State Consumer Disputes Redressal Commission
Mandakni Pingle vs Dr. Jairam Lyer And Anr. on 31 March, 2012
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION
PANDRI, RAIPUR
(CC/08/9)
Complaint Case No.15/2008
Instituted on : 22/12/2008
Mandakni Pingle, D/o Shri Triyambak Rao Pingle,
R/o : Chatapara
BILASPUR (C.G.) ... Complainant.
Vs.
1. Dr. Jairam Iyer,
(Former Senior Consultant, Apollo Hospital)
R/o : Plot No.1&2, Gitanjali City,
Phase - 1, Bahtarai Road,
BILASPUR (C.G.)
2. General Manager, Apollo Institute,
Apollo Hospital, Seepat Road,
BILASPUR (C.G.) ... Opposite Parties.
PRESENT: -
HON'BLE JUSTICE SHRI S.C. VYAS, PRESIDENT
HON'BLE SHRI V.K. PATIL, MEMBER
COUNSEL FOR THE PARTIES: -
Shri V.P. Gupta, for complainant.
Shri Ranbir Singh Marhas, for O.P.No.1.
Shri Y.P. Singh, for O.P.No.2.
ORDER
Dated: 31/03/2012 PER: - HON'BLE SHRI V.K.PATIL, MEMBER This complaint, under Section 12 of the Consumer Protection Act, 1986, has been filed by the complainant alleging medical negligence committed by OPs, causing the death of her younger brother and for such deficiency in service, prayed for compensation of Rs.3,40,000/- towards expenses incurred on medical treatment, // 2 // Rs.60,00,000/- for improper treatment, Rs.80,000/- towards compensation on account of loss of income of the deceased and Rs.2,00,000/- for mental and physical harassment along with cost of proceeding. Besides interest @ 18% p.a. on the claimed amount has also been sought.
2. Facts of the case, as averred in the complaint, are that Shri Ashok Pingle, younger brother of the complainant, was admitted in the hospital of O.P.No.2 for treatment of pain in chest and for that purpose, procedure of 'Angioplasty' was performed on him by O.P.No.1 on 02.08.2008. Shri Ashok Pingle started suffering from fever with headache 04.08.2008 onward which continued till his death. The condition of the patient had been communicated to OPs continuously by his relatives but both O.P.No.1 & O.P.No.2 did not take adequate care & precaution about his frequent complaint of fever, resulting in deterioration of his health condition which ultimately became serious. Complainant further averred that on 11.08.2008 when health condition of Shri Ashok Pingle started deteriorating, employees of the hospital had given intimation on intercom to O.P.No.1 at about 2 to 3 P.M. but O.P.No.1 carelessly and contrary to its duties attended the patient late at about 5 P.M. and looking to serious health condition of the patient, he was shifted to cathlab on 11.08.2008 where he was kept on ventilator applying a pacemaker. Complainant further averred that // 3 // the patient was declared dead on 12.08.2008 at 3.45 P.M. giving cause of death as "CAD with acute Anterior NSTEMI with Post Primary PTCA Status to LAD&D, with acute Re-infarction with stent thrombosis and Lt Main thrombosis with sepsis with cardio- respiratory arrest". Complainant further averred that in view of the death of the patient under suspicious circumstances, his relatives submitted an application with Government of Chhattisgarh for making a probe into the case and accordingly an inquiry committee headed by Dr. G.B. Gupta, Professor of Medicine, Medical College, Raipur was formed consisting of two other members Dr. U. S. Paikra, Professor, Medical College, Jagdalpur, and Dr. R.R. Tiwari, Superintendent, C.I.M.S. The committee after through investigation submitted its inquiry report, wherein it was found that cause of death mentioned by OP no.1 was different than that mentioned by the Hospital O.P.No.2. The inquiry committee also found that no activity of heart was noticed, after 9.02 P.M. on 11.08.2008 as per available record and the cause of death mentioned was "A Block in the left main coronary artery and Blockage of the implanted stents". Complainant further averred that on her report dated 03.09.2008, a case No.0/08 under Section 304A of I.P.C. was registered by Civil Lines Police Station, Bilaspur against both O.P.No.1 & O.P.No.2 (Dr. Jairam Iyer and Apollo Hospital, Bilaspur). Complainant further averred that O.P.No.1 was engaged by O.P.No.2 and it had collected Rs.3,40,000/- for the purpose of medical // 4 // treatment and the patient himself and also his relatives had been intimating OPs all along, about health condition of the patient but no proper treatment was provided, resultantly the patient died. Complainant further averred that the patient had died at 9.02 P.M. on 11.08.2008 but OPs falsely projecting him as alive had kept the deceased on ventilator till 3.45 A.M. on 12.08.2008 thus misguided the relatives and hurt their sentiments. Complainant further averred that the deceased was on the post of mayor of Bilaspur, drawing emoluments of Rs.5,000/- P.M. having remained 16 months of his tenure and had also the pride of being a first citizen. Had he been properly treated, he could have continued as mayor and progressed in his political career further as M.L.A. or Member of Parliament. Complainant further averred that she had sent a registered notice on 14.11.2008 to O.P.No.1 & O.P.No.2 about the alleged medical maltreatment thus demanding compensation, but no heed was given, hence for such deficiency in service, complaint has been filed. Complainant also submitted affidavit dated 19.12.2008 along with documents (C-1 to C-9) and also subsequently documents as per list dated 03.03.2012 documents (C-11 to C-85) during final hearing stage.
3. O.P.No.1 Dr. Jaiam Iyer while resisting the complaint, in his written version, averred that he was not in a position to reply with regard to the aspects of alleged medical treatment in the case since // 5 // entire related papers had been seized by the police, however he had replied as per his memory and therefore prayed that he would add further to its version on availability of relevant documents. O.P.No.1 averred that the deceased Shri Ashok Pingle had suffered initially a cardiac arrest in a public meeting on 02.08.2008 so he consulted Dr. B.R. Hotchandani, who advised him to get admitted immediately in Apollo Hospital, Bilaspur (O.P.No.2) and on the same day he (O.P.No.1) performed the procedure of 'Angioplasty' for severe blockages in his arteries. O.P. No.1 further averred that after the said operation, patient continued good recovery for 2 to 3 days and was ready for discharge on 06.08.2008 but since O.P. No.1 happened to be a good friend of Late Shri Ashok Pingle, he realized that the patient (Mr. Pingle) would not take the required rest after his discharge, so advised him to stay in the hospital for further 2-3 days, in order to avoid strenuous work. O.P.No.1 further averred that everyday thousands of visitors used to see Shri Pingle and moreover he was also in habit of chewing tobacco, which he continued even after his operation. Cumulative result of aforesaid facts ultimately became cause of post-operative infection leading to the death of Shri Ashok Pingle since he was not serious about precautions. O.P.No.1 has further averred that he is a Cardiologist and does not treat patients for fever. He averred that Internal Medicine Doctors of the hospital had been attending to Shri Ashok Pingle for fever and on 11.08.2008 the // 6 // persons attending to him consulted some other Doctors, who also advised some medicines. O.P.No.1 further averred that on 11.08.2008 between 2 to 3 P.M. urgent investigation reports were sought by those Doctors and on getting information from them, he (O.P.No.1) also instructed one Dr. Vijay Shrives. O.P.No.1 averred that at about 4 P.M on 11.08.2008, when the patient was taken for ultrasonography, he received first call from the ward. O.P.No.1 further averred that since he was attending to another patient so after completing his 'Echo' test at about 4.30 P.M. he reached the ward and then only could know that Shri Pingle was sent for ultrasonography. O.P.No.1 further averred that he could see the patient Shri Pingle at about 5 P.M. and was briefed by the attending Doctor. On check up, he observed that blood pressure of the patient was low so he continuously stayed with the patient till 9 P.M. and did everything what was necessary to save the life of Late Shri Ashok Pingle. O.P.No.1 further averred that Dr. G.B. Gupta had come there, attended to the patient and thereafter the patient was put on life supporting system after being taken away in the light of a chaotic situation prevailing then, as a mob had entered into the hospital. O.P.No.1 was also locked in a small room and was confined there till early morning of 12.08.2008. O.P.No.1 averred that he was not liable to pay any amount to the complainant, as such the complaint deserved to be dismissed. O.P.No.1 filed his affidavit dated 01.07.2010 in support of his version followed by additional affidavits // 7 // dated 20.10.2010 and 21.10.2010. O.P.No.1 submitted documents Sl.Nos.1 to 70 on 22.10.2010 (OP-1 -86 to OP-1-150) & another set of documents on 27.11.2010 (OP-1 to OP-85).
4. O.P.No.2 in its written version while denying other allegations of the complainant averred that the allegations leveled against it by the complainant, about careless and improper medical treatment of the patient, were baseless and it had not committed any deficiency in service as the object of medical profession is to serve and save the life of patients. O.P.No.2 further averred that the medical treatment of the patient was done with full satisfaction since expenses of medical treatment were paid without lodging any complaint. O.P.No.2 filed a statement dated 06.2010 of Dr. V. Ramanna, Chief Executive Officer, Apollo Hospital Enterprises Limited, Bilaspur in the form of affidavit in support of its version but the same has not been verified by any oath Commissioner or Notary, so it is a useless document.
5. We have perused the documents placed on record and heard arguments advanced by all parties.
6. The issues to be considered are ;
(i) Whether O.P.No.1 had committed any deficiency in service and if so how far liable to pay compensation?
// 8 //
(ii) Whether O.P. No-2 had committed any deficiency in service and if so how far liable to pay compensation?
7. The issues being inter-related are considered and decided together. Admittedly Shri Ashok Pingle, younger brother of the complainant had taken medical treatment in the establishment of O.P.No.2 the Apollo Hospital, Bilaspur where the procedure of 'Angioplasty' was performed on him by O.P.No.1 Dr. Jairam Iyer and thereafter was attended by O.P.No.1 and also by other doctors for his post operative management. We find that the deceased Shri Ashok Pingle being the Corporator of local Bilaspur was a popular personality having the support of mass in the public so soon after his death, a mob had agitated in the hospital suspecting some negligence/ carelessness during his medical treatment and as such on the application of the complainant, Government of Chhatisgarh formed a three members Committee on 20.08.2008 headed by Dr. G. B. Gupta (document no. C-2) to inquire into the matter which having investigated the matter submitted its report dated 31.08.2008 (document no.C-3) and in its conclusion ( document at page s.no.441 ) observed as under;
"Conclusions (1). Regarding time of death, there is no finding neither physical nor instrumental evidence that could suggest the // 9 // patient survived beyond 9:02 pm on 11.08.2008. So he was dead at this time.
(2). There are many gaps in investigation and Post operative management in this case c might be responsible for this unfortunate event.
(3). Dr. J.R. Iyer was in charge of the case & he is responsible for the management of the patient, so he is at fault. (4). Apollo Hospital, Bilaspur management failed to provide the needed care to late Shri Ashok Pingle in the event of need, so they are also at fault."
8. Followed by aforesaid inquiry report, another Expert Committee CIMS. Bilaspur in its 9 points report (document at Sl.Nos.370 to 372) had concurred the same view as was expressed by the aforementioned committee of Raipur Medical College and did not express any additional opinion, however it suggested to seek further opinion of super specialists.
9. Shri Ashok Pingle was admitted in the hospital of O.P.No.2 on 02.08.2008 under care of O.P.No.1 Dr.Jairam Aiyer as per Registration sheet (document no.OP-1 & 2) and thereafter he was examined, his clinical investigations were done, and was diagnosed and advised for medical treatment. All the documents on record show that entire medical treatment was provided by O.P.No.2 the Apollo Hospital, Bilaspur through its group of medical experts and allied staff, out of which O.P.No.1 was also one as Interventional Cardiologist. As per // 10 // Cash Receipt No.38074 dated 07.08.2008 document no.C-9) Rs.2,00,000/- was deposited with Apollo Hospitals Enterprise Ltd, Bilaspur, obviously on behalf of O.P.No.2. There is no evidence on record to show that any payment towards medical treatment was made to Dr. Jairam Iyer O.P. No.1, by the relatives of the deceased. It indicates that O.P.No.1 was performing on behalf of O.P.No.2 which in fact used to hire his services as an expert in the field of cardiology who diagnosed and performed 'Angioplasty' procedure of late Shri Ashok Pingle, who subsequently remained in the hospital for post operative care till death.
10. (i) Contention of O.P.No.1, as per para no.6 of his affidavit dated 01.07.2010, is that he being a cardiologist, works in a tertiary hospital where fever beyond certain time and limit, is taken care by the internal physician or medicine specialist in infectious diseases. He submitted in his another affidavit dated 21.12.2010 stating that the cause of death of Ashok Pingle was "Stent thrombosis resulting from septic shock state" and also that there was investigative evidence to prove the presence of very serious kind of infection called "gram negative Klebseilla" O.P. No.1 also pointed out that as per urine culture report, which was received two days after the patient's death, the bacteria was resistant to almost every antibiotic, which was used on the deceased and in that regard. Dr. Rajesh Agrawal and Dr. Manoj Rai being Medicinal Specialist were // 11 // to decide for any effective antibiotic. In para 3 of the affidavit dated 21.12.2010, O.P.No.1 referred about medical literature No.A, as reported in the scientific literature about the relationship of infection leading to septic shock and these both could be the factors for clot formation. He also referred another medical literature No.A-1 which relates to inflammation / infection and clot formation. OP No.1 has also referred medical literature No.A-2 and A-3, which highlight the importance of intensivists/ internal medicinal specialists & cardiologist and their role in the management of intercurrent non- cardiac illness which a cardiac patient having undergone intervention may suffer from. OP No.1 relying upon aforesaid documents argued that a team of intensivists / internal medicinal specialists and cardiologist ought to have taken care collectively in the case rather than the cardiologist alone, which fact was not looked into by the inquiry committee constituted in the case. O.P. No.1 further referred about documents Nos. B, B-1, B-2, B-3, B-4 and B-5 in his affidavit dated 21.12.2010, which are articles relating to direct evidence of infection causing stent thrombosis. The aforesaid articles are from circulation of reputed cardiac scientific journal issued by American Heart Association and in the literature No.B-1, general principles of infection, pathogenesis, the role of host factor to medical devices, the virulence of the offending organism physical and chemical characteristics of different devices, the diagnostic work up and the // 12 // antibiotic therapy to treat and prevent, have been discussed for different devices. On internal page No.2027, relevant points with regard to infections, specifically related to coronary artery instance, have been discussed. It states that infections, specifically related to the use of intra coronary stents, although very rare, are associated with significant morbidity and mortality and also quoted some reports of study. It also says that optional management strategy with infected coronary stents is unknown. Document No.B-2 speaks of four such cases where there was direct relationship of infection and stent causing lethal complications. Out of eight such referred cases, only two could survive, however in the instant case at hand, there was no such direct relationship of stent per se causing such a lethal event. OP No.1 stated that in the instant case, it was urinary track infection the gram negative bascilli which was resistant to most of the antibiotics leading to septic shock situation as has been described earlier. Aforesaid literatures have been produced to stress that primary infection of a stent is a rare complication. O.P. No.1 also produced document No.B-3, a literature which refers about direct relation of infection to different organ system, other than heart, ultimately causing sepsis and subsequently a stent related complication as occurred in the instant case. In the document a case of pneumonical sepsis of a patient was reported who developed thrombosis LAD and died prior to that. He had undergone surgery (splenectomy) 20 years back known to cause low resistance to // 13 // infection which was a lone case till 2007. O.P.No.1 also submitted a literature of observational study relating to non-cardiac infection pertaining to coronary stent thrombosis which was published in February 2010 in Journal of "Internal Emergency Medicine" by Group of Italian Doctors from University of Florence which studied whether acute infection/inflammation could facilitate the occurrence of coronary stent thrombosis. Out of 41 cases 21 were found to have acute infection. The group finally concluded that acute infection/inflammation could play a role in facilitating coronary stent thrombosis. In the study out of 21 patients 3 had similar infection (urine sepsis) as in the instant case. 12 out of said 21 patients did not survive. The study also revealed that in 68.3% cases patients were found resistant to Aspirin and Clopidogrel, which are important to prevent stent thrombosis. Same drugs were used in the instant case also (document.no.B-4).
10 (ii). O.P. No.1 also filed document No.B-5 which is a study of 363 patients from Dutch stent thrombosis registry which concludes that "triggering mechanism" such as time of the day, physical exertion, emotion stress and infection may be an important role in a considerable number of patients presenting stent thrombosis. The prevalence of these triggers is particularly high in patients with late and very late thrombosis. O.P.No.1 referred about cathlabs notes // 14 // related to the instant case of Late Shri Ashok Pingle, recorded by him on 11.08.2008 as mentioned in para no.9 of his additional affidavit dated 21.12.2010 (document no.OP 1-50 & OP 1-51), which could be made possible by very few interventional cardiologists in such a manner and in fact it deserved appreciation rather than criticism.
11. In another additional affidavit dated 20.10.2010 O.P.No.1 stated that a crime No.426/2008 in the Court of Chief Judicial Magistrate, Bilaspur was filed on 03.08.2010. In para no.4 of the said affidavit he stated that as per case sheets of the case, patient Shri Ashok Pingle was given proper treatment as per test reports and also symptomatically. The tests reports of samples of Late Ashok Shri Pingle taken on 11.08.2008, which were received from Microbiological Department of Apollo Hospital on 14.08.2008 (3 days after death of Mr. Pingle), indicated about infectious bacteria named "Klebseilla Exotica"
which was immune to most of the antibiotics thus a life threatening infection (document at page s.no.124). O.P.No.1 also stated that systematic effect of such an infection could also cause such a derangement in the blood coagulation system so as to cause hyper co augulable state in the body which could have predisposed for formation of clot within the coronary stents, which in the instant case was still fresh and in a layman's terms "naked" (Not yet endotheliased/naturalized). In such situation, the reported possibility // 15 // of death was about 70 to 80%. O.P.No.1 argued that even in such situation he tried his level best to save the patient Shri Ashok Pingle. O.P. No.1 added that if at all this kind of infection would have been known to exist in Mr. Pingle's body, then it could have come to him through some outside source either the crowd visiting him or hospital acquired and could be diagnosed even, which was done twice on 09.08.2008 and also on 11.08.2008 but Pathology Department of Apollo Hospital Bilaspur reported no significant pus cells/cast. O.P.No.1 contended that during initial couple days of fever he treated the patient with an antibiotic of broad spectrum against community acquired infections and infection of even moderate magnitude. O.P.No.1 further added that when he realized that fever of the patient was not settling down even beyond three days, then the case was referred to expert Physicians namely Dr. Rajesh Agrawal who probably did not realize the severity of infection and predicted the precipitating of shock state in so quick a manner and recorded normal blood pressure at 4.52 P.M. and advised ultrasonography to Mr. Pingle without realizing that he was to go in shock state soon. O.P.No.1 stated that Mr. Pingle's family doctor, a renowned physician of the City, was also along with him but none could sense the imminent danger. O.P.No.1 contended that he being a interventional cardiologist, is not an expert in treating infectious diseases which could cause blockage of stents in the body of Mr. Ashok Pingle.
// 16 // O.P.No.1 further contended that it was the primary duty of internal medicine doctors to take care of the infection mentioned in the case, which was referred to them on 10.08.2008, as per case sheets. The part of the complication, the patient had to face, was to be questioned from attending internal medicine consultant Dr. Rajesh Agrawal and Dr. Manoj Rai which the medical committee headed by Dr. G.B. Gupta has mentioned, was the beginning of the complication leading to shock state.
12. We find substance in the contention of O.P.No.1; since a cardiologist is an expert in the faculty of cardiology whose services were hired by O.P.No.2 Hospital. The opinion of expert committee constituted by Chhatisgarh Govt. revealed that there was no deficiency so far as Angioplasty operation done by O.P.No.1 Dr.Jairam Aiyer was concerned. Further as per expert opinion given by Cardiological Society of India, Kolkata (document at page s.no.433) also, in the concluding lines of its report dated 1.12.2011, it is mentioned that :-
"We do not feel that Dr.Jairam Iyer has shown negligence in his duties as far as the standard of treatment is concerned."
Further after 'angioplasty" operation, Mr. Ashok Pingle's recovery of health had been progressing for 3 -4 days as a result he was being planned for discharge from the hospital on 06.08.2008 but on observance of fever with chill with him, he was retained there for // 17 // onward line of treatment. As per documents on record, the patient was reported to have been complaining of fever with chill persistingly & intermittently with a feeling of discomfort after date 06.08.2008 onward, the cause of which needed to have been investigated by the group of various medical experts of the hospital so as to arrive at appropriate line of treatment but it was not adequately done. The cause of fever i.e. infection could have generated thorough any source. Late Shri Ashok Pingle was of advanced age of 60 years and reportedly had been in the habit of tobacco chewing even after operation, and he being a social person of repute so several visitors used to visit him in the hospital so all these factors could be a contributory factor to acquire infection. The health condition of the patient went on deteriorating fast, leading to his unfortunate death which could arise out of infection or any other factor but it was not be established. Dr. Jairam Iyer O.P.N.1 has produced aforementioned literature which clarifies that the highly resistant infection found with Late Shri Ashok Pingle could also be the cause of 'shock state of the deceased'.
13. In this context it is relevant to cite case of Kusum Sharma & ORS. Vs. Batra Hospital & Research Centre & ORS., I (2010) CPJ 29 (SC) in which the conclusions under different case laws on the subject of medical negligence have been summarized as under :-
// 18 // 'Para" 90" In Jacob Mathew's case (supra), conclusions summed up by the Court were very apt and some portions of which are reproduced hereunder:
(1) Negligence is the breach of a duty caused by omission to do something which is a reasonable man guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do. The definition of negligence as given in Law of Torts, Ratanlal & Dhirajlal (edited by Justice G.P. Singh) referred to hereinabove, holds good.
Negligence becomes actionable on account of injury resulting from the act or omission amounting to negligence attributable to the person sued. The essential components of negligence are three: 'duty', 'breach' and 'resulting damage'.
(2) Negligence in the context of medical profession necessarily calls for a treatment with a difference. To infer rashness or negligence on the part of a professional, in particular a doctor, additional considerations apply. A case of occupational negligence is different from one of professional negligence. A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of a medical professional. So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed.
(3) The standard to be applied for judging, whether the person charged has been negligent or not, would be that of an ordinary competent person exercising ordinary skill in that profession. It is not possible for every professional to possess the highest level of expertise or skills in that branch which he practices. A highly skilled professional may be possessed of better qualities, but that // 19 // cannot be made the basis or the yardstick for judging the performance of the professional proceeded against on indictment of negligence.
Para "94'. On scrutiny of the leading cases of medical negligence both in our country and other countries especially United Kingdom, some basic principles emerge in dealing with the cases of medical negligence. While deciding whether the medical professional is guilty of medical negligence following well known principles must be kept in view:
I. Negligence is the breach of a duty exercised by omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do.
II. Negligence is an essential ingredient of the offence. The negligence to be established by the prosecution must be culpable or gross and not the negligence merely based upon an error of judgment.
III. The medical professional expected to bring a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires.
IV. A medical practitioner would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field.
V. In the realm of diagnosis and treatment there is scope for genuine difference of opinion and one professional doctor is clearly not negligent merely because his conclusion differs from that of other professional doctor.
// 20 // VI. The medical professional is often called upon to adopt a procedure which involves higher element of risk, but which is honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure. Just because a professional looking to the gravity of illness has taken higher element of risk to redeem the patient out of his/her suffering which did not yield the desired result may not amount to negligence.
VII. Negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence.
Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession.
VIII. It would not be conducive to the efficiency of the medical profession if no Doctor could administer medicine without a halter round his neck.
IX. It is our bounden duty and obligation of the civil society to ensure that the medical professionals are not unnecessary harassed or humiliated so that they can perform their professional duties without fear and apprehension.
X. The medical practitioners at times also have to be saved from such a class of complainants who use criminal process as a tool for pressurizing the medical professionals/hospitals or clinics for extracting uncalled for compensation.
Such malicious proceedings deserve to be discarded against the medical practitioners.
XI. The medical professionals are entitled to get protection so long as they perform // 21 // their duties with reasonable skill and competence and in the interest of the patients. The interest and welfare of the patients have to be paramount for the medical professionals."
14. In view of foregoing discussion, we are of considered view that Dr. Jairam Iyer O.P.No.1 being a cardiologist had performed his duties in good faith with a reasonable care what a professional in the faculty is reasonably expected of, therefore he is not liable for the unfortunate death of late Shri Ashok Pingle.
15. Next question remains whether there was any deficiency on the part of O.P. No.2 the Apollo Hospital Bilaspur and if so, compensation there for ?.
15 (i) From the statements of various witnesses made before the Police i.e. Smt. Renuka Pingle, Shri Alok Pingle, Sister and brother of Shri Ashok Pingle, Shri Vibhar Soni, Shri Mahendra Kumar Yadav (Driver), Shri Pratik Kumar Verma, Shri Vijay Tamrakar, Shri Vikas Shukla, Shri Hashmukh Rai Kothari, Shri Manish Agrawal, Shri Ravi Shekhar Rao, Dr. Vijay Shrivas, Dr. Yashwant Dubey, Shri S. Venkatesh, Dr. Ramesh Agrawal, Shri Jerin Jose, M. Monisha, Smt. Ravi Lal, C.G. Rop, Nitu Joseph, Pratima Agasti, Dr. B.R. Ramna, C.E.O. CIMS, Bilaspur (document nos.C-30 to C-85 ), it is clear that the deceased Shri Ashok Pingle was reported to have been suffering from // 22 // fever with chill requiring blanket to wrap from 06.08.2008 afternoon onwards which persisted intermittently till the date of death. He was also reported not to have been feeling comfortable from 06.08.2008 onwards. As per records, there had been reportedly persistent and intermittent fever to Mr.Ashok Pingle and having got no proper response by his relatives & friends from the hospital administration, they had got agitated on happening of the unexpected death of late Mr. Pingle, which created a chaotic situation in the hospital requiring Dr. Jairam Iyer to be kept separately in safe room. For such reason, on the application of the complainant, the Government of Chhattisgarh had constituted a committee to inquire in to the matter. The inquiry committee submitted its report and observed some discrepancies in medical treatment and also some lapses in post operative management on the part of O.P.no.2 Apollo Hospital, Bilaspur as under :- (As per documents at page s.no.99 & 100) ;
"Discrepancies:-
1. USG report - Ft. Jairam Iyer (OP no.1) reports prostatomegaly while Radiologist in his report mentioned splenomegaly later appears to be correct.
2 .ECG recorded on 12th February 2008 did not appear to belong to Late Shri Ashok Pingle.
3. ECG was available for 2nd, 3rd and 11th August, 2008.
4.Hypertension and Septic Shock were not included in the diagnosis."
// 23 // Further lapses on the part of O.P.No.2/Apollo Hospital, Bilaspur were reported as under :-
"1. In the event of emergency requirement, administration is not able to provide care to needy person on time.
2. Senior faculty member are Single in the department and not able to extend coverage to the patient under their care in the emergency requirement.
3. Format of the appointment letter Point No.09 assures group practice and collectively responsibility for care of the patient hence the institution is equally responsible for this incidence.
4. Dr. Jairam Iyer was seeing his indoor patient in the evening time once a day only."
From the aforesaid observation of the inquiry committee, we find that there were some lapses on the part of O.P. No.2 the Apollo Hospital in post operative management of late Shri Ashok Pingle. Had investigative reports been properly procured such as, if ECG reports of Shri Ashok Pingle had been recorded daily from 4th August to 10th August 2008, had microscopic urine culture report been sought on noticing persisting and intermittent fever with chill, which was done very late on 10.08.2010 (report received on 14.08.2008 after the death of late Mr.Ashok Pingle), then proper line of medical treatment could have been managed to save the patient. Moreover as per observation of the inquiry committee and as per statements of witnesses before the // 24 // police, the hospital administration lacked in providing adequate care & help in case of acute need to Late Mr. Ashok Pingle thereby giving scope of dissatisfaction & agony to the patient and also his attending relatives leading to complaint in mass. It is a common belief that patients are referred to a hospital with an object that a patient would get comprehensive medical treatment under one roof with the help of various medical experts collectively by way of a common administration and if it lacks, then it amounts to negligence. Although it is a well known fact that human life is always associated with uncertainties of its survival both due to inherent condition of the body and also due to various external factors and doctors cannot guarantee about success of medical treatment given by them to the patient, but a diligent and adequate clinical investigation of any acute problem of health of the patient is required as per prescribed norms followed by its treatment prudently, does give satisfaction and consolation to the patient and relatives as well, otherwise entails their complaint and agony. O.P No.2 Apollo Hospital, Bilaspur lacked in post operative care of the patient since there was reportedly no control on visitors who came to see him particularly when he had been recently operated of 'angioplasty' having been planted stents in arteries. Frequent visit of visitors in the hospital could also be the contributory factor of the resistant infection which the deceased Shri Ashok Pingle had acquired during his post operative tenure. It was the duty of hospital to take // 25 // adequate care for prevention of all sorts of infections from outside source. Further no adequate efforts by O.P. No.2 Hospital were made to ascertain the exact cause of serious type of infection developed in the deceased which led to persistence and intermittent fever to him from 06.08.2008 onward especially when medicines like 'crocin' or antibiotic drugs could not control the same. Moreover, when complaint of frequent fever was brought to the notice of hospital staff by the relatives of late Shri Ashok Pingle, it was attended with 'crocin' tablet ignoring the patient to undergo the required clinical investigations at the earliest when it could be done in the hospital itself. When 'Maleria' the likely cause of fever with chill was found 'negative' in the test reports, stringent investigative reports such as microscopic urine culture ought to have been taken out which was done very late on 10.08.2008 report of which was received after the death of the patient.
16. Under the foregoing discussion and facts of the case, we find deficiency in service, in respect of post operative management of the deceased, on the part of O.P.No.2/Apollo Hospital, Bilaspur, so it is held liable for the same.
17. Contention of O.P.No.2 is that the complainant has not established that she is the only legal representative of the deceased. We find that as per documents on record, there are other relatives also of // 26 // Late Shri Ashok Pingle, who should have either joined the complainant in the complaint or they should have authorized the complainant alone to file complaint on their behalf also. Thus the contention of O.P. No.2 has substance to sustain.
18. We further find that Late Shri Ashok Pingle was a single person with an income of Rs.5,000/-per month which appears to be merely self supporting only during the relevant time. As per documents on record, nobody appears dependent on the deceased for livelihood. The loss, caused to the legal heirs of Late Shri Ashok Pingle due to his unfortunate death, remains only sentimental out of love & affection. The relatives of the deceased, as per documents on record, appear to have incurred expenses Rs.2,00,000/- only towards medical expenses vide Receipt No. DR 38074 dated 07.08.2008. There is no evidence about any other expenses as claimed in the complaint.
19. Under the foregoing discussion and facts of the case, we direct O.P No.2/the Apollo Hospital, Bilaspur to pay compensation to the complainant along with other LRs of the deceased as under :-
(i). Rs. 2,00,000/- (Rs. Two Lakhs only) being the expenses incurred for medical expenses of the deceased.
(ii). To pay Rs.1,50,000/-(Rs. One Lakh Fifty thousand only) being the compensation for mental agony and physical harassment.
// 27 //
(iii). Cost of proceedings quantified as Rs.3,500/- shall also be payable.
The amount of award under this order will be payable to the complainant along with other LR's of the deceased on production of succession certificate issued by the competent authority within a period of two months otherwise the amount will carry interest @ 9% p.a. (Justice S.C.Vyas) (V.K. Patil) President Member /03/2012 /03/2012