State Consumer Disputes Redressal Commission
N. Kashinath vs The Director, St. John'S Medical ... on 31 May, 2024
Cause Title/Judgement-Entry KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION BASAVA BHAVAN, BANGALORE. Complaint Case No. CC/150/2012 ( Date of Filing : 19 Dec 2012 ) 1. N. Kashinath S/o. Late L. Narayana Swamy, 29 years, R/at No. 21/1-23, Krishna Reddy Building, 1st Cross, Behind Vinayaka Temple, Madiwala, Bangalore 560068 . ...........Complainant(s) Versus 1. The Director, St. John's Medical College Hospital, Sarjapura Road, Koramangala, Bangalore 560034 . ............Opp.Party(s) BEFORE: HON'BLE MR. Ravishankar PRESIDING MEMBER HON'BLE MRS. Smt.Sunita Channabasappa Bagewadi MEMBER PRESENT: Dated : 31 May 2024 Final Order / Judgement BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BANGALORE. (ADDL. BENCH) CONSUMER COMPLAINT NO.150/2012 DATED THIS THE 31st DAY OF MAY, 2024 PRESENT SRI RAVI SHANKAR, JUDICIAL MEMBER SMT. SUNITA C.BAGEWADI, LADY MEMBER Sri.N.Kashinath, S/o late Sri.L.Narayana Swamy, 29 years, R/at No.21/1-23, Krishna Reddy Building, 1st Cross, Behind Vinayaka ... Complainant/s Temple, Madiwala, Bengaluru - 560 068 (By Sri.D.R.Basavarajappa, Advocate) -Verses- The Director, St.John's Medical College Hospital, Sarjapura Road, ... Respondent/s Koramangala, Bengaluru-560 034 (By Sri.Ganapathi Hegde, Advocate) O R D E R
BY SRI.RAVISHANKAR, JUDICIAL MEMBER This complaint is filed by the complainant against the Opposite Party alleging medical negligence, hence prays for compensation to the tune of Rs.91.00 lakhs with 18% interest from 6.7.2012 till realization and other reliefs, in the interest of justice and equity.
2. The brief fact of the complaint is that, the complainant with a history of loose motion, vomiting and approached one Cauvery Nursing Home situated at Madiwala. The said hospital issued prescriptions to secure the medicines. The complainant being not satisfied with the treatments provided by the said nursing home had approached this Opposite Party hospital on 6.7.2012 at 4.30 p.m. He was shifted to emergency ward and started treatment to stop the vomiting. Further he was shifted to Male Medical Intensive Trauma Unit (MMITU) and doctor informed that he is going to be Insert Central Line at neck at about 2.00 p.m. on 7.7.2012. Accordingly, they have inserted central line at 2.00 p.m. and within 10 minutes the complainant become unconsciousness and he was unable to recognize any person, even he was not able to walk and sense anything. The complainant suffered paralysis stroke at left side of the entire body. But the Opposite Parties have not given anti clotting injection and the same day due to non availability of the medicine, the doctor wrote a letter to Narayana Hrudayalaya and referred the complainant to the said hospital, the complainant was shifted to the Narayana Hrudayalaya Hospital wherein the MRI scan was conducted and it was noticed and doctor attached to Narayana Hrudayalaya informed that the blood was clotted at brain. Hence he suffered paralysis stroke and due to none injecting anti clotting medicine within five minutes of the clot he suffered paralysis stroke. After treating at Narayana Hrudayalaya the complainant somehow recovered from the paralysis stroke and now he was not able to work as usual. It is only due to negligence on the part of Opposite Party inserting the catheter negligently when he was admitted the complainant suffered this complication and the complainant during the hospitalization at Narayana Hrudayalaya had spent nearly Rs.3.00 lakhs towards medical expenses.
The complainant further submits that, once again he visited St.John's Medical Hospital where the Opposite Party informed that there was no bed available to treat the complainant and then advised the relatives of the complainant that the complainant is already discharged and do not want to admit the complainant by that time the relatives of the complainant's have created galata with the Opposite Party. In order to safeguard the image of the hospital the Opposite Party admitted the complainant and started giving treatment in the medical ward. The complainant due to negligence on the part of doctors at Opposite Party was not able to move from the bed and failed to recognize mother, brother and relatives etc. for more than one month for which he requested the Opposite Party to provide free treatment till his life but the Opposite Party has not accepted the same. The Opposite Party has provided physiotherapy for two months only during the said period the Opposite Party issued Radiology Investigation report and issued MRI brain report also which clearly discloses that the blood was clotted at brain and other parts of the body.
The complainant further alleges that, he is a Diploma holder in Electronic and Communication and pursuing to M.Sc. in Information Technology and he is employed at Alcatellucent Network Management Services Pvt. Ltd. he drawing a Rs.22,000/- per month excluding other benefits. The family of the complainant are depending on his earning only, due to negligence on the part of the Opposite Party the complainant was forced to hospitalize from 6.7.2012 to 28.9.2012, thereby the entire income was stopped due to hospitalization. From 4.10.2012 onwards the complainant was not able to work as usual due to above said ailments and unable to move his hands freely, to talk fluently even could not work properly even he was not able to drive the vehicle and also walk on the road due to negligence on the part of the Opposite Party. He became totally permanent disabled person. Hence, he prayed for compensation to the tune of Rs.91.00 lakhs for medical expenses, in the interest of justice and equity.
3. After service of notice, the Opposite Party appeared through his counsel and filed version and contended that, the complainant has field the instant complaint inter-alia, seeking compensation for alleged deficiency of service on the part of the Opposite Party in the treatment of the complainant and consequent hardship and loss arising from the same. The complaint is not maintainable against the Opposite Party who is the Director of St.John's Medical College Hospital and hence on this ground alone, the complaint is liable to be dismissed in limine. Without prejudice to the above contention, the Opposite Party craves leave of this Hon'ble Court to briefly state the facts. It is submitted that nothing stated in the complaint shall be deemed to be admitted unless the same is specifically admitted hereunder.
The Opposite Party further contended that the complainant presented himself to the Opposite Party on 6th July 2012 complaining of loss motion, vomiting etc. The Opposite Party immediately admitted the complainant in the emergency ward for prompt treatment. Inj. Ciplox, Inj.Emeset, Inj.Metrogyl and IVF Ringer Lactate were administered to the complainant to control his vomiting and diarrhea. The complainant was admitted to the Male Medical Ward Intensive Treatment Unit so that he could be monitored closely and treated. While at the intensive Treatment Unit, the complainant was attended to by the resident doctor on duty and was monitored closely. The complainant's blood pressure was low, he had not passed urine for four hours and his kidney function tests were abnormal. The last symptom was suggestive of kidney failure. On conducting necessary investigations and in view of severe dehydration and decreased urine output, the decision to put in a central line was taken by the duty consultant doctor at 01.00 a.m. The Opposite Party further contended that the complainant's condition was such that administration of less fluid to him could have led to serious damage to his kidney's, perhaps resulting in the need for dialysis and even a potential risk of non-recovery of kidneys, while giving too much fluid could have led to heart failure. Therefore it was necessary to insert a central line in order to control the quantity of fluids to be given to the complainant.
The Opposite Party further contended that the central line also called central venous catheter, is a catheter placed into a large vein in the neck, chest or groin of a patient, using external landmarks. It is a well-established medical procedure. In certain cases, catheterization is indispensable for controlled administration of medication and/or fluids. In this case, the central line was inserted using external landmarks and guided towards the jugular vein, which is adjacent to the carotid artery. It is submitted that there are at least 3-4 cases every day in the hospital in which it is necessary to insert the catheter and the well established landmark method is used to insert the catheter.
The Opposite Party further contended that after the central line was inserted in the complainant, he was continued to be monitored closely. A chest X-ray was done to ensure that the catheter was placed properly and to ensure that there was no injury. The X-ray revealed that there was a kink in the central line and possible puncture of the carotid artery. Following standard medical practice, the central line was removed immediately.
The Opposite Party further contended that subsequently the complainant developed slurring of speech, weakness of left side of the body, deviation of mouth to the right and decreased vision in the left eye. The doctors attended to the complainant immediately, all the necessary tests, including CT scan of the brain in addition to ultrasound Doppler of the neck were conducted and treatment was administered to him as per standard medical practice. The investigations revealed a floating thrombus (blood clot) in the right carotid artery. He was diagnosed to have suffered from a Thromboembolic Right Medical Cerebral Artery Territory Infarct. Immediately the Neurology team, led by the Head of Department of Neurology in addition to specialists including a Radiologist and a Physician attended to the complainant.
The Opposite Party further contended that the Neurologist opined that the complainant required Neuro-vascular intervention. An intervention in this case would have meant removal of the stroke-causing clot to lessen and to prevent further damage caused to the brain. Since the facility was not available in St.John's Hospital, the complainant was referred to Dr.Vikram Huded an Interventional Neurologist at Narayana Hrudalaya.
The Opposite Party further contended that arrangements were made for the complainant to be immediately taken to Narayana Hrudayalaya. All discharge formalities including payment of fee were waived off in view of the urgency. The complainant was thereafter transported to Narayana Hrudayalaya in the vehicle of the Opposite Party, in the presence of an attending doctor. However the doctors at Narayana Hrudalaya opined that no active intervention was needed and advised conservative management. Although the complainant was advised to be admitted in Narayana Hrudayalaya, the attendants of the complainant brought him back to St.John's Hospital.
The Opposite Party further contended that formation of kinks in the catheter during internal jugular vein cannulation is a fairly common occurrence. Carotid artery puncture is documented as the most common complication during central venous cannulation. The rate of occurrence ranges from 6 to 25%. However incidences of thrombosis and consequent stroke as a result of this are quite rare.
The Opposite Party further contended that further investigations in this case revealed that the complainant had genetic factors, such as an abnormal mutation of Factor V leading to factor V Leiden, elevated Factor VII levels, diminished protein C levels as well as elevated homocysteine levels. Factor V Leiden is an inherited disorder of blood clotting. It is a variant of human factor V that causes a hypercoagulabity disorder. It is a genetic disorder and catalyzes coagulation and makes the person more prone to thrombosis (formation of blood clots). Elevated homocysteine is also a known risk factor for cardiovascular disease and thrombosis. These genetic disorders have been present in the complainant from his birth and are permanent in nature. It is submitted that line elevated factor V Leiden, elevated factor VIII levels and low protein C levels predispose a patient to blood clots. The existence of the genetic abnormality has been admitted by the complainant in the letter dated 11th September, 2012 produced along with the complaint.
The Opposite Party further contended that in the present case, the stroke suffered by the complainant is not attributable to any negligence of the hospital. As stated above, the landmark technique of central venous cannulation is a well established medical procedure and has a recorded high rate of success and minimal risk. Carotid artery puncture, which is the most common and well documented complication (Authorities document injuries to the carotid artery in the range of 2-25%) in case of central venous cannulation, can result in bleeding at times, which can be easily controlled. However, thrombosis and consequent stroke as a result of the same is a very rare occurrence. The genetic condition of the complainant rendered him more vulnerable to this occurrence. None of the above is attributable to any negligence of the doctors treating the complainant.
The Opposite Party further contended that reports of the conducted on the complainant by both the Opposite Party hospital as well as Narayana Hrudalaya demonstrated that he had infarcts on both sides of the brain. The trauma caused to the right carotid artery could account for the infarcts on the right side of the brain and the weakness experienced by him on the left side of his body, since the right side of the brain controls the left side of the body. However the same cannot account for the infarcts on the left side of the brain. In other words the infarcts found on the left side of the brain indicate that it was caused due to the genetic predisposition of the complainant to blood clotting.
The Opposite Party further contended that on his return from Narayana Hrudayalaya, the complainant has undergone extensive physiotherapy, occupational therapy and other treatment at the Opposite Party hospital as explained in the discharge summary. The complainant was in the Opposite Party hospital for close to three months. At the time of discharge, the complainant was able to walk unaided and carry on activities of daily living independently. The complainant and his attendants were counseled before his discharge. At the request of the complainant's mother, the Opposite Party hospital also waived off the entire fee for treatment of the complainant on humanitarian grounds.
The Opposite Party further contended that its doctors and staff involved in the treatment of the complainant have discharged their professional duties in accordance with well established principles of medical practice and have at all times, acted in good faith. All decisions were made only after briefing and the complainant and his attendant, after taking consent and in the best interest of the complainant. The doctors and staff of the Opposite Party used their experience to do everything with a view to cure the complainant. The various medical procedures done on the complainant are strictly in accordance with standard and accepted medical practice. There is no negligence or deficiency of service by any of the doctors or staff of the Opposite Party. They are not liable to pay any compensation as claimed by the complainant and they have given full free treatment during his hospitalization. Therefore, there is no cause of caution aroused in the instant case, hence prays for dismissal of the complaint.
4. The complainant filed affidavit evidence and marked documents as Exs.C1 to C64. The Opposite Party also filed affidavit evidence and marked documents as Ex.R1 to R3. The Opposite Party filed written arguments.
5. Heard arguments.
6. On perusal, the following points will arise for our consideration;
(1) Whether the complainant has proved medical negligence on the part of Opposite Party hospital?
(2) Whether the complainant is entitled to the reliefs as sought?
(3) What order? 7. The findings to the above points are; (1) In the affirmative (2) In the partly affirmative (3) As per final order R E A S O N S
8. Point Nos.1 & 2: It is not in dispute that, the complainant admitted to the Opposite Party hospital on 6.7.2012 with a history of loose motion, vomiting etc. After check up by the duty doctor of the Opposite Party hospital, they arrived for insertion of central venous catheter which is also called as central line. At the time of insertion, the duty doctors noticed that, there was a puncture of carotid artery. Immediately the said the catheter was removed and treatment was given. It was noticed during MRI the blood clot was reached to the brain. On advice of the doctors at Opposite Party hospital, the complainant was shifted to Narayana Hrudalaya where he was taken treatment for removal of the blood clots. The complainant had produced the entire medical records marked as Ex.C1 to C64 to show the line of treatment taken in the Opposite Party hospital and Narayana Hrudalaya and subsequent to Narayana Hrudalaya hospital and Vikram Hospital after the said complication was noticed.
9. It is an admitted fact that, the Opposite Party at the time of insertion of the central venous catheter there was a puncture in the carotid artery which resulted in the clots of the blood. The said clots were reached to the brain, in this regard one Neurologist opined that Neuro Vascular Intervention for removal of the stroke causing clot and to lesson to prevent the damage caused to the brain. The complainant was subsequently referred to Narayana Hrudalaya where one Dr.Vikram who had treated, the said clots was removed and the complainant recovered to normal health.
10. The contention of the Opposite Party is that, it is quite common complication during central venous cannulation rate of occurrence ranges from 6 to 25% but the incidences of thrombosis and consequent stroke are result of are quite rare and also contended that the stroke was not due to miss administration of the catheter, the Trauma caused to the right carotid artery could be on account for the infarcts on the right side of the brain and the weakness experienced by the complainant on the left side of the body and also states that the said facts indicates that it was caused due to the genetic predisposition of the complainant through blood clotting and submits that, there is no any deficiency of service/negligence on the part of doctors who have performed insertion of the catheter.
11. We are of the opinion that, the Opposite Party has admits that it is a common complication rages to 6 to 25% occurrence, when the duty doctor known these complications are common they should take proper care and caution at the time of insertion of the catheter in central line. It is clear case of negligence on the part of doctors at Opposite Party who have not made diligent attempt to insert catheter to the complainant. It is only due to wrong insertion or improper insertion puncture occurred and blood clotting was started. The doctors at Opposite Party have not taken a proper care and caution ever after noticing the stroke caused to the complainant. Anyhow they have referred the complainant to the Narayana Hrudalaya for further treatment where he was recovered subsequently. Though the complications are known to the doctors they should take due care and caution instead of that due to negligence the complainant suffered stroke and subsequently he suffered hospitalization for further treatment. For which the complainant is entitled to get compensation from the Opposite Party hospital. We are opinion that, it is just and proper to award compensation of Rs.5.00 lakhs towards medical negligence on the part of the Opposite Party along with litigation expenses of Rs.25,000/- to the complainant
12. Point No.3: In view of above discussion, we proceed to pass the following:-
O R D E R The complaint filed by the complainant is partly allowed with litigation cost of Rs.25,000/- to the complainant.
The Opposite Party hospital is directed to pay compensation of Rs.5.00 lakhs to the complainant towards medical negligence.
Further the Opposite Party hospital is directed to comply the above order within 30 days from the date of receipt of this order. Failing which, the payable amount shall carry interest @12% p.a. from the date of default till realization.
Send a copy of this order to both parties.
Lady Member Judicial Member [HON'BLE MR. Ravishankar] PRESIDING MEMBER [HON'BLE MRS. Smt.Sunita Channabasappa Bagewadi] MEMBER