State Consumer Disputes Redressal Commission
Ram Dhan vs Noida Medicare Centre Ltd on 20 March, 2006
IN THE STATE COMMISSION : DELHI IN THE STATE COMMISSION : DELHI (Constituted under Section 9 clause (b)of the Consumer Protection Act, 1986 ) Date of Decision: 20th March, 2006 Complaint Case No.C-564/93 (1) Shri Ram Dhan Complainant No.1 S/o Late Sh. Jagat Ram. In person. (2) Shri Chander Kant Complainant No. 2. S/o Sh. Ram Dhan. (3) Shri Surya Kant Complainant No. 3. S/o Sh. Ram Dhan. (4) Ms. Rajni Complainant No.4. D/o Sh. Ram Dhan. All R/o 537, Sector 14, Gurgaon (Haryana)-122 001. Versus (1) M/s Noida Medicare Centre Ltd. Opposite Party No.1 16-C, Sector 30, NOIDA-201 303, Uttar Pradesh. (2) Dr. Harsh Jauhri, Opposite Party No.2 R/o R-826, New Rajinder Nagar, New Delhi-110060. (3) Dr. Ashok Kumar Opposite Party No. 3 R/o A-2/167, Safdarjang Enclave, New Delhi-110029. CORAM : Justice J.D. Kapoor- President Ms. Rumnita Mittal- Member
1. Whether reporters of local newspapers be allowed to see the judgment?
2. To be referred to the Reporter or not?
JUSTICE J.D. KAPOOR, PRESIDENT (ORAL) This is a case of medical negligence arising out of transplant of kidney. Kidney was transplanted at the Noida Medicare Centre of the OP. On account of deficiency in service and medical negligence on the part of the OPs in not properly carrying out the kidney transplant operation due to which the patient expired, the following reliefs have been claimed :-
a) Grant an award in the sum of Rs. 20 lacs to be paid jointly and severally by Noida Medicare Centre/Dr. Harsh Jauhri/Dr. Ashok Kumar, which award may be made jointly in favour of petitioners. Break-up of Rs. 24 lacs though claim is confined to Rs. 20 lacs is as under:-
(i) Book expenses incurred in procuring - Rs.
36,000.00 the Kidney.
(ii) Book expenses in obtaining the -
Rs. 5,000.00 report from National Heart Institute.
(iii)Book expenses incurred towards -
Rs. 2,20,224.00 the bill of NMC.
(iv) Expenses towards transportation etc.- Rs. 50,000.00
(v) Overhead expenses not reflected - Rs. 1,00,000.00 in the aforesaid bill.
(vi) General and special compensation -Rs.20,00,000.00 claims towards the individual claim of the petitioners No. 1 to 4. _______________ Total -Rs.24,06,229.00 ============
b) Award interest @ 10% with quarterly rests on the amount of the award from the date of the institution of the present proceedings till the date of realisation of the award claim.
c) Costs of the present proceedings, and in that behalf.
d) Pass/make such orders and/or directions as this Honble Commission may deem fit and proper in the facts and circumstances of the present case.
2. Allegations giving rise to this complaint in brief are like this. The deceased patient Mrs. Saroj Sharma was admitted to the All India Medical Sciences (AIIMS) in November 1992. The patient was diagnosed of suffering from renal problem and was recommended a kidney transplant by the Doctors of AIIMS. As a suitable kidney from a blood relative was not available the surgery could not be undertaken in AIIMS (as it was against the AIMS rules). Under the circumstances, the complainant contacted OP No.2 i.e. Dr. Harsh Jauhri, who was a kidney transplant surgeon. The complainants were advised by the OP No.2 that the patient should be brought to the Noida Medicare Centre(i.e. NMC).
3. The kidney transplant surgery was conducted on December 28, 1992 in the NMC by OP No.2 and OP No.3 (the first surgery). Immediately after surgery i.e. on December 29, 1992 unusual bleeding was noticed. The patient was rushed to emergency ward. The patient was again operated upon on December 29, 1992 (second surgery). On January 12/13, 1993 the kidney in question got burst and the patient had to undergo another surgery (third surgery). The patient had to undergo another operation on January 14, 1993 (fourth surgery). The patient had to undergo surgery on her left arm for preparation of shunt on January 16, 1993 (fifth surgery). On the same night, the patient had to undergo another surgery since the bleeding was continuously noticed from the stitching (sixth surgery). The patient was again operated on January 22, 1993 (seventh surgery). The patient developed infection which had already developed and which seemingly went out of control resulting in artery getting burst leading to profuse bleeding like that of a shower and had to undergo yet another surgery on January 30, 1993 (eighth surgery). The patient was operated upon on the left leg for preparing a shunt on February 2, 1993 (ninth surgery). This operation was unsuccessful and a fistula was made on the patients hand.
4. On the night of February 14, 1993 the left leg shunt burst leading to profuse bleeding. The patient was subjected to yet another operation on February 27, 1993 (tenth surgery). On March 1, 1993 a Luman Cathetiar Subelavian Femoral was inserted in the patients neck. The patient was discharged on March 3, 1993. It is further pertinent to mention here that during aforesaid period 70 bottles of blood was transfused into the body of the patient. The patient was taken to Sir Ganga Ram Hospital and first dialysis was conducted on March 5, 1993. The patient died on March 9, 1993 during the second dialysis.
5. The long chain of circumstances, sequence of events referred below have been held by the complainant as a gross medical negligence causing death of an otherwise healthy woman:-
(i) Other than the tests referred to above, Dr. Harish Jauhri or NMC got no other tests performed including such tests as tissue matching of the patient/deceased and the donor for the purpose of deciding the compatibility of the kidney of the donor.
(ii) The operation of kidney transplant was carried out in the operation theatre which was also used by NMC and its doctors including Dr. Harish Jauhri and Dr. Ashok Kumar for other general surgery purposes.
(iii) The said operation was conducted in a negligent and in an unprofessional manner without keeping regard to the requirements of medical standards.
The sterilization of the operation theatre was not properly performed. For the purpose of conducting an operation of kidney transplant, in which the patient is given extensively high doses of immuno-suppressant drugs, the patient is extremely vulnerable and susceptible even to the slightest exposure to infection and therefore the operation theatre should be absolutely and completely disinfected by appropriate fumigation process for which purpose the operation theatre should remain totally closed for a minimum duration of eight hours.
(iv) The operation (the 1st one) which normally lasts for about two to three hours was unduly and unusually long and the patient/deceased was ultimately wheeled out after about 10 to 11 hours.
(v) OP No.3 Dr. Ashok Kumar who was the Chief Nephrologist, was responsible for the build up of the patient/deceased and also for post-operative management. The patient/deceased on being wheeled out after the operation was then taken to the K.T.U. (Kidney Transplant Unit) which is supposed to be totally sterile and infection free.
(vi) On the night of 28th December 1992 itself immediately after the operation the patient/deceased was in great distress having breathlessness, fluctuation of blood pressure and was not passing any urine. Immediately after the operation when the above condition of the patient/deceased was drawn to the attention of the doctors at NMC as also Dr. Harish Jauhri and Dr. Ashok Kumar they stated that the problems were arising on account of large size of the donors kidney; and that the abdominal cavity of the patient/deceased was not enough to accommodate the said kidney.
They also stated that the donors kidney had two arteries, which did not match the requirements of the patient/deceased.
(vii) Thus firstly it was not the right kidney of the donor which had been donated but the left kidney which kidney as is not only very well known but was also clear from the various tests of the donors kidney had only one artery; and secondly quite apart from the fact that the size of the kidney is much too small as compared to the abdominal cavity, which abdominal cavity can accommodate far great volumes, the aspect of the size of the donors kidney should have been assessed by Dr. Harsh Jauhri during the pre-operative ultra-sound and other procedures of the donor and the patient/deceased so as to ascertain the suitability of the donors kidney.
(viii) The petitioners were informed that the highly excessive bleeding was due to the breakdown of the suturing of two blood vessels, which was due to the faulty and wrong operative techniques adopted by Dr. Harsh Jauhri and Dr. Ashok Kumar. Thereafter the patient/deceased was brought back to K.T.U. and she continued to suffer from bleeding and discharge of puss. The transplanted kidney was apparently not functioning since hardly any urine was being passed by the patient who had to continuously undergo hemo-dialysis which would not have been required had the operation(s) been successful.
(ix) It is clear that not only had the operation(s) been performed negligently, carelessly and in complete breach of expected standards of medical proficiency and in a deficient manner, but also the management of the operation together with the post-operative management were deficient.
(x) The transplanted kidney in question burst on the night of 12th 13th January 1993 prior to which for a period of two days the patient/deceased had been complaining intolerable pain. On account of bursting of the kidney the patient/deceased suffered profuse bleeding and had to be once again rushed to the operation theatre during which operation (the third one) the transplanted kidney was removed. The said operation of 12th 13th January 1993 could not check the bleeding for which purpose the patient/deceased had to undergo another operation on 14th January 1993 (the 4th one).
On 16th January 1993 the patient/deceased underwent a surgery (the fifth one) on her left arm for preparation of shunt which shunt got immediately blocked for which another shunt was made. On the night of 16th January 1993 the patient/deceased had to undergo another emergency surgery (the 6th one).
(xi) The operation done on 28th December 1992 had thus proved to be quite clearly unsuccessful and a glaring failure andDr. Harsh Jauhri sensing the complications of the case mounting on account of his blunders and errors, performed yet another operation (the 7th one) on the patient/deceased on 22nd January 1993 during which operation he clamped the main artery (Rt. Illac artery) resulting in the cutting off of the supply of the blood from the main artery to the right leg of the patient/deceased. Despite the patient/deceased Rt. Illac Artery being clamped on 22-1-1993 she had profuse bleeding from the operative site which shuldn't have occurred in the above clamping had been done properly which bleeding hence necessitated further surgery(s).
(xii) The infection which had already developed and which had now seemingly gone out of control resulted in the said main artery getting burst on 30-1-1993, leading to profuse bleeding like that of a shower, and the patient/deceased had to undergo yet another surgery (the 8th one). The second shunt which had been prepared by Dr. Ashok Kumar on the left arm of the patient/deceased once again got blocked and this time on 2nd February 1993 the patient/deceased had to undergo another surgery (the 9th one) on the left leg for preparing a shunt.
(xiii) The shunt prepared on 2nd February 1993 too was not successful and a fistula was made by Dr. Ashok Kumar on the patient/deceaseds right hand on 9-2-1993 which also became blocked before becoming operational. On the night of 14th 15th of February 1993 the left leg shunt burst leading to profuse bleeding. The fistula and shunt prepared by Dr. Ashok Kumar were made in such a negligent manner that instead of a normal expectation to work for considerable period, these shunts rarely worked for even a day.
(xiv) Since there was no arrangement for dialysis, and as the kidney transplant operation had also been a total failure, the patient/deceased was given dialysis by inserting a cannula in her thigh for every dialysis. The patient/deceased was subjected to yet another operative surgery (the 10th one) 27-02-1993 when a fistula was prepared by Dr. Harish Jauhri/Dr. Ashok Kumar on her left arm and secondary suturing was done.
(xv) OPs-NMC, Dr. Harish Jauhri and Dr. Ashok Kumar knowing fully well that they had milched the cattle dry and knowing that the patient/deceaseds survival chances are nil, discharged her on the afternoon of 3rd March 1993 despite the patient/deceased being in a very precarious condition having continuous bleeding, discharge of puss, non-functional shunt and fistula and the patient/deceased being far from stable. It is strange that the patient/deceased was discharged from NMC even when dialysis facilities were available at NMC, and Dr. Harish Jauhri and Dr. Ashok Kumar knew fully well that the patient/ deceased would have to travel to to Sir Ganga Ram Hospital/NMC for the purpose of dialysis, which travel would expose her to greater risks of infection and also since the patient/ deceased would now be an out-patient, dialysis facilities could not be made available to her because of leading to building-up of waste products.
(xvi) The fistula made by Dr. Harish Jauhri had also got blocked and all these circumstances ultimately led to the death of the patient/deceased on 9-3-1993 even before the dialysis could be completed (xvii) The state of the health of the patient/deceased can be well gauged by the reasons given in the Death Certificate given by the doctors at Sir Ganga Ram Hospital, who certified that the patient/deceased had died due to Septicaemia, which means the presence of infection in the blood.
6. While absolving themselves from the charge of medical negligence and resisting the allegations of the complainant the OPs have come up with the following version:-
(i) All relevant tests were performed. Tissue matching test is one of the tests, but it is not mandatory and its role is controversial especially in India where often only a single suitable live donor is available. The important test is Final Tissue Cross Match which was done. The Renal Angiography of donor was advised. The complainant got Renal Angiography performed at National Heart Institute. In the report given by National Heart Institute there was only one Artery on left kidney.
(ii) That all prescribed procedures for sterilization of the Operation Theatre were carried out. The Operation Theatre is a twin Operation Theatre. The Operation Theatre is sealed in the evening so that no other case precedes it. In the instant case, every care was taken. As such, the allegation is false, concocted, malafide, malicious and motivated.
(iii) It is wrong that operation finished after nine hours. Operation finished much earlier. However, for the patient to recover anaesthetic drug time was also jotted down by the Chief Anaesthetist and after the patients recovery from anaesthesia, the patient was kept in the recovery area which may have taken 1-2 hours and the time taken for the procedure is well recorded in the notices of the operation.
(iv) The Operation team at NMC consists of the following well qualified, experienced and renowned doctors:
1. Dr. Harsha Jauhari Surgeon
2. Dr. Ajit Saxena Surgeon
3. Dr. S.Sharma Surgeon
4. Dr. Meenakshi Surgeon
5. Dr. K.J. Chaudhry Anaesthetist
6. Dr. S. Chaudhry Anaesthetist
7. Dr. Kumar Anaesthesian
8. Dr. Ashok Kumar Chief Nephrologist
9. Dr. Sanjay Wadhavan Transplant Physician
(v) The angiography report showed two arteries on the right side and one on the left side. In any case the left kidney is always preferred for donation for technical reasons and the angiography report made it easier to select the left side. While angiography is a highly accurate investigation, it is not infallible and false negatives are known i.e. vessels can be missed.
In any case, it is reporting of an image and cannot replace visual inspection of a kidney at the operating table.
(vi) The angiography was performed in a separate hospital by a separate set of doctors.
The complainant went to National Heart Institute of his own volition for Renal angiography. A surgeon has to deal with the situation as he actually finds it and not as he has been led to a belief on a report. There were two arteries on the left side, which unfortunately had not read the angiography report that one of them did not exist. These arteries were found and had to be dealt by the surgeon team.
(vii) The comment about the size of the kidney is that the kidney was large and while in a female pelvis there is usually adequate room the disparity can sometimes make it difficult technically to close the abdomen. The kidney is placed deep into the abdominal muscles outside the patients peritoneal cavity, in a space created for it by the surgeon and is not free floating in the abdominal cavity, but limited in movement by the length of blood vessels and ureter available to be placed just right, failing which various problems may occur. All relevant assessments were made suitably.
(viii) The patient obviously was stable and that there was no apparent danger or distress otherwise the patient would surely have been advised admission on urgent basis at the hospital. The fistula got blocked but that in no way contributes to the death of the patient.
The death happened due to some other reasons or negligence of patient.
(ix) It is false to say that as many as 10 surgeries on the body of the deceased were performed. First surgery was performed when the kidney transplant took place. On the morning of 29th December (i.e. 24 hrs after 1st surgery) bleeding was noticed at drain site. The patient was rushed to the O.T. and relatives were asked to arrange blood (4 bottles). During operation a small superficial rent was found in the convex body of the kidney close to where the plastic drain tube would have been lying and for that purpose second operation was done. The wall of the kidney was ruptured from the other place and this necessitated for the third operation. The so called fourth operation was performed merely for removing the clot which was evidence of superficial haematoma which means that there was a clot underneath skin on the superficial layers. Fifth operation was for making of a shunt for the purpose of dialysis for administering drugs. Sixth surgery was performed as the earlier shunt got blocked and the patient required access for dialysis. Seventh surgery was necessitated to make the right ext. iliac legated to exclude the renal stump and there was no loss of limb or need to augment blood supply.
Eighth surgery was nothing but an effort for the preparation of new shunt, which had been blocked, which had been made in the fifth so called alleged operation. Ninth surgery was also for the same purpose and the last tenth surgery was for making fistula in order to facilitate the dialysis etc. Thus in nutshell there were only three major surgeries and rest were only for making the shunt for the purpose of dialysis which otherwise was not possible.
(x) The four main surgeries and four accessory surgeries were necessitated in view of the report given by the National Heart Institute which are to the following effect:-
Summary of findings:
1.
Normal aortic pressure.
2. Abdominal aortography revealed ;
-
Normal abdominal aorta.
-
Normal right and left renal artery and right accessory renal artery.
3. Selective right renal angiography:
-
Right renal artery has divided into two branches immediately after origin.
-
There is accessory right renal artery supplying the lower venous phase.
Selective left renal angiography:
Normal left renal artery & its branching pattern. Normal arterial, nephroghenic and venous phase.
Final comment:- Normal right & left artery.
-
Accessory right renal artery.
7. Thus according to the Counsel for the OP the main allegation of the complainant is that two arteries were there when the patient was operated upon but in actuality one artery was found when angiography was taken and when on operation two arteries were found in the donors kidney the complainant was informed and as per medical practice the OP adopted the standard procedure in transplanting the kidney. The medical opinion or literature in this regard has been culled out by the counsel for the OPs from the National Library of Medicine and the National Institute of Health. The relevant opinion is as under:-
Vascular imaging should be performed after all the investigations have confirmed the suitability of the donor. Multiple arteries to one or both kidneys of the potential donor are not uncommon. They are associated with higher incidence of thrombosis, acute tubular necrosis and urinary fistulae but they do not influence the graft or recipient survival rate. If both kidneys have single artery, the left kidney is performed because of its longer vein. Early branching, short arteries make the nephrectomy difficult. Donor with multiple arteries can be accepted based on the experience and skills of the surgeon and the donor and recipient should informed about the increased risks.
Two alternate imaging techniques (spiral CT angiogram and MR angiogram) are gaining wider acceptance because they are non-invasive, do not require any hospital stay, less expensive and provide better images of the venous system, which is helpful to surgeons performing laparoscopic nephrectomy. The multi-detector CT scanners provide better images with reduced scanning time and radiation. Particular advantage of MR angiogram is that it can be used in donors with contrast allergy.
8. Fortifying the aforesaid opinion the Counsel for the OPs has also relied upon the Kidney Transplantation Principles and Practice by Peter J. Morris which is to the following effect :-
Although it is technically reasonable a to transplant kidney with multiple arteries, a kidney with a single artery is preferable. When either kidney is shown to be satisfactory, the left is usually chosen because the longer renal vain contribute to the technical ease of the nephrectomy and subsequent transplant.
9. The Counsel for the OPs has also placed reliance upon the angiography report submitted by the complainant showing that right kidney has two arteries, left kidney was shown to be normal with one artery and acting upon this report the OP doctor started operating upon the patient and it was during the process of operation that two arteries on the left side were found as the possibility of both the arteries not being seen in the photograph cannot be ruled out as it is difficult from the photograph to decide whether one artery or two arteries existed.
10. As to the allegation of nine surgeries, the counsel has contended that on 29-12-1992 there was bleeding which was found after the transplat and had the second operation not been conducted the patient would have died due to bleeding. Bleeding happened because of rupture of the kidney. Third operation was done after 13 days of the second surgery because the kidney was rejected. In this regard the Counsel for the OP relied upon the report of USC Kidney Transplant Programme which isto the following effect:-
Postoperative Complications:
Rejection This happens when your bodys immune system thinks your new organ is foreign and attempts to destroy it. You will take immunosuppressive medications for the rest of your life to prevent rejection.
11. Several types of rejections have been enumerated in the said journal. Some of which are Hyperacute rejection, acute rejection, Chronic rejection, Diabetes and Acute Tubular Necrosis.
Rejection may happen within days of transplantation and therefore the OP just undertook the transplant surgery.
It did not ensure that he has given 100% surety that the kidney will function. Rejection itself is an unhealthy phenomena. So called 4th operation was done because the kidney was rejected and removed and it became necessary to put the patient on dialysis and therefore shunt was made on 16-1-1993. Shunt is prepared in the manner described in Kidney Failure Chosen treatment Thats Right for you as under:-
The two main types of access are a fistula and a grant:
A surgeon makes a fistula by using your own blood vessels; an artery is connected directly to a vein, usually in your forearm. The increased blood flow makes the vein grow larger and stronger so that it can be used for repeated needle insertions. This is the preferred type of access. It may take several weeks to be ready for use.
A graft connects an artery to a vein by using a synthetic tube. It doesnt need to develop as a fistula does, so it can be used sooner after placement. But a graft is more likely to have problems with infection and clotting.
12. While making the shunt certain complications arise that have been discussed in the above referred journal/book. According to the Journal common problems include infection, blockage from clotting and poor blood flow. The patient may need to undergo repeated surgeries in order to get a properly functioning access. According to the counsel the patient in question was having high urea in the body and therefore she was prone to infection and the complications referred to above. Cause of its infections is the external alive artery which had to be plugged with the femur.
13. Ld. Counsel further contended that on 22-11-93 the last so called surgery was done and the patient was discharged on 03-03-1993 i.e. after one month and six days when the patient was doing daily routine, going to the toilet and the wound was in the process of healing when the patient started asking and planning for a re-transplant. At this stage at the request of the patient on 3-3-93 she was only required to undergo dialysis till the next transplant and since Ganga Ram Hospital was the nearest convenient place she opted for Ganga Ram Hospital. First dialysis was done on 5-5-93 at Ganga Ram Hospital. Till that dialysis no problem was there and patient was advised for another dialysis on 7-3-93 which she missed and as a result died on 9-3-93.
14. While referring cause of death Ld. Counsel contended that it was shown in the death certificate as septicaemia whereas the complainant is now making allegation that at the time of first operation proper sterilisation was not done resulting in septicaemia. Such type of operations are prone to get septicaemia as is evident from the medical literature which is know as Patients Guide to Kidney Transplant Surgery. There are several precautions which the patient is required to take like washing hands often, keep hands away from face and mouth, stay away from people with colds or other infections, as friends to visit only when they are well, if the patient has a wound and must change his own dressing, wash hands before and after, etc. etc.
15. Thus, according to the counsel while we apply the criteria for determining the medical negligence the OP can no way be held negligent in either performing the first surgery and subsequent surgeries. These tests have been laid down by the Supreme Court in Jacob Mathew Vs. State of Punjab (2005) 6 Supreme Court Cases 1 which are as under:-
A person who holds himself out ready to given medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for that purpose. Such a person when consulted by a patient owes him certain duties viz. a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to be given or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence, judged in the light of the particular circumstances of each case, is what the law requires. The doctor no doubt has a discretion in choosing the treatment which he proposes to give to the patient and such discretion is relatively ampler in cases of an emergency.
16. According to the learned Counsel as far as skill is concerned the OP doctor was possessed with requisite degree and experience and as far as standard norms of performing the operation or transplantation of kidney is concerned the OP has performed its duty as per medical guidance and literature produced and referred above and therefore allegation on behalf of the complainant as to what kind of care was not taken or what kind of negligence occurred at the hands of the OP doctor does not stick.
17. After according careful consideration to rival contentions of the parties and facts and circumstances of the case, medical literature we find that the following circumstances demonstrated medical negligence on the part of the OPs:-
(i) OPs state that the complications after the first surgery arose because of the presence of two renal arteries in the donors kidney as against one reflected in the angiography test. The angiography test is a highly correct test and there arises no situation in which an apparent assessment as to the number of arteries can be wrongly made in the said test. Assuming that that the donors kidney had two arteries, OPs should have abandoned the operation being fully aware of the complications that may arise as a result of the same.
(ii) OPs state that the complications after the first surgery arose due to the large size of the donors kidney. The size of the donor kidney is not a major consideration since the potential space above the groin where a kidney is transplanted can accommodate a normal kidney of any size irrespective of the size of the recipient. If at all OPs had found any abnormalities with the donors kidney then they should have abandoned the operation.
(iii) Normally a transplant operation shall not last more than two hours whereas the first surgery followed by subsequent surgeries lasted unreasonably for ten to eleven hours which were result of medical negligence in allowing the transplantation of abnormally large size of kidney and not abandoning the operation when two arteries in donors kidney were found.
(iv) After the first surgery the patient exhibited symptoms of infection and on the same night after the surgery there was profuse bleeding due to the deficient and negligent operation performed during the first surgery. The patients body may reject the kidney at any time after the transplant but that was not the situation in the instant case.
Right after the operation itself she was not stable and in the night started bleeding profusely due to a rupture in the kidney and not because the body had rejected the kidney in normal course.
(v) When OPs found that the body had rejected the kidney they should have removed the faulty kidney rather than trying to correct the earlier wrongs done. It is an established fact that if the first transplant fails, there may be subsequent transplants but OPs chose to carry on with the failed transplant which worsened the condition of the patient. To say that the decision of repairing the kidney during the second surgery was taken with the consent of the complainants is gross act of deficiency as OPs allowed the insistence of a layman to override the medical need.
(vi) OPs continued to act with negligence after the second surgery, when the bleeding and puss did not stop. As a result of continuous bleeding the patient was again transferred to the KTU but no action was taken for the removal of the rejected kidney.
OPs did not act until the kidney burst fifteen days after the surgery, when the third surgery was performed.
Even the third surgery failed to check the bleeding and the fourth surgery had to be conducted to remove a blood clot.
(vii) Negligence and deficiency is further projected by the fact that the various shunts prepared by them kept getting blocked leading to other surgeries.
(viii) The OPs admit that the wound had developed infection and there was profuse bleeding on January 30, 1993 when the eighth surgery had to be performed.
The patient was subjected to the tenth surgery on February 27, 1993 when OPs prepared a fistula on her left arm and secondary suturing was done. On March 1, 1993 Luman Cathetiar Subclavian Femoral was inserted in patients neck, which intermittently worked and also got chocked. This shows that the patient was not in stable condition. The patient was suffering from repeated haemorrhage and infection and her urea was also very high. Thus the body immunity of the patient was very low as immuno-supressant drugs were being administered. The patient was discharged on March 3, 1993 and she died on March 9, 1993.
(ix) The Death Certificate reveals the cause of death to be septicaemia, which is cause due to infection. The patient exhibited symptoms of infection right after the first surgery. The discharge summary of Noida Medical Centre also reflects that the patient suffered from infection.
18. Having held the OPs guilty for medical negligence in hurrying with the transplant of a kidney by a donor who was not a blood relative and whose kidney was of abnormally large size and was not transplantable in the body of the patient and also continuing with the operation inspite of having detected two arteries in the left kidney as these two factors resulted in the death of the patient as major surgery was followed by as many as nine surgeries we deem that compensation of Rs. 2,00,000/- (Rupees Two Lacs) payable jointly and severally by the OPs shall meet the ends of justice. We further award Rs. 20,000/- as cost of the complaint and proceedings. These payments shall be made within one month.
19. Complaint is disposed of in aforesaid terms.
20. A copy of this order as per the statutory requirements, be forwarded to the parties free of charge and also to the concerned District Forum and thereafter the file be consigned to Record Room.
Announced on 20th March, 2006.
(Justice J.D. Kapoor) President (Rumnita Mittal) Member jj