State Consumer Disputes Redressal Commission
Mr. K. J. Chaturvedi vs Mr. Narendra Kumar & Anr. on 28 October, 2013
BEFORE THE HON'BLE STATE CONSUMER DISPUTES REDRESSAL
BEFORE THE HON'BLE STATE CONSUMER DISPUTES
REDRESSAL
COMMISSION, MAHARASHTRA,
MUMBAI
Complaint Case No. CC/00/468
1. Mr. K. J.
Chaturvedi
E/16, Cottage Nensey
Co. Op. Hsg. Soc., Borivali (East), Mumbai - 400 066.
Maharashtra
...........Complainant(s)
Versus
1. Mr. Narendra
Kumar, Consulting Physician
Cardiologist and
Chest Physician Narendra Hospital, Seeta Mahal, Kasturba Road No. 5,
Borivali (E), Mumbai - 400 066.
Maharashtra
2. Narendra Hospital
Sheetal Mahal, Kasturba Road No.
5, Borivali (E), Mumbai - 400 066.
Maharashtra
............Opp.Party(s)
BEFORE:
HON'ABLE MRS. Usha
S.Thakare PRESIDING MEMBER
HON'ABLE MR. Narendra
Kawde MEMBER
PRESENT:
Mr.C.M. Jha, Advocate
for the complainant.
Dr.Mahesh Baldwa, A.R.
for the opponents.
ORDER
Per Mrs.Usha S. Thakare, Honble Presiding Judicial Member Complainant-Mr.K.J. Chaturvedi has filed complaint case by alleging deficiency in service against the opponents due to acts of negligence while giving medical treatment to Pushpa K. Chaturvedi, wife of the complainant.
2. The facts giving rise to file present complaint in short are as under:-
On 19/07/1997 at about 7.45 a.m. wife of the complainant suddenly felt a severe headache and her right hand and leg were shivering. She fell down on floor in the kitchen. Family Doctor-Dr.K.G. Moharir was called immediately. Wife of the complainant was admitted under the reference of family doctor in Narendra Hospital i.e. opponent No.2 at about 8.25 a.m. on 19/07/1997. She was under the treatment of opponent No.1/Dr.Narendra Kumar. On 19/07/1997 wife of the complainant was suffering from headache and she was vomited once. There was nausea. It was opinion of the doctor that the patient had neurological problem.
Patient was recovering on 20/07/1997. It was revealed from the medical report that on 21/07/1997 the patient had headache and weakness only. CT scan was recommended. The report revealed that there was brain haemorrhage on the left side.
Headache of the patient was continued till 24/07/1997 after which there was only weakness. This weakness persisted till 02/08/1997.
No other medical complaint was recorded in the medical report. On 03/08/1997 at 9.15 a.m. it was noted as per medical report that the patient had perspiration and therefore, injection Decadran was administered to the patient. Prior to administration of injection by the nurse, patient was watching programme on T.V. She had consumed class of milk and a chickoo. She was speaking to her brother-in-law and her sister. Injection was administered in their presence.
After administration of injection within few minutes, the patient expired. When nurse was questioned on the cause of death, she destroyed the bottle of injection. She tried to destroy the evidence.
3. It is alleged that the complainant arrived at hospital at 9.25 a.m. and he found that doctor was trying to show a false efforts of reviving the patient by putting the patient on oxygen. During this time, doctor directed the complainant to wait in the Consultation Room for about 15 minutes. The complainant was not informed that his wife expired. Without informing the complainant, doctor called the ambulance to take body of the patient to the complainants house. At 9.45 a.m. complainant was made aware about death of his wife.
Body of the patient was at complainants house at 10.00 a.m. Cause of death was revealed as cardio respiratory arrest. Opponent No.1 took full advantage of the grief stricken atmosphere and did not issue the bed head ticket. The complainant was made to pay total sum of `17,680/- for medical expenses at hospital. Carelessness and negligence of opponent Nos.1&2 led the patient to death.
Complainant issued a notice to opponent No.1 on 13/12/1997. Opponent No.1 denied all the allegations and ignored the request of the complainant about issuance of bed head ticket. Since opponent No.1 refused to issue bed head ticket, the complainant approached to ACASH Voluntary Association. Finally, it was only after the intervention of Police Inspector, opponent No.1 handed over the indoor papers on 24/07/1998. On account of opponent Nos.1&2, on unreasonable acts of harassment and mental torture, the complainant and his family members suffered hardship, mental agony and torture. Opponents are responsible for untimely death of his wife.
Hence, by filing complaint, he claimed compensation of `17,48,680/- from the opponents.
4. Opponents have resisted the complaint by filing written version and denied all adverse allegations against them. It is submitted that the complaint is false and vexatious. The complainant tried to get entangled in litigation for no reason. In fact the complainant is abusing the benevolent legislation of Consumer Protection Act, 1986. The facts placed by the complainant did not show professional medical negligence on the part of the opponents. The facts established that abundant measures were taken by the opponents in treating brain haemorrhage as well as sudden, spontaneous, inherent aspiration caused by sudden extension of brain haemorrhage. Xerox copies of the case papers, documents and material pertaining to the patient were immediately given to the complainant but neither he took copies nor did he pay the bill for hospitalization for next one and half months. The facts of the case that Mrs.Pushpa K. Chaturvedi, aged about 50 years came to the opponents for uneasiness/pain in chest, ghabrahat, headache, sudden weakness in right upper and lower limb. She fell down in the morning and thereafter, there was difficulty in standing. There was past history of hypertension but patient was not on any medication.
Examination revealed upper motor neurone type of hemiparesis on right side. These details and other findings are mentioned in case paper which was handed over to the complainant. On admission to hospital at 8.25 a.m. the opponents diagnosis was acute stroke (sudden brain haemorrhage or infarction i.e. thrombosis) and hypertension on 19/07/1997. Thereafter, patient was treated but she had status epilepticus on 20/07/1997. CAT scan of brain could not be done as patient was not stable. CAT scan of brain was done on 21/07/1997 which revealed venous sinus occlusive disease with venous haemorrhage infarct in left parieto-occipital cortex. The haematoma measures about 3.2 x 2.7 cms. It was very clear that same was causing right upper and lower limb paralysis. Deceased fell down because she had paralysis of right side. Patient was having hypertension, but she was not taking any treatment. For above said problem, she was admitted and treatment was started. The patient was improved a little bit as far as weakness in upper and lower limbs but headache continued till death with varying severity. On 20/07/1997 patient relatives were informed about status epilepticus which is itself a grave prognosis. Subsequently, patient was checked regularly as per the indoor papers.
Queries of relatives were answered.
From 28/07/1997 patient at times used to get drowsiness. Therefore, on request of relatives, opponent No.1-Dr.Narendra Kumar spoke to Dr.A. Ghosh on phone. Dr.Ghosh was satisfied with diagnosis and management. On 01/08/1997 Dr.Narendra Kumar discussed with the relatives and advised to take opinion of Neurophysician. The complainant agreed to this suggestion.
Therefore, Dr.Nirmal Surya was contacted and he gave appointment for 02/08/1997. Dr.Nirmal Surya felt that initially there was improvement and again deterioration. His impression for diagnosis, treatment and management was same that of the opponent. He added oral glycerao. Dr.Nirmal Surya advised MR angiography / follow up CAT scan of brain, Eptoin level, coagulation profile, Serum sodium and potassium. Dr.Nirmal Surya discussed with complainant and relatives. Relatives felt that since patient was improving and the tests were costly, they did not want to do the tests but wished to start the advised medicine by Dr.Nirmal Surya. Continuous headache and sudden drowsiness along with vomiting, vomiting sensation suggested the continuity of disease process. The opponent examined the patient as usual in morning. He informed relatives that patient stopped speaking and had severe perspiration. The opponent-doctor was in the hospital. He examined the patient and diagnosed as aspiration due to extension of brain hemorrhage. He found that patient has stopped breathing. He took immediate resuscitative measures as per standard protocol. When the patient did not start breathing in spite of those efforts she was given injection Hydrocortisone, adrenaline, sodabicarb and simultaneously, opponent-doctor had started intravenous Dobutamine, monitor drip, oxygen and ambu bag respiration. In addition, D.C. Shock was also given along with other treatment.
Opponent-doctor observed that the complainants wife stopped breathing and heart stopped.
Therefore, at abound 9.40 a.m. on 03/08/1997 complainant was called to explain the situation of aspiration causing respiratory and cardiac arrest due to aspiration caused by extension of disease. Deceased was continued to be resuscitated. Opponents mentally explored for various other causes of aspiration. Opponents excluded one by one various causes of aspiration. Meanwhile, all measures like oxygen, intravenous injections, cardiac massage were given to the patient. In spite of all best emergency measures, the patient did not recover. The complainant was explained that medical resuscitative line of treatment is started and patient is serious. Patient went in respiratory and cardiac arrest and became serious.
Resuscitative procedure is ideally done to save life but it is not necessary to save all the patients on whom it is performed. Resuscitation was demanding in skill and care as patient was gravely sick and serious due to aspiration caused due to vomiting, due to extension of basic disease. There is always an element of risk that a brain haemorrhage patient takes of it getting its sudden extension in spite of on treatment which is benefiting her.
The allegation of act of negligence of opponents in causing death of wife of the complainant is incorrect.
She died her natural death and not due to negligence of the opponents. Doctor is supposed to treat with care and same is done. No doctor gives warranty or guarantee for any disease. Doctor had given actual reason of death. Opponents have acted like a prudent doctor with care and skill in providing medical care. The complaint may be dismissed with compensatory cost of `10,000/-.
5. To substantiate the claim of compensation, complainant-Mr.K.J. Chaturvedi led his evidence by filing affidavit. Complainant has also filed an affidavit of Kaushalkishore Chaturvedi, a real brother of complainant-Mr.K.J. Chaturvedi, who is eye-witness.
Opponent-Dr.Narendra Kumar has filed his affidavit in support of his written version. Dr.Kirti R. Patel, Senior Physician and Cardiologist and Dr.Ajmera Parag Champaklal, Senior Physician and Cardiologist, Dr.Sumatichandra H. Doshi, practicing General Physician have filed their affidavits in support of defence of opponent-Dr.Narendra Kumar. Mrs.Anagha Tawade, Nurse, who was on duty at hospital of opponent-Dr.Narendra Kumar has filed her affidavit to prove that opponent-Dr.Narendra Kumar tried his level best to resuscitate the patient i.e. wife of complainant.
Both parties have filed their brief notes of written arguments. We have heard Learned Counsel Mr.C.M. Jha for the complainant and Authorised Representative of the opponents, namely, Dr.Mahesh Baldwa at length.
6. Admittedly, wife of complainant-Mr.K.J. Chaturvedi, namely, Pushpa was admitted at Narendra Hospital for medical treatment on 19/07/1997. She came to opponent No.1 for uneasiness, pain in chest, ghabhrahat, sudden weakness in right upper and lower limb. She fell down in the morning and therefore, she had difficulty in standing with past history of hypertension but she was not on medication.
7. Dr.Mahesh Baldwa, A.R. of the opponents urged that hypertension is a well known silent killer of body. The opponents have filed on record medical case papers. Through medical case papers, it is brought to our knowledge that at relevant examination, BP was found out as 160/90. The patient was conscious. She was having severe headache (throbbing).
Weakness in right upper and lower limb Gr iii/v of upper motor neurone type. On clinical examination of provisional diagnosis of acute stroke leading to right hemiparesis and hypertension due to brain haemorrhage was done. CT Scan of the patient was done at Shreeji C.T. Scan Centre Pvt. Ltd.
The CT features were suggestive of venous sinus occlusive disease with venous haemorrhagic Infarct in the left parieto-occipital cortex. The haematoma measures about 3.2 x 2.7 cms. CT scan Report showed two diseases :-
(a) Venous sinus occlusive disease
(b) Venous haemorrhagic infarct (haematoma) in left parito occipital region. Oedema was also noticed around haematoma.
8. Patient-Pushpa died on 03/08/1997. The material question is whether opponent-Dr.Narendra Kumar was diligent in treating the patient and whether prudent treatment was given to the patient during 19/07/1997 to 03/08/1997?
9. Case papers filed on record show that capsule Nifedepine was prescribed to reduce blood pressure.
Tablet Covasa (perindopril) was given to reduce blood pressure. Capsule Nimodip was given to reduce cerebral Vasospasm. Injection Decadron was prescribed and given to reduce swelling of brain following brain haemorrhage. IV Manitol was given to reduce swelling of bran following brain haemorrhage. Oral Glyceraol was given by the opponent to reduce brain swelling. Tablet Diamox was given to the patient to reduce brain pressure following brain haemorrhage. Tablet Encephabol (pyrinitol) which is brain tonic and increases mental function was also given to the patient. Injection voveran (diclofenac) was given to control headache. Tablet Eptoin (diphynyl hydentoin sodium) and tablet Valparin (valproic acid) were prescribed and given to prevent fit (convulsion). Injection Dizepam (Paxum) was given as convulsion was not under control. To maintain fluid balance in body, IV Dextrose, Isolyte-M was given to the patient during the treatment. Injection Ranitin was given to control acidity and vomiting caused by brain haemorrhage and also to prevent gastric haemorrhage. Injection perinorm was given to stop vomiting.
Injection Clafron and/or Omnatex which is antibiotic was given for prevention of brain haemorrhage.
Capsule Ceftum 500- Antibiotic was orally given when injection Clafron was stopped. Tablet Sennavac was given to avoid constipation.
Ointment Hirudoid was given for application at IV site swelling (thrombophlebitis). Tablet ASA was given so that clot does not form.
Capsule Nutrolin B was given to prevent diarrhea as oral broad spectrum antibiotic. Capsule Zebex T is a tablet of vitamine which was prescribed. Injection Beplex was given for general weakness. Syrup B.G. Prot was given to the patient as a tonic.
10. Nothing is brought on record by the complainant to prove that the treatment given by the opponent-Dr.Narendra Kumar to the patient-Pushpa, wife of the complainant was incorrect or against the standard protocol of medicines. On the other hand, record shows that reference was made to Dr.Nirmal Surya. Dr.Nirmal Surya examined patient-Pushpa on 02/08/1997. Dr.Nirmal Surya continued the same treatment given by opponent-Dr.Narendra Kumar to the patient. No new medicines or drugs were started by Neurophysician. No medicine started by opponent-Dr.Narendra Kumar was stopped.
11. Witness Dr.Kirit R. Patel, Senior Physician and Cardiologist, Dr.Ajmera Parag Champaklal, Senior Physician and Cardiologist and Dr.Sumatichandra H. Doshi, General Physician had gone through the xerox copies of indoor case papers pertaining to patient-Pushpa, wife of the complainant. They found that Dr.Narendra Kumar managed patient-Pushpa with proper medical line of treatment. Patient is correctly treated for brain haemorrhage. Accordingly, all the three expert-doctors have filed their affidavits and submitted on solemn affirmation that opponent-Dr.Narendra Kumar treated the patient with proper skill and care. Nothing is brought on record to find out the fault in the treatment and medicines given by the opponent-doctor to the patient.
12. Opponent-Dr.Narendra Kumar is a qualified doctor. He passed his M.B.B.S. in 1975 and M.D. in 1978. He worked as Research Associate in Bombay Hospital under Dr.K.K. Datey in Department of Cardiology for around three years. Since 1979 Dr.Narendra Kumar is practicing as Consulting Physician and Cardiologist at Borivali (East), Mumbai. He has completed 21 years of practice. In short, opponent-Dr.Narendra Kumar is an expert and experienced doctor in medical field.
13. It is unfortunate that wife of the complainant lost her life on fateful day i.e. on 03/08/1997.
Case papers make it clear that the patient was attended and treated by opponent-Dr.Naredra Kumar from time to time since her admission till her death at the hospital. The patient was regularly checked by opponent-Dr.Narendra Kumar. Deceased Pushpa was improved little bit far as weakness in upper and lower limbs but it is pointed out by opponent-doctor that headache was continued till death with varying severity. On 20/07/1997 patient relatives were informed about status epilepticus which is itself a grave prognosis. On 28/07/1997 patient was used to get drowsiness.
Opponent-Dr.Narendra Kumar discussed with the relatives who advised to take opinion of Neurophysician.
On suggestion of the relatives, Neurophysician Dr.Nirmal Surya was called to examine the patient.
Dr.Nirmal Surya advised MR angiography / follow up CAT scan of brain, Eptoin level, coagulation profile, Serum sodium and potassium. Relatives thought that patient was improving. They did not want to do the tests as the tests were costly but advised to start the medicines prescribed by Dr.Nirmal Surya.
14. On fateful day, patient was seen and examined by opponent-Dr.Nrendra Kumar in the morning.
Relatives talked with the patient.
Morning doses of medicines were given as usual. Injection Dexamethasone was injected at 9.00 a.m. which was used to give many times during the hospital stay. At about 9.15 a.m. patient stopped speaking and had severe perspiration.
At the relevant time opponent-Dr.Narendra Kumar was in the hospital itself. He examined the patient and diagnosed as aspiration due to extension of brain haemorrhage. His written version on affidavit shows that he found that the patient stopped breathing. So, the opponent had taken immediate resuscitative measures as per standard protocol. The patient had aspiration and stopped breathing. Emergency medicines, oxygen, ABC, suction, cardio pulmonary resuscitation, D.C. shock, etc. were tried approximately for 45 minutes.
There was no response. The patient was declared dead at 10.00 a.m.
15. Opponent has filed on record medical literature on brain haemorrhage and medical literature on aspiration pneumonia. It shows that Mephentine, Hydrocortisone, Adrenaline, Dobutamine Drip and Soda Bai Carb are emergency drugs which were used to save life of patient on 03/08/1997.
16. In the instant case, no expert witness is examined by the complainant to prove medical negligence of the opponents. The material placed before the Commission is not sufficient to prove professional medical negligence on the part of the opponents. On the other hand, line of treatment and other established facts prove that the abundant measures were taken by the opponent-doctor in treating brain haemorrhage as well as sudden, spontaneous, inherent aspiration caused by sudden extension of brain haemorrhage. The patient was admitted on 19/07/1997 for paralysis on right side due to intra cerebral haemorrhage. She died in Nursing Home due to aspiration in lungs due to extension of intra cerebral haemorrhage on 03/08/1997. Deceased was continued to be resuscitated and opponents had explored for various other causes of aspiration were excluded one by one.
17. In the process of exercise of excluding causes of aspiration, the opponents had examined the vial of injection. The vial was dexamethasone. Dexamethasone is not known to cause aspiration. The opponents did examination to confirm before starting resuscitation that aspiration was due to vomiting which in turn was due to extension of disease because clinical examination was shown that the right upper and lower sides were simply limp as against left side.
Opponents had taken care, made efforts to save life of patient with skill and care. Evidence affidavits of Dr.Kirit Patel, Dr.Parag Ajmera and Dr.Sumatichandra Doshi prove that opponent-doctor acted as a prudent doctor and used skill and knowledge of reasonable standard in handling the patient. It appears that resuscitation is the indication for aspiration due to extension of brain haemorrhage.
18. It is urged on behalf of the opponents that extension of brain haemorrhage occurs in as many as 13.7 to 50%. It is observed by various authorities at various large hospitals in India in series of studies. The complication of aspiration accounts for 6.7% cases of extension of brain haemorrhage in mortality of brain haemorrhage. If opponents would have been faulted for giving incomplete treatment to the patient, even after knowing that when there was aspiration due to extension of brain haemorrhage, then opponents would have been charged with negligence caused by act of omission. There is always an element of risk that a brain haemorrhage patient takes of it getting its sudden extension in spite of treatment which benefiting her.
19. The line of treatment given by the opponents was perfectly correct right from the beginning.
The right treatment was continued till the unfortunate death of wife of the complainant. The aspiration was developed due to natural and spontaneous reasons and beyond the control of the opponent-doctor. Nothing is on record to suggest that treatment given by the opponents was scientifically wrong. The treatment was given knowledgeably and skillfully.
The opponent-doctor has taken due care while treating the patient. There was no negligence on the part of the opponents at any stage of treatment from start till the unfortunate death of patient-Pushpa.
20. The test of medical negligence is laid down in the case of Bolam V/s. Friern Hospital Management Committee, reported in [1957] 1 WLR 583, has been unanimously accepted. The following principles have been laid down while deciding said case :-
"A doctor/medical professional is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.
21. In view of above discussions, we are of the opinion that the complainant failed to prove medical negligence on the part of the opponents to brand deficiency in service. In our view the complaint is liable to be dismissed. Hence, we pass the following order :-
-:
ORDER :-
1. Consumer complaint stands dismissed.
2. Parties to bear their own costs.
3. Copies of the order be furnished to the parties.
Pronounced Dated 28th October 2013.
[HON'ABLE MRS. Usha S.Thakare] PRESIDING MEMBER [HON'ABLE MR. Narendra Kawde] MEMBER dd.