State Consumer Disputes Redressal Commission
S.Muhammed Basheer, vs M/S.Samad Hospital, on 9 January, 2012
Daily Order
Kerala State Consumer Disputes Redressal Commission Vazhuthacaud,Thiruvananthapuram Complaint Case No. CC/03/27 1. A.K.Nazeer Perayathu Mukal,Pirappan Code,Tvpm BEFORE: HONARABLE MR. SRI.M.V.VISWANATHAN PRESIDING MEMBER PRESENT: ORDER
KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM.
O.P. 27/2003
JUDGMENT DATED.09.01.2012
RESENT:-
SHRI. M.V. VISWANATHAN : JUDICIAL MEMBER
SHRI.M.K.ABDULLA SONA : MEMBER 1. S.Muhammed Basheer, S/0 Shahul Hameed, Jessy Manzil Mamoodu, Venjaramoodu, Thiruvananthapuram. 2. Sainam Beevi, W/0 Muhammed Basheer, Jessy Manzil, Mamoodu, Venjaramoodu, Thiruvananthapuram. 3. Sunitha Beevi, -- COMPLAINANTS D/0 Sainam Beevi Jessy Manzil, Mamoodu, Venjaramoodu, Thiruvananthapuram. 4. Shameena Beevi, D/0 Sainam Beevi Jessy Manzil, Mamoodu, Venjaramoodu, Thiruvananthapuram. 5. Jasim, S/0 Muhammed Basheer Jessy Manzil, Mamoodu, Venjaramoodu, Thiruvananthapuram. (By Adv.C.Sasidharan Pillai) Vs. 1. M/s.Samad Hospital, Repdt.by Dr.Sathi M.Pillai, Near KSRTC Bus station, Attingal, Thiruvananthapuram. 2. Dr.Sathi M.Pillai, Samad Hospital -- OPPOSITE PARTIES Attingal, Thiruvananthapuram 3. Kerala Institute of Medical Sciences Reptd. by the Managing Director, Kumarapuram, By pass Road, Thiruvananthapuram. 4. Dr.Sahadulla, Consultant Physician, KIMS Hospital, Kumarapuram, Thiruvananthapuram. (By Adv.K.Murlidharan Nair) JUDGMENT SHRI.M.V.VISWANATHAN,JUDICIAL MEMBER Complaint filed under Section 12 of the Consumer Protection Act. 2. The case of the complainants in brief is as follows: Complainants 1 to 6 are the husband, father, mother, sisters and brother of deceased Sajeena. The first complainant married Sajeena in the year 1995 and they had no children in the said wed lock. As advised by the doctors they continued medical treatment for infertility. The first complainant had given up his implement abroad and returned home for continuing the treatment for infertility. They approached the second opposite party Dr.Sathi N Pillai of the first opposite party M/s Samad Hospital, Attingal, Thiruvananthapuram. Sajeena had undergone U.S. Scan and the second opposite party Dr, Sathi M.Pillai went through the scan report and subjected Sajeena for various tests. The second opposite party told the first complainant and Sajeena that Sajeena had some growth in her uterus and laparoscopy had to be done. On 31.7.02 that they met second opposite party at the first opposite party hospital. Sajeena was admitted in first opposite party hospital. On 1.8.02, Sajeena went to the operation theatre by walking and she was very cheerful. At 3'0 clock one nurse of the first opposite party hospital informed that the operation is over. The complainants 1 to 3 searched for the doctor, but they got information that the doctor had already left. Even after 10 p.m; Sajeena was not brought to the room, even though all other patients who had undergone operation on that day were taken to their respective rooms. The complainants 1 to 3 were told by the hospital staff that Sajeena is very weak and the doctor advised not to remove her from the theatre and there is nothing to worry. At about 11'0 clock, the complainants 1 to 3 were told that the patient is suffering from profused bleeding and her condition is very critical and the patient should be removed to KIMS Hospital, Thiruvanthapuram. Immediately Sajeena was removed from the operation theatre to the ambulance and she was taken to Thiruvananthapuram accompanied by the complainants 1 to 3. When the ambulance reached the Medical College Hospital, the first complainant requested the doctor present in the ambulance to admit Sajeena in the Medical College Hospital. But the doctor told him that admission of Sajeena at KIMS Hospital is necessary to save her life. When they reached KIMS hospital, the second opposite party was present there waiting for them. Sajeena was admitted at KIMS hospital and blood was given to her. On that night itself Sajeena's blood was sent for examination at Cosmopolitan Hospital, Thiruvananthapuram and the second complainant and his brother Ashraf were told by the staff of Cosmopolitan Hospital, that the hospital authorities had committed great mistake by giving B - ve blood instead O + ve and her condition is worsened due to the said mistake. Complainants 1 & 2 enquired about said the matter with 4th opposite party, he also endorsed the said fact with reluctance. On the next day after giving about 15 bags of blood, the bleeding tendency seized. On 3.8.02 the patient was given 2 units of O + ve blood transfusion and taken up for exploratory laprotomy. On 4.8.02, the 4th opposite party called the first and 6th complainants to his room and told them that the condition of the patient is serious due to the presence of O +ve and B - ve blood and stated that immediate dialysis is required. Thereby, dialysis started. They were also told that as the wrong blood had been given to the patient, at least 8 dialysis are required. In spite of continuous dialysis, the condition of the patient was not improved. On 16.8.02 complainants were informed that the BP of the patient had been reduced and her Kidney is functioning at 40% only. On 20.8.02, the complainants were again told that the patient's Kidney has been functioning 70% and there is no further need for dialysis. On 24.8.02, the patient was again taken from I.C. unit to the dialysis room and she was brought back immediately. At that time, the complainants noticed color change to the body of the patient. On 26.8.02, ventilator support was introduced. On 31.8.02 complainants were told that the blood sugar of the patient is increased. On 2.9.02, the complainants were told that the condition of Sajeena has been improved and the ventilator support has been reduced. On 4.9.02 at about 1.15 am, 4th opposite party summoned the first complainant to his room and told that the patient Sajeena died due to heart attack. Sajeena was 26 years old and very healthy. She succumbed to the cruelty and the callous indifference of opposite parties 1 and 2. The irresponsible conduct of opposite parties 1 and 2 in conducting surgery in a total reckless and negligent manner and also transfusing wrong blood had deprived the life of a young educated girl who had a lot of ambitions to cherish. The opposite parties 1 and 2 sought the assistance of opposite parties 3 and 4 in order to cover up their criminal act and grave mistake. It is for that purpose the patient Sajeena was admitted in third opposite party hospital disregarding the request of the complainants for admission of the patient in Medical College Hospital. The opposite parties suppressed material facts regarding the patient and the omissions and negligence committed by them. Complainants paid about 2.5 lakhs as medical expenses at third opposite party hospital. The complainants and their relatives and friends of Sajeena were waiting in the hospital for 34 days. They spent about Rs.2 lakh for arranging blood and other facilities. The second opposite party made a promise that they will make full payment to the KIMS hospital and invited complainants 1 and 6 to first opposite party hospital. The second opposite party wanted the complainants to sign many papers and as they refused, they were caused to be arrested by the police and were remanded to Sub Jail, Attingal. Deceased Sajeena was a computer technologist and she has got training in Computer Programme. She started a Computer and DTP centre by name Bismi Communications at Thycaud, Pirappancode. She was making a monthly income of Rs.15,000/-. There occurred deficiency in service and negligence of duty on the part of the opposite parties. Complainants 1 and 2 sent lawyer notice to the opposite parties calling upon to indemnify the bereaved family of deceased Sajeena. Opposite parties 1 and 2 sent a reply in one sentence denying the allegations leveled against them. Opposite parties 3 and 4 have also sent a reply to the said notice. The death of Sajeena happened only due to the negligence and deficiency in services of opposite parties. They are jointly and severely liable for their unfair trade practice and deficiency in service. The cause of action for the complaint occurred on 31.7.02 when the patient Sajeena was admitted at first opposite party hospital and on 1.8.02 when she was taken to KIMS Hospital and on 4.9.02, the date of death and thereafter within the jurisdiction of this State Consumer Commission. Hence the complainants prayed for awarding compensation of Rs.45 lakhs to the complainants with future interest for the deficiency in service and unfair trade practice on the part of the opposite parties. They also claimed reimbursement of Rs.4.5 lakhs which they spent for medical treatment of Sajeena and also for payment of cost of Rs.50,000/-.
3. During the pendency of the complaint in OP.27/03, the first complainant died and the name of the first complainant is deleted from the party array as per the order dated 13.11.03 passed on an interlocutory application.
4. Opposite parties 1 and 2 entered appearance and filed joint written version contending as follows -
The complaint is not maintainable either in law or on facts. It is a vexatious complaint filed without bonafides. There is no negligence or deficiency in service as alleged by the complainants. The complainants are not entitled to get any relief as prayed for. On 31.7.02, Dr.Sindhu examined the patient and admitted her for surgery in first opposite party hospital. Blood sample of the patient was sent through the relatives of the patient to obtain blood from Dr.Rao's Blood Bank, Thiruvananthapuram. O + ve blood was brought by relatives and the same was kept in the Fridge. The patient Sajeena had given one bottle of blood, which was issued from Dr.Rao's Blood Bank. The aforesaid transfusion was done on 2.7.02 and the same was uneventful. On 1/8/02, patient was seen by Dr.Sathi M pillai during the routine morning rounds. The operation was done by Dr.S.Meera, assisted by Dr.Sindhu and nurse Pushpavally. The surgery was performed after getting informed consent Anaesthesia was given by Dr.Rony Kurian, in the Form of General anaesthesia, supplemented by Epidural Anaesthesia Dr.Meera and her team finished the operation at 5 pm. Operation was uneventful and the patient's condition was good. Dr.Meera again seen the patient in good condition at 5.30 pm. The operation was done to remove the Fibroid which developed in the uterus. On 1/8/02 at 6.15 pm Dr.Salini as duty doctor examined the patient and found her in good condition. Dr.Salini had seen the patient at 6.30 and 7.15 pm. The second opposite party had seen the patient at 7.30 pm and advised to give blood which was kept for the patient in the fridge. Dr.Salini had seen the patient at 10 and 10.30 pm. Blood transfusion started at 8.30 pm. After verifying the name, age IP.No, blood group and Rh of the patient and those on the blood bag. The records and blood bag are kept in the first opposite party hospital. The patient was given injection Avil 2 ml and injection betnazol ambule I.V as extra precaution to avoid any pyrexial reactions. Dr.Salim was seeing the patient routinely. At 9 pm patient started shivering and blood transfusion was stopped. The patient's vital signs were remaining normal. Wetting of wound sites was noticed by 11.15 pm. Dr.Sindhu had seen the patient at 11.30 pm and had given necessary treatment. She was with the patient and giving on necessary treatment. By about 12.30 am (2.8.02) Dr.Meera arrived and seen the patient. By 12.50 am Dr.Prabhu, Physician, Government Taluk Hospital, Chirayinkil was called in to see the patient. As advised by Dr.Prabhu, the patient was shifted to a higher centre at Thiruvananthapuram. At 1.30 am the patient was shifted to Thiruvananthapuram in first opposite party Hospital Ambulance, with doctors and nurses of the hospital, attending the patient. Second opposite party also was present when the patient was admitted to third opposite party hospital. The patient was an inpatient in KIMS hospital from 1.8.02 to 4.9.02. The patient was admitted at KIMS Hospital at the request and consent of the relatives of the patient. There was no suppression of facts. Opposite parties 1 and 2 have not sought the assistance of opposite parties 3 and 4 in suppressing material facts. The patient died on 4.9.02 at KIMS Hospital. The patient Sajeena and the first complainant were undergoing treatment at first opposite party hospital for infertility. They were not willing for tests like Sono Salpinography and IUI. There was no negligence or deficiency in service in performing the surgery on Sajeena. Blood transfusion was started for the patient at 8.30 pm, after adequate precautions. There was no negligence or mistake committed by opposite parties 1 and 2 in the blood transfusion. The patient developed DIC (Disseminated Intra Vascular Coagulation) and advised to continue the Oxygen inhalation, IV fluids, Injection hiper corteisone and also advised urgent blood transfusion or fresh frozen plasma. The doctor advised to shift the patient to a higher centre and the patient was transferred to KIMS Hospital. The patient was shifted to KIMS hospital with all due care and attention with doctors and nurses. The allegation that the second complainant and his brother Ashraf were informed by staff of hospital that the hospital authorities had committed great mistake by giving B - ve blood instead of 0 + ve and her condition is worsened due to the said mistake is totally false and cooked up with ulterior motives. Only cross matched labeled 0 +ve blood supplied for the patient by Dr.Rao's Blood Bank, Thiruvananthapuram was given to the patient, after proper verification of the name, blood group and other particulars of the patient on the blood bag. The label and the blood bag are kept at the first opposite party hospital. It is learned that for blood transfusion to the patient, the blood samples of Sajeena were taken to blood banks at Medical College Hospital, Thiruvananthapuram and Sree Chithira Medical Centre, Thiruvananthapuram. There is no blood bank at Cosmopolitan Hospital, Thiruvananthapuram. There was no cruelty or callous indifference on the part of second opposite party. The operation was performed by Dr.Meera, a competent and experienced Gynecology and assisted by Dr.Sindhu and nursing staff of first opposite party hospital with due care and caution. No wrong blood was given to the patient and the allegation to the contrary is denied. The blood was given to the patient under the supervision of the duty doctor and nurse. All necessary precautions and prompt attention was given to the patient during the surgery and blood transfusion. The problems which the patient developed, were beyond the control or expectation of second opposite party and other doctors of first opposite party hospital when the problems arose, Blood transfusion was stopped and prompt treatment and measures were adopted to treat the same. The patient developed DIC which is a very serious condition. The complainants had not sought to have an autopsy done on the body of the patient to find out the actual reason for the death of the patient. Exaggerated claims have been made by the complainants. The opposite parties 1 and 2 are not liable or responsible to pay any compensation to the complainants. The relatives of the patient and friends were arrested by the Attingal Police while attempting to attack the hospital with deadly weapons. A criminal case is pending against them in the Judicial First Class Magistrate Court I, Attingal as Crime No.478/02 of Attingal Police Station. Thus, the opposite parties prayed for dismissal of the complaint filed against them.
5. Opposite parties 3 and 4 entered appearance and filed joint written version denying the alleged negligence and deficiency in service. They contended that the patient Sajeena was brought to the Hospital by the relatives of the patient and that the opposite parties 3 and 4 treated the patient with utmost care and caution. The patient arrived in third opposite party hospital in a critically ill state with relatives and was found to have disseminated intra vascular cogulation (DIC). It was evidenced by intra peritoneal bleeding, severe anemia, low platelets count and renal failure. This was confirmed by elevated FDO value. A case summary of the same has been given to Mr.Mohammed Basheer at request. Thus, the opposite parties 3 & 4 prayed for dismissal of the complaint filed against them.
6. The points that arise for consideration are:-
1. Whether there was any negligence or deficiency in service on the part of second opposite party Dr.Sathi M.Pillai and other doctors and hospital staff attached to first opposite party hospital in treating the patient by name Sajeena and in performing surgery on the patient Sajeena and in giving blood transfusion to the said patient on 31.7.02 or 1.8.02 at first opposite party hospital?
2. Whether there was any collusion between opposite parties 1 and 2 with opposite parties 3 and 4 in suppressing the material facts involved in the treatment of the patient Sajeena at first opposite party hospital on 31.7.02 or 1.8.02?
3. Whether there was any medical negligence or deficiency in service on the part of opposite parties 3 & 4 in treating the patient Sajeena in third opposite party hospital from 1.8.02 to 4.9.02?
4. What order as to reliefs and costs?
7. The evidence in this case consists of the oral testimony of PWs 1 to 3 and DWs 1 to 5 and also the documentary evidence marked as Exts. A1 to A6 and B1 to B10.
8. POINT NO.1 The first complainant A.K.Nazeer and his wife Sajeena were undergoing treatment at first opposite party Samad Hospital, Attingal, Thiruvananthapuram. Their marriage was in the year 1995 and they had no child born to them in the said wedlock. So, they were undergoing infertility treatment at first opposite party Hospital. While so U. S. Scan abdomen was taken and Fibroid Uterus was detected. Thereby, the doctors at Samad Hospital advised removal of the Fibroid by laparoscopic surgery. Sajeena was admitted in first opposite party/hospital on 31.7.02 for laparoscopic surgery. The aforesaid surgery was performed on 1.8.02. After surgery Sajeena was in the post operative ward. It is the admitted case that the second opposite party doctor Sathi M Pillai ordered blood transfusion at 7.30 p.m of 1.8.02 and blood transfusion commenced at 8.30 p.m. It is after starting blood transfusion the patient Sajeena developed complications of blood transfusion reaction.
9. The case of the complainants is that the blood transfusion reaction was caused due to administration of mismatched blood by transfusion. The complainants alleged medical negligence and deficiency in service in giving mismatched blood to Sajeena. It is alleged that the hospital staff of Cosmopolitan Hospital disclosed to the second complainant and his brother Ashraf about the mistake committed by the hospital authorities of first opposite party Samad Hospital by giving B+ve blood instead of O+ve blood. The complainants have also averred in Paragraph 8 of their written complaint that mismatched blood was given to the patient Sajeena at the first opposite party hospital and the name has been endorsed by the 4th opposite party Dr.Sahadulla, Consultant Physician, KIMs Hospital, Thiruvananthapuram. It is the definite case of the complainants that Sajeena was given mismatched blood on the night of 1.8.02 and as a result of the aforesaid negligence, the patient Sajeena developed complications such as blood transfusion reaction.
10. The opposite parties 1 and 2 in their written version denied the case of the complainants regarding transfusion of mismatched blood to Sajeena on 1.8.02. They also denied the alleged medical negligence and deficiency in service on their part in treating the patient Sajeena at first opposite party hospital, especially in transfusion of blood to the patient Sajeena. It is their case that the patient developed complications which were beyond their control and expectation; that the opposite parties and the doctors and hospital staff of first opposite party hospital had adopted prompt treatment on finding the complications. The definite case of the opposite parties in Paragraph 16 of their written version is that the patient Sajeena developed DIC (disseminated Intra Vascular Coagulation) which is a very serious condition. It is further contended that the doctors of the first opposite party hospital sought for the advice and consultation of Dr.R.K.Prabhu of the Taluk Hospital and the patient was promptly referred to a higher centre for better management. Thus, the opposite parties 1 & 2 denied the alleged negligence and deficiency in service attributed against them.
11. The complainants have got a case that the laparoscopic surgery for removal of fibroid from the uterus was performed by second opposite party Sathi M Pillai. On the other hand, the second opposite party contended that the aforesaid laparoscopic surgery was performed by Dr.S.Meera assisted by Dr.Sindhu and nurse Pushpavally and that the said surgery was performed under general anesthesia by the Anesthetist Dr.Rony Kurian. The complainants have also alleged medical negligence in performing the aforesaid laparoscopic surgery. But, there is nothing on record to suggest negligence in performing the laparoscopic surgery on the patient Sajeena. On the other hand, the materials on record would only suggest that laparoscopic surgery was uneventful and the same was successful. The complainants could not adduce any evidence in support of their case regarding medical negligence in performing laparoscopic surgery on the patient Sajeena. The available materials on record would also suggest that the surgery was performed by Dr.S.meera. Anyhow, there cannot be much controversy or dispute regarding identity of the doctor who performed the laparoscopic surgery on Sajeena, because of the fact that the said laparoscopic surgery was uneventful.
12. It is the case of the opposite parties 1 and 2 in their written version that the laparoscopic surgery was over by 5 pm on 1.8.02. It is also the case of the opposite parties 1 and 2 that the surgery was uneventful and the same was finished by the evening of 1.8.02. It is the definite case of the second opposite party that she examined the patient at 7.30 pm on 1.8.02 and she ordered blood transfusion. Ext.B1 is the original case sheet of Smt.Sajeena maintained at Samad Hospital, Attingal, Thiruvananthapuram. B1 case sheet would show that the laparoscopic surgery was uneventful and the surgery was over by 5 pm of 1.8.02. It would also show that at 7.30 pm blood transfusion was ordered. It is the definite case of the second opposite party Dr.Sathi M Pillai that blood transfusion was ordered by her at 7.30 pm. B1 case sheet would show that the blood transfusion started at 8.30 pm on 1.8.02. It would also show that at 9 pm, the patient developed shivering and thereby blood transfusion was stopped. It is also noted that vital signs of the patient were stable. B1 case sheet would further show that at 11.15 pm, the patient developed complications of wetting of wound sites, mild pallor and the matter was informed to Dr.Sudheer. At 11.30 pm there were oozing from surgical wounds and epidural site; that there was severe pallor with mild shivering and BP at 120/80. It is at 11.30 pm injection Hydrocortisone, injection Avil, injection Botropace etc; were administered. It was also noticed blood stained urine flowing through catheter. Thus, it can be seen that the entire complication developed only after starting of the blood transfusion.
13. B1 case sheet is silent on the point as to why the second opposite party Dr.Sathi M Pillai ordered blood transfusion at 7.30 pm of 1.8.02. It is to be noted that according to the second opposite party, the laparoscopic surgery was performed by Dr.S.Meera assisted by Dr.Sindhu. It is also the case of second opposite party that the patient Sajeena was admitted in first opposite party Samad Hospital by Dr.Sindhu. There is nothing on record to show that the second opposite party Dr.Sathi M Pillai had any active role in performing the laparoscopic surgery on the patient Sajeena. Even according to the second opposite party she examined the patient only at 7.30 pm that too, after the surgery. On examination, the second opposite party ordered blood transfusion. But, B1 case sheet is totally silent about the purpose for which blood transfusion was ordered at 7.30 pm. It is further to be noted that after ordering blood transfusion, the second opposite party left the patient. There is nothing on record to show that there was blood loss while doing the surgery or after the surgery. The doctor who said to have been performed surgery and the doctor who said to have been assisted the surgery did not notice any blood loss. It is also to be noted that the surgery was laparoscopic surgery and there was little scope for blood loss by doing laparoscopic surgery. If there occurred any such blood loss on account of laparoscopic surgery that fact should be found a place in B1 case sheet. In the absence of any such entry regarding blood loss, it would give a strong indication that the blood transfusion at that stage of the treatment was unwarranted.
14. DW2, Dr.R.K.Prabhu, Assistant Surgeon (Physician) at Taluk Hospital, Chirayinkil visited the patient on emergency call from the duty doctor at Samad Hospital, Attingal. DW2 examined the patient Sajeena at about 1 am on 2.8.02. DW2has categorically deposed that the patient Sajeena was not in a shock stage warranting blood transfusion. According to DW2,the situation warranting blood transfusion was blood loss due to the surgery. But, DW2 is not sure and certain what was the type of surgery whether it was laparoscopic or laprotomy. The testimony of DW2 would suggest that the blood transfusion was ordered only due to blood loss. But he is not sure whether there was blood loss due to the surgery. DW2 further deposed that it is for the surgeon who has done the operation to decide whether the patient needs blood or not. If that be so, the Dr.S.Meera or the doctor who assisted the surgery Dr.Sindhu could have ordered blood transfusion. It is further deposed by DW2 that blood transfusion can also be ordered by the doctor who has been doing the post operative assessment of the patient. Admittedly, the post operative assessment was done by Dr.Salini and subsequently by Dr.Sindhu. It is to be noted that at no point of time, the second opposite party Dr.Sathi m Pillai has done the post operative assessment. If that be so, the blood transfusion ordered by the second opposite party at 7.30 pm can be considered as an order without any proper examination or without ascertaining the real situation. It is further to be noted that there is not even an indication regarding blood loss on account of the laparoscopic surgery. The facts, circumstances and evidence on record would suggest that the order for blood transfusion was made by the second opposite party un-necessarily and the said action was un-warranted. It is further to be noted that the patient Sajeena was given blood on 2.7.02 and thereby one pint of 0+ve blood was administered. The mere fact that blood was collected before the surgery and the same was kept in the fridge cannot be taken as a ground for ordering blood transfusion on 1.8.02 at 7.30 pm. The circumstances would suggest that there was no urgency or emergency for ordering blood transfusion after the laparoscopic surgery which ended uneventful.
15. Dr.Sindhu said to have been assisted the laparoscopic surgery on patient Sajeena is examined before this Commission as DW3. She deposed that she was at first opposite party hospital on 1.8.02 from 9 am to 6 pm and she assisted Dr.S.Meera for doing the laparoscopic operation on Sajeena. She also deposed that patient Sajeena was admitted by her on 31.7.02 and the entry at Page 14 of B1 is in her handwriting. She also identified the handwriting of Dr. Sathi M Pillai at Page 15 of B1. This witness has also deposed that blood was stored for Sajeena on 31.7.02 and blood transfusion was ordered by Dr.Sathi M Pillai. DW3 has also deposed that she left the hospital at 6 pm by entrusting the patients including Sajeena to the duty Dr.Salini. It is also deposed that she came to the hospital at 11.30 pm, on getting the emergency call from Dr.Salini. She arrived at 11.30 pm and noticed the problem of bleeding from surgical sites and immediately started the treatment. But DW3 has no case that there occurred blood loss to the patient Sajeena on account of laparoscopic surgery. This witness has also not spoken to anything about the need for blood transfusion to the patient Sajeena on the night of 1.8.02. Thus, the evidence of DW3 would suggest that the blood transfusion order was passed by second opposite party un-necessarily and the said action would amount to medical negligence.
16. The second opposite party Dr.Sathi M Pillai was examined before this State Commission as DW1. The testimony of DW1 would show that she had no role in admitting the patient Sajeena in the hospital on 31.7.02 and also in performing the laparoscopic surgery on Sajeena. She admitted the fact that laparoscopic surgery was done by Dr.Meera assisted by Dr.Sindhu. It is also admitted by DW1 that she visited the patient Sajeena at about 7.15 p.m and she was there in the post operative ward only for 15 minutes. It is during the said 15 minutes; she examined the patient Sajeena and ordered blood transfusion at 7.30 p.m. It is on the basis of the said direction blood was transfused on the patient at 8.30 p.m. DW1 has got a case that the decision to transfuse blood was taken as a combined decision after consultation with Dr.Meera. But, there is nothing on record to show that DW1 had discussion with Dr.Meera and it is on the basis of the combined decision DW1 ordered blood transfusion at 7.30 pm. The materials available on record would show that Dr.Meera left the hospital after the said surgery and Dr.Sindhu was there in the hospital up to 6 pm. The case of DW1 that she had discussion with Dr.Meera for the blood transfusion cannot be believed. The aforesaid testimony of DW1 is not supported by any material. It would show that there was no probability for a discussion with Dr.Meera.
17. At this juncture, the testimony of DW3 Dr.Sindhu has got much importance. She has deposed that the blood transfusion was given to Sajeena as directed by Dr.Sathi M Pillai. There is no whisper in the testimony of DW3 regarding the alleged discussion with Dr.Meera for blood transfusion on the patient Sajeena. It can very safely be concluded that the order for blood transfusion was given by DW1 independently without any consultation or discussion with Dr.Meera or Dr.Sindhu.
18. The evidence of DW2 would suggest that decision for blood transfusion is to be taken by the surgeon who performed the surgery or the doctor who has been doing the post operative assessment. In the present case, DW1 had no role in performing the surgery on Sajeena or doing the post operative assessment. It is also admitted by DW1 that she spent only 15 minutes time in the post operative ward where to the patient Sajeena was taken from the operation theatre. It is also admitted by DW1, that the vital signs of the patient were stable after the laparoscopic surgery and that the patient was not in shock. Thus, the evidence of DW1 would also show that there was no situation warranting blood transfusion on the patient Sajeena. DW1 is not at all sure about the details of laparoscopic surgery conducted on the patient Sajeena. So, the argument of the learned counsel for the complainants that the decision for blood transfusion on the patient Sajeena was taken without any basis and the said action itself was unwarranted.
19. DW1, the second opposite party has admitted the fact that she is also the owner of the first opposite party Samad Hospital. DW1 categorically admitted the fact that the patient Sajeena developed complications only after blood transfusion. She further deposed that there was perfect haemostasis after the laparoscopic surgery on Sajeena. She has also deposed that Dr.meera who performed laparoscopic surgery on the patient has recorded that the patient was not bleeding and the vital signs were normal. The aforesaid report was recorded at 5.30 pm.
20. It is deposed by DW1, the second opposite party that the patient had bleeding from the surgical sites and epidural site at about 11.15 pm. DW1 was cross examined on the point regarding bleeding due to mismatched transfusion. She categorically admitted that the bleeding happened due to blood clotting problem. It is deposed by DW1 that bleeding happened because of prevention of clotting of blood. According to DW1, there are plenty of reasons preventing of clotting of blood and when clotting is interrupted there will be profused bleeding. It is also admitted that DW1 that about 2 liters of blood was removed from the abdomen of Sajeena at KIMS hospital (third opposite party hospital). It is also deposed that when the platelets in the blood are interrupted in the blood by some particles, blood clotting is delayed she also admitted the fact that mismatched transfusion of blood is one of the reasons for bleeding. According to DW1 mismatched transfusion, infection, malignancy are also reasons for haemolysis. The evidence of DW1 would also show that the patient Sajeena had haemolysis and the same was diagnosed at KIMs Hospital. The evidence of DW1 would also show that the patient Sajeena had no malignancy and that there is nothing on record to show that she had any infection. It is true that DW1 has also deposed rarely haemolysis can also occur in cross matched blood transfusion. DW1 further stated that there is a possibility of getting infection if the blood which was transfused infected. But, there is no case for the opposite parties in B1 case sheet that the blood was infected.
21. According to DW1 the complication developed due to DIC (Disseminated Intra Vascular Coagulation). But, at the same time, DW1 admitted that DIC could have been due to the blood transfusion reaction. DW5 Dr.K.C.Usha, Professor and Head, Department of transfusion medicine, Medical College Hospital, Thiruvananthapuram has explined what is meant by DIC (Disseminated Intra Vascular Coagulation). According to DW5 DIC means "by some reason or other, if a clot is formed inside the circulatory system, this clot disintegrates and these disintegrated products again form further clot formation and this goes a vicious cycle. So, the coagulation factors in the body multiplied rapidly at a greater speed compared to its production in the body. So, finally it will lead to lack of coagulation factors in the system leading to bleeding from multiple sites.
DW5 has deposed about the procedures to be adopted when blood transfusion reaction is happened. It is stated by DW5 that immediately on finding blood transfusion reaction the transfusion must be stopped. Then give patient care ie; resuscitate the patient to save the life of the patient. Third step is to take sample from the opposite vein for further investigation and if possible collect urine and sent these samples along with the balance of blood in the blood bag to the centre from where it is issued. Urine specimen is collected for checking haemolysis. Examination of first specimen of urine is important as haemoglobinuria is often transient. Thus, the evidence of DW5 would make it clear that it was incumbent upon the doctors of the first opposite party hospital to collect sample of blood from the opposite vein of the patient for further investigation and also to collect first urine for investigation. It was also the bounden duty of the doctors of first opposite party hospital to preserve the balance of blood in the blood bag and to send the same to the blood bank from where the blood was issued. But, in the present case, the opposite parties 1 and 2 miserably failed in following the aforesaid procedures.
22. It is true that the immediate first step to be taken in case of blood transfusion reaction is to take necessary steps to save life of the patient. But, after those steps to save the life of the patient, it was also the duty of the doctors of the concerned hospital to collect blood sample from the opposite vein and to preserve the balance blood and forwarding the same to the concerned blood bank. The failure on the part of the doctors of the first opposite party hospital to follow the aforesaid procedures would amount to medical negligence and deficiency in service.
23. DW5 Dr.K.C.Usha, who is the Professor and Head, Department of transfusion medicine, Medical College Hospital, Thiruvananthapuram, Kerala has also filed affidavit dated 22nd January 2010 . It is come out in evidence that she filed the affidavit in this case before this State Commission on the basis of A6 letter dated 21st January 2010 issued by Adv.K.Murlidharan Nair, the counsel for opposite parties 1 and 2 to the Principal, Medical College Hospital, Thiruvananthapuram. In A6 letter, it was requested to file an affidavit by the head of Department of transfusion medicine explaining the modalities of blood transfusion. A6 letter would also show that Principal, Medical College Hospital, Thiruvananthapuram instructed DW5, the Head of Department transfusion medicine to do the needful in the matter. The aforesaid endorsement is dated 21.1.10. On the basis of A6 letter, DW5 filed an affidavit.
24. It is to be noted that DW5 was not directed by this Commission to file an affidavit in this case. She was not asked to submit an expert opinion in the matter. The cross examination of DW5 would make it clear that she was asked by the second opposite party and her husband to submit an affidavit and it is on the basis of the aforesaid request made by the second opposite party she filed the affidavit to support the case of the second opposite party. On evaluation of the circumstances under which DW5 has given evidence in this case would show that this witness is not an independent and impartial witness. In fact, she made an attempt to support the stand taken by second opposite party. She tried to explain the reason for the failure on the part of opposite parties 1 and 2 in following the procedures in the event of blood transfusion reaction.
25. A close scrutiny of the testimony of DW5 would make it clear that there was failure on the part of opposite parties 1 and 2 in collecting the blood from the opposite vein for further investigation. They also failed to forward the balance of the blood in the transfused blood bag to the blood bank where from the blood was issued for transfusion. In effect opposite parties 1 and 2 were negligent in investigating the actual reason for blood transfusion reaction or blood reaction. The aforesaid failure on the part of opposite parties 1 and 2 caused hindrance in investigating the reason for haemolysis which was caused in the patient Sajeena after the blood transfusion on 1.8.02.
26. The opposite parties 1 and 2 relied on the testimony of DW2 Dr.R.K.Prabhau to substantiate their case that the reason for blood transfusion reaction is DIC (Disseminated Intra Vascular Coagulation). DW2 at the relevant time was working as a physician in Government Thaluk Hospital, Chirayinkil. He was examined before this Commission on 17.9.07 and that day also he has been working as Asst. Surgeon and Physician at Taluk Hospital, Chirayinkil. It is the case of DW2 that he rendered free service to the first opposite party hospital on getting an emergency call from the duty doctor at first opposite party hospital. He arrived at the first opposite party hospital at about 1 am on 2.8.02. He deposed that he used to render free service to the first opposite party hospital as there was no other physician available in the locality where the first opposite party hospital is situated. An analysis of the testimony of DW2 during his cross examination would suggest that he has been rendering service as a physician for private hospitals in the locality and thereby he was monetarily benefited for doing private practice in private hospitals. The evidence of DW2 would suggest that he is interested in protecting opposite parties 1 and 2. He has well acquainted with the second opposite party Sathi M Pillai. In his attempt to defend the second opposite party, he has even expressed his disagreement with the authority G.C de Gruchy on clinical Haematology in medical practice. The attention of DW5 was drawn to page 790 of the aforesaid authority (4th edition) with respect to circulatory overload following blood transfusion. In the aforesaid authority, it is reported that "circulatory overload resulting in pulmonary congestion and acute heart failure is the most important complication of transfusions and is probably the most common cause of death following transfusion". The aforesaid proposition was denied by this witness. But he has not given any explanation for his disagreement.
27. DW4 Dr.M.I. Sahadulla, an experienced and well qualified physician attached to third opposite party KIMS Hospital has categorically admitted the fact that the aforesaid authority G.C de Gruchy, 4th edition on clinical haemotology is an authority on the subject. It is to be noted that DW4 Dr.M.I Sahadulla is having 34 years of experience as a specialist in general medicine having Post Graduate Degree in general medicine and FRCP from London and also FRCP from Iyerland. There can be no doubt about the fact that DW2 is not having so much experience and medical qualification as that of DW4, Dr.Sahadulla. This circumstance would also give an indication that DW2 made an attempt to support the second opposite party.
28. Ext.B10 case sheet with respect to the patient M/s.Shoja produced by opposite parties 1 and 2 would also show that DW2 Dr.R.K.Prabhu was in the habit of working as physician in private hospitals in Attingal area, while he was working as a consultant physician and Asst. Surgeon in Kerala State Health Services. The testimony of DW2 that he has been rendering free services as physician to private hospitals cannot be believed for a moment. First page of P10 case sheet is the reference letter issued by Dr.R.K.Prabhu. It would show that he was working as physician in Samad Hospital, Attingal and he had also working as a consultant physician in Multi Specialty Hospital, Attingal.
29. The cross examination of DW2 by the counsel for the complainants would show that on detecting blood transfusion reaction at about 9 pm, no immediate steps were taken at first opposite party Samad Hospital. This witness was cross examined with respect to the entries in B1 case sheet of the patient Sajeena and this witness had admitted that there is no such entry in B1 case sheet maintained at first opposite party hospital regarding the treatment and procedure adopted between 9 pm and 11.30 pm. Ext.B1 case sheet is silent about the treatment steps taken on the patient Sajeena between 9 pm and 11.30 pm.
30. The evidence of DW3 Dr.Sindhu and Ext.B1 case sheet would show that the effective treatment started only after the arrival of DW3 Dr.Sindhu at the first opposite party hospital. This circumstance would also prove medical negligence and deficiency in service on the part of the opposite parties 1 and 2. The evidence of DW3 would also show that Dr.Salini was there in the hospital to attend the patient Sajeena. But she could not do any effective steps and she informed Dr.Sindhu about the complications developed by the patient. The evidence of DW3 would also show that Dr.Meera arrived the hospital only thereafter and that DW1 Dr.Sathi M Pillai had left the Hospital at about 7.30 pm, after ordering blood transfusion. Thus, the available circumstances and evidence would show that there occurred delay in taking prompt and effective steps on finding blood transfusion reaction on the patient Sajeena.
31. DW2 in his re-examination by the counsel for opposite parties 1 and 2 admitted the fact that in case of major blood reaction, the steps for further investigation to detect the cause for the blood transfusion reaction ought to have taken in the first opposite party Samad Hospital. This witness has also admitted in his cross examination that normally in transfusion reaction or suspected transfusion reaction the pre-transfusion blood sample from the patient for grouping and cross matching is to be collected and blood sample from the units which have been administered and sample of venues blood from the vain well away from the transfusion site are also to be collected. He also deposed that he could not notice any such samples collected at first opposite party Samad Hospital.
32. DW2 has also admitted in his cross examination that haemolytic reaction can also be caused due to blood group incompatibility. It is also deposed that incompatibility of blood group is nothing but pre-formed anti bodies or antigens. He further deposed heamolytic reaction may also result from the transfusion of blood which has been improperly stored or stored for too long or transfusion of blood which is already haemolysed by overheating or freezing. He has also deposed that the patient Sajeena was having bleeding from surgical sites and the reason for oozing of blood was DIC. It is further deposed that DIC was caused on account of blood transfusion reaction and that DIC can also result from infection, malignancies, Lung cancer, Leukemia, certain tumors and viral causes. Thus, the testimony of DW2 and the entries made by him in B1 case sheet would show that the bleeding from multiple sites of the patient Sajeena happened due to DIC and that the cause for DIC is haemolytic reaction and that haemolytic reaction can be the result of incompatibility of blood group or due to infection or malignancies. But there is nothing on record to show that the patient Sajeena was affected by infection or any other malignancies. In such a situation, it can very safely be concluded that the cause for haemolytic reaction/blood transfusion reaction is only due to incompatibility of blood group. This would strengthen the case of the complainants that the blood transfusion reaction occurred on the patient Sajeena because of administration of mismatched blood.
33. DW4, the 4th opposite party Dr.M.I.Sahadulla has deposed that there was no medical negligence or deficiency in service on the part of the opposite parties 3 and 4 in treating the patient Sajeena who was brought to the third opposite party hospital at 2 a.m. on 2.8.02. The evidence of DW4 would show that the patient Sajeena was brought to third opposite party hospital as a case of DIC with haemoperitonium and acute respiratory distress , acute renal failure and the patient was in a critical states. Exts. B5, B6 and B7 are the medical records with respect to the treatment of the patient Sajeena at third opposite party KIMS hospital. He has also deposed about those medical records maintained at third opposite party hospital. It is to be noted that DW4 was the consultant physician and Chairman of KIMs Hospital. According to DW4, immediate provocation or cause for DIC can be the result of transfusion reaction or after effect of surgery or by poisoning due to snake bite. But there is no case that the DIC was the result of after effect of surgery or on account of snake bite. It is the definite case of both parties that DIC was the result of transfusion reaction. The evidence of DW4 would also show that if DIC was developed due to infection the complication will develop roughly after 12 hours. This circumstance would also rule out the cause of infection on the patient Sajeena. This witness has also categorically answered that the available evidence and circumstance would revel that DIC was developed on account of transfusion reaction.
34. DW4 was cross examined on the basis of the authority G.C de Gruchy on clinical haemotology in medical practice. His attention was drawn to immediate steps to be taken in case of transfusion reaction. The aforesaid question was put to him on the basis of the proposition stated at Page 793 of the aforesaid authority (4th edition). He answered that 5 steps or procedures are to be adopted. The steps to be taken are as follows: -
1. The pre-transfusion blood sample taken from the patient for grouping and cross-matching.
2. Samples from the pilot bottles or plastic pack tubing used for cross matching.
3. Samples from the units which have been administered. These samples allow rechecking of the blood groups and cross-matching.
4. A sample of venous blood collected from a vein well away from the transfusion site. Part is delivered into a collection tube containing heparin and part is placed in a plain tube and allowed to clot.
5. Urine specimens from the patient which are examined for haemoglobin. As haemoglobinuria is often transient, examination of the first specimen is particularly important.
35. This witness has also deposed that no such sample was collected from the first opposite party Samad Hospital. Thus, it can be seen that opposite parties 1 and 2 miserably failed in following the procedures to be adopted in the event of suspected haemolytic reaction. It is also come out in evidence that haemolytic reaction was developed in the patient Sajeena and the said haemolytic reaction was due to blood transfusion reaction. Thus, it is established in this case that opposite parties 1 and 2 failed to follow the procedures in the event of blood transfusion reaction. The aforesaid failure would amount to medical negligence and deficiency in service.
36. The opposite parties 1 and 2 in their written version and also in the affidavit filed in support of their contentions have stated that the balance of the blood which was transfused was available with the blood bag. But, opposite parties 1 and 2 have not taken any steps to get the said balance of the blood sample tested by the blood bank which issued the blood. They also failed to take any steps in investigating the cause for blood transfusion reaction. It is admitted by DW4 and the second opposite party as DW1 and Dr.Sindhu attached to the first opposite party hospital (DW3) that the blood transfusion reaction or the complication developed only after starting the blood transfusion at 8.30 pm of 1/8/02. It is also admitted that the patient Sajeena was stable in all respects after the laparoscopic surgery (laparoscopic myomectomy). Thus, it is an established fact that the complication of blood transfusion reaction developed only after staring of blood transfusion. It was incumbent upon opposite parties 1 and 2 to investigate the cause for the blood transfusion reaction. Even though, the balance of the transfused blood was available with first opposite party hospital, they did not rise their little finger to get the said transfused blood sample tested and investigated. The aforesaid inaction on the part of opposite parties 1 and 2 would suggest that they were well aware of the reason that the blood transfusion reaction happened due to administration of mismatched blood.
37. DW4 on verification of B1 case sheet maintained at 1st opposite party hospital has admitted the fact that blood transfusion reaction was suspected at 9.00 pm of 1.8.2002, that the duty doctor at the 1st opposite party hospital noted the shivering of the patient at 9.00pm and 9.30pm. It is also deposed that at 11.15 pm the doctors at 1st opposite party hospital could notice wetting of wound sites. But the procedure for suspected transfusion reaction was taken only after 11.15 pm. DW4 has also deposed that in the event of transfusion reaction, medicines such as adrenalin antihistamine are to be administered and that hydrocortisone is to be given intermittently. But the aforesaid medicines were administered only after 11.15 pm. The aforesaid delay would amount to deficiency in service.
38. The contention of the opposite parties that even in the case of cross matched blood transfusion, there is also possibility of causing transfusion reaction cannot be accepted as such. The authority G.C. de Gruchy Clinical haemotology in medical practice (4th edition) at page 792 has stated that delayed haemolytic transfusion reactions occur 3 days to 2 weeks after the administration of apparently compatible blood. In such cases, the amount of anti body in the patient's pre-transfusion serum is so low that no incompatibility is detected by the usual serological test and there is no immediate haemolysis following transfusion of incompatible red cells. Over the following days, a secondary immune response occurs with the prediction of large amounts of anti-body and gradually increasing predominantly extra vascular destruction of the transfused red cells. Symptoms are often mild or absent and the first indication of the reaction may be an unexplained fall in hemoglobin or the development of jaundice, impairment of renal function is unusual, but may occur.
39. The principle enunciated by the aforesaid authority would show that in the case of patient Sajeena there was no such transfusion reaction with respect to cross matched or compatible blood transfusion. In the case on hand, the patient Sajeena developed transfusion reaction causing haemolysis immediately on administration of blood. It is also to be noted that there occurred renal failure and acute respiratory distress. The symptoms exhibited by the patient would suggest that there was incompatibility of the blood transfused to the patient.
40. The counsel for the complainants much relied on the authority G.C.de Gruchy on clinical haemotology in medical practice (4th edition). On going through the aforesaid authority one can see that the symptoms developed by the patient Sajeena are that of transfusion reaction due to mismatching.
41. Ext.B6 is the medical record with respect to the treatment of the patient Sajeena at 3rd party hospital. Page 58 of B6 case sheet would give an indication regarding provisional and final diagnosis. It is recorded as transfusion reaction with DIC and ARF. It is to be noted that on the reverse side of page 57 of B6 against the heading investigations and management, it is recorded as "suspected mis matched transfusion? "
"Suspected DIC?"
"Suspected Haemoperitoneum?"
42. The aforesaid diagnosis is endorsed by Dr. Kiran V. again on the reverse side of page 56. The impression is stated as DIC- to transfusion reaction, suspected haemoglobinuria. It is also recorded at page 54 of B6 under the heading impression DIC. Cause suspected? transfusion reaction? Uncontrolled bleeding - haemoperitonia. It is also noted at page 52 under the heading impression (i) transfusion reaction (ii) RO. DIC. Another important finding is entered on the reverse side of page 52 of B6 against the date 2.8.2002 as follows. " ** apparently mismatched Tx Pt - O+ve given A+ve blood. The aforesaid entry in B6 would show a very very crucial aspect regarding administration of mismatched blood to the patient Sajeena and the resultant transfusion reactions. It is further to be noted that the aforesaid entries are endorsed by doctor Valentina. It is to be noted that the Doctor was sure and certain that the patient Sajeena was given A+ve blood instead of O+ve blood and the aforesaid mismatched transfusion developed transfusion reaction and the resultant DIC.
43. The very same Dr.Valentina has also recorded in B6 case sheet, the probable cause for the transfusion reaction as mismatched blood transfusion and the resultant DIC + ARF + severe bleeding. It is also noted that the patient continues to be oliguric.
44. The authority G.C.de Gruchy in his book Clinical Haemotology in Medical Practice (4th edition) at chapter 18 pages 791 & 792 has given the clinical features of administration of incompatible blood. It is stated that there are 4 phases such as the phase of i) Haemolytic shock 2) the post shock phase 3) the oliguric phase 4) the diuretic phase . It is further stated under the head oliguric phase -- in many but not all patients with haemolytic reactions the kidneys are damaged due to the development of acute tubular necrosis. It is not possible to predict the occurrence of renal damage in the individual patient with a haemolytic reaction. Nevertheless it appears that the incidence bears a relationship to the rapidity with which the haemolysis occurs and the condition of the patient at the time of transfusion, and the shock and pre-existing renal damage act as pre-disposing factors. Oliguria is the first sign of renal failure. Thus, the oliguric condition of the patient Sajeena would also suggest administration of incompatible blood.
45. The aforesaid authority has also narrated the occurrence of blood transfusion reaction due to administration of incompatible blood. It is stated that "the administration of incompatible blood may be due to (i) an error in blood grouping or cross matching, or (2) an error in identification of the blood, so that the wrong blood is administered to the patient; this may result from inadequate or incorrect labelling of blood containers, failure to check the labels on the container before administration, or confusion of identity of patients with the same or similar names. Many fatal reactions have arisen from this cause". (Page 791)
46. The opposite parties 1 and 2 have not kept any well maintained register or record for storing cross matched blood reserved for the patients in the first opposite party hospital. The absence of such register or record would lead to many complications and confusions and there may occur error in identification of the blood bags or identifying the patients. DW3, Dr.Sindhu has categorically reported that there is no such record kept by the first opposite party hospital for receiving and storing cross matched blood bags in the hospital. There is also nothing on record to show as to who has taken the blood from the fridge and kept the same for transfusion. According to DWs 2 and 3 the blood transfusion was performed under the control of the duty doctor Salini and the duty nurse. But the duty doctor Salini has not been examined in this case, to substantiate the case of opposite parties 1 and 2 that proper identification of the blood bag and the patient was done. DW3 is not in a position to say as to whether the blood was transfused at the instance of the duty nurse or the duty doctor Salini. The further case of opposite parties 1 and 2 that there was only one blood bag stored in the fridge of the first opposite party hospital cannot be accepted as such.
47. No acceptable evidence is forthcoming to substantiate the aforesaid contention of opposite parties 1 and 2.Exts.B8 to B10 case sheets would suggest that three other surgeries were performed on 1.8.02. Ext.B9 is the case sheet of the patient by name Sreelatha. It would show that blood was expected for the aforesaid patient Sreelatha. It would also show that cross matching of the patients blood was done with that of one Raju. It would show that on 18.7.02 the blood of Raju was found compatible with that of the blood of Sreelatha. The case of opposite parties 1 and 2, that no blood was stored for the patient Sreelatha cannot be accepted as such. A close study of B9 case sheet would suggest that the pages 1 to 13 of B9 case sheet are written subsequently and incorporated as the part of the case sheet of the patient Sreelatha. The remaining pages 14 to 24 appear to be rather old . So, much reliance cannot be placed on B9 case sheet. The facts, circumstances and the materials available on record would suggest that there occurred mistake in identifying the blood bag containing the blood which was administered to the patient Sajeena.
48. Page 28 of B6 case record of the patient Sajeena contains the details of follow up notes prepared and maintained by department of Anesthesia. The entry therein against the date 8.8.02, 9 am it is recorded that problem: - post myomectomy patient -- mismatched blood transfusion - DIC Renal failure - pulmonary edema, ARDS. The aforesaid entry would make it abundantly clear that the blood transfusion reaction occurred only due to mismatched transfusion. There is no dispute about the genuineness and correctness of B6 inpatient record maintained by KIMS Hospital with respect to the patient Sajeena. The aforesaid entry is more than enough to come to a definite finding that there was transfusion of mismatched blood and it resulted in the serious problems and ended in the death of the patient Sajeena. The aforesaid transfusion of mismatched blood can be held as medical negligence on the part of opposite parties 1 and 2. So, this State Commission have no hesitation to hold that there was medical negligence and deficiency in service on the part of opposite parties 1 and 2.
49. Again at page 12 of B6 under the heading consultation sheet with Sub Heading reason for consultation it is recorded as 'mismatched blood transfusion to R/O DIC. The name of DW4 Dr.Sahadulla is recorded as referring consultant, and the date is noted as 2.8.02 with the consultant doctor as Dr.Satheesh.B. Therein, it is reported that the patient had apparently uneventful myomectomy and was well in the immediate post operative period. Following mismatched transfusion, she has developed shock with bleeding from surgical sites. The aforesaid entry would make it further clear that the complication developed only due to transfusion of mismatched blood.
50. The entries at page 11 of B6 would also show the transfusion of mismatched blood and the resultant development of DIC. At page 10 also it is recorded with a query "mismatched transfusion reaction". Thus, Ext.B6 case record maintained at third opposite party hospital would clinch the issue regarding medical negligence on the part of opposite parties 1 and 2. It would also establish that on account of their negligence the patient Sajeena developed transfusion reaction and as a result of the same, the patient developed DIC renal failure, respiratory distress and like complications. The aforesaid complications resulted in the death of the patient on 4.9.02 while undergoing treatment at the 3rd opposite party KIMS hospital. Hence, this issue is found against the opposite parties 1 and 2.
51. POINT NO 2 & 3 Complainants have alleged deficiency in service on the part of opposite parties 3 and 4 on the ground that they colluded with opposite parties 1 and 2 in suppressing the material facts regarding the lapse and medical negligence on the part of opposite parties 1 and 2 in treating the patient Sajeena. The complainants have not alleged any medical negligence or other deficiency in service on the part of opposite parties 3 and 4. In fact, PW1, the second complainant and PW2 the witness on the side of the complainants have categorically deposed that they have no case of medical negligence or deficiency in service on the part of opposite parties 3 and 4 in treating the patient Sajeena at third opposite party KIMS Hospital from the early hours of 2.8.02 to 4.9.02, the date of death of the patient Sajeena. Exts. B5, B6 and B7 case records maintained by third opposite party KIMS hospital with respect to the treatment of the patient Sajeena would speak volumes about the effective and sincere efforts taken by the doctors and hospital staff of the third opposite party hospital in providing the necessary and adequate medical treatment to the patient Sajeena. Unfortunately, even after adopting such effective procedures in treating the patient Sajeena, the death of the patient happened on 4.9.02. The mere fact that expected result could not be actived cannot be taken as a ground to hold medical negligence or deficiency in service on the part of the doctors and hospital staff of third opposite party KIMS hospital. There is also no cogent evidence available on record to substantiate the case of the complainants that opposite parties 3 and 4 colluded with opposite parties 1 and 2 in suppressing the material facts involved in the treatment of the patient Sajeena.
52. It is true that there are circumstances to suspect suppression of material facts by opposite parties 3 and 4 with respect to the treatment of the patient Sajeena at first opposite party hospital. The inpatient record maintained by KIMS hospital in treating the patient Sajeena would show that immediately on the admission of the patient Sajeena at third opposite party hospital in the early hours of 2.8.02 blood was taken for examination and the same was forwarded to Cosmopolitan Hospital, Thiruvananthapuram. PWs 1 and 2 have also spoken to about the forwarding of blood of Sajeena for examination at Cosmopolitan Hospital, Thiruvananthapuram. PW2 has deposed that blood was taken for examination and the hospital staff of Cosmopolitan Hospital told him and the husband of Patient Sajeena about the wrong transfusion of blood and that great mistake had committed by the first opposite party hospital in administering mismatched blood to the patient Sajeena. PW2 further deposed that they were sent back from Cosmopolitan Hospital by stating that the result will be forwarded to KIMS hospital, Thiruvananthapuram. But the aforesaid result of the blood examination is not seen attached to the inpatient records produced from the side of the third opposite party. It is true that a result of examination of blood is seen attached to B5 case record. But the aforesaid result is not signed by the lab technician or any other competent authority certifying the correctness of the result of the blood examination. It is also to be noted that there are no entries in the said blood examination result , issued on the letter head of Cosmopolitan Hospitals Private Ltd; Thiruvananthapuram, with respect to the date of acceptance of the blood sample at Cosmopolitan hospital and the date of examination of the blood sample etc. So, the aforesaid result of blood examination written on the letter head of Cosmopolitan Hospital Private Ltd; cannot be treated as a proper result of blood examination. The pertinent question that would merge in the circumstance is as to what happened to the said blood result. This is a circumstance to doubt the genuineness and correctness of the blood result attached to Ext.B5 inpatient medical record. This would in turn create genuine suspicion regarding the alleged suppression of material fact by opposite parties 3 and 4.
53. Another circumstance available in this case to create doubt about the case of opposite parties is the entries in B6 inpatient medical record produced by opposite parties 3 and 4. This Commission have already taken into consideration the entries in B6 medical record regarding the complication resulted from transfusion of mismatched blood. A perusal of B6 case record would make it abundantly clear that the doctors of third opposite party hospital could detect the transfusion of mismatched blood to the patient Sajeena and the resultant complication of haemolytic reactions and development of DIC. But, DW4, the chief consultant and physician of third opposite party hospital namely 4th opposite party Dr.M. I.Sahadulla was not straight forward in admitting the finding of the doctors of KIMS Hospital regarding transfusion of mismatched blood. DW4 is keeping silence about the entries in B6 medical record regarding transfusion of mismatched blood to the patient while the patient was at first opposite party hospital. The attempt on the part of DW4 was to save opposite parties 1 and 2. He is not dare enough to depose that there was negligence on the part of opposite parties 1 and 2 in administrating mismatched blood to the patient Sajeena, or that the complication of incompatibility of blood transfusion occurred. This witness was very much interested in giving a vague statement that the complication occurred due to DIC on account of blood transfusion reaction. The attempt on the part of DW4 was to hide the negligence on the part of doctors of first opposite party hospital in administering mismatched blood. It is true that there is no concrete or cogent evidence on record to come to a definite finding that there was an attempt on the part of DW4 to suppress the material facts or that the opposite parties 3 and 4 collected with the opposite parties 1 and 2 in suppressing material facts regarding medical negligence on the part of opposite parties 1 and 2. Mere suspicion of a fact cannot be equated to evidence. It is not fair on the part of this Commission in finding opposite parties 3 and 4 guilty of suppression of material facts, on the basis of mere suspicion. The complainants have not succeeded in establishing the alleged suppression of material facts on the part of opposite parties 3 and 4. Considering the nature of the treatment and procedures adopted by opposite parties 3 and 4 in treating the patient Sajeena and the sincere and earnest effort taken by opposite parties 3 and 4 in adopting the adequate and necessary procedures and treatment to save the life of the patient Sajeena, this Commission is pleased to hold that there was no sort of negligence or deficiency in service on the part of the opposite parties 3 and 4. Hence these issues are found in favour of opposite parties 3 and 4.
54. ISSUE NO 4 The findings on the previous points would make it clear that there was medical negligence and deficiency in service on the part of opposite parties 1 and 2. It would also show that opposite parties 3 and 4 were not guilty of medical negligence and deficiency in service. So, the opposite parties 3 and 4 are to be exonerated from the liability to pay compensation to the complainants. It is also to be held that opposite parties 1 and 2 are guilty of medical negligence and deficiency in service and they are to be found liable to compensate the complainants.
55. The complaint in OP.27/03 was filed by 6 complainants. The first complainant was the husband of the patient Sajeena who died on account of the medical negligence and deficiency in service of opposite parties 1 and 2. The complainants 2 and 3 are the father and mother respectively of the patient Sajeena. The complainants 4 to 6 are the sisters and brother of the patient Sajeena. It is an admitted fact that the patient Sajeena and the first complainant A.K.Nazeer had no child in their wedlock. In fact, the patient Sajeena and her husband A.K.Nazeer were undergoing treatment for infertility at the first opposite party Samad Hospital, Attingal, Thiruvananthapuram. It is come out in evidence that the first complainant A.K.Nazeer died in a motor vehicle accident during the pendency of the complaint in OP.27/03. At the request of the remaining complainants, the name of the first complainant was deleted by virtue of the order dated 13.11.03 passed on an interlocutory application filed in this case.
56. The original complainants including the first complainant A.K.Nazeer claimed compensation of Rs.4.5 lakhs with future interest for the deficiency in service and unfair trade practice on the part of opposite parties. They had also claimed reimbursement of Rs.4.5 lakhs which they spent for medical treatment of Sajeena and also cost of Rs.50,000/-. It is to be noted that the most aggrieved party by the death of Sajeena was her husband A.K.Nazeer who was arrayed as the first complainant. Unfortunately, during the pendency of this case the first complainant A.K.Nazeer died in a motor vehicle accident and his name was deleted from the party array.
57. The complainants 2 and 3 are the parents of deceased Sajeena. There can be no doubt about the fact that the complainants 2 and 3 suffered mental agony on account of the death of their daughter Sajeena. No doubt that the complainants 4 to 6 being the sisters and brother of Sajeena had also suffered mental agony due to the untimely and unexpected death of their sister Sajeena. So, the complainants 2 to 6 are to be awarded a sum of Rs.1 lakh under the head of mental agony and inconvenience.
58. The complainants 2 and 3 have lost the love and affection of their married daughter. Likewise the complainants 4 to 6 have also lost the love and affection of their sister Sajeena. So, the complainants 2 to 6 are also to be awarded compensation under the head loss of love and affection. We fix the compensation under this head at Rs.1 lakh.
59. The complainants have got a case that Sajeena was conducting a computer and DTP centre by name BISMI Communications at Thycaud, Pirappancode. She was earning monthly income of Rs.15,000/- But, there is no scrap of paper available on record to substantiate the said case of the complainants that deceased Sajeena was conducting such a business establishment and earning monthly income of Rs.15,000/-. So, the case of the complainants that deceased Sajeena was getting monthly income of Rs.15,000/- cannot be upheld. For the purpose of determining compensation due to the complainants 2 to 6 under the head loss of financial support, the monthly income of deceased Sajeena can be taken as Rs.5,000/-. She was only aged 24 years at the time of her death. Considering the expected span of life of Sajeena and the monthly income which she was getting, a sum of Rs. 3 lakhs can be awarded to the complainants 2 to 6 under the head loss of financial support. There can be no doubt that there will be an element of guess work in determining compensation under the head of loss of financial support. The compensation under this head is fixed by taking into consideration the uncertainties in life. So, the compensation of Rs.3 lakhs ordered can be treated as just and reasonable.
60. The complainants have got a case that they spent a total of Rs.4.5 lakhs in connection with the treatment of deceased Sajeena. The opposite parties 3 and 4 have not disputed Ext.A5 series of medical prescriptions and medical bills issued from third opposite party KIMS hospital. The 4th opposite party Dr.Sahadulla filed an affidavit in this case and in Para 10 of the said affidavit dated 11th January 2008, it is admitted that the total bill amount with respect to the treatment of the patient Sajeena at KIMS Hospital was Rs.2,49,183.30 and out of that amount Rs.20,062.30 was given as discount. So, the actual amount remitted towards the bill amount would come to Rs.2,29,121/-. Ext.P4 series are the medical prescriptions and bills issued from first opposite party Samad Hospital in connection with the treatment of Sajeena. The total amount covered by P4 series of bills would come to Rs.3866.60.
61. It is an admitted fact that Sajeena was admitted in third opposite party hospital on 2.8.02 and she had undergone treatment as an inpatient up to 4.9.02. Thus, she had undergone treatment at third opposite party hospital for a continuous period of 34 days. She was in a critical ill stage. The complainants and their relatives were waiting at third opposite party hospital during the said period. They had also arranged blood for Sajeena on several occasions. Blood samples were also taken to hospitals like Cosmopolitan Hospital, Sree Chithira Thirunal Institute, Medical College Hospital, Thiruvananthapuram etc. No doubt the complainants had spent more amounts by way of transportation charges and other expenses. So, the miscellaneous expenses can be assessed at Rs.2 lakhs. Therefore, the total expense met by the complainants in connection with the treatment of Sajeena is fixed at Rs.4,33,000/-.
62. Therefore, the complainants 2 to 6 are entitled for a total compensation of Rs.9,33,000/-, for the medical negligence and deficiency in service on the part of opposite parties 1 and 2. The aforesaid compensation amount of Rs.9,33,000/- would carry interest at the rate of 9% per annum from the date of complaint in OP.27/03. They are also entitled to get cost of Rs.15,000/-. The opposite parties 1 and 2 are jointly and severely liable to pay the aforesaid compensation with interest and costs to the complainants 2 to 6. The complainants 2 and 3 being the aged parents of deceased Sajeena are entitled for 70% of the compensation amount with interest and costs and the remaining 30% will go to the complainants 4 to 6 and the same can be apportioned among them in equal proportion. This point is answered accordingly.
In the result, the complaint is allowed partly. The opposite parties 1 and 2 are found guilty of medical negligence and deficiency in service. They are directed to pay a total compensation of Rs.9,33,000/- to the complainants 2 to 6 with interest at the rate of 9% per annum from the date of the complaint in OP.27/03 till realization and cost of Rs.15,000/-. The opposite parties 1 and 2 are made jointly and severely liable to pay the aforesaid compensation with interest and costs. The complainants 2 and 3 being the aged parents of deceased Sajeena are entitled for 70% of the compensation amount with interest and costs and the remaining 30% of the compensation with interest and costs will go to the complainants 4 to 6 in equal proportion. The opposite parties 3 and 4 are exonerated from the liability to pay compensation to the complainants. The opposite parties 1 and 2 are directed to pay the decree amount with interest and costs within one month from the date of receipt of copy of this order, failing which the complainants 2 to 6 will be at liberty to get the order executed as provided under the provisions of the Consumer Protection Act, 1986 and the rules there under.
M.V.VISWANATHAN,JUDICIAL MEMBER M.K.ABDULLA SONA -- MEMBER SL APPENDIX COMPLAINANTS WITNESS PW1 : Second complainant S.Mohammed Basheer PW2 : Asharaf Ghan PW3 : A.A.Rasheed.
COMPLAINANTS EXHIBITS Ext.A1 : Copy of lawyer notice issued at the instance of the complainants 1 and 2 to the opposite parties 1 to 4 Ext.A2 : Reply notice dated 18.2.03 issued by the opposite parties 1 and 2 Ext A3 : Reply lawyer notice issued by opposite parties 3 and 4 Ext.A4 : Medical prescriptions and bills issued by first opposite party Samad Hospital.
Ext.A5 : Medical prescriptions and bills issued by third opposite party KIMS Hospital Ext A6 : Copy of the letter dated 21st January 2010 issued by Mr.K.Murlidharan Nair, Advocate to the opposite parties, Principal Medical College Hospital, Thiruvananthapuram.
OPPOSITE PARTIES WITNESS
DW1 : Sathi M Pillai
DW2 : Dr. R.K.Prabhu
DW3 : Dr.Sindhu Mol
DW4 : Dr.M.A.Sahadulla
DW5 : Dr.K.C.Usha
OPPOSITE PARTIES EXHIBITS
Ext.B1 : Original case sheet of Smt.Sajeena maintained by Samad Hospital, Attingal.
Ext.B2 : Reference letter
Ext. B3 : Blood transfusion form
Ext.B4 : Operation register of Samad Hospital, Attingal.
Ext.B5, B6, B7 : Medical records of KIMS Hospital, Thiruvananthapuram.
Ext.B8: Original case sheet of Sheeba Sethunad of Samad Hospital, Attingal.
Ext.B9 : Original Case sheet of Sreelatha of Samad Hospital, Attingal.
Ext.B10 : Original case sheet of Shoja Suresh of Samad Hospital, Attingal.
M.V.VISWANATHAN -JUDICIAL MEMBER
M.K.ABDULLA SONA -- MEMBER
[HONARABLE MR. SRI.M.V.VISWANATHAN] PRESIDING MEMBER