State Consumer Disputes Redressal Commission
Ramnarash Rai vs G.M. S.E.C.L Chirmiri on 27 May, 2011
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION
PANDRI, RAIPUR
Appeal No.655/2009
Instituted on 16.11.09
Ramnaresh Rai, S/o Shri Sahdeo Rai,
R/o Nehru Colony, Po. Sonawani,
Dist. KOREA (C.G.) ... Appellant.
Vs.
1. General Manager,
South Eastern Coal Fields Ltd., Area Head Office,
Malviya Nagar, West Chirmiri,
Dist. KOREA (C.G.)
2. Chief Medical Officer, Regional Hospital,
Kurasia Colliery, Godripara,
Dist. KOREA (C.G.)
3. Baldeo Prasad, Medical Officer,
Regional Hospital, Kurasia Colliery, Godripara,
Dist. KOREA (C.G.)
4. Shekhar Mukharji, Chief Lab Technician,
Regional Hospital, Kurasia Colliery, Godripara,
Dist. KOREA (C.G.) ... Respondents.
PRESENT: -
HON'BLE JUSTICE SHRI S.C. VYAS, PRESIDENT
HON'BLE SHRI V.K. PATIL, MEMBER
COUNSEL FOR THE PARTIES: -
Ram Naresh Rai, appellant present in person.
Shri Ramesh Singh, for respondents.
ORDER
Dated: 27/05/2011 PER: - HON'BLE JUSTICE SHRI S. C. VYAS, PRESIDENT This appeal is directed against order dated 03.10.09, passed by District Consumer Disputes Redressal Forum, Korea-Baikunthpur (hereinafter called "District Forum" for short) in complaint case No.110/07, whereby the complaint of the appellant herein, containing allegation of medical negligence against the respondent and seeking // 2 // compensation on account of the same, has been dismissed on the ground that the allegation has not been established.
2. Briefly stated facts of the case are that son of the complainant namely Siddharth Roy was suffering from cerebral malaria and severe anemia and therefore was admitted in the Regional Hospital Kurasia, S.E.C.L., Chirmiri Area, where respondent No.2 was the Chief Medical Officer and respondent No.3 was Medical Officer and respondent No.4 was Chief Lab Technician. After examination, it was advised by the Doctors that looking to the condition of the patient, blood transfusion is necessary and therefore his blood was sent for determination of blood group and respondent No.4 informed that the patient is having O+ blood group and requested to provided the blood of that group for transfusion to the patient Siddharth Roy. Friend of the complainant Mr. Rakesh Tiwari was having the blood group of O +. Therefore, he donated blood of O+ group, which was transfused to the patient Siddharth Roy. During blood transfusion, condition of the patient Siddharth Roy became deteriorated and therefore during such transfusion he was referred to the Higher Medical Centre MMI Hospital Raipur for further treatment, on 21.07.06. The patient was admitted in the MMI Hospital Raipur, where again looking to his serious condition, blood transfusion was found necessary and then again blood group of the patient was determined. It was found that he // 3 // is a person having blood group of B+ and therefore, blood of that group was transfused to him. Family members of the complainant and complainant himself were having the same blood group, therefore he donated blood for his son. It is alleged in the complaint that on account of transfusion of blood of wrong group, son of the complainant was required to suffer many physical problems including skin infections, hair loss, pus mixed in urine, chest pain, difficulty in breathing etc. With these allegations, on different heads claim of Rs.11,80,000/-, as compensation, was made by the complainant before District Forum. It has also been averred by the complainant before District Forum that, as per the latest study, now a person having O + blood group, no more remains universal donor and complications may occur on account of blood transfusion of O+ group as universal donor.
3. In reply the OPs refuted the allegations leveled by the complainant in the complaint against them. It has been averred by them that when Siddharth Roy was admitted in the Hospital then he was unconscious and on examination his condition was found very poor and poor prognosis was explained to the complainant also. Treating physician advised for urgent blood investigation including Hemoglobin, Blood Group and R.H. type, TLC, DLC, M.P. By Kit, Blood Urea, Serum bilirubin and urine test etc. As the patient was suffering from severe anemia and plasmodium falciparum infection, so // 4 // he was advised for immediate blood transfusion. It has also been averred by the respondents / OPs in their written version that on examination it was found that in plasmodium falciparum infection due to autoagluttination, it was difficult to trace the blood group of the patient therefore to save life of the boy, O+ group of blood was selected for transfusion and it was cross-matched with the blood of the patient, which was found matching and it was also observed that there was no antigens on the surface of RBC in O+ blood group, so no antibodies are developed in recipient‟s blood at the time of transfusion so it can safely be transfused to the patient. In these circumstances, blood of O+ group was transfused to him, as it was difficult to trace the correct blood group of the patient and as per the medical research, it is safe to transfuse blood of O+ group to a patient, where it is difficult to trace correct blood group and thus the life of the patient could be saved on account of such transfusion. It has further been averred by the OPs / respondents that, their Hospital was not having the facility of ICU and therefore to prevent further complication and for proper management of the patient in ICU, he was referred to Higher Medical Centre. It has been specifically stated that no negligence was committed by respondent Nos.3 & 4 in transfusing blood. On the contrary on account of such transfusion of blood of O+ group, life of the patient was saved. Report of Dr. D.K. Chikenjury was also filed by the complainant himself before the District Forum to show that on account // 5 // of such transfusion, no abnormal cells were found and therefore no complications have been arisen on account of such blood transfusion and if the patient later on suffered skin infection, loss of hair and pus in urine, chest pain etc., then it was not on account of transfusion of O+ group of blood and might be on account of illness, from which he was suffering or on account of any other disease of which he was having the problem. Thus, the allegations leveled in the complaint have been totally denied by the OPs / respondents.
4. Learned District Forum, after having considered the material placed before it by all parties, agreed with the contentions made by the OPs / respondents and dismissed the complaint.
5. During pendency of this appeal, when it was found that the complainant had not produced any independent opinion before the District Forum, then following the mandate of Hon‟ble Supreme Court in the case of Martin F. D'souza V. Mohd. Ishfaq, I (2009) CPJ 32 (SC), which was not declared per incuriam by that time, this Commission called opinion of Committee of experts constituted by the Chief Medical Officer, Korea-Baikunthpur. Opinion of such Committee was received, which was challenged by the respondents and they have also filed opinion of another Committee of experts along with affidavit of // 6 // Dr. P.G. Ansingkar and Dr. Pratibha Pathak. This additional evidence was also taken on record, during the course of hearing of this appeal.
6. We have gone through the record of the District Forum and heard arguments advanced by both parties in detail.
7. The allegations of the complainant against the respondents / Ops, are of transfusion of blood of wrong group and causing complications on account of such transfusion of blood of wrong group, but before District Forum no expert evidence or opinion was filed by the complainant to substantiate such allegations. Merely affidavit of the complainant Ram Naresh Roy was filed and in support of the version of complainant, affidavit of his friend Rakesh Tiwari, who donated blood for transfusion to the patient Siddharth Roy, has also been filed. But in that affidavit, only it has been averred that he donated his blood having group of O+ for transfusion to the patient Siddharth Roy, but when that blood was transfused, to that patient, then condition of the patient deteriorated and he developed other critical medical problems.
8. To counter affidavit of the complainant, OPs have filed affidavit of Dr. Baldeo Prasad and Shekhar Benerjee, the OP Nos. 3 & 4 in support of their contentions.
// 7 //
9. Affidavit of Shekhar Benerjee is more important as he is the person who was working on the post of Chief Lab-technician in the Regional Hospital Kurasia Colliery, who conducted test of blood of the patient. He took sample of blood of the patient and tried to determine blood group but he found that on account of severe falciparum malaria and on account of autoagluttination, it was not possible to determine correct group of blood of the patient and as the condition of the patient was deteriorating, therefore blood group of the donor Rakesh Tiwari was determined, which was found O+, then his HIV and Hepatitis-B tests were also conducted. In emergency condition, when donor‟s blood was matched with the blood of the patient and was found compatible in cross-matching, then he had given his opinion that the blood group has cross-matched with the patient‟s blood group and is compatible. The same facts have been stated by Dr. Balewo Prasad also in his affidavit. In the Discharge Ticket, Annexure A-1 of the Regional Hospital Kurasia, SECL and treatment chart it appears that when the patient was admitted in the Hospital, at that time his pulse was 90 per minute and his general condition was poor and his poor prognosis was explained to the complainant. It has also been mentioned that he was unconscious and therefore urgently he was advised for test of blood for blood transfusion and determining blood group. Report of respondent No.4 is also available on record, in which it has been stated clearly that blood of O+ group is compatible and he // 8 // had also examined the blood of the donor for HIV, Hepatitis-B etc. Discharge Ticket also shows that during treatment of the patient 300 ml blood of the donor of O+ group was donated in the Hospital.
10. We find that the Committee of experts which was appointed by the Chief Medical Officer of Baikunthpur-Korea has mentioned in its report that in the Discharge Ticket, the blood group of the patient has been mentioned as O+, which shows negligence on the part of the OPs as it shows that the respondents were having no doubt that the patient was having that blood group. But, from the Discharge Ticket it is clear that whatever entries made under the head Diagnosis, are cerebral malaria along with severe anemia, renal failure with hepatitis and under the column Treatment Given, name of some injections have been mentioned and merely it has been mentioned that 300 ml blood of O+ group was transfused to the patient, so this mention is not sufficient to show that the OPs / respondents failed to determine the correct blood group or have determined a wrong blood group.
11. In the treatment slip it has been mentioned that he was patient of cerebral malaria along with severe anemia and renal failure along with hepatitis. Merely looking to the fact that at the time of admission, the patient was unconscious with poor general condition, it can safely be said that he was in serious condition and in that condition his // 9 // correct blood group could not be determined and then to save his life blood of O+ group was transfused to him, which was found compatible after cross-matching. We find that the expert Committee appointed by Chief Medical Officer of Baikunthpur-Korea has mentioned in its opinion, in paragraph No.2, that at the time of admission condition of the patient was normal and his condition became deteriorated after transfusion of blood. It appears to be an incorrect statement of fact, which is contrary to the Medical papers available on record and on account of this it is difficult to agree with the opinion expressed by this Committee.
12. Committee further says that if it was not possible to determine the correct blood group of the patient then the Hemoglobin test could have been conducted and even if when the blood cells were auto- agglutinating continuously, even then as the blood group never changes, it could have been determined through antigen-antibody reaction etc. because antibodies never changes. It has also been stated by the Committee that a person who is having O+ blood group, no more remains universal donor. These conclusions are also contrary to the medical literature, which is available on record.
13. A Laboratory Manual For Rural Tropical Hospitals, written by Monica Cheesbrough and John McArthur, ELBS edition reprinted 1980 // 10 // was referred by the respondent before District Forum and the same has been relied by the another Committee of experts, constituted by the Chief Medical Officer of Chirmiri Area of SECL and consisting of Dr. P.G. Ansingkar, Chief Medical Officer (Path) and Dr. Pratibha Pathak, Deputy Chief Medical Officer (Paed). The committee has expressed following opinion : -
"We have studied the bed head tickets and other details of patient named Master Sidharth Ray S/O Ram Naresh Ray, who was admitted in Regional Hospital Kurasia on 20.07.2006 at 11:05 AM. He was unconscious at the time of admission. On examination his condition was poor and poor prognosis was explained to the father of patient.
He was advised urgent blood investigations which include Hb, TLC, DLC, Blood grouping Rh typing, MP by Kit, blood urea and serum bilirubin (total and direct).
Due to his serious condition and as he was suffering from severe anaemia and plasmodium falciparum infection, he was advised blood transfusion. In plasmodium falciparum infection due to autoagluttination there was a difficulty in finding the blood group of patient (Ref. No. 1 & 2).
To save the life of patient, „O‟ positive blood group donor was selected for blood transfusion. In „O‟ positive blood group there are no antigens on the surface of RBC. So no antibodies are developed in receipients blood at the time of transfusion or in future and so there is no chance of blood transfusion reaction.
Compatibility test is the most important step in transfusion medicine. „O‟ positive donor‟s blood was cross matched with patient‟s blood and was found fully compatible, so „O‟ positive blood donor was bled after doing HIV, HbsAg, VDRL and other tests which are mandatory for selecting a blood donor. All above tests were negative.
// 11 // Blood transfusion started at 12:45 PM and finished at 4:45 PM. Reports (blood urea and serum bilirubin) of blood which was collected prior to blood transfusion were available at 4:45 PM and were abnormal (blood urea 52.6 mg% and serum bilirubin 3.4 mg%). These reports were indicative of liver and renal involvement due to plasmodium falciparum infection. Patient was unconscious and irritable that indicated that brain involvement was also there.
To prevent further complications and need of ICU management, patient was referred to higher centre for further management. At MMI patient was treated for complicated plasmodium falciparum malaria infection with hepatitis with cerebral malaria and renal impairment (mentioned in discharged certificate) and again blood transfusion was given. Patient was discharged after 10 days. In transfusion reaction as per Davidson‟s Principles and practice of medicine seventeenth edition 1995, Page 825 (photocopy enclosed) has mentioned that for delayed hemolytic transfusion reaction, finding of spherocytes and polychromasia on blood film is a must. In peripheral smear examination report by Dr. D.K. Chikenjury that there were no abnormal cells (spherocytes and polychromasia) seen. On conclusion and looking of the findings as above there is no indication of delayed transfusion reaction.
In view of above patient‟s life was saved and further complications were prevented by giving a compatible blood transfusion at the earliest. So there was no negligence on the part of the treating doctor and management."
This opinion is started with the opinion of the author of „A Laboratory Manual For Rural Tropical Hospitals‟, which has been referred hereinabove. Author of that book has clearly stated "Auto- agglutinins are special antibodies which may be in the patient‟s serum causing the agglutination of his own red cells, in severe P. falciparum // 12 // infections it may occur. The red cells may already be agglutinated before grouping is started, and this can be confirmed by setting up what is called an auto-control". It has also been stated by that author that "occasionally in severe falciparum malaria, autoagglutination may also occur following treatment with some herbal preparations".
"Occasionally a patient‟s serum may contain autoagglutinins which are antibodies that cause the agglutination of a person‟s own and other red cells (autoagglutination)". "When autogglutinins are present, a patient‟s red cells appear agglutinated before commencing grouping".
"Type O individuals are "universal donors" because they lack A and B antigens and type O blood can be given to anyone without producing a transfusion reaction due to ABO incompatibility".
14. Considering the opinion of author of aforesaid book as well as the Committee of experts consisting of Chief Medical Officer Dr. P.G. Ansingkar and Dr. Pratibha Pathak, Deputy Chief Medical Officer, we find that the opinion expressed by the Committee of experts appointed by Chief Medical Officer, Baikunthpur-Korea becomes doubtful and therefore cannot be acted upon.
15. We have got opinion of many experts including the respondents as well as independent experts of Burhar Central Hospital and that of District Hospital Baikunthpur. After going through the opinion of all // 13 // the aforesaid experts and also the treatment record of the patient Siddharth Roy, available in the record of the District Forum, we are convinced that blood of O+ group was transfused to the patient in emergency, to save his life when it was not possible to determine the correct blood group and when it was found that blood of O + group was cross-matching with the blood of the patient and was compatible. Therefore, we are of the view that the respondents were not negligent in transfusing blood of O+ group to the patient Siddharth Roy.
16. Clearly there appears no evidence to show that any problem has been suffered by the patient on account of transfusion of blood of O+ group and no-one has expressed any opinion in this regard. There appears nothing in the treatment papers of MMI Hospital Riapur also, to shows that the patient suffered any problem on account of transfusion of blood of O+ group. Discharge Ticket of MMI Hospital Raipur, shows that when the patient came to the Hospital then at that time he was diagnosed as patient of complicated plasmodium falciparum malaria infection with hepatitis with cerebral malaria and renal impairment and he was treated accordingly. These were the complications, from which the patient was suffering when he was brought to the MMI Hospital and treatment was given to him in that Hospital, but in the Hospital of respondents the treatment was started and blood was transfused to bring him out from the stage of severe // 14 // anemia to save his life and then he was brought to the MMI Hospital to prevent further complications. The Complete Blood Count report dated 21.07.06 of the patient of MMI Hospital Raipur also does not show that any complications were developed on account of transfusion of blood of O+ group.
17. Thus, after minutely going through the material available on record, we find that there was no medical negligence on the part of the OPs / respondents and the District Forum has not committed any error in dismissing the complaint. The appeal has got no substance and is dismissed. No order as to cost.
(Justice S.C. Vyas) (V.K. Patil)
President Member
/05/2011 /05/2011