State Consumer Disputes Redressal Commission
Care Hospital, Hydeabad And One Another vs Consumer Guidance Society , Krishan ... on 30 December, 2013
. P. Vasantha, W/o Sri P. Venkata Ramana. P. Vasantha, W/o Sri P. Venkata RamanaBEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD. FA 955 of 2012 against CC 56/ 2010, Dist. Forum, Vijayawada Between: 1. Care Hospital, Rep: by its Managing Director, 5-4-199, J.N. Road, Nampally, Hyderabad 500 001. 2. Pinnamaneni Care Hospital (Quality Care India Ltd.,), Rep: by its Managing Director, Sidhartha Nagar, Vijayawada 520 010 *** Appellants/ Ops 1 & 2. And 1. Consumer Guidance Society Representing: Lukka Nageswara Rao, S/o Venkateswara Rao, Door No.1-120, Royyuru Street, Royyuru Village (Post), Thotlavalluru Mandal, Krishna District. 2. Consumer Guidance Society Representing: Smt Lukka Venkateswaramma, W/o Venkateswara Rao, Door No.1-120, Royyuru Street, Royyuru Village (Post), Thotlavalluru Mandal, Krishna District. 3. Consumer Guidance Society Representing: Sri Lukka Venkateswararao, S/o Jayantu, Door No.1-120, Royyuru Street, Royyuru Village (Post), Thotlavalluru Mandal, Krishna District *** Respondents/ Complainants 4. Dr. N. Murali Krishna, Consultant Doctor, Pinnamaneni Care Hospital, (Quality Care India Ltd.,), Sidhartha Nagar, Vijayawada 520 010. 5. Dr. K. Suni Kumar, Consultant Doctor, Pinnamaneni Care Hospital, (Quality Care India Ltd.,), Sidhartha Nagar, Vijayawada 520 010. 6. Aarogya Sree Health Care Trust, Rep: by its Chief Executive Officer, 3rd Floor, Municipal Complex, Sulthan Bazar, Koti, Hyderabad 5000 095. *** Respondents/ Ops 3 to 5. Counsel for the Appellants: M/s. A. Srinath Counsel for the Respondents: M/s. Mod. Siraj-ur-Rahman CORAM: SRI R.L. NARASIMHA RAO, HONBLE INCHARGE PRESIDENT SRI T. ASHO KUMAR, MEMBER
& SRI S. BHUJANGA RAO, MEMBER THIS THE THIRTIETH DAY OF DECEMBER TWO THOUSAND THIRTEEN ORAL ORDER:
(Per Sri T. Ashok Kumar, Member) ***
1) This is an appeal preferred by the opposite parties 1 and 2 as against the order in C.C. No. 56/2010 on the file of Dist. Forum II, Krishna Vijayawada. For convenience sake, the parties as arrayed in the complaint are referred to hereunder.
2) The case of the complainant in brief is that complainant No. 1 a heart patient (hereinafter called as patient) has been referred to by Op1 to Op2 with a history of Pace Maker Syndrome (Syncope) as he had earlier undergone pacemaker implantation at Op1 hospital. On 12.8.2008 he was admitted to Op2 hospital. On 18.8.2008 after necessary investigations Op.3 performed operation to implant a new pacemaker by removing the existing pacemaker on the patient for which Op5 paid Rs. 80,000/-. The patient was kept in the same hospital as in-patient as advised by Op3 doctor for better management of the patient and to monitor post-operative complications if any.
While the things thus stood, the patient had been experiencing intermittent pain and numbness in his right leg and the same was brought to the notice of nursing staff of the Ops hospital but the Op3 did not attend to the patient and he did not take proper post-operative care. On account of negligence and poor monitoring of the patient, he developed Thrombo Embotolic Pneumonia of Right Leg on 4.9.2008 Op2 informed the complainant that the patient had a serious problem in his right leg warranting immediate amputation above the knee and has issued two discharge summaries though the patient developed Thrombo Embotolic Pneaumonia of Right Leg while he was undergoing treatment as in-patient and the patient was discharged only after the amputation of his right leg. The patient developed ISCHEMIA during his stay at Op2 hospital however he was shown to have discharged on 5.9.2008. Again he was readmitted with a different registration No. . Ops. 2, 4 & 5 informed them that the patient was suffering from ISCHEMIA and his right leg has to be amputated up to thigh level to save his life.
Accordingly, the patients right leg was amputated for which an amount of Rs. 34,100/- was charged by Op2 in addition to medical and other incidental expenses. The 1st complainant is a non-diabetic and had his case been properly monitored by the Ops his leg would not have been amputated. The opposite parties refused to issue case sheet despite repeated demands. The complainant got issued legal notice demanding compensation but Op2 did not heed their request. As there is no option the complainants filed this complaint seeking compensation.
The complainant a 20 years old boy owing to sheer negligence of Ops 1 to 3 has been permanently crippled resulting in incapacity to work, causing mental agony and trauma to all the complainants.
The physical and mental agony being experienced by them cannot be equated in terms of money yet they are claiming compensation for deficiency of service on the part of Ops and hence the complaint for a direction to the Ops 1 to 5 for refund of Rs.34,100/- amount of fee and medical bills paid to the 2nd OP, to pay Rs.80,000/- towards refund of fee paid by OP. 5 to the 2nd OP to pay Rs.12,00,000/- compensation to the first complainant, to pay Rs.5,00,000/- compensation to the complainants 2 and 3 for life long support to their son, 1st complainant and costs of the complaint.
3) Op1 filed counter resisting the complaint and OP. 2 adopted the same. According to Op.1 the complainant had long history of heart block. He approached Op2 in the year 2004 after receiving treatment from a local Neuro Hospital for seizures and convulsions. He was found to have bradycardia with a complete congenital heart block. He was not responding to deep stimuli, exhibited shallow breathing. ECG report revealed bradycardia. A temporary pace maker was implanted and the patient was stabilized. Necessity of implanting a permanent pace maker was explained to the parents. In October, 2004 a Permanent pace maker was successfully implanted. The patient and their family members did not adhere to the medical advice. In August, 2008 a new pace maker implantation was suggested as there was complete heart block. An emergency temporary pacemaker was implanted by the cardiologist. The old permanent pacemaker showed fractured circuit (lead) at the left clavicular area. Echocardiography revealed severe left ventricular dysfunction and left ventricle clot. The patient intubated and mechanically ventilated and simultaneously started I.V. fluids. Utmost care was taken while implanting the pacemaker. The development of numbness and pain in the leg of the patient was due to complete heart block and severe left ventricular dysfunction that led to ischemia of right lower limb due to showering of clots from left ventricle into systemic circulation. It has happened in spite of heparinisation and anticoagulation. The thromboembotolic pneumonia of right leg was due to said Ischemia and not due to any negligence on their behalf. The complainant did not state specifically as to what was required to be done and what they ought to have done. The patient was discharged after amputation of his right leg. Unfortunate condition of the patients congenital heart problem and its complications are not due to any medical negligence either on the part of treating doctors or the hospitals.
4). Op3 filed counter denying the allegations made by the complainants. The patient was harbouring left ventricular clot due to Chronic Disease Process of Congenital Complete Heart Block and severe L.V. Dysfunction. The patient developed ischemia of right lower limb due to showering of clots from left ventricle into systemic circulations in spite of Heparinisation and Anticoagulation. Expert opinion from cardiothoracic surgeon, vascular surgeon and Orthopaedic surgeon was also taken. Right lower limb condition did not show improvement. The recommendation was to amputate the right lower limb to save the life of the patient before gangrene spreads to the other parts of the body that could cause toxaemia which would be life threatening. It was explained to the family members of the patient and after taking consent the patient was subjected to surgery.
The amputation was performed on 15.9.2008 up to right above knee. Though they saved the life of the patient, the complainants made baseless allegations with a view to defame the opposite parties. There was no deficiency of service on the part of Op3 or other opposite parties during the course of treatment given to the patient.
Therefore they prayed that the complaint be dismissed.
5) Op4 filed counter almost adopting the written version filed by Op1. He further stated that except for using general phrases like neglect, absence of precautions, sheer negligence etc., the complainant did not state specifically as to what was required to be done as a prudent doctor equipped with reasonable skill.
His services are required only at the stage of amputation. Prior to that the patient was seen by the Vascular Surgeon and CT Surgeon only after treatment given by the consultant cardiologist. The necessity of amputation of patients leg was informed to the complainants. Second opinion of General Surgeon was also taken before amputation. All necessary steps were taken to save the life of the patient and the amputation became necessary to prevent spreading of gangrene to other parts of the body. Rest of the allegations made by the complainant are denied and they were made for the purpose of this case. The unfortunate condition of the patient was due to congenital heart problem and its complications and not due to any medical negligence on the part of treating doctors or hospitals. There is no medical negligence on their behalf and therefore prayed that the complaint may be dismissed with costs.
6) Op5 filed counter denying the allegations made by the complainant against it. Op5 is not a necessary party to this complaint. The information sought by the complainant has already been furnished under the RTI Act and the State Information Commission closed the appeal filed by the complainant vide order dt. 23.12.2009. Op5 is no way concerned with the alleged medical negligence and therefore prayed that the complaint may be dismissed against Op5.
7) The complainant in proof of their case filed their affidavit evidence and got Exs. A1 to A18 marked while the Opposite Parties filed their affidavit evidence and Op3 was subjected to cross-examination.
Exs. B1 to B3 were marked on behalf of Opposite Parties.
8) The Dist. Forum after considering the evidence placed on record allowed the complaint in part directing the Opposite Parties 1 & 2 to refund Rs. 30,000/- collected towards amputation charges with interest @ 9% p.a., from 15.9.2008 till the date of payment together with compensation of Rs. 8 lakhs with interest @ 9% p.a., from the date of complaint i.e., from 29.7.2009 till the date of payment and costs of Rs. 3,000/-. The complaint against Ops 3 to 5 was dismissed but without costs.
9) Aggrieved by the said order Ops 1 & 2 preferred this appeal contending that the complainant has not even been able to establish suggesting negligence or deficiency of service on their behalf.
The Dist. Forum gravely erred in holding that the hospital was negligent in treating the patient when they noticed Ischemia in the patient and that the Dist. Forum ought to have seen that there is no expert evidence to establish any negligence or deficiency of service on the part of Ops 1 and 2 and thus prayed that the appeal be allowed by setting aside the order of the Dist. Forum.
10) Both sides filed written arguments. Further Respondents/complainants 1 to 3 filed additional written arguments.
11) now, the point for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact or law?
12. Point for consideration is whether the order of the District Forum is vitiated either in law or on facts ?
13. There is no dispute that the first complainant patient was a known heart patient and that in the hospital of first opposite party a Pace maker was implanted to him in the year 2004 and that Ops 1 and 2 rendered medical services to the patient in the year 2004.
The case of the complainants is that the patient approached the second Opp party hospital on 12.8.208 for treatment on the ground that he was experiencing repeated health problems.
There is no dispute that third party is a consulting doctor at Ops hospital. He examined the first complainant patient and diagnosed him to have Pace maker syndrome, in such circumstances, on 12.8.2008 the first complainant patient was admitted in the hospital of second opposite party and after due investigations on 18.04.2008, 3rd OP performed operation and implanted a new Pace maker to the first complainant by removing the existing Pace maker for which 5th opposite party trust paid Rs.80,000/- to the second opposite party. Since third opposite party advised to keep the first complainant patient in the same hospital as inpatient for better management of the patient and also to monitor post-operative complications if any the first complainant continued to stay in the said hospital as in patient. Thereafter, third opposites party consultant doctor had been to abroad i.e. U.K., on 22.08.2008 and returned to India on 05.09.2008. Thus, safely it can be said that in between the said dates ie for about two weeks OP.3 did not treat or attend on the first complainant. The said OP. 3 who is examined as DW.1 has admitted that any Pace maker implantation required not more than two or three days hospitalization but as the first complainant patient developed Limbeschemia his hospitalization was extended. However, the complainants did not allege any deficient service on the part of OPs hospital or the third opposite party that there was defect in implantation of the Pace maker. Merely because Pace maker worth of Rs.40,000/- was donated or sponsored by the first opposite party in the year 2004, it is in no way helpful for the contesting Ops to say that they did not render any deficient service to the first complainant in this case which ultimately led for amputation of his right lower limb on account of eschemia.
14. The grievance of the complainants is that the Ops 1, 2 and 3 were negligent in attending the first complainant during the emergency when they noticed that the first complainant experienced intermittent pain and numbness in his right leg which is technically called as thrombo embotolic pneumonia ( eschemia) during postoperative period and that did not provide proper medication, continuous monitoring and as a result of it, the right leg of the 1st complainant patient was amputated above the knee on 04.09.2008. According to the complainants, had the Ops 1 to 3 taken immediate care after Ex. A18 Doppler test report the first complainant would not have been subjected for such an amputation of the right leg.
Though, the discharge summary dt. 5.09.2008 reveals that patients condition was uneventful and hemodynamically stable but it is incorrect as the first complainant had Occlusion ie. Blockage of the flow of blood in the right arteries on 22.8.2008 which is an early symptom against the health of the first complainant and in such circumstances it was the duty of the OPs hospital to take care of the patient and to see that blockages to the flow of blood are dissolved by prescribing required medicines and keep the patient in proper observation and monitoring. Since OP.3 was not available during the said period we cannot find fault with him in the said context and he cannot be even prevented from going abroad on his schedule work . In such circumstances, it was the duty of the Ops hospital to take services of another expert in the said context and see that patient is not subjected to any such ill health or hardship.
Even though, Ops contended that in the corporate hospital in the absence of one Specialist, another specialist would look after the critical care of the patients, no dependable evidence has been placed on record by Ops hospitals in the said context. DW.1 Third opposite party also admitted that usually, two or three days the patient was required to be kept in the hospital as inpatient after pace maker implantation but the 1st complainant was not so discharged as he developed limb eschemia. As seen from impugned order and also Ex. A17 the said document received from 5th opposite party is not in order and it is not known which leaf pertains to which date and the dates are noted only on some of the sheets. Ex. A18 colour Doppler test report reveals that on 22.08,.2008 colour Doppler study was done and the report relating to the limb of the first complainant was received by the second opposite party and that the said patient was suffering from the said eschemia and the substance the said report is as under :
i). normal calibre common illac, external illac, common femoral arteries show echogenic occluding thrombus with no detectable flow.
ii) Reformation ( all letters of this word are not visible due to punching) of deep femoral artery with monophasic spectral wave noted ( flow velocity 70 cms.)
iii) No flow detected in superficial femoral, popliteal, posterior tibial and peroneal arteries.
iv) very minimal flow noted inn proximal anterior tibial artery.
Impression is noted as : Thrombotic occlusion of right lower limb arteries. The said report clearly discloses the threatening situation present in the right leg of the 1st complainant. There is a blockage to flow of blood in all major arteries and there was a minimal flow in only one of the tibial arteries and by the time of receipt of Ex. A18, the third opposite party left for UK and as such he had no chance to treat the first complainant and in such circumstances it was the duty of the Ops hospitals 1 and 2 to make alternative arrangements to treat the first complainant in the said context, more so, as it is a case of anticipated peril or consequence as per OP. 3 doctor itself but they did not do and in such circumstances rightly the District Forum held that OP. 3 cannot be found at fault and also that he rendered deficient service. The complainant did not prefer any cross appeal as against the said finding and thus as far as the order of the District Forum that OP.3 is not liable to answer the claim of the complainants attained its finality and hence no discussion further in the said context is required to be made in this appeal. Whether for not making alternate arrangements in treating the first complainant by Ops 1 and 2 which led for the amputation of his right limb subjecting him for untold hardship, permanent disability throughout his career at his age of 20 years amount to deficiency in service has to be seen now.
15. According to the opposite parties 1 & 2 , since the first complainant was harbouring left ventricle clot due to chronic disease process of congenital complete heart block and LV Dysfunction he developed eschemia of right lower limb due to showering of clots from left ventricle into systematic circulations in spite heparimisation and anticoagulation and that immediately expert opinion cardio thoracic surgeon vascular surgeon and orthopaedic surgeon was taken but the first complainant lower limb condition did not show improvement and the recommendation was to amputate the right lower limb to save the life of the first complainant before gangrene spreads to the other parts of the body which could cause toxaemia which would be life threatening due to critical limb eschemia and that all the said aspects were explained to the family members of the complainants and after obtaining their consent the first complainant was subjected to surgery and his right leg above the knee was amputated and he was discharged from Care hospital on 15.09.2008 in a stable condition. Ops also contended that the first complainant was covered under Arogyasri benefit and that hospital management for the purpose of Arogyasri procedure prepared a discharge summary of the first complainant to cover the pace maker implantation showing the discharge of the patient on 5.09.2008 but practically but he was not discharged and fresh admission was made in orthopaedic wing of the said hospital. But there is no dependable evidence from the side of the contesting Ops in the said context. During relevant time, Op. 3 was not present in India and therefore his evidence touching the events that had taken place in the hospital and also the contention of the Ops 1 and 2 that they have taken necessary precautions could not be appreciated for want of evidence of the concerned who actually attended on the first complainant during the absence of the said OP. 3 in the said hospital more particularly in India. Mere taking consents informing the complainants about high risk to the first complainant was not sufficient and in the circumstances of the case the contesting Ops ought to have taken necessary precautions and recourse as that of a prudent medical practitioners which they did not do so and hence the said contention holds no water because the medical record is not clear as to the developments of stages of eschemia or the observations recorded in that context from time to time. There is no dispute that right leg of the first complainant was amputated above the knee and the complainants contend that Rs.34,100/- was charged by Op. 2 in addition to medical and other expenses.
Similarly, there is no dispute that the first complainant is a non-diabetic so that possibility of saying that on account of diabetes gangrene formed which lead further amputation of the right leg is ruled out.
16. Ops 1 and 2 commented that the District Forum had acted as an expert in arriving at conclusions in the impugned order but as seen from the order under appeal the District Forum had taken lot of pains in studying the medical literature on both sides narrated in the impugned order in detail and arrived at right conclusion with regard to the finding tht Ops 1 and 2 rendered deficient service and there is no need to reiterate the same in this order. The Ops 1 and 2 did not convince this Commission with any other literature or experts evidence that they have taken necessary precaution and did not render any deficient service and that the literature referred to in the orders under appeal relied upon by the Forum in favour of the complainants is incorrect. In view of the decision reported in .CIVIL APPEAL NO.2641_ OF 2010 (Arising out of SLP(C) No.15084/2009) V. Kishan Rao ..Appellant(s) Versus Nikhil Super Specialty Hospital ..Respondent(s) & Another in each and every case expert evidence is not required depends upon the facts and circumstances of the case. Therefore the contention of the contesting Ops who are appellants herein that there is no expert opinion in this case to come to a conclusion that Ops rendered deficient service to first complainant could not be appreciated. so also the decisions cited by the Ops reported in 2009 ( 9) SCC between Ramesh Chandra Agarwal Vs. Regency hospital ltd and another, Jacob Mathew Vs. State of Punjab and another, 2005 (6) SCC (1), martin F D Souza Vs. Mohd. Isaac. 2009 (3) SCC 1, Kusum Sharma and others Vs. Batra hospital , Medical Research Centre and another (2010) 3 SCC, 2012 (2) ALD (cons.) IV NC between BH Farmer ( Dr.) Vs. Dodyamanharbhai alias Manubhai. The proportions laid down in the said decisions in connection with experts opinion and medical negligence aspect etc cannot be questioned but in the circumstances of the case they are not helpful to the Ops.
17. Since 4th OPs role was only to carry out amputation after the patient was admitted in his Ward on 5.09.2008 he cannot beheld to be negligent in treating the first complainant and thus the District Forum dismissed the complaint against him also apart from the complaint against OP 3 for the reasons described supra. As OP. 5 is only a Trust and as there are no allegations against it in the complaint regard to negligence and as there is no dependable evidence on record that 5 the Op connived and cooperated with the Ops 1 and 2. The complainants is not entitled for any claim against OP. 5 and as against it also the complaint was dismissed. As already described supra no cross appeal was filed by the complainants challenging dismissal of the complaint against OPs 3 to 5 and hence the said dismissal attained finality.
18. Op.1 is the main hospital and Op.2 is its branch and in view of the discussion made supra certainly it has to be held that Ops 1 and 2 rendered deficient service to the first complainant in treating him in connection with eschemia which is a known peril after implantation and pace maker which ultimately led to the amputation of right leg of first complainant. In the circumstances of the case, refund of Rs.30,000/- paid towards amputation charges with interest thereon @ 9% pa from 15.09.2008 till payment directing Ops 1 and 2 jointly and severally to pay the same to the first complainant so also costs of Rs.3,000/- needs no interference. On account of amputation of right leg at the age of 20 years the first complainant permanent disabled and he is unable to work and earn as before. The fact that the was suffering from heart ailment since 2004 is a mitigating circumstance in favour of the Ops to some extent. There is no dependable evidence on record form the side of the complainants with regard to his avocation and income. In view of the said age of 20 years of the first complainant, multiplier 16 under the M.V. Act is applicable for computation of compensation for the said permanent disability of the first complainant and as there is no dependable evidence as to avocation and income of the first complainant and as he took treatment under Arogyasri which indicates his income was meagre his income on some guess work is taken as Rs.3,000/- per month which comes to Rs.36,000/- per annum and if the said amount is multiplied with 16, the total loss of his earnings on account of such permanent disability comes to Rs.5,76,000/- and thus amount of Rs.8 lakhs awarded to the first complainant towards compensation has to be scaled down to Rs.5,76,000/- Payable with interest there on 9% pa from the date of complaint ie. 29.7.2009 till payment. The District Forum did not award any compensation to the complainants 2 and 3, so also, for life long support to their son as prayed for. So also, to refund Rs.80,000/- fee paid by OP.5 to the 2nd opposite party towards implantation of pace maker and no cross appeal in the said context has been preferred nor any case was made out for such reliefs. Thus, in view of the above discussion, point is answered mostly in favour of the complainants modifying the order of the District Forum directing Ops 1 and 2 to pay jointly and severally Rs.30,000/- towards refund of amputation charges with interest thereon at the rate of 9% pa from 15.09.2008 till payment and also a sum of Rs.5,76,00/- towards compensation with interest @ 9% pa from the date of complaint ie 29.07.2009 till payment and also costs of Rs.3,000/- to the first complainant and the remaining order stands set aside.
19. In the result, the appeal is disposed of modifying the order of the District Forum directing Ops 1 and 2 to pay jointly and severally Rs.30,000/- towards refund of amputation charges with interest thereon at the rate of 9% pa from 15.09.2008 till payment and also a sum of Rs.5,76,000/- towards compensation with interest @ 9% pa from the date of complaint ie 29.07.2009 till payment and also costs of Rs.3,000/- to the first complainant and the remaining order stands set aside. Time for compliance four weeks from the date of receipt of the order.
INCHARGE PRESIDENT MEMBER MEMBER DATED : 30. 12.2013.