State Consumer Disputes Redressal Commission
1. Jana Swarnalatha W/O Late Jana ... vs 1. Dr.K.Anjani Kumar, M.D. And Another on 3 August, 2010
BEFORE THE A BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD. F.A.No. 552 OF 2007 AGAINST C.D.NO.15 OF 2004 DISTRICT CONSUMER FORUM NELLORE Between 1. Jana Swarnalatha W/o late Jana Srinivasulu Aged about 48 years, 2. B.Kavitha D/o late Jana Srinivasulu, aged about 29 yrs 3. Jana Surekha D/o late Jana Srinivasulu, aged about 25 yrs 4. Jana Venkata Sukumar S/o Jana Srinivasaulu aged about 22 years (All are R/o H.No.16/III/735, IIIrd Street Haranadhapuram, Nellore) Appellants/complainants A N D 1. Dr.K.Anjani Kumar, M.D. (Cardiology) Medical Practitioner Hindu, aged about 47 yrs, Sai Chandana Hospital Heart & Pediatric Care Centre H.No.16/953, Somasekharapuram Opp.Kalyani Films, Nellore 2. Dr.A.V.Sudhakar Rao Medical practitioner as lung Specialist Hindu, aged 47 years, R/o Raghava Cine Complex, Road, Pogathota, Nellore Respondents/opposite parties Counsel for the Appellants Sri V.Gourisankara Rao Counsel for the Respondents Sri V.Sreenivasa Rao QUORUM: THE HONBLE SRI JUSTICE D.APPA RAO, PRESIDENT & SRI R.LAKSHMINARSIMHA RAO, HONBLE MEMBER
TUESDAY THE THIRD DAY OF AUGUST TWO THOUSAND TEN Oral Order ( As per R.Lakshminarsimha Rao, Member) *** The unsuccessful complainants are the appellants.
The facts leading to filing of this appeal are that the complainant no.1 is the wife, complainants no.2 and 3 are the daughters and the complainant no.4 is the son of late Jana Srinivasulu. On 8.1.2002 the husband of the complainant no.1, Jana Srinivasulu got admitted in the opposite party no.1 hospital due to breathlessness. The opposite party no.1 after examining the patient opined that the problem may be with the lungs and called the opposite party no.2 who after examining the patient stated that the problem was not with the lungs but it is not for the heart. The patient was in the hospital from 9.1.2002 till 11.1.2002 but the opposite parties could not detect the main problem of illness. As the condition of the patient deteriorating the complainants shifted him to Bollineni Super Specialty Hospital, Nellore where after careful examination of the patient the doctors opined that the patient consumed poison and condition of the patient was critical. The doctors at Bollineni Hospital expressed their opinion that as the patient did not receive proper treatment prior to his admission in Bollineni Hospital the condition became critical. The patient while undergoing treatment in the hospital died on 18.1.2002.
The case of the complainants is that the opposite parties instead of giving treatment for complications due to poisoning, they have treated it as a pediatric problem and lungs problem and due to wrong diagnosis and treatment the patient was died. The complainants had spent Rs.35,000/- at the hospital of the opposite party no.1 and Rs.50,000/- at Bollineni Hospital. The IV town P.S. Nellore registered a case in Cr.No.18/2002 u/s 174 Cr.P.C. An inquest was conducted over the body of the wife of the 1st complainant and the mediators opined that the deceased died due to lack of proper treatment at the hospital of the opposite partyno.1. The complainants got issued legal notice dated 28.7.2002 and the same was received by the opposite parties but they did not respond. Hence, the complainants filed the complaint before the District Forum seeking direction to the opposite parties to pay Rs.9 lakhs under different heads mentioned in the complaint.
The opposite parties filed counter admitting that on 9.1.2002 the deceased husband of the complainant no.1 was brought before the opposite partyno.1 hospital for treatment but denied that the deceased first treated by the opposite party no.1. The opposite party no.2 was treated him and diagnosed that there was no problem with the functioning of respiratory system of the deceased but opined that there restlessness of the deceased and also difficulty in breathing might be a cardiac problem. Hence, without any delay the opposite party no.2 immediately referred the deceased for treatment to the opposite party no.1. The opposite partyno.1 treated him and found that the deceased was not suffering from cardiac problem. As the patient condition was not at all improving and also showing some manifestation relating to cardiac problem creating a doubt that there might be hidden cardiac problem and hence the opposite party no.1 opined some more tests were to be conducted to rule out any remote possibility.
The case of the complainant is that both the opposite parties failed to diagnose that the cause of death of the deceased was due to consumption of poison by him. But nobody gave case history of poisoning. The correct diagnosis can usually be established by the history, physical examination etc. The history should include the name and amount of poison, time and first air measures provided and also the medical and psychiatric history.
In the absence of history and denial of poisoning consumption by the deceased by the complainants and their relatives, it is difficult to investigate for problems of poisoning. Another important factor which could help in diagnosing poisoning is physical examination of the patient. If it is a poisonous case, the patient should smell poison, subjected to vomiting, fear, problems inCardio-pulmonary system, neurological status, pulse, BP and temperature. But no smell emanated from the person of the deceased and vomiting and motions were also not there.
As the condition of the deceased was not improving, the opposite party no.1 in consultation with the opposite party no.2 called for Mr.Osman Shariff, M.S., ENT Specialist and he ruled out the possibility of ENT problem and Dr.S.Bhaskar, Anesthetist was requested to attend on the deceased. He intubated the patient for connecting him to ventilators. As the deceased husband of the complainant no.1 was alcoholic, smoker, diabetic and known asthmatic patient, the opposite parties also thought that the deceased might have consumed spurious liquor and to treat it medicines like Basix and Mannitol broad spectrum of antibiotics were used as a measure of abundant care and caution.
Thereafter when the opposite parties thought of conducting some tests to detect poison, the complainant no.1 with the consultation of their relatives and specialists shifted the deceased to Bollineni Hospital in the ambulance. The deceased was given best possible life supporting treatment based on symptom and utmost care was taken even during shifting him to the higher centre. The problem of the deceased was diagnosed as ARDS etc., as stated in discharge summary.
The complainant no.1 encashed two insurance policies for Rs.10,000/- and Rs.15,000/- of her deceased husband.
Hence, the opposite parties prayed for dismissal of the complaint.
In support of their case, the complainant no.3 was examined as PW3 and two doctors, Dr.K.Mallikarjuna and Dr.D.Chandrasekhar Reddy were examined as PWs1 and 2 while Bandla Ravi was examined as PW4.
Exs.A1 to A16 had been marked.
The opposite parties have not adduced oral evidence nor any documentary evidence.
Majority members of the District Forum dismissed the complaint while the Member, Sri C.P.Suresh has allowed the complaint awarding an amount of Rs.1,00,000/- with interest and costs holding that the complainants were entitled to the relief on humanitarian grounds.
The points for consideration are:
1) Whether the opposite parties failed to do proper diagnosis while treating the husband of the complainant no.1?
2) Whether the opposite parties negligently treated the deceased husband of the complainant no.1?
3) To what relief?
POINTS NO.1 & 2 It is the version of the complainants that the deceased Jana Srinivasulu suffered from breathing problem on 9.1.2002 and he was rushed to the hospital of the opposite party no.1 and the opposite party no.1 summoned the opposite party no.2 for check up and diagnosis of the problem of the patient. Both the doctors failed to diagnose the problem. The patient was shifted to Bollineni Super Specialty Hospital where it was declared that the patient consumed poison and he was not properly treated prior to his admission Bollineni Hospital. The patient died on 18.1.2002. The opposite parties denied any negligence on their part and stated that the attendants of the patient had not given the details of the ailment of the patient as also history of the patient.
PW1 Dr.K.Mallikarjuna deposed that he had treated the patient for lung related problem and he is not an expert in treating the poison cases. In his cross-examination he has stated that it is very difficult to detect the cases of poison without revelation of the cause either by the patient or his attendants as held by the authors, Mody J.A. Henry and H.M.Wiseman.
In the discharge of summary of Bollineni Super Specialty Hospital, it is noted that the patient was brought for management of evaluation of unconscious state due to unknown cause.
A chest physician has examined the patient and came to the conclusion that the patient might be suffering from OP Poisoning or Aspiratory pneumonia. The contention of the opposite parties is that the patient and his attendants had not revealed his history nor the fact that the patient had consumed poison. In Bollineni Hospital also initially PW1 came to conclusion that it might be a case of consuming poison or the aspiration pneumonia. At this stage it appears also the attendants of the patient had not revealed the fact to the PW1 that the patient consumed poison.
In his evidence PW4 wrongly numbered as PW6, Bandla Ravi has stated that the deceased was husband of his elder sister. He has stated in the cross examination in the absence of PWs1 and 2 my relative handed over the pesticide bottle to the Jr.Doctor of Bollineni Hospital. This statement of the witness has direct nexus and impact on the conclusion of PW1 that it was a case of OP Poison. Prior to that PW1 was in dilemma whether it was a case of OP poison or aspiration pneumonia and in the light of the evidence of Bandla Ramesh it can be said that he came to conclusion that it was a case of OP Poisoning and referred the patient to PW2. As the information was furnished to a junior doctor PW1 might not have the direct knowledge of the fact. However, in the circumstances, PW2 has his own doubts whether it was a case of unknown poising with shock or aspiration pneumonia.
PW1 has stated that in Sai Chandana Hospital of opposite party no.1 the deceased was suffering from high blood pressure and this fact has direct bearing on the diagnosis of the patient by the opposite parties no.1 and 2 that the deceased was hypertensive and diabetic. PW1 has, further stated that the treatment administered by the opposite party no.1 was medically sound and proper.
Dr.Chandrasekhar Reddy, PW2 treated the deceased on being referred to him by PW1. According to him the husband of the complainant no.1 died due to poising complication, shock and aspiration pneumonia. He deposed that at the time of admission of the patient in his hospital, the deceased presented unconsciousness and pupillory constriction which are the symptoms that one comes across in poisonous cases and non-poisonous cases as well. He has stated in case of non-disclosure of consumption of poison by the attendants of patient he will be given supportive treatment and specific treatment will be delayed. Further, in his cross examination, PW2 has stated there is no doubt to say that history (history means related or unrelated matter of the ailment) of the patient occupies pivotal role and most important to administer proper treatment.
In the light of evidence of the doctors PWs1 and 2 it is established that the patient or his attendants had not projected his proper profile at the time of his admission in the hospital of the opposite party no.1. Had the attendants of the patient given the correct picture depicting the consumption of poison by the patient at the time of admitting him in the hospital of the opposite party no.1, the opposite parties no.1 and 2 could have come to a proper conclusion in regard to the diagnosis of the problem and adoption of line of treatment thereof.
A doctor cannot be expected to proceed to diagnose the problem of a patient where the patient and his attendants suppressed the vital information and expect the doctor to diagnose the problem in terms of the suppressed fact relevant for adopting a particular line of treatment. The complainants and the attendants of the patient had come up with a theory of wrong diagnosis by the opposite parties no.1 and 2 despite the fact of suppressing the relevant information for the opposite parties no.1 and 2 to come to the conclusion as to the diagnosis of the problem. In the absence of the information furnishing of the consumption of poison by the patient, the opposite parties no.1 and 2 cannot be held guilty of diagnosing the problem of the deceased as ARDS and for having administered treatment adopting the procedure required there for.
The concept of medical negligence has been crystallized in Bolam Vs Friern Hospital Management Committee (1957) 1 WLR 582. It was held that a doctor cannot be said to have been negligent if he exercises the ordinary skill of an ordinary competent man of medical profession.
In Jacob Mathew vs. State of Punjab, 2005(I) Decisions Today (SC) 653 the Supreme Court held that the doctor when faced with an emergency situation ordinarily, tries his best to redeem the patient out of his suffering. He does not gain everything by acting with negligence or by omitting to do an act.
In Samira Kohli v. Dr.Prabha Manchanda, 1(2008) CPJ 56 (SC), the Surpeme Court was dealing with the situation where a doctor is or is not said to have committed negligence and rendered deficient service in administering the treatment to the patient.
It was held as follows:
A doctor is negligent if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art..Putting it the other way round, a doctor is not negligent if he is acting in accordance with such practice, merely because there is a body of opinion that takes a contrary view.
The Supreme Court held in Dr.C.P.Sreekumar vs. S.Ramanujam reported in 2009(5) ALD 93 (SC) that the decision of the doctor in choosing a particular line of treatment does not amount to medical negligence.
In the case on hand the opposite parties no.1 and 2 came to the conclusion that ARDS was the problem and the proper treatment therefor had to be administered. The two doctors PWs 1 and 2 examined by the complainant had unequivocally stated that the line of treatment adopted by the opposite parties no.1 and 2 was proper and commensurate with the attending circumstances. Hence, we find no merit in the appeal.
In the result the appeal is dismissed confirming the order of the District Forum. There shall be no order as to costs.
PRESIDENT MEMBER Dt.03.08.2010 KMK*