National Consumer Disputes Redressal
Lt. Col. Surjit Singh (Retd) vs Silver Oaks Hospital & Ors. on 3 January, 2018
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI FIRST APPEAL NO. 378 OF 2009 (Against the Order dated 12/08/2009 in Complaint No. 21/2009 of the State Commission Punjab) 1. LT. COL. SURJIT SINGH (RETD) - - 2. AMITA GUPTA AND ASSOCIATES Amita Gupta And Associates 100 Sukhdev Vihar New Delhi -110025 ...........Appellant(s) Versus 1. SILVER OAKS HOSPITAL & ORS. S/o Sector 63, SAS Nagar Mohali 2. DR. AKHIL BHARGAV Managing Director, Silver Oaks Hospital, Phase - IX, Sector 63, SAS Nagar Mohali 3. ///// ///// ///// ...........Respondent(s)
BEFORE: HON'BLE MR. DR. B.C. GUPTA,PRESIDING MEMBER HON'BLE MR. DR. S.M. KANTIKAR,MEMBER For the Appellant : Ms. Amita Gupta, Advocate For the Respondent : For Respondents No. 1&2 :
Mr. Jatin Mongia, Advocate For Respondent No. 3 :
Deleted Dated : 03 Jan 2018 ORDER
1. This first appeal has been filed under Section 19 of the Consumer Protection Act, 1986 against the order dated 12.8.2009 passed in Complaint Case No. 21 of 2009 by Punjab State Consumer Disputes Redressal Commission, Chandigarh (for short, 'the State Commission') whereby the complaint of the complainant was dismissed.
2. The brief facts:
Ms. Rashmi Singh (hereinafter referred as 'the patient') aged about 66 years of age, wife of Lt. Col. Surjit Singh (retd.) was admitted in Silver Oaks Hospital, Mohali/OP 1 under care of Dr. Akhil Bhargava/OP-2 on 12.1.2008 for the problems of loose motion and swelling of lower limbs. She was conscious and alert. On clinical examination and laboratory investigations, it was not a serious medical problem. The patient remained in the hospital upto 20.3.2008. During the treatment, on 26.1.2008 morning, she was given oxygen and later in the evening, the complainant/attendant noticed the swelling on her face and called for the duty doctor, who in turn called the specialist. On the advice of specialist, she was shifted to ICU and patient was put on life support and administered heavy doses of antibiotics. It was informed to the complainant and the attendants, that the patient had suffered renal failure, but as per her past reports, including ultrasound there was no renal problem. Thereafter, on 6.2.2008, Dr. Akhil Bhargava opined that patient had multi-organ failure and septicemia and issued a certificate that the patient's condition was critical and put on the life support. Subsequently, patient developed Coma. There was no bedsore till that stage. The patient slowly developed the hospital borne infections. No attendant was allowed in ICU, therefore, it was the duty of medical staff in the ICU to provide physiotherapy, turning the patient at intervals and to take all precautions to avoid bedsore. But, due to failure ICU staff to take proper care, the patient developed bedsores. The staff there every time told that nothing to worry, as it was a minor issue. On 12.3.2008, patient recovered from coma and she was operated on 15.3.2008 for removal of dead skin at bedsore on the lower back and patient was shifted to normal room. The bedsore cavity was nearly 5 inches in diameter and 2-3 inches in depth. On 20.03.2008, hospital informed the complainant that the patient requires only nursing care, accordingly, she was discharged on the same day. It was alleged that patient was in critical stage due to deep bedsore, which had developed in the ICU and by that time, she had already suffered memory loss because of being in coma for about 40 days.
3. The nursing care at home for the bedsore was not manageable, the patient deteriorated further, therefore, on 26.3.2008 she was taken to Command Hospital, Chandimandir. She was treated there by Plastic Surgeon and Psychologist. In May, 2008, the Military hospital performed the surgery for 3½ hours to cover the bedsore, but patient expired on 1.6.2008. The cause of death was mentioned in the death certificate was "pre-renal Azetomia with bedsore". It was alleged that due to the alleged deficiency in service and the lapses in the treatment, the patient died. The complainant filed a complaint before the State Commission, Punjab against the OPs for alleged medical negligence.
5. The OPs filed their written version and denied the negligence on their part. The OP-2 submitted that the treatment given was proper. The patient had previous history of Cancer and Diabetes. She was also a known hypertensive on medication. Previously, she had been operated for Laminectomy (Lumbar spine) and also had surgery in the right ankle. She was admitted in the hospital/OP-1 with the complaint of loose motions, increased frequency of urination with urgency, pain in lower back, region and nausea. After admission, she was examined by Gastroenterologist. For her abdominal complaints, she underwent Sigmoidoscopy and CECT of abdomen. Colonoscopy was also done with barium enema. She was also suffering from depression, therefore, physician had also seen her and started proper medication. She was treated with anti-biotics, anti-hypertensive drugs, insulin, painkillers and IV fluids, but the loose motions continued. As a preventive measure for bedsore, it was advised to change the patient on sides frequently and to clean genitalia with Savalon solution. On 26.1.2008, the patient's condition deteriorated and her investigations revealed that she was in renal failure with breathing difficulties due to chest infection. Hence, she was shifted to ICU in critical stage. She developed metabolic acidosis, hence, assisted ventilation was given. The patient's attendant's consent was taken before putting the patient on ventilator. The patient's poor prognosis was explained to the patient's attendants. During 30.1.2008 to 4.2.2008, the patient's condition was continued to be critical. She had episode of Tachycardia (fast heart rate), hence, she was given IV antiarrhythmic medication. There was leukocytosis. TLC was 29100 cmm and dearranged renal function tests as creatinine was 6.41 mg%. Her Haemoglobin was low, and therefore, she was given blood transfusion about 12 units during her stay in the ICU. Tracheostomy was performed on 5.2.2008 after obtaining the consent from the attendants, and patient's dialysis was also continued on 5.2.2008. The hospital has issued a letter certifying that patient needed further prolonged hospitalization due to multiple health ailments. The said letter was issued for obtaining permission from the Army Commandant for extension of patient's stay in the hospital as she was covered under ECHS. During the period from 6.12.2008 to 11.2.2008, the patient had showed gradual improvement. However, on 12.2.2008, she suffered cardiac arrest, she was revived by Cardio Pulmonary Resuscitation. During 13.2.2008 to 25.2.2008, she was given chest and limb physiotherapy, I/V albumin besides other supportive care. T-piece was given and the ventilator was gradually weaned off and her general condition was improved. Despite proper care and precaution by adopting standard protocol, the patient had developed bedsore, for which daily dressing and cleaning was done. The Culture test of bedsore was done on 19.2.2008, which detected Pseudomonas bacteria, accordingly, appropriate antibiotic was given from 22.2.2008. From 27.2.2008, the patient was mobilized with active limb movement, chest and limb physiotherapy.
6. Despite the care and treatment, bedsore was developed. She was also given Meropenem (higher antibiotic). On 3.3.2008, plastic surgeon advised debridement, it was done on 8.3.2008, the dead skin and tissue was removed. Proper washing with normal saline/hydrogen peroxide was done. The patient was conscious and oriented from 16.3.2008, she was decannulated and her chest was clinically clear. Therefore, the patient was shifted from ICU to the room on 18.3.2008, but so far as the treatment of bedsore is concerned, the patient was advised for daily dressing for betadine solution. As the patient was ECHS, the permission had to be taken by the complainant from the Army Commandant for every extension of stay in the Hospital. Accordingly, the doctor from OP/Hospital wrote to the commandant of the Army Hospital updating him regarding the condition of the patient and also informed that there was need for nursing care of the bedsore. In response to the letter, the Commandant asked the patient may be discharged since only nursing care was required. Also, informed that the management will be done at home and the medicines or dressing will be issued from the Military Hospital. Therefore, the patient was discharged on 20.3.2008 from the OP/Hospital in stable condition with the specific advised for bedsore dressing with Oxum and Betadine daily. Therefore, there was no negligence during treatment of patient on the part of OP/hospital from 12.1.2008 to 20.3.2008.
7. During the adjudication vide interim order dated 5.5.2009, the State Commission sought medical opinion from the Board of expert doctors at PGI Chandigarh. The State Commission on the basis of expert opinion and affidavit evidences, dismissed the complaint. Being aggrieved by the dismissal, the complainant filed the instant appeal.
8. We have heard the arguments from both the parties. Learned counsel for the appellant complainant vehemently argued that, it was gross negligence committed by OP/Hospital. The treating doctor of hospital has not taken proper care in the ICU, therefore, the patient developed large bedsore, which went on increasing and became uncurable. Because of bedsore only, the patient developed other multiple problems and succumbed to death. It was due to the deficiency in service from OPs.
9. The arguments on behalf of the respondent/OP that, the hospital and doctor therein treated the patient with care and as per standard of practice. Counsel reiterated the evidence which was filed before the State Commission.
10. I have thoughtfully considered the arguments advanced by the counsel of both the parties and also perused the entire medical record alongwith relevant medical literatures from the textbooks of surgery. It is an admitted fact that the patient was 66 years old having multiple health problems. She was previously operated for breast cancer and underwent radiotherapy. She was hypertensive, and also was suffering from Urinary Tract Infection, Type II Diabetes, respiratory failure, acute renal failure, hyponatremia and septic shock. Pulmonary thromboembolism was also suspected. As, patient was admitted with loose motion and edema over the leg, OP treated the patient with multiple anbitotics. Patient was given further dialysis and respiratory support. As the patient was comatose for a month and further bedridden for long period, led to development of bedsore. The bedsore can be avoided with intensive nursing care by frequent change of posture and mattresses but, even with the best efforts, it was difficult to prevent bedsore in the seriously ill patient. On perusal of medical record, it is clear that during the hospitalization, the patient including bedsore was properly treated as per standard norms. The Board of Experts from the Director, PGI, Chandigarh opined that 'patient was seriously sick and the treatment provided was appropriate'. Therefore, there was no deficiency in treatment or negligence on the part of OPs.
11. The Hon'ble Supreme Court in number of cases had discussed about the elements of medical negligence. I would like to rely upon the judgment Dr. Laxman Balkrishna Joshi (Dr.) Vs. Dr. Triambak Bapu Godbole, AIR 1969 SC 128, it was held that a doctor when consulted by a patient owes him certain duties. It has held as under:
A person who holds himself out ready to give medical advice and treatment, impliedly undertakes that he is possessed of skill and knowledge for the Purpose.Such a person when consulted by a patient, owes certain duties, namely, a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give, and a duty of care in the administration of that treatment.
In the instant case, the OP/doctor has not deviated from his duties and there was no failure of duty of care. The treatment was given to the patient, as per clinical assessment and after proper investigations.
11. On the basis of foregoing discussion, I do not find any negligence on the part of OP/hospital. I, therefore, do not find any infirmity, illegality in the well reasoned order passed by the State Commission and the same is upheld. The present appeal is ordered to be dismissed. There shall be no order as to costs.
...................... DR. B.C. GUPTA PRESIDING MEMBER ...................... DR. S.M. KANTIKAR MEMBER