National Consumer Disputes Redressal
Suman D. Mane (Dead) Through Lrs. & 4 Ors. vs Director, Grant Medical Foundation & ... on 22 July, 2025
IN THE NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
AT NEW DELHI
Judgement reserved on 29.11.2024
Judgement Pronounced on 22.07.2025
FIRST APPEAL NO. 207 OF 2013
(Against the order dated 11.12.2012 in Complaint Case No.CC/11/96
of the State Consumer Disputes Redressal Commission, Maharashtra)
With
LA. No.1129 of 2021
(Directions)
Smt. Suman D. Mane (Dead)
Through LRs
1. Shri Rajendra D. Mane
Balram
Sanjog Colony
Near Civil Hospital
Sangli, Maharashtra.
2. Shri Chandrakant D. Mane
Sanjog Colony
Near Civil Hospital
Sangli, Maharashtra.
3. Mrs. Sunanda S. Balungade
A-505, Building No.63
Tilak Nagar
Chembur (West)
Mumbai.
4. Mrs. Shubhangi S. Deshmukh
A-103, C-DOT Colony
SectOr-56, Gurgaon
Haryana. Appellants
Versus
1. Director
Grant Medical Foundation
Ruby Hall Clinic
Pune, Maharashtra.
1 | Page
2. Dr. Jagdish Hiremath
C/o Ruby Hall Clinic
Pune, Maharashtra.
3. Dr. V.R. Karmarkar
C/o Ruby Hall Clinic
Pune, Maharashtra.
4. Dr. Chaitanya Raina
C/o Ruby Hall Clinic
Pune, Maharashtra. Respondents
BEFORE:
HON'BLE MR. JUSTICE A.P. SAHI, PRESIDENT
HON'BLE MR. BHARATKUMAR PANDYA, MEMBER
Appeared at the time of arguments:
For the Appellants Mr. Abdulrahiman Tamboli, Advocate
Mr. Rahul Joshi, Advocate
For the Respondents Mr. Sudeep Nargolkar, Advocate
Dr. (Ms.) Anuja Athale
Ms. Manjusha Kulkarni, Legal Advisor
ORDER
A.P. SAHI, J. (PRESIDENT)
1. The Appellants/Complainants preferred Complaint Case No.96/2011 before the SCDRC, Maharashtra, alleging medical negligence against the Respondents with regard to the treatment and care of late Shri Dattajirao B. Mane who is stated to be a practicing lawyer at Sangli, Maharashtra. He had complaints of chest congestion and breathlessness in September 2009 and was undergoing a treatment at Sangli with some Cardiologist and Neurophysician.
2 I Page /
2. A right shoulder pain was experienced, for which late Mr. Mane thought it appropriate to take opinion from one Dr. Wadia and then with the Opposite Party Dr. Jagdish Hiremath of Ruby Hall Clinic, Pune. He was attended to by Dr. Hiremath to advise a Treadmill test which turned out to be positive and on the recommendations of Dr. Hiremath he was admitted in the Cardiac Care Unit of Ruby Hall Clinic and an angiography was planned on 22.10.2009 for being conducted on the next day i.e. 23.10.2009.
3. With the angiography performed it was found that the major arteries were blocked to the extent of 90% and since the same was incapable of being corrected by angioplasty, a Bypass surgery was advised.
li 4. The Bypass surgery were arranged to be performed by the Opposite Party Dr. V.R. Karmarkar and Dr. Chaitanya Raina in the same hospital and accordingly, various tests were carried out and on account being found fit to undergo the surgery, the Bypass surgery was performed on 24.10.2009.
5. The Bypass surgery was reported to be successful and therefore, for recovery, he was shifted to the recovery-room and he regained consciousness in the evening of 24.10.2009.
n 3 I Page
6. According to the Complainants, the patient was fully uncomfortable and on 27.10.2009, he was moved to the Coronary Care Unit on a wheel chair where he was administered liquids and some solid food. He continued in the Coronary Care Unit on 28th, 29th and 30th October, 2009 where he experienced distension of the stomach. The symptoms were complained of and on 31.10.2009 at about 01.30 a.m. he suffered a cardiac arrest from which he recovered and was revived. He was, however, on some ventilator support on 1st, 2 nd rd and 4th November, 2009 when it was informed to the Complainants that the patient was improving slowly but a portion of his small intestine had been paralyzed and there was a leak for which a surgery was proposed to rectify the blockage. The patient was in the recovery-room on 5th, 6th and 7th November, 2009 and no improvements were observed. The secretions in the chest and the stomach continued whereupon a CT Scan was carried out and on 07.11.2009 he suffered another cardiac arrest but was successfully revived.
7. On 08.11.2009, a surgery was performed to examine and rectify the defect in the intestine when a small part of the intestine was removed and then the patient was moved to the Intensive Care Unit where he remained on ventilator support. The patient remained in the ICU on 9th, 10th and 11th November, 2009 and fever was discovered 4 | Page which was informed by the doctors due to some infection. On 12.11.2009, the patient was permitted to take fresh lime juice through the stomach tube but his condition remained weak and incoherent and he could not be removed from the ventilator. There was no fever on 14.11.2009 and the patient continuing on ventilator without any improvement in the general condition and finally on 15.11.2009, he suffered another cardiac arrest but could not be revived and was declared dead.
8. According to the Complainants, the sequence of events and the manner in which the treatment was carrying out and the patient attended to, the Complainants believed that the source of post-operative infection arose with the surgeries which were performed negligently or the lack of proper post-operative care and treatment in the hospital. The 20 days that the patient spent in the hospital has been narrated in the Complaint, an allegation was made against Dr. Hiremath for having been negligent by not attending to the patient and the line of treatment and the manner led to a fatal infection that was a result of a totally uncoordinated treatment at the hospital.
9. Learned Counsel for the Complainants has pointed out that the aforesaid apprehension stood confirmed with the Death Summary dated 15.11.2009 that has been brought forth on record by the Opposite 5 | Page Parties on the directions of this Commission. Learned Counsel has pointed out towards the opinion which has been recorded as post CABG with Bowel Ischemia with caecal perforation with septicemia with multi organ failure.
10. The Complainants tendered a legal notice on 16.07.2010 to which a Reply was given on 21.08.2010 and again on 12.10.2010.
11. The Complainants also alleged that the death occurred on a Sunday when no cardiac specialists were available nor any doctor was present and the staff was completely indifferent to the suffering of the patient. The compensation was claimed to the tune of ?61,00,000/-, ^50,00,000/- for loss of dependency, ^8,00,000/- for medical expenses at the hospital, ^3,00,000/- for medicines and pathological test charges as compensation for deficiency in service.
12. The State Commission after analyzing the facts proceeded to hold that the Opposite Party Dr. Hiremath was not the surgeon but only a physician and cardiologist whereas Dr. Karmarkar was the surgeon who conducted the Bypass surgery. The State Commission held that f medical negligence could not be fastened on Dr. Hiremath for the post operative infection as the patient was under the care of the surgeon yet care had been taken in the manner explained as such medical negligence cannot be attributed towards to the said Opposite Party.
6| Page /!
13. It has been further held that from the notes of the nurses and the doctors, it is evident that the intestinal problems of the patient were identified and due care was taken with the aid of an expert namely Dr. Deshpande who advised the treatment that was carried out accordingly. The State Commission, therefore, came to the conclusion that the Complainants had failed to establish that the treating doctors namely the Opposite Parties had conducted themselves below the standard of a reasonably competent doctor and that event of the matter, there was no reason to accept that there was any breach or negligence causing the death of the patient.
14. The State Commission referred to the 'Bolam Test' and held that in the absence of any substantial material to infer medical negligence, the Complaint deserves to be dismissed at the admission stage itself. Accordingly, the Complaint was dismissed on 11.12.2012. At the outset, the Complainants have alleged that the Complaint ought to not dismissed at admission stage and the matter ought to have been examined, more so with the aid of an expert before arriving at the conclusion as to whether the line of treatment adopted by the Opposite Parties was in conformity with the medical protocols that are expected to be followed by the doctors possessed with reasonable skills. In the instant case, there was no attendance and Dr. Hiremath had absolved 7 | Page himself by stating that he had entrusted the care to one Dr. Duggal appointed by him in his team. According to the Complainant, the doctors were not even qualified. It is also urged that the Intensive Care Unit and the Critical Care Unit both should be possessed of efficient and qualified doctors which was absent and this led to the improper care leading to the infection which ultimately cause the death of the patient who was not even looked after as the infection was not diagnosed nor any proper test were carried out. The very identification of the problem was delayed and even thereafter no proper treatment was conducted as a result whereof the patient succumbed to the negligence of the Opposite Parties. The findings of the State Commission have been, therefore, assailed contending that no proper consent was taken. It is urged that there was no endorsement of Dr. Duggal on the treatment sheet and without examining the complications arising out of a CABG surgery the Complaint was dismissed summarily.
15. It was also alleged that Dr. V.R. Karmarkar was not duly qualified and in the absence of any opportunity to lead appropriate evidence the State Commission hurriedly disposed of the matter without adverting to the integrity of the progress of the medical treatment of patient who developed post-operative complications which require a high degree of care and precision that was not observed by the Opposite Parties.
8 | Page
16. Learned Counsel has also invited attention of the Bench to the Affidavit filed in support of the Complaint to urge that the details had been indicated regarding the short-falls in the investigations and the improper treatment of the patient. It was also alleged that even the basic diagnosis test like ultrasound, CT Scan and X-Ray were not carried out post-surgery until 30.10.2009 in spites of the fact that the first signs of stomach distention had already been observed on 25.10.2009.
17. The Appeal was entertained and notices were issued calling upon the Opposite Parties/Respondents to file their response. During the I • pendency of the Appeal, the Appellant No.1 Smt. Suman D. Mane expired and I.A. No.2619/2014 accompanied by the Death Certificate was moved that was accepted and the amended Memo of Parties has been recorded. The case was admitted on 17.12.2014 and the Respondents came to be represented through Ms. Manjusha Kulkarni their Authorised Representative. The Appeal remained pending and Covid intervened. Whereafter adjournments were sought by either side. The case was adjourned thereafter and I.A. No.1129/2021 was moved on behalf of the Appellants on 27.01.2021 with a prayer that in view of the fact that the Complaint had been summarily dismissed by the State Commission without taking any expert opinion and with all the allegations made, it would be appropriate to call for a report of a Medical 9 | Page Board before proceeding to decide the matter. The said Application alleged misrepresentation regarding the qualification of the treating doctors and the absence of a qualified intensivist doctor. It is also alleged that the deficiency in the part of the treating doctors was evident and there was a complete failure to anticipate an known and forcible consequence of gastrointestinal post-surgical infection. The negligent post-operative care and neglectful nursing resulted in the death of the patient. It has also been alleged that there was a failure to complete the pre-surgical procedures and therefore, it is necessary to call for an expert report in the matter. The said Application remains undisposed of. When the matter came to be heard in 2023 but on the adjournments sought and thereafter, the case was released by the Bench hearing it and then it came up before another Bench on 14.08.2023 when the following Order was passed:
"Mr. Abhimanyu Kumar, learned counsel for the appellant seeks an adjournment stating that the arguing counsel is unable to appear today for some personal reasons.
We have perused the docket of the case since 2013 and we find that the notices were issued way back in the year 2014. This Appeal was instituted by the widow of the patient who died during medical treatment and a claim was set forth contending that death was caused due to medical negligence of the opposite parties.
Unfortunately, the original appellant Suman D. Mane also died during the pendency of this appeal and was sought, to be substituted by her legal heirs. Thereafter,vakalatnama was filed and on seeking adjournment a cost of Rs. 10,000/- was imposed on the appellant on 27.02.2020.
A 10 | P a g e Almost three years have passed by then and adjournment has again been sought on behalf of the appellant. We also find that on a couple of dates, the respondent had also sought adjournment. The case had not proceeded so far except for the fact that some arguments were heard in June, 2023. The learned Member, who was hearing the matter, has demitted office and the appeal was released after having been heard in part. It is thus clear that apart from the adjournments, the Bench also proceeded to release the matter after hearing it in part. In this back ground we give a last opportunity to the learned counsel for the appellant to attend the Commission and argue the matter on merits.
The matter be again listed on 14.12.2023."
18. The case was again taken up and a detailed Order was passed on 28.06.2024, which is extracted hereunder:
"Heard learned Counsel for the Complainant, who has advanced his submissions contending that the condition of the patient post-surgery, according to the pleadings on record, worsened on account of the negligence of the Opposite Parties, particularly Opposite Parties Nos.2,3 and 4, who, in general terms it is argued, have failed to attend to the patient and also did not observe the requisite medical protocols in spite of the fact that abdominal distension was noticed consistently from 25.10.2009 onwards as is evident from the notes of the Doctors as well as Nurses. It is urged that on account of the negligence and non-attendance to the said Gastro Intestinal complications led to future complications of perforation of the intestine, septicemia, infections and finally multi organ failure. The submission therefore is that even the nursing staff did not take care to deploy a Ryles Tube in spite of specific i instructions for its insertion and specific instructions to administer oral sips only. It is pointed out that in spite of these instructions, the nursing sheet discloses that the patient had lunch on 27.10.2009. Learned Counsel for the Complainant submits that the patient was admitted to the Coronary Care Unit post CABG procedure and therefore administration of medicines and food were entirely in the hands of the hospital staff, doctors and the nurses.
Consequently in the absence of any appropriate steps having been taken or the attendance of the concerned Doctors, patient seems to have been handled only by nursing and junior doctors without any attention and medical advice from the Opposite Parties No.2,3 and 4. Learned Counsel in order to substantiate his 11 | P a g e submission has taken the Bench through the Doctor's notes as well as nurses note sheets and the letter dated 10.08.2010 of the Opposite Party No.2 to demonstrate that the fact that the patient was not attended to by the Opposite Parties No.2, 3 and 4 and that one Dr.D.Duggal privately engaged by the Opposite Party No.2, was entrusted with the duty of taking care of his patient. Submission therefore is that this also clearly amounts to negligence on the part of the Opposite Parties whose consultation was absolutely minimal and no steps were taken to rectify the Gastro Intestinal problem that continued to persist to 25.10.2009 till 30.10.2009 whereafter the situation went out of hand.
He further submits on the strength of a literature cited by him with regard to care of a patient post CABG where Gastro Intestinal glitches need to be taken care of by resorting to Diagnostic tests including abdominal X-ray, Electrolyte Paneling and Complete Blood Count. He submits that even though electrolyte balancing was advised there seems to be no steps taken for even conducting an ultrasonography which was done almost five days later on 30.10.2009. Thus, the monitoring as per the aforesaid literature (Page No. 152) was totally absent and as such this absenceto take due care clearly amounts to medical negligence. The contention therefore is that the clinical notes from 25.10.2009 to 30.10.2009 according to the Complainant demonstrate a negligence on the part of the Opposite Parties in treating, managing and ultimately taking care of the patient which resulted in serious complications finally leading to his death. The submission therefore is that this situation was brought about on account of this negligence, and the fact that the death had occurred on account of these symptoms stands recorded in the death summary which has been brought on record by the Opposite Parties alongwith additional documents, (at Page No.180-181).
Responding to the submissions of the Complainant, the representative of the Opposite Party stated that the nature of the complication that was noticed on account abdominal distension was treated as per protocol and that when this appeal was being heard on 11.01.2023, the Opposite Parties were directed to produce the treatment details of post abdominal distension and care taken at their end supported by documents. This order dated 11.01.2023 was complied with by filing of a compilation alongwith the list of the documents including the entire treatment details with the charts as well as other documents including the death summary of the patient. A copy of the same was served on the Learned Counsel for the Complainant and was filed on 06.03.2023.
12 | P a g e It is with the aid of these documents that the representatives of the Opposite Parties attempted to explain the line of treatment that was undertaken by them datewise. The submission is that the said details in the chart broadly indicate that after noticing the symptoms, the electrolyte balance was sought to be maintained with appropriate administration of fluids as well as other concerned medicines as per medical protocol. The contention is that the details demonstrate that this was the appropriate medical protocol that was required to be taken, given the nature of the complication that had arisen. The aforesaid details seem to have been needed as is evident from the order passed by this Commission on 11.01.2023 in order to appreciate the argument which has been advanced on behalf of the Appellant.
It may be pointed out that the present case arises out of the proceedings undertaken under the Consumer Protection Act, 1986, where the procedure prescribed for hearing a complaint is as per Section 13 of the 1986 Act. The forum exercising jurisdiction has the power of discovery and production of any document or any other material that may be required for an effective disposal of the complaint. The said power is co-extensive and is available to the appellate forum as well in order to arrive at the correct conclusion more particularly in such type of cases where the treatment details of a patient where negligence is alleged need to be appropriately gone into. It is for this reason that the orders were passed on 11.01.2023.
Since this material has been placed under the orders of this Commission it would be appropriate to grant an opportunity to the Appellant to either contest or rebut the contents of such documents which relate to the treatment of the deceased patient about whom negligence has been alleged against the Opposite Parties. Ld. Counsel for the Appellant prays for six weeks' time to file a response, if any, in respect of the said documents.
The authorized representatives for the Respondents are also permitted to file any appropriate affidavit which they may choose to corroborate or support the documents already filed alongwith any authority or literature in support of the line of treatment which was given to the deceased patient. This affidavit may also be filed within the same period after serving a copy on the Ld. Counsel for the Appellant.
Either side, if they so choose, may file responses to the respective affidavits within two weeks thereafter. Accordingly, let the matter be listed after eight weeks.
List on 30.09.2024 at 02:00 p.m."
K 13 | P a g e /
19. \Ne may point out that on 11.01.2023, an Order had been passed by a learned single Member of this Commission directing the Respondents to produce the treatment details of post abdominal distention and the care taken at their end within four weeks. It is in response to the said Order that a compilation through a letter dated 28.02.2023 by the legal representative of the Opposite Party the complete set of documents and medical case papers along with the ICU charts of the patient were tendered that were received and are on record through Diary No.7930 dated 06.03.2023. It is alongwith the said compilation that the Death Summary referred to above has been placed on record alongwith the ICU charts etc. regarding the treatment of the patient. It is after perusing the same that the Orders were passed on 28.06.2024 granting time to the Respondents to file an Affidavit in support of the aforesaid documents alongwith any literature or authority to support their contention. Learned Counsel for the Appellant was also granted time to file a response thereto and accordingly on 09.09.2024, learned Counsel for the Complainant filed his objections through Diary No.31021/2024.
20. The arguments have been advanced based on these objections as well which contain pointed objections regarding the line of treatment 14 | P a g e adopted by the Opposite Parties. The said objections are reproduced hereinunder:
NATIONAL CONSUMER DISPUTES REDRESSALCOM MISSION NEW DELHI FIRST APPEAL NO. 207 OF 2013 IN THE MATTER OF:-
1. Suman D. Mane (dead) through Lrs & ors Appellant(s) Versus
1.Director, Grant Medical Foundation & ors. .... Respondent(s) RESPONSE/QBJECTIONS TO THE ADDITIONAL DOCUMENTS FILED BY THE RESPOENDATS IN PERSURANCE OF ORDER DATED 11.02.2023.
1. The Appellant submits that the charts relied upon by the Respondents ought to have been made available to the Complainant along with all other medical records when demanded initially be his legal notice. Production of these charts at such a late stage appears to be an afterthought.
2. The Appellant further submits that the xerox copies of the charts are not certified as true copies by any authority. Furthermore, none of the charts have any orders/ opinion/ advice by either Dr JSH or Dr VRK. Dr Raina and Dr Duggal seemed to be looking after the patient.
From 04/11/2019 only Dr Duggal seems to have looked after the patient.
k A h 15 | P a g e
3. The Appellant further submits that in the entire medical documents produced by the Respondents ICU Consultants are indicated as "ICU Team" - no single doctor was named as responsible for leading the treatment of the deceased.
4. The Appellant further submits that Abdominal girth record was maintained only from 30/10/2019 whereas the clinical notes of 26/10/2019 record that patient had stomach distention and that bowel sounds were sluggishi.
5. The Appellant further submits that despite noting .the abdominal distension no USG was carried out and as per the record USG has been carried out for the first time on 4/11/2019.
6. The Appellant further submits that on the charts for 12/11/2019, 13/11/2019 and 14/11/2019 the diagnosis is indicated as "Bowel Ischemia which is a clear admission that the post-operative complication did occur.
7. The Appellant further submits that the Doctor (Authorised representative) who has appeared on behalf of the Respondents was as per her own admission was not in the team of treating doctors between 25.11.2019 and 30.11.2019. So, her comments about the medical treatment are limited only to explaining the steps taken by 16 | P a g e the unnamed treating doctors instead of placing on record the steps which should have been taken by the treating doctors as per the standard protocol laid down in medical literature in case of CABG post operative complication. That to fortify his stand the Appellant is relying upon two more research Article (in addition to those which are already part of the paper book) laying down the protocol imcases of CABG post operative complication. ANNEX THE ARTICLES (13 to'N)
8. The Appellant further submits that many minor observations and discrepancies indicate the lack of care and attention by the doctors and nurses. Specific chart-wise observations given in the Table below.
9. In conclusion, the ICU monitoring charts corroborate the averments in the complaint and the affidavit of the Complainant. There are no contradictions.
Doc.
Nature of Document Comments Remarks SI.
No.
a) Admitting Consultant
ICU monitoring chart Day of the
182 indicated as "Dr JSH" and ICU
for 24/10/2009 CABG
' consultant as "Dr VRK'1
a) Admitting consultant is
indicated "Dr J.S.H." and'ICU
consultant as "Dr VRK".
b) Diagnosis indicated as
ICU (RR-01) monitoring
183 "CABG x 3"
chart for 25/10/2009 c) The abdominal girth record is
missing in the chart
d) Fluid Orders state "Soft
Diet". However, Intake chart
17 | P a g e
Doc.
SI. Nature of Document Comments Remarks
No.
shows that patient had Biscuits,
Bread and dinner oralfy.
a) the output chart shows
the total output as 2315 ml
while it is indicated as 2865 ml
at the bottom of the chart_____
a) Admitting consultant is
indicated "Dr I.S.H." and ICU
consultant as "Dr VRK".
b) Diagnosis indicated as
"CABG x 3"
c) The abdominal girth record is
missing in the chart
d) Fluid Orders state "RT +
sips of water orally". However,
Intake chart shows that panent
had Biscuits, Bread and dinner
ICU (RR-O1) monitoring
< 184 orally.
chart for 26/10/2009
e) Chart records that
patient suffered recurrent
attacks of asthma. But no
advice/opinion by any doctor.
f) The fluid orders include the
name of Dr Duggal. Rason is not
clear.
b) The output chart shows
the total output as 1970 ml
while it is indicated as 2315 ml
at the bottom of the chart
I a) Admitting consultant is
indicated "Dr I.S.H." and ICU
consultant as "Dr VRK".
b) Diagnosis indicated as
"CABG x 3"
c) The abdominal girth record is
ICU (CCU 22)
missing in the chart
185 monitoring chart for
d) Fluid Orders state
27/10/2009
"Liquids orally + soft diet"
e) Total output recorded in
the output table is 1320 ml
while it is stated as 1970 ml at
the bottom
c)The intake table shows that
18 | ? a g e
Doc.
SI. Nature of Document Comments Remarks
No.
patient had food orally________
a) Admitting consultant is
Indicated ' Dr J.S.H." and ICU
consultant as "Dr VRK".
b) Diagnosis Indicated as
ICU (CCU 22) "CABGx 3"
186 monitoring chart for c) The abdominal girth record is
28/10/2009 missing in the chart
d) Fluid Orders state
"liquids orally + soft diet",
intake chart shows that patient
i
had food orally.______________
a) Admitting consultant is
indicated "Dr J.S.H." and ICU
consultant as "Dr VRK".
b) Diagnosis indicated as
"CABG x 3"
c) The abdominal girth record is
missing in the chart
d) Fluid Orders state "soft
ICU (CCU 22) diabetic diet"
187 monitoring chart for e) Total output recorded in
29/10/2009 the output table is 2090 ml
while it is stated as 1320 ml at
!
the bottom
J e) The chart records that
the patient had gone to
bradycardia where the pulse
went down to 41/mln but the
pulse chart shows a steady
pulse at 100/min____________
a) Admitting consultant is
indicated "Dr J.S.H " and ICU
ICU (CCU 22) consultant as "Dr VRK".
i
188 monitoring chart for b) Diagnosis indicated as
30/10/2009 "CABGx3"
f) The chart records abdominal
girth
a) Admitting consultant is
indicated Dr J.S.H. and ICU
ICU (RR 5) monitoring
189 consultant as "Dr VRK".
chart for 10/10/2009
b) Diagnosis indicated as
"CABG x 3"
19 | P a g e
k.
Ooc.
Nature of Document Comments Remarks
SI
1
i No.
i cjThe chart records ab'Jommal
g.rth
81 The chart records "USG
abdomen portable" but theie <s
no record of the test being
conducted_________________
ClAdmittmg consultant is
t
indicated Dr J S.H and ICU
consultant as "Dr VRX*
d) Diagnosa indicated as
"CABG x 3"
e) The chart records
abdominal girth
Q Total output is indicated as
ICU (RR-5) monitoring
190 3110 ml in the outpul table
chart for 31/10/2009
while it is indicated as 4080 ml
at the bottom
h) Fluid orders state "NU
I ORALLY TODAY" and "RT feed-
i
100 ml plain water" which are
contradictory The patient has
been given RT feed a: 12 00.
15:00 and 22-.00____________
a) Admitting consultant is
indicated Dr J.S.H and ICU
I consultant as "Or VRK*-.
b) Diagnosis indicated as
'CABG » 3"
ICU (RR-5) monitoring
191 :)The chart records abdominal
chart for 1/11/2009
girth
i) Total output is indicated as
2555 ml in the output table
while it is indicated as 3110 ml 1
at the bottom._________
a) Admitting consultant is
indicated Dr J.S.H and ICU
consultant as ''Dr VRK".
b) Diagnosis indicated as
ICU monitoring chart
192 "CABGx 3" I
for 2/11/2009
c) The chart records abdominal
girth
d) Total output <s indicated
!
as 1795 ml on top of the chart
L
20 I P a g e
Doc. f
SI Nature of Document Comments Remarks
No. i
! i
while it is indicated as 2r>55 nil
at the bottom
i l) Fluid Orders state ' Sips of
water orally"
a) Admitting consultant 15
I indicated Dr J S ft and ICU
consultant as ' Dr VRK" In
addition, the chart indicates
i i "DM Dr Duggal"
b) Diagnosis indicated as
i
t
"CABGx 3"
c) lhe chart records abdominal
girth
d) Total output is indicated t
as 1985 ml m the output table i
I while it is indicated as 1795 ml
I ICU (RR-5) monitoring at the bottom
193
I chart for 4/1 1/2009
e) Fluid Orders state "RT
i
and sips of watei orally" i
i
Nursmg Chart records "NBM' at
01:00 I
f) Chart shows "patient taken to
BPAP mask at 12 30 p m and at
3 p.rn. but RT is shown
| removed only at 3 p.m. No
, entry for 12-30p.m
■ i
k) The medication order
chart has been blanked out
with some hand written notes
_ without sign a t u r e
a) Admitting consultant is
indicated Dr j S.H and ICU
, consultant as "Dr VRK". In
addition, the chart indicates
"DM: Dr Duggal"
b) The chart records
ICU (RR-S) monitoring
j 194 abdominal girth
chart for 4/11/2009
i c) Total output is indicated as
2315 ml in the output table
while it is indicated as 1985 ml
| at the bottom
t
j d) Fluid Orders state
j ' NBM"
21 | ? a g e
I Doc- ,
i si. ! Nature of Document Comments Remarks
No.
e) Record of USG earned
at 5:30 p.m
t
I i a) Admitting consultant is
I indicated Dr J S.H and ICU
I consultant as "Dr VRK" in I
addition, chan indicates "DM:
ICU (RR-5) monitoring Dr Duggal" on top
195
chart for 5/11/2009 b) rhe chan records
abdominal girth
I) Chart records the Order
l a)
'Repeat USG abdo." But no
_ rGCQrd l<-'sl being repeated
Admitting consultant is
indicated "Dr J.S H." and ICU
i
consultant at. "Dr VRK". In
addition, chart indicates "DM: I
ICU monitoring chart
Dr Duggal" on top i
196 b) The chart records
for 6/11/2009
abdominal girth
cjTotal output is indicated as
2690 ml on top of the chart
while it is indicated as 2100 ml
at the bottom.
a) Admitting consultant is
indicated "Dr and ICU
consultant as "Dr VRK '. In
ICU monitoring chart
197 addition, chart indicates "DM:
for 6/11/2009
Dr Duggal" on top
b) The chart records
abdominal girth
a) Admitting consultant is
indicated Dr l.S.H. and ICU
consultant as "Dr VRK". In
addition, chart indicates "DM:
I Dr Duggal" on top i
ICU (RR05) monitoring b) The chart records
198
Chart for 7/11/2009 abdominal girth
cJPatient seen by Dr
Deshpande. No review by Dr t
JSH Or Dr VRK even though
patient suffered a cardiac arrest
I at 23:00 hrs
22 | Page
Doc.
SI. Nature of Document Comments Remarks
No.
a) Admitting consultant is
indicated "Dr J.S.H." and ICu
consultant as "Dr VRK" In
addition, chart indicates "DM;
' Dr Duggal" on top
ICU (BROS) monitoring
199 . b) RT Aspiration indicated
chart for 8/11/2009
as 21 cc on top of chart while it
I is indicated as 107 ml at the
| bottom
I c)The chart records abdominal
i girth________________________
a) Admitting consultant is
indicated "Dr J.S.H," and ICU
ICU monitoring chart consultant as "ICU team"
200
for 9/11/2009 b) Remark states "S/0 Dr
SG Deshpande" but no review
by DR JSH___________________
a) Admitting consultant is
indicated "Dr J.S.H." and ICU
ICU monitoring chart consultant as "ICU team"
201
for 10/11/2009 b) Patieni reviewed by Dr
Duggal and Dr Kulkarni, No
review by DR JSH_____________
a) Admitting consultant is
indicated Dr J.S.H. and ICU
consultant as "ICU team"
b) Fluid orders state
"NBM" as well as "Plain water
through RT 30 ml every 3 hrly".
ICU monitoring chart This contradicts remark
202
for 11/11/2009 "??dear liquids through RT" at
the bottom of the chart
c|A review by Dr JS Hiremath
was sought as per remark at
the bottom of chart. But no
record of the review being
done
ct) Admitting consultant is
indicated Dr J.S.H. and ICU
ICU monitoring chart consultant as "ICU team"
203
for 12/11/2009 e) Diagnosis is indicated as
"Bowel Ischemia" which is an
admission that the Post-
23 | P a g e
Doc.
SI. Nature of Document Comments Remarks
No.
operative complication did
occur
fjAge indicated as 75 yrs/Male
g) Nurses remark at 18:00
states "motion passed" while
prescription remark states
i
_ "motion not passed"_____
1) Admitting consultant is
indicated "Dr JSH" and the ICU
Consultant is indicated as "ICU
ICU monitoring chart Team"
204
for 13/11/2009 2) Diagnosis is clearly
indicated as "Bowel Ischemia"
which matches our claim
c) Age indicated as 72/M
a) Admitting consultant is
indicated Dr Hiremath IS
b) Diagnosis is clearly
ICU monitoring chart
205 indicated as "Bowel Ischemia"
for 14/11/2009
which matches our claim
d) Age indicated as 75
yrs/Male
DRAWN BY: FILED BY
ABDULRAHIMAN TAMBOLI
Filed on 29.08.2024 ADVOCATE FOR THE APPELLANTS
21. The Respondents/Opposite Parties filed their Affidavit and
parawise Reply to the Objections on 19.11.2024 vide Diary
No.38179/2024 with a copy of the same to the learned Counsel for tine Appellant. The same is extracted hereinunder:
24 | Page BEFORE THE HON'BLE NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI, FIRST APPEAL NO. 207/2013 SUMAN D MANE (DECEASED}THROUGH LRS. I 4 ORS.
....APPELLANTS Versus DIRECTOR. GRANT MEDICAL FOUNDATION & ORS .RESPONDENTS Para-wise Reply being filed by the Respondents to the Response / Objections filed by the Complainant in furtherance to the Order dated 11 02 2023 of the Hon'ble Bench No 1 of Hon'ble National Commission.
1(a) In furtherance to an application dated 24 11.2009 from Adv. Mr. Chandrakant D. Mane with a request to send copies of medical reports and records of the treatment given at Ruby Hall Clime to late Dattajirao B. Mane, all documents including all charts of treatment demanded were sent at the address of the applicant.
(b) During the course of the proceedings before this Hon'ble National Commission, on 11 01.2023 the Respondents were directed to produce details of post abdominal distention and care taken by the Opponents.
[c] In pursuance of the said directions, the Opponents submitted on 28.02.2023 along .with a list, the entire treatment case papers pertaining to the deceased patient and a full set of the same were once again also given to the Appellants
(d) Inspite of all pages duly numbered along with the list being given to the Appellants, the learned Counsel appearing for the Appellants submitted that he has not received Page Nos. 131 to 138 in the compilation of documents. Therefore the Opponents once again forwarded vide speea post the documents asked for by the Appellants. Therefore, now to submit that the charts relied upon by the Respondents ought to have been made available to the Appellants is not correct. The entire medical record was first sent to the origiral Complainants in the year 2009 itself and once again during the proceedings in accordance, to the directions. Therefore to allege late production of records by an afterthought is incorrect.
25 | P a g e 2 In response io Pare 2 of the response and objections filed by the Complainant, it is submitted that Dr. Duggal being a highly trained Intensivist and also in the team of Dr. J.S. r Hiremath, she had been not only seeing the patient but also following the instructions and course of treatment advised by Dr. J S Hiremath as well as coordinating between all the Opponents and the surgical team and General Surgeon. In the ICU charts, in view of space constraints the Consuilanls names may or may not be mentioned, though they are always kepi in picture regarding health conditions of the patient and treatment provided. 3 When a patient is in the ICU, the Consultants are on duty every 8 hours and every round may not be documented I signed But while the patient is critically ill in ICU. it is unimaginable that no one has seen the patient.
It is a protocol that consultants take rounds every day and so was the case with the patient of the Complainant and Dr Duggal would see the patient atleast twice and 3 Consultants are in the ICU round the clock apart from other Consultants who personally take care of every aspect ot treatment of each patient in the ICU.
4. In response to para 4 and 5 of the objections, it is stated that upon noticing abdominal distention on 26.10.2009, the Consultant on duty has advised NBM (Nil by Mouth), Inj. Reglan, K+ was corrected, P/R Dulcolex Syrup. Later on towards evening patient passed motion thrice, hence he was started on liquids and later was given soft diet Patient did not have any motion on 27lh October, but he passed motions twice on 28"' October and once on 29"' October, which indicate that his intestines were working well therefore he was given soft diet and no abdominal girth was recorded. He had oradycardia on the night of 29th October (1 am - i.e. on 30"' October) and then next day he developed abdominal distension Patient's abdominal girth charting was started immediately. USG was done -
photocopy of which is attached herewith.
It is thus incorrect to say that it was first carried out on 04.11.2009, 26 | P a ge 5 The Doctor may not be In the team of treating Cardiologist I Cardiac Surgeon, but is herself a very senior Surgeon and was in the team of Abdominal Surgeons. Sb® has a very vast experience in the field of surgery. Therefore she attended the hearing to explain how the case of the deceased was shifted from Cardiology poml of view to a surgical one. 6 In para 8 and 9, the responses io specific comments made out by the Appellants m Para 8 and 9 vide the table are as follows:
Doc. Sr. No. Answer | 182 Yes, It is true that the admitting consultant was Dr. J.S. Hiremath 183 [cf At that time it was not required
Intake and output written at bottom are total intake and output from previous day It is written in the morning so as to plan fluid 184 Abdominal girth was asked to be recorded.
But by the late afternoon / evening patient passed motion 3 times. So started on diet.
Already mentioned in reply to para No. 4 & 5 of the objections. 185 Patient had passed 3 motions a day prior. Therefore started diet. 186 Patient had again passed motion twice.
No need for abdominal girth.
187 Patient had again passed motion so girth not maintained.
Mentioned in chart at 1 AM 191 Same issue. Intake and output written at bottom are total intake ant output from previous day. It is written in the morning so as to plan fluid 193 (e) Chart has orders for the whole day. So can have orders from NBM to liquid orally or vice versa as day progresses. 196 (a) Bottom intake and output is from the previous day. 199 (bj RT Aspiration on top at that particular time At the bottom - include present in the BAG.
202(b) These are changes done over the day.
27 | P a g e It is horehy stated that Gastrointestinal complications which includes Bowel Ischaemia Is associated with high morbidity and mortality rata - Rof. Al, Bl, 02 The diagnosis of gastrointenstinal complications post cardiac surgery is a challenge due to various factors. ReL A2, C, 03 There were various risk stratification score models for whole context of cardiac surgery in 2009 but Risk score model for specific gastrointestinal complications was published in 2010 (that is 1 year later) Ref. A3, A4, A5.
Various risk factors have been mentioned in scoring systems. Our patient was elderly above 75 years had an emergency bypass and developed bradycardia (cardiogenic '©vent) and shock and required ventilator and ionotropic support from 30 10.2009 which probably made him more prone for developing bowel ischaemia later The medical literature in support of the statements made by the Respondents is annexed herewith as per the list hereunder Sr. No. Title of Literature Page Numbers A~ Institutional Report - Cardiac General 01 to 05 b7" Sage Journals c~ Intestinal Ischaemia after Cardiac surgery . Analysis of 07 to 13 a large registry Serious Gastrointestinal complications after cardiac 14 to 22 D. surgery and associated mortality Copy of the Progress Sheet dated 30.10.2009 23 E. Place: New Delhi Date:
DR. J.S. HIREMATH RESPONDENT No. 2.
22. A perusal of the objections and the replies also indicates the medical literature which has been relied on by the learned Counsel for the either side in support of their contentions. A perusal of the
28 | P a g e authorities cited by them indicates that a gastrointestinal problem including any such infection is a possibility after a CABG is carried out on a patient. The literature also indicates the ratio of mortality in such cases and needless to mention once again, the patient of about 75 years of age.
23. The contention of the learned counsel for the Complainant is that recording of the abdominal distention is evident from the notings of the nurses as well as the progress sheet indicating a gastrointestinal complication from 24.10.2009 onwards. It is also urged that the removal of tricube remains unexplained and the patient went on deteriorating without any improvement in his general condition. The Opposite Parties did not conduct any proper test between 24.10.2009 and 30.10.2009 and it is during this period that the infection developed into septicemia and then resulting in the complications which is evident from the fact that the patient went on a ventilator and did not survive ultimately. The cumulative effect of the negligence of the doctors in not attending to the patient and Intensive Care Unit being equipped by unqualified personnel with no attendance by Dr. Hiremath, the same ultimately led to the death of the patient.
24. The Authorised Representative Ms. Manjusha Kulkarni who is also their Legal Advisor along with the supporting material has invited 29 | P a g e the attention of the Bench to the documents that had been introduced earlier and were very much available with the Complaint together with the Reply given to the objections on 19.11.2024. It is urged that the said details firstly demonstrate that all documents were available to the Complainant and therefore, the allegations that the documents were not given or produced belatedly is without any basis. It has also pointed out that Dr. Duggal was a fully trained intensivist in the team of Dr. Hiremath and she had been continuously monitoring the patient coupled with the instructions and the course of the treatment advised by Dr. Hiremath in coordination with the surgical team and the general surgeon. It is urged that the monitoring was being done continuously even if some names of the consultants may not have mentioned in the charge-sheets but in the Intensive Care Unit, all the consultants are on duty every eight hours. It is, therefore, wrong to allege that the patient was unattended. The protocols were observed by the consultants who were taking rounds and there are three consultants on the round in the ICU who personally take care of the patient.
25. It is then pointed out on 26.10.2009 that the consultants on duty had noticed the gastrointestinal problem and had accordingly advised nil by mouth with certain prescriptions of medicines. However, on the same day in the evening, the patient passed motion thrice and therefore, he 30 | P a g e was support on liquids and later on given a soft diet. The patient did not have any motion on 27.10.2009, but he passed motion twice on 28.10.2009 and once again on 29.10.2009 which indicated that the intensivist had been working and the patient was advised soft diet when no increase in abdominal gath.
26. The submission is that the abdominal distention developed in the night of 29.10.2009 when an Ultrasonography was done. Thus, it is wrong to allege that no Ultrasonography was carried out and was done only on 04.11.2009.
27. Dr. Duggal was herself a senior surgeon and was in the team of surgeons with a very vast experience in the field of surgery. The attention of the Bench has been invited to the response given to the respective objections raised and keeping in view of the age of the patient and the bradycardia which he suffered probably developed and all precautions and treatment were taken which are on record and hence, the contention raised on behalf of the Appellant about negligence is unfounded.
28. We have considered the submissions raised as well as the aforesaid submissions and we proposed to therefore, deal with the Application moved by the Complainant in this Appeal requesting for an expert opinion.
31 | P a g e r\
29. From the facts stated above, it is correct that the Complaint came to be summarily dismissed at the admission stage on the allegations contained in the Complaint and the documents filed with it. Some of the documents which have been filed under the directions of this Commission and referred hereinabove to which objections have been filed by the Complainants/Appellants do not seem to be a part of the proceedings before the State Commission. However, keeping in view of the previous Orders passed, it was found appropriate to entertain the said documents and provide an opportunity of objection to the Complainants which has been done. The response to the objections has also been filed. In such circumstances, we find that the material on record has been placed and therefore, to proceed for any expert opinion at this stage after 16 years of the incident and 15 years having passed by with the filing of the Complaint, it would be appropriate to proceed to advert to the respective arguments on merits before us instead of delaying the matter any further.
30. We may point out that the Complaint No. 96 was filed in the year 2011 and has been dismissed at the admission stage on 11.12.2012. The contention of the Complainants was noted in Para 4 & 5 and then in Para 6 of the State Commission's Order. The following observation has been made _ 0 32 | P a g e "[6]. Above-referred statements show that the Complainants have a suspicion about the alleged medical negligence at the hands of treating doctors but failed to show any specific case of negligence. In Paragraph (11) of the complaint, the Complainants tried to level allegations which according to them are based upon unexplained occurrences. These summarizations made the Complainants to believe on their own that the patient's medical condition was not properly evaluated and the surgical procedures were performed without due care. It may be pointed out that to which surgical procedure the Complainants are referring viz, first one pertaining to bypass surgery or the second one pertaining to intestine is not clear. In the second surgery neither Opponent Dr. V.R. Karmarkar nor Opponent Dr. Chaitanya Raina were connected and so also, Opponent Dr. Jagdish Hiremath. "
31. In Para 7, it has been observed that the Complainants were not sure about the source of infection and therefore it was concluded in Para 8, as follows "[7] About the infection which was contacted by the patient, the Complainants themselves were not sure about the source of infection and they alleged in that respect in paragraph (12) of the complaint as under
"The sequence of events and the accompanying circumstances have caused the Complainants to believe that the source of infection suffered by the patient was either the two surgeries which were performed at Ruby Hall Clinic or the lack of due and proper care and medical treatment given 33 | P a g e to the patient. The fatal infection was further aggravated by the lack of any coordinated treatment. "
32. The State Commission then went on to consider the allegations made against Dr. Jagdish Hiremath and observation was made that prima facie, there was no material to fasten any medical negligence on him.
33. However, in Para 11 and 12, the observations made by the State Commission are as follows "[11] Some reference is tried to be made to the nurses' notes dated 26/10/2009. However, those were the clinical conditions of the patient and do not, per-se, establish any medical negligence on the part of the treating doctors or the hospital. Once intestinal problem of Late Dattajirao was identified/noticed, due care was taken to call an expert from the field namely- Dr. Deshpande and the patient was accordingly examined by Dr. Deshpande and the treatment was advised accordingly.
[12] Cumulative effect of the above-referred discussion lead us to infer that, prima-facie, there is no case established to infer any medical negligence vis-a-vis deficiency in service on the part of either of the Opponents. Prima facie, the Complainants failed to establish that the conduct of the Opponents 'treating doctors' fell below that of the standards of a reasonably competent doctors. Similarly, the Complainants, prima-facie, failed to establish proximate 34 | P a g e cause of the death of Late Dattajirao with the breach, if any, on part of the 'treating doctors' (of alleged medical negligence). Applying the 'Bolam Test' or the test 'but for' or 'substantial factor' to establish a proximate cause (Sunil Adhye Vs. Shailesh Puntambekar and Others - 2012-(1)-CPR-
390), it cannot be said that prima-facie, any such case for medical negligence is made out. No doubt it is an unfortunate death for the family but to admit a consumer complaint of this nature, it needs something more as amply pointed out by the Apex Court in the case of Martin F. D'Souza V. Mohd. Ishfaq, reported in 2009-(3)-SCC-1. We hold accordingly and pass the following order ORDER The complaint is not admitted and stands dispose off, accordingly.
In the given circumstances, the parties to bear their own costs. "
34. A perusal thereof indicates that a reference was made to the Nurses' Notes and it was observed that the intestinal problem of the patient had been identified and noticed. Then Dr. Deshpande had arrived on the same day and had taken care of the patient.
35. These findings have been questioned by the Complainant(s)/Appellant(s) contending that the allegation required an explanation from the Opposite Parties and the Complaint could not have
35 | P a g e K been dismissed only on an alleged shortfall in the documents which have not even been discussed in detail.
36. The contention is that it is for this reason that this Commission had called upon the Opposite Parties to produce the entire documents pertaining to the treatment of the deceased patient. The Order dated 11.1.2023 is extracted herein as under
"Part heard.
Arguments to continue on 28.03.2023.
The Respondents are directed to produce the treatment details of post abdominal detention and care taken at their end within four weeks."
37. In response thereto the entire compilation of the Progress Sheet and the Nurses' Notes have been placed before us through D.No. 7930 dated 6.3.2023 and the Death Summary has also been placed. Ld. Counsel for the Complainants has filed the objections through D.No. 31021 dated 9.9.024 contending that despite having noticed the abdominal distention that was continuing soon after surgery, no effective steps were taken to diagnose the root-cause of such distention which developed into the infection that ultimately became fatal. The same is extracted hereinunder . 36 | P a g e "6. The Appellant further submits that on the charts for 12/11/2019, 13/11/2019 and 14/11/2019 the diagnosis is indicated as "Bowel Ischemia" which is a clear admission that the post-operative complication did occur.
7. The Appellant further submits that the Doctor (Authorised representative) who has appeared on behalf of the Respondents was as per own admission was not in the team of treating doctors between 25.11.2019 and 30.11.2019. So, her comments about the medical treatment are limited only to explaining the steps taken by the unnamed treating doctors instead of placing on record the steps which should have been taken by the treating doctors as per the standard protocol laid down in medical literature in case of CABG post operative complication. That to fortify his stand the Appellant is relying upon two more research Article (in addition to those which are already part of the paper book) laying down the protocol in cases of CABG post operative complication. ANNEX THE ARTICLES 13 to 22).
8. The Appellant further submits that many minor observations and discrepancies indicate the lack of care and attention by the doctors and nurses. Specific chart wise observations given in the Table below.
37 | P a g e
9. In conclusion, the ICU monitoring charts corroborate the averments in the complaint and the affidavit of the Complainant. There are no contradictions.
Doc.
SI. Nature of Document Comments Remarks
No.
a) Admitting Consultant
ICU monitoring chart Day of the
182 indicated as "Dr JSH" and ICU
for 24/10/2009 CABG
consultant as "Dr VRK"_______
a) Admitting consultant is
indicated "Dr J.S.H." and ICU
consultant as "Dr VRK".
b) Diagnosis indicated as
ICU (RR-01) monitoring
183 "CABG x 3"
chart for 25/10/2009
c) The abdominal girth record is
missing in the chart
d) Fluid Orders state "Soft
Diet". However, Intake chart
38 | P a g e
Doc.
SI. Nature of Document Comments Remarks
No.
shows that patient had Biscuits,
Bread and dinner orally.
a) The output chart shows
the total output as 2315 ml
while it is indicated as 2865 ml
at the bottom of the chart
a) Admitting consultant is
indicated "Dr J.S.H." and ICU
consultant as "Dr VRK".
b) Diagnosis indicated as
"CABG x 3"
c) The abdominal girth record is
missing in the chart
d) Fluid Orders state "RT +
sips of water orally". However,
Intake chart shows that patient
had Biscuits, Bread and dinner
ICU (RR-01) monitoring,
184 orally.
chart for 26/10/2009
e) Chart records that
patient suffered recurrent
attacks of asthma. But no
advice/opinion by any doctor.
f) The fluid orders include the
name of Dr Duggal. Rason is not
clear.
b) The output chart shows
the total output as 1970 ml
while it is indicated as 2315 ml
at the bottom of the chart
a) Admitting consultant is
indicated "Dr J.S.H." and ICU
consultant as "Dr VRK".
b) Diagnosis indicated as
"CABG x 3"
c) The abdominal girth record is
ICU (CCU 22)
missing in the chart
185 monitoring chart for
d) Fluid Orders state
27/10/2009
"Liquids orally + soft diet"
e) Total output recorded in
the output table is 1320 ml
while it is stated as 1970 ml at
the bottom
c)The intake table shows that
39 | P a g e
Doc.
SI. Nature of Document Comments Remarks
No.
patient had food orally______
a) Admitting consultant is
indicated "Dr J.S.H." and ICU
consultant as "Dr VRK".
b) Diagnosis indicated as
ICU (CCU 22) "CABG x 3"
186 monitoring chart for c) The abdominal girth record is
28/10/2009 missing in the chart
d) Fluid Orders state
"liquids orally + soft diet".
Intake chart shows that patient
had food orally. ________
a) Admitting consultant is
indicated "Dr J.S.H." and ICU
consultant as "Dr VRK".
b) Diagnosis indicated as
"CABG x 3"
c) The abdominal girth record is
missing in the chart
d) Fluid Orders state "soft
ICU (CCU 22) diabetic diet"
187 monitoring chart for e) Total output recorded in
29/10/2009 the output table is 2090 ml
while it is stated as 1320 ml at
the bottom
e) The chart records that
the patient had gone to
bradycardia where the pulse
went down to 41/min but the
pulse chart shows a steady
pulse at 100/min ________
a) Admitting consultant is
indicated "Dr J.S.H." and ICU
ICU (CCU 22) consultant as "Dr VRK".
188 monitoring chart for b) Diagnosis indicated as
30/10/2009 "CABG x 3"
f) The chart records abdominal
girth__________ ___________
a) Admitting consultant is
indicated Dr J.S.H. and ICU
ICU (RR 5) monitoring
189 consultant as "Dr VRK".
chart for 30/10/2009
b) Diagnosis indicated as
"CABG x 3"
40 | P a g e
Doc.
SI. Nature of Document Comments Remarks
No.
c)The chart records abdominal
girth
g) The chart records "USG
abdomen portable" but there is
no record of the test being
conducted__________________
c) Admitting consultant is
indicated Dr J.S.H. and ICU
consultant as "Dr VRK".
d) Diagnosis indicated as
"CABG x 3"
e) The chart records
abdominal girth
f) Total output is indicated as
ICU (RR-5) monitoring
190 3110 ml in the output table
chart for 31/10/2009
while it is indicated as 4080 ml
at the bottom.
h) Fluid orders state "NIL
ORALLY TODAY" and "RT feed-
100 ml plain water" which are
contradictory. The patient has
been given RT feed at 12:00,
15:00 and 22:00___________ _
a) Admitting consultant is
indicated Dr J.S.H. and ICU
consultant as "Dr VRK".
b) Diagnosis indicated as
"CABG x 3"
ICU (RR-5) monitoring
191 c) The chart records abdominal
chart for 1/11/2009
girth
i) Total output is indicated as
2555 ml in the output table
while it is indicated as 3110 ml
at the bottom.______________
a) Admitting consultant is
indicated Dr J.S.H. and ICU
consultant as "Dr VRK".
b) Diagnosis indicated as
ICU monitoring chart
192 "CABG x 3"
for 2/11/2009
c) The chart records abdominal
girth
d) Total output is indicated
as 1795 ml on top of the chart
41 | P a g e
Doc.
SI. Nature of Document Comments Remarks
No.
while it is indicated as 2555 ml
at the bottom.
j) Fluid Orders state "Sips of
water orally"______________
a) Admitting consultant is
indicated Dr J.S.H. and ICU
consultant as "Dr VRK". In
addition, the chart indicates
"DM: Dr Duggal"
b) Diagnosis indicated as
"CABG x 3"
c) The chart records abdominal
girth
d) Total output is indicated
as 1985 ml in the output table
while it is indicated as 1795 ml
1CU (RR-5) monitoring at the bottom.
193
chart for 4/11/2009 e) Fluid Orders state "RT
and sips of water orally".
Nursing chart records "NBM" at
01:00
f) Chart shows "patient taken to
BPAP mask at 12:30 p.m. and at
3 p.m. but RT is shown
removed only at 3 p.m. No
entry for 12:30 p.m.
k) The medication order
chart has been blanked out
with some hand written notes
without signature___________
a) Admitting consultant is
indicated Dr J.S.H. and ICU
consultant as "Dr VRK". In
addition, the chart indicates
"DM: Dr Duggal"
b) The chart records
ICU (RR-5) monitoring
194 abdominal girth
chart for 4/11/2009
c) Total output is indicated as
2315 ml in the output table
while it is indicated as 1985 ml
at the bottom.
d) Fluid Orders state
"NBM"
42 I P a 2 e
Doc.
SI. Nature of Document Comments Remarks
No.
e) Record of USG carried
at 5:30 p.m._________________
a) Admitting consultant is
indicated Dr J.S.H. and ICU
consultant as "Dr VRK". In
addition, chart indicates "DM:
ICU (RR-5) monitoring Dr Duggal" on top 195 chart for 5/11/2009 b) The chart records abdominal girth I) Chart records the order "Repeat USG abdo." But no record of test being repeated
a) Admitting consultant is indicated "Dr J.S.H." and ICU consultant as "Dr VRK". In addition, chart indicates "DM:
Dr Duggal" on top ICU monitoring chart 195 b) The chart records for 6/11/2009 abdominal girth
c) Total output is indicated as 2690 ml on top of the chart while it is indicated as 2100 ml at the bottom.______________
a) Admitting consultant is indicated "Dr J.S.H." and ICU consultant as "Dr VRK". In ICU monitoring chart 197 addition, chart indicates "DM:
for 6/11/2009 Dr Duggal" on top
b) The chart records abdominal girth_____________
a) Admitting consultant is indicated Dr J.S.H. and ICU consultant as "Dr VRK". In addition, chart indicates "DM:
Dr Duggal" on top ICU (RR05) monitoring b) The chart records 198 chart for 7/11/2009 abdominal girth
c) Patient seen by Dr Deshpande. No review by Dr JSH or Dr VRK even though patient suffered a cardiac arrest at 23:00 hrs 43 | P a g e Doc.
SI. Nature of Document Comments Remarks No.
a) Admitting consultant is indicated "Dr J.S.H." and ICU consultant as "Dr VRK". In addition, chart indicates "DM:
Dr Duggal" on top ICU (RR05) monitoring 199 b) RT Aspiration indicated chart for 8/11/2009 as 21 cc on top of chart while it is indicated as 107 ml at the bottom
c) The chart records abdominal girth______________________
a) Admitting consultant is indicated "Dr J.S.H." and ICU ICU monitoring chart consultant as "ICU team"200
for 9/11/2009 b) Remark states "S/B Dr SG Deshpande" but no review by DRJSH__________________ r ! a) Admitting consultant is indicated "Dr J.S.H." and ICU ICU monitoring chart consultant as "ICU team"201
for 10/11/2009 b) Patient reviewed by Dr Duggal and Dr Kulkarni. No review by DRJSH____________
a) Admitting consultant is indicated Dr J.S.H. and ICU consultant as "ICU team"
b) Fluid orders state
"NBM" as well as "Plain water
through RT 30 ml every 3 hrly".
ICU monitoring chart This contradicts remark
202
for 11/11/2009 "??clear liquids through RT" at
the bottom of the chart
c) A review by Dr JS Hiremath
was sought as per remark at
the bottom ofchart. But no
record of the review being
done
d) Admitting consultant is
indicated Dr J.S.H. and ICU
ICU monitoring chart consultant as "ICU team"
203
for 12/11/2009 e) Diagnosis is indicated as
"Bowel Ischemia" which is an
admission that the post-
44 | P a g e
Doc.
SI. Nature of Document Comments Remarks
No.
operative complication did
occur
f) Age indicated as 75 yrs/Male
g) Nurses remark at 18:00
states "motion passed" while
prescription remark states
"motion not passed"________
1) Admitting consultant is
indicated "Dr JSH" and the ICU
Consultant is indicated as "ICU
ICU monitoring chart Team" '
204
for 13/11/2009 2) Diagnosis is clearly
indicated as "Bowel Ischemia"
which matches our claim
c) Age indicated as 72/M_____
a) Admitting consultant is
indicated Dr Hiremath JS
b) Diagnosis is clearly
ICU monitoring chart
205 indicated as "Bowel Ischemia"
for 14/11/2009
which matches our claim
d) Age indicated as 75
yrs/Male
38. To these objections, the Opposite Parties have preferred a reply denying the contentions through D.No. 33001 filed on 26.9.2024 followed by an Affidavit of Opposite Party No. 2 filed through D.No. 38179 on 19.11.2024. The said compilations are accompanied by medical literature and the Progress Sheet dated 30.10.2009 that had already been filed earlier. The said reply of the Opposite Party is extracted hereinunder 45 | P a g e K ■1 BEFORE THE HON'BLE NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI, FIRST APPEAL NO. 207/2013 SUMAN D. MANE (DECEASED) THROUGH LRS. & 4 ORS.
....APPELLANTS Versus DIRECTOR, GRANT MEDICAL FOUNDATION & ORS ....RESPONDENTS Para-wise Reply being filed by the Respondents to the Response / Objections filed by the Complainant in furtherance to the Order dated 11.02.2023 of the Hon'ble Bench No.1 of Hon'ble National Commission.
1(a) In furtherance to an application dated 24.11.2009 from Adv. Mr. Chandrakant D. Mane with a request to send copies of medical reports and records of the treatment given at Ruby Hall Clinic to late Dattajirao B. Mane, all documents including all charts of treatment demanded were sent at the address of the applicant.
(b) During the course of the proceedings before this Hon'ble National Commission, on 11.01.2023 the Respondents were directed to produce details of post abdominal distention and care taken by the Opponents.
[c] In pursuance of the said directions, the Opponents submitted on 28.02.2023 along with a list, the entire treatment case papers pertaining to the deceased patient and a full set of the same were once again also given to the Appellants
(d) Inspite of all pages duly numbered along with the list being given to the Appellants, the learned Counsel appearing for the Appellants submitted that he has not received Page Nos. 131 to 138 in the compilation of documents. Therefore the Opponents once again forwarded vide speed post the documents asked for by the Appellants. Therefore, now to submit that the charts relied upon by the Respondents ought to have been made available to the Appellants is not correct. The entire medical record was first sent to the original Complainants in the year 2009 itself and once again during the proceedings in accordance to the directions. Therefore to allege late production of records by an afterthought is incorrect. 11 P a g e 46 | P a g e
2. Dr. Duggal being a highly trained Intensivist and also in the team of Dr. J.S. Hiremath, she had been not only seeing the patient but also following the instructions and course of treatment advised by Dr. J.S. Hiremath as well as coordinating between all the Opponents and the surgical team and General Surgeon.
3. When a patient is in ICU, the Consultants are on duty every 8 hours and every round may not be documented / signed.
But while the patient is critically ill in ICU. it is unimaginable that no one has seen the patient.
It is a protocol that consultants take rounds every day and so was the case with the patient of the Complainant and Dr. Duggal would see the patient atleast twice and 3 Consultants are there round the clock apart from other Consultants. 4&5 Upon noticing abdominal distention on 26.10.2009, the Consultant on duty has advised NBM (Nil by Mouth), Inj. Reglan, K+ was corrected, P/R Dulcolex Syrup. Later on towards evening patient passed motion thrice, hence he was started on liquids and later on soft diet Patient did not have any motion on 27lh October, but he passed motions twice on 28tf' October and once on 29lh October, which indicate that his intestines were working well therefore he was given soft diet and no abdominal girth was recorded. He had bradycardia on the night of 29"' October (1 am - i.e. on SO"' October) and then next day he developed abdominal distension » started with abdominal girth charting USG done - photocopy to be attached.
So it is incorrect to say that it was first carried out on 04.11.2009.
7. The Doctor may not be in the team of treating Cardiologist / Cardiac Surgeon, but is herself a very senior Surgeon and was in the team of Abdominal Surgeons. She has a very vast experience in the field of surgery. Therefore she came to explain how the case of the deceased was shifted from Cardiology point of view to a surgical one.
2|Page 47 | P a g e 8 & 9 The responses to specific comments made out by the Appellants in Para 8 and 9 vide the table are as follows:
Doc. Sr. No. Answer
182 Yes, It is true that the admitting consultant was Dr. J.S. Hiremath
183 [c] At that time it was not required
Intake and output written at bottom are total intake and output from previous day. It is written in the morning so as to plan fluid 184 Abdominal girth was asked to be recorded.
But by the late afternoon / evening patient passed motion 3 times. So started on diet.
Already mentioned in reply to para No. 4 & 5 of the objections. 185 Patient had passed 3 motions a day prior. Therefore started diet. 186 Patient had again passed motion twice.
No need for abdominal girth.
187 Patient had again passed motion so girth not maintained Mentioned in chart at 1 AM 191 Same issue. Intake and output written at bottom are total intake and output from previous day. It is written in the morning so as to plan fluid 193 (e) Chart has orders for the whole day. So can have orders from NBM to liquid orally or vice versa as day progresses. 196 (a) Bottom intake and output is from the previous day. 199 (b) RT Aspiration on top at that particular time At the bottom - include present in the BAG 202(b) These are changes done over the day.
It is hereby stated that Gastrointestinal complications which includes Bowel Ischaemia is associated with high morbidity and mortality rate - Ref. Al, Bl, D2 The diagnosis of gastrointenstinal complications post cardiac surgery is a challenge due to various factors. Ref. A2, C, D3 3I Page 48 | P a g e There were various risk stratification score models for whole context of cardiac surgery in 2009 but Risk score model for specific gastrointestinal complications was.published in 2010 (that is 1 year later) Ref. A3, A4, A5.
Various risk factors have been mentioned in scoring systems. Our patient was elderly above 75 years had an emergency bypass and developed bradycardia (cardiogenic event) and shock and required ventilator and ionotropic support from 30.10.2009 which probably made him more prone for developing bowel ischaemia later.
The medical literature in support of the statements made by the Respondents is annexed herewith as per the list hereunder Sr. No. Title of Literature Page Numbers A. Institutional Report - Cardiac General 01 to 05 B. Sage Journals - 6 c? Intestinal Ischaemia after Cardiac surgery : Analysis of 07 to 12, a large registry D. Serious Gastrointestinal complications after cardiac 14 to 22 surgery and associated mortality E. Copy of the Progress Sheet dated 30.10.2009 23 Place: New Delhi Date: 30.09.2024 Respondents Cn W • R.VWS- • 4 | Page 49 | P a g e
39. From the record filed on 6.3.2023, it has been pointed out that the abdominal distention was noticed on 26.10.2009 and at 9.30 a.m.. The Dr.'s advice was to measure the abdominal girth every 4 hourly. This was also noted by Dr. Joshi who attended the patient on the same day and noticed that the abdominal distention was positive and the bowel sounds were sluggish. In this background, only oral sips were advised.
40. However, what deserves to be noticed is that 'Dulcolax' was advised as a medicine and Nurses' Notes dated 26.10.2009 takes notice of the same and reports that the patient was to be on liquid diet as advised. However, Nurses' Notes further records that on 27.10.2009 in the early morning hours, the patient had passed motion thrice which is recorded at 6.00 a.m. indicating that the patient had been administered 'enema' before that.
41. The Dr.'s Progress Note on 28.10.2009 records that the patient is better and stable and his activities are increasing at about 8.50 a.m. in the morning but at 3.50 p.m. even though the patient was stated to be better, the abdominal distention was reported as positive. However, the Nurses' Notes on the same day at about midnight demonstrate that the patient passed motion and was stable the next day as well. On 29.10.2009, the Dr.'s Progress Sheet mentions abdominal discomfort with a positive distention noticed at about 8.50 a.m. This discomfort . 50 | P a g e reported to continue at 4.00 p.m. but at 7.50 p.m. he passed urine as well as motion.
42. The distention however continued on 30.10.2009 and on account of complications he was also put oh Ventilator after he had an attack of 'Bradycardia'. Ultrasonography was advised on 30.10.2009 itself and it was noted on 31.10.2009 at 4.00 p.m. that the abdominal girth has increased. The girth was being measured as is evident from the Notes dated 1.11.2009. This is also evident from the chart extracted by the Complainant in Para 9 of the objections filed by the Complainant on 9.9.2024.
43. Thus, it cannot be said that no care was taken or that the Doctors were negligent in not attending to the patient. It was therefore confirmed later on that the distention was existing but the treatment was on. Dr. Deshpande arrived on the scene on 7.11.2009 and Bowel Ischemia was finally diagnosed on 12.11.2009. The bowel movement of the patient was continuing as noted in the Sheets, but the fact remains that the patient was ultimately found to be suffering from Bowel Ischemia.
44. The question therefore is as to whether there was any delay or a negligent delay in conducting the tests or diagnosing the impact of the infection that was being noticed through the indications of abdominal distention and its prompt treatment.
51 | P a g e
45. On an assessment of the said Notes to which objections have been filed and reply has been given as quoted above, the medical records clearly indicate attendance of the patient to Doctors regularly as well as by the Hospital staff.
46. The question as to whether a prompt diagnosis was not made, we may point out that, from the Notes it is evident that from 26.10.2009 till 30.10.2009 even though there was an abdominal distention noticed, yet the patient was having bowel movement that was being noted and attended to by the Doctors. To say that there was a lapse of diagnosis or taking care of the patient according to medical negligence, would be negating the recorded symptoms as mentioned in the Dr'.s Sheets and Notes. It is correct that such a complication does arise after a CABG is carried out and has a high rate of morbidity. But this is not a case where the patient remained unattended and rather on account of his age of 75 years and weak frame, he had also to be ventilated during the treatment. It is also on record that he suffered cardiac problems and was able to revive himself with the aid of the treatment that was given but ultimately collapsed on the last occasion. The patient had survived for a considerable number of days after the surgery and had been indicating the signs of improvement but it seems that on account of such an infection, the patient could not withhold the impact thereof and ultimately passed away.
52 | P a g e
47. We may however point out that there are certain medical literatures which need to be referred to to understand the promptness and the methodology required for rectifying Intestinal Ischemia or Bowel Ischemia. One of the journals cited on behalf of the Hospital and is contained along with the para-wise reply filed on behalf of them quoted hereinabove is the Gastrointestinal Complications after Cardiac Surgery, which is a report of some doctors dated 06.11.2009 of the Lund University, Sweden. The same recites that there is a risk of delayed diagnosis and treatment and the study endeavours to develop a risk score model in order to meet such situations. It concludes that it is a dreaded and diagnostically challenging complication after cardiac surgery and no specific risk score model can be provided, but predictions can be made. Mortality rates in the said study have been indicated from 14 to 63 per cent. Another Medical Journal, Sage Journals, indicates that Incidents range from 0.5% to 5.5% while mortality rates in such complications vary from 0.3% to 87%. Another research article of 2013 by Johan Nilsson, Erika Hansson refers to Intestinal Ischemia after cardiac surgery being common in patients with a poor cardiac state. It was observed in the results on an examination of 17 patients including 5 men and 12 women that the median age was 60 to 75 and 10 of the patients, 59%, died due to the complication. However, it was observed that radiological and endoscopic investigation 53 | P a g e being time consuming, patients with a high index of suspicion should be taken directly to intervention.
48. Another article of 2020 from Cleveland Clinic, Ohio states that from the clinical perspective some of these tend to be present in a mild form that can be managed effectively with conservative measures and on the other hand the severe form can be missed and only recognized after it is too late to intervene. The diagnosis is challenging and therefore a care pathway chart was suggested in the said article. The clinical suspicion and features of high suspicion is to be followed by examinations suggested in order to establish diagnosis. The chart is extracted herein under:
Care Pathway for Gastrointestinal Complications Features of high suspicion Clinical suspicion . Persistent and progressive lactic acidosis despite edeguatc i Symptoms I Abdominal pain, nausea, resuscitation, optimizing (iov.-, and minimizing pressors I vomiting, change in bowel • Preserved cardiac output I habits . Bleeding per rectum 1 Signs I Abdominal distention, rigidity. . increased pressors requirement (sudden significant change) | tenderness, high NGT output, . Multi-organ dysfunction I tachycardia, low urine output I leukocytosis, dropping Het Hold Ueding. m.en Wb. " S""
Abdominal X-ia, • > tool, to * »nda. d,3pWa9m to Follow closely vdltt, serial abdominal exam, lacto, level, hem.tont andhem_y---------
I Establish diagnosis - Treat the pathology ^4 | P a g e
49. It is on the strength of these articles it is urged on behalf of the opposite party Hospital that on the strength of the abdominal distension noticed, all steps were taken and the ultrasonography was also performed.
50. Another research article indicating the need for early surgical intervention for improving survival in cases of acute Intestinal Ischemia patients in the ICU has been published in the Bio-Medical Research International authored by Hassan Adnan Bukhari and Anand Kumar, published on 17.05.2021. The said article discusses an analysis made by the authors of the article, who are associated with the department of surgery of AL-Qura Univesity, Makkah, Saudi Arabia and the University of Manitoba, Canada. The said study indicates that whenever there is such a situation a surgical intervention if promptly done has registered rates of survival, but the survival rates decline where the control was exercised after 12 hours. The conclusion is that early surgical resection of Ischemia Bowel is a critical determinant of survival. In the present case the same was confirmed on 07.11.2009 and the surgery was performed on 08.11.2009.
51. In another article of Acute Mesenteric Ischemia, indicates that the key to early diagnosis is a high level of clinical suspicion and is more prominent in patients about 75 years and above. Any delay in diagnosis k55 | Page increases the rate of mortality. This review article has been published in World Journal of Emergency Surgery contributed by a large number of authors in the year 2022.
52. Another article published by Sarah J. Allen titled Gastrointestinal Complications and Cardiac Surgery of the Auckland City Hospital, New Zealand in 2013, in the summary states that the diagnosis remains difficult because symptoms and signs are often subtle or nonspecific and this commonly leads to delay in definitive diagnosis and treatment.
53. Broadly understanding the aforesaid principles for the purpose of judicial approximation, once again the facts pertaining to the ongoing diagnosis and examination of the patient in the Hospital needs reference. The clinical notes provided by the Hospital that was filed through diary no. 7930 on 06.03.2023 and has been referred to above indicates that on 04.11.2009 at 10 a.m. a suggestion was made and an X-ray and Ultrasonography of abdomen and after noting abdominal distention, an advise of CT Scan suspecting of Ischemic Bowel is noted. The notes reiterate with the words IMP Ischemic Bowel and a suggestion of laparotomy was also made. It was also suggested that a review should be made with a reference to Dr. Deshpande. At 12 midday on the same day there is a noting of abdominal X-ray and a plain US scan of the abdomen suspecting Pneumoperitoneum and a further 56 | Page suspicion of saecal perfora. There was some fever also recorded and then ultrasonography was repeated and the treatment was discussed with (D/W) Dr. S. G. Deshpande and Dr. Karmakar with a note of high risk status for further surgical intervention and a plan was proposed for exploratory laparotomy and it was again discussed with Dr. Deshpande and Dr. Karmakar at about 12.30p.m. All these factors were again noted at 4 p.m. by Dr. Deepanjali Pawar and fluid supports were prescribed. A gassy abdomen was noted at 5.45 p.m. by resident Dr. Geetanjali Jadhav and radiologist. Injections were prescribed at 9.45 p.m. and the same diagnosis was noted as earlier by Dr. Seema.
54. The abdominal distention was again noted on 05.11.2009 by Dr. Joshi at 10 a.m. and the ultrasonography was awaited. The ultrasonography report arrived at 10.30 and it remained the same as the previous day. The fluid supports were continued as noted by Dr. Deepanjali Pawar. Pathological tests were advised the next day on 06.11.2009 at 9.40 a.m. that were awaited and at 4.30 p.m. the history of . events were noted again indicating abdominal gaseous distention. The patient was seen by Dr. Karmakar and a plan of consultation with Dr. Deshpande was noted. The patient was continuing on mechanical ventilation, but was taken on a ventilator. At about 11.30 p.m. the patient did complaint of pain and was comforted with the administration of 57 | P a g e k/ tramadol 100 mg. with a note that he had not passed motion. A repeat ultrasonography was advised and all supports were continued.
55. The ultrasonography was conducted at 10.40 a.m. on 07.11.2009 and Dr. Deshpande arrived on that day at about 10.50 a.m. and discussed with Dr. Karmakar advising laparotomy to be conducted. This surgery was advised after having monitored the patient from 04.11.2009 till 07.11.2009. The consent for X-ray laparotomy was taken as noted in the clinical notes/ progress sheets and at about 11 p.m. the patient suffered Bradycardia, but he revived and Dr. Karmakar and Dr. Joshi were informed. CPR was done and during CPR motion passed as noted by Dr. Manisha. On 08.11.2009 these symptoms were noted once again including the attack of Bradycardia the previous night and at 9 a.m. It was noted that the condition of the patient was not settling and therefore a decision was taken to undergo an emergency laparotomy on that date itself. Accordingly the entire symptoms were discussed and the surgery was performed that has been captioned as Emergency Extended Hemicolectomy by Dr. Deshpande. The intra operative finding indicated ischemic patches and post-operative he was shifted to the ICU for further management. It is therefore seen that a suspicion about Bowel Ischemia was noted on 04.11.2009 and was sustained as a suspicion till it was confirmed to proceed with emergent surgical intervention on 58 | P a g e 07.11.2009 and was performed on 08.11.2009. The surgery was therefore performed within hours of the final diagnosis and therefore it cannot be said that any delay was caused that may amount to a medical negligence. The time line for surgical intervention as suggested in the article referred to above was published in 2020-2022 and quite possibly may not have been a confirmed protocol during the period of the treatment in the present case but even there the probabilities of survival were sufficient and not disproportionate to conclusively construe a lapse of gross medical attendance.
56. This entire episode from 04.11.2009 to 08.11.2009 does indicate that the patient was being attended promptly and timely with tests being carried out and with multiple ultrasonography and X-rays performed when ultimately the doctors found that he needed an emergency surgical intervention, the same was performed on 08.11.2009.
57. It is one week thereafter that the patient suffered a third cardiac arrest and could not be revived and was declared dead. The death summary records the reason for the death as post CABG with Bowel Ischemia and Septicemia with multi organ failure.
58. From the facts narrated above it can be clearly seen that all possible steps were being taken and as a matter of fact the details indicate the attention of medical care that was undertaken and was 59 | P a g e being looked after with regular review and consultation having been made in discussion with Dr. Karmakar and Dr. Deshpande.
59. It appears that Dr. Hiremath being the person in charge of the cardiology section had performed CABG and there is no complaint or any evidence of any negligence in the performance of the bypass surgery. It is the post-surgery complications that have been made the basis of the contention raised about the alleged negligence during the post-operative care of the patient.
60. We have noted the hospital notes and have also taken notice of the comments made on behalf of the complainants in the shape of response and objections to the hospital documents that were filed pursuant to the order of this Commission. From a reading of the same and comparing it with the hospital notes discussed above we find that the explanation given by the Hospital is satisfactory and the degree of care and consultative process as well as medical attention to the patient seems to have been carried out with due diligence as expected in such situations. In our considered opinion the line of treatment including diagnosis and patient care as demonstrated through the Hospital records broadly passed the Bolam Test as explained by the Apex Court in the case of Jacob Mathew vs. State of Punjab & Anr. (2005) 6 SCC 1, The ordinary care and the special care required to be taken in .60 | P a g e k attending to the patient seems to have been satisfactorily done and therefore the contentions raised on behalf of the appellant do not make out a case of medical negligence. The conclusion therefore drawn by the State Commission deserves to be affirmed for all the reasons stated hereinabove. The appeal fails and is hereby dismissed. X Sd/- i I ( A.P. SAHI, J.) PRESIDENT 1 I 1 Sd/- I t ( BHARATKUMAR PANDYA) MEMBER AS+MK+Brahm/CM-VM/C-1/Reserved matter 61 | P a g e