6- -- - Postal Receipts & Ack. Ex.A7- -- - Medical Bills. Opposite parties Exhibits: Ex.B1 (One Bound book) - x-copy of medical records. Ex.B2- 9.6.2004 - X-copy of Reply notice. Ex.B3- -- - Ack. Card. MEMBER-I MEMBER-II PRESIDENT.
| | [ Hon'ble Tmt G.Malarvizhi, B.E] MEMBER[ Hon'ble Thiru A.Sampath, B.A., B.L] PRESIDENT[ Hon'ble Tr K.Dhayalamurthy, Bsc] MEMBER | | 
