State Consumer Disputes Redressal Commission
Master K.Tharun Mohan And Another ... vs C.D.R.Health Care Limited And Others ... on 11 February, 2009
BEFORE THE A BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: HYDERABAD. F.A.No.797/2005 AGAINST C.D.No.696/2003, DISTRICT FORUM-I, HYDERABAD. Between: 1. Master K.Tharun Mohan S/o.K.Jagan Mohan Minor, 17 years, Occ:Student at USA Under the guardianship of paternal uncle Dr.Raj Pratap Mathur, 10218 Yearling Drive Rock Ville, Maryland, USA 20850 per GPA Dhanraj Pratap Mathur R/o.Flat No.401, Kanti Avenue Anand Nagar Colony, Khairatabad, Hyderabad. 2. Miss K.Ramya, D/o.K.Jagan Mohan, Minor, 12 years, Occ:Student at USA Under the guardianship of Paternal Uncle Dr.Raj Pratap Mathur 10218 Yearling Drive Rock Ville, Maryland, USA 20850 per GPA Dhanraj Pratap Mathur, R/o.Flat No.401, Kanti Avenue, Anand Nagar Colony, Khairatabad,. Hyderabad. ..Appellants/ Complainants And 1. C.D.R.Health Care Limited of which CDR Hospital is a unit through its Chairman & Managing Director, Dr.C.Dayakar Reddy, Hyderguda, Hyderabad-500 029. 2. Dr.C.V.Sudhakar. 3. Dr.K.Srinivas 4. Dr.Niranjan 5. Dr.Divakar. 6. Dr.Bharath Reddy (Anesthetist) (Complaint against opposite party No.1 to 6 for medical negligence in treatment of K.Tanuja resulting her death and claim for consequential loss compensation and damages. O.P.2 to O.P.6 are staff and duty doctors though made party but opp.party No.1 wholly liable for their acts and deeds), 7. K.Jagan Mohan, S/o.late Ram Mohana Rao, aged about 45 years, Occ:Govt. Employee, R/o.Nallakunta, Hyderabad. (Who is the father of the complainant herein above subsequently married and living with his second wife separately, hence minor children under the guardianship paternal uncle at present at USA. Thus he is not a necessary party to the claim). ..Respondent/ Opp.party Counsel For the Appellants:Shri Ahmed Mohiuddin Counsel for the Respondents:Mr.S.S.Subrahmanya Reddy-R2 R1, R3, R4, R5 & R6 served through s.s. QUORUM:THE HONBLE JUSTICE SRI D.APPA RAO, PRESIDENT. AND SMT.M.SHREESHA, MEMBER.
WEDNESDAY, THE ELEVENTH DAY OF FEBRUARY, TWO THOUSAND NINE.
Oral Order:(Per Smt.M.Shreesha, Honble Member) *** Aggrieved by the order in C.D.No.696/2003 on the file of District Forum-I, Hyderabad, the complainants preferred this appeal.
The brief facts as set out in the complaint are that the first and second complainants, who are minor children of the deceased and Mr.K.Jagan Mohan, are studying at USA under the guardianship of their paternal uncle and hence the complaint is filed by G.P.A. i.e. father of the guardian and grand father of the complainants. The complaint is filed alleging criminal negligence committed in burns to Smt.K.Tanjua, mother of the complainants at C.D.R. hospital resulting in her death against opposite party No.1 including its staff and duty doctors who are jointly and severally liable to pay compensation and damages.
The complainants submit that their mother was born on 1-3-1963 and was deaf and dumb and was appointed as Lower Division Typist in M.C.H and was leading a happy married life. On 14-2-2000, she met with an accident at her parents residence at about 8.00 a.m. while she was boiling water on kerosene pump stove and was admitted in CDR hospital at about 9.40 a.m. in burns ward under the care of Dr.G.V.Sudhakar, who is a Plastic Surgeon and Burns Specialist.
The duty doctor recorded the total burn surface as 57% and has not signed the process check list on 14-2-2000 whereas Dr.K.Srinivas, recorded as 30% to 40% superficial to deep burns. Thus there is a contradiction in the observation found between process checklist and progress record. It is observed that Dr.K.Srinivas having prescribed the diet, injection and other medicines directed to inform Dr.G.V.Sudhakar, whereas date and time was not recorded under the said progress record and it is not known whether the said Dr.G.V.Sudhakar was informed or not and whether he subsequently attended the patient or not. The complainant submitted that there is no indication available on record that the duty doctors discharged their professional duties as and when required by the patient more particularly in burn cases, as such no monitoring of vital signs are mentioned like B.P., heart rate, temperature and monitoring of oxygen saturation, cardiac and respiratory monitoring, mental status of the patient checked and noted. On 14-2-2000 at about 8.00 a.m. Dr.Niranjani attended the patient and recorded that the patient had received 57% burns mostly superficial and that both doctors found and noted different findings about burns impression i.e. 30% to 40% and 57% respectively. Dr.Niranjani also prescribed medicines and recorded 5 directions. It is not known whether Dr.G.V.Sudhakar under whose care the patient was admitted have been complied with or not. Similarly on the same day i.e. on 14-2-2000, another doctor namely Dr.Divakar observed that the patient is dumb and pointed out 57 mixed type burns impression in the case sheet notes. At about 12 noon on 14-2-2000 progress record sheet disclosed the laboratory results showing abnormal blood urea of 31 mg./dl a low sodium of 135 mg/dl which indicate acute renal failure and hypoxemia both second to fluid loss and burn needs for more IV fluid. There was abnormal laboratory report indicating high count of 23,200 note and high rate of hemoglobin at 16.3 and whereas on the said progress sheet, it is not indicated whether the incharge of burns unit, Dr.G.V.Sudhakr attended to the patient and issued any directions.
On 15-2-2000 the treatment prescribed was the same injection and medicine and it was not known whether the said treatment was complied or not. On 15-12-2000, Dr.Divakar made observation that the patient conscious & coherent while the patient is dumb and unable to speak and this undoubtedly shows that the opposite parties are careless, irresponsible in behavior and writing notes without properly examining the patient.
The temperature, urine output, respiratory care, pulse rate were noted but blood pressure, mental status, lungs and heart examination, oxygen saturation which are essential were neither recorded nor monitored. The undated progress record furnished two results of ABG test at 10.15 a.m. and 12.30 p.m. and in the report, the partial pressure of oxygen PO2 recorded was 29.0 and 35.0 mm which indicate Acute Respiratory failure and requires treatment but there was no evidence available in the progress recorded by Specialist Dr.G.V.Sudhakar under whose care the patient was admitted.
The complainants submitted that the patient was neither examined by any doctor nor any monitoring was done between 11.00 a.m. to 3.30 p.m. however, Dr.Divakar made an observation at 3.30 pm. that the patient is conscious and responding and recorded the oxygen saturation at 95% urine output at 85 ml, respiratory rate at 26 per minute which is high but no monitoring was done. Further at about 4.35 pm. it was noted that the patient is sedated/responding, urine output 78 ml, oxygen saturation 90% respiratory rate 27 per minute and lastly the then duty doctor noted inform anesthetist at once to see the case.
But no anesthetist visited the patient till 8.00 a.m. and no monitoring was done by any doctor.
Finally on 16-2-2000 at 1.00 a.m. Dr.Barath Reddy closed the progress record. It is pertinent to note that the patient died on 15-2-2000 itself while she was struggling for life between 3.30 p.m. to 8.00 p.m. and no required medical aid was provided nor any specialist of the opposite party visited and discharged professional duties even at these crucial hours. The complainants submit that if Dr.Bharat Reddys note is scrutinized, analyzed and verified in the light of earlier notes from 14-2-2000 and upto 8.00 p.m. one can come to the conclusion that Dr.Bharat Reddy examined the dead body of the patient and on 16-2-2000 at 1.20 p.m. the patient was declared died. All investigations, reports, x-ray, chest film, death certificate were handed over to attendant on 16-2-2000 and the death certificate states the cause of death as Cardio Respiratory Arrest while the patient was admitted for treatment of burns and submitted that the cause of death is the result of opposite parties negligence in discharging their professional duties.
The complainants subitted that Dr.G.V.Sudhakar never visited the patient during the period from 14-2-2000 to 16-2-2000 till she expired and hence a case in Crime No.59/00 u/s.174 of Cr.P.C. was registered and subsequently the father of the deceased filed private complaint against 1. CDR Hospital, 2. Dr.G.V.Sudhakar and 3. Dr.Divakar under C.C.600/02 which is pending for disposal on the file of XVII, M.M.Nampally, Hyderabad. The Investigation Officer recorded statement from other doctor, who also opined that opposite parties did not discharge professional duty and hence the patient died.
Hence the complaint for a direction to pay compensation of Rs.18,17,334/- together with interest @ 18% p.a. along with costs.
Opposite party No.1 filed counter denying the allegations made in the complaint and submitted that the complainants through GPA are not permitted to attend and proceed with the matter in the absence of guardianship certificate from the competent court. Opposite party No.1 submitted that it has not committed any criminal negligence in treating the patient and that the paternal uncle has taken over charge of the minor children and that the father of the deceased children is not interested in filing a case. Opposite party No.1 submitted that the patient was admitted in the hospital with burns in separate burns ward maintained to prevent infection and isolate the patient to prevent infection. The burns ward itself is an acute care area and intensive care area where all necessary material and equipment needed in such cases is maintained and hence the claim that the patient was not taken to an intensive care unit is not correct. It is submitted that Dr.G.V.Sudhakar is a Senior Consultant in Plastic surgery and he saw the patient on 14-2-2000 itself and on admission talked to the relatives and attendants of the patient including Dr.Premalatha and explained in detail the condition of the patient and the possible complications were explained.
He has not documented the case sheet as Dr.Neeranjani gave necessary instructions and it is usual that senior consultants write instructions occasionally whenever there are some changes needed. It is also submitted that fluids replacement is calculated as per the extent of burns injury and usual method of monitoring is by hourly urine output. This is the standard practice and in most of the burns centers, recording of the blood pressure is not feasible in majority of the patients especially with limb burns, because of dressing and is also not a usual practice. Respiratory rate of 22 or 5 per minute is not uncommon in burns patient and does not indicate any serious problem. ABG is monitored in those patients where some pulmonary pathology preexists and a respiratory involvement is there and not done as a routine. In this present case ABG was done more to draw a baseline. Sudden deaths are not uncommon in burns patient which are not completely explained and on many occasions, it is noted that patients while giving statements to Police, etc. suddenly died after answering a few questions.
Dr.G.V.Sudhakar is one consultant, who is known to visit his patients 3 to 4 times a day and often quite late in the night. It is not correct to say that Dr.Diwakar,the duty doctor is not competent. The burns ward staff are trained staff and are competent. Opposite party No.1 submits that the husband of the patient was also admitted in the same unit and was on treatment and kept in the next room and he never had any complaint against the opposite parties and he was again readmitted for skin grafting as he was discharged to facilitate performing necessary rituals to his wife. Opposite party No.1 submitted that they have not acted negligently in dealing with the patient and submitted that there is no negligence on the part of opposite parties.
A petition was filed before A.P.Medical Council after due verification of case sheet and affidavit and it has come to the conclusion that there was no negligence in treating the patient either by the doctors or hospital/staff and sought for dismissal of the complaint.
Opposite party No.2 filed counter denying the allegations and denied that opposite party No.1 and all other concerned staff committed criminal negligence in treating the burns of the patient and are liable to pay compensation. He submitted that the treatment given to the patient at opposite party No.1 hospital by opposite parties and staff was in accordance with the accepted norms and procedure prescribed for treating such cases. The husband of the deceased did not show any interest to register a complaint and claim compensation and damages against opposite parties No.1 to 6 and he continued his treatment. Opposite party No.2 submitted that the patient was seen by the duty doctors in the causality and was admitted into burns ward which by itself is an intensive care unit specially demarcated and equipped for admitting and treating burn patients. Immediately on admission Dr.Sreenivas, Surgical Registrar examined the patient and documented the Total Burns Surface Area (TBSA as 30% to 40%.
Dr.Niranjani, working as team member has seen the patient and revised the prescription and the TBSA and documented the same as 57% and thus there is a variation of 17% in TBSA in the assessment of surgical registrar and specialist. The normal practice is to make quick assessment of the nature of injury in the causality and shift the patient to the specific area of management and in the instant case as the burns are more than 20%, the case was categorized as critical and the patient was shifted to burns ward immediately.
Opposite party submits that in any hospital, an emergency case is initially seen by the duty doctor and referred to appropriate ward in consultation with and under the supervision of senior consultants. In the instant case, the patient was first seen by the duty doctor in the causality and then admitted in the burns ward where she was seen by Dr.Sreenivas, Surgical Registrar and within a short time thereafter seen by Dr.Niranjani and it is not necessary for the senior consultant to write instructions every time he sees a patient, which is more than 3 to 4 times a day.
His oral instructions are carried out by the medical team which works under his supervision. Dr.Niranjani discussed with the attendants about the condition of patient and proposed line of treatment and possible risk to her life etc. which is a routine practice in every case and all these things will not be documented in the case record. Dr.Diwakar, the duty doctor, was in the burns ward and was monitoring the patient and by 12 noon on 14-2-2000, reports of initial investigation were entered in case record which were within normal acceptable limit and the treatment showed satisfactory progress. By 5 p.m. wounds were cleaned and covered with Kollagen which is a membrane used to cover the wounds to form a dressing. In addition, swabs were taken for culture studies, which is a regular feature to enable selection and use of suitable anti-biotics at later stage, if needed.
He submitted that the normal range of blood urea is 20 to 40% and a reading of 31 mg% is not considered abnormal.
Similarly serum sodium also has normal range which is between 120 to 140 meg. and a reading of 135 meg. is not considered abnormal. The minor variations for short periods are not detrimental to life or health and can occur even in a healthy individual in different periods of exercise or seasonal changes and are not indicators of Acute Renal failure as claimed by complainant.
As burn patients go through a stage of fluid loss during the first 48 hours, which gets corrected with the treatment, fluctuations due to fluid loss are natural during this period, almost in every patient and for these reasons, patients are monitored not by one parameter but by more than one which also includes the clinical appearance for assessing their condition and to correlate all lab data with clinical picture which is more wholesome unlike any one particular report. Opposite party No.2 submitted that the burn patients will be in a stage of hyper metabolic response and hence will have tachycardia and tachypnea with more than normal heart rate and respiratory rate and this is normal picture to every doctor treating such patients.
Monitoring oxygen saturation in all burn patients is not necessary or mandatory, however as the patient had burns on the face, oxygen saturation was monitored more as a precaution than because of any suspicion. The method of monitoring oxygen saturation, besides pulse oxymeter was followed in this patient and showed a satisfactory value of 94%. ABG was done only as a routine baseline investigation and the record at 3.30 p.m also showed satisfactory saturation of 95% and there were no other signs warranting panic. At 4.35 p.m. the patient was sedated/responding, urine output 78 ml, oxygen saturation 90%, none of which are alarming and therefore the noting of Dr.Diwakar to inform Anesthetist once to see the case is more of a precautionary measure than out of urgency.
The grossly lower values as shown by ABG can only be due to a sampling error and does not reflect the true picture under the circumstances and intake output chart maintained for the patient shows that the patient was given feed at about 11 p.m. which could not have taken place if the condition was not satisfactory. The claim that the patient died on 15th itself between 3.30 and 8 p.m. is not correct and is only aimed to scandalize the opposite party and the allegation that there is no indication that the duty doctors discharged their professional duties as and when required is absolutely false. The case record as well the nurses record shows the various visits made by duty doctors as well as other doctors and the cause of death is absolutely correct and no exception can be taken to the same. The Medical Council before whom the complainant made a similar complaint had gone through all allegations made by him and absolved the opposite party of any negligence and even the police could not find any negligence and dropped charges. Opposite party No.2 submitted that he is not guilty of any professional conduct deliberately, discharging of professional duty and the complainants are not entitled to any relief and prayed for dismissal of the complaint.
Opposite parties 3 to 7 were set exparte.
Based on the evidence adduced i.e. Exs.A1 to A32 and B1 and B2 and the pleadings put forward, the District Forum dismissed the complaint.
Aggrieved by the said order, the complainants preferred this appeal.
Heard. Both counsel filed their written arguments.
The point for consideration is whether there is any negligence on behalf of the opposite parties and if the complainant is entitled to the compensation claimed for?
We have perused the material on record. The first and second complainants are minors, who are under the guardianship of their paternal uncle and their uncle empowered their grand father with the Power Of Attorney to file this case on their behalf for medical negligence rendered to their mother. The complainants submit that their mother, Mrs.K.Tanjua, was born deaf and dumb on 1-3-1963 and passed typewriting and secured a Government job as Lower Division Typist and was in the pay scale of Rs.910-1625 in M.C.H., Hyderabad and her last drawn pay for the month of January, 2000 was Rs.4,388/-. It is the complainants case that their mother met with an accident on 14-2-2000, at 8.00 a.m. while she was boiling water on kerosene pump stove and received burn injuries and was admitted in opposite party No.1 hospital at 9.40 a.m. and was under the care of Dr.G.V.Sudhakar, who is the Plastic Surgeon and Burns Specialist. It is the complainants case that Dr.K.Srinivas, recorded the burns impression as 30% to 40% and on the same day i.e. on 14-1-2000 at about 8.00 a.m. another doctor Dr.Niranjani attended on the patient and recorded that the patient had received 57% burns mostly superficial and once again on the same date, another doctor, Dr.Divakar observed that the patient is dumb and recorded 57% respectively mixed type burns. As against this the learned counsel for the opposite party submitted in written arguments that the variation of 17% in TBSA (Total burn surface area TBSA for short) in the assessment of the surgical registrar and the specialist is because there is stress on immediate action of shifting the patient and valuable time is not wasted in the causality for a detailed examination and the variation of TBSA may occur between causality an later assessments. The opposite party contends that this does not change the line of immediate management and treatment and cannot be said to be negligence. Burns with TBSA of more than 15% to 20% in an adult are categorized as critical and as the burns in the instant case are more than 20%, the case was categorized as critical and the patient was shifted to burns ward immediately.
It is observed from the record i.e. in Ex.A9, which is the progress check list issued by CDR Hospital, the date of admission is 14-2-2000 and the burns surface area is written as 57% and once again in Ex.A12, which is the progress record, recorded by Dr.K.Srinivas, the burns are stated to be 30% to 40% superficial to deep burns. Opposite parties have not established as to whether this 17% difference in the T.B.S.A. has necessitated any change in the course of medical treatment.
We rely on the judgement of the apex court in Savitha Garg v. National Heart Institute reported in Supreme Court and National Commission on Medical Negligence and Insurance under Consumer Protection= IV, (2004) CPJ 40 (SC), it is held by the Apex court as follows:
Burden lies on the hospital and the concerned doctor, who treated the patient to prove that there was no negligence involved in the treatment. In both contingencies i.e. contract of service and contract for service, courts have taken a view that the hospital is responsible for the acts of their permanent staff as well as for the staff, whose services are temporarily requisitioned for treatment of patients. Therefore, hospital can discharge burden by producing the treating doctor in defense that all due care and caution was taken and despite that the patient died. With this judgement, the entire burden cannot be placed on the complainant to prove negligence and it is the duty of the hospital also to satisfy that there was no lack of care of diligence. The hospitals are institutions, people expect better and efficient services, if the hospital fails to discharge its duties through its doctors being employed on job basis or employed on contract basis, it is the hospital that has to justify and by not impleading a particular doctor will not absolve of its responsibility.
In the instant case, the respondents/opposite parties have failed to establish what exactly the line of treatment is rendered to a critical patient and if they have followed the standard medical practice in rendering this treatment. To reiterate, there is no documentary evidence on record to state that 20% of burns as stated in their written arguments are treated as critical. It is pertinent to note that if the patient had suffered 57% burns as recorded by their own doctor in Ex.A9 and the patient is dumb and as to why the patient was not shifted to intensive care unit when they themselves are admitting that the burns are critical. We observe from the conclusion of Dr. Thakur Hameer Singh and Dr.R.Sudhina Lakshmi whose opinion was sought for from Osmania General Hospital dated 26-4-2001 in Ex.A27, it is stated as follows:
Records maintained are very poor regarding date and time.
Cardiovascular monitoring was not done.
There is varied assessment of burns ranging from 30 to 57% CPV line was asked to be put, but no records of C.V.P. monitoring.
Oxygen saturations has been mentioned at various places. Whether the patient was monitored by Pulse oximetry is not known from the records.
Records does not show clearly whether the Consultant has seen or not.
It cannot be ascertained as to who is taking the responsibility of calling the consultants or other Medical Officers. Is there a call book with necessary date and time of having sent the call, having received the call, which will clearly show whether the Medical Officers have been contacted and attended the patient on time. Burns of more than 50% should have been monitored closely and extensively preferably in Intensive Care Area.
Opposite party did not file any medical literature or documentary evidence in support of their contention that more than 20% burns are treated as critical and the same line is followed whether it is 30% burns or 57% burns and also that they have followed standard medical practices in not admitting the patient in ICU. To reiterate, the burns of more than 50% ought to have been monitored extensively preferably in intensive care unit. Therefore, we are of the considered view that recording of TBSA 30 to 40% burns and 57% burns on the same day and not admitting the patient in ICU is an act of negligence.
Secondly the complainants contend that inspite of noting of the duty doctor in the progress record dated nil at 11.00 a.m. of oxygen support 8lt. per minute but the said advise was not complied with by the opposite party and the patient was continuously neglected and that on the same day i.e. on 14-2-2000 the laboratory results recorded in the progress record show abnormal blood urea of 31 mg. low sodium of 135 mg/dl which indicates acute renal failure and hypoxemia both secondary to fluid loss and burn needs for more IV fluid, a high total WBC count of 23200 and that on 15-2-2000 i.e. the next day at about 8.00 a.m. the laboratory report showed a high rate of hemoglobin value at 16.3 which is indicative of abnormally high and significant fluid loss, W.B.C. is 24,300 and as per Annexure XVIII ABG (Arterial Blood Gas) test conducted at 10.15 a.m. and 12.30 p.m. showed a partial pressure of oxygen PO2 as 29.0 mm and 35.0 mm respectively which indicate Acute Respiratory failure. It is also the case of the complainant that a reading of conscious and responding was made by the opposite party when the patient is dumb and oxygen saturation is recorded as 95%, urine out put at 85 ml and respiratory rate at 27 per minute and that though the duty doctor noted to inform the anesthetist to see the case no doctor or anesthetist ever visited the patient till 8.00 p.m. and also that there was no recording in the case sheet that any of these instructions were carried out at various stages.
As against this the opposite party contended that at about 9.40 a.m. on 14-2-2000, the patient aged 37 years was seen by the duty doctors in the causality and was admitted into burns ward and was seen by Dr.Srinivas, Surgical Registrar, third opposite party and also by 4th opposite party, Dr.Niranjani, who is a plastic surgeon and also by the duty doctor , who is the 5th opposite party and his notes find place in the case record that by 12.00 noon on 14-2-2000, the reports of initial investigations were entered in the case sheet which were within normal acceptable limits for such a case. The second opposite party contends in his counter that a reading of 31 mg of blood urea is not considered abnormal and 135 mg/dl of sodium is also within the normal range and that some amount of electrolyte fluctuation is natural in burn injury and not indicative of Acute Renal Failure as claimed in the complaint. Burn patients go through a stage of fluid loss during the first 48 hours which gets corrected with treatment. They deny that the opposite parties did not visit the patient and neglected her. It is not the practice to mention seen by the respondent every time he visits the patient and the same was followed in this case also. The case of the 5th opposite party is that on 15th urine output is 85 ml during the previous hour which is more than adequate, that the practice is to maintain urine output of about 1 ml/kg/hr in burn patients and in this situation 85 ml reading is more than adequate and that this goes to prove that the complainants claim is false. ABG was done as a routine baseline investigation and there was no clinical indication to suggest a possible respiratory failure and the value reported for the ABG was not relied upon as it was not consistent in the clinical picture. It is the case of the opposite parties that the normal practice is to rely more on the clinical picture rather than one particular lab report and that ABG is pure arterial blood value and there could be many reasons for inconsistent value like the sampling being wrong or when there is contamination in the sample even by a minor droplet of atmospheric air or minor temperature fluctuations. Dr.Divakar noting Anesthetist to see the patient once is only as a precautionary measure than out of urgency. The grossly lower values are shown by ABG is only because of a sampling error and does not reflect the true picture under the circumstances and that case record as well as the nurses record shows the various visits made by the duty doctors as well as other doctors and therefore there is no negligence on their behalf.
We observe from the record on page 23 dated 15-2-2000 that there is no continuity of dates and though it states seen by Dr.Divakar, the case record dated 15-2-2000 does not state the time nor the exact line of treatment. The note is patient conscious and coherent and it is an admitted fact that the patient is deaf and dumb but no such observation has been made along with this note. We observe on page 24 that the assessment of burns is 57%.
Here we rely on Ex.A27, which is the expert opinion of Dr.Thakur Hameer Singh and Dr.R.Sudhina Lakshmi which was sought by the Superintendent of Osmania Government Hospital, Hyderabad. In this report, they have concluded as follows:
Records maintained are very poor regarding date and time. Cardiovascular monitoring was not done. There is varied assessment of burns ranging from 30 to 57% CPV line was asked to be put, but no records of C.V.P. monitoring.
Oxygen saturations has been mentioned at various places. Whether the patient was monitored by Pulse oximetry is not known from the records.
Records does not show clearly whether the Consultant has seen or not.
It cannot be ascertained as to who is taking the responsibility of calling the consultants or other Medical Officers. Is there a call book with necessary date and time of having sent the call, having received the call, which will clearly show whether the Medical Officers have been contacted and attended the patient on time. Burns of more than 50% should have been monitored closely and extensively preferably in Intensive Care Area.
We have gone through the entire record to peruse the cardio respiratory monitoring but there was no cardio respiratory monitoring done at all.
We rely on the statement of Dr.Ajit Vig, who is Consultant Physician and Chest Specialist in Ex.A28 in which he stated as follows:
I have gone through the copy of case sheet of CDR Hospital, Hyderguda of late Smt.D.Tanjuja, W/o.K.Jagan Mohan, D/o.Dhanjraj Pratap and after going through the same carefully I have to state that, patient was admitted in CDR Hospital on 14-2-2000 at 9.40 a.m. and expired on 16-2-2000 after 40hours during her stay in the Hospital. I am not able to find a proper record of her cardio Respiratory Monitoring.
I have also gone through the Testimony of Dr.Raj Pratap Mathur. I would like to add that the oxygen saturation of 90% should have been followed up with frequent Arterial Blood gas Analysis and a serious consideration for effective ventilation should have been done.
I state that the patient died due to the negligence on the part of the doctors who attended the patient in the CDR Hospital.
With respect to 100% oxygen to be given to the patient and her respiratory cardiac situation was worsening and cardiac respiratory monitoring not done properly, we also rely on the statement given by Dr.V.Raghavender Rao in Ex.A29, in which it is stated as follows:
After going through the case sheet I can state that, the cardiac respiratory monitoring of the patient was in adequate and ineffective. The patient should have been given 100% oxygen when her respiratory cardiac state worsening.
I also state that she should have been shifted to Intensive Care (IC) unit where monitoring is continuous. The patient was left in the hands of Junior Doctors who are not proficient in Burns Management.
The Anesthetist failed to see the patient in time and the patient was not intubated and put on ventilation, and the oxygen level has come down. This was required when the condition was deteriorating when he did not do the needful.
Negligence on the part of the Burns unit incharge and other duty doctors, caused the death of the patient Smt.Tanuja.
Nowhere it is mentioned either in the case sheet or in any documentary material filed by the opposite party that the cardiac monitoring was done or that the patient was on ventilation. It is pertinent to note that even when the oxygen level had come down as seen in page-26 of the case sheet at about 10.15 a.m. date not mentioned: ABG report showed Hypoxemia, repeat ABG requested, the progress record does not state by whom again ABG was repeated at 12.30 p.m., date not known shows Hypoxemia PCO2-35.0 SO2-70.0 The contention of the opposite party that burns shown by ABG could only be due to a sampling error and does not reflect the true picture is not supported by any medical literature or documentary evidence.
There are no notings made in the hospital record that care was taken in recording the cardiac respiratory monitoring, pulmonary monitoring when the results of ABG showed acute respiratory failure. This is further substantiated and supported by the opinion of other doctors in Exs.A27, A28 and A29.
The contention of the opposite party that anesthetist was asked to come only as a precautionary measure and that there was no urgency is unsustainable on the ground that the patient needs to be intubated by an Anaesthetist when the ABG level showed acute respiratory failure, hence to contend that the presence of Anaesthetist was not urgent cannot be sustained. The learned counsel for the opposite party further contended that there was no expert opinion and relied on the judgements of the National Commission in CHARAN SINGH v. HEALING TOUCH HOSITALS AND OTHERS in III (2003) CPJ 62 NC, DR.JARKANWALJIT SINGH SAINI v. GURBAX SINGH AND ANOTHER in I (2003) CPJ 153 (NC), RANI DEVI v. DR.S.R.AGARWAL AND OTHERS in III (2002) CPJ 136 (NC) wherein it was held that in the absence of expert evidence, no relief can be granted.
However, in the instant case Exs.A27, A28 and A29 which is the medical opinion given by Dr. Dr.Thakur Hameer Singh and Dr.R.Sudhina Lakshmi, Dr.Ajit Vig and Dr.V.Raghavender Rao can be treated as expert opinion and we observe from the record that the opposite party did not choose to examine any of these doctors, who had filed their statements and whose statements have been marked as exhibits before the District Forum.
We rely on the judgement of the National Commission in SUSHMA SHARMA v. BOMBAY HOSPITAL in II (2007) CPJ 9 (NC) wherein it was held that One cannot expect the patient and his relatives to play this coordinating role and to find out as to which doctor has prescribed what treatment and whether the Specialists instructions are being implemented properly and within reasonable time by the resident doctors. It is also clearly not possible for the individual subject Specialist to coordinate the overall management of the patient and such responsibility has to rest on the doctor in charge of the parent unit. It is necessary that all super speciality hospitals lay down a clear protocol for coordination and management of a patient suffering from multiple medical problems requiring consultation with various specialists and to see that there instructions are properly implemented.
In view of the above, we hold that it is the hospital and the doctors who are responsible for coordinating their team and put forth the best possible treatment which in the instant case did not happen as seen from the hospital records.
In SPRING MEADOWS HOSPITAL v. HARJOT AHLUWALIA, I (1998) CPJ 1 (SC), the apex court held that the hospital is responsible for the cause of negligence attributable to the employees and is liable for their consequences.
Hence we hold that the hospital is equally liable for the acts of opposite parties 2 to 6.
Keeping in view the medical record, the opinion of the expert doctors in Exs.A27, A28 and A29 and the arguments put forth by both parties, we are of the opinion that opposite party No.1, which is a hospital along with the doctors 2 to 6 is liable. The patient is aged 37 years old and though deaf and dumb was appointed as a Lower Division Typist in M.C.H. Exs.A6 and A7 are the appointment and salary certificates of the deceased. The net salary is Rs.3,943/- after deductions. Taking into consideration, her age which is 37 years and after deducting 1/3 from her pay and multiplying the annual salary with 15, we arrive at Rs.4,73,220/- rounded to 4,75,000/- together with compensation of Rs.15,000/- to be paid to each of the complainants for loss of estate and further Rs.15,000/- to each of the complainants for the loss of love and affection of their mother. These amounts are to be paid to the G.P.A. holder and he is directed to keep these amounts in fixed deposits in the name of minors in any nationalized banks till they attain majority. We also direct the opposite parties 1 to 6 to pay costs of Rs.10,000/- to the complainants.
In the result this appeal is allowed and the order of the District Forum is set aside directing opposite parties 1 to 6 to jointly and severally pay 4,75,000/- together with compensation of Rs.15,000/- to be paid to each of the complainants for loss of estate and further Rs.15,000/- to each of the complainants for the loss of love and affection of their mother. These amounts are to be paid to the G.P.A. holder and he is directed to keep these amounts in fixed deposits in the name of minors in any nationalized banks till they attain majority. We also direct the opposite parties 1 to 6 to pay costs of Rs.10,000/- to the complainants.
These amounts are to be paid within six weeks from the date of receipt of this order.
PRESIDENT. LADY MEMBER.
Dt.
11-2-2009.