State Consumer Disputes Redressal Commission
Smt. Susheela K.R. vs Dr. Savio Pereira Ma, M.Phil on 17 November, 2022
Cause Title/Judgement-Entry KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION BASAVA BHAVAN, BANGALORE. Complaint Case No. CC/8/2013 ( Date of Filing : 29 Jan 2013 ) 1. Smt. Susheela K.R. W/o. Late Muralidharan S., Age about 55 years, R/at No. 1392/10, 4th A Cross, 9th Main, RPC Layout, Hampinagar, Bangalore 560104 . ...........Complainant(s) Versus 1. Dr. Savio Pereira MA, M.Phil The Medical Superintendent, St. John's Medical College Hospital, St. John's National Academy of Health Sciences, Johnnagar, Bangalore 560034 ............Opp.Party(s) BEFORE: HON'BLE MR. Ravishankar PRESIDING MEMBER HON'BLE MRS. Smt.Sunita Channabasappa Bagewadi MEMBER PRESENT: Dated : 17 Nov 2022 Final Order / Judgement BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BANGALORE (ADDL. BENCH) DATED THIS THE 17th DAY OF NOVEMBER 2022 PRESENT MR. RAVISHANKAR : JUDICIAL MEMBER MRS. SUNITA CHANNABASAPPA BAGEWADI : MEMBER CONSUMER COMPLAINT NO. 8/2013 Smt. K.R. Susheela, W/o Late S. Muralidharan, Aged about 55 years, R/at No.1392/10, 4th 'A'Cross, 9th Main, RPC Layout, Hampinagar, Bangalore 560 104. (By Sri R.G. Halesha) ....... Complainant/s V/s 1. Dr. Savio Pereira, MS., M.Phil The Medical Superintendent, St. John's Medical College Hospital, St. John's National Academy of Health Sciences, Johnnagar, Bangalore 34. .... Opposite Party/ies 2. Dr. Reddy, Father name not known, Aged about 46 years, 3. Dr. Sriram Sampath, Father name not known, Aged about 58 years, 4. Dr. Rithvik, Father name not known, Aged about 42 years, 5. Dr. Amit Kumar Tireey, Father name not known, 6. Dr. Bhuvana, Father name not known, Aged about 30 years, Respondent Nos. 2 to 6 are Working as the Medical Superintendent, St. John's Medical College Hospital, St. John's National Academy of Health Sciences, Johnnagar, Bangalore 34. (By M/s Dua Associates & GH) ORDER
Mr. RAVISHANKAR, JUDICIAL MEMBER
1. This is a complaint filed by the complainant alleging medical negligence in not treating the husband of the complainant properly which resulted in death, hence, prayed for a compensation for the tune of Rs.99 lakhs along with other relief deemed fit.
2. The averments in the complaint are as hereunder;
It is the case of the complainant that her husband Mr.S.Muralidharan, aged about 59 years was a known chronic kidney disease and he was in regular dialysis apart from this he had no serious problem in his health. Such being the case, in the month of December 2011, he had contacted Gyndaise at Gurushree Hospital for Hepatitis-B and referred him to BGS Global Hospital. Accordingly, on 19.11.2011 Mr. S. Muralidharan was admitted to BGS Hospital where he was given hemodialysis and was diagnosed as acute Hepatitis-B with hepatic encephalopathy, anemia with HT then he was discharged on 26.12.2011 with advise to take prescribed medicines. Again on 13.01.2012 he was readmitted to BGS Hospital for bleeding gums of 3 days duration. Then the BGS Hospital referred him to the Opposite Party Hospital on 14.01.2012 after obtaining the opinion from Hematologist. On 14.01.2012 he was admitted to Opposite Party hospital and various medical tests were done. The clinical investigation of the patient discloses that Respiratory System-NVBS present, no added sounds, Cardio Vascular System-S1, S2 heard, no murmurs, Abdomen-Soft, no organomegaly, Bowel Sounds + Central Nervous System- Conscious, alert and oriented. The condition of the husband of the complainant was not so serious and it was curable if proper treatment and care was given at the right time, but, the Opposite Party hospital has not shown any proper care and they have not discharged their duty faithfully and shown medical negligence which is against to medical profession and humanity. By looking at the initial medical report which was done at 14.01.2012, there was no very serious and the hemoglobin was 6.5%. Later on it was reduced to 5.1% and it is very clear from their own report at that time Opposite Party hospital has not taken any steps to transfusion of the blood which is very much required to the patient.
3. The complainant further alleges that in the Death Summary given by the Opposite Party hospital it was categorically mentioned that the death was due to failure of multi organs dys-functions and secondary to sepsis, but, it was not found at the time of admission and in medical examination report. The entire death report is false and the cause of death is shown in the death report is nowhere mentioned in their day today report. The patient was not diagnosed sepsis at the time of admission and also not mentioned which date and how he got sepsis and how it was lead to death which clearly goes to show that there is a total negligence on the part of the Opposite Party Nos. 1 to 6 in not treating the husband of the complainant properly. The report submitted by the hospital authorities states that he was died due to multi-organ dys-function secondary to sepsis, but, it is a false statement made without any basis of expert doctors opinion. The Opposite Parties have not shown the cause of death of the deceased which is clearly a medical negligence on their part. The hospital authorities have not done dialysis as required, that normally to be done dialysis once in two days whereas when the person was being given liquid food. The dialysis is required to be done very frequently, but, hospital authority has not done dialysis as required to the husband of the complainant when he was in ICU and particularly when giving a liquid food.
4. The complainant further alleges that due to medical negligence and failure from making dialysis continuously, failure in not transfusion of blood and failure from not taking proper care about the patient who was in ICU which clearly goes to show the commercial mind of the Opposite Parties hospital and negligence in treating the husband of the complainant. Due to negligence on the part of the Opposite Parties, the complainant lost her beloved husband who was only 59 years old which resulted in mental agony and irreparable loss and untold feeling which she cannot express and shows before the world. Hence, prayed for a compensation of Rs.99 lakhs in the interest of justice and equity. Hence, the complaint.
5. After service of notice, the Opposite Party Nos. 1 to 6 appeared through their counsel and filed their version and contended that St. Johns Medical College Hospital is a charitable hospital established in 1975 having highly qualified doctors to provide the best medical services. It is one of the leading hospitals in Bangalore, reputed for excellent medical services and patient care, with more than 15 specialty service and 13 super-specialty services and caters to approximately 1200 inpatient and 1400 out-patients every day. SJMC Hospital employs more than 2000 staff, 400 doctors and close to 900 nurses. On account of the exceptional medical services rendered by it, SJMC Hospital has been rated as one of the leading hospitals in Bangalore.
6. Opposite Party No.1 is the Associate Director of SJMC Hospital and was not involved in the treatment of the patient. Opposite Party No.3 has completed M.D. in General Medicine. He has undertaken intensive care training in Australia and has worked in intensive care since 1995. He has more than 29 years experience after his post-graduation and more than 19 years of experience in critical/intensive care. He took care of the patient on 15, 16, 23, 25 and 27 January 2012. The Opposite Party No.6 is the Associate Professor of Critical Care Medicine at SJMC Hospital. She has more than 8 years of experience in Critical Care and holds a Diploma from the Indian Society of Critical Care Medicine in addition to her post-graduate degree. She took care of the patient on 22nd January 2012. Opposite Parties 2 & 4 were senior residents with post graduate qualifications and duty doctors who monitor patients and ensure that the care plan for a patient is executed. Opposite Party No.5 was a junior resident in SJMC Hospital whose duties were supervised by senior residents.
7. The patient Mr. Muralidharan was admitted to Opposite Party hospital on 14.01.2012 after being referred from BGS Hospital with a diagnosis of chronic kidney disease on regular hemodialysis, anaemia, hypertension, Hepatitis B infection with acute hepatitis and encephalopathy. Initial investigations conducted in BGS Hospital had also revealed leucocytosis (increase in the number of white blood cells in the body, indicative of an infection), hyperbilurubinemia (abnormally high amounts of bilurubin in the blood) due to hepatitis B infection. After noticing this he was started on Lamivudine (medicine used in the treatment of AIDS and Hepatitis B infections). Then he was discharged from BGS Global Hospital on 26.12.2011. This clearly goes to show that at the time of admission to this hospital the patient's kidney and liver functions and platelet count were not in order. The platelet counts were found to be 11000 and platelet counts were persistently low and the patient had already received multiple blood transfusions and it was also noticed that the patient had multi-organ dysfunction at the time of admission dysfunction at the time of admission to the Opposite Party hospital itself. The Opposite Party further contended that the patient was examined at the Emergency Department and he was found to have deep jaundice (icterus ++++), pedal oedema (swelling of the feet), petechial rashes (purple rashes caused by minor hemorrhage of capillaries), hepatomegaly (abnormal enlargement of liver) and was found to be bleeding into his skin. He also had a high Creatinine count of 6.2 g/dl, Hemoglobin countof 6.5 g/dl, bilirubin count of 22.3 g/dl and a very low platelet count. A high creatinine count is indicative of abnormal kidney function and bilirubin and platelet counts pertain to liver and hematological disease respectively.
8. The patient was severely ill. He was given 13 bags of platelets, 1 bag of special platelets till 18.01.2012. In addition he also received 2 bags of red blood cells till 18.01.2012. However, despite the regular platelet transfusions, there was a sudden drop in the patient's hemoglobin count to 5.0 g/dl on 19.01.2012. This was owing to the gastrointenstinal bleeding secondary to his low platelet count. He was given emergent treatment with 4 bags of platelet transfusion, 2 bags of red blood cells transfusion and his hemoglobin count was built up 6.3 g/dl as on 20.01.2012. Further, the patient was treated for his kidney problems by Nephrologists visiting on daily basis. Based on the assessment of the Nephrologists, the patient was dialysed atleast 9 times.
9. The Opposite Parties further contended that the patient's jaundice was also evaluated by relevant investigations like an ultrasound scan of the abdomen, hepatitis markers in addition to the known hepatitis state, serological tests for Rickettsioses ( a disease caused by intracellular bacteria), enteric fever, dengue and Leptospirosis (bacterial infection). All the relevant investigations were found to be non-contributory and the anti-viral medication (Entecavir) was continued as per the advice of the Gastroenterologist. The low platelet count of the patient was also investigated appropriately with prior consultation with hematologists. Bone marrow examinations and necessary blood tests were also performed and the platelet count of the patient was monitored regularly. Pharased platelet transfusion, a special technique to administer a large amount of platelets was utilized and over 40 units of blood products were given to the patient. Even after these treatments, the condition of the patient deteriorated on 23.01.2012 and he had to be put on artificial ventilation. A post-intubation chest x-ray taken on the same day indicated a lung infection and Hospital Acquired Pneumonia (HAP).
10. The development of pneumonia in a very sick patient is common with incidence rates up to 50-75%. The patient was also noted to have become unstable with low blood pressure, requiring medicines for maintenance of blood pressure. Due to long time treatment and infection like pneumonia leads to sepsis ( a serious medical condition caused by an overwhelming immune response to infection, leading to widespread inflammation and organ damage), respiratory failure and low blood pressure. Even noticing all these, the patient treated was aggressively for sepsis and pneumonia in accordance with standard medical practices and was started on an antibiotic, meropenem the same day. On 28.01.2012, the patient's blood pressure continued to drop despite the continuation of treatment on him for sepsis and medicines to maintain blood pressure. The patient had already been suffering from multi-organ dysfunction and his health further deteriorated due to severe sepsis. Regrettably, the patient succumbed to these afflictions. There is no negligence on the part of the Opposite Parties in treating the husband of the complainant. The complainant is very much aware of the treatment given to the patient inspite of that she alleged medical negligence without any basis. The Opposite Parties further contended that there is no ground whatsoever found in the averments of the complainant for payment of the compensation to the tune of Rs.99 lakhs. There is no any expert opinion produced by the complainant to establish that there is medical negligence on the part of the Opposite Parties. Hence, prayed to dismiss the complaint. Opposite Party Nos. 1 to 6 also filed a parawise answers to the allegations made in the complaint which reiterates the abovesaid facts.
11. The complainant has filed his affidavit evidence. The Opposite Parties have also files affidavit evidence and marked documents at Ex.R-1 & R-2. Opposite Party files written arguments. Heard the arguments.
12. On perusal, the following points will arise for our consideration;
(i) Whether the complaint deserves to be allowed? (ii) What order? 13. The findings to the above points are; (i) Negative (ii) As per final order REASONS
14. On going through the pleadings, affidavit evidence and documents produced by both parties, we noticed here that the husband of the complainant aged about 59 years was initially took treatment at Gurushree Hospital for his chronic kidney disease and he was in regular dialysis. Such being the case, in the month of December 2011 on advise of Gurushree Hospital, he was admitted to BGS Hospital for treatment with respect to Hepatitis-B. On 19.11.2011, the husband of the complainant Mr. S. Muralidharan was admitted to BGS hospital and he was given hemodialysis and was diagnosed as acute hepatitits-B with hepatic encephalopathy, anemia with HT. The said BGS Hospital discharged the patient Sri S. Muralidharan on 26.12.2011 with an adivce to take medicines as prescribed. Further, the husband of the complainant was admitted to BGS Hospital on second week of January and discharged on 14.01.2012 with an advise to admit to St. John's Hospital. Accordingly, on 14.01.2021 he was admitted to Opposite Party hospital and certain medical tests were conducted in the Opposite Party hospital where he was noticed that the complainant's husband had a respiratory problem, deep jaundice (Icterus +++), pedal oedema, (swelling of the feet), petechial rashes (purple rashes caused by minor hemorrhage of capillaries), hepatomegaly ( abnormal enlargement of liver) and was found to be bleeding into his skin. He also had a high creatinine count of 6.2 g/dl, haemoglobin count of 6.5 g/dl, bilirubin count of 22.3 g/dl and a very low platelet count. A high creatinine count is indicative of abnormal kidney function and bilirubin and platelet counts pertain to liver and haematological diseases respectively. After admission the hospital authorities have given treatment to increase the platelet counts and also to increase haemoglobin level in the blood. We noticed here that the Opposite Parties during their treatment to the patient on 18.01.2012 they have given 13 bags of platelets and 1 bag of special platelet also. At that time, the platelet was reduced with sudden drop in the haemoglobin count to 5.0 g/dl on 19.01.2012. The said sudden drop of the haemoglobin count as per the opinion of Opposite Party No.1 hospital i.e., that there was a gastro intestinal bleeding secondary to his low platelet count. Again he was given emergent treatment with 4 bags of platelet transfusion, 2 bags of red blood cells transfusion and his haemoglobin count was built up to 6.3 g/dl as on 20.01.2012. The said treatment was not disputed by the complainant. Further, we noticed here that the patient was treated for kidney problems by nephrologists visiting on daily basis.
15. Admittedly, the patient was under dialysis frequently during hospitalization. The only allegation made by the complainant is that the haemoglobin level was not increased by the Opposite Party Nos. 1 to 5 hospital they shown negligence in not regularising haemoglobin level in the blood and also made an allegation that the patient was not given dialysis as is very much required frequently. The said allegations cannot be accepted because on perusal of the case sheet and line of treatment the patient was provided a sufficient number of platelet bags and haemoglobin in order to regularise the blood. Inspite of that the health condition of the patient was deteriorating.
16. The complainant had not brought any documents before this Commission to draw an opinion with respect to the negligence on the part of the Opposite Party Nos. 1 & 2 also not brought the BGS Appollo Hospital before this Commission to show the condition of the patient at the time of reference to Opposite Party Nos. 1 to 5. The complainant in her affidavit has sworn that he was suffering from chronic kidney disease having dialysis on regular basis and also sworn that he has no serious problems in his life which is contrary to both statements. When the patient was chronic kidney disease having a treatment of dialysis no doctor will give opinion that he was not suffering any serious problem at the time of admission to the hospital of the Opposite Parties. The complainant had blindly alleges negligence on the part of the Opposite Party Nos. 1 to 5 without any specific allegations with respect to the treatment given by the said Opposite Party Nos. 1 to 6 doctors. The documents produced by the Opposite Party No.1 & 2 and complainant clearly disclose that the doctors at Opposite Party No.1 hospital treated the patient to the best of their knowledge in order to keep the patient in a stable condition. Inspite of that an unlucky day i.e. on 28.01.2012 he succumbed to his infections and multi organ failure.
17. Further we noticed that during the hospitalization, the patient was suffering from multiorgan dysfunction and his health was further deteriorated due to severe hospitalization sepsis. The said reason was notified in the cause of death. Mere not mentioning the cause of death due to sepsis does not amounts to negligence on the part of the op Nos. 1 to 5.
18. The learned counsel for the Opposite Parties had produced a citation Jacob Mathew v/.s State of Punjab & another in Appeal (Crl) No.144-145/2004 and also submits a literature with respect to the incidents of sepsis and its facts. On going through the literature produced by the Opposite Parties, most of the hospitals patients suffered hospitalization sepsis due to long time inpatient and mortality level is 68%. We noticed here in this case also having multiple organ failure and dysfunction. The complainant's husband suffered hospitalization sepsis. The same was mentioned in the death summary issued by the Opposite Parties. Further, basing on the principles laid down in Jacob Mathew case we found that the line of treatment given by the Opposite Party hospital doctors are best of their knowledge and to keep the patient in stable condition. We found that there is no any medical negligence on the part of the Opposite Parties as alleged by the complainant. In the absence of any expert opinion, the complainant cannot fix any liability on the part of the Opposite Parties for the death of the husband of the complainant on 28.01.2012. The complainant has claimed such a huge amount of 99 lakhs without any basis. Hence, the complainant is not entitled to get any relief as claimed in the complaint. Hence, the following;
ORDER The complaint is dismissed.
Forward free copies to both the parties.
Sd/- Sd/- MEMBER JUDICIAL MEMBER KCS* [HON'BLE MR. Ravishankar] PRESIDING MEMBER [HON'BLE MRS. Smt.Sunita Channabasappa Bagewadi] MEMBER