State Consumer Disputes Redressal Commission
Smt. Durgesh Nandini & Ors. vs Director Chandu Lal Chandrakar ... on 24 August, 2017
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION,
PANDRI, RAIPUR (C.G.)
Complaint Case No.CC/2015/04
Instituted on : 02.05.2015
1. Smt. Durgesh Nandini Dubey,
Widow of Shri Rajendra Kumar Dubey.
2. Nishant Duey,
S/o Late Rajendra Kumar Dubey,
3. Nikhil Dubey,
S/o Late Rajendra Kumar Dubey,
4. Nimish Dubey,
S/o Late Rajendra Kumar Dubey.
All are residents of Zone - 2, Street - 6,
New Adarsh Nagar,
Tehsil and District Durg (C.G). ... Complainants.
Vs.
1. Director,
Chandulal Chandrakar Memorial Hospital, Bhilai,
Nehru Nagar Chowk, G.E. Road,
Bhilai, Tehsil & District Durg (C.G.)
2. Dr. M.P. Chandrakar (Cardiologist),
Chandulal Chandrakar Memorial Hospital, Bhilai,
Nehru Nagar Chowk, G.E. Road,
Bhilai, Tehsil & District Durg (C.G.)
3. Dr. Prabhat Pandey (Cardiologist)
Chandulal Chandrakar Memorial Hospital, Bhilai,
Nehru Nagar Chowk, G.E. Road,
Bhilai, Tehsil & District Durg (C.G.)
4. Dr. Rahul Gulati (Cardiologist),
Chandulal Chandrakar Memorial Hospital, Bhilai,
Nehru Nagar Chowk, G.E. Road,
Bhilai, Tehsil & District Durg (C.G.)
5. Narayana Hrudayalaya M.M.I.,
Through : Managing Director,
Dhamtari Road, Pachpedi Naka,
Raipur (C.G.)
// 2 //
6. The Oriental Insurance Company Limited,
Through : Divisional Manager,
Shivnath Complex, G.E. Road, Supela,
Bhilai, District Durg (C.G.)
7. National Insurance Company Limited,
Through : Branch Manager / Competent Authority,
Second Floor, Shambhu Chatterjee Street,
Kolkata West Bengal - 700007. ... Opposite Parties
PRESENT: -
HON'BLE SHRI JUSTICE R.S. SHARMA, PRESIDENT
HON'BLE SHRI D.K. PODDAR, MEMBER
COUNSEL FOR THE PARTIES:
Shri S.K. Pandey, Advocate for the complainants.
Shri R.K. Bhawnani, Advocate for O.P. No1 to 4 with O.P. No.2, O.P.
No.3 and O.P. No.4.
Shri Apurv Goyal, Advocate for O.P. No.5.
Miss B.S. Kanthi, Advocate for O.P. No.6.
Shri P.K. Paul, Advocate for O.P. No.7.
ORDER
Dated : 24/08/2017 PER :- HON'BLE SHRI JUSTICE R.S. SHARMA, PRESIDENT. The complainants have filed this consumer complaint against the OPs seeking following reliefs :-
(a) To direct the OPs to pay to pay a sum of Rs.5,00,000/-
(Rupees Five Lakhs) to the complainants as they deprived from love and affection of the deceased, Rs.3,00,000/- (Rupees Three Lakhs) towards compensation for fulfilling circumstantial liability, Rs.2,00,000/- (Rupees Two Lakhs) towards other compensation, Rs.89,99,900/- (Rupees Eighty Nine Lakhs Ninety Nine Thousand Nine Hundred) // 3 // calculated on the basis of amount of salary, G.P.F and other to be received in service period of the deceased.
(b) To direct the OPs to pay the compensation for mental agony and amount of expenses, cost of litigation, etc. to the complainants.
(c) To directed the OPs to pay the compensation for unexpected loss to the complainants.
2. Briefly stated the facts of the complaint of the complainants are that on 12.07.2013 at about 12.P.M. to 1 P.M., the husband of the complainant no.1 and father of complainant no.2 to 4, namely Rajendra Kumar Dubey has suffered chest pain and sweat was coming, therefore, he was taken by complainant No.3 to Chandulal Memorial Hospital (O.P. No.1) where he was examined. As per instruction of the O.P. No.1 hospital, Rajendra Kumar Dubey was immediate admitted in the hospital and he was shifted to Cardiac ICU Ward, where he was admitted from 12.07.2013 to 18.07.2013. The amount was paid as per direction of the hospital. On 13.07.2013, the general condition of the patient was stable and his proper treatment is required to be done but the instructions had not been occurred. The necessary test was not done by the hospital due to which the expected result could not be occurred. On 14 & 15th July 2013, the O.P. No.3 discussed with the relative of the deceased and informed him that the patient is suffering // 4 // from Unstable Angina disease. The relative of the deceased was surprised because information regarding another disease was given. As the complainant No.3 is a Dentist and the O.P. No.1 to O.P. No.4 were required to give information on the basis of test report, but they did not provide the information. Thus, during the course of admission, the patient was not given proper treatment. The treatment and test done by the O.P. No.1 hospital was of inferior quality, due to which there was no possibility of improvement in his condition. The O.P. No.2 & O.P. No.3 pressurised to keep admit the patient because his blood pressure is high and his oxygenation is less whereas on 13.07.2013, the blood pressure of the patient and vital sign was equivalent to normal. On this basis, the complainants doubted that the patient is not suffering from cardiac problem, treatment of which was done by the O.P. No.1 to O.P. No.4. The treatment given by the O.P. No.1 to O.P. No.4 was wrong and they treated the deceased for that disease from which the deceased was not suffering. The O.P. No.1 to O.P. No.4 did not properly treat the patient and also did not discharge the patient for referring to a higher centre for proper treatment. The O.P. No.1 to O.P. No.4 committed negligence in treatment of the patient, due to which he died. The patient was given expiry date medicines and the above medicines were used in treatment of the patient, which comes in the category of medical negligence. The Trop- T and CKMB Report of the deceased was negative / normal even then // 5 // diagnosis was prepared for heart attack (Non ST elevated myocardial infarction) which is false. In the two documents relating to the treatment of the patient dated 12.07.2013, the blood pressure is mentioned 90/70 and 110/70. It means that the blood pressure is normal, but in the document in which blood pressure is mentioned as 110/70, Cardiiogenic Shock is mentioned. When the blood pressure of patient is normal then mentioning Cardiogenic Shock by the O.P. No.1 to O.P. No.4 shows medical negligence on their part. Later on for increasing blood pressure of the patient, the O.P. No.1 to 4 had given Nor-Adrenaline medicine whereas in acute Aortic Dissection by giving medicine for increasing blood pressure, due to increase of blood pressure, at the time dissection, it increase the dissect. The patient would not be given medicines for increasing blood pressure in Acute Aortic Dissection and by not doing so the O.P. No.1 to O.P. No.4 have committed negligence. On 12.07.2013 D-Dimer Test of the patient was got conducted by the O.P. No.1 to O.P. No.4, which was increased. For testing Pulmonary Embolism, CT test or CT Angiography was to be done, which was not done by the O.P. No.1 to O.P. No.4. In the clinical examination of the patient, the blood pressure of both hands and legs was not taken from the first day, which comes in the category of medical negligence. When the doubt is created regarding treatment of the patient and when the expected improvement is not made by treatment given at Chandulal Chandrkar Memorial Hospital, then the // 6 // patient was got admitted at NH MMI Hospital, Raipur where it is found that the diagnosis done and treatment given by Chandulal Chandrakar Memorial Hospital is not proper because due to treatment given by O.P. No.1 to O.P. No.4, the condition of the patient was deteriorated and became critical. The O.P. No.1 to O.P. No.4 gave Heparin (Low Moecular) medicine due to which dissect was increased. On 14.07.2013 the O.P. No.1 to 4 told that the patient is having abdominal discomfort and the same is recorded in the slip by the O.P. No.1 to O.P. No.4 but the CT abdomen of the patient was not got done and only USG abdomen was got done. If the CT Abdomen of the patient would have been done, the dissection would have been seen. On 16.07.2013, it is mentioned that the D-Dimer of the patient is normal whereas on 16.07.2013 itself the O.P. No.3 informed the O.P. No.4 that the D-Dimer of the patient has been raised, and told to Rule Out Pulmonary Embolism, but only Echo was done and CT Angiography was not done. On 12.07.2013, if the O.P. No.1 to O.P. No.4 mentioned that the blood pressure is 110/70 which is normal then the O.P. No.1 to O.P. No.4 were required to conduct Angiography and if the condition of the patient was stable then why coronary angiography or CT angio was not conducted which shows medical negligence. In spite of this fact on 19.07.2013 in Narayana Hrudayalaya MMI Raipur at about 11.58 AM, the CT Angiography of the patient was done and about 2.00 PM the expert doctor told that the // 7 // patient is suffering from Type A Aortic Dissection and told that immediately the operation is required to be conducted and operation is not to be done at Raipur. For operation, the patient is required to be shifted to Narayana Hrudayalaya Bangalore. In the meantime the patient suffer cardiac arrest and he died. The complainants did not find that Narayana Hrudayalaya, MMI, Raipur has committed any medical negligence while treating the patient, therefore, it has not been made party . In Chandulal Chandrakar Memorial Hospital, Durg (C.G., facility of C.T. Angiography is not available and even registered and passed Cardiologist is not there, even then the treatment of heart patient is done, which is deficiency in service. The patient was not sent immediately for C.T. Angiography and expiry date medicines was given to the patient, which shows negligence of the O.P. No.1 to O.P. No.4. On 18.07.2013, the complainants requested in writing to the O.P. No.1 hospital to discharge the patient and he was discharged then he was got admitted in Narayana Hrudayalalya MMI Raipur where the expert examined the patient and conducted necessary test and echo and it was informed that patient is not suffering from heart attack disease the heart function of the patient is normal. On 19.07.2013 at about 11.58 A.M. anigiography was done and on 19.07.2013 at about 01.45 PM. To 2.15 PM the expert doctor told that the patient is suffering from Type A Aortic Dissection and told that the operation is required to be done immediately, the above // 8 // facility is available at Narayana Hrudayalaya, Bangalore, therefroe, the patient is required to be referred to Bangalore. Thereafter, the nurse of authorised ward of the MMI Hospital informed that the patient had suffered cardiac arrest it means that on conducting examination, the patient had already died. The O.P. No.2 & O.P. No.3 are famous Cardiologist. In the test report of the patient Trop - T and CKMB was found negative. Which confirm that the O.P. No.1 to O.P. No.4 had deliberately wrongly treated the patient and during his admission in the hospital, expiry date medicines were used. The O.P. No.1 to O.P. No.4 have committed medical negligence. Hence the complainants have filed instant complaint and prayed for granting reliefs as prayed in the complaint.
3. The O.P. No.1 to 4 OPs have filed their joint written statement and raised preliminary objection. The O.P. No.1 to O.P. No.4 averred that it is settled principle of law that the expertise processed or discrimination used by a medical practitioner in the best interest of a patient would not be judicially determinable upon complaint made on behalf of a dissatisfied person. It is also settled proposition of law that if two or more views are possible viv-a-vis the line of treatment then the view adopted by the treating doctor cannot constitute a lis against him whether in civil or criminal action. On this short ground alone the instant complaint as drafted would be liable for dismissal. The complainants now here question the competence of the O.P. No.1 to 4 // 9 // and yet tend to question their discretion, which is judicially not determinable. On the scrutiny of the documents filed with the complaint by the complainants, which have been sent to the O.P. No.1 to O.P. No.4 along with the notice for appearing before this Commission in the captioned matter, it is submitted that the complainants deliberately did not send the complete documents along with the notice, but sent only 223 documents. It clearly reveals from the perusal of para 4(2) of the complaint where the complainants have referred to a document vide document No.236 but the same is not provided for by the complainants to the O.P. No.1 to O.P. No.4 with an oblique motive. Similarly in para 4 (3) of the complaint, it has been again referred with regard to the document No.253, 282 and 283. Further the complainants have referred to in para 4(4) of the complaint about the document No.225 and 226, but the same have not been provide for by the complainants. It clearly reveals that the complainants have filed the instant complaint with malafide intention and tried to obtain some favourable order by suppressing the relevant documents from the O.P. No.1 to O.P. No.4. The complaint filed by the complainants is not maintainable as per allegations of the complainants in the matter. It will require detailed evidence, which is not possible in summary procedure. Therefore, the complaint of the complainants is not maintainable and is liable to be dismissed. The complainants have not made the Oriental Insurance Company as party // 10 // in the complaint. The O.P. No.1 has taken a policy in the name of "Error and Omission - Medical Establishment" vide policy No.192100/48/2013/1246. Similarly O.P. No.2 has also taken a policy in the name of "Professional Indemnity -Doctors Policy Schedule" vide policy No.192500/48/2013/807. The aforesaid policies have been taken from the Oriental Insurance Company Limited, Shivnath Complex, G.E. Road, Supela, Bhilai (C.G.). The complaint is not maintainable on the ground that the O.P. No.1 to O.P. No.4 have not committed deficiency in service nr have given any wrong treatment and no medical treatment has been committed. Therefore, the complaint of the complainants is liable to be dismissed. The contents of the complaint are misconceived, composed of figment of imagination and also attributive of malafides against the genuine medical services rendered by the O.P. No.1 to O.P. No.4 to the aforesaid deceased. Moreover the complaint of the complainants is replete with apparent contradictions and tainted misgivings about the actual nature of ailment of the deceased and the appropriate line of treatment that was adopted bonafide, in good faith also in the best interest of the aforesaid deceased The expertise of a medical practitioner in detecting the cause of ailment of a patient including conducting clinical investigations would not be specially disputable in the event the consequences and results with regard to the aforesaid patient have shown positive results, which is explicit in the instant // 11 // case. The complainants have taken with them the admission / discharge summary and also other clinical reports from the hospital of the O.P. No.1 to O.P. No.4. In accordance with the principles of medical ethics and responsibilities of the treatment the complainants have been continuously informed about the progress and treatment of the deceased repeatedly on day to day basis under their specific acknowledgement. The complainants also mentioned in their complaint that the complainant No.3 Nikhil Dubey (son of the deceased) himself is a doctor of Dentistry. Despite day to day knowledge of the line of treatment and the resultant progress thereto with regard to the condition of the deceased, the reports given to them and the care and treatment rendered to the patient / deceased by the O.P. No.1 to O.P. No.4 was appreciated by the complainants without or any protestation, which is also discernible from a bare perusal of the complaint. The complainants even otherwise did not ask for any further clarifications or information from O.P. No.1 to O.P. No.4 and as such it is clinchingly deducible that complainants were totally satisfied throughout regarding the medical services rendered to the deceased by the O.P. No.1 to O.P. No.4 The progress and development with regard to the physical and overall condition of the deceased on day to day basis has been a redeeming feature even in the reckoning of the complainants which would be noticeable from a bare perusal of the admission / discharge summary of the clinical case along with other // 12 // documents. During the admission of the deceased in the hospital of the O.P. No.1 to O.P. No.4 and after his death , the complainants have been meeting with the O.P. No.1 to O.P. No.4 and were faithfully informed about the entire history of the ailment and treatment given to the deceased resulting in their satisfaction. The symptoms narrated have also been faithfully recorded. Appropriate medicines were adequately administered. The patient / deceased was kept under constant monitoring of the O.P. No.1 to O.P. No.4. The deceased showed progress in all the parameters of physical condition as well. The O.P. No.1 to O.P. No.4 were even otherwise always agreeable and helpful for discharging and shifting the patient upon request by the complainants even before 18.07.20`13 subject to steady condition and eliminating any risk factor for the patient/deceased with which fact also the complainants were acquainted with. Summarily speaking the complaint therefore does not contain or mention any deficiency whatsoever in specifics as far as the medical services rendered by the O.P. No.1 to O.P. No.4 are concerned. The complaint is not maintainable on the ground of non-joinder of necessary party. The complainants ought to have impleaded the Narayana Hrudayalaya, MMI, Raipur (C.G.) as party respondent for just and proper decision of the case. According to the complainants, they have willingly taken discharge of the deceased Rajendra Kumar Dubey on 18.07.2013 from the hospital of O.P. No.1 to O.P. No.4 and admitted him to Narayana // 13 // Hrudayalaya, MMI, Raipur on the same day i.e.18.07.2013, wherein the deceased was treated as indoor patient till 19.07.2013. The last treatment was given to the deceased by the aforesaid Narayana Hrudayalaya MMI Hospital and the patient has died in that hospital. The death certificate has also been issued by the Narayana Hrudayalaya, MMI, Raipur. Hence, the Narayana Hrudayalaya MMI, Raipur is the proper and necessary party to adjudicate the present complaint but the complainants knowingly did not make the party Narayana Hrudayalaya MMI, Raipur. Therefore, the complaint of the complainants should have been dismissed on this ground alone. The deceased Rajendra Kumar Dubey was admitted in the state of collapse and his blood pressure was 70 systolic that too by palpation with profuse sweating and chest discomfort with cold extremities which come under clinical definition of Shock. The patient was rescued with fluids and inotropic support in the form of Noradrenaline to store the peripheral end organ perfusion and to stabilize the patient. The patient responded well and his reduced urine output gradually improved with improvement of blood pressure (according to case sheet), same medication was used in other hospital also. It is made clear that the patient was admitted upto 18.07.2013 with regard to the contents regarding payment of the bills, it is made clear that as per the procedure the amount was paid by the relatives of the patient. The condition of the patient was informed to the relatives of the patient // 14 // (complainants). The amendment incorporated by the complainants in their complaint is after thought and after the defence taken by the O.P. No.1 to O.P. No.4. The complainants have tried to cover up their mistake by said amendment. It is made clear that because of the problem in the computer system there was some misunderstanding about description which would be a curable proposition. The diagnosis was made on clinical suspicion as the patient was having diffuse chest pain with perspiration. Previously diagnosis of NSTEMI was made which was revised to unstable angina. Both the diagnosis are part of constalaion known as ACS i.e. Acute Coronary Syndrome. The patient with unstable angina have evidence of myocardial necrosis on the basis of elevated cardiac serum markers, such as cardiac-specific toponin T or I and creatinine kinase issoenzyme (CK)- MB, and thus have a diagnosis of NSTEMI. As troponin measurement become progressively more sensitive, an increasing fraction of patients with NSTE-ACS exhibit some release of troponin, and therefore these should be considered case of NSTEMI with a reciprocal reduction in the fraction with unstable angina. The contents of the complaint very erratically mentions about the deceased picking up high blood pressure etc. which in contrast according to the attendant clinical papers would be falsified. On the one hand the complainants alleges wrong line of treatment or even administration of medicines but on the other hand concedes that due to the treatment given by the O.P. No.1 // 15 // to O.P. No.4, the condition of the patient improved to become normal. The D-dimer is a non-specific test in achieving diagnosis of pulmonary embolism and aortic dissection. They are also increased in other conditions in patients of myocardial infarction sepsis cancer or almost any other systemic illness nor clinical findings and echo were suggestive of pulmonary embolism. The D-dimer test of the patient became normal vide report dated 16.07.2013. The CT Angiography was not done as patient was in state of shock and on ionotropic support and contrast media cannot be administered if patient is found to be oligouric or anuric or on ionotropic supports, or cardiac failure due to risk of developing contrast induced nephropathy. The patient was stable on inotropic supports clinical examination was done where all peripheral pulsations were well felt and there was no any evidence of vascular compromise in any limbs as evidenced by clinical condition of the patient till he was received in hemodynamically stable condition in other hospital. Patient's relatives were told by Dr. Prabhat Pandey that patient is now hemodynamically stable on 17.07.2013. Condition was continuously discussed with Dr. Sumant Padhi, Cardiologist, NH MMI for his condition by relatives of patient and as patient was on ionotrops and not maintaining saturation and due to no availability of cardiac ambulance with ventilator, he suggested to manage the patient in CM Hospital till he improves, and patient gradually improved, and was shifted to NH MMI in totally // 16 // hemodynamically stable condition. The same treatment was followed in other hospital i.e. NH MMI till next day. This is totally false allegation that patient was admitted to NH MMI in serious state. Even clinical findings of patients including other investigations were comparable to hospital of O.P. No.1 to O.P. No.4 the day he was admitted to NH MMI hospital. The patient on 14th of July was taking feeds, passing urine through on ionotrops his per abdomen soft the patient complained of mild abdominal discomfort to USG abdomen was performed which revealed normal findings as per abdomen findings were absolutely normal. On 16th d-dimur of the patient was found to be normal on review echo there was no right ventricular dysfunction and no findings consistent with pulmonary embolism, even in CT angio performed on second day of admission in NH MMI showed no pulmonary embolism. The blood pressure reflected in case sheet till 16th and 17th was due to inotropic supports and patient was gradually improving but still patient was having signs of cardiac failure and was not maintaining saturation of oxygen so CT angio was not feasible at that point of time as patient was on ionotropic supports, and cardiac failure due to risk of developing contrast induced nephropathy and further worsening of symptoms. The O.P. No.1 to O.P. No.4 are conscientious, humanitarian and dutiful doctors of repute in the area. The kind of cause of death sought to be informed in by the complainants is a rarity in medical science which has its own // 17 // symptoms and attributes. The patients of such aortic arch detection have mortality rate of 1 per cent to 2 per cent per hour after event. The complainants are very well informed of the latest trends in such clinical problems and applicability of the correct line of treatment. No physical examination findings with regard to acute, aortic dissection were discernibly found even on 18.07.2013 after the patient was discharged from the hospital of O.P. No.1 to O.P. No.4. However, contents in half hearted complaint do not constitute any assertive allegation with regard to the step by step deficiency in the medical services rendered to the patient because for obvious reasons no such deficiency ever existed. The ;patient was admitted to NH MMI on 18th of July, 2013 where he was investigated the findings were same as the hospital of the O.P. No.1 to O.P. No.4, even echo showed no signs of aortic regurgitation or aortic root dilatation and as patient gradually improved from failure and acute aortic regurgitation induced failure would never have improved. If NHMMI doctors would have found any findings in echo or any clinical examination they would had done CT angio the very same day of admission, but it was done as elective investigation next day in house facility on 19th July,2013. That even according to the contents of the complaint it is undeniable that consequent upon the discharge of the aforesaid patient from the hospital of the O.P. No.1 to O.P. No.4 the patient was subjected to clinical and other investigations in the Narayanan // 18 // Hridyalaya, MMI Raipur the findings whereof have been stated to have endorsed the findings made in the hospital of O.P. No.1 to O.P. No.4. It would obviously justify the bonafides of the line of treatment adopted by the O.P. No.1 to O.P. No.4. However, if the findings with regard to the condition of the patient dated 19.07.2013 consequent upon CT angiography conducted resulting in his death, it would not be possible to comment by O.P.No.1 to O.P. No.4 not having any nexus or control over the treatment component with regard to the deceased. The patient had CT angio and collapsed immediately after CT angio with VF. There was no sign of content rupture in CT angio as cause of death pulmonary embolism which is reflected by the document No.205 of the complaint. The diagnosis was made on technical suspicion as patient was having diffuse chest pain with prespiration previously diagnosis of NSTEMI was made which was revised to unstable angina after trop T CPKMB values. Both the diagnosis are part of constalation known as ACS i.e. Acute Coronary Syndrome. The patient gradually improved by the management of the O.P. No.1 to O.P. No.4 and was discharged in stable condition and was received in same condition at other hospital. A wrong line of treatment would not improve the overall condition of any patient. The O.P. No./1 to 4 have received only 223 documents with the complaint but the complainants have referred in page no. about document no.236, 229, 253, 283, 282, 225 and 226 which are not received by the // 19 // O.P. No.1 to O.P. No.4. The State Commission has no jurisdiction to entertain the complaint and the complaint filed by the complainants is not maintainable. Therefore, the complaint of the complainants is liable to be dismissed. The complainants are not entitled for the compensation claimed by them. The patient was admitted in ICU with complaints of diffuse chest pain with profuse sweating in state of shock with cold extremities with blood pressure of 70 systolic, intermittently not maintaining oxygen saturation, patient was immediately resuscitated with intravenous fluids, ionotropic supports in the form of injection Noradrenaline, Inj. Dopamine and was given other medications in the form of Tab Deplatt (clopidogrel), Tab. Ecosprin, tab Lipicure (atorvastatin), Inj. Pentoprazole (pansec), and low molecular weight heparin in the form of Loparin / Lmwx. The patient responded to treatment and his pain disappeared and had improved blood pressure due to inoropic supports. Patient started having urine as he was given Inj. Lasix due to no urine output. Patient continue to have intermittent profuse sweating and his general condition was still unstable on 12.07.2013. The patient gradually showed signs of clinical stabilization and was continued with ionotropic supports and same medications. The patient was conscious and oriented with heart rate of 68/min, blood pressure 130/70 and febrile and complaining slight pain in epigastric region for which USG abdomen was done with normal findings. On 13.07.2013, patient was // 20 // conscious, oriented and was still on inotropic supports and was on medications in form of Inj. LMWX, Inj. PANSEC, Tab. Deplatt, Tab. Aldectone, Tab. Lipicure, Inj. Dopamine, Inj. Lasix. The patient was conscious and oreinted having heart rate 96/min with blood pressure of 140/70 and febrile for which cold sponging was done by the O.P. No.1 to O.P. No.4. On 14.07.2013, the patient was conscious and oriented heart rate 106/min blood pressure 130/80 lungs bilateral diffuse crepts and the patient was not maintaining oxygen saturation without oxygen. The patient was administered with Inj. LMWX, Inj. PANSEC, Tab. Aldectone, Tab. Deplatt A, Tab. Lipicure, Syp. Lactihep, Inj. Dopamine, Inj. Lasix. On 15.07.2013, patient had chest pain which responded to sublingual nitrates his heart rate was 121 / min, blood pressure 120/50 with not maintaining saturation without oxygen along with bilateral diffuse crepitations in lungs. The patient was administered with Inj. Zubacef (antibiotics), Inj. Lmwx, Inj. Pansec, Tab.Aldectone, Tab. Deplatt A, Tab. Lipicure, Syp. Lactihep, Inj. Dopamine, Inj. Dobutamine. The patient took semisolid diet dose reduction of inotropic drugs was planned. On 16.07.2013 patient was still on ionotropic support conscious, oriented, not maintaining oxygen saturation was on intermittent bipap i.e. non invasive positive pressure ventilation, bilateral diffuse crepts heart rate 80/min pulses bl symmetrical all peripheral pulses well felt, blood pressure 120/80, per abdomen examination revealed normal findings with central nervous // 21 // system findings within normal limits. The Inj. Dopamine as gradually tapperd to stopped and other medications such as Inj. Zubacef, Inj. Lmwx, Inj. Pansec, Tab Aldectone, Tab. Deplatt A, Tab. Lipicure, Tab. Ivabradine, Tab. Montrate SR, Tab. Metolazone & Syp. Lactihep was given to the patient. The D-dimer test was done and that was in normal limits. On 17.07.2013, the patient was gradually improved and was conscious, oriented, heart rate 64/min, blood pressure 120/70 cardiovascular examination improved, respirator system suggested improvement with fine crepitations with adequate urine output. The patient was administered with Inj. Zubacef, Inj. Lmwx, Inj. Pansec, Inj. Ondem, Tab. Ranozex, TabIvabrad, Tab. Manotrate, Tab. Metoz, Tab. Deplatt A, Tab. Lipicure, Tab. Lasilactone and Tab. Cardace. The patient was totally stable and due to the request of the complainants, there was plan to shift the patient to other hospital for further evaluation. On 18.07.2013 patient was stable and was without inotropic support conscious, oriented, heart rate 60 / min, blood pressure 140/90, lungs clear, CVS normal findings, per abdomen findings no abnormality with bowel and bladder normal, passed motion, comfortable with adequate urine output. The patient was discharged on request of the complainants and had been taken to other hospital. The O.P. No.1 to O.P. No.4 have not committed any medical negligence. Therefore, the complaint is liable to be dismissed.
// 22 //
4. The O.P. No.5 has filed its written statement and averred that the patient Rajendra Kumar Dubey was admitted in the hospital of the O.P. No.5 for treatment. When the patient was brought and admitted for treatment in the hospital, he was stable and pain free. He was admitted on 18.07.2013 at about 7.30 PM in the hospital in stable condition. Before admission, he was treated for old IWMI (Inferior Wall Myocardial Infarction), current NSTEMI (Non ST Elevation Myocardial Infarction) and recovered from shock. At the time of admission patient was stable hemodynamically (blood pressure 130/80, heart rate 90 / min). As per the referral letter there was documented ECG changes and documnted RWMA (Regional Wall Motion Abnormality) in echocardiography, hence was treated in the line of ACS (Acute Coronary Syndrome) Ecosprin, Clopidogrel, Atorvastanin and heparin. The Consultant Cardiologist Interventional Cardilogy Dr. Sumanta Shekhar Padhi, started treatment and advised several tests, investigations to assess the condition, diagnosis. Since D- DIMER done in the previous hospital was very high (>2500 unit) the consultant thought to rule out Pulmonary thromboembolism by CT angiography. Since the patient was stable hemodynamicaly, there was no RA/RV dilatation or RV dysfunction. Pulmonary CT angio was planned effectively on the next day morning. On 19.07.215 Pulmonary Angiography did not show any pulmonary thromboroembolism. However a type "A" dissection of ascending // 23 // aorta was noted at the level of branching at cephalic artery. After the CT angiography the patient was shifted to cardiac ICU. In the ICU the patient developed sudden VT/VF (Ventricular tachycardia / Ventricular Fibrillation) and the patient arrested. Direct current shock (DC shock) and antiarrymhic was given and resuscitation measures were carried out as per the ACLS (Advanced Cardiac Life Support) protocol. However, patient could not be revived. The patient expired at about 3.00 PM on 19.07.2015. The O.P. No.5 is neither necessary nor proper party in this complaint. The patient was brought in the hospital of the O.P. No.5 on 18.07.2015 at 7.30. He was immediately admitted, examined according to the need, requirement and medical protocol, necessary investigations were done by the competent, qualified, experienced consultants and proper medicines were provided to the patient and the latter was kept under strict, constant, medical supervision. The patient's relatives were made aware of the condition of the patient and prognosis was explained. All investigations were done after obtaining consent. The patient's relatives were fully satisfied by the treatment provided to the patient and advice given by consultants and staff of the O.P. No.5. The complainants never made any complaint, grievance to the consultants or staff. They never issued any notice to the O.P. No.5 at any time in the past before adding name of O.P. No.5 in the complaint. The complainants have not made any allegation of negligence, deficiency // 24 // in service or unfair trade practice against the O.P.No.5 in the complaint. The O.P. No.5 obtained a Professional Indemnity (Medical Establishment Policy No.100304/46/12/8700000135 from National Insurance Company Limited for the period from 31.10.2012 to midnight of 30.10.2013. The insurer of the O.P. No.5, National Insurance Co. Ltd., M.G. Road, Kolkata (W.B.) is also proper and necessary party. In view of the averments made by the complainants in amended paragraphs of the complaint and submissions made by the O.P. No.5 in this reply and the documents filed by the complainants and O.P. No.5 and in the absence of any evidence, proof of negligence, deficiency in service against the O.P. No.5, the complaint is liable to be dismissed against the O.P. No.5.
5. The O.P. No.6 has filed its written statement and raised preliminary objections. The O.P. No.6 averred that on close scrutiny of the documents filed by the complainants before this Commission, it has come to light that the complainants had intentionally not sent the complete set of documents with an oblique motive. The cause of action for filing complaint mentioned by the complainants in para 2 sub para (b) regarding damage caused due to unfair trade practice, deficiency of services and any other relief are all baseless and not relevant to the OPs. Therefore, the pleadings of the complainants are all baseless and concocted for the purpose of damaging the repo of the OPs. The deceased Rajendra Kumar Dubey was lastly treated at // 25 // Narayanan Hrudayalaya MMI Hospital, Raipur and during the course of treatment at the Narayana Hrudayalaya MMI Hospital, Raipur patient Rajendra Kumar Dubey died. To that effect the complainants had filed document No.191 (Death Report) which clearly reveals that Rajendra Kumar Dubey was admitted in Narayana Hrudayalaya MMI Hospital on 18.07.2013 and he was expired on 19.07.2013. Basing on the document No.111 dated 18.07.2013, it is evident that the complainant No.3 had voluntarily got the patient (Rajendra Kumar Dubey) discharged from Chandulal Chandrakar Memorial Hospital being satisfied with treatment given by O.P. No.1 to O.P. No.4 and also the condition of the deceased Rajendra Kumar Dubey was stable. As such the allegations created by the complainants are baseless which forces the complaint to be dismissed against O.P. No.6. Mere issuing policy in the name of Chandulal Chandrakar Memorial Hospital shall not entitle the complainants to seek reliefs from the O.P. No.6. The complainants had never raised any objection during the course of treatment of Rajendra Kumar Dubey from 12.07.2013 to 18.07.2013 in the hospital of O.P. No.1. The complainants have kept satisfactory silence with regard to the treatment given by the O.P. No.1 to O.P. No.4 to the deceased and voluntarily got discharge at their own wish. Relying on the documents filed by the complainants, it is evident that the O.P. No.1 to O.P. No.4 have not committed any professional negligence, error in treatment. As there is no cause of // 26 // action raised against the O.P. No.1 to O.P. No.4, the complaint filed by the complainants is liable to be dismissed against the O.P. No.6. The O.P. No.1 had purchased a policy covering risk of error and omission -Medical Establishment Chandulal Memorial Hospital, Nehru Nagar, Bhilai, vide Policy No.192100/48/2013/1246 covering period commencing from 06.09.2012 to midnight of 05.09.2013. The total sum assured under the Policy No.192100/48/2013/1246 obtained by the O.P. No.1 to O.P. No.4 is Rs. Sixty Lakhs. The total sum insured would be indemnified in case of error and omission caused by the insured during the policy period limited to four individual cases. That is to say that he liability of O.P. No.6 in any one case is limited to Rs.15,00,000/- subject to compliance of conditions, causes, warranties and endorsements. In case if the complainants succeed to prove negligence of O.P. No.1 to O.P. No.4, limit of indemnity of the O.P. No.6 would be Rs.15,00,000/- only subject to terms and conditions of the policy. The complainants had suppressed the material facts of their case and had filed complaint with malafide intention. The complaint filed by the complainants does not contain or mention any specific deficiency of medical services on the part of O.P. No.1 to O.P. No.4. As such the complaint is liable to be dismissed. The complainants had willingly taken discharge of deceased Rajendra Kumar Dubey on 18.07.2013 from the hospital of O.P. No.1 and admitted him to Narayana Hrudayalaya MMI Raipur on the same day // 27 // which is evident from the document No.195 (Final Bill). Regarding giving medicine of expiry date, it is submitted that the document which the complainants are relying to prove that expiry date medicines were given to deceased Rajendra Kumar Dubey are not medicines as mentioned in the sales summary report. In fact the medicines purchased by the complainants were provided with bill in which the expiry date is mentioned. The report dated 06.08.2013 is a sales summary report but not bill, which is not relevant to sales of medicines given to Rajendra Kumar Dubey. There are four basic elements to constitute a medical negligence / malpractice case. The four legal elements must be proven by the complainants to claim in a medical negligence case:
a. Duty - a professional duty owed to the patient.
b. Deficiency / breach of such duty.
c. Direct causation-injury caused by the breach.
d. Resulting damages.
In the case of the complainants, the complainant were satisfied with the treatment of the O.P. No.1 to O.P. No.4 and they have never raised any question during the treatment period. When the patient Rajendra Kumar Dubey was in stable health condition, the complainants had with their free will got discharge him from the hospital of O.P. No.1.
Therefore, the case of the complainants is not relevant to the O.P. // 28 // No.1 to O.P. No.4 . Hence the allegations made by the complainants are baseless. The complaint is liable to be dismissed.
6. The O.P. No.7 filed its written statement and averred that the complainants have made Narayana Hrudayalaya MMI Hospital as O.P. No.5 and filed instant complaint against the OPs, but when it is proved that the O.P. No.5 has deliberately committed negligence then the O.P. No.7 is not liable to pay compensation. As per provisions of Professional Indemnity (Medical Establishment) Policy, if negligence of the insured hospital is proved by any Court and the above order is provided by the insured to the Insurance Company, then there is provision of reimbursement. When there is no violation of the terms and conditions of the insurance contract then only the Insurance Company is liable to indemnify the insured hospital. In the instant case the Court has not held that the O.P. No.5 committed negligence and also did not pass any order and the O.P. No.5 did not provide copy of such order to the O.P. No.7, therefore, the complaint is premature against the O.P. No.7 and is not maintainable. The patient Rajendra Kumar Dubey or complainants have not obtained insurance cover by making payment of premium to the O.P. No.7, therefore, there was no privity of contract between them. Therefore, the complainants are not consumer of the O.P. No.7 as defined under Section 2(1)(d) of the Consumer Protection Act, 1986, hence, the complaint filed by the complainants against the O.P. No.7, is not // 29 // maintainable and is liable to be dismissed. The complainants have not submitted any claim before the O.P. No.7 and no dispute has arisen between the complainants and O.P. No.7 from which complaint receives base. The O.P. No.7 did not accept or repudiate the claim of the complainants, therefore, there was no fault of the O.P. No.7, hence no complaint can be instituted against it, therefore, the complaint is liable to be dismissed against it.
7. The complainants have filed documents. Annexure A-1 is Discharge Summary issued by Chandulal Chandrakar Memorial Hospital, Annexure A-2 are Cash Receipts dated18.07.2016, Annexure A-3 is Bill, Annexure A-4 is receipt dated 18.07.2013 issued by Central Pharmacy, Annexure A-5 is Summary Report, Annexure A-6 is Cash Receipt, Annexure A-7 is Cash Receipt, Annexure A-8 is Dept. wise detail bill, Annexure A-9 is IPNO Wise Sales Summary Report, Annexure A-10 are bills issued by Central Pharmacy, Annexure A-11 is Salary Certificate of Shri R.K. Dubey, Annexure A-12 is letter dated 26.11.2013 sent by Nikhil Dubey to Shri Sohan Lal, Annexure A-13 are Admission / discharge Summary of Chandulal Chandrakar Memorial Hospital, Bhilai and treatment papers, Annexure A-14 is X-ray Chest PA report, Annexure A-15 is Abdominal Ultrasonography Report, Annexure A-16 is Echo Cardiography & Colour Doppler Study Report, Annexure A-17 is ECG report, Annexure A-18 are Report of Cardiac Profile etc., Annexure A-19 is X-ray Chest PA, // 30 // Annexure A-20 is Death Report issued by Narayana Hrudayalaya MMI Hospital, A-21 is Death Certificate of Rajendra Kumar Dubey, Annexure A-22 is Final Bill issued by NH MMI Narayana Multispeciality Hospital and receipts etc., Annexure A-23 is Death Summary issued by NH MMI Narayana Multispeciality Hospital, Annexure A-24 is CT Angiography Report, Annexure A-25 is Pathology Report, Annexure A26 is ECG Report, B-1 is literature -
Misdiagnosed acute aortic dissection Type A, B-2 is literature - Cardiac Enzymes and Markers for Myocardial Infarction, B-3 is literature - Laboratory Diagnosis of Acute Myocardial Infarction, B-4 is literature - Classification of Unstable Angina and Non-ST Elevation Myocardial Infarction, B-5 is Task Force Report, B-6 is literature - The Diagnosis and Management of Aortic Dissection, B-7 is Literature - Aortic Dissection, C-1 is Braunwald's Heart Disease A Text Book of Cardiovascular Medicine, C-2 is Contemporary Reviews in Cardiovascular Medicines, C-3 is ACC/AHA Practice Guidelines, C-4 is letter dated 28.01.2015 sent by Public Information Officer, C.G. Medical Council, Raipur to Shri Gaurav Upadhyay, letter dated 24.1.2015 sent by Public Information Officer, C.G. Medical Council, Raipur to Dr. Nikhil Dubey, Information Bulletin and Application Forum for Diplomate of National Board Final Examination (Super Specialties, C-5 is registered notice dated 08.08.2014 sent by Shri S.K. Pandey, Advocate to O.P. No.1 to O.P. No.4, D-1 is complaint made to // 31 // Chhattisgarh State Medical Council and postal receipts, D-2 is letter dated 07.07.2015 sent by Nikhil Dubey to Deputy Director & CPIO, National Board of Examinations, D-3 is letter dated 12.08.2015 sent by Deputy Director and CPIO, National Board of Examinations, D-4 is letter dated 20.08.2015 sent by Nikhil Dubey to Dr. Anurag Agrawal, Additional Director, National Board of Examinations, D-5 is letter dated 09/13 October, 2015 sent by Dr. Anurag Agrawal, Additional Director and Appellate Authority, National Board of Examinations, D- 6 is letter dated 26.10.2015 sent by Dr. Nikhil Dubey to Central Information Commission, New Delhi, D-7 is letter dated 22.01.2016 sent by Under Secretary to Govt. of India, Ministry of Health & Family Welfare to Secretary, Department of Health & Family Welfare, Govt. of Chhattisgarh, New Raipur, D-8 is letter dated 16.2.2016 sent by Section Officer, Medical Council of India to The Registrar, Chhattisgarh Medical Council, E-1 is Medical Attendants Certificate, Annexure F are letter sent by Dr. Rahul Gulati to The Registrar, Chhattisgarh Medical Council, letter dated 04.11.2016 sent by Dr. Nikhil Dubey to Registrar C.G. Medical Council, letter dated 30.08.2014 sent by Shri Kanak Tiwari, Advocate to Shri Shashi Kumar Pandey, Advocate, Annexure G-1 is letter dated 19.04.2017 sent by Chhattisgarh Medical Council, Raipur to Shri Nikhil Dubey, G-2 is Discharge Summary, Coronary Angiography Report.
// 32 //
8. The O.P. No.1 to 4 have filed documents. Annexure D-1 is Error and Omission Medical Establishment Policy issued for the period from 06.09.2012 to 05.09.2012, Annexure D-2 is Error and Omission Medical Establishment Policy issued for the period from 06.09.2013 to 05.09.2014, Annexure D-3 is Error and Omission Medical Establishment Policy issued for the period from 06.09.2014 to 05.09.2015, Annexure D-4 is Professional Indemnity - Doctors Policy Schedule issued for the period from 21.09.2012 to 20.09.2013, Annexure D-5 Professional Indemnity Doctors Policy Schedule issued for the period from 21.09.2013 to 20.09.2014, Annexure D-6 is Professional Indemnity Doctors Policy Schedule issued for the period fro 21.09.2014 to 20.09.2015, Report given by C.G. Medical Council, A- 1 is Conversation between Dr. Rahul Gulati and Dr. Suman Padhi in mobile, Marij Suchna Form.
9. The O.P. No.5 has filed documents. The documents are Admission Case Sheet of deceased Rajendra Kumar Dubey, maintained by the O.P. No.5, Registration Certificate of Dr. Sumanta Shekhar Padhi, with the Orissa Council of Medical Registration, Certificate of Additional qualification registered issued by Orissa Medical Council Office, Degree of Doctor of Medicine Cardiology issued by Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum.
// 33 //
10. The O.P. No.6 has filed documents. Annexure I is certified copy of policy, Annexure II is policy conditions.
11. The O.P. No.7 has not filed any documents.
12 Shri S.K. Pandey, learned counsel for the complainants has filed written arguments and the complainants have taken ground that O.P. No.2, O.P. No.3 and O.P. No.4 are not qualified doctors and Dr. M.P. Chandrakar, is not a Cardiologist, even then he treated the deceased Rajendra Kumar Dubey. Dr. M.P. Chandrakar is simply possessing M.D. degree and he is not possessing degree of DM, DNB and is not recognised by Medical Council of India, therefore, the act of the O.P. No.2 to 4 comes within purview of deficiency in service and ambit of medical negligence. The complainant have filed on line doctor search list. On the basis of above list, the complainants submitted that the O.P. No.2 to O.P. No.4 doctors are not qualified Cardiologist. The deceased Rajendra Prasad Dubey was admitted in the O.P. No.1 hospital on 12.07.2013 and he was shifted to Cardiac ICU Ward, where he admitted from 12.07.2013 to 18.07.2013 and the amount was paid by the complainants, as asked by the O.P. No.2 to 4. All necessary tests were not done by the O.P. No.1 to 4 and expected result could not be occurred. The O.P. No.2 to O.P. No.4 gave expiry date medicines to the patient and O.P. No.2 to O.P. No.4 did not obtain angiography report of deceased and deceased was not given proper treatment and facilities of O.P. No.1 is of inferior quality, therefore, there is // 34 // possibility of improvement in the condition of the patient. The complainants doubted that the patient is not suffering from disease of heart attack and treatment was given by the O.P. No.2 to 4 to the patient in wrong direction. The O.P. No.2 to O.P. No.4 did not treat the patient properly and also did not discharge the patient and diagnosed that the deceased was suffering from myocardial infarction, which is false and wrong medicines were given by the O.P. No.2 to O.P. No.4 to the patient and without conducting CT test or CT angiography, treatment was done by the O.P. No.2 to O.P. No.4. The condition of the patient was deteriorated, then the patient was shifted to NH MMI Hospital where proper treatment was given to him. The patient died due to heart attack. The condition of the patient was deteriorated due to wrong treatment given by the O.P. No.2 to O.P. No.4, which comes within meaning of negligence, therefore, the complainants are entitled to get compensation as prayed by them in the complaint. The complainants placed reliance on Chhattisgarh State Medical Council Website Shot, DR. Dharam Sahu's C/o O.P. No.1 RTI From Chhattisgarh State Medical Council, Braunwald hear dis 10th edition Page 1162, AIIMS, New Delhi Department of Cardiology Alumni Screen Shot, Standard Assessment from PG Court Year 2017-18 downloaded from mciindia.org, Medical Records and issues in negligence Author Joseph Thomas, Reason for Outpatient Referral from Generalist to specialists, The practice of medical referral; Ehical concerns, AIIMS resident's manual, // 35 // judgment passed in Revision Petition No.4023 of 2011 - Goyal Hospital and Research Centre Pvt. Ltd. & Ors. Vs. Kishan Gopal Shukla & Another, decided by Hon'ble National Commission vide order dated 07.05.2013, judgment passed in Civil Appeal No.2867 of 2012 - Dr. Balram Prasad Vs. Dr. Kunal Saha & Ors. With Civil Appeal No.692 of 2012 Advanced Medicare & Research Institute Ltd. Vs. Dr. Kunal Saha & Ors. with Civil Appeal No.2866 of 2012 Dr. Kunal Saha Vs. Dr. Sukumar Mukherjee & Ors. with Civil Appeal No.731 of 2012 Dr. Baidyanath Haldar Vs. Dr. Kunal Saha & Ors. and Civil Appeal No.858 of 2012 Dr. Sukumar Mukherjee Vs. Dr. Kunal Saha, decided by Hon'ble Supreme Court vide order dated 24.10.2013, Medical Council of India Ethics Meeting No.MCI MCI- 211(2)/2008-ethics attended by Dr. S.L. Adile present member of Chhattisgarh State Medical Council, Gazette of India Notification dated 07.03.2008 and Gazette of India notification dated 20th February, 2009.
13. Shri R.K. Bhawnani, learned counsel appearing for the O.P. No.1 to O.P. No.4 has argued that the O.P. No.2 to O.P. No.4 are competent and well qualified doctors. The complainants have not provided copies of all documents which were relied by them. The O.P. No.1 has taken a policy in the name of "Error and Omission - Medical Establishment vide Policy No.192100/48/2013/1246 and O.P. No.2 has also taken a policy in the name of "Professional Indemnity - Doctors Policy Schedule" vide Policy No.192500/48/2013/807. The // 36 // above policies have been taken from the Oriental Insurance Company Limited, Supela, Bhilai. The complainants have filed the instant complaint on frivolous grounds. Proper treatment was given by the O.P. No.2 to O.P. No.4. The complainant No.3 Dr. Nikhil Dubey, who is son of deceased Rajedra Kumar Dubey, is a Dentist and all things were discussed by O.P. No.2 to O.P. No.4 with him. Dr. Nikhil Dubey was fully satisfied with the treatment given by the O.P. No.2 to O.P. No.4 to the patient. Dr. Nikhil Dubey (Complainant N.3) never objected regarding qualifications of the O.P. No.2 to O.P. No.4. Appropriate medicines were adequately administered to the deceased. The deceased showed progress in all parameters of physical condition as well. The patient was rescued with fluids and inotropic support in the form of Noradrenaline to store the peripheral end organ perfusion and to stabilize the patient. The patient responded well and condition had improved. The CT Angiography was not done as patient was in state of shock and on ionotropic support and contrast media cannot be administered if patient is found to be oligouric or anuric or on ionotropic supports, or cardiac failure due to risk of developing contrast induced nephropathy. Even O.P. No.5 Hospital had also given same treatment to the patient which was given by the O.P. No.2. In its reply at para 4 the O.P. No.5 has admitted that the patient Rajendra Kumar Dubey was admitted in the hospital of O.P. No.5 for treatment and when patient was brought and admitted for treatment // 37 // in the hospital, he was stable and pain free, which is supported by the affidavit of Dr. Sumanta Shekhar Padhi, which had been filed along with written statement. Subsequently Dr. Sumanta Shekhar Padhi, denied the above contention. Initially Dr. Sumanta Shekhar Padhi, admitted the facts and written statement was not amended by the O.P. No.5, therefore, the affidavit subsequently given by Dr. Sumanta Shekhar Padhi, is not helpful to the complainants. In reply of the questionnaire, Dr. Sumant Shekhar Padhi, did not mention regarding wrong treatment or any negligence committed by the O.P. No.2 to O.P. No.4. It shows that the O.P. No.2 to O.P. No.4 did not commit any medical negligence. Merely deceased died due to heart attack, it cannot be held that the O.P. No.1 to O.P. No.4 have committed any medical negligence. The burden to prove allegations of medical negligence is on complainants, but the complainants have not been able to prove the above facts. Even no expert opinion has been obtained by the complainant. The O.P. No.1 to O.P. No.4 have filed order of Chhattisgarh Medical Council, Raipur. The Ethics Committee was consists of Dr. Kamleshwar Agrawal as President, Dr. Alka Gupta and Dr. Rakesh Gupta as Member. The Ethics Committee exonerated the O.P. No.2 to O.P. No.4 from the allegation of medical negligence. On the contrary to rebut the report of Ethics Committee, the complainants have not filed any expert opinion. Even Dr. Rahul Gulati discussed with Dr. Sumanta Shekhar Padhi in mobile which was // 38 // recorded . The O.P. No.1 to 4 have filed the same in the C.D. form and its transcript is mentioned in the affidavit of O.P. No.2 to O.P. No.4., which shows that proper treatment was given by the O.P. No.1 to O.P. No.4 to the deceased. The complaint is not maintainable against the O.P. No.1 to O.P. No.4 and is liable to be dismissed.
14. Shri Apurv Goyal, learned counsel appearing for the O.P. No.5 has argued that the complainants have not made any allegations against the O.P. No.5. The O.P. No.5 is not a necessary party in the compliant. Merely on the allegations made by the O.P. No.1 to O.P. No.4, the O.P. No.5 was made party in the complaint. No relief has been sought by the complainants against the O.P. No.5, therefore, the complaint is liable to be dismissed against the O.P. No.5.
15. Miss B.S. Kanthi, learned counsel appearing for the O.P. No.6 has filed written arguments and has supported the arguments advanced by learned counsel for the O.P. No.1 to O.P. No.4.
16. Shri P.K. Paul, learned counsel appearing for the O.P. No.7 has supported the arguments advanced by learned counsel for the O.P. No.5.
17. We have heard learned counsel appearing for the parties and have perused the documents filed in the complaint case.
// 39 //
18. Now we shall examine whether the O.P. No.2 to O.P. No.2 are qualified doctors and are competent to treat the deceased Rajendra Kumar Dubey ?
19 Initially the complainants have not pleaded regarding the qualification of the O.P. No.2 to O.P. No.4. In amended complaint at para 4(10), it is pleaded that the O.P. No.2 to O.P. No.4 are not Cardiologists.
20. Dr. M.P. Chandrakar, has filed his affidavit dated 28.04.2017, in which it is mentioned thus :-
"1. That I have completed my M.D. Court in 1968 from Indore erstwhile Madhya Pradesh region, CGMC reg. No.1889/2008 and after that I have taken the training of Cardiology for two years from Dr. Sipaha.
2. That at that time when I have passed the M.D., there was absence of D.M. Cardiac Course (Super Specialty) in our region. And all the Physician after taking training use to practice their field of interest and patients still were treated and getting better since that time, how many of patient of this region would have reached Dr. Guleria in state of circulatory collapse and shock and not maintaining oxygen saturation if they would have been denied immediate help and stabilization for the sake of hypothetical situation. I have taken the training I am practicing Cardiology since more than 46 years. My // 40 // duty is to save life and act in situation of emergency rather than get involved in these type of proper work if this will be the situation then lots of patients will be in loss and lots of life lost just because of hesitation to provide and treat the patient in need and getting in these type of situation and I know my work since 46 years. "
21. Dr. Prabhat Pandey, O.P. No.3 has filed his affidavit dated 28.04.2017, in which it is mentioned that "I Dr. Prabhat Pandey, MD Medicine CGMC Reg. 1743/2008 , Senior Consultant Practising since last 26 years, working in Chandulal Chandulal Chandrkar Memorial Hospital, Nehru Nagar Square, Bhilai, District Durg (C.G.)."
22. Dr. Rahul Gulati, O.P. No.4 has filed his affidavit dated 28.04.2017 in which it is mentioned thus :
"(1) I Dr. Rahul Gulati, MD Medicine CGMC Reg. No.5346 Consultant Chandulal Chandrakar Memorial Hospital, Nehru Nagar Square, Bhilai, District Durg (C.G.) 3 (3,4,5) I am trained in Cardiology as per NBE Norms Completed My THESIS as provision fulfilment towards degree have a training completion certificate and am board eligible to appear for certification in cardiology. "
23. Looking to the contents of para 2 of the affidavit of Dr. M.P. Chandrakar, it can safely be held that he passed the M.D., and had // 41 // taken training and used to practice, therefore, Dr. M.P. Chandrakar is qualified doctor to treat deceased. Dr. Prabhat Pandey also stated in his affidavit that he is MD Medicine CGMC Reg.1743/2008, Senior Consultant practicing cardiology since last 26 years. Dr. Rahul Gulati is also trained in Cardiology. Therefore, the O.P. No.2 to 4 are qualified doctors and if they treated the patient Rajendra Kumar Dubey. The complainant No.3 Dr. Nikhil Dubey, is Dentist and he knows about the qualifications of O.P. No.2 to O.P. No.4 from very beginning, even then he admitted the deceased in O.P. No.1 Hospital and the matter was discussed by the O.P. No.2 to O.P. No.4 with the complainant No.3. The complainant No.3 never raised question regarding the qualifications and competency of the O.P. No.2 to O.P. No.4 during treatment of the patient, therefore, the plea raised by the complainants is after thought and is not acceptable, therefore, on the basis of qualifications of the O.P. No.2 to O.P. No.4, it cannot be held that the O.P. No.2 to O.P. No.4 committed any negligence for want of requisite or proper qualification.
24. Now we shall examine whether the O.P. No.2 to O.P. No.4 have committed medical negligence ?
25. In the book titling "Medical Negligence" written by Shri S.P. Tyagi (Edition 2004) Reprint 2008, he has mentioned at Page No.64, 65, 66, 67 and 68 regarding Medical Negligence, Classification of medical negligence or mistakes. It runs thus :-
// 42 // "What is Medical negligence The term medical negligence is nowhere defined in any Code or Act. No legislature, has so far, made any attempt to define it. Even the medico- legal jurists have not come forward to provide a specific meaning to this express.
'Medical negligence' is always an outcome of doctor patient inter se conduct and relationship, which lacks uniformity. The issue of medical negligence is a complicated one as medical professionals deal with human body. They do not deal with the machine. Human body is not a mere composition of bones and flesh. It is susceptieable to emotions also. Response of medicinal treatment varies from patient to patient. This phenomenon is also applicable to recovery aspect. Further recovery aspect is not solely dependent upon the appropriateness of treatment provided by the doctor. Response or recovery of a patient also depends on his individual anatomy and physiology. Possibility cannot be ruled out that a drug may be effective in case of one patient, it may not be effective in second and may cause reaction in third. Medico Legal experience also establishes that there exist inherent risk in every treatment, medicinal or surgical. Further possibility of unforeseen mishap may not be ruled out. Even the medicinal literature provides for failure rates particularly in surgery.
The skill of medical practitioners differs from doctor to doctor. The very nature of the profession is such that there may be more than one course of treatment which may be more than one course of treatment which may be advisable for treating a patient. Medical opinion may differ with regard to the course of action adopted by a doctor treating a patient.
Further the concept of medical negligence may be studied with reference to the extent of approach of a medical professional towards three under mentioned concepts, which generally work as guidelines to determine the factum of medical negligence or otherwise in a particular case.
(1) Duty of care in accepting the patient for treatment. (2) Duty of care in providing appropriate treatment. (3) Breach of duty or commission of negligence in any of them and damage cause by such breach.
In other words, medical negligence is result of some irregular conduct on the part of any member of the profession or related services in discharge of professional duties. Broadly speaking medical negligence means negligence resulting from the failure on the part of the doctor to act in accordance with // 43 // medical standards in vogue, which are being practiced by an ordinary and reasonably competent man, practicing on the same branch of medicine or surgery.
Classification of medical negligence or mistakes. Negligence in medical care may broadly be classified into four categories :-
(1) Medical negligence at the level of doctors / paramedical staff / hospital authorities. Liability for negligence may be fixed at individual level and / or jointly or vicariously where hospitals nursing homes are involved.
(2) Negligence at the level of patient himself or his attendants also known as contributory negligence.
(3) Negligence at the level of manufacturers of drugs, equipment etc. and dispensers.
(4) Composite negligence i.e. at more than one of the above 3 levels.
Negligence of first category may further be sub-classified into two categories viz.
(i) Individual liability of a medical professional.
(ii) Vicarious liability of an individual doctor or hospital for the Medical negligence may also be classified as under :
1. Medical mistakes.
2. Clinical negligence.
3. Surgical mistakes
4. Misplaced injection."
26 In Pally Srikanth & Ors. Vs. M/s. Krishna Institute of Medical Sciences Ltd. & Ors., 2016 (4) CPR 46 (NC), Hon'ble National Commission has observed that "Onus of proving alleged negligence in treatment of a patient lies with person alleging medical negligence."
// 44 //
27. In Prayag Hospital & Research Center Pvt. Ltd. & Anr. Vs. Vijay Pal, 2016 (2) CPR 2 (NC), Hon'ble National Commission has observed that "complainants must provide materials to prove allegation of medical negligence."
28. In Ashok Kumar Pathak Vs. Dr. Swarnava Roy and Anr. 2017 (1) CPR 251 (NC), Hon'ble National Commission has observed that "Medical Negligence must be proved by expert opinion."
29. In the instant case, the burden lies on the complainants to prove that the O.P. No.1 to O.P. No.4 have committed negligence during treatment of the deceased Rajendra Kumar Dubey. In the instant case, the complainants have not sent medical documents of the deceased, to the Medical Board for obtaining expert opinion and have not obtained expert opinion. For want of expert opinion, mere allegation made by the complainants, is not sufficient to hold that O.P. No.2 to O.P. No.4 have committed medical negligence while treating the patient.
30. In Dr. Laxman Balkrishna Joshi v. Dr Trimbak Bapu Godbole and another, AIR 1969 Supreme Court 128, Hon'ble Supreme Court has observed thus :-
"11. The duties which a doctor owes to his patient are clear. A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give // 45 // or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task 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 : (cf. Halsbury's Laws of England, 3rd ed. Vol. 26 p. 17). The doctor no doubt has a discretion in choosing treatment which he proposes to give to the patient and such discretion is relatively ampler in cases of emergency..........."
31. 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 :-
'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 // 46 // 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 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.
// 47 // 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.
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 // 48 // 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 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."
32. In the instant case, the complainants have pleaded that the O.P. No.2 to O.P. No.4 have given expiry date medicines to the patient, but the complainants have not filed any documents to prove that the // 49 // medicines given by the O.P. No. 2 to 4 are expiry date medicines. The patient Rajendra Kumar Dubey was admitted in the O.P. No.5 Hospital on 18.07.2013. In para 4 of written statement, the O.P. No.5 admitted that the patient Rajendra Kumar Dubey was admitted in the hospital of the O.P. No.5 for treatment. When the patient was brought and admitted for treatment in the hospital, he was stable and pain free.
He was admitted on 18.07.2013 at about 7.30 PM in the hospital in stable state. Before admission he was treated for old IWMI (Inferior Wall Myocardial Infarction), current NSTEMI (Non ST Elevation Myocardial Infarction) and recovered from shock. At the time of admission patient was stable hemodynamically (blood pressure 130/80, heart rate 80 min). As per the referral letter there was documented ECG changes and documented RWMA (Regional Wall Motion Abnormality) in echocardiography, hence was treated in the line of ACS (Acute Coronary Syndrome) - Ecosprin, Clopidogrel, Atorvastatin and heparin.
33. The Consultant Cardiologist Interventional Cardiology Dr. Sumanta Shekhar Padhi, started treatment and advised several tests, investigations to assess the condition, diagnosis. Since D-Dimer done in the previous hospital was very high (> 2500 unit) the consultant thought to rule out Pulmonary thromboembolism by CT angiography. Since the patient was stable hemydynamically, there was no RA/RV dilation or RV dysfunction Pulmonary CT Angio was planned // 50 // electively on the next day morning. On 19.07.2015 Pulmonary Angiography did not show any pulmonary thromboroembolism. However a type "A" dissection of ascending aorta was noted at the level of branching at cephalic artery. After the CT Angiography the patient was shifted to Cardiac ICU. In the ICU the patient developed sudden VT/VF (Ventricular tachycardia / Ventricular fibrillation) and the patient arrested. Direct current shock (DC shock) and antiarryhimic was given and resuscitation measures were carried out as per the ACLS (Advanced Cardiac Life Support) protocol. However, patient could not be revived. The patient expired at about 3.00 PM on 19.07.2015." In the affdavit also in para 5 Dr. Sumanta Shekhar Padhi has stated that contents of paragraphs 1 to 7 of the reply are true and correct. It shows that when patient was discharged from the O.P. No.1 hospital, at that time his condition was sable and was pain free. The treatment given b y the O.P. No.5 is on the same line, which was given by the O.P. No.2 to O.P. No.4 to the patient.
34. The complainants in para 4(10) of the complaint pleaded that the O.P. No.5 treated the deceased Rajendra Kumar Dubey properly and the O.P. No.5 did not commit any deficiency in service. The O.P. No.5 also given same line of treatment which was provided by the O.P. No.2 to O.P. No.4 to the patient. Had the O.P. No.5 treated the deceased Rajendra Kumar Dubey properly then it can safely be presumed that the O.P. No.2 to 4 also treated him properly. From bare // 51 // perusal of the para 4 of the written statement of the O.P. No.5 and affidavit dated 28.08.2015 of Dr. Sumanta Shekhar Padhi, it appears that the O.P. No.2 to O.P. No.4 properly diagnosed and treated the deceased on proper direction. Dr. Sumanta Shekhar Padhi filed additional affidavit on 13.10.2016 in which he stated that the O.P. No.3 Dr. Prabhat Pandey made false averment but initially Dr. Sumanta Shekhar Padhi never stated against the O.P. No.2 to O.P. No.4. The O.P. No.5 has not amended its written statement and in the written statement, the O.P. No.5 specifically admitted that the O.P. No.2 to 4 have properly treated the patient. The written statement of the O.P. No.5 was verified by Dr. Sumanta Shekhar Padhi. It shows that written statement has been filed by Dr. Sumanta Shekhar Padhi, on behalf of the O.P. No.5. Dr. Sumanta Shekhar Padhi specifically admitted that the O.P. No.2 to O.P. No.4 properly treated by the patient and he had also treated the deceased in same line which was adopted by the O.P. No.2 to O.P. No.4. The answers given by Dr. Sumanta Shekhar Padhi shows that Dr. Sumanta Shekhar Padhi avoided to give answers of the questions asked by the O.P. No.1 to 4. On the basis of the written statement and answers given by Dr. Sumanta Shekhar Padhi asked by the O.P. No.1 to 4, it is not established that the O.P. No.2 to O.P. No.4 have committed medical negligence.
// 52 //
35. Dr. M.P. Chandrakar (O.P. No.2), Dr. Prabhat Pandey (O.P. No.3) and Dr. Rahul Gulati (O.P. No.4) filed their affidavits. In their affidavits, they stated regarding discussion of Dr. Rahul Gulati held with Dr. Sumanta Shekhar Padhi. In the affidavits it is mentioned that Dr. Rahul Gulati asked regarding patient (Rajendra Kumar Dubey) to Dr. Sumanta Shekhar Padhi, The answers given by Dr. Sumanta Shekhar Padhi has been mentioned in the affidavits of Dr. M.P. Chandrakar (O.P. No.2), Dr. Prabhat Pandey (O.P. No.3) and Dr. Rahul Gulat (O.P. No.4), which was not rebutted by the complainants. Looking to the answers given by Dr. Sumanta Shekhar Padhi, it appears that the condition of the patient was stable and he was pain free at the time of admission in O.P. No.5 hospital. It shows that when the deceased was discharged from O.P. No.1 hospital, he was stable and in fit condition.
36. Dr. Sumant Shekhar Padhi was cross-examined by O.P. No.1 to O.P. No.4 through questionnaire. By question No.1 the O.P. No.1 to O.P. No.4 asked Dr. Sumant Shekhar Padhi whether the patient was totally stable at the time of shifting and patient was received at NHMMI ICU. The answer was given by Dr. Sumant Shekhar Padhi and he gave answer that it is not a question and it is a matter of record. Question No.3 was denied by Dr. Sumant Shekhar Padhi. In respect of Question No.9 he answered that the Point No.9 is not a question and hence needs no answer, whereas the O.P. No.1 to 4 // 53 // specifically asked to Dr. Sumant Shekhar Padhi that as per literature contrast reaction in one hour of the contrast administration, but answer was not given by Dr. Sumant Shekhar Padhi. According to the answer given by Dr. Sumant Shekhar Padhi, he answered theses questions superficially. The Sumant Shekhar Padhi was also cross- examined by the complainants through questionnaire and answers of the questions asked were given by him.
37. The complainants have made complaint before Chhattisgarh Medical Council, Raipur against the O.P. No.2 to O.P. No.4 and the matter was referred to Ethic Committee. The Ethics Committee consists of Dr. Kamleshwar (Preident), Dr. Alka Dubey (Member) and Dr. Rakesh Gupta (Member) and Ethics Committee gave their finding as under :-
1. f'kdk;rdrkZ dk MkW- fuf[ky nqcs] Lo- Jh jktsUnz dqekj nqcs] U;w vkn'kZ uke uxj tksu&2] lsDVj&6] nqxZ¼N-x-½
2. f'kdk;r fdlls MkW- jkgwy xqykVh] MkW-a izHkkr ik.Ms] ,oa MkW- ,e-ih-
gS panzkdj] panw yky panzkdj gkWfLiVy] fHkykb] ftyk nqxZ¼N-x-½
3. iath;u dzekad MkW- jkgqy xqykVh] lhth,elh 3558@2011 fnukad 30@04@2011] MkW-izHkkr ik.Ms lhth,elh 3558@2011 fnukad 30@04@2011] ,oa MkW- ,e-ih-
panzkdj lhth,elh] 3558@2011 fnukad
30@04@2011]
4 f'kdk;rdrkZ ds vkjksiksa ds vuqlkj ejht dks fnukad
12-07-2013 dks panw yky pUnzkdj gkWfLiVy] fHkykbZ ftyk nqxZ¼N-x-½ esa dkfMZ;ksykWftLV fMikVZesaV esa MkW- jkgqy xqykVh] MkW- izHkkr ik.Ms ,oa MkW ,e-ih- pUnzkdj ds }kjk bZZykt fd;k x;kA According to the complainant :- They are not Specialist in Cardiology. Because hospital does not have // 54 // essential facilities for running a cardiology department including a qualified cardiologist they did not do essential test like CT angiography of pulmonary artery and aorta and missed diagnosis of aortic dissection, also they did not follow the correct guideline and due skill for what they diagnosed i.e. cardiogenic shock in NON STEMI. So my father died because of unqualified doctors and due to giving expiry medicines to him.
On 18/07/2013 I shifted my father to Narayana MMI Hospital, Raipur on DOR (discharge on request) where the Dr. Sumanta Padhi, Cardiologist told me 'your father is not suffering from heart attack / Myocardial infarction it is something else.' Next day on 19/07/2013 my father underwent CT angiography of aorta and pulmonary artery which reveals type A dissection of aorta.
After 2 hours approx my father died because of this aforesaid diseased.
Most important part of my complaint are giving expiry medicine to the patient of cardiology in serious condition. Second treated the patient of cardiology inspite of not having necessary qualification. Third showing a doctor Rahul Gulati DNB Cardiology as a Cardiologist but actually he is not.
5 MkW- jkgwy xqykVh] MkW- jkgwy xqykVh] MkW-a izHkkr ik.Ms] ,oa MkW- ,e-ih- MkW-a izHkkr ik.Ms] panzkdj] }kjk fn;s x;s vkius nLrkostksa esa dgk x;k gS ,oa MkW- ,e-ih- fd NRrhlx<+ esfMdy dkSafly jk;iqj }kjk bafM;u panzkdj] dk tokc esfMdy ,lksfl;s'ku ds 'kk[kkvksa dks fy[ks x;s ,oa lwpuk Hkh nh xbZZ Fkh fd ,sls fpfdRld ftUgksaus viuh ih0th0 ,oa lqij Lisf'k;fyVh fMxzzh dk iath;u NRrhlx<+ esfMdy dkSafly ls ughsa djok;k gS] og nks ekg ds Hkhrj vfuok;ZZ :i ls viuk iath;u djok ys ,oa vU; ,sls fpfdRld ftuds ikl ih0th0 ,oa lqij Lisf'k;fyVh fMxzh u gksrs gq, Hkh ih0th0 ,oa lqij Lisf'k;fyVh fMxzh fy[krs gS] os rRdky izzHkko ls fy[kuk can djsaA ftldh tkudkjh feyus ij gekjs }kjk cardiology fy[kuk can dj fn;sA ejht dks norms ds vuqlkj bZykt fd;k x;k gSA eq>s cardiology esa dk;Z dk cgqr o"kZ ls vuqHko gSA That // 55 // the patient Rajendra Kumar Dubey was admitted in the state of collapse and he was admitted in my (Dr. M.P. Chandrakar & Dr. Prabhat Pandey) unit in emergency by Dr. Prabhat Pandey with H/O Diffuse Chest pain, profuse perspiration in acute shock and cardiac failure. According to the treating doctors that he was attended immediately as per our duty to help the patient who is sick and was not at all ain shiftable state, after giving treatment and he was stabilized promptly to a shiftable condition and was discharged. The patient was treated with all cure.
Sir back tenet of medicine are clinical history, signs and symptomatology and patient was treated accordingly and he started showing signs of improvement and his vitals stabilised. The patient was shifted in completely recovered, pain free, maintaining saturation, mobile, passing motion and flatus and in complete hemodynamically stable condition without any supports. That the patient was in totally hemodynamically stable condition. As per my knowledge rediocontrast investigation was contraindicated as he was on ionotropic supports and cardiac failure. That as per the bed head ticket of the NH MMI Hospital, it is clear that the treatment, which was given in our hospital was continued there also.
6. vfHker NRrhlx<+ esfMdk dkSafly ds }kjk ;g f'kdk;r ,fFkDl desVh ds le{k izLrqr fd;k x;kA izdj.k esa ,fFkDl desVh ds }kjk ppkZ ij ;g ik;k x;k fd izdj.k ij fo"k; fo'ks"kK ls vfHker izkIr fd;k tk;A fo"k; fo'ks"kK MkW- fLeFk JhokLro }kjk vius vfHker esa dgk fd More than 50% of cases are not correctly diagnosed ante mortem. Today all physicians must assess "triple rule out" test -
(1) coronary artery disease, (2) Pulmonaryembolism and (3) acute aortic dissection, in every chest symptom patient as standard of practice. Liberal use of computed tomographic imaging in patients with chest symptom with cardiogenic shock will assess // 56 // the "triple rule out" test. f'kdk;rdrkZZ }kjk iqu% dkSflay esa nLrkost tek fd;k x;k] ftls dkSafly ds lnL;ksa }kjk iqu% fo"k; fo'ks"kK MkW- fLeFk JhokLro dks Hkstk tk;sA fo"k; fo'ks"kK MkW- fLeFk JhokLro us iqu% vius vfHker esa dgk x;k fd Aortic Dissection has a typical symptoms in 20% cases and hence may escape clinical suspicion. -lkekU; lHkk esa NRrhlx<+ esfMdy dkSafly ds lnL;ksa ,oa fo"k; fo'ks"kK MkW- fLeFk JhokLro }kjk fn;s x;s vfHkerksa ds vuqlkj MkW- jkgqy xqykVh] MkW- izzHkkr ik.Ms ,oa MkW- ,e-ih-panzkdj }kjk ejht dk mipkj muds fgrksa esa djus dk izz;kl fd;k x;kA MkW- deys'oj vxzoky MkW- vYdk xqIrk MkW- jkds'k xqIrk v/;{k lnL; lnL;
,fFkDl desVh ,fFkDl desVh ,fFkDl desVh 7 NRrhlx<+ NRrhlx<+ esfMdy dkSafly ds lkekU; lHkk esa izdj.k
esfMdy dkSafly ds fo"k; esa ppkZZ dh xbZZA izdj.k ls fo"k; fo'ks"kK dk fu.kZ; }kjk fn;s x;s vfHker dks n``f"Vxr j[krs gq, ;g izrhr gksrk gS fd ejht dk bZykt muds fgrks esa djus dk iz;kl fd;k x;kA
38. Looking to the report of the Ethics Committee, it appears that the O.P. No.2 to O.P. No.4 had treated the deceased Rajendra Kumar Dubey properly and they did not commit any misconduct.
39. As against the report of the Ethics Committee, the complainants have not obtained any expert opinion from the Medical Board, therefore, the report given by the Ethics Committee is reliable. On the basis of report of Ethics Committee, it appears that the O.P. No.2 to O.P. No.4 have properly treated the deceased and they did not commit any medical negligence. Looking to the facts and circumstances of the case, the judgments cited by the complainants, are quite // 57 // distinguishable from the facts of the instant case, therefore, they are not helpful to them.
40. The complainants have not been able to prove that the O.P. No.1 to O.P. No.4 have committed any medical negligence, therefore, the complainants are not entitled to get any compensation from them.
41. Therefore, the complaint filed by the complainants against OPs, is liable to be dismissed, hence the same is dismissed. Parties shall bear their own costs.
(Justice R.S. Sharma) (D.K. Poddar)
President Member
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