State Consumer Disputes Redressal Commission
Sal Hospital And Medical Institute vs Shri Ashokbhai Shah on 21 October, 2020
BEFORE THE CONSUMER DISPUTES REDRESSAL COMM ISSION
GUJARAT STATE AT AHMEDABAD.
APPEAL NO. 87 of 2009 Dt: 21.10.2020
1.Sal Hospital & Medical Institute Door Darshan, Drive-In Road, Thaltej, Ahmedabad. ...Appellants (Orig. Opp. No.1)
2. The Oriental Insurance Co. Ltd.
(Divisional Office-V)
At C/30-6,
Amrutjayant Bhavan,
Second Floor, Ashram Road,
Ahmedabad. (Orig. Opp. No.3)
Vs.
1. Shri Ashokbhai Shah
502, Neeldip Tower,
Navrangpura School Circle,
Navrangpura,
Ahmedabad. ...Respondents
(Orig. Comp. No.2)
2. Consumer Education and Research Society,
„Suraksha Shankul‟,
Ahmedabad- Gandhinagar Highway,
Ahmedabad. (Orig. Comp. No.1)
3. The oriental Insurance Co. Ltd.
Regional Office, Navjivan
Trust Building, Navjivan,
Ahmedabad. (Orig. Opp. No.2)
4. Rajasthan Hospital
Shahibaug,
Ahmedabad. (Orig. Opp. No.4)
Appearance: Mr. A. O. Chudgar, Ld. Advocate for the Appellant No.1 Ms. Karuna Rahevar, Ld. Advocate for the Respondent No.3 Mr. H. J. Thakkar, Ld. Advocate for the Respondent Nos.1,2 Coram: (Shri S. N. Vakil, Judicial Member) (Shri J.Y. Shukla, Member) 1 Order by Shri S.N. Vakil, Judicial M ember
1. This is against Medical Negligence.
2. The Complainant Ashokbhai Shah alongwith Consumer Education and Research Society filed Consumer Complaint with the CDRF, Ahmedabad (Rural) being CC No.101 of 2004 against Sal Hospital and Medical Institute, subsequently joining Rajasthan Hospital and their insurance Co.-the Oriental Insurance Co. Ltd., alleging that his mother Rukshmaniben Shah aged about 86 years was admitted for problem of Angina Pain in Sal Hospital on 14.06.2003, and deposited Rs. 10,000/-. After admission in MICU, it started giving treatment and applied Oxygen mask, she was responding well, so mask was removed after few hours on the same day. After couple of days as she was recovering and responding to the treatment, was transferred from MICU to general room, was allowed to walk in the corridor, as her condition was found stable. Eco test carried out on 17.06.2003 showed good result. She was getting better and feeling comfortable. She was advised to go for Angiography which was decided to be carried out on 20.06.2003. She was in hale and hearty condition, woke up at 5:30 A.M. and had a cup of Tea as advised by the Doctor and herself walked without any support from bed to toilet and was taken to CATH-LAB, on 20.06.2003 at about 7:30 A.M. She was feeling comfortable. The relatives stood outside the CATH-LAB. After an hour at about 8:30 A.M, Dr. Nayank Shah come out and informed the complainant and other relatives that angiography equipment got jammed and not functioning at present, the complainant No.2 was 2 allowed by Dr. Nayank Shah to enter into the CATH-LAB where seeing Rukshmaniben on the table with gadgets and equipments wiring for angiography administered in her body, he got mental shock and pain as she was in great deep pain due to failure of machine which the hospital should have checked before starting the angiography. There was sever pain at the back of Rukshmaniben as all equipments were still in the body, and was bleeding also, and was trying herself to adjust in the bed to minimize/ reduce the pain which was not possible at all. The complainant was in tears. Even after the machine got jammed and procedures stopped, the gadgets and equipments were in her body. It transpired that two shoots were taken which revealed 95% distal left mainstem lesion. After this the machine in the CATH LAB partly stopped functioning. He immediately tried to contact the person concerned, including the senior Doctors. Dr. Harshaben Parikh who is the Medical Director of the Opponent‟s Hospital was also seen by him in her chamber and informed her about the whole incident and requested about putting the machine in order so as to avoid disaster. She did not realize the seriousness of the situation, did not even care to attend the CATH LAB or to inquire as to what has happened with the machine and also with the condition of the patients. She in a casual way, called staff member to verify, that too not by herself. During all these efforts he was in great, worry, pain and shock, was running here and there in such a big hospital, and all throughout these efforts he was informed by all hospital staff to arrange two bottles of blood for the patient, as for 5-6 hours there was bleeding all throughout. It was for the hospital to keep them ready in case of emergency to save the patient‟s life in which they failed. Throughout these six hours he was 3 requesting the opponent management, staff doctors either to arrange for the equipments for the angiography or to shift the patient to another hospital. At last, was allowed to shift her to the Rajasthan Hospital, only when they came to know that the machine or equipment was not going to function. She was shifted to Rajasthan Hospital on 20.06.2003 at about 2:30 P.M. for which Rs.500/- as shifting charges from opponent hospital to Rajasthan hospital. The Opponent did not allow in time to shift the patient inspite of the fact that he and other relatives were trying to convince the hospital staff and doctor to shift the patient to another hospital immediately so as to save her life and to relieve her from pain and bleeding. They failed to put the machine in order, did not arrange for another stand-by equipment or machine and did not allow to shift the patient for 6 hours, which resulted into her death the same day at about 11:45 P.M. It resulted for the carelessness and deficiency in service. Death certificate issued by Rajasthan hospital suggests that cause of death was acute coronary syndrome with left main coronary artery disease. He called for medical treatment papers but was not given, gave letter by Registered AD on 24.02.2003 (?); asked medical treatment papers personally, gave letter for the same which was not accepted, gave Registered letter on 29.02.2003(?) but was not replied to; gave another letter dated 26.07.2003 in reply where he was informed on 05.08.2003 to come personally to collect the details but was not so given when he went there, and wrote letter dated 14.08.2003. He was in total dark for this 9 to 10 months. He gave notice dated 02.02.2004 through the Consumer Education and Research Society - the Complainant No.1 but instead of giving papers it was replied that his charges were still pending. The opponent did 4 not utter a single word about charges for all this 9 to 10 months, the opponent has shown clear violation of law and also deficiency in service for not parting with the medical paper. The question also arises about opponent‟s steps taking for periodically inspecting for and maintaining such critical machines. Register of treating doctors and staffs present then is required to be called for by the Forum and made personally liable. It will be further replied when the register is so produced. The opponent hospital has shown negligence and carelessness for not putting the machine in order and keeping late Rukshmaniben for more than six hours in „as is where is‟ condition and in pain, and when tried to convince the treating doctor and management of the hospital to shift the patient immediately the opponent hospital concerned doctor and management did not allow her to be shifted to another hospital. For this deficiency in service, Claimant is entitle to recover (1) expenses of Rs. 79,145/-, (Rs. 10,000/- for Refund of deposit to SAL Hospital, Rs.1,000/- for Refund of Eco-test receipt No. 3828 dated 17.06.2003, Rs.55/- for Refund of Ambulance charges dated 20.06.2003, Rs. 1,900/- for Sanket Diagnostic Pathology Test, Rs. 23,087/- for Medicine Expenses) (Bills attached), (2) Rs. 42,658/- the amount paid to Rajasthan Hospital for the treatment and Hospitalization) for this deficiency. (3) Bill of Rs. 76,588/- (Rs. 49,588/- alleged to have been unpaid vide Bill No.1423 dated 20.06.2003, Rs. 27,000/- bill raised by Dr. Sanjay Gupta. Dated 03.07.2003 for Maveric 10 mm x 1.5 mm balloon, P.T.Floppy Coronary Guidewire, 80 W Floppy mark wire etc.) are not liable to be paid, (4) Rs. 10,00,000/- for mental pain with 12% interest, (5) Rs.10,000/- towards costs and (6) also Rs. 10,000/- to the Opponent.
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3. Defence of the Appellant - Opponent No.1 SAL Hospital and Medical Institute vide written version is of total denial. Each and e very allegations of the complaint have specifically been denied. Rukshmaniben aged about 84 years was admitted in the Opponent Hospital on 14.06.2003 with a positive complaint of chest pain which is contracting type non-radiating, associated with nausea and giddiness. When she was seen' by Dr.Sanjay Gupta, according to the history given by the family members, she was having long standing Chronic Stable Angina - Crescendo Angina since, 2- 3 days. She was also having severe pain which was not relieved with Sorbitrate alongwith other treatment. After her admission, at the initial stage she was seen by Dr. Chetan (M.D.) and was given all the required treatment after measuring pulse, B.P., CVS, RS and taking the ECG. Her ECG was not normal and it suggested ST-T changes in lead - V2 to V6, S/O-AW Ischemea. She was diagnosed of acute coronary syndrome. After the admission she was given all the necessary treatment round the clock and was under the care of M.D Physician as well as Cardiologist. All the doctors of the opponent hospital were continuously attending her and were giving all the necessary treatment. On 15-06-2003 night there was a chest discomfortment at about 4:30 am and hence, ECG was also taken; she was having the complaint of Gabhraman and weakness and hençe, after examination ECG was also taken by the hospital. When she was seen by Dr Chirag Joshi MD she was diagnosed of IHD - Unstable Angina alongwith Global Ischemia and ECG confirmed the said diagnosis. Despite giving all the necessary treatment she was complaining of chest pain on and often. As the condition of her was not improving, and was complaining of chest pain, etc. on the same day she was seen 6 by Dr. Nayan Shah. After examination of her, the said doctor also prescribed all the necessary treatments and medicines which were given by the opponent hospital. On account of the treatment given by the opponent hospital, she was feeling better however; she was complaining of the chest pain, nausea and vomiting sensation. As the condition of her was not improving and was complaining of chest pain, etc. it was decided to perform Angiography to know the exact cause of her chest pain and if required Angioplasty. This was suggested by the treating doctor in the interest of patient and by performing this test if there is blockage , with the treatment of Angioplasty she can get relief in her chest pain and pass normal life. After explaining the procedure of Angiography to the complainant no 2 and his relatives and taking consent, it was decided to perform Angiography of her on 20-06-2003. Before performing CAG (Coronary Angiography), she was seen by Dr. Sanjay Gupta, Cardiologist and according to his opinion also the Angiography is required to be performed to know the exact cause of chest pain i.e. Angina. To perform Angiography of patient CATH LAB is the only available equipment/machine by which the Angiography/Angioplasty can be done . The cost of such machine is around Rs 3/- crores and for the set up of CATH LAB the hospital is required to invest Rs 5/- Crores. It is a highly sophisticated machine through which the catheterization is done and if there is any blockage the same can be cured by performing Angioplasty. The entire process can be visualized through monitors and the doctors can perform Angiography/Angioplasty through this equipment only. Without the help of this equipment it is not possible for any Cardiologist or any doctor to trace out blockage and perform angioplasty or give any other treatment 7 (except medicine) to the Cardiac patient. Where the case is serious and the Angioplasty is not possible the only available treatment is by-pass surgery i.e CABG. The opponent hospital is having highly sophisticated CATH LAB of GE Company (General Electricals). By the help of this CATH LAB the opponent hospital is performing Argiography round the dock. For the maintenance of such machine the opponent is having a maintenance contract with the supplier i.e. Wipro G.E. Medical System. When the Angiography is performed one technician, two nursing staff, one OT Assistant, one ward boy and one Cardiologist are remaining present. Normally every day the engineer of the Wipro G.E. Medial system is visiting the opponent hospital to check the CATH LAB and it is their routine practice. On 20- 06-2003 when she was taken into CATH LAB the CATH LAB was absolutely in working condition and there was no problem to the said CATH LAB. If there is any minor problem, the CATH LAB will not function and no doctor will perform Angiography on any patient. As the CATH LAB was absolutely in working condition, she was taken into CATH LAB and Dr Sanjay Gupta starte d Angiography of her. After taking two shoots at about 8.00 am, it re vealed that she was having 95% Distal Left Main Stenosis i.e, almost complete blockage. After taking two shoots all of a sudden the CATH LAB got stopped and in this view of the matter, Dr. Sanjay Gupta had immediately withdrawn the Catheter. Though the machine was rebutted twice, it could not start and hence, G.E people were informed to come immediately. The treating doctors also immediately informed both the sons of her and they were called inside the CATH LAB and told about the 95% Left Main Stem Lesion of her. As she was having 95% Distal Left Main Stenosis, both the sons of her and her 8 relatives were specifically informed that, they would have to be prepared for either by-pass surgery as patients with this type of disease can become unstable at any time. The technician of Wipro GE System came to hospital at about 8:30 am and they immediately tried their level best to start the CATH LAB However, as the fault was major, they could not start the machine immediately. At about 9 00 am. when the doctors measured Intra Arterial Blood Pressure of her, it was falling. Under these circumstances, though she was having subjective complaint, I.V. Ringer was started fast with which her B.P. which had gone down to 60 mmHg came up to 80 mmHg and then to 100 mmHg. After about 15 to 20 minutes when the patient complained of chest heaviness. I.V. Ringer was restarted alongwith injection Dobutamine, etc Since, the chest pain of patient was pe rsistent, Dr. Sanjay Gupta and Dr. Nayan Shah informed both the sons that looking to the problem of patient she need immediate high risk CABG (by-pass). It was also informed to both the sons that because of age, low body weight and height, the risk was high. Still, however, this is the only available remedy. It was also suggested to both the sons that the only other alternative/option was high risk PTCA. Since, the CATH LAB of the opponent hospital was not working, the said PTCA was not possible in the SAL Hospital and for that the patient immediately required transfer to other hospital. When the treating doctor explained all these things to both the sons they refused for CABG and requested the doctors to treat the patient by medicine. In interest of her, the doctors have also informed the sons that they have already booked CATH LAB of Rajasthan Hospital and it is in the interest of her that she gets transferred from SAL Hospital to Rajasthan Hospital so that treatment of PTCA can be given. 9 Though the treating doctor and the staff of the hospital were trying to convince the complainant no.2 regarding the transfer of patient to Rajasthan Hospital, they were not willing to transfer the patient and instructed the treating doctor to continue medical treatment. In this view of the matter, according to the instructions of her son, Dr. Sanjay Gupta and Dr. Nayan Shah continued with the medical line of treatment. Though the doctors were treating the patient and were giving all the possible medical treatment, even though her BP was falling slowly and she was complaining about the increased chest pain. Though the doctors increased the dose of both Dobutamine and Dopamine, her condition was not improving. In this view of the matter, once again the treating doctors requested to consider about shifting of patient to Rajasthan Hospital, however the complainant no. 2 and his relatives were not considering the transfer of patient and (? nor) showning their willingness for CABG. During this period the GE Technician were constantly trying to start the CATH LAB machine. However, looking to the fault of machine they could not identify the problem. At about 11.30 nor-adrenaline infusion was started but the pressure continued to lower around 80 - 85 mmHg systolic. In this situation, once again the relatives were again told to consider shifting of patient or to agree for by - pass surgery (CABG). Again they were told that she continued to have chest pain and there was only minimum response of medical treatment. Though I.V. mild sedation and painkillers were also given to her, she continued to have chest pain. A small dose of Heparin, 300 LV. was repeated still, however, her condition was not improving. At about 12:00 noon the relatives agreed to placement of IABP (Intra Aortic Balloon Pump) and the same was inserted in the left femoral artery 10 immediately. With the help of IABP balloon the BP increased to 110 mmHg systolic. However, the patient continued to have chest discomfortment. Relatives were again told this improvement in BP was only treatment (? Transient). The EGC monitor still showed increase in BP and along the chest pain the left main CA probably closed. After being repeatedly told ultimately, at about 2:00 p.m the relatives of the patient agreed to shift the patient for attempting PTCA. When the relatives agreed to shift the patient, it was specifically stated by the treating doctors that the shifting of patient would also be risky and would have to be done alongwith one IABP machine. In interest of patient the hospital authority have also agreed to transfer the patient alongwith one IABP machine. The patient was not only shifted with IABP support but, when she was shifted she was given intravenous Dobutamine, Dopamine and Adrenaline with anesthetic MD with cardiologist, hospital staff and MD in attendance. In the interest of patient and to give full support she was transferred to Rajasthan Hospital and Dr. Sanjay Gupta was constantly present alongwith the patient till she breathed last in the Rajasthan Hospital. Dr. Sanja Gupta gave all the necessary treatment to the patient after she was shifted in Rajasthan Hospital and he remained present with the patient till night. In view of the above true and correct facts, it is submitted that the opponent hospital had given all the necessary treatment to the patient and there was no carelessness or negligence on the part of either hospital or its staff or the treating doctors. According to the medical ethics, no doctor will allow the patent to die and he will definitely give all the possible treatment to the patient till the patient breaths last. The averments made by the complainant regarding the carelessness, 11 negligence, etc. are absolutely baseless and they have made all these averments only with view to claim the higher amount of compensation and avoid the payment to the hospital.
4. The defence of Rajasthan Hospital - Respondent - Opponent No. 4 vide written version is of total denial. When the patient came at about 2:50 P.M., she was having administered Intra- Aortic Balloon Pump. She was in serious condition and in pain, was admitted having Intra- Aortic Balloon Pump and was declared dead at about 9:20 P.M. on the same day. Death certificate was issued by the opponent No.4. The bill for Rs. 42,638/- was issued and paid up. There are no allegations against the opponent No.4. The same deserves to be dismissed.
5. CDRF, Ahmedabad (Rural), partly allowed the complaint by its order dated 26.08.2008, ordered (1) the Opponent Nos. 1, 2 and 3 to jointly and severally pay to the complainant No.1 Rs. 79,145/- for medical expenses with 9% interest, and Rs. 2,00,000/- towards mental pain with 9% interest, (2) the Opponent No.1 is not entitled from the complaint to Rs. 76,588/- and (3) cancelled the demands of Rs. 76,588/- raised by its bill dated 20.06.2003. It dismissed the complaint against Rajasthan Hospital. It is in the ground that before proceeding for the operation of Rukshmaniben, they ought to have checked whether the CATH-LAB Machine was working properly or not. There is nothing on record nor any proof to show that the expert technician ever checked the machine, there is nothing to show which technician person was present at the time of angiography. They have produced 12 proof whether they tried to inspect the machine and on what account it stopped the working. If the machine stopped working the doctor and the staff should have shifted her into another hospital. Despite they have kept Rukshmaniben in Operation Theater till 2:30 with the attachments and wires still inserted into her body. There is no allegation by the complainant that condition of her mother deteriorated for deficiency in service and negligence of the opponent but the allegations are that the CATH LAB machine stopped during process of angiography, no efforts were made to put it in order nor any steps were taken to shift her, for which her condition became serious. She was taken to Rajasthan Hospital at 2:30 P.M. for entire negligence of the Opponent. She became serious because the CATH LAB machine stopped working abruptly and because no steps were taken to shift her. There is no need of an expert opinion because it is clearly proved that she died of intolerable negligence and deficiency in service of the opponent. For the aforesaid reason he is entitled to refund of Rs. 79,145/- paid by him to the Rajasthan Hospital and also for relieving him of Rs. 76,499/- claimed by the Sal Hospital. Considering her age as 86 years and was heart patient Rs. 2,00,000/- towards mental pain would be just. There is no responsibility of Rajasthan Hospital for her death when she was taken to Rajasthan Hospital, she was admitted with ventilator and died at 11:45 P.M. The insurance company is also liable, it having taken the insurance, for mental pain also.
6. Being aggrieved by the same the SAL Hospital and Medical Institute and the Oriented Insurance Co. Ltd. -Opponent No. 1 and 3 respectively, have preferred this 13 appeal on the ground that the judgment and order are against the evidence of record and without appreciating the defence of the appellants, the Forum has not considered the defence raised in the written version, has not considered cross- examination of complainant No.2 wherein he had admitted that he had not obtained any opinion of expert doctor regarding the case before filling the complaint, has not considered his admission that his mother had a heart disease since 6 to 7 years and that he has no knowledge regarding medical science. It has also not considered the fact that the complainant No.2 is aware that angiography is one kind of test and the same is required to be carried out by CATH LAB machine. It also ignored the admission that he had consented for inserting balloon in the patient at about 10:30 to 11:00 A.M. Thus it was specifically proved on record that the patient was treated at the hospital of the appellant No.1 even after the stoppage of CATH LAB machine as desired by the relatives of the patient. The Forum has not considered the treatment papers produced by appellant No.1 at Exh.21, there is no reasoning given by the Forum that the treatment given to the patient was incorrect. It also failed to appreciate that the complainant had not cross-examined Dr. Sanjay Gupta who has filed the affidavit before the Forum and remained unchallenged, therefore the order is erroneous. It wrongly held that expert evidence is not necessary in the present case. The National Commission has held in (II) 2006 CPJ 348 that in case of medical negligence, expert opinion is necessary. The Forum has posed itself as if is a medical expert and formed opinion without any independent expert evidence that her death was due to deficiency in service on the part of the appellant hospital. It also failed to consider the judgment by National Commission 14 in case of Gurubax Singh that the Forum cannot constitute itself into an expert body and contradict statement of the doctor unless there is something contrary on record by way of expert opinion or there is any medical treatise on which reliance could be based. It wrongly found the allegations of the complainants as proper and correct, and wrongly held that considering the treatment papers, it is proved without any doubt and that there was negligence and deficiency in services on the part of the original opponents and that the death of the patient was caused due to the deficiency of services. It failed to mention that which treatment papers proved deficiency of services. It erred in opining that the hospital was required to check the CATH LAB Machine before starting procedure of operation when angiography was not at all an operation but only a test. It also wrongly observed that the hospital ought to have examined the expert technicians regarding functioning of the CATH LAB Machine though contract of maintenance of the CATH LAB Machine was very much before Forum. It has not assigned any reason which shows the nexus between the non-functioning of the CATH LAB Machine and cause of death of the patient. The stoppage of CATH LAB Machine is not a reason for the death of the patient. It ignored fact that there was no Postmortem report which could show the exact cause of death and the treatment of the appellant No.1‟s hospital has any connection of the cause of death of the patient. It erred in observing that the opponents ought to have started the procedure of shifting the patient to another hospital. As per the record of the case relatives of the patient had refused to shift the patient to another hospital inspite of the specific instructions/requests of appellant No.1 hospital. The relatives of the patient had consented to follow with 15 the treatment at hospital of the appellant No.1 as could be seen from his cross- examination that the balloon was inserted at about 10:30 A.M. to 11:30 A.M., after obtaining the consent of the relatives of the patient. Therefore, the shifting of the patient to another hospital was delayed due to the reluctant attitude of the relatives of the patient. It erred in awarding Rs. 79,145/- with 9% interest towards the treatment expenses charged by the appellant hospital. It also erred in ordering that the appellant No.1 is not entitled to claim/ demand the balance amount of Rs. 76,588/- from the Claimant No.2 and quashing hospital‟s claim for the same. It erred in award Rs.2,00,000/- under the head of mental torture and harassment and cost of litigation with 9% interest to the claimant. It did not assign any reason for awarding such amount under the head mental torture and harassment. It also erred in awarding interest at 9% on the amount under the head of mental torture and harassment. It did not consider various submissions submitted by the appellants in written statements and has erred in arriving at the conclusion without assigning any solid reason. It failed to appreciate that the complainants had not produced the single independent documentary evidence which could be said to be reliable, on the basis of which the award could be passed. The judgment is on the basis of conjectures and presumption, and moreover on the sympathy, without any logic and reasons. Some of the reasons in not believing the contention raised by the appellants are absolutely superficial and illogical. It ought to have dismissed the complaint.
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7. Heard Advocate Mr. A. O. Chudgar for the Sal Hospital and Medical Institute, Ms. Karuna Rahevar for the Oriental Ins. Co. Ltd. and Mr. H. J. Thakkar for the Opponents.
8. The complainant in cross-examination answered to the effect that on 14.06.2003 chest pain started to her mother, on 20.06.2003 after 2:30 P.M. and therefore was taken to Sal Hospital at about 4:00 P.M. Before that Dr. Nayan Shah was called up on at the residence, who examined and they took her to Sal Hospital as advised by him, where she was admitted in MCIU unit. Angiography was started on 20.06.2003 at about 7:30 A.M. and they were sitting outside the Operation Theater. At that time Dr. Nayan Shah came out of OT at about 8:15 and said that angiography of one side is over and they will start of the other side. Then he went into the OT and came out after sometime and told that angiography machine has jammed and other person have been called to attend it. At about 10:30 the complainant told him that if the machine is not repaired than they would shift her mother to some other hospital. She was at that time in a severe pain as the attachemnts were attached to her body. Thereafter on the same day at about 2:30 she was shifted to Rajasthan Hospital. The complainants were insisting ever since the machine stopped working and thereafter at 2:30 only was given permission to shift her mother. At that time all the gadgets were attached in her body. In cross- examination for the Sal Hospital he answered to the effect that when they took her mother to Rajasthan Hospital at that time her condition was not good. He admits that when her mother was admitted in the hospital it was not certain which 17 treatment was to be given. It cannot be known without seeing. She was having chest pain from half an hour before she was admitted in the hospital. Admits that she had pain for 2 to 3 days before the admission. Dr. Nayan Shah was called before she was admitted. He gave some tablets but thereby the pain did not reduce therefore decided to admit her. He does not remember whether tablet was given or injection. But the doctor did give some. He has no good knowledge of medical; have only some general knowledge as to what kind of treatment the patient of heart decease should get. And the general knowledge is only to the exten t that if there is trouble in functioning of heart, tablets or injections should be given. He has not studied medicine. Before filling this case no opinion of any expert doctor is taken. He has no knowledge of the treatment the doctors gave and in the Sal Hospital diifferent doctors gave the treatment after her admission. According to him after the treatment there was relief in her pain but cannot say about B.P. or whether B.P. was remaining stable or not. It is not in his knowledge whether she ever fell down in hospital after her admission. She was referred to Dr. Sanjay Gupta, at the instance of Dr. Nayan Shah the same day. He does not know why Dr. Sanjay Shah was referred to. He is a doctor of heart disease. Her angiography was required as she was having pain in the heart. Therefore after discussions with doctors, the doctors suggested that angiography should be done and hence was caused to be done. Angiography is required to be done to know whether there is blockage in the heart. He does know that Angiography is one kind of test only, and that help of CATH LAB is required to be taken for angiography. After the angiography report comes doctor takes decision of removal of blockage by balloon or stand. He knows 18 it, but he has no knowledge that if the balloon or stand could not be placed, by- pass surgery is required to be done. If balloon or stant is to be placed, cath lab is required. He has no information what would be costs of the entire set up of CATH LAB and infrastructure. He was present when his mother was taken in the CATH LAB. She was taken into the CATH LAB at about 7:15 to 7:30 in the morning. After an hour Dr. Nayan Shah coming out informed that a problem was arisen in the CATH LAB and took him his mother in the CATH LAB room. 15 minute before it, he informed that angiography of left side is over and now are starting the right side. He does not remember whether he said of 95% blockage in the le ft side, but said that there is 95% blockage. He knows that if there was 95% blockage, serious problem would arise at any time. It is true that after there were taken into the CATH LAB room, the doctors discussed of condition of her mother. When we went into CATH LAB room, he did not see that her treatment was going on. But he saw that there were 6 - 7 wardboys and nurses that caught her hands and legs. She was having severe pain but was in sense. It is not true that as there was 95% blockage and problem occurred in CATH LAB the doctors informed them to take her mother to some other (hospital). It is not true that doctors advised of high risk by-pass surgery and that they refused for the by-pass surgery. According to him the doctors did not say any such thing. It is not true that they said the doctors to give medicine treatment only. It is true that they gave consent to the doctors to insert IABP balloon and the consent was given at about 10:30 to 11:00 in morning. And that after the consent, doctors inserted the IABP balloon but he does not know not in which condition IABP balloon should be inserted. They did not make any booking of 19 the CATH LAB with the Rajasthan Hospital. It is also true that they had not made any kind of booking to admit her into the Rajasthan hospital. After the IABP balloon was inserted there was no improvement in her condition. It is not true that even after the IABP balloon was inserted there was no improvement and therefore the doctors advised to shift her. According to them they were telling them to shift her right from the morning. It is also not true that only after the doctors explained us, we gave consent at about 2:00 P.M. only to shift her. When she was shifted there were attachments in her body but have no knowledge of what kind they were. It is true that Dr. Sanjay Gupta was together with them when she was shifted to the Rajasthan hospital and she was under the care of Dr. Sanjay Gupta and was present when she died. He has not produced any proof of payment made to the Sal Hospital. The total bill of the Sal Hospital has remained unpaid. It is not true that all the necessary treatment was given to her by the Sal Hospital. Angiography machine stopped working in an hour and when could not start to work till they left. He has no knowledge of the function of the cath-lab, and how it works.
9. Note of Dr. Nayan shah from the case paper dated 20.06.2003 is to the effect: "8:00 P.M., Angiography started, cath lab machine stopped working after two shoots. Not repaired till 9:00 A.M. When patient became unstable question regarding shifting to another hospital were discussed with both sons but they refused both shifting and CABG. Patient was managed conservatively in the Cath Lab".
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10. Note of Dr. Sanjay Gupta dated 20.06.2013 is practically to the same effect the w.v. as aforesaid is: 20.06.2013. In the Cath lab 2 shots taken at 8 A.M. re veal 95% distal left stenosis, after which the cath lab stopped. Catheters were withdrawn. Patient was kept on the table. Machine was rebooted twice but would not start. GE people were informed to come immediately. The relatives, both sons were called inside the lab, and told about the 95% left mainstem disease by me and Dr. Nayan Shah. They were told that they would have to prepare for higher risk CABG surgery as patient with this type of disease can become unstable at any time, though she was asymptomatic at present. Then it reads arrival of technician at 8:30, testing of machine at 9:00 A.M., noticed falling of intra arterial blood pressure without subjective complaint, starting of IV Ringers whereby BP rose to 100 mmHg, 15-20 minutes later she complained of chest heaviness, ECG monitor then showed rise, restating of IV Ringer and giving of medicines, stabilizing of BP at 80 mmHg, chest pain was persistent, both sons were told she would need immediate high risk CABG, risk was high because of age, low body weight and height, ongoing antiplatelet Rx and Reopro which had been given in the MICU. The only option of high risk PTCA was not possible as the medicine was not working. Both the sons refused CABG. Incharge of the cath-lab was asked to book the Rajasthan Hospital cath-lab if the relatives considered transfer. The relatives told us that they did not want to transfer their mother and to continue medical treatment. Then it reads of continuations of Ringers and medicines, but the BP went on falling slowly with increased chest pain. Dose of medicine reads to have been increased. The relatives still would not consider either shifting her or agreeing to CABG, though the GE 21 technician could still not identify the problem. Then it speaks of starting of nor- adrinaline at 11:30 and coming up of BP to 80-85 systolic. The relatives were again told to consider shifting her or to agree to bypass surgery. Again they were told that she continued to have chest pain and response to medical Rx was only minimal. She continued to have chest pain even after giving of sedation and painkiller. Small dose of heparin was given. At about 12 noon the relatives agreed to placement of IABP balloon. It was inserted in let formal artery, with which the BP increased to 110 mgHg systolic. However, she continued to have chest discomfort. Relatives were again told this improvement in BP was only transient. ECG monitor s till showed increased BP and along the chest pain the left main CA was probably closed. After being repeatedly told, ultimately, at 2:00 P.M. they, (i.e. relatives) agreed to shift the patient for attempting PTCA. They were told that shifting her would also be risky and would have to be done along with the IABP machine. Hospital authorities agreed transferring her with the IABP machine. At 2:30 P.M. she was shifted to the ambulance with IABP, dobutamine, dopamine, noradrenaline, with anesthetist MD. He (Dr. Sanjay Gpta) accompanied the patient to Rajasthan Hospital in his car.
11. Affidavit of Dr. Sanjay Gupta, Hindu, adult working as a cardiologist in the Sal Hospital & Medical Institute, dated 04.03.2008, is to the effect that he is qualified Cardilogist and working with the SAL Hospital since last several years, and treated Ruxmaniben Shah when she was admitted in the SAL Hospital and Rajasthan Hospital. What is stated by the opponent hospital in its reply to the complaint is 22 true according to the best of his knowledge, and he believes the same to be true. The opponent hospital had taken utmost care of Ruxmaniben Shah when she was admitted in the SAL Hospital. During the Angiography when the Cath Lab stopped functioning, he had personally requested the son and relatives of Ruxmaniben to shift her at Rajasathan Hospital as she was having 95% Distal on left side. Though number of times he had requested the son and the relatives of Ruxmaniben to shift her to Rajasthan Hospital, they had refused transfer the patient. As the condition of Ruxmaniben was not satisfactory and the relatives of the patient were not willing to transfer the patient to Rajasthan Hospital, he treated the patient by giving all the necessary treatment. When the relatives of the patient agreed to transfer the patient to Rajasthan Hospital, in interest of patient, he had accompanied the patient alongwith M.D Doctor, staff of the opponent hospital and IABP support. In Rajasthan Hospital also, he had treated the patient and remained present alongwith the patient till she breathed last i.e. about 9.30 pm. In interest of patient, the opponent hospital, the doctors as aslo the staff of the opponent hospital and himself had taken utmost care and the patient was treated and was given all the necessary available treatment. What is stated in the indoor case papers and other documents produced by the opponent hospital regarding the treatment given to Ruxmaniben Shah in the SAL Hospital is true to the best of his knowledge.
12. Dr. Sanjay Gupta has not been cross-examined upon his aforesaid affidavit.
13. Now, from the aforesaid it is clear that when she was having chest pain before she was admitted in the hospital and even thereafter, and even after she was found to 23 have 95% blockage in left, it cannot be believed that she was relieved of her chest pain before the angiography was done. In state of her heath it is only believable that she was in pain e ven then, under which circumstances when she was trying to adjust herself on the CATH LAB table, it was for her chest pain only and not for the any attachemnts inserted. Note of Dr. Sanjay Gupta dated 20.06.2020 reads that after two shoots were taken at 8 A.M. which revealed a 95% distal left mainstem lesion, and the cath lab machine stopped working, the cathe ters were withdrawn, and hence it was not any cause of her discomfort since it had already been withdrawn. The notes also show that her B.P. was constantly being monitored and tried to be stabilized during conservative treatment, after the cath lab stopped. It is quite believable that these wires were for monitoring the pressure etc. of the patient. It cannot be taken as causing pain as alleged by the complainant. Intravenous Ringers Lactate was also started. The notes goes to read that antiplatelet treatment and Reopro was being administered to her at MICU. It does not show any bleeding. Hence what might had been called for was not the bottles of blood nor for bleeding as alleged, but platelets like which is not uncommon to call for during procedures or visits or so. Therefore, the allegations in this regard fails.
14. Dr. Nayan Shah, who was asked to visit her residence before she was admitted in the hospital as aforesaid was also there in the angiography procedure. His notes as aforesaid shows that after the machine could not be repaired till 9 A.M. when the patient became unstable, question regarding shifting to another hospital were discussed with both sons but they refused shifting and patient was managed conservatively in the cath-lab. This was at about 9 A.M. However, he maintains that 24 ever since the cath-lab stopped working he was insisting for her transfer but was not allowed. It is falsified for the reasons that after the machine stopped the doctors were not able to do any consequent angiography angioplasty or anything together during angioplasty or PTCA which could be by cath-lab, and the complainant was not agreeable to CABG, yet conservative treatment was being done as monitoring BP and correcting it with Ringers and medicine; that cath-lab at Rajasthan Hospital was not booked, which the doctor instructed to the incharge of the cath-lab to if the relatives considered transfer; that BP was continued be corrected with as before, that her chest pain was tried to be reduced by sedation, pain killer and medicine to correct the falling BP, even when the GE technician could not still identify the problem; that the relatives agreed to placement of IABP balloon which was inserted in left femoral artery at 12 noon for which the bill reads charges also; that thereby BP increased for which the doctor said would be transient only, there being chest discomfort; that her shifting was only after the doctor found that probable left main CA was closed along the chest pain. All these cumulatively and also singly prove that the complainant, her relatives did not want to shift her and wanted her to be treated conservatively there, after the machine stopped. These treating her conservatively could not have been there without complainant‟s refusal to transfer her and asking to treat her conservatively. His allegations are also disproved by the fact that ultimately the shifting was to be for PTCA with the hospital bill unpaid, with the IABP machine support and medicines, anesthetist MD and the treating Dr. Sanjay Gupta also accompanying, treating and staying with her in Rajasthan Hospital till she breathed last, where the complainant did not get PTCA done nor 25 book the cath-lab also. All of which would not have been there had the Sal Hospital/doctor disallowed her transfer as alleged. Therefore all the allegations fail.
15. It is also clear that her condition did not deteriorate by stoppage of the cath-lab but by already blockage up to 95% of the left main and its closure, and in absence of any other expert opinion that after the two shoots in the left main showing 95% blockage were already taken but before the angiography of the right side could be conducted if the machine stopped, it only deteriorated her condition the allegations of the complaint on this point also fail.
16. However, it is difficult to hold that if the cath-lab machine how costly or how difficult it may be to keep in spare, if stops midway, there was no deficiency on the part of the hospital conducting it, though the finding is that it had not deteriorated her condition by its failure. More particularly it is for the reason that with the very cath-lab angiography, then angioplasty, alongside other procedure, PTCA are also done, and it is not shown that the complainant would have rested with angiography only then. Therefore, the finding of the Forum on this point cannot be disturbed axcept for the amount for mental pain at Rs. 2 lakhs as assessed by it. There is no proof that cath-lab machine was faulty before she was taken in. Forum‟s finding as to fault in mid way for non-maintenance cannot be sustained in face of angiography of left side was completed, with the same machine.
17. She was admitted in the hospital on 14 th in painful condition. The question of cath-lab is of 28th June only. She was treated in the meantime against which there are no allegations, so also was treated conservatively, and also of balloon in the left femoral artery, after the cath-lab stopped at about 9 A.M. The complainant would 26 not be entitled to refuse the payment thereof, at the best the bills for cath-lab charges could be avoided. The bill No. 1423 dated 20.06.2003 shows Rs. 46,500/- towards „angiography package and IABP and Balloon charge‟, without any further breakup thereof. It would be just to hold the complainant not liable to pay charges for angiography package, and also entitled to some mental pain on the ground of stoppage of machine half way. Which can at the best in our estimation be at Rs.23,000/- for the angiography package, and for mental pain at Rs.25,000/- in all Rs.48,000/-, considering the fact that the complainant did not book any cath-lab for her angiography in the Rajasthan Hospital, but asked them to conservatively treat, that with his consent IABP balloon were inserted, and also that he did not get her PTCA done at Rajasthan Hospital for which he shifted her there.
18. He cannot find fault with Sal Hospital if he ultimately taken her to Rajasthan Hospital in the ambulance and say that he is not liable to ambulance charges or that Sal Hospital should not have charged for the same.
19. The bill of Rs.27,000/- raised on 03.07.2003 by Dr. Sanjay Gupta for services at Rajasthan Hospital could not have been raised, in absence of specific consent from the complainant before such services. It is for the reasons that his notes do not speak of his going there was on charge basis and that entire cinereous suggests that his going to Rajasthan Hospital and treating was of his own only. Had it been on chargeable basis, the bill could have been raised in Rajasthan Hospital and not Sal Hospital as was sought to be done on 03.07.2003. it needs to be discarded, by adding to what is the complainant is entitles to. That is the total goes to (Rs.48,000/- + Rs.27,000/-=) Rs.75,000/-.
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20. No any angiography or angioplasty was done at the Rajasthan Hospital. Nor any PTCA was also got done for which she was taken there. Hence it is difficult to find the complainant entitled to any expenses made at Rajasthan Hospital.
21. The amount of mental pain does not carry any interest and therefore the order of the Forum to that effect cannot be sustained.
22. When the complainant was asked to come and collect the case papers, which remained undelivered to him for non-payment of the unpaid bill, it is difficult, in facts of this case, to find deficiency in service thereby with the Sal Hospital.
23. It would be between the Sal Hospital and this Insurance Co. whether the amount allowed by this appeal falls within the terms of the insurance policy or not. It was not the subject matter of this appeal. Certainly the Forum could not have made the insurance co. also liable without any reference to any specific terms of policy in this regard. Therefore, the question is kept open on this point between the Sal Hospital and its Insurance Company.
24. For the reasons stated, the appeal deserves to be partly allowed, for which following final order is passed.
FINAL ORDER
i) Appeal No. 87 of 2009 is partly allowed.
ii) The judgment and order passed by Hon‟ble CDRF, Ahmedabad (Rural), dated 26.08.2008, rendered in CC No.101 of 2004 is hereby set aside.
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iii) The Opponent No.1 Sal Hospital and Medical Institute do pay the Complainant Rs.75,000/- (Rupees Seventy Five Thousand only) without any interest, which the Opponent-Sal Hospital and Medical Institute would be entitled to and do adjust against its dues from the complainant.
iv) No order as to costs.
v) Registry is directed to pay the deposited amount, if any, with accrued interest on proper verification to the appellant by account payee cheque and the cheque be handed over to the learned advocate for the appellant after obtaining receipt.
Pronounced in the open Court today on 21st Day of October, 2020.
(J.Y.Shukla) (S.N.Vakil)
Member Judicial Member
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