National Consumer Disputes Redressal
Dr. Surendranath Reddy vs Umkal Hospital And Anr. on 23 January, 2023
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI CONSUMER CASE NO. 53 OF 2007 1. DR. SURENDRANATH REDDY P.H.D. HOUSE 2ND FLOOR-4/2-SIRI INSTITUTIONAL AREA AGUST KRANTI MARG NEW DELHI ...........Complainant(s) Versus 1. UMKAL HOSPITAL AND ANR. A-520 SUSHANT LOK-1 GURGAON GURGAON-122002 2. Medical Superintendent Umkal Hospital, A-520, Sushant Lok-1, Gurgaon - 122 002. 3. UNITED INDIA INSURANCE COMPANY LIMITED DIVISIONAL OFFICE VIII, 503-504, KAILASH BUILDING,
26, KASTURBA GANDHI MARG, NEW DELHI-110001 ...........Opp.Party(s)
BEFORE: HON'BLE DR. S.M. KANTIKAR,PRESIDING MEMBER HON'BLE MR. BINOY KUMAR,MEMBER
For the Complainant : For the Opp.Party :
Dated : 23 Jan 2023 ORDER
APPEARED AT THE TIME OF ARGUMENTS
For Complainants
:
Ms. Kanika Agnihotri, Advocate
Ms. Yashodhara Gupta, Advocate
For Opposite Parties
:
Mr. Rajeev Sharma, Sr. Advocate
Mr. Rajat Krishna, Advocate
Ms. Shruti Sharma, Advocate
Mr. Saket Chandra, Advocate
For OP Nos.1 & 2
Pronounced on: 23 rd January 2023
ORDER
DR. S. M. KANTIKAR, PRESIDING MEMBER
1. This Complaint was filed by Dr. Surendranath Reddy the Complainant under Section 21(a)(i) of the Consumer Protection Act, 1986 against the Opposite Parties Umkal hospital & Ors. for the alleged untimely death of his son due to medical negligence and deficiency during treatment.
2. The facts are that on 07.06.2005, the Complainant's son Harish Reddy, about 33 years old (since deceased hereinafter referred to as 'the patient') was taken by his friend Mr. Shivaz Rai to the Umkal Hospital (hereinafter referred to as 'the OP No. 1 - Hospital) with the complaints of tachypnoea, breathlessness and extreme fatigue. The patient had not consumed food for 4-5 days . It was diagnosed alcoholic keto-acidosis and alcoholic liver disease. On the next day 08.06.2005 the Partial pressure of Carbon Dioxide (PCO2) level was continuously fluctuating, but no medication was given to correct PCO2 level. Once the PCO2 level shot up to 56.2 and thereafter, on 09.06.2005, the level of PCO2 became very low 28. Subsequently at 3:45 PM the patient suffered the first Cardiorespiratory arrest and he was intubated. It was alleged the patient was not kept under constant cardiac observation or ECG. The patient became restless, violent therefore, his hands were tied. However, the patient was left unattended and he himself self-extubated. It was further alleged that, on 10.06.2005 around 6:30 PM the patient suffered second cardiac arrest. However, the Intensivist Dr. Seema recorded nothing in the progress sheet about the emergency steps taken by the doctors. It was alleged that the cardiac massage was delayed, it was done at 7:15 PM which was about 30-40 minutes after the arrest. Dr. Seema did not record about cardiac massage and suffered Ventricular asystole. However, the doctors mentioned about false story of self-extubation in the medical record, and attempted to cover their deficiencies. The progress sheet had the second cardiac arrest was mentioned as 'Ventricular Asystole'. Eventually, on 11.06.2005 at 3:00 AM the patient expired due to another cardiac arrest. The complainant alleged about the several discrepancies in the history sheet. It was medical negligence while treating the cardiac arrest.
3. The Complainant being doctor himself sought an opinion from Mr. Bijoy Mehta from Queens-Long Island Medical Group, P.C. According to him the EKG (ECG- No marked as 15301/05) shows "Q" waves and ST elevation, which was due to acute coronary antero-septal infraction. The treating doctors at Umkal Hospital failed to diagnose it. Moreover, the marker Serum Troponin level was not available, which was specific to detect acute coronary insult. The Angiogram could have detected possibility of the coronary block and further lifesaving Angioplasty would be performed, if necessary.
4. Being aggrieved, the Complainants filed the present Consumer Compliant under section 2(c), (d), (g) and (o) read with Section 12, 13 and 14 of the Consumer Protection Act, 1986 before this Commission against the Opposite Party Hospital. The Complainants prayed for compensation to the tune of Rs.2,29,89,992/- under various heads.
5. The Opposite Parties filed their respective Written Versions and denied the allegations of negligence or deficiency during treatment of the patient. It was submitted that prior to admission at OP hospital, the patient was admitted in the Psychiatric de addiction centre of Dr. Deepak Raheja in Gurgaon on 07-06-2005 and on the same day for further management he was taken to the OP-1 hospital by one Mr. Shivaz Rai as no close relative of patient available. His parents were in U.S at the time when the patient was admitted in OP-1. At the time of admission patient had breathlessness since morning associated with marked weakness and loss of appetite. For the past one week, he had consumed Alcohol and not taken food. He was a heavy smoker. On examination the patient had tachypnea, sinus tachycardia, low oxygen saturation and was having cold clammy skin. The Random blood sugar was very high - 314 mg/dl. The Urine ketones were present in traces and Arterial Blood Gas analysis (ABG) revealed severe metabolic acidosis. He was administered insulin to control sugar (ketones) and given I.V. Ringer Lactate to correct dehydration and acidosis. To control the heart rate and to prevent arrythmias Inj. Betaloc (Betablocker) was given as also recommended in alcohol withdrawal cases. Patient's Echocardiography (ECHO) revealed severe Left Ventricular Hypertrophy with non-obstructive hypertrophic cardiomyopathy (more apical). Since, the patient was not hypertensive, severe LVH was suggestive of pre-existing Cardiomyopathy. After treatment the blood PH was improved from 7.04 to 7.35, within normal limit and the Blood sugar was under control. He was administered Dextrose, insulin infusion with Inj. Potassium Chloride. His Serum K+ was regularly monitored. His liver enzymes were deranged. He was given a hepatoprotective agent Hepamerz. The patient showed some improvement.
6. He was kept under monitoring in the ICU, but due to his comorbid conditions developed sudden ventricular arrhythmias and subsequently cardiac arrest at 3.45 PM on 9.6.2005. Immediately he was revived by Cardio pulmonary resuscitation (CPR). He was intubated and kept on ventilator. Inotropic support with Dopamine infusion started to restore his blood pressure. Also the Senior Prof. J. P. Wali and Pulmonologist Dr. Navin Kishore and Cardiologist Dr. Umesh Gupta from AIIMS examined the patient. He was also seen by Gastroenterologist Dr. Arvind Kumar and gastric aspiration through Ryles tube done, there was no GI bleed. Dr. Arvind Kumar increased the doses of antibiotics and for monitoring the patient was put on central venous line. On 10.06.2005 at 6.50 pm, the patient himself extubated despite the restraints. He was immediately reintubated and again put on ventilator support by the intensivist on duty. Thereafter, patient suffered ventricular asystole and revived with CPR and with higher doses of inotropic support for maintaining his vitals. At around 11 pm, he developed focal seizures and given Phenytoin infusion and Inj. Midazolam. Thereafter started on Dobutamine infusion and then nor-adrenaline infusion. However, his blood pressure did not improve despite all best efforts he expired on 11.06.2005 at 3 a.m. Evidence on behalf of Complainant:
7. The Complainants filed their rejoinder and evidence by the way of affidavit. The Complainant in his affidavit submitted that Harish was healthy boy and had never suffered any disease or ailment except the occasional fever or cold or cough. He was in good health when he left the United States to visit India in December 2004. He was doing well in his career and was earning well too. He was in excellent physical and mental health can be borne out from the fact that in November 2002, thus got issued a medical policy for $1,000,000.00 by MetLife. He further state in his affidavit that two medical opinions were sought by him one from Mr. Bijoy Mehta and Dr. Praphul Misra. Both have opined the possibility of Acute MI which remained undiagnosed by the doctors at OP hospital and might have led to his death
8. One affidavit of evidence was filed by Mr. Shivaz Rai. According to him, his friend Harish ended up consuming excessive alcohol. Harish needed hydration, therefore on 07.06.2005 he admitted Harish to Dr. Raheja's clinic at Gurgaon. The consulting physician Dr. Ravinder Gupta from Umkal hospital (OP) was called to see him and he suggested to admit Harish for observation in the ICU of nearby Umkal hospital. Therefore, in the late evening on same day the patient was admitted to the ICU at Umkal Hospital. He further submitted that some of the doctors at Umkal also spoke to Harish's parents on the phone about his condition, but they never expressed any serious concerns. On 9.6.2005 the patient was to be shifted to room, but the evening he had a sudden Cardiac arrest. The staff at Umkal Hospital revived him. He spoke to the doctor for shifting another better hospital however the treating doctors wanted the patient to be stable before he moved him around. Dr. Ish Ghai and Shivaz Rai instructed the OP-1 staff to keep 24/7 nurse services for personal care for Harish which they assured they would do. He called his parents and his relative from Hyderabad and Bangalore made their way to Delhi the next day. Harish was in discomfort because of the tube inside his mouth therefore the Umkal hospital Doctors decided to release Harish's hand restraints. About 5-10 minutes of being left alone Harish pulled out his endotracheal tube and consequently suffered a second heart attack, followed by coma. He passed away on 11.06.2005 at 3 am.
9. Evidence on behalf of Opposite Party (ies):
The OPs filed evidence by the way of affidavits of the treating doctors namely Dr. Ravindra Gupta, Dr. Umesh Gupta, Dr. Sushila Kataria, Dr. Ish Ghai and Dr. Seema Kamal.
10. Evidence of Dr. Ravindra Gupta Dr. Ravindra Gupta submitted that the patient was chronic heavy cigarette smoker and severely alcohol abuse and had a pre-existing hypertrophic cardiomyopathy. The patient was seen by senior Consultants several time., The patient was remained without eating properly and suffered various complications led to cardio respiratory arrest. The liver enzymes were raised due to alcoholic hepatitis. The ultrasound also revealed fatty liver. The Gastroenterologist, Dr. Arvind Kumar also confirmed it as alcoholic hepatitis. Due to the effect of severe metabolic acidosis PCO2 showed variation. IV fluids were given for correction of acidosis and insulin to control the blood sugar. Thereafter PH was improved from 7.04 to 7.35. The Acid base balance and ABG was continuously monitored. Thus to correct the PC02 levels necessary steps like correction of acidosis, institution of oxygen therapy and ventilator adjustments were done from time to time. He further submitted that the Cardiac arrest was managed with CPR as per the standard guideline. It was stated that the restraint/bandaging of patient does not mean that the patient was chained in an inhuman manner so that he cannot even move. Sometimes Self-extubation takes place despite the restraints.
11. Evidence by OP -Dr. Umesh Gupta:
He stated that Mr. Shivaz Rai visited the patient occasionally, but never stayed more than 5 minutes inside the ICU. He and the Complainant filed concocted affidavits. The allegation that a 24 hour separate nurse was requested for was incorrect. The ICU had 24 hours nurses. Dr. Gupta denied that the patient suffered a cardiac arrest each day. The patient was treated as per accepted medical practices and there was no negligence or deficiency in service.
12. Evidence by OP - Dr. Sushila Kataria She submitted that at 9.50 PM on 07.06.05, she performed bedside 2-D Echocardiography of the patient and the ECHO findings were informed to the patient's friend Mr Shivaj Rai. Thereafter, he made her to speak telephonically to the mother of the patient and explained the condition of the patient. On 9.6.2005, the patient developed Ventricular Arrhythmia leading to cardiac arrest. The successful resuscitation was done and did a screening ECHO which showed an Ejection fraction as 40% and global hypokinesia of left ventricular wall. There was no evidence of Myocardial Infarction. An ECG done immediately after the resuscitation was similar to the one done on admission. She further discussed with Prof J.P. Wali and Dr Ravindra Gupta about further management of patient. The repeat ECHO done on 10.6.2005 at 5.30 pm revealed severe LVH, Global Hypokinesia and Ejection Fraction to 30-35. There were no changes of Myocardial Infarction.
13. Evidence by OP -Dr. Ish Ghai He submitted that in past during late 2004 / early 2005 Mr. Shivaj Rai brought the same Harish Reddy to him with the history of alcoholism. Harish was under his treatment for nearly six months and advised to stop alcohol. In the first week of June, 2005 he referred Mr. Harish to Dr. Deepak Raheja who was running De-addiction Clinic in Gurgaon. AT the request of Mr. Shiva] Rai, he visited Umkal Hospital and found Mr. Harish in a well-equipped ICU. He met Dr. Umesh Gupta and Dr. Ravindra Gupta who explained the condition and prognosis of the patient. He also gone through the relevant medical records and of the opinion that the diagnosis and line of treatment was correct.
14. Evidence by OP -Dr. Seema Kamal It was submitted that on 9.6.2005 she was on night ICU duty. The patient was on ventilator along with ionotropic support. He was on sedatives so that he could tolerate the Endotracheal Tube and maintain adequate hemodynamic and respiratory status. Throughout the night, his status was assessed and according to the needs, adjustments were made in the ventilatory support. On next day she was off duty at home. She received a call from the hospital at around 7 PM that the patient had self-extubated himself. When I reached the ICU the patient was already intubated by Dr. Ram and his CPR was in progress. With joint team effort the patient was revived and put back on ventilator support. She left the Hospital at around 8.30 PM.
Arguments:
15. We have heard the arguments from the learned counsel on both the sides. They have reiterated their evidence on record. They have filed medical literatures on the subject.
Findings and Conclusion:
16. We have perused the medical record and the relevant investigations conducted at OP-1 hospital. Admittedly the patient was in serious condition when he was brought to the hospital. He was a known alcoholic and the LFT enzymes where de-arranged. The urine ketone bodies were positive, thus patient was in ketoacidosis. The blood sugar was very high and in addition, the patient remained empty stomach without consuming any food for one week. We have perused the Cardiac findings. On 07.06.2005 and 08.06.2005, the ECHO showed drastic fall in ejection factor from 66 to 30%. Thus it was a case of cardiac failure. It is pertinent a note that ECHO findings revealed LVH, though the patient was not hypertensive. Thus, it goes in favour of alcoholic cardiomyopathy due to chronic alcoholism. Perused the medical record and the expert opinion from Dr. Vijay Mehta, the Cardiologist at Queens Long Island Medical Group USA. According to him, there was evidence of acute coronary antero septal infarction which was not diagnosed and treated by the opposite parties, ECG was undated. Moreover, the OP failed to do serum marker Troponin, it would have helped to detect coronary blockage and angiogram could have helped. The alcohol causes reduction in potassium level which the OP failed to correct and it became fatal. Even the ventricular fibrillation is possible due to low potassium level, however the OP stated that it was toxic myocarditis or myopathy.
17. On 11.06.2005 the patient's mother was present in the Hospital and she was informed about the poor condition of her son. The patient remained critical and despite Inotropic Vasopressor support and IV fluids the BP did not improve, but he remained unconscious. At 2.30 AM the patient's mother was informed about his grave condition. At 2.45 AM the patient developed sinus bradycardia with fall in blood pressure. He was administered Injection Atropine. However, his bradycardia did not respond and he developed ventricle asystole. Immediately cardio respiratory resuscitation measures including cardiac massage were instituted by a team of doctors. Despite resuscitative measures, the patient could not be revived and was declared dead at 3 AM.
18. It is submitted that best possible treatment consistent with the standard medical practises was given to the patient. Ali possible investigation relevant to the patient's condition was carried out. Each day, the patient was seen by Senior Consultants a number of times, as is evident from the Hospital records. The patient had a pre-existing disease of hypertrophic cardiomyopathy, chronic severe alcohol abuse and chronic heavy cigarette smoking. It is this history coupled with a binge of alcohol for about one week without eating properly which resulted in the various complications and the ultimate death of patient.
19. The cause of death of the patient was cardio respiratory arrest, which is multifactorial, being alcoholic liver disease, multiple metabolic abnormalities like Ketoacidosis, dehydration, acidosis in the presence of hypertrophic cardiomyopathy. The contention of the complainant that the patient was not suffering from hepatitis is incorrect. Hepatitis inflammation of liver leading to raised liver enzymes, which the patient had. The medical history of the patient shows that the patient had hepatitis due to alcohol. His ultrasound also revealed fatty liver. The patient had a history of alcoholism and had alcohol related liver disease i.e. alcoholic hepatitis which required abstinence from alcohol and symptomatic treatment.
20. The contention of the complainant regarding the treatment for PC02 is also incorrect. It is submitted that the PC02 levels are never seen in isolation. The minimally low PC02 at the time of admission was the effect of severe metabolic acidosis, which causes hyperventilation (fast breathing) leading to wash out of carbon dioxide. This requires correction of acidosis, the treatment of which was immediately instituted by giving IV fluids and insulin with control of blood sugar, as a response to the aforesaid treatment his PH improved from 7.04 to 7.35 thereby correcting acidosis. There is no specific medication neither the same is warranted to correct the low PC02 levels in isolation. The correct the PC02 levels necessary steps like correction of acidosis, institution of oxygen therapy and ventilator adjustments were undertaken from time to time.
21. Considering the entirety, in our considered view, the instant complaint is misconceived and based upon ignorance regarding medical procedures and practices. The patient - Harish Reddy was given the best possible treatment in accordance with accepted medical standards. It is indeed unfortunate that the patient could not be saved and the death was not on account of lack of care or negligence. The Opposite Parties were not guilty of any negligence/ deficiency in their services.
22. We would like to put reliance upon the various decisions on medical negligence by the Hon'ble Supreme Court in the case S. K. Jhunjhunwala vs. Dhanwanti Kaur and Another[1] held that in every case where the treatment is not successful or the patient dies during surgery, it cannot be automatically assumed that the medical professional was negligent. Recently in the case of Dr. (Mrs.) Chanda Rani Akhouri & Ors. Vs Dr. MA Methusethupathi & Ors.[2]. It was observed that:
it clearly emerges from the exposition of law that a medical practitioner is not to be held liable simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another.
23. Based on the discussion above, we do not find any merit. Hence, the Complaint is dismissed. Parties to bear their own costs.
[1] (2019) 2 SCC 282 [2] 2022 LiveLaw (SC) 391 ...................... DR. S.M. KANTIKAR PRESIDING MEMBER ...................... BINOY KUMAR MEMBER