State Consumer Disputes Redressal Commission
E. Shantha Kumari W/O Late M.R. Eshwaran vs Apollo Hospitals, on 16 September, 2022
BEFORE THE TELANGANA STATE CONSUMIER DISPUTES
REDRESSAL COMMISSION:HYDERABAD
C.C.2/2015
Betwoen
1.EShantha Kumari , W/o.late M.R.Eshwaran,
Aged 49 years, Oce: House Wife, R/o.Plot No.36,
Huda Colony, Chandanagar, Serilingamally Mandal,
Ranga Neddy District 500 050,
2. M.E.Sowmya,D/o.late M.R. Eshwaran,
Aged 23 years, Oce:Student, R/o.Plot No.36,
Huda Colony, Chandanagar, Serillingampally Mandal,
Ranga Reddy District 500 050,
3. M.E.1arun, S/o.late M,R,Eshwaran,
Aged 18 years, Occ: Student, R/o.Plot No.36,
Huda Colony, Chandanagar, Serillingampally Mandal,
Ranga Reddy District 500 050.
-
Complainants
And
1.Apollo Hospitals, Rep. by its Chairman cum
Managing Director, Jubilee Hills, Hyderabad 500 096.
2. Dr.Rajnesh Chander Reddy. B, S/o.not known, Major,
Occ:Medical Profession, Apollo Hospitals,
Jubilee lills, Hyderabacd - 500 096.
3. Dr.Ravindra Babu k, S/o not known, Superintendent &
Consultant Major, Occ:Medical Profession, Apollo Hospitals,
Jubilee Hills, Hyderabad - 500 096.
4. Dr.Santosh. K, S/o.not known , Major,
Occ: Medical Profession, Apollo Hospitals, Jubilec Hills,
Hyderabad - 500 096.
5. Dr. C.Rajesh Reddy, S/o.not known,Major
Oc: Medical Profession, Apollo Hospitals, Jubilee Hills,
Hyderabad - 500 096.
6. Dr.Shekhar Reddy. G, S/o.not known , Major,
Occ: Medical Profession, Apollo Hospitals, Jubilee Hills,
Hyderabad - 500 096.
7. Dr.Rabindra Nath Mehrotra, S/o.not known, Major,
Occ: Medical Profession, Apollo Hospitals, Jubilee Hills,
Hyderabad 500 096.
Opposite parties
Counsel for the Complainant :M/s.S.s.Prakash
Counsel for the Opposite Parties: M/s.Indus Law Firm-
OP. Nos.1,2,3,5,6 8 7.
M/s.M.V.Durga Prasad-OP.No.4
2
cORAM: Hon'ble Sri Justice M.S.K. Jaiswal, President.
And
Hon'ble Smt. Meena Ramanathan, Lady Member
FRIDAY, THE SIXTEENTH DAY OF SEPTEMBER, TWO THOUSAND TWENTY TWO.
Order: (Per Hon'ble Smt. Meena Ramanathan, Lady Member) ****
1. This is a complaint filed by the Complainant under Section 17(1)(a)i) of the Consumer Protection Act, 1986 praying to direct the opposite parties to pay Rs.95 lakhs towards compensation and to award costs
2. The brief facts of the case are as follows:
The present complaint is filed by the complainant no.1 being the wife of the deceased M.R.Easwaran and complainants 2 and 3 are his daughter and son aged 23 years and 18 years respectively. It is submitted that M.R.Easwaran was called for a Colonoscopy Test on 20.9.2012 at about 12 noon. Although his appointment was given, he had to wait for about 3 hours for his turn and finally he underwent the test in the presence of the doctors of the opposite party no.1. The complainants further add that within minutes of conducting the test, the nurses and staff came out in anxiety and rushed to get a fresh oxygen cylinder. During this period, the patient- M.R.Easwaran lost consciousness and slipped into coma and never recovered. Although he was on ventilator under the care and custody of the opposite parties for 116 days, he passed away on 14.1.2013.
The complaint is filed against the acts/omission of the doctors of the opposite party no.1 and their careless attitude and management. For this gross negligence, they are seeking adequate compensation and costs of litigation.
3. Opposite parties 1 to 3 and 5 to 7 filed their written version with the following submissions:
The patient M.R.Easwaran, aged 53 years was a known case of diabetes and hypertension and under treatment since 8 years. He was admitted in the hospital on 18.9.2012 with complaints of abdominal pain for the last 45 days and that he also had two episodes of vomiting on the day of admission. Upon examination, the 2nd opposite party advised him for further evaluation and treatment. It was found that the patient had tenderness in the right hypochondriac region and was advised CT Abdomen. For further evaluation a colonoscopy was necessary to obtain biopsy from the bowel loops, for confirming the diagnosis.
On 20.9.2012 pre procedural clinical evaluation was conducted and the patient was sedated. Within few minutes of starting the colonoscopy, there was a sudden fall of heart rate and blood pressure Patient was shifted to Intensive Care Unit for further management. It was concluded that the patient had severe hypoxic encephalopathy and the prognosis for recovery was poor and the same was explained to the family members.
It is incorrect to state that the procedure was carried out without prior evaluation and it was ensured that the patient's condition was conducive for colonoscopy He was thoroughly examined under proper pre procedural evaluation conducted by the Anaesthesiologist and Gastroenterologist. The sudden Bradycardia and Hypotension resulted in decreased blood supply to the brain resulting in hypoxic encephalopathy. With these the complaint as emphatic denials, the opposite parties claim, devoid of any merits or substance and pray for its being dismissal.
version submitting that
4. Opposite party no.4 filed his written he is a consultant Endocrinologist in opposite party no.1 hospital and also has an independent practice. He submits that he has the had no play in the general treatment accorded to role to the complainant or in the decision making for conducting colonoscopy procedure. He was only consulted for the diabetic.
management of the blood sugar since the patient was a There is absolutely no complaint of grievance with regard to the findings about the blood sugar. Therefore, the action of the a callous and complainants in dragging everybody shows irresponsible attitude and the complaint is filed without verilying the basic facts.
5. On behalf of the complainants, Evidence Affidavit of and Exs.A1 to A14 marked on behalf of complainant no.1 filed them. On behalf of opposite purtics 1,3 and 5 to 7,Dr.A.Ravindra Babu, Mcdical Superintendent of M/s.Apollo Hospital opp.purty no.3 filed Evidence Affidavit and addl evidence uffidavit. Evidence Afidavit of opp.purtics nos.2 und 4 filed. Exs.131 to 34 are marked on behall of the opposite purtics. Written Arguments of the complainants filed.
. The points that arise for consicleration arc:
i). whether there is deficicncy in servicc on the part of the oppositc partics?
ii). If yes, whether the complainants are entitledd to the reliefs claimed for and what is the cquuntum of relief to be gruntecd?
7. The admitted facts are as follows:
T h e deceased patient Mr.Eashwaran was 53 ycars old and admitted in opposite party no.1 hospital on 18.9.2012.
H e had been suffering from abdominal pain for 45 days prior to admission and also had two episodes of vomiting on the day of admission.
For a proper diagnosis, he was advised to undergo a Colonoscopy and pre procedural evaluation was done by Dr.Ramakrishna (Castroenterologist) & Dr. Manjula . The Colonoscopy procedure was started and there was a sudden fall of heart rate and blood pressure. Thc colonoscopy was withdrawn and cardiopulmonary resuscitation was initiatcd.
The patient was shifted to intensive care unit for further management and he died on 14.1.2013.
8. It is the complainants' grievance that the doctors/opposite parties planned and conducted the colonoscopy without considering the condition of the patient. On the morning of 20.9.2012 the blood pressure of the patient/deceæsed was low and he was on saline support for 4 days prior to 20.9.2012 They reiterate that the opposite parties are liable for the patient sullering from cardio pulmonary arrest and hypoxic ischemic encephalopathy. Their negligence caused the death of the patient and they have filed Exs.A1 to A14 in support of their case.
9. A thorough study of the evidence on record reveals the following information and we have re-connoitered the facts and circumstances to arrive at the conclusion.
The patient/deceased was only 53 years 1 month 8 days old at the time of admission vide Ex.A1. The name of the consultant on the admission Card is Dr.Rajncsh Chander Reddy oPposite party no.2. As per Ex.A2 patient history and physical record reveals the following details.
Pain in abdomen for 1% months and is a known case of diabetes and HTN for the last 8 years. The list of medication taken by the patient/deceased is recorded on page 12 of Ex.A2 (which corresponds to Ex.B4) and is reproduced below.
T. Losan-H T.Ecosprin T.Atorvas T.Glycemnet T.Glyciphage GP T.Pioz"
Patient was admitted on 18.9.2012 at about 4 p.m. and apart from the fact that he was sufering from pain in the abdomen, rest of the patient assessment does not reveal any aspect of concern. His B.P. recording is quite normal and he did not exhibit any psychiatric symptoms of anxiety or agitation either. The Nutrition Assessment Form has only underlined the symptom of "Persistent vomiting" and no other impairments are noted.
10. The complainants have also stressed on the point that the deceased had undergone a colonoscopy on 29.8.2012 and the report is filed vide Ex.A4. This was conducted at Mediciti Hospitals and to subject the patient to undergo one more similar procedure within such a short duration was quite unnecessary and unfair on the part of the opposite parties. This exhibit reveals the impression that the patient had a "Deminutive sigmoid polyp".
When the patient consulted opposite party no.2 in his Out Patient Department, the evidence allicdavit iled by the opposite parties elearly contends that "On exumination patient had tenderness right hypochondriac region, the ultrasound abdomen revealed distended thickened (Gall Bladder, Patient was advised CT abdomen with contrast which reveals thickening of ceacum and terminal ilial loops, moderate ascities, which warrants colonoscopy for internal visualization of the affected bowel for biopsies which would lead to the diagnosis. Paticnt was administered IV fuids, pain killers, anti hypertensive, anti diabetic, untibiotic and other supportive medications. It is pertinent to mention at this juncture that there was no alternative than colonoscopy to obtain biopsy from the bowl laops involved for confirming the diagnosis Colonoscopy was suggested by the 2nd opposite party alter seeing the patient as well as the reports. The said line of treatment was also approved by Dr.Ramakrishna, Gastroenterologist."
11. The patient had just undergone a similar procedure and the impression recorded is "Deminutive sigmoid polyp". This impression requires to be understood and also why did the opposite parties ignore this report and conduct a similar investigation on the patient?
A polyp in the colon is a projection (growth) of tissue from the inner lining of the colon into the lumen (hollow center) of the colon. Polyps are normally benign but can be thought of as precancerous, which is why it is important to have it removed.
At the time of undergoing the procedure on 29.8.2012 the polyp was not biopsied and the report filed as Ex.A4 does not provide any other information about the growth pattern. The most important point to be considered is that the deceased's polyp was not removed and the next colonoscopy was not determined.
12 The complainants took their husband/father to opposite party no. 1 hospital on 18.9.2012 and the Death Summary filed as Ex.A10 states that patient was presented with History of abdominal pain since 45 days. History of vomiting 2 episodes History of past illness only refers to diabetes and hypertension and physical examination was satisfactory. It is also noted that the patient had 'No known drug allergies' On 20.9.2012- the discussion on "MEDICATION RECONCILIATION" is reproduced to comprehend the complication that occurred during the colonoscopy:
n the endoscopy suite on 20 th September patient was taken up for colonoscopy under monitored anesthesia care. Patient condition remained stable. During the procedure patient developed brady arrhythmia and hypotension. Brady arrhythmia further worsened inspite of all efforts and cardiopulmonary resuscitation was initiated".
In their Evidence Affidavit, the opposite parties have contended that there was no alternative than colonoscopy to obtain biopsy from the bowel loops to confirm diagnosis. They have also stated in the Evidence Afidavit that within two minutes of starting the Colonoscopy, there was a sudden fall in heart rate and blood pressure. However, they have failed to provide any reasonable explanation as to why the patient/deceased developed Brady Arrhythmia and Hypotension when the physical examination only revealed the patient's condition as 'stable' .
13 The patient was not very old only 53 years when he underwent the procedure. One of the main Concerns with performing colonoscopy on elderly patients is the potential for increased risk of complications. Adverse events are typically categorised as those occurring during or immediately after the procedure. Cardio pumonary complications are the most common peri-procedural adverse events. The level of sedation, presence of co-morbidities and procedure length and complexity, all contribute to the risk and should have been addressed to the extent known during pre-procedural planning, especially for elective colonoscopies. The opposite parties have failed to provide the reason or any valid explanation as to why the patient developed these complications as soon as the procedure commenced.
14. During Colonoscopy, the level of sedation related complications, once occur can lead to significant morbidity and occasional mortality in patients. The risk factors of these complications include the type, dose, mode of administration of sedative agents, as well as the patient's age and underlying diseases. In the instant case, the patient was not very aged, nor did he have any serious underlying disease as evidenced vide Ex.A2 and deep The complications attributed to moderate sedation levels are more often associated with cardiovascular and discussed the respiratory systems. The opposite parties have only treatment provided to the patient after the colonoscopy procedure was interrupted, but have very carefully circumvented referring to the reason as to why the procedure was so abruptly interrupted. They have failed to provide the proper pre-operative assessment by the anaesthesiologists. The opposite parties failed to evaluate that cardio respiratory problems which could occur during the GiE procedure should have been elicited and identified as risk factors in the pre-admission process. Safety monitoring should be an intrinsic part of quality assurance programme for endoscopic units.
15. It is our considered view that sedation-related complications which rarely occur during the GIE procedure caused the untimely death of the patient. The opposite parties could have prevented this complication by taking a relevant medical and drug history before the procedure with particular detail since tlhe patient was diabetic and hypertensive. Patients with mild hypotension, with co-morbidities, should be carefully sedated. Prevention of complications in the first place is the best form of management. It is also the professional responsibility of health providers to prevent the avoidable risks by following standards for sase sedation. We find the opposite parties have not followed the appropriate pre-sedation assessment and preparation of the patient. There were so many skilled professionals/doctors involved, yet proper optimisation of their skill is sadly lacking and the patient suffered for approximately four months in a vegetative state and eventually died on 14.1.2013. He was deeply comatose and required prolonged ventilator support and paid a very high price for undergoinga routine colonoscopy.
16, The voluminous records submitted by the opposite parties have been perused and pertain to the treatment provided to the patient subsequent to the procedure which caused the cardio in the instant case is the pulmonary attack. The requirement reason that caused the patient to slip into a coma and the records submitted only support the prolonged treatment provided to the patient who was in a vegetative state. The records and material submitted pales into insignificance and does not provide any material evidence in the defence of the opposite parties
17. Considering all these facts and the foregoing discussion we find that there is deficiency in service and negligence on the part of the opposite parties and they are liable to compensate the complainants for the death of their husband/ father. Only opposite parties 2,3,5,6 &7 are liable and the 1st opposite party is vicariously liable for the acts of the above mentioned opposite parties.
18. In the the following result, complaint is allowed on terms:
i). the opposite parties 1 to 3 and 5 to 7 are jointly and severally directed to pay to the complainants a sum of Rs. 15 lakhs as compensation along with costs of Rs.15,000/-
i). Time for compliance is 2 months, failing which, the amount granted as compensation will carry an interest @ 7% p.a.