State Consumer Disputes Redressal Commission
Gaurav Gaur S/O Shri H.R.S.Gurav vs M/S Parshvnath Developers Ltd. on 8 March, 2018
jkT; miHkksDrk fookn izfrrks"k vk;ksx] cSap la- 2 t;iqj ¼jkt-½ 1& ifjokn la- 34@2015 Gaurav Gaur S/o Shri H.R.S. Gaur, R/o Flat No. RF-4, Konark Oasis, Alwar Bye Pass Road, Bhiwadi, District Alwar (Rajasthan.) Presently Residing at - 26, Settlers Court, 17 New port Avenue, London-E-14 2DG, Through Power of Attorney Holder H.R.S. Gaur S/o Late Shri K.S. Sharma, R/o Flat No. RF-4, Konark Oasis, Alwar Bye Pass Road, Bhiwadi, District_Alwar (Rajasthan.)
-----Complainant.
Versus 1- M/s Parsvnath Developers Ltd., A Company Incorporated under Companies Act, 1956 And having its Registered Office At - 6th Floor, Arunachal Building, 19 Barakhamba Road, New Delhi - 110001, through its Director.
2- Pradeep Kumar Jain, Chairman, M/s Parsvnath Developers Ltd., 6th Floor, Arunachal Building, 19 Barakhamba Road, New Delhi - 110001.
3- Rajeev Jain, Director Marketing, M/s Parsvnath Developers Ltd., 6th Floor, Arunachal Building, 19 Barakhamba Road, New Delhi - 110001.
4- Sanjeev Kumar Jain, M.D. & C.E.O., M/s Parsvnath Developers Ltd., 6th Floor, Arunachal Building, 19 Barakhamba Road, New Delhi - 110001.
----- Non Complainants.
2& ifjokn la- 35@2015 Garima Gaur W/o Shri Gyan Ranjan Singh, R/o Flat No. RF-4, Konark Oasis, Alwar Bye Pass Road, Bhiwadi, -2- District Alwar (Rajasthan.) Through Power of Attorney Holder H.R.S. Gaur S/o Late Shri K.S. Sharma, R/o Flat No. RF-4, Konark Oasis, Alwar Bye Pass Road, Bhiwadi, District_Alwar (Rajasthan.)
-----Complainant.
Versus 1- M/s Parsvnath Developers Ltd., A Company Incorporated under Companies Act, 1956 And having its Registered Office At - 6th Floor, Arunachal Building, 19 Barakhamba Road, New Delhi - 110001, through its Director.
2- Pradeep Kumar Jain, Chairman, M/s Parsvnath Developers Ltd., 6th Floor, Arunachal Building, 19 Barakhamba Road, New Delhi - 110001.
3- Rajeev Jain, Director Marketing, M/s Parsvnath Developers Ltd., 6th Floor, Arunachal Building, 19 Barakhamba Road, New Delhi - 110001.
4- Sanjeev Kumar Jain, M.D. & C.E.O., M/s Parsvnath Developers Ltd., 6th Floor, Arunachal Building, 19 Barakhamba Road, New Delhi - 110001.
----- Non Complainants.
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;kno@& Brief facts of this complaint are that complainant's wife was brought to Daksh Hospital which is owned by Dr. Monika Gupta and Dr. Mukesh Gupta (OP no.1&2) on 8/11/2012 when she felt labour pains. She was admitted to the hospital at about 9.15 AM. Dr.Monika Gupta examined her and found that mouth of uterus had not fully opened and necessary medicines were administered for the purpose of delivery.In the evening at 5.39pm she delivered a healthy male child by normal delivery. After delivery the complainant was summoned in the labour room by Dr. Monika and was informed there was continous bleeding from the vagina and he was asked to arrange 2 units of blood. He was informed that probably the uterus has burst and they have to go for hysterectomy and further 4 units of blood would be needed. The complainant arranged the blood and gave her consent for hysterectomy. Dr.Monika a;so called another Gynecologist Dr. Saneh Yadav. She examined the patient and gave her opinion vide Anx.R-1&2/7. She prescribed some medicines and advised fundal massage. If the bleeding is not stopped she advised exploration-laparotomy plus hysterectomy. Dr. Monika Gupta opted for hysterectomy and her uterus was removed under general anesthesia. By that time 12units of blood had been transfused After hysterectomy the patient was put on ventilator. In the morning the ventilator was removed but the patient had become critical her pulse was recorded at 140-145,she ran very high fever, urine output was very low, BP was low and her abdomen had bulged. After sometime vomited blood. On this Dr. Mukesh Gupta examined the patient and called Dr. Sunil Verma who runs Sunil Nursing Home (OP NO.3). Dr. Sunil Verma examined the patient and opined that blood has accumulated in the abdomen. He suspected that it is a case of multi organ failure and that was the cause of high fever and high pulse.
However the patient was shifted to Sunil Nursing Home by a transfer ticket on 9.11.2012, at that time patient was running 108 FH fever and pulse was 200/205. At Sunil Nursing Home sone tests were carried out. Sonography , ECG, Blood tests were done. Sonography revealed that blood had accumulated in the abdomen which was oozing slowly and kidney and lever had stopped working. Dr. Sunil Verma advised that patient should be shifted to Jaipur at a higher centre. Patient was thent shifted to Mahatma Gandhi Hospital at Jaipur.
History recorded at Mahatma Gandhi Hospital was as under:
"Patient referred from Sunil Nursing Home Alwar, delivered normally a male child on 8/11/12 developed PPH treated on standard line. But due to atonic uterus hysterectomy done on night 8/11/12. Pt. was on ventilator4-5 hrs then weaned off. Pt.had high grade fever.12 unit BT & 2 unit FFP were transfused. Pt.had abdominal destention+.Urine output was 100ml. Pt. is on Dopamine drip.O/E Pallor++obeying verbal commands, dressing soaked in blood , Pulse 150 p/m BP 10/70 Spo 98mmRR26/min urine output 100ml in last 12hours. Few cc blood in Drain"
At Mahatma Gandhi Hospital explorative laparotomy was done under general anesthesia on 10/11/2012. Abdomen was opened by vertical incision iupto parietal peritoneum . Bladder was flushed down. Right stump was seen bleeding and secured by ligation of bleeders. Right saipingo -oophorectomy was done. Hemostasis sutures were applied to left vault which was bleeding on all stumps. Around 2000ml of blood was removed as clots. Hemostatis was achieved. Patient was treated till 18/11/2012 but patient died due to septicemia and renel shut down and the cause of death was recorded as cadio pulmonary arrest following multi organ failure and septicemia. The complainant has alleged medical negligence on part of OP No.1&2 on ther ground that OP No.1 failed to refer the patient to some other hospital as she was not able to control the bleeding for three hours and after advice from Dr. Sneha Yadav she went for hysterectomy. This hospital had no IICU. Hysterectomy was done negligently and bleeding did not stop and blood accumulated in peritoneum which led to failure of multi organs. There were no investigations done to find out the cause of bleedeing. The complainant alleged that OP No.1&2 have forged the records of their hospital to show that investigations were done. No reports of investigations are on record. After hysterectomy the condition of the patient was critical she was put on ventilator, her BP was not recordable, pulse was very high still the OP 1&2 kept the complaint in dark . Complainant was continuously urging them that patient is feeling difficulty in breathing but no heed was paid. When the patient vomited blood they did understand that patient is serious and wanted to get rid of the patient by referring her to Sunil Nursing Home. When tests were done at Sunil Nursing Home it was revealed that blood has accumulated in stomach and multi organ failure was suspected then Dr. Sunil Verma too wanted to get rid of patient and referred the patient to Jaipur.
The OP No1&2 have filed their reply. They submitted that wife of the complainant was brought to them in a critical condition, at that time mouth of uterus had not been opened and certain medicines were prescribed. After delivery bleeding from vagina did not stop and to check this conservative means were followed. When bleeding did not stop a decision to remove the uterus was taken. Second opinion of Dr. Sneh Yadav was also obtained . On operation it was found that uterus was relaxed with no contraction. They further submitted that the complainant was informed time to time during the course of treatment that doubt for occurrence of injerent complication Disseeminated Intravascular Coagulopathy(DIC) was also suspected. They submittd that patient was treated as per the standard protocol and there was no callous attitude of deficiency in service.
The OP No.3-Sunil Nursing Home in its reply submitted when he was called to examine the patient he found the patient in a very critical condition. The patient was shifted to its hospital where certain tests were conducted . At that time pulse of the patient was 180 and fever was 107 Forenhite, her BP was 100/70. Patient was in a state of confusion and she felt pain in her abdomen all over. She was admitted in ICU. Her fever and BP was managed. However , sonography revealed that there was 2 litres of blood in her abdomen. Her kidney and lever investigations were bad. In consultation with OP NO.2 it was decided that patient should be referred to some tertiary hospital as she need another operation and she was referred to SMS Hospital or Mahatma Gandhi Hospital or Santokba Durlabhji Hospital at Jaipur. Patient was sent to Jaipur in an ambulance to Jaipur.
The OP NO.4 -Mahatma Gandhi Hospital has not filed any reply.
The OP No.5 is the insurance company from whom the OP 1&2 had taken an indemnity policy.The insurance company submitted that allegations of the complainant have never been supported by any expert opinion n.They have denied the parawise allegations.
The complainant has supported his allegations by way of an affidavit He denied the allegations of the OP NO.1&2 that his wife was in critical condition when brought to hospital. He submitted that if his wife's condition was critical why induced parturition was done as in such conditions there is possibility of 20percent increased bleeding why then induced parturition was done. He submits that when blood loss is more than 500ml haemotological test was to be done which was never done. He further submits that when there is transfusion of more than 13 units of blood it is essential to carry out lever function test an d urea and cretinine tests which were not done. After operation patient was to be shifted to ICU whereas she was shifted to general ward where she contacted septicemia. The OP 1 &2 never went for any investigations. He submitted that patient was in a hypovolemia as all the symtoms were evident of this fact still the OP 1 &2 did not care for this.
Another affidavit of Sohan Singh Naruka has been submitted who happens to be a friend of the complainant and was with through out this period has supported the averments of the complaint.Supporting the complaint Dr. Vijaypal Singh has also filed an affidavit who himself is a doctor. He is his affidavit has submitted that it is not correct to say that condition of the wife of the complainant was critical when she was brought to OP no.1 & 2 . He submits if condition was critical why they waited for 8 hours for delivery why they did not go for caesarean . They went for induced delivery and the delivery was normal is evident of the fact that nothing was wrong at that time. He submits that the main reason of death after delivery in a induced parturition is PPH. When 13 units of blood had been transfused haematological, liver function test, bllod urea, creatinine, electrolyte should have been done He supported the allegation that patient contacted septicdemia when she was shifted to general ward. He further submits that without sonography how could the OP1&2 were sure of internal bleeding. He has stated that in hypovolumic shock there is multi organ failure. He submits at Sunil Nursing Home the serum creatinine was 3.1 mg% which shows kidneys had failed at ehd Daksh Hospital. He states that septicemia occurs when bacterial infection enter in blood stream which causes drop in blood pressure and acute respiration distress and multi organ failure. He further states that if the OP 1&2 suspected DIC then why treatment was not started , patients should be given platlets in this condition. He has denied the allegations that patient ever suffered DIC as there were no such symtoms.
The OP No.2 Dr Mukesh Gupta has filed a counter affidavit tht during treatment they suspected occurrence of inherent complications-Disseminated Intravascular Coagulopathy(DIS). In Bed Head Ticket datged 9/11/2012 it was recorded . They suspected DIC because of high fever, low blood pressure and low urine output. He states that death of the wife of the complainant took place due to inherent complication instead of any service deficiency. They had followed the standard protocol of treatment.
The OP No. 3 Dr.Sunil Verma ahs deposed in his affidavit that the sonography report revealed that there was blood in the abdomen. He immedialtely contacted Dr. Mukesh Gupta on phone. After consulting other doctors it was decided to refer the patient to Jaipur.
The OPNo.5 insurance company has filed an affidavit of Ramesh Goyal and has denied its liability on the ground that under the policy condition only first seven hundred patients were covered under the policy and the deceased was at patient no.705, hence no claim arises. Another affidavit of Raghuvir Singh was filed by the insurance company who has denied any case of medical negligence on the part of OP No.1 &2.
A counter affidavit has been filed by complainant Umesh Kumar contradicting the facts of the affidavit filed by Ramesh Goya l and the investigator appointed by the insurance company. He states that records of the hospital have been forged and interpolated in order to show that his wife was 705th patient. He has submitted that record shows that at page no.134 of the register on 22.09.2012 last indoor patient was admitted at serial no.6699 but the next day on 23.09.2012 nest indoor patient was shown and admitted at no.6800 while it should have been at no.6700. Register clearly shows interpolation the number 7 has been interpolated as number 8, which is a forgery.
I have heard the detailed oral submissions of the ld.Counsels of both sides. I have perused the written submissions submitted by the OP No.1&2. I have also perused the copies of medical literature submitted by both sides.
First I will mention the grounds on which the complainant alleged medical negligence.Ld Counsel for the complainant has mostly relied on the detailed affidavit of the Dr. Vijay Pal Singh who is medical doctor(MBBS) working in a government PHC. Though at page 3 of his affidavit he states that some wrong decisions were taken by opposite party and at some places they were negligent. He has summed up the grounds of negligence as under:
i)if the condition of the patient was critical why caesarean section was not opted why they waited for eight hours and induced parturition was done. In induced parturition the risk of postpartum haemorrhage(PPH) is increased by 20%;
ii)no investigations were conducted for liver function, blood urea, creatinine, electrolyte when the patient was transfused blood;
iii) patient contacted septicemia because after operation she was not kept in ICU
iv) opposite party 1&2 did nothing to prevent bleeding from right stump, left vault why they allowed 2 litres of blood to be accumulated in abdomen
v) in transfer ticket opposite party did not mention the complications which had arisen in the case The ld Counsel for OP NO.1&2 sumitted that the wife of the complainant had a history of PPH in her previous delivery.Before delivery the OP No.1&2 had made all the preparations for any eventuality such as keeping the requisite medicines ready and keeping the operation theatre ready . The patient was given antibiotic through injection . All the investigations were done.Continuous foetal monitoring was done. Patient was induced with syntocinon injection as per standard protocol . After delivery when patient had PPH bleeding injection syntocinon,injection methergin, and injection prostodin was given . Uterine cavity was explored for placental pieces. Bimanual massage of uterus to contract uterus was done.Second opinion of Dr. Sneh Yadav was obtained who advised repeat does of above injections,but when there was no improvement in the condition decision to do hysterectomy was taken and done with the prior consent of the complainant. After operation patient was kept on ventilator and her condition was stable until 7 AM .Suddenl y the patient developed fever after 12 noon which was treated with anti pyretic medicines , by evening the patient developed other complications like difficulty in respiration, urine output was reduced and it was decided to consult senior physician and patient was shifted to OP No.3. Where investigations revealed moderate ascites from where patient was referred to a higher centre at Jaipur. Ld Counsel has referred to the treatment given at Mahatma Gandhi Hospital. He further argued that patient earlier developed PPH which was managed but later she developed DIC which was managed at Dakash Hospital by blood and fresh frozen plazma.
I have considered the arguments. Taking any decision by the treating doctor even if it later turns out to be wrong cannot constitute medical negligence. Doctor treating the patient is the best judge of the situation in hand and comaplainant has not been able to point out what decision was wrong. No sooner did the PPH was detected the standard treatment for the disease was started. The medical literature says that in case vaginal bleeding after delivery if packing the vagina and fundal massage fail to control the bleeding then laparatomy should be done and in this also fails the doctor must go for a hysterectomy. The medical record certifies that patient was injected injections which were even confirmed by second opinion of Dr. Sneh Yadav but when it did not work hysterectomy was don e. The complainant secondly alleges that no investigations were carried out when the blood was being transfused. It is seen that patient had become critical in the evening on 9.11.2012 . Immediately a senior physician was called and patient was shifted . No expert evidenceor literature has been produced to prove that it was mandatory to simultaneously carry out investigations with regard to liver function,urea, creatinine etc. However these were done at Sunil Nursing Home the same evening.