State Consumer Disputes Redressal Commission
Ravi Pratap Verma vs S G P G I on 1 May, 2015
Daily Order STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UP C-1 Vikrant Khand 1 (Near Shaheed Path), Gomti Nagar Lucknow-226010 Complaint Case No. C/2011/86 1. Ravi Pratap Verma a ...........Complainant(s) Versus 1. S G P G I A ............Opp.Party(s) BEFORE: HON'BLE MR. JUSTICE Virendra Singh PRESIDENT HON'BLE MR. Jitendra Nath Sinha MEMBER For the Complainant: For the Opp. Party: ORDER RESERVED STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UTTAR PRADESH, LUCKNOW COMPLAINT NO. 86 OF 2011 01.Ravi Pratap Verma S/o Sri Rishidev Narain Lal R/o T4/2, J.V.T.C. Campus Nishatganj, Lucknow, U.P. 02.Aprajita Verma D/o Shri Ravi Pratap Verma R/o T4/2, J.V.T.C. Campus Nishatganj, Lucknow, U.P. 03.Ankita Verma D/o Shri Ravi Pratap Verma R/o T4/2, J.V.T.C. Campus Nishatganj, Lucknow, U.P. 04.Ajita verma D/o Shri Ravi Pratap Verma R/o T4/2, J.V.T.C. Campus Nishatganj, Lucknow, U.P. ...Complainants Vs. 01.Sanjay Gandhi Post Graduate - Institute of Medical Sciences Lucknow Endocrinology Department SGPGI MS, Lucknow 02.Dr. Preeti Dabadaghao (Consultant) Endocrinology Department SGPGI MS, Lcknow. 03.Dr. Vijay Bhaskar Reddy (SR) Endocrinology Department SGPGI MS, Lcknow. 04.Dr. Amit Aggarwal (Surgery) Endocrinology Department SGPGI MS, Lcknow. 05.Prateek Mehrotra (S.R.) Endocrinology Department SGPGI MS, Lcknow. ... Opposite Parties BEFORE: HON'BLE MR. JUSTICE VIRENDRA SINGH, PRESIDENT HON'BLE MR. JITENDRA NATH SINHA, MEMBER
For the Complainants : Sri Abhai Mani Tripathi, Advocate.
For the Opposite Parties : Miss. Babita Awasthi holding brief for Sri
Praveen Kumar, Advocate.
Dated : 01-07-2015
:2:
JUDGMENT
PER MR. JUSTICE VIRENDRA SINGH, PRESIDENT
This complaint under Section 17 of the Consumer Protection Act, 1986 has been filed by Ravi Pratap Verma and others against Sanjay Gandhi Post Graduate Institute of Medical Sciences and other with the following prayers :-
(i)direct the opposite parties to pay to the complainants the amount claimed herein:
Loss of Estate: (multiplier of 8 has been applied to her annual income rounding of monthly salary to Rs.36,000/- ... Rs.,34,56,000/-
Loss of Consortium and mental agony ... Rs.20,00,000/- Expenses ... Rs. 20,000/- Total Rs.54,76,000/- (ii)Call for the records of hospital. (iii)Constitute a medical board.
(iv)any other or such other order/orders as this Hon'ble Court may deem fit and proper in the facts and circumstances f the case may also pass.
The facts of the complaint case stated in brief are that the deceased Mrs. Sudha Verma was wife of the complainant no.1 and mother of complainant no. 2 to 4. The deceased was principal of Nari Siksha Niketan Intermediate College, Lucknow at the time of her death. The deceased was a known case of type-2 diabetes mellitus for around 10 years. Type 2 diabetes occurs when insulin that the body produces is less efficient at moving sugar out of blood stream. Some sugar is moved out of the blood, just not as effectively compared to a person with normal insulin efficiency which results in High Blood Sugars. Diet, exercise weight loss and possible medication are treatment for this type of diabetes. Occasionally, someone with type-2 diabetes may be placed on insulin for better control of blood sugar. The deceased was admitted endocrinology in 2004 for initiation of insulin thereby for glycenio control. She was diagnosed to have diabetic neuropathy, nephropathy, retinopathy and hypertension which are common effects of long term diabetes. On the said occasion she was discharged on insulin. The deceased was living a normal life since then with precautions to be observed by a diabetic person. The deceased has suffered needle prick in the sole of her left foot for around 10 days before her death i.e. 9/10-04-2011 due to which swelling and redness has occurred in the effected area. The deceased was not having fever nor there any pus collection in the affected area. In the pathological test conducted before hospitalisation, her Haemoglobin was found to low (8.2 gdl. Reference range female 11.7) although the total leucocytes, neotrophills and erythorocycle sedimentation rate found to be on higher side, marking the infection level. She was a febrile throughout; marking the fact that infection was only localized and had not spread. The Physician who was treating her advised for further evaluation and treatment and referred her to the opposite party no.1 Institute. On 20- :3: 04-2009 deceased approached endocrinology department of opposite party no.1 where she was advised admission by Dr. Amit Aggarwal (Consultant Surgery), opposite party no.4. On examination diagnosis was made for left diabetic foot with cellulites and fundus examination (direct opthalmoscopy) test was suggested. After admission tissue from the affected foot of the deceased was taken for finding nature of infection. The examination of the tissue suggested presence of bacterium klebsiella pueumoniae and enterococcus facealis. The deceased was put on conservative treatment of antibiotic (pipzo) through i.v. At the time of admission there was no pus deposit as swelling in the affected foot and only redness was found, indicating the fact that the infection was localized and minor. In the morning of 21-04-2009 the deceased complained of breathlessness even at the rest. The complainant no.1 tried to contact the respondent no.4 under whose supervision the deceased was admitted but despite repeated efforts he did not visit the deceased for evaluation of her condition. The condition of the deceased was finally reviewed by Dr. Vijay Bhasker Reddy, Senior Resident and on examination deceased was found to be having features of volume overload. At around 8.00 p.m. the deceased was shifted to endocrinology department under opposite party no.2 as the condition of the deceased had further deteriorated. The complainant tried to convince the opposite parties no.2 and 4 but none of them visited the deceased. The deceased was left in the hands of Senior Resident and Nurses who could not manage the treatment and deceased declared dead at 1.40 a.m. on 22-04-2009. The cause of death stated to be type 2 diabetic mellitus, severe sepsis with metabolic acidosis (lactic acidosis). Interestingly opposite parties provided the complainants with three different death summaries giving different cause of death. The death summary is manipulated and false statement has been made therein which do not match with the treatment sheet provided by the hospital under Right to Information Act. The death summary reveals serious negligence on the part of the opposite parties. The negligence on the part of hospital and the doctors is writ large from the bare reading of the death summary. The narration of the facts in the death summary does not support the cause of death as stated therein.
The complainants had earlier filed Complaint No. 78 of 2011 before the Hon'ble National Commission which was dismissed as withdrawn vide order dated 27-07-2011 with liberty to file fresh complaint in an appropriate forum within 30 days from the order after making necessary amendments in the complaint. The present complaint is within time.
The opposite parties no. 1 to 5 have filed their written statement thereby stating that the various allegations of carelessness, negligence and deficiencies in services levelled against the opposite parties in the complaint are absolutely baseless, unsubstantiated and without any specific medical evidence and are based on :4: conjectures only and the patient was given the best possible and appropriate treatment/advise as and when required. It is submitted that in the year 2004, the patient had the adverse effect of long standing diabetes in the form of Neuropathy (damage to Nerves), Nephropathy (kidney damage), Retinopathy (damage to Retina) and hypertension (damage to blood vessels and heart), which by passage of time in their natural course only deteriorate withstanding treatment. It is further submitted that diabetic patients such as the deceased, are at very high risk of developing serious infections even with minor trauma. Certain external features such as fever and pus may not be present even when the infection is established. The low Hemoglobin, high leucocytes count with predominantly neutrophils and raised ESR, they are all suggestive of underlying infection. Diabetic patients are immune-compromised and may not display the usual signs and symptoms of fever and pus unlike relatively health humans, in spite of underlying serious systemic infection. It is further submitted that in medical terms, CELLULITIS means INFECTION OF THE FLESH. Diabetic patients may not show features similar to an apparently health individual as already explained. The examination if would suggested the possibility of pus collection, which required further investigations for which she was admitted. It is submitted that breathlessness in the patient is indicative of wide spread infection of excess fluid in the body. Antibiotics, insulin and other treatment were duly given by the Senior Residents in the ward in direct consultation with their consultants who had visited the patient on their routine round and as and when required. The decision to shift the patient to Endocrinology ward was a medical one, as the focus of treatment was not surgical but medical and it was done as soon as feasible. In spite of the best Antibiotics and supportive care, the patient unfortunately succumbed to extensive infection called Sepsis or Septicaemia in medical terms but her treatment was being administered by the Senior Residents who were in constant touch/communication with the opposite party nos. 2 and 4, who were guiding the management. It is further submitted that the computer generated death summary is the death Summary which is available with the Death Certificate with the patient's attendants and it carries all information whereas a detailed Death Certificate goes in to the patients records, which are prepared by the Senior Residents after the patient's death. The third alleged death summary is actually the case summary which was provided under RTI. The blood pressure/pulse were stable on admission in the presence of swollen foot without overt pus in no way negate the presence of infection which was correctly suspected and promptly managed by the consultants and was subsequently confirmed by pathology reports that showed infection with virulent bacteria. She was not at all normal. The Senior Residents working in the Institution are posted as MD/MD Residents undergoing training in super-speciality. These residents cannot be termed as inexperienced. As per routine policy of most hospitals :5: all over the world, trained nurse and Senior Residents/Junior Residents depending upon hospital structure, manage the patient 24 hours a day while consultants come for regular rounds and as and when needed and they are also readily available on phone 24 hours and also in this institution, the authorities are taking proper and attentive care of the patients. The complainants have failed to demonstrate the illegality/deficiency in service; therefore, the present case is liable to be dismissed at the threshold.
Evidence by the complainant An affidavit, in support of the complaint case has been filed by Sri Ravi Pratap Verma the complainant. The following documents have also been filed on behalf of the complainant as annexure with the complaint.
Photocopy of prescription of Dr. Manoj K. Srivastava of M.K. Medical Clinic and Dr. K M Singh of K K Hospital.
Photocopy of Pathological reports before hospitalisation.
Photocopy of Patient Account Statement (Endocrinology) of SGPGI, Lucknow.
Photocopy of Requisition Form for consultation of SGPGI.
Photocopy of Investigation requisition form of SGPGI.
Photocopy of pathological test reports of SGPGI.
Photocopy of treatment sheet of SGPGI.
Photocopy of death summaries of SGPGI.
Photocopy of death certificate of SGPGI.
Photocopy of medical literature.
Photocopy of salary record of the deceased.
Photocopy of Complaint No.78/2011 filed before the Hon'ble National Commission, New Delhi.
Photocopy of order dated 27-07-2011 of Hon'ble National Commission.
Evidence by Opposite Party Learned Counsel for the opposite parties stated that the evidence in the shape of written statement/counter affidavit has already been filed.
An affidavit on behalf of the opposite party sworn by Dr. R K Sharma S/o Late Sri S L Sharma has been filed. The following documents have also been filed on behalf of the Opposite Party as annexure with the affidavit.
Photocopy of O.P.D. case file of the deceased.
Photocopy of Medical Certificate of Cause of Death.
Photocopy of Death Summary.
Photocopy of Hospital Admission Card dated 20-04-2009.
Photocopy of Admission and Discharge Form dt. 20-04-2009.
Photocopy of Requisition form for Consultation.
:6:Photocopy of Patient Account Statement.
Photocopy of Admission and Discharge Form dated 26-04-2004.
Photocopy of Hospital Admission Card dated 23-07-2004.
Photocopy of Education for Type 2 Diabetes with OHA failure or on insulin.
Photocopy of Vital Chart of SGPGI.
Photocopy of Nurses record for Indoor Patients.
Photocopy of Blood Sugar Chart.
Photocopy of Progress Notes and orders.
Photocopy of Diabetes Clinic Flow Sheet.
Photocopy of Department of Radiodiagram report.
Photocopy of Requisition form for consultation.
Photocopy of Investigation Chart.
Photocopy of Drugs, Treatment & other orders by doctors of SGPGI.
Photocopy of Intake-Output Chart.
We have heard Sri Abhai Mani Tripathi, learned Counsel for the complainants and Km. Babita Awasthi holding brief for Sri Praveen Kumar, learned Counsel for the opposite parties and perused the entire record including the evidence and written arguments of both the parties.
Learned Counsel for the complainant has argued that the deceased was admitted with the opposite party no.1 for the sole reason that she was Diabetic patient and needed extra care than that of a normal person and knowing the history of the deceased she was required more conscious approach. The deceased admittedly at the time of admission was a febrile and there was no pus collection at or around the wound. The deceased being a febrile denotes that there was no virulent infection as suggested by the opposite party in the body of the deceased. The heart and kidney function of the deceased was normal. The PH (7.29) level of the deceased was within normal range. The normal PH level shows that the deceased was not having acidosis . The deceased was put under observation but no medication was suggested. The death summary suggests only mild acidosis. It is further submitted by the learned Counsel for the complainant that it is an admitted case of the opposite party that the deceased has shown the breathlessness at rest at 8 a.m. at the time of alleged visit of opposite party no.4 but she was shifted to endocrinology ward only at 8.00 p.m. after 12 hours. The reason of the death has been given as severe sepsis. However, there is no multi-organ failure in the deceased which is common effect of the severe sepsis. The deceased's examination has shown volume overload but no immediate step was taken nor were nephrologists consulted. Though the situation of the deceased has begun to worsen but the opposite parties admittedly did not visit the patient for evaluation of her condition. It is submitted that to cover up their negligence the opposite party no.1 has provided 3 death summaries to the complainant. The perusal of the summaries :7: shows apparent attempt to cover the negligence of the opposite parties. The opposite parties have not placed any record to support the contention that the deceased was suffering from virulent bacteria which had spread to her entire body. It is further pleaded by the learned Counsel for the complainant that the deceased died because of highly negligent and lackadaisical approach of the opposite parties as they failed to show the kind of urgent and earnest approach as required in the case of deceased despite knowing her medical history and after her death trying to cover up true facts by misusing their expertise.
Learned Counsel for the opposite parties argued that the allegations of carelessness, negligence and deficiencies in services levelled against the opposite parties are absolutely baseless, unsubstantiated and without any specific medical evidence and are based on conjectures only and the patient was given the best possible and appropriate treatment/advise as and when required. Learned Counsel submitted that in the year 2004, the patient had the adverse effect of long standing diabetes in the form of Neuropathy (damage to Nerves), Nephropathy (kidney damage), Retinopathy (damage to Retina) and hypertension (damage to blood vessels and heart), which by passage of time in their natural course only deteriorate withstanding treatment. It is further submitted that diabetic patients such as the deceased, are at very high risk of developing serious infections even with minor trauma. Certain external features such as fever and pus may not be present even when the infection is established. The low Hemoglobin, high leucocytes count with predominantly neutrophils and raised ESR, they are all suggestive of underlying infection. Diabetic patients are immunocompromised and may not display the usual signs and symptoms of fever and pus unlike relatively health humans, inspite of underlying serious systemic infection. It is further submitted that in medical terms, CELLULITIS means INFECTION OF THE FLESH. Diabetic patients may not show features similar to an apparently health individual as already explained. The examination of would suggested the possibility of pus collection, which required further investigations for which she was admitted. It is submitted that breathlessness in the patient is indicative of wide spread infection of excess fluid in the body. Antibiotics, insulin and other treatment were duly given by the Senior Residents in the ward in direct consultation with their consultants who had visited the patient on their routine round and as and when required. The decision to shift the patient to Endocrinology ward was a medical one, as the focus of treatment was not surgical but medical and it was done as soon as feasible. Inspite of the best Antibiotics and supportive care, the patient unfortunately succumbed to extensive infection called Sepsis or Septicaemia in medical terms but her treatment was being administered by the Senior Residents who were in constant touch/communication with the opposite party nos. 2 and 4, who were guiding the management. It has further been argued that the computer generated death summary is the death Summary which is :8: available with the Death Certificate with the patient's attendants and it carries all information whereas a detailed Death Certificate goes in to the patients records, which are prepared by the Senior Residents after the patient's death. The third alleged death summary is actually the case summary which was provided under RTI. The blood pressure/pulse were stable on admission in the presence of swollen foot without overt pus in no way negate the presence of infection which was correctly suspected and promptly managed by the consultants and was subsequently confirmed by pathology reports that showed infection with virulent bacteria. She was not at all normal. The Senior Residents working in the Institution are posted as MD/MD Residents undergoing training in super-speciality. These residents cannot be termed as inexperienced. As per routine policy of most hospitals all over the world, trained nurse and Senior Residents/Junior Residents depending upon hospital structure, manage the patient 24 hours a day while consultants come for regular rounds and as and when needed and they are also readily available on phone 24 hours and also in this institution, the authorities are taking proper and attentive care of the patients. The complainants have failed to demonstrate the illegality/deficiency in service, therefore, the present case is liable to be dismissed at the threshold.
Looking in to the entire facts and circumstances of this case and after hearing of both the parties, we have found that The deceased Mrs. Sudha Verma was a known case of type-2 diabetes mellitus for around 10 years. Type 2 diabetes occurs when insulin that the body produces is less efficient at moving sugar out of blood stream. Some sugar is moved out of the blood, just not as effectively compared to a person with normal insulin efficiency which results in High Blood Sugars. Diet, exercise weight loss and possible medication are treatment for this type of diabetes. The deceased was admitted for endocrinology in 2004 for initiation of insulin thereby for glycenio control. She was diagnosed to have diabetic neuropathy, nephropathy, retinopathy and hypertension which are common effects of long term diabetes. On the said occasion she was discharged on insulin. The deceased suffered needle prick in the sole of her left foot for around 10 days before her death i.e. 9/10-04-2011 due to which swelling and redness has occurred in the effected area. On 20-04-2009 deceased approached endocrinology department of opposite party no.1. Diagnosis was made for left diabetic foot with cellulites and fundus examination (direct opthalmoscopy) test was suggested. The examination of the tissue suggested presence of bacterium klebsiella pueumoniae and enterococcus facealis. The deceased was put on conservative treatment of antibiotic (pipzo) through i.v. At the time of admission. there was no pus deposit as swelling in the affected foot and only redness was found, In the morning of 21-04-2009 the deceased complained of breathlessness even at the rest.. The condition of the deceased was reviewed by Dr. :9: Vijay Bhasker Reddy, Senior Resident and on examination deceased was found to be having features of volume overload. At around 8.00 p.m. the deceased was shifted to endocrinology department under opposite party no.2 as the condition of the deceased further deteriorated.
In this regard the case and contention of complainant that the deceased was not having fever nor there was any pus collection in the affected area being there found her Haemoglobin to low (8.2 gdl. Reference range female 11.7) the total leucocytes, neotrophills and erythorocycle sedimentation rate to be on higher side, marking the infection level that infection was only localized and had not spread and the complainant tried to convince the opposite parties no.2 and 4 but none of them visited the deceased, the deceased was left in the hands of Senior Resident and Nurses who could not manage the treatment and the negligence on the part of hospital and the doctors remained a writ large do not seem convincing in the light of the facts that the allegations of carelessness, negligence and deficiencies in services levelled against the opposite parties are unsubstantiated and without any specific medical evidence while as per opposite parties the patient was given the best possible and appropriate treatment/advise as and when required. The patient had the adverse effect of long standing diabetes in the form of Neuropathy (damage to Nerves), Nephropathy (kidney damage), Retinopathy (damage to Retina) and hypertension (damage to blood vessels and heart) since the year 2004, which by passage of time in their natural course only seems to deteriorate withstanding treatment. Diabetic patients such as the deceased are ever at very high risk of developing serious infections even with minor trauma. These contentions of the opposite parties may not be ruled out without any medical expert opinion adverse. Certain external features such as fever and pus may not be present even when the infection is established and the low Haemoglobin, high leucocytes count with predominantly neutrophils and raised ESR are all suggestive of underlying infection. Diabetic patients are immunocompromised and may not display the usual signs and symptoms of fever and pus unlike relatively health humans, inspite of underlying serious systemic infection. In medical terms, CELLULITIS means INFECTION OF THE FLESH. Diabetic patients may not show features similar to an apparently health individual. The examination would have been suggested the possibility of pus collection, which required further investigations and for which she was admitted and breathlessness in the patient was indicative of wide spread infection of excess fluid in the body.
Antibiotics, insulin and other treatment are found duly given by the Senior Residents in the ward in direct consultation with their consultants who had visited the patient on their routine round and as and when required. The decision to shift the patient to Endocrinology ward was a medical one, as the focus of treatment was not surgical but medical and it was done as soon as feasible as is submitted by the :10: opposite parties and in spite of the best Antibiotics and supportive care, the patient unfortunately succumbed to extensive infection called Sepsis or Septicaemia in medical terms. The treatment was being administered by the Senior Residents who were in constant touch/communication with the opposite party nos. 2 and 4, who were guiding the management. The Senior Residents working in the Institution are posted as MD/MD Residents undergoing training in super-speciality. These residents cannot be termed as inexperienced. As per routine policy of most hospitals all over the world, trained nurse and Senior Residents/Junior Residents depending upon hospital structure, manage the patient 24 hours a day while consultants come for regular rounds and as and when needed and they are also readily available on phone 24 hours and also in this institution, the authorities are taking proper and attentive care of the patients. The complainants cannot claim any illegality/deficiency in service in the given circumstances and facts of this case and they have failed to demonstrate it by way of any expert opinion required in such type of cases.
Hon'ble Supreme Court has held in the case of Ramesh Chandra Agrawal v. Regency Hospital Ltd., (2009) 9 SCC 709 in reference to expert evidence, when called for and test for issues involving medical science that test is whether matter is outside knowledge and experience of a layperson. Where a medical issue is to be settled, scientific question involved therein is assumed to be not within court's knowledge and hence there is a need to hear expert opinion. Since medical science is complicated, expert opinion provides deep insight. Where diagnosis and the method of treatment suggested to a patient vary, held, expert opinion forms an important role in arriving at a conclusion.
Hon'ble Supreme Court held in the case of Malhotra v. Dr. A. Kriplani, (2009) 4 SCC 705 regarding need of expert opinon for medical negligence that where statements made by respondent doctors neither rebutted nor appellant leading evidence of any expert doctor and where it was not the case of appellant that doctors were not qualified and specialized and all the doctors who treated patient were skilled and duly qualified specialists in their respective fields and tried their best to save the patient's life and performed their professional duties as a team, there is no case made out of negligence or deficiency in service.
In the case of Vinitha Ashok v. Lakshmi Hospital, (2001) 8 SCC 731 at page 746, Hon'ble Supreme Court has held as follows;
33. After considering the effect of all these decisions, this Court in Achutrao Haribhau Khodwa case [(1996) 2 SCC 634] held as follows: (SCC pp. 645-46, para 14) "14. The skill of medical practitioners differs from doctor to doctor. The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be slow in attributing negligence :11: on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. Medical opinion may differ with regard to the course of action to be taken by a doctor treating a patient, but as long as a doctor acts in a manner which is acceptable to the medical profession and the court finds that he has attended on the patient with due care, skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence."
In the light of aforesaid law, we are of this view that in this case whatever may be the alleged three death summaries in this case provided by the opposite parties to the complainants and whether the computerised death summary is authentic or others should be considered, we need not to go through those death summaries as the doctors acted in a manner which is not acceptable to the medical profession has not been the case of the complainants proved on record by medical expert opinion and we find that doctors attended on the patient with due care, skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence.
Hence we find no substance in this case which deserves to be dismissed.
ORDER The aforesaid complaint is hereby dismissed accordingly.
( JUSTICE VIRENDRA SINGH ) PRESIDENT ( J N SINHA ) MEMBER Pnt.
[HON'BLE MR. JUSTICE Virendra Singh] PRESIDENT [HON'BLE MR. Jitendra Nath Sinha] MEMBER