State Consumer Disputes Redressal Commission
Ajay Chaturvedi And Oth. vs Ajanta Hospital And Ivf Centre Pvt Ltd ... on 22 August, 2022
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UP C-1 Vikrant Khand 1 (Near Shaheed Path), Gomti Nagar Lucknow-226010 Complaint Case No. CC/281/2016 ( Date of Filing : 08 Sep 2016 ) 1. Ajay Chaturvedi and Oth. S/O Late Sri Shyam Suder Chaturvedi R/O House No. J-156 Aasiyana Colony Jail Road Lucknow ...........Complainant(s) Versus 1. Ajanta Hospital and IVF Centre Pvt Ltd And Oth. (A Multi Disciplinary Superspeciality Hospital) 765 ABC Complex Kanpur Road Lucknow ............Opp.Party(s) BEFORE: HON'BLE MR. Rajendra Singh PRESIDING MEMBER HON'BLE MR. Vikas Saxena JUDICIAL MEMBER PRESENT: Dated : 22 Aug 2022 Final Order / Judgement Reserved State Consumer Disputes Redressal Commission U.P. Lucknow. Complaint Case No.281 of 2016 1- Ajay Chaturvedi, aged about 43 years, S/o Late Shyam Sunder Chaturvedi, R/o House no.J-156, Asshiyana Colony, Jail Road, Lucknow. 2- Tarun Chaturvedi, aged about 42 years, S/o Late Shyam Sunder Chaturvedi, R/o House no.J-156, Asshiyana Colony, Jail Road, Lucknow. 3- Smt. Kamlesh Chaturvedi, aged about 68 years, W/o Late Shyam Sunder Chaturvedi, R/o House no.J-156, Asshiyana Colony, Jail Road, Lucknow. ...Complainants. Versus 1- Ajanta Hospital & IVF Centre Pvt. Ltd., (A Multi-Disciplinary Superspeciality Hospital) 765, ABC Complex, Kanpur Road, Lucknow through its Director. 2- Dr. Deepak Dewan, Ajanta Hospital & IVF Centre Pvt. Ltd., 765, ABC Complex, Kanpur Road, Lucknow. 3- Dr. Ritesh Purvar, (Director), SIPS (Sushrat Institute of Plastic Surgery Pvt. Ltd.), 29, Shameena Road, Lucknow. 4- Director, Sahara Hospital, Viraj Khand, Gomti Nagar, Lucknow. 5- Dr. R.K. Mishra, (Cardiologist), Sahara Hospital, Viraj Khand, Gomti Nagar, Lucknow. 6- Dr. Surjeet Bhattacharya, (Plastic Surgeon), Sahara Hospital, Viraj Khand, Gomti Nagar, Lucknow. ...Opposite parties. Present:- 1- Hon'ble Sri Rajendra Singh, Member. 2- Hon'ble Sri Vikas Saxena, Member. Sri Vikas Agarwal, Advocate for the complainants. Sri Manish Mehrotra, Advocate for Opposite Parties no.1 & 2. Sri Brijendra Chaudhary, Advocate for the opposite party no.3. Sri A. K. Srivastava, Advocate for the Opposite party no.4 & 5. None for the opposite party no.6. (2) Date : 3.10.2022 JUDGMENT
Per Sri Vikas Saxena, Member- The present complaint has been filed by the complainants for the following reliefs:
Direct the respondent no.1 to 2 jointly as well as severally to pay a sum of Rs.2,40,000.00 to the complainants which was incurred in the treatment from 30.9.2014 to 9.10.2014.
Direct the respondent no.3 to pay a sum of Rs.81,000.00 to the complainants which was incurred in the treatment from 18.10.2014 to 21.10.2014.
Direct respondent no.4 to 6 jointly as well as severally to pay a sum of Rs.8,00,000.00 to the complainants which was incurred in the treatment from 20.10.2014 to 9.11.2014.
Direct respondent no.1 to 6 jointly as well as severally to pay a sum of Rs.50,00,000.00 to the complainants as compensation towards the deficiency in services as well as committing medical negligence.
Direct respondent no.1 to 6 jointly as well as severally to pay a sum of Rs.10,00,000.00 to the complainants on account of mental agony.
Direct respondent no.1 to 6 jointly as well as severally to pay a sum of Rs.20,00,000.00 to the complainants for depriving his whole life for love care and affection.
Allow the complaint and direct respondent no.1 to 6 jointly as well as severally to pay a sum of Rs.50,000.00 to the complainants towards cost of the case.(3)
Any other order which this Hon'ble State Commission may deem fit and proper in the circumstances of the case may also be passed.
The brief facts of the complaint are that, that Late Shyam Sunder Chaturvedi was having kidney problem for which he was under treatment of the opposite party no.2 Dr. Deepak Dewan. On 30.9.2014 when suffering from cough and cold on advice of Dr. Dewan he got himself admitted in the opposite party no.1 Ajanta Hospital & IVF Centre Pvt. Ltd. At the time of admission the opposite party no.2 Dr. Dewan informed the complainants that the patient is suffering from infection and viral fever and there is nothing to worry about it and within 2-3 days the patient will be discharged. On his assurance, the complainants got admitted his father in the hospital/opposite party no.1 upto 9.10.2014. On the very next day, without any information opposite parties no.1 & 2 shifted the patient in ICU while the patient was not having any serious problem. In ICU, the complainant and his family members were restricted to enter and again without informing the complainant or his family, the patient was put on ventilator on 2/3 October, 2014 and dialysis was started on 6.10.2014. Thereafter, the patient was shifted to private ward and then the complainant and the relatives came to know that during the stay in ICU and ventilator, bed sores were developed in the body of the patient and general condition was very poor due to non-hygienic atmosphere of ICU and ventilator.
When the complainants complained about the bed sores, the opposite parties no.1 & 2 took it casually and assured not them not to worry. Upto 9.10.2014, the conditions of the bed (4) sores were serious and despite the critical condition of the patient, the opposite parties no.1 & 2 discharged the patient. If they were unable to handle the patient, the patient should have been referred to some other higher centre. On the date of admission i.e. on 30.9.2014 the parameters of the patient were normal but on 8.10.2014, the parameters were abnormal. The bed head ticket and entire records of the treatment of the patient was not provided by the opposite parties no.1 & 2 at the time of discharge. The opposite party no.1 issued a bill of Rs.81,000.00 which was duly paid by the complainants. On the advice of the opposite parties no.1 & 2, the compounder of the opposite party no.1 regularly visited the house of the complainants for dressing of bed sores on a charge of Rs.300.00 per day. After one week, when the condition of bed sores were very critical, the compounder Sri Jai Chand advised him to admit the patient once again in the hospital. The complainant immediately met with opposite party no.2 Dr. Deepak Dewan and informed the critical condition of the patient, upon which the opposite party no.2 Dr. Deepak Dewan denied to admit the patient on the excuse that there was no plastic surgeon in their panel and the patient needs plastic surgery for bed sores. The opposite party no.2 Dr. Dewan gave false information regarding non availability of plastic surgeon while Dr. Surjeet Bhattacharya, opposite party no.5 was there in the panel of doctors of the opposite party no.1 which is evident from the file cover of the hospital.
The opposite parties no.1 & 2 deliberately concealed the critical condition of the patient and misguided the complainants and their relatives and gave wrong treatment upto 9.10.2014 and when the patient was about to die, (5) discharged him and did not refer him to any other higher centre and sent their compounder for dressing at home. It is important to mention that the patient on 30.9.2014 went to the opposite party hospital on their foot because he had only complaint of cough and cold but in the hospital, the patient developed bed sores within a short period. The opposite party no.1 & 2 first sent the patient to ICU and then put him on ventilator without informing the complainant or his family members. When the condition of the patient became critical they discharged him and thereafter, refused to admit again in the hospital and it is a clear case of medical deficiency and medical negligence. The complainant spent about Rs.2,40,000.00 in the treatment of the patient at Ajanta Hospital.
When the O.P. No. 1 & 2 denied for readmission in their Hospital then the patient was brought in SIPS Hospital O.P. No.3 on 18.10.2014 for the treatment of Bed Sours and at time of admission in SIPS Hospital/O.P. No. 3 the staff of the Hospital inform that in their Hospital the treatment of Bed Sours will be done by the team of the specialized Doctors and after admission on 18.10.2014 the VAC DRESSING was done Dr. Purvar and after that the patient was shifted In ICU and up to 20.10.2014 the patient was kept in ICU and the complainant and their relatives were unable to see their patient and the staff of the O.P. No.3/SIPS Hospital not allowed to see their patient and when the complainant realised that the O.P. No.3/SIPS Hospital are making fool the complainants and charging exorbitant money then the complainants forcefully discharged their patient O.P. No.3/ (6) SIPS Hospital charged about 80,332/- within a short period of two days. The complainants spend about Rs 81,000/- in the treatment of SIPS Hospital.
After taking discharge from the SIPS Hospital/O.P. No.3 the patient was brought to O.P. No.4/Sahara Hospital where he was admitted on 20.10.2014 for the treatment of Bed Sours as well as Kidney problem and at the time of admission in Sahara Hospital in Clinical history also it is specifically mentioned that the patient is suffering from Kidney problem and due to wrong treatment in Ajanta Hospital and SISPS Hospital the bed sores were developed and ignoring this aspect the patient was admitted under the supervision of Dr. R.K. Mishra, (Cardiologist), Sahara Hospital while the patient was never before suffering from any heart problem.
The time of admission the O.P. No. 4 and 5 assured that they have fully equipped with all modern treatment facility and the patient will recover very soon since they have very experienced team of Doctors and on the assurance of the Sahara Hospital the complainant and their family members admitted their patient with assurance that their patient will be OK very soon.
On 20.10.2014 at the time of admission in Sahara Hospital the Creatinine level of the patient was 4.9 and he needs the treatment of Kidney immediately but despite the request of the complainants the specialized doctor of Kidney was not called by the Sahara Hospital even the required Dialysis was not started and conducted many pathological (7) tests and misguided the attendants of the patient for grabbing money.
From 20.10.2014 to 9.11.2014 about 20 days the patient was admitted in Sahara Hospital where he was dribbled from here to there without any reasons firstly they admitted the patient in medical ICU then without any consent and information of the attendants shifted in Transplant ICU where on 9.11.2014 at 8.50 a.m. patient was died.
From 20.10.2014 to 08.11.2014 the para medical staff of the Sahara Hospital conducted pathological as well as various other tests conducted each day sometimes repeated the tests in one day and the attendants were running pillar to post to collect the report and it was very difficult to them to contact the doctors and consult the reports of the patient. The management of the Sahara Hospital was very poor they just know how to grab money from the pocket of the attendants of the patients and once they received money in the head of the test or for any other reason thereafter they does not bothered how to collect the sample from the patient and how to transport the patient from one ward to another ward for test it was the attendants headache that how they manage the conduct the daily tests and then collect it from different places and them met with the doctors or staff to hand over the reports and finally to know the outcome of the tests and how is the patient. During the stay in Sahara Hospital no one is ready to give feedback of the patient even the attendants were not allowed to see their patient as such the Sahara Hospital committed gross medical negligence as well as committed (8) unfair trade practice for which Sahara Hospital along with OP no.5 & 6 were also responsible jointly and individually.
From the very beginning of admission of the patient the complainants requested the doctors of the Sahara Hospital that kindly call Dr. Surjeet Bhattacharya, OP no.6 who is a Plastic Surgeon for treatment of bed sores and further make arrangement for specialized doctor of kidney but the doctors of Sahara Hospital ignored the request and neither call any plastic surgeon nor call any kidney specialist while the patient primarily suffering from ssevere bed sores and kidney problem. The Sahara Hospital does not conduct the dialysis while the creatinine level was raised day by day which shows the deficiency on the part of the OP no. 4 to 6.
The Sahara Hospital records during the stay in Sahara Hospital was not provided despite several requests only death certificate was given by the Sahara Hospital in which the cause of death is mentioned as Cardio Repertory arrest. On 9.11.2014 at the time of death of the patient the no doctor or trained staff of the Hospital was available to take care of the patient. The patient was unattended and when the attendants were ran to call the doctors the patient was died.
When the Sahara Hospital not called the OP no.6 Dr. Surjeet Bhattacharya, Plastic Surgeon despite several requests of the complainant while he is associated with Sahara Hospital and very well available in Sahara Hospital then the complainant himself met with him personally and discussed the case and the OP no.6 Dr. Surjeet Bhattacharya brought the case history of the patient and after seeing it told that now it is too late and annoyed upon the treating doctor of Sahara (9) Hospital as well as upon the complainant and inform that if they came before then the bed sores will be manage now the condition of the bed sores are very critical and due to infection the entire body become detreated as such OP no.4 to 5 are also responsible in the wrongful treatment. The complainant spend about Rs.8,00,000.000 in Sahara Hospital in the treatment of his father.
The cause of untimely death of the father of the complainants no.1 & 2 and husband of the complainant no.3 which were only due to medical negligence attributing by the opposite parties including the Ajanta Hospital, SIPS Hospital, and Sahara Hospital and the Doctors as arrayed causing the untimely death of the patient and thereafter the Doctors hide the condition of the father/patient from the complainants and their relatives and treated themselves to patch up their blunder mistakes to save themselves which comes to unfair trade practice as such the respondents are guilty for attributing medical negligence and untimely death of the mother of the complainants. To save themselves the respondents changed all the records which were in their possession and not providing the treatment papers of the mother of the complainants.
The father of the complainants no.1 & 2 and husband of the complainant no.3 was hale and healthy person and till 30.09.2014 he was absolutely all right and it is beyond imagination that in a very short period he were left this world the entire family is shattered by the death of Sri Shyam Sunder Chaturvedi.(10)
The death of the father of the complainants no.1 & 2 and husband of the complainant no.3 was due to medical negligence of the Opposite Parties including Ajanta Hospital, SIPS Hospital & Sahara Hospital and their Doctors for which they are jointly as well as severally responsible. The services of the O.P's. are gross negligent and comes under the definition of deficiency in services as such the present complaint case is maintainable for legitimate compensation.
Initially due to wrong advice the complainant no.1 filed three Complaints against the Ajanta Hospital, SIPS Hospital & Sahara Hospital before the learned District Consumer Forum-II, Lucknow and subsequently when the complainant was realized their fault then engaged another counsel who filed Application for Withdrawal of Complaint Case with liability to file fresh case before this Hon'ble Commission in 3 Complaint Cases.
On the Applications of the Complainant No.1 the learned DCF-II, Lucknow pleased to allow the Applications for Withdrawal of the Complaint Case with liability to file fresh Complaint Case before this Hon'ble Commission.
The Cause of Action was firstly accrued on 30.09.2014 when the father of the Complainants no.1 & 2 and husband of the complainant no.3 was admitted in Ajanta Hospital and thereafter on 9.11.2014 when the father of the Complainants no.1 & 2 and the husband of the complainant no.3 was in Sahara Hospital.
The opposite parties no.1 & 2 filed their written statement in which it is stated that the opposite party no.1 (11) Ajanta Hospital is a hospital of repute with super specialty services and has been successfully catering medical needs to all its patients since last several years. The hospital is a well equipped hospital with vast experienced and highly qualified doctors and para-medical staff. At the outset the answering opposite party no.1 strongly and emphatically denies the false and fabricated allegations of the complainant as being totally misconceived and incorrect factually and medically both.
The answering opposite party no.2 Dr. Deepak Dewan is a highly experienced and well qualified doctor having specialization in the sphere of nephrology DM(Nephrology) from SGPGIMS, Lucknow in the year 2006.
At the outset, however, the answering opposite parties assert that the present complaint, as filed by the complainant before this Hon'ble State Commission is not maintainable in view of legal provisions and judicial precedent, further the complainant is stopped to file the present complaint case after it being admittedly withdrawn by him form before the Ld. District Consumer Forum-II, Lucknow. No liberty to file a fresh complaint was sought without any valid grounds.
The opposite parties further stated that the conduct of the complainant clearly demonstrate that he has not approached this Hon'ble Commission with clean hands because he has also resiled from his own statement in the withdrawal application preferred before the ld. District Consumer Forum dated 26.5.2016 wherein the amount of compensation mentioned by the complainant was Rs.37,75,000.00 whereas the present complaint petition, has now been deliberately revised by the complainant by (12) demanding an exaggerated compensation to the tune of more than Rs.80,00,000.00.
Mr. S.S. Chaturvedi a 78 year old male who was a pan masala and tobacco chewer with a strong family history of Type-2 diabetes Mellitus & Hypertension consulted the Answering Opposite Party No. 2 doctor on 08.02.2014 with the past history of hypertension since last 40 years, Type-2 diabetes Mellitus since last 20 years; 3 episodes of right sided hemiparesis in 1993, 1996 and 1998 ischemic infarct; seizure disorder in 1993; about 15 months back he was earlier admitted with the Awadh Hospital, Lucknow; was suffering from cervical compression since last 2 years and chronic kidney disease since last 6 months and which were all purely controlled. Further it is noted that the patient presented with complaint of 1) Pedal edema since last 6 months; dysuria since last 3 months along with constipation. On examination it was found he had BP: 150/90 mm of Hg (uncontrolled); 2) Pallor and 3) Pedal edema. Accordingly, he was prescribed various medications and investigations and was asked to come back after 7 days. Instead of 7 days he came after about 40 days on 20.03.2014 and was not taking the medications as prescribed. He used to change the medications all by himself. As peer the reports his prescription was modified and he was advised to come against after 21 days after getting some of the investigations (which were abnormal) repeated. However, he was following instructions of the Answering Opposite Party doctor.
Instead of 21 days the attendants came back after about 73 days on 02.06.2014 and did not bring the patient along with them. Even now the patient not taking the medications (13) as prescribed. He was changing the medications all by himself. As per the reports his prescriptions were modified and he was advised to come again after 14 days after getting some of the investigations (which were abnormal) repeated. As usual practices instead 21 days the attendants came back after about 137 days on 17.10.2014 and again did not bring the patient along with them. The attendants told that the patient has developed bedsores. Even this time the patient not taking the medications as prescribed. He was changing the medications all by himself. As per the reports and attendants giving a history of patient developing bedsores his prescription was modified with antibiotics being added for bedsores and he was advised to come again after 5 days since at times bedsores can worsen. He was also advised some investigations to be repeated. Finally, he came back on 30.10.2015 after 12 days instead of coming back after 5 days.
All along from 8th February 2014 to 30th October 2014 that is for a period of around 8 months the patients came to the Answering Opposite Party no.2 doctor very rarely and never on prescribed date. He was on very irregular follow up 8 months and not 1 year. It is also clear that he had already developed bedsores sometime between 2.6.2014 and 17.10.2014 as told by patient's relatives. Even before he consulted with the answering opposite party treating doctor he was not under regular follow up of any consultant. It is reiterated that the patient was admitted with complaints of difficulty in breathing for 2 days fever and vomiting for 2 days, mild abdominal distension and drowsiness (as per history given by attendants and patient himself). On (14) examination his chest was full of crepitations. With a provisional diagnosis of chest infection treatment was started with broad spectrum antibiotics (Piperacillin +Tazobactum and Levofloxacin), diuretics and other supportive treatment. In view of lbreathlessness and patient being drowsy he was advised to be shifted to ICU (as documents in the case sheet) but attendants were not willing for the same. Attendants were also explained about the poor prognosis. In view of the deteriorating condition his antibiotics were changed to higher group (from piperacillin + tazobactum to Meropeneum) & teicoplanin was added on 1st October, 2015. Patient continued to deteriorate and was shifted to ICU on 1.10.2014 evening at around 9.00 pm after obtaining informed consent by the patient's son and again explaining them the poor prognosis. All along patient's attendants were in direct contact with the doctors in the ICU and with the answering opposite party doctor on telephone.
The fact is that the patient was under treatment on 08.02.2014 and not 30.09.2014 as wrongly mentioned in the complaint petition. The patient was not a simple case. Multiple disease already existing in 78-year old male patient. It was not a simple kidney problem presents with cough and cold. The patient was also highly irregularly in follow ups and taking treatment.
It is submitted that the patient had bedsores from much earlier. These were reported to the Answering Opposite Party doctor by patient's attendants themselves much earlier on 17.10.2015. He had developed bedsores at home somewhere between 02.06.2014 and 17.10.2014 as told by patients (15) relatives. The Answering Opposite Party doctor had even added antibiotics for these bedsores as is evident from his OPD prescription dated 17.10.2014. He already had a history of 3 episodes of right sided hemiparesis in 1993, 1996 and 1998. He was not mobile and was brought in the OPD on wheel chair. He developed bedsores at home because of repeated episodes of hemiparesis (muscle endeavour or partial paralysis) making him unable to move in bed at home. It is a complete false and baseless allegation that he developed bedsores during ICU stay of just 4 days.
The fact of the matter is that the Condition of the patient was already bad and investigation were abnormal initially itself. The patient on ventilator, decreased urine output of only 460 cc in 24 hours with volume overload, increasing S. Creatinine level of 4.3 mg% and uremic encephalopathy, it was decided to dialyze the patient in consultation with the attendants. Patient's creatinine was never normal as alleged by attendants. He had a creatinine of 4.3mg% (up from 2.9 mg% earlier) when he was dialyzed for the first time besides this there were other indications for dialysis as outlined. Patient was managed aggressively in the ICU with continued ventilator support, antibiotics, nursing care etc. He started showing improvement. He was weaned off from the ventilator and was successfully extubated on 04.10.2015. He was kept in the ICU for another 2 days for close monitoring and management and was shifted out of the ICU on 06.10.2015. Patients bedsores were taken care of with regular dressing, side to side turning, air mattress and broad spectrum antibiotics. Patient continued to improve and finally was (16) discharged on 09.10.2015 in consultation with relatives with advice for follow up after 5 days.
It is submitted that there is no such provision of sending of compounder by hospital. It is with the personal negotiation of the patient's attendants and service providers. The Answering Opposite Parties while reiterating the contents of previous paragraphs of this written statement it is reiterated that some staff of the hospital might have been visiting his residence for the dressing but hospital is not responsible for any of staff visiting any patient outside the hospital premises and none of its staff represent the hospital or any of its consultants when they are not on duty. It is exclusively the mutual understanding of the staff and patient's and his attendant's. The hospital and its consultants have nothing to do with it. All staff is free to do anything when not on duty and the hospital or any of its consultants are not responsible for any of their actions. We never suggest any patient to take services of any of its staff beyond the designated duties. Why the attendants did take the services of a staff and did not bring the patient to the hospital for consultation or dressing. That means the attendants were not themselves concerned about the patient's well being and were avoiding bringing him to the hospital or to the consultants. The attendants did not contact Dr. Dewan post discharge. If they were in contact, they should be able to produce consultation fee receipt/OPD consultation slip or any other document to the support of their claim.
Since he never came to the hospital there is no question of hospital doctors or staff misbehaving with them or refusing (17) admission. Further it is confirmed that Dr. Surajit Bhattacharya is very much in panel of this hospital but he is a visiting consultant who comes on call only. Patient's attendants and relatives never came to hospital to seek consultation from him. Further the allegations of the complainant regarding misguiding, wrong treatment is preposterous.
It is totally wrong on part of the complainant to state that the patient was hale and hearty.
The present complaint petition has been filed with ulterior motives and lack of bonfide and claiming exaggerated compensation which is not legally tenable, more particularly in view of the preliminary objections as raised by the Answering Opposite Parties in the present written statement.
The opposite party no.3 has filed his written statement in which the answering respondent denies each and every statement, averment, allegation, contention made by the complainant.
The complaint filed by the complainant is not maintainable and is liable to be dismissed as the complainant has attempted to misguide and mislead this ld. Forum. In fact, the complainant has suppressed material facts from this Hon'ble Forum and as such the complaint is liable to be dismissed. No cause of action that ever arose in favour of the complainant and against the respondent to file the present complaint and hence, liable to be dismissed.(18)
The complainant has not come with clean hand before this Hon'ble Forum and has suppressed the material facts from this Hon'ble Forum.
The patient admitted in the hospital with the complaint of bedsore and in such type cases proper medical facilities/ treatment were given to the patient. On admission proper treatment was given to the patient, being a plastic surgeon the answering opposite party had explained the seriousness of the bedsore and its treatment. The answering opposite party duly exercised their reasonable degree of care and skill while diagnosing and administering treatment on the patient. The attendant complainant was duly explained about the complication of bed sores. The patient's condition was not critical but unfortunately the patient was discharged LAMA.
Throughout the patient was looked after by expert doctors and all the relevant facts would be evident from a bare perusal of the hospital records and thus, there is no question of any negligence having been committed by the treating doctor towards the patient and accordingly all the ill-founded allegations of the complainant of purported medical negligence are strongly and emphatically denied as incorrect.
The opposite parties no.4 Sahara Hospital & 5 Dr. R.K. Mishra have filed their written statement wherein it is submitted that the Complaint does not disclose any cause of action and is based on false and distorted facts. The true and correct facts have intentionally been withheld from this Hon'ble Court. A perusal of the complaint of the complaint itself reveals that the complaint is frivolous and the Respondents are unnecessarily being dragged into frivolous (19) litigation. The averments in the complaint are also defamatory. It may be appreciated that the patient was examined and given requisite treatment and attention, as was medically required, in the light of the existing medical history and his medical condition. The line of treatment as administered to the patient was the correct line of treatment that could have been administered to the patient. It may be appreciated that the judgment, diagnoses of the expert Doctors and medical treatment administered by them on the patient when confronted with the medical condition of the patient, was the best possible and correct medical care, that could be given to the patient under the circumstances. It may be appreciated that no fault/negligence can be attributed and the present complaint is thus liable to be dismissed.
It is submitted by the opposite parties no.4 and 5 that the patient visited Sahara Hospital emergency on 20.10.2014 with problem of hypertension, Diabetes Mellitus with chronic kidney disease with acute kidney injury, 20.10.2014 with problem of hypertension, Diabetes Mellitus with chronic kidney disease with acute kidney injury, septicemic shock with old cerebro vascular accident with bed sores and intermittent atrial fibrillation seen on monitor and blood pressure was not recordable which was maintained on Dopamine and Noradrenalini drip. It is important to mention here that the above condition needs care to maintain vitals for which cardiologist is required, therefore Dr. R.K. Mishra who was incharge of the emergency was called upon. It is wrong to say that the patient was not suffering from heart problem/disease. He was with multiorgan disease at the age (20) of 75 years with atrial fibrillation and during stay he had cardiac event. The patient was critically ill at the time of admission.
Before starting the treatment the patient and his attendant has gone through the benefits and consequences of the treatment which was very well explained to them by the opposite parties after understanding the same the complainant and the patient agreed for the treatment. Further it is pertinent to mention here that the patient after stabilization was shifted from MICU to TICU. There was no assurance for recovery as the patient was admitted in a critical condition. The patient was under the care of Dr. Mufazzal Ahmed, Nephrologist from the very beginning. Dressing was daily done and the same can be seen in records as well.
The pathological tests conducted by the paramedical staff by the patient bedside. The sample are collected and sent for testing at the pathology. The report of the same is to be collected by the concerned attendant from the counter. It is wrong to say that the doctors cannot be contacted. The doctors are available in OPD from 9.00 am to 4.00 pm. Further the attendants can show the reports to the concerning doctor without appointment or receipt. Such statements are given by the complainant to malign the reputation of the doctors and the hospital. As regards to the feed back of the patient, there is a complaint & suggestion box across hospital where a patient or attendant can write and give their feedback for the management to take action. Further, it is pertinent to mention here that the patient after stabilization was shifted from MICU to TICU. Also in TICU an attendant is also (21) allowed with the patient along with constant monitoring facility. Thus, it is wrong to say that the hospital is minting money by shifting its patients from MICU to TICU or there is any kind of unfair trade practice. The patient came with septicemic shock and high S. Creatinine. On the same day Dr. Mufazzal Ahmad, Nephrologist had seen the patient and he was under his care.
It is submitted that the pressure sore was being managed as per standard protocol followed in the best centres of the world Annexure no.1 is the Management Protocol of Mayo Clinic, Rochester, Minnesota, U.S.A. and Annexure 2 are pages from a chapter on Pressure Sores in a standard text book of plastic surgery.
On 21.10.2014, when the patient was seen for the first time by Dr. Surjeet Bhattacharya, he had a grade IV pressure sore i.e. sore reaching right up to the bone (in this case-sacrum) and all tissues from the skin to the bone were dead (photographno.1). In such cases the standard protocol is to protect all other potential places of pressure sore development by using air mattresses or alpha beds, which are present is all our medical ICU beds, multiple pillow and water bubbles under bony points and by frequent change of posture. As the patient was medically not fit for an emergency surgery the sacral sore could not be surgically attended immediately. Antibiotics, respiratory physiotherapy, steam inhalation, incentive spirometry and care of mouth, eye and back were done. @ units of blood was arranged to build up the patient for a future surgery an negative pressure wound therapy was (22) applied on the sacral sore till the time we were able to treat it surgically.
On 25.10.2014, the negative pressure wound therapy was discontinued and a surgical debridement was planned. Debridement is a procedure in which all dead tissues are surgically excised in order to reduce the load of infected tissues and provide the surrounding healthy tissues and opportunity to commence the process of healing (Annexure no.2 page 4 and 6 Surgical treatment and Annexure no.4). As you would appreciate dead tissues do not have any blood supply, the is why they are dead, antibiotics-given orally or as injections into the blood stream will only reach those tissues which have blood flowing through them, but bacteria can reach a sacral sore from the anal orifice and tissues which do not have blood supply become ideal culture medium for them as they can multiply unhindered by the absence of antibiotics in the dead tissue. So, debridement aims at excising all the dead tissues and leave behind only living tissues which are able to fight bacterial invasion with the help of antibiotics.
The opposite party no.3 explained to the relatives the details of this surgery and also told them that we are going to leave behind a large wound over the sacrum after this procedure which will be dressed with traditional dressings and/or negative pressure wound therapy. A final surgery of closing this open wound will only be done once the general condition of the patient improves. Blood transfusion was advised and consent was sought from 3 sources-family, physicians and anesthetists.(23)
On 27.10.2014, after proper consent, a debridement was performed in local anaesthesia as the anesthetists felt giving general anaesthesia was risky. All the dead tissues were removed and negative pressure wound therapy was applied. From the excised wound tissues would culture samples were sent. Anitibiotics were prescribed by physicians as they had to also care for his kidney - the serum creatinine remaining higher than normal levels. Negative pressure would Therapy (NPWT)-This is an invaluable tool in management of pressure sores and involves application of sub-atmoshpheric pressure to a wound using a computerized unit to intermittently or continuously convey negative pressure to promote wound healing. Negative pressure treatment, called Negative Pressure Wound Therapy (NPWT) or Vacuum assisted closure (VAC) is effective for deed, cavitating, infected and copiously discharging pressure ulcers, particularly with exposed bone as was seen in our patient. With growing clinical exposes bone as was seen in our patient. With growing clinical experience it can be said with certainty that NPWT assists wound healing and its benefits can be summarized thus:
Assists Granulation Applies controlled, localized negative pressure to help uniformly draw wounds closed Helps remove interstitial fluid allowing tissue decompression Helps remove infectious materials and quantifies exudates loss Provides a closed, moist wound healing environment Promotes flap and graft survival Both hospital and domiciliary use Reduces hospital/dressings/nursing cost.(24)
On 28.10.2014, the negative pressure wound therapy dressing showed a minor leak and promptly it was changed. We are extremely vigilant while the NPWT is on because a leak will defeat its very purpose. The Haemoglobin was 9.9 gm% and 1 unit of blood was transfused. Treatment prescribed by all other specialists continued.
On 29.10.2014 with the benefit of a new culture report antibiotics were changed an Dalacin C (Clindamycin) was started. Frequent change of posture, deep breathing exercises and respiratory physiotherapy all continued but because of his poor respiratory compliance we could not nurse him in prone position. Later in the day, at around 3.30 p.m. the patient suddenly developed cardio respiratory arrest for which prompt Cardio Pulmonary resuscitation was done and DC shock was given and an endotracheal tube was put in and his respiratory efforts were supported by a ventilator. All this was because of his primary disease, Diabetes affecting his vital organs-heart, kidneys and lungs and had nothing to do with the operated and dressed pressure sore. It only proved that he remained a very high risk patient and no future surgery will perhaps be possible on the pressure sore under general anaesthesia and our anaesthesia team was right in denying general anaesthesia.
On 30.10.2014, he was oriented and awake and had no fever. Our NPWT was working satisfactorily and his haemoglobin was 13.8 gm%. Our plastic surgery team had nothing to add in the treatment and we ensured proper care of all pressure points to avoid any new pressure sore.(25)
On 31.10.2014, he remained listless and had signs of infection (Total leukocyte count 17,000/cu mm and 93% Polymorphs). Our NPWT system was still functioning properly and vacuuming out all the exudates from the pressure sore wound, so this could not be the cause of infection. A consultation was requested from the pulmologist. The patient still showed cardiac arrhythmias in the ECG monitor. Thus, with involvement of kidneys, heart and lungs the patient was progressing towards multiple organ failure. These three organs are the vital organs of the body, absolutely essential for human survival, a pressure sore, properly dressed by the state of the art dressing system, cannot be cause of challenge to survival.
On 2.11.2014, while the patient remained drowsy his general condition had improved, serum electrolytes were within normal limits and we planned to change the NPWT dressing in the operative theatre the next day as still it was sucking out 100 ml exudates per day, suggesting appearance of dead tissue in the wound. Respiratory physiotherapy continued and his position in bed was periodically changes.
On 3.11.2014, after obtaining proper consent from the family, the NPWT dressing was changed. The floor of the pressure sore had some dead tissue but another surgical debridement was not possible as that would require some sort of anaesthesia and his general physical condition did not permit us to even try it. I visited him postoperatively in the ward and insisted that he should never be put in supine position as the sacral sore would worsen. In a patient with general condition as friable as his, this a however easier said (26) than done, because when any life threatening emergency occurs the team resuscitating him will have their hands full, caring for his heart, lungs and other vital factors and a bed sore naturally is not very high in their priority. Patient has to be put in supine position (resting on h is back) to assist respiration.
On 5.11.2014, the patient was in altered sensorium with 2 cardiac arrest, uremia and in multiple organ failure. His haemoglobin was 7.4 gm%, blood urea and serum creatinine were high, serum proteins and albumin were low and general condition was not satisfactory. Blood transfusion had been arranged and our NPWT was still functioning.
On 6.11.2014, for the first time it was felt that the sacral sore is getting contaminated by fecal matter as the NPWT dressing us unable to shield the sore from the anal orifice. We promptly discontinued the NPWT and planned conventional dressings. On 6.11.2014, Dr. Surjeet Bhattacharya point wise instructed the nursing team to do the following:
Wash with saline Spray OXAM and wait for 2 minutes Pack the wound with betadine gauze Cover with large pads Clean surrounding superficial sores with betadine Cover them with Jelonet or Bactigrasa Micropore to ensure the dressing stays in place.
Diaper.
On the same date in the afternoon the relatives visited the doctor (Dr. Bhattacharya) regarding the open wound of (27) the patient. They were under the impression that the open wound in the sacral area is the cause of the patient's septicemia. It was explained to them that as long as we have an open wound, which is draining its exudates out freely, either by NPWT or by conventional dressings, it cannot be the source of infection and septicemia. On the contrary, if we try to close an infected wound and do not allow the exudates to freely flow out, that surely will be the cause of septicemia. It is like treating an abscess- we drain it, but we do not stitch it back, we heal it gradually by regular dressings. Also, any attempt at closing the wound in presence of infection and dead tissue will invariably fail as a pre-requisite for covering a pressure sore wound is that it should be infection free. It was also explained to them that the general condition of the patient is so fragile that he cannot be given anaesthesia and neither can he lie in prone position- a requirement after any surgery for sacra sore. His disease process in totality has made him very weak and immune-compromised and his body is not able to fight the process of infection, which is occurring at multiple sites.
On 7.11.2014, Dr. Vaibhav Khanna and Dr. Romesh Kohli visited the patient and suggested two dressing materials-Reliheal silver and Relihead aqueous. The general condition of he patient remained poor and besides suggesting continuing with respiratory physiotherapy, would dressing, protecting other bony prominences and changing posture.
Further if a 75 year old patient, admitted in 2 different hospitals in the past and dissatisfied with both of them, suffering from diabetes and hypertension for the last 20 years, (28) chronic renal disease (diabetic nephropathy) for the last 2 years and with history of cerebro-vascular accidents is admitted with a large grade 4 pressure sore in sacrum, it is safely presumed that he is a very sick patient. It also goes without saying that treatment of such a patient will be multidisciplinary i.e. involve many specialists. All this is always explained to such patients and their family when they come for treatment in Sahara Hospital. And at no stage does a hospital guarantee that in treatment of such serious patients, life will be saved. As doctors we can try, and try to the best of our ability, at par with the best effort anywhere in the world, but we cannot guarantee success and survival.
The patient's attendant was handed over all the records concerning patient as and when demanded. Every person who dies, his death occurs due to cardio respiratory arrest.
It is wrong to say that the patient was unattended. The patient was duly monitored and vitals were taken hourly by the trained staff.
The patient was duly attended by Dr. Surjeet Bhatacharya as mentioned in Para 21 of this written statement.
There is no deficiency in service or Unfair trade practices or negligent act on the part of the opposite party no. 4 to 5.
The opposite party no.6 Dr. Surjeet Bhattacharya, in his written statement denies each and every statement, averment, allegation, contention made by the complainant that is inconsistent with, contradictory to whatever is stated herein (29) below and no statement, allegation, contention not specifically denied by the opposite party shall be deemed to have been admitted merely for want of transverse.
On 21.10.2014 when the patient was examined he had a Grade-IV Pressure Sore i.e. sore reaching right up to the bone (in this case-sacrum) and all tissues from the skin to the bone were dead (photograph is enclosed separately). In such cases the standard protocol is to protect all other potential places of pressure sore development by using air mattresses or alpha beds, which are present in all over Medical ICU beds, multiple pillows and water bubbles under bony points and by frequent changes of posture. As the patient was medically not fit for an emergency surgery the sacral sore could not be surgically attended immediately. Antibiotics, respiratory physiotherapy, stream inhalation, incentive spirometry and care of the mouth, eyes and back were done. Two unit of blood was arranged to build up the patient for a future surgery and negative pressure wound therapy was applied on the sacral sore till the time was available to treat it surgically.
On 25.10.2014 the negative pressure wound therapy was discontinued and a surgical debridement was planned. Debridement is a procedure in which all dead tissues are surgically excised in order to reduce the load of infected tissues and provide the surrounding healthy tissues an opportunity to commerce the process of healing. The copy of literature is being annexed herewith this reply.
On 27.10.2014 after proper consent a debridement was performed in local anesthesia. All the dead tissues were removed and negative pressure wound therapy was applied.(30)
From the excised wound tissues wound culture samples were sent. Antibiotics were prescribed by physicians as they had to also care for his kidney-the serum creatinine remaining higher than normal levels.
On 28-10-2014 the negative pressure wound therapy dressing showed a minor leak and promptly it was changed. We are extremely vigilant while the NPWT is on because a leak will defeat its very purpose.
On 29-10-2014 with the benefit of a new culture report antibiotic were changed and respiratory physiotherapy all continued but because of his poor respiratory compliance he could not be nursed in prone position. Later in the day at around 3.30 PM the patient suddenly development cardio respiratory arrest for which prompt Cardio pulmonary resuscitation was done and DC shock was given and an endotracheal tube was put in and his respiratory efforts were supported by a ventilator. All this was because of his primary disease, Diabetes effecting his vital organs-heart, kidney and lungs, and had nothing to do with the operated and dressed pressure sore. It only proved that he remained a very high risk patient and no future surgery will perhaps be possible on the pressure sore under general anesthesia. On 30.10/2014 the patient was oriented and awaked and had no fever. NPWT was working satisfactorily and his hemoglobin was 13.8gm%. On 31.10.2014 the remained listless and had sign of infection (total leukocyte count 17000/ cu mm and 93% polymorphs). NPWT system was still functioning properly and vacuuming out all the exudates from the pressure sore wound, so this could not be the cause of infection.(31)
On 06.11.2014 for the first time the answering respondent felt that the sacral sore is getting contaminated by fecal matter as the NPWT dressing is unable to shield the sore from the anal orifice. The NPWT was discontinued and planned conventional dressing, the same is apparent from the notes dated 06.11.2014 in which nursing team was instructed to do the following-
Wash and Saline Spray OXAM and wait for 2 minutes Pack the wound with Betadine gauze Cover with large pads Clean surrounding superficial sores with Betadine.
Cover them with JELONET or BACTIGRASA Cover with more pads Micropore to ensure the dressing stay in place Diaper It was clear instructions of the answering respondent that this dressing be done twice daily and after fecal soiling. Frequent change of posture was getting increasingly difficult but still it was done.
The Complaint has miserably failed to make out of any case of medical negligence against the Answering Opposite Party sand hence as such the complaint petition being devoid of any merit deserves to be rejected by this Hon'ble commission and the complainants are not entitled or any relief whatsoever against the Answering Opposite Party. It is humbly submitted that this learned forum may be graciously pleased to dismiss the complaint petition against the Answering Opposite Party and the same shall sub-serve the ends of justice.
Opposite Party did his MBBS, MS and MCh (plastic Surgery) from KGMC, Lucknow subsequently he did a Fellowship in Microsurgery in Microsurgery Research Centre in Melbourne, Australia. He has 96 publications in National and International Journals and has authored 4 book chapters. He is the sectional editor of a forthcoming Text Book of Plastic, Reconstructive & Arthetic Surgery. He has presented 196 papers in various National and International conferences and has been in the faculty of many symposia and workshops of Plastic Surgery and allied specialties. Presently he is a member of association of plastic surgeons of India and the past editor of Indian Journal of Plastic Surgery. He is the examiner of plastic surgery fellowship programmes in University Saints Malaysia and thesis examiner of University of Manipal and Karachi. A member of association of surgeons of India since 1984. He was awarded the SR Jogenlkar Gold Medal for the best paper published in Indian Journal of Surgery in 1989, PEET Prize and APSI Best Paper award for the best scientific paper of association of plastic surgeons of India in 1989 and the Ethicon Travel Fellowship in 1990. He was also awarded the Overseas Travel Fellowship to mayo Clinic, Rochester, Minnesota by American Society of Surgeons of India Origin and Sir Lindsay Fox Fellowship in Microsurgery by Bernard O'Brien Institute of Microsurgery. He is the senior consultant of Plastic Surgery.
Therefore, it is humbly submitted that that his Hon'ble Commission may be graciously pleased to dismiss the present complaint against the opposite party no.6.
We have heard ld. Counsel for the complainant Sri Vikas Agarwal, ld. Counsel for the Opposite Parties no.1 & 2 Sri Manish Mehrotra, ld. Counsel for the Opposite Parties no.3Sri Brijendra Chaudhary and ld. Counsel for the Opposite Parties no.4 & 5 Sri A. K. Srivastava.None appeared for the opposite party no.6.
The complainant has sought reliefs of compensation against the 6 opposite parties on different grounds alleging medical negligence in case of death of their father/husband Shri Shyam Sundar Chaturvedi. The main grounds of reliefs against that different opposite parties are given below: -
1. The opposite parties no.1 and 2 Ajanta Hospital, deliberately concealed the critical condition of the patient and misguided complainant and attendants of the patient and gave wrong treatment and when the patient was about to die the discharge him and did not refer to any higher center.
2. The opposite party no.3, SIPS hospital assured the complainant that the patient will be treated by the specialized doctors but the patient was shifted to ICU of the hospital and when the complainant realized that that the opposite party number 3 were making a fool and charging exorbitant money, they got discharged the patient from the hospital.
3. At the time of admission of the patient in Sahara Hospital, in the clinical history it was specifically mentioned that the patient is suffering from kidney problem and bed sores but he was admitted under the supervision of Dr. RK (34) Mishra A Cardiologist. At that time that the Creatinine level of the patient was 4. 9 but specialized doctor of kidney was not called and required dialysis was not started. The condition of the patient was not communicated to the complainant and attendants of the patient.
4. The bedsores developed in the body of the patient were not taken care and properly treated by the all opposite parties.
The complainant has said in the complaint that his father/the patient was in perfect condition but after the medical treatment of the all opposite parties he became critically ill, but on the other hand he has said that the opposite party number 1 and 2 deliberately concealed his critical condition. In this way, the complaint contains two contradictory versions of the complainants and it appears that they are is not sure about physical and mental condition of his father and as to whether he was is perfectly fit at the time of admission in opposite party number one i.e. Ajanta Hospital or a was in a critical condition and this condition was concealed from them by the opposite parties. In this reference the annexure 1 of the evidence submitted by the complainant was perused and it is found that it is written on the prescription dated 30.90.2014 that the patient Shri Shyam Sundar Chaturvedi was patient of diabetes, renal failure, hypertension, anemia and other old age diseases. The immediate problem was cough and expectoration for 25 days, fever for one day and he was given many medicines according to his previous ailments and for also the immediate problems arose at that time. The annexure number one contains the following: -
(35)Shyam Sundar Chaturvedi 78 years, male, R/O Lucknow Chronic Kidney Disease Moderate Renal Failure Diabetic Nephropathy Hypertension Anemia Benign Prostatic Cervical Cord Narrowing H/o CV A C/o Complete preparation for 25 days, reddish since one-day Fever for one day The 'clinical summary' submitted by the complainant on the next page of annexure 1 gives the reason as to why the patient was admitted to the Intensive Care Unit (ICU) of the hospital. It is also written on the clinical summary that the patient has to visit after five days of the discharge. It is given in the clinical summary that though the patient was admitted for Fever, nausea and vomiting and also for difficulty in breathing but the general condition of the patient was deteriorating therefore, it was shipped it to ICU. The complainants have alleged that bedsores were developed in the body of the patient due to negligence and in hygienic conditions in Ajanta hospital but they have admitted in the complaint that in the Ajanta hospital the patient remained in ICU for a long time and it is natural to develop bedsores in this condition. It is well known fact that bedsores are developed when a patient is so serious i.e. unable to move his body on the bed itself. On consulting on the website https://www.mayoclinic.org › bed-sores it is discernible as given in the site that Bedsores are caused by pressure against the skin that limits blood flow to the skin. Limited movement can make skin vulnerable to damage and lead to development of bedsores.(36)
This is ffurther given in the website that:-
Causes Pressure. Constant pressure on any part of one's body can lessen the blood flow to tissues. ...
Friction. ...
Shear........
This is provided in website Premierlegal.org that:-
Bad Hygiene and Bed Sores Bed sores are skin wounds that are caused by pressure. When nursing home patients remain in the same position for a long time, the pressure from their bones and bodies pushing into the bed or wheelchair can damage the skin.
Bed sores generally begin as mild skin abrasions but, without proper care and treatment, can progress into ulcers or wounds that cause deterioration of the skin, tissues and muscles. If bed sores remain untreated for long enough, the damage can penetrate deep into the tissue, muscle and bone, causing severe pain and infection and potentially resulting in death.
Unfortunately while pressure is the cause of bed sores, there are a lot of contributing factors that can make bed sores more likely to develop, more likely to worsen and more likely to become infected and potentially fatal. One of the major contributing factors that can cause bed sores and make them worse is bad hygiene.
Bad Hygiene is a Danger to Nursing Home Patients A patient who is not kept clean and whose bed and covers are damp or moist will have a significantly increased chance of developing bed sores and of developing complications associated with bed sores.
Unfortunately, most patients who are bedridden or wheelchair bound and who are prone to bed sores due to being unable to change their position will also be unable to tend to their own hygiene needs. These immobile patients will need to count on nursing home staff to clean them so they do (37) not develop a build-up of sweat and dirt. Patients will also depend upon the nursing home staff to make going to the bathroom possible, and to clean soiled bed covers and clothing.
If nursing home staff falls short in any of the duties that they have to their bedridden and wheelchair bound patients, the staff may be considered negligent in the eyes of the law. As such, poor hygiene that leads to bedsores can be an example of nursing home neglect that leads to a nursing home injury lawsuit.
Poor hygiene is also one of the major factors that visiting friends and family members should look for when visiting a family member in a nursing home. If you see that you're relative in a nursing home is not being kept clean, if his or her room is soiled or if the bed clothes look dirty, you should take action to make sure that the proper care is being provided.
Nursing home patients don't deserve to develop bed sores or complications because a nursing home fails to do its job. Unfortunately, understaffing, inadequate training, poor policies and a host of other problems can all cause a patient to be left without sufficient care. When this happens, the injured victim may have a right to compensation for the harm endured due to the nursing home negligence.
- From Steven Peck, Senior Attorney at Peck Law Group https://www.premierlegal.org/attorneys/meet-steven-peck/ (38) http://www. Healthline.com was consulted or verifying the stages of it is given in the affidavit of evidence of Sahara Hospital that the patient was brought 20. 09. 2014 the stage-4 bedsores. It is given in that website that there are four stages of bedsores. These are: -
Stage 1: ulcers have not yet broken through the skin. Stage 2: ulcers have broken in the top two years of skin Stage 3: ulcers affect top two layers of the skin Stage 4: ulcers are deep wounds that may impact muscle, tendons, ligaments and bones.
It is evident from the record that the patient remained in Ajanta Hospital from date 30. 08. 2014 to date 08. 09. 2040 i.e. for nine days and thereafter, from date 08. 09. 2040 till date 18. 09. 2014 a compound of the hospital was visiting to the patient for dressing of bedsores. After that the patient was admitted to SIPS hospital for two days only the records of SIPS hospital shows that from the inception the patient was treated for bedsores. He was given VAC dressing and even after two days he was relieved from the second hospital and in the third a little i.e. Sahara Hospital, he was admitted the stage for bedsores. It is also pertinent to note that at the time of admission in Ajanta hospital no bedsores are reported in the admission card of the hospital. The document annexure number one, which was prepared at the time of admission to the hospital, contains no mention of any bedsores on the body of the patient. In paragraph 10 of the affidavit in evidence of Dr Deepak Diwan, submitted on behalf for opposite party number one and two, the various reasons of development of bedsores are given among them it spinal injury is one of the causes of it. The medical literature is also submitted by the (39) opposite parties no.1 and 2, wherein it is given that bedsores maintainable due to spinal injury but neither it is pleaded not anywhere given in any document of medical treatment that the patient was having any spinal injury. Therefore, it is clear that the bedsores were developed during the period when the patient was admitted in the Ajanta hospital. In these nine days, the developed bedsores were so intense that they were found to be in stage four and reached to the bones. I.e. why, it may be concluded without doubt that the nursing staff in the Ajanta hospital was negligent in treating the patient. There was lack of nursing care in the Ajanta Hospital. The record of Ajanta hospital shows that the medical treatment prescribed to the patient was appropriate and there was no lack of care on the side of doctors treating the patient, but due to lack of proper nursing care of the patient serious bedsores of the stage for were developed. Which could have been avoided if proper nursing care would have been imparted to the patient?
Now we come to the death certificate given by the Sahara Hospital which is titled as 'Medical Certificate of Causes of death' In this document the immediate cause of the has been shown as 'cardiac respiratory failure' but in the 'Antecedents causes' bedsores are also mentioned as distant cause of death of the patient. This shows that the bed sores developed during the admission of the patient in Ajanta hospital also contributed in causing death of the patient which was already in a critical condition and his body was in a frail condition. For this reason, we find that The Nursing Staff and consequently the management of the Ajanta hospital are (40) liable to pay damages to the heirs of the patient who suffered due to improper nursing care in the hospital.
The complainant has alleged against SIPS hospital that they did not care for the patient and finding lack of care the relatives and attendants of the patient decided to leave the hospital against medical advice so that better care of the patient be taken in another hospital and for this reason the admitted the patient in Sahara Hospital for the general care and treatment of bedsores of the patient. The record of SIPS hospital shows that immediately on admission of the patient to the hospital he was given VAC dressing on the bedsores. Considering the general medical condition the patient was prescribed many medicines. Although, the complainant has said that on finding the fact that there was lack of care in SIPS hospital and also they were extracting money from the relatives and relatives of the patient withdrew the patient from the hospital, yet nothing on record corroborates the version of the complainant's that the patient was not properly taken care of in the SIPS hospital. In The prescription dated 20. 09. 2014 Of the SIPS Hospital it is clearly mentioned that for bedsores VAC dressing was done to the patient on 18. 09. 2014 at 11 AM. Besides, many medicines are also prescribed to the patient considering is existing ailments. The complainant argued that the medical Council have found that the hospital did not provided the proper medical treatment to the patient and therefore they have warned the hospital for taking proper care of their patient in future. In this finding of the Medical Council does not affect finding of this bench, as from the record of this case we do not find any fact from (41) which a conclusion can be drawn that there was any lack of care at SIPS hospital.
As far as the Sahara hospital is concerned, The Medical Council has exonerated it and found no fault with them in their immediate medical treatment during the state of the patient in the hospital from the records also it is discernible that a continuous vigil and proper medical treatment was given to the patient and his general condition was so pathetic that he could not survive, even after the best treatment he received. In Sahara Hospital also back dressing was given for the bedsores of the patient besides all his other ailments and diseases many medicines the prescribed, but unfortunately, he could not survive despite the apparent appropriate medical care. Hence, the opposite party number 3 and 4 cannot be held liable for any medical negligence and for that matter any compensation or damages to the complainant's for any wrong treatment or any medical negligence in the treatment of the patient.
The first point formulated since the ground of relief against opposite parties number 1 the hospital and no. 2 as owner of the hospital, Ajanta hospital is that they have given wrong treatment and the patient, and conceals the condition of the patient from his relatives and discharging when he was in a critical condition. From the first document of Ajanta hospital it is revealed that they have mentioned all the ailments and adverse condition of the patient and also gave the necessary medicines for these. This allegation of the complainant's is not find any ground that the patient was the discharged prematurely when he was in a critical condition.(42)
After discharge from the hospital the patient remained is his house for 10 days and also survived for a long time thereafter. Hence, it cannot be concluded that the patient was discharged prematurely. However, on the basis of aforesaid discussion it is concluded that there was lack in nursing care of the patient which contributed the development of bedsores on his body. By proper nursing care and maintaining proper hygiene the growth of bedsores would have been retarded and within 10 days the bedsores of stage four would have been not developed.
The second point has been formulated against The Sips Hospital that they assured that the patient will be treated by specialized doctors but no specialist was deployed for treatment of the patient. On this point the documents of sips hospital where perused. The document dated 18. 10. 2014 titled as 'History' shows that the patient was having many ailments. The document contains the history of the patient as follows: -
"The patient...Shyam Sundar chaturvedi Age 78 years/1 month is a FTC acute on the chronic kidney disease c pnemento c with renal failure urinary track infection and DNC Htn c Bph Cervical Cord narrowing H/O CVA P/A bedsores sepsis slurred speech H/O DMx 20 years The document dated 18. 10. 2014 titled as 'treatment order' provides that the name of consultant Dr Anant Sheel Chaudhary, MD [ pulmonary medicine] k g m u has been given as Consultant for the respiratory problem of the patient. The other name of the consultant Dr Hariom Singh DM [neurology] has been given who has prescribed many (43) medicines to the patient. On the next page name of doctor Dr Pankaj Rastogi MD (medicine) has been given who has also prescribed many medicines on the prescription sheet on the next page name of Dr A K Singh coma MD (nephrology) has been given who has given the treatment and prescribed other medicines to the patient. The treatment order dated 18. 10. 2014 give that the relatives and attendants of the patient did not give permission for applying ventilator to the patient but from the treatment order dated 19. 10. 2014 it is Apparent that later on they have given permission for the ventilator also. The aforesaid treatment order transpires that the patient was in continuous treatment and observation of many consultants doctors as per the ailments of the patient Shyam Sundar Chaturvedi in the grievance raised by the complainant in this regard does not find ground and the SIPS hospital is not found guilty of not providing specialist doctors for the treatment of the patient. The complainant has also alleged that they found that the sixth Hospital is charging exorbitant fees and charges therefore they discharge their patient on their own. This version of the patient can be verified from the discharge certificate of SIPS Hospital where it is given that the patient was discharged Lama (left against medical advice). The heavy fees and charges of a hospital cannot be said to be a deficiency in service or 40 business practice because every Private hospital or institution can charge their own fee and if the relatives for attendants of the patient do not like the charges they can leave the hospital and opt for another Hospital according to the charges which suits them. On the basis of the above analysis and conclusion we are of the view that the objections raised by the complainants (44) against the SIPS Hospital are not sustainable and the hospital and doctors of SIPS hospital cannot be held liable for damages on account of deficiency in service.
The complainant has alleged against Sahara Hospital that they have given wrong treatment to the patient. It can be seen that the patient Shyam Sundar Chaturvedi was admitted to the hospital for or more than 10 days. The initial admission slip of the hospital shows that the patient Mr Shyam Sundar Chaturvedi was admitted with many ailments including bedsores and other adverse bodily conditions which include hypertension, chronic diabetes, respiratory problem etc. Against Sahara Hospital the main grievance raised by the complainant is that the patient Shri Shyam Sundar Chaturvedi was a serious patient of chronic kidney disease but despite their prayer the hospital did not provide the advice of a kidney expert. He was initially kept under observation of one doctor RK Mishra despite the fact that the relatives and attendants of the patient from the beginning requested for or Dr Mufazzal Ahmad who is the kidney expert... Regarding this allegation we perused the records, we find that a copy of progress sheet dated 21. 10. 2014 annexed with the affidavit of evidence produced by opposite party number 4 and 5 the Sahara Hospital which is page number 108 it is given that Dr R.K. Mishra and Dr. Mufazzal Ahmed were taking care of the patient Shri Shyam Sundar Chaturvedi from this date only and Dr. Mufazzal Ahmad not only given medical advice for the patient but also administered some medicines on that date. The copy of records after this document annexed with the affidavit of evidence submitted by Sahara Hospital shows that (45) Dr. Mufazzal Ahmed continuously provided medical treatment to the patient. The patient was also under care and prescription of Dr S. Bhattacharya the plastic surgeon at Sahara Hospital, who also prescribed and advised surgical operation for bed sores of the patient. The copies of the records further shows that the complainant Ajay Chaturvedi has duly given consent for the operation and after taking the permission from him the patient Shri Shyam Sundar Chaturvedi was operated upon by the team of doctors. Thus, the copy of records clearly show that the Sahara Hospital provided medical treatment of the expert doctors available with them and on this score deficiency of service or any medical negligence cannot be attributed to them.
Another allegations against the Sahara Hospital is leveled by the complainants is that they did not give proper care to the bedsores of the patient for which he was admitted to the hospital. But, copies of the documents annexed with the affidavit submitted by the Sahara Hospital shows that since admission of the patient to the hospital he was given VAC dressing for the treatment of his bed sores and this treatment was went on during his stay in the hospital. Hence, the contention of the complainants has no force that Sahara Hospital failed to give proper treatment and services of expert doctors to the patient. This complaint was also raised by the complainants before the 'Uttar Pradesh Medical Council', which exonerated the hospital from the charges. A copy of letter dated 25. 0 8. 2017 of the registrar for Ethical committee of UP medical council is produced on record at page number 178 off the affidavit of evidence by Sahara (6) Hospital. In the letter the order of ethical committee U.P. Medical Council has been produced in the following way: --
"The ethical committee heard both the parties and went through all the documents. The committee warns Dr Deepak Diwan and administration of Ajanta Hospital and instructs them to take proper consent while shifting to ICU/ ventilator. Management of SIPS Hospital too is strictly warned to give comprehensive treatment whenever any patient is admitted the ethical committee found no negligence on the part of Sahara Hospital and its treating doctors."
It is also show from the record that the components went in appeal against this order of 'Board of Governors, Supersession of Medical Council of India' confirmed the order of Uttar Pradesh Medical Council. In all, we do not find any evidence from which it may be concluded that Sahara Hospital was committed any act of deficiency of service for medical negligence.
On the basis of aforesaid discussion we conclude that from the evidence on record it may be inferred that the nursing staff at Ajanta Hospital did not take proper care and hygiene of the patient who was bedridden and seriously ill and even unable to move on the bed itself. The best source developed due to this condition could have been avoided or might be retarded if the nursing staff at Ajanta hospital would have taken proper hygiene and nursing care because within a short span of time bedsores off stage 4 were developed on the body of the patient. Had the nursing staff of Ajanta Hospital taken proper care and maintained proper hygiene this stage (47) could not be an arisen so early. Therefore, we find that the Ajanta Hospital is liable to pay compensation for damages of to the heirs of the deceased patient, who undergone through sufferings and also which contributed his early death, due to this negligence and deficiency in service by the hospital- staff. On the other hand, the other two hospitals SIPS hospital and Sahara Hospital are not liable to pay any damages you are compensation to the complainants as we do not find any medical negligence or deficiency in service in the treatment of the deceased patient. In this manner we find that the complaint deserves to be partially allowed against O.P. no.1 the hospital and no. 2 as owner of the hospital. As far as the question of quantum of compensation is concerned, the patient was admittedly having a very poor health and bodily condition therefore a compensation of Rs. 5,00,000/- ( Rs. Five Lakh) to the complainants if found sufficient in this case.
ORDER The complaint is partially allowed against O.P. no.1 the hospital and no. 2 as owner of the hospital. The opposite parties no.1 & 2 are jointly and severally directed to pay a compensation of Rs. 5,00,000/- (Rs. Five Lakh) to the complainants within 30 days from the date of judgment.
The stenographer is requested to upload this order on the Website of this Commission today itself.
Certified copy of this judgment be provided to the parties as per rules.
(Vikas Saxena) (Rajendra Singh)
Member Presiding Member
(48)
Judgment dated/typed signed by us and pronounced in the open court.
Consign to record.
(Vikas Saxena) (Rajendra Singh)
Member Presiding Member
Jafri, PA II
Court 2/tbv
[HON'BLE MR. Rajendra Singh] PRESIDING MEMBER
[HON'BLE MR. Vikas Saxena] JUDICIAL MEMBER