State Consumer Disputes Redressal Commission
A.S. Sunder vs Dr. Sandeep Dhawan on 12 August, 2015
FIRST ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.
Consumer Complaint No.24 of 2006
Date of Institution: 04.09.2006.
Date of Decision: 12.08.2015.
Amita Shyam Sunder wife of late Sh. Shyam Sunder Sharma R/o
H.No.1814, Sector 22-B, Chandigarh, through their lawful General
Power of attorney Sh. Deepak Sharma.
.....Complainant.
Versus
1. Dr. Sandeep Dhawan, resident of H.No.88, Sector 16-A,
Chandigarh.
2. Forties Heart Institute and Multi Specialist, Hospital, Phase
VIII, Mohali.
3. Dr. G.S. Kalra, Heart Specialist, Forties Hospital, Phase VIII,
Mohali.
4. Dr. Harsh Batra, Forties Hospital, Phase VIII, Mohali.
5. Forties Health Care Ltd. through its Managing Director,
Registered Office B-9, Maharani Bagh, New Delhi-110065,
through its.
6. Oriental Insurance Company Limited, through its Branch
Manager, SCO no.45, Sector 20-C, Chandigarh.
....Opposite parties
Consumer complaint under Section
17(1)(a) of Consumer Protection Act, 1986
Quorum:-
Shri J. S. Klar, Presiding Judicial Member
Shri H.S. Guram, Member Present:-
For the complainant : Sh. Kapil Sharma, Advocate
For opposite party no.1 : Sh. S.K. Monga, Advocate
For opposite party nos.2-5 : Sh. Munish Kapila, Advocate For opposite party no.6 : None.
.............................................. Consumer Complaint No.24 of 2006 2 J. S. KLAR, PRESIDING JUDICIAL MEMBER:-
Complainant Amita Shyam has filed the complaint under Section 17(1) (a) of Consumer Protection Act 1986 (in short "the Act") against the OPs on the averments that Shyam Sunder Sharma, since deceased, was her husband who was admitted in the Fortis Hospital OP no.2 on 26.08.2008 for treatment of his Hepatitis-C disease. Her late husband Shyam Sunder consulted OP no.1 for the treatment of Hepatitis-C and he also gave estimate for the treatment of Rs.1 lakh, as OP no.1 was on the panel of Fortis Hospital as a Gastroenterologist. Her husband Shyam Sunder was admitted in the above hospital on 26.08.2004 of OP no.2 and OP no.1 started his treatment. It was alleged in the complaint that Shyam Sunder deceased was earlier admitted in the Hospital in the year 2003 and he was operated upon for removal of Spleen and various tests were also conducted at that time. Shyam Sunder, since deceased, underwent angiography at Christen Medical College Ludhiana and it was found that there was no blockage/trouble of heart to the deceased. OP no.1 started treatment of Interferon Therapy to the above patient and gave one dose each of Interferon Injection on 26th, 28th, 30th August and 1st September, 2004. After administering the dose of interferon on 01.09.2006, above patient developed high grade fever on 02.09.2006 and he was given tablets of combiflame and Kalpol and other heavy doses for bringing down Consumer Complaint No.24 of 2006 3 his temperature to normal, but the temperature could not come down and continued till 03.09.2004. Due to heavy doses, the blood pressure of the deceased fell down and he was shifted CCU at about 1:00 p.m. on 03.09.2004 with very low blood pressure. At the time of admission of husband of complainant, his blood pressure was normal i.e. 150-80 mmHg, as OP no.3 recorded this fact in the death summary of the deceased. In CCU, Shyam Sunder since deceased was given I.V. fluids very fast in the presence of the complainant and OP no.4, who was on duty, was pressing the bottles of I.V. fluids containing injection of Dopamine for restoring his blood pressure to normal. C.V.P. was not inserted at that time to administer the I.V. fluids to the patient which is mandatory, despite the fact that patient was known anemic with known hyper dynamic circulation. Shyam Sunder, since deceased started complaining breathing problem and his face was swollen and complainant requested OP no.4, who was a senior resident and Incharge of CCU, but the OPs did not care to attend the deceased. Dr. Vijay Kumar Sharma, the brother of Shyam Sunder since deceased, approached Dr. G.S. Kalra (Head of Cardiology and treatment was given under his supervision in CCU) on his mobile phone. He told him that the patient was well and being looked after by him. The complainant narrated the whole of the treatment to Dr. Vijay Kumar Sharma, the brother of Shyam Sunder since deceased and requested him to reach immediately at the above hospital. When Dr. Vijay Kumar Sharma reached the Hospital Consumer Complaint No.24 of 2006 4 premises at about 4:15 p.m., but he was not allowed to enter into CCU by the concerned staff on duty, despite the fact that complainant requested Dr. Harsh Batra to the effect that he was brother of patient and was also a doctor and wanted to see his ailing brother, but OP no.4 also refused to entertain the request of the complainant. Then Dr. Vijay Kumar Sharma contacted OP no.3 on phone and he stated that Shyam Sunder since deceased was fine and perfectly all right and there was no need for him to come to the CCU. At about 5:15 p.m., Dr. V.K. Sharma entered into CCU and met his brother Shyam Sunder since deceased, who again complained to him about his breathlessness in the presence of the complainant. Dr. V.K. Sharma, immediately checked the chest of the above deceased with stethoscope and he found that lanes were filled with bilateral crepitation fluid and he immediately told the Jr. Doctor to administer the injection of lasix to the patient, but after administering the injection of lasix within five minutes, Shyam Sunder since deceased collapsed due to rapid intervene fluids leading to over-fluid failure, resulting into Pulmonary Edema. OPs failed to acknowledge this fact that patient who was anemic should not have been given rapid intervenes fluid transfusion. The complainant alleged that OPs were negligent in treating her husband. At 1:00 p.m. with 100% Oxygen saturation and respiratory rate of 22 per minutes with normal (L.V.F.) as revealed on ECHO (which was done in CCU) could suddenly have developed a gross Consumer Complaint No.24 of 2006 5 L.V.F. after passing of the stool, which is indigestible in the medical history. The death summary of Shyam Sunder submitted by Dr. G.S. Kalra OP no.3 revealed that lungs of the patient functioned properly with normal respiratory rate and normal left Ventricular functions as revealed by ECHO and he also told that Left Ventricular Ejection Fraction was 70% at about 1:00 p.m. The complainant has alleged medical negligence on the part of OPs in treating her husband Shyam Sunder resulting in his death. The complainant further pleaded that her husband was drawing salary of 7260 Euro, which is equivalent to Rs.4 lakhs approximately in Indian currency, as he was posted as an Engineer in Multinational Construction Company. Her two sons namely Sudhir Sharma and Sandeep Sharma were dependent upon him. Father of Shyam Sunder since deceased also died due to shock on account of his death. The complainant has, thus, prayed for compensation of Rs.1 crore on account of medical negligence of the OPs in the case.
2. Upon notice, OP no.1 Dr. Sandeep Dhawan filed his separate written reply by raising preliminary objections that complex questions of facts and law are involved in this case, which require voluminous evidence and, thus, cannot be adjudicated in summary proceeding by the Consumer Forum. The compliant has been filed with unexplained delay of two years and is, thus, barred by time. It was further pleaded that the patient died in the year 2004, whereas the complaint has been filed in the year 2006. On merits, OP no.1 Consumer Complaint No.24 of 2006 6 admitted this fact that Shyam Sunder was admitted in the Fortis Hospital on 26.08.2004 for treatment of Hepatitis-C disorder and the answering OP was on the panel of Fortis Hospital, as a Gastroenterologist. It was further denied that Shyam Sunder since deceased got himself admitted in the Fortis Hospital on 26.08.2004 for treatment of Hepatitis-C on any kind of assurance given by the answering OP. It was further averred that 7-8 months back, Shyam Sunder since deceased had visited OP no.1 at Deep Hospital Ludhiana, where OP no.1 was working as a visiting Consultant and he examined Shyam Sunder since deceased on the recommendation of Dr. Vijay Kumar Sharma, who is brother of deceased and working as consultant Surgeon at Deep Hospital Ludhiana. During examination of deceased and the patient had gone through various test reports including hemoglobin, TLC, DLC, Platelet count and liver function test as well as liver biopsy. OP no.1 advised Shyam Sunder since deceased that he required "Interferon Treatment" to prevent further progression of the disease and its complications. Shyam Sunder since deceased informed that he was employed abroad and he was not having so much time and the above treatment was going to take almost six months, as such, he told that he would come back again for this purpose and would thereafter start his treatment. It was further averred that Shyam Sunder since deceased was admitted in the Hospital in the year 2003 and was operated upon for removal of spleen and various tests Consumer Complaint No.24 of 2006 7 were conducted at that time and the reports were prepared and it was found that the deceased was suffering from Hepatitis-C and Shyam Sunder since deceased provided the information that he had met with an accident in the year 1984 and due to injuries suffered in the said accident, blood transfusion was done to the deceased for emergency surgery in Nigeria and from there, the deceased got himself infected with Hepatitis-C. As per the information given by the deceased, he was first so diagnosed in the year 1994. This fact was also mentioned in the report dated 26.09.2003 by Dr. Mohnish Chhabra, who examined the deceased for pre-operational examination on 26.09.2003 and advised him to have liver biopsy and to follow up after surgery and also informed the deceased/patient that he required 'Interferon Therapy'. As per advice rendered by Dr. Mohnish Chhabra, liver biopsy was done on the patient at the time of operation and report was prepared on 27.09.2003. Shyam Sunder since deceased was found positive for above disease, who was informed about the treatment, but Shyam Sunder since deceased never started his treatment. Shyam Sunder since deceased visited the Fortis Hospital on 26.08.2004 and got himself admitted for the treatment of Hepatitis-C. Shyam Sunder since deceased prior to 26.08.2004, had visited Fortis Hospital on 09.08.2004 and Doctor Anshu had advised the above patient to get himself treated with deferoxamine therapy for the complication of Thalassemia before the treatment of Hepatitis-C. For this purpose, the patient was admitted Consumer Complaint No.24 of 2006 8 in the Fortis Hospital on 09.08.2004 under the supervision of Dr. Anshu and at that time, the patient was examined by OP no.1 on 10.08.2004 on the request of Haematologist i.e. Dr. Anshu. OP no.1 examined Shyam Sunder since deceased and advised him for review of the liver biopsy before starting any treatment for Hepatitis- C. Thereafter the report of liver biopsy was got reviewed from the expert in PGI and in the report given by the Department of Histopathology PGI Chandigarh, it was stated that the overall features were those of chronic Hepatitis, as per report dated 20.08.2004. It was admitted that the treatment of Interferon injection was given to Shyam Sunder since deceased on 26th, 28th, 30th August and 1st September, 2004. Shyam Sunder since deceased had developed fever on 2nd of September 2004. The fever is the common side effect of the interferon treatment and is developed in more than 50-60% cases. Since the patient developed fever, therefore, interferon therapy was stopped and paracetamol was given to Shyam Sunder since deceased for the control of fever. The above patient was a patient of Hepatitis-C since 1994. It was denied that ECG and Echo Cardio were mandatory, prior to starting the treatment with Interferon, as per medical literature. The Angiography was done at CMC Hospital Ludhiana in the year 2003 on Shyam Sunder since deceased, which revealed ecstatic coronary vessel and patient was already on anti-anginals even during the present admission. When the patient was admitted for interferon treatment Consumer Complaint No.24 of 2006 9 for Hepatitis-C, his hemoglobin was 6.9 and when the patient died, his hemoglobin was 7.3, thus, there was no fall of hemoglobin level in deceased and during the interferon treatment, his hemoglobin level was tested and it was made sure that the same did not fall below 6.9. OP no.1 denied the allegations of the complainant regarding any medical negligence on the part of OPs and, thus, prayed for the dismissal of the complaint.
3. OP nos.2 to 5 filed their separate written reply and contested the complaint of the complainant vehemently. It was averred in the preliminary objections that complaint is barred by time. The complainant has concealed the material facts regarding the medical history of Shyam Sunder since deceased including the fact that the deceased was suffering from Ectasia in his coronary arteries since birth. Any medical negligence or deficient service in treatment of deceased was vehemently denied by the contesting OPs. On merits, it was averred that Shyam Sunder since deceased was a known case of multiple medical problems like Thalassemia Intermedia, Chronic Anemia, in addition to this the patient was suffering from Hepatitis-C. Shyam Sunder since deceased was earlier admitted in the Hospital of the answering OP in September 2003 for the surgical removal of his spleen. The cardiology consultation showed that the patient had undergone an angiography about two years prior to September 2003, which showed that the patient had Ectatic Coronary Arteries. The liver function tests of the Consumer Complaint No.24 of 2006 10 patient were done in 2001, which revealed that functioning of the liver of the patient was abnormal. It was admitted that patient was admitted in the OP hospital and was put on Interferon therapy under consultation of OP no.1. On 2nd September 2004 at 10:00 p.m. the patient developed fever of 104 degree F for which one tablet Paracetamol was given. On 3rd September 2004, the patient developed fever for which injection Paracetamol one ampoule and one tablet of combiflame was given and the patient complained chest pain with radiation to left arm. ECG was suggestive of ST depression in leads V4 to V6 and a VL. There was a fall in his systolic blood pressure to 70mmhg. The patient was given 200 ml N/s IV fluid at 1:30 PM. Oxygen was started on the advice of Dr. Anurag Sharma (Cardiologist) and Dr. Sandeep Dhawan and the patient was shifted to CCU at 2:00 p.m. The patient increased in total leukocyte court (TLC) of 26285 thousand/micro liter with Neutrophilia of 82% and Hemoglobin of 7.3.gm/dl. The patient was having fever with increased TLC, which was suggestive that the patient was having sepsis and his respiratory rate was normal, on pulse oximetry his oxygen saturation was within the normal limits. The symptoms of the patient at that time brought about the possibility of septic shock for which the patient was given IV fluids, normal saline one liter from 2:00 p.m. to 3:00 p.m, as a fluid challenge. Injection dopamine infusion in infusion pump at the rate of eight mcg/kg/min was also given at that time. At 3:00 p.m. the patient's heart rate was 92/min, Consumer Complaint No.24 of 2006 11 B.P. improved to 90/50 mm of Hg, respiratory rate was 22/min O2 saturation was 100% on 2 liters of oxygen, which suggested that patient was not in left ventricular failure. The blood pressure of the patient had also improved. The patient was responding well to the fluid challenge. At 3:00 p.m. onwards, IV fluids were given at a rate of 50 ml/hr, heparin infusion was started at the rate of 1.6-ml/hr (750 units/hr). The patient was on dopamine infusion, IV lasix 40 mg was given, as his output was less. 2-D echo was done, which was suggestive of good LV function, which further revealed that the patient did not have any active cardiac problem. The patient had mild mitral regurgitation with no regional wall motion abnormality. At 4:00 p.m. patient's heart rate was 88/min, B.P. improved to 104/50 mm of Hg with respiratory rate of 20/min and oxygen saturation was 100% which again justified that the patient was not in pulmonary edema. The patient was seen by Dr. Anurag Sharma, Cardiologist. All the parameters indicated that patient was improving and was not in fluid overload, as alleged in the complaint. The patient had an infection, which was evident from blood culture report sent at that time. Intravenous lines are a known source of infection in the CCU. The patient was not given a CVP line because CVP is only mandatory in refractory shock. The patient was already suffering from infection another CVP would have been rather a risk factor to aggravate the same. Moreover, the patient was showing signs of improvement and was not in fluid overload. As such, the patient did not require CVP Consumer Complaint No.24 of 2006 12 line at that time, as the patient had improved considerably. The patient was a candidate predisposed to an acute coronary event at any time due to his ectatic arteries, which is a condition present either from birth itself. Not only this, his septic shock combined with low BP made him even more vulnerable to clot formation and sudden thrombosis. At 5:00 p.m, the patient went into flash pulmonary edema after straining at stools in the bed. His HR was 98/min and blood pressure fell to 90/60 mm of Hg. Respiratory rate of 26 per minute with a drop of oxygen saturation to 80% by pulse oximetry. On respiratory system examination, the patient had coarse crepitations. The patient was electively intubated and put on ventilator by the anesthetist on call. At that time, the patient was given an injection of lasix 100mg IV stat. The patient had sudden asystole for which CPR was done. The patient was started on epinephrine and nor-epinephrine infusion, atropine and sodium bi carbonate was given. Temporary pacemaker insertion was done, but in spite of all emergency procedures, patient could not be resuscitated and was declared dead at 6:15 p.m. on 3rd September, 2004. The medical opinion in this case in all possibility brings out the possibility of an acute cardiac even i.e. thrombotic occlusion in the major ectatic coronary artery following which patient went into acute pulmonary edema and cardiac arrest. In other words, there was an acute coronary syndrome, which caused acute LVF and sudden cardiac arrest in the patient. The complaint was even contested on Consumer Complaint No.24 of 2006 13 merits on the above referred grounds by the contesting OPs. It was denied that patient was left unattended by the doctors at the above time. It was denied that face of the patient was swollen or the patient was feeling breathlessness at that time. The contesting OPs controverted the averments of the complainant regarding any medical negligence on their part and hence prayed for the dismissal of the complaint.
4. The complainant tendered in evidence her affidavit Ex.CW-2, affidavit of Deepak Sharma Ex.CW-1 and affidavit of Dr. Vijay Kumar Sharma Ex.CW-3 alongwith documents Ex.C-1 to Ex.C- 7 and closed the evidence. As against it, OP no.1 tendered in evidence affidavits of Dr. Ajay Duseja Ex.R1/11 and Ex.R1/15, affidavit of Dr. Sandeep Dhavan Ex.R1/14, affidavit of Dr. Anuradha Dhavan Ex.R1/16 and affidavit of Dr. Rajeev Sarwal, Gastroenterologist Ex.R1/17 alongwith documents Ex.R1/1 to Ex.R1/10 and Ex.R1/12 to Ex.R1/13. OP nos.2 to 5 tendered in evidence, the affidavit of Dr. G.S. Kalra, Senior Consultant and Interventional Cardiologist, Fortis Hospital Mohali Ex.RW-3/A & Ex.RW-3/A, affidavit of Dr. Yashpal Sharma, Professor & Head Department of Cardiology PGIMER Chandigarh Ex.R-2/8 and affidavit of Sh. Harsh Batra Ex.RW-4 and affidavit of Abhijit Singh, Facility Director Fortis Hospital Ex.RW-5 alongwith documents Ex.R- 2/1 to Ex.R-2/7-B and closed the evidence.
Consumer Complaint No.24 of 2006 14
5. We have heard the learned counsel for the parties and have also examined the record of the case. Firstly, we deal with this point as to whether the complaint has been filed by the complainant within time or not. The complainant pleaded in the complaint that cause of action accrued to file the complaint on 03.09.2004, when Shyam Sunder her husband expired. As per own admission of the complainant contained in para no.10 of the complaint, that cause of action arose to file the complaint on 03.09.2004, it is evident from the record of the case that the complaint was filed on 04.09.2006 before this Commission. One day of limitation can be excluded under Section 12(1) of The Limitation Act, 1963 in counting the limitation, as per own admission of the complainant contained in para no.10 of the complaint, the cause of action accrued on 03.09.2004 and instant complaint has been filed on 04.09.2006 by the complainant and as such, the instant complaint cannot be said to be barred by time. One day has to be excluded in counting under the Limitation Act, 1963 and hence the complaint cannot said to be barred by time.
6. Now, we proceed to adjudicate this controversy on the basis of the pleadings and evidence in this case. The complainant has leveled the allegations of medical negligence against the OPs. The complainant also led evidence on the record in support of her allegations of medical negligence against the OPs. Evidence of the complainant on the record is the affidavit of Amita Shyam Sunder complainant Ex.CW-2. This affidavit is the reiteration of the versions Consumer Complaint No.24 of 2006 15 of the complaint on oath by the complainant. Affidavit of Deepak Sharma Ex.CW-1 and affidavit of Dr. Vijay Kumar Sharma Ex.CW-3 are on the record to the effect that Shyam Sunder had expired due to the negligence of the OPs. Ex.C-1 is the copy of death certificate of Shyam Sunder Sharma, proving his death on 03.09.2004 at Fortis Hospital Mohali. Ex.C-2 is the copy of certificate dated 31.08.2004 issued by Dr. Sandeep Dhawan to the effect that Shyam Sunder Sharma had been suffering from chronic hepatitis-C with Thalassemia with haemochromatosis and was undergoing treatment for chronic hepatitis-c at that time. The total cost of treatment would be 1,40,000/-. Admittedly, Shyam Sunder since deceased was admitted in Fortis Hospital OP no.2 on 26.08.2004 and this certificate was issued by Dr. Sandeep Dhawan on 31.08.2004. Ex.C-3 is the copy of Death Summary report of Shyam Sunder prepared by Dr. G.S. Kalra Consultant and Senior Interventional Cardiologist and this report is also signed by Dr. Harsh Batra, Sr. Resident on duty ICCU. Ex.C-4 is the copy of inpatient bill of Rs.49,560/- prepared by OP no.2 in the name of Shyam Sunder since deceased. Ex.C-5 is the copy of salary slip of Shyam Sunder since deceased issued by the employer. Ex.C-6 is the copy of final summary sheet of treatment of Shyam Sunder since deceased issued by Fortis Hospital Mohali and the copy of document is Ex.C-7. This is the evidence produced on the record in support of her allegations of medical negligence on the part of OPs by the complainant.
Consumer Complaint No.24 of 2006 16
7. The OPs strongly relied upon the affidavits of Dr. G.S. Kalra Ex.RW-3 & Ex.RW-3/A, affidavit of Dr. Harsh Batra, MD Ex.RW-4. Ex.R-2/1 is copy of medical literature of Sepsis and Septic Shock. Ex.R-2/2 is the copy of medical literature of Coronary Angiodysplasia of Epicardial and Intramural Vessels. Ex.R-2/3 to Ex.R-2/7 are the other medical literatures on the record. Ex.R-2/7-A is the copy of power of attorney in favour of Mr. Ashish Bhatia, Chief Operating Officer of OP hospital. Affidavit of Dr. Yashpal Sharma, Professor & Head Department of Cardiology PGIMER Chandigarh is Ex.R-2/8 on the record. Ex.R1/1 is copy of Doctor's progress/order sheet dated 24.09.2003. Ex.R1/2 is copy of laboratory report in the name of Shyam Sunder Sharma dated 09.10.2003. Ex.R1/3 is the copy of discharge summary of Shyam Sunder since deceased dated 09.08.2004 issued by Fortis Hospital Mohali. Ex.R1/4 is the copy of Surgical Pathology Report of Shyam Sunder since deceased issued by PGIMER Chandigarh. Ex.R1/5 to Ex.R1/6, are the copies of medical literatures on the record. Ex.R1/7 is the copy of prescription slip issued by Fortis Hospital Mohali in the name of Shyam Sunder since deceased. Ex.R1/8 is the copy of treatment of hepatitis C virus infection in Thalassemia. Ex.R1/9 is the copy of Doctor's Progress/Order Sheet dated 26.08.2004 in the name of Shyam Sunder since deceased issued by Fortis Hospital. Ex.R1/10 is the copy of medical literature. Ex.R1/11 is the copy of Dr. Ajay Duseja Assistant Professor Department of Hepatology, PGI Chandigarh. Consumer Complaint No.24 of 2006 17 Ex.R1/12 and Ex.R1/13 are the copies of medical literatures. Ex.R1/14 is the affidavit of Dr. Sandeep Dhavan, Ex.R1/15 is the affidavit of Dr.Ajay Duseja, Associate Professor Department of Hepatology PGI Chandigarh. Ex.R1/16 is the affidavit of Dr. Anuradha Dhavan and affidavit of Abhijit Singh, Facility Director Fortis Hospital Mohali is Ex.RW-5 on the record.
8. The counsel for the complainant submitted that OPs are negligent in treating Shyam Sunder since deceased and thereby resulting into his death. The first point stressed by the complainant to prove the negligence of the OPs is that OP no.1 started treatment of Interferon Therapy by giving one dose each of Interferon Injection on 26th, 28th, 30th August and 1st September, 2004 to Shyam Sunder since deceased. After administering the dose of interferon on 01.09.2006, patient developed high grade fever on 02.09.2006 and he was given tablets of combiflame and Kalpol and other heavy doses for bringing down the temperature to normal, but the temperature could not come down and continued till 03.09.2004. Due to heavy doses, the blood pressure of the deceased plummeted and he was shifted to CCU at about 1:00 p.m. on 03.09.2004 with very low blood pressure. At the time of admission of husband of complainant, his blood pressure was normal i.e. 150-80 mmhg, as OP no.3 recorded this fact in death summary of the deceased. In CCU, Shyam Sunder since deceased was given I.V. fluids very fast in the presence of the complainant and OP no.4, who was on duty Consumer Complaint No.24 of 2006 18 was pressing the bottles of I.V. fluids containing injection of Dopamine for restoring his blood pressure to normal. C.V.P. was not inserted at that time to administering the I.V. fluids, which is mandatory, despite the fact that patient was known anemic with known hyper dynamic circulation. Shyam Sunder since deceased started complaining breathing problems and his face was swollen and complainant requested OP no.4, who was a senior resident and Incharge of CCU, but the OPs did not care to attend the deceased. The complainant has alleged medical negligence on the part of OPs in treating her husband Shyam Sunder resulting into his death. On this point, the submission raised by the OPs before us is that deceased Shyam Sunder was suffering from hepatitis-C disorder of the liver for the last many years. The spleen of deceased Shyam Sunder was removed in the year 2003 by the OP and the tests were conducted at that time and reports revealed that deceased was suffering from hepatitis-C. We have to examine this point as to whether the Interferon Therapy started by OP no.1 for the liver disorder brought about by hepatitis-C on deceased patient is in accordance with the medical standard practice or not. As per the medical standard practice Interferon therapy is an effective treatment for hepatitis-C patients, as per text books of medical literatures. OP no.1 rightly gave Interferon Therapy for treatment of hepatitis-C to patient Shyam Sunder and it cannot be said that OPs are negligent in administering the Interferon Therapy to the patient Shyam Sunder Consumer Complaint No.24 of 2006 19 since deceased. We have examined the affidavit of Dr. Sandeep Dhavan Ex.R1/14 on the record, wherein he stated that Interferon Therapy was administered to the patient. He further stated that Dr. Anshu had advised the patient to get himself treated with Deferoxamine therapy for complication of Thalassemia before the treatment of hepatitis-C and for this purpose, the patient was admitted in Fortis Hospital on 09.08.004 under the supervision of Dr. Anshu and on request of Dr. Anshu, the patient was examined by him on 10.08.2004. After examining the patient, OP no.1 advised the patient for review of the liver biopsy before starting any treatment for hepatitis-C. The report of liver biopsy was got reviewed from the expert in PGI and in the report given by the department of Histopathology PGI Chandigarh, it was revealed that the overall features were those of chronic hepatitis. He further stated in his affidavit that patient was a perfect candidate for interferon therapy. Thereafter with all due deliberations, the patient/deceased had got himself admitted for the treatment of hepatitis-C and was rendered Interferon Therapy. The complainant only relied upon affidavit of Mr. Deepak Sharma Ex.CW-1 and affidavit of Dr. Vijay Kumar Sharma Ex.CW-3 on the record to this effect in support of her case. OPs also place reliance on affidavit of expert witness Dr. Rajeev Sarwal Gastroenterologist Ex.R1/17 to the effect that he would treat the patient, in which way Dr. Sandeep Dhavan had treated Shyam Sunder since deceased. There is another affidavit of Abhijit Singh Consumer Complaint No.24 of 2006 20 Facility Director Fortis Hospital Mohali on the record. On perusal of treatment record of Shyam Sunder deceased and the affidavit of Dr.Harsh Batra M.D. of Fortis Hospital Mohali Ex.RW-4, affidavits of Dr. G.S. Kalra Ex.RW-3 and Ex.RW-3/A, affidavit of Dr. Yashpal Sharma, Professor & Head Department of Cardiology PGIMER Chandigarh Ex.R2/8, we have come to this conclusion that the Interferon Therapy as administered by OP no.1 to Shyam Sunder cannot be said to be any departure from medical standard practice. We are unable to find any medical negligence on the part of OPs with regard to administering of Interferon Therapy to the patient Shyam Sunder since deceased by OP no.1 for hepatitis-C disorder. The patient was admittedly suffering from hepatitis-C and his spleen was removed about one year ago and he was also suffering from Thalassemia to boot.
9. The next point argued by counsel for the complainant before us in this complaint is that the blood pressure of the patient Shyam Sunder since deceased fell with Interferon Therapy, whereas at the time of admission, his blood pressure was absolutely normal i.e. 150-80 mmhg, as recorded in death summary of the deceased. When patient was in CCU, he was given IV fluids very fast in the presence of the complainant by OP no.4 who was on duty. The argument of counsel for the complainant that OP no.4 Dr. Harsh Batra was pressing the bottles of IV fluids containing the injection of dopamine for restoring the blood pressure of the patient to normal. Consumer Complaint No.24 of 2006 21 On this point, the complainant relied upon her affidavit Ex.CW-2. To counter it, the OPs relied upon the affidavit of Dr. Harsh Batra Ex.RW-4 on the record. He has denied this fact on oath that he gave IV fluids in hasty manner to the patient, as alleged in the complaint. He has stated in his affidavit that patient was given IV saline 1 liter from 2:00 p.m. to 3:00 p.m. and was started on injection dopamine infusion in infusion pump at the rate of 8 mcg/kg/min. There is total denial in the affidavit of OP no.4 Dr. Harsh Batra contained in Ex.RW-4 to the allegations of the complainant that OP no.4 pressed the bottles of IV fluids in a hasty manner to administer fast fluid. We do not find any substance on the record in support of averment of the complainant that OP no.4 pressed the bottles of IV fluids in hasty manner, so as to give quickly IV fluids to the patients. The allegations contained in the affidavit of complainant stands equally rebutted by the affidavit of Dr. Harsh Batra OP no.4 on the record, as discussed above. There is no other evidence aliunde on the record to substantiate this fact. Consequently, this contention of the complainant remained unsubstantiated on the record. Even otherwise, a doctor tries his best to save the life of the patient and would not press the bottles of IV fluid, so as to create complications to the patient as the honor and reputation of the doctor is at stake.
10. The next argument of the counsel for the complainant is that C.V.P. was not inserted at the time of administering the IV fluids to patient, which is mandatory to control the over-fluid. It was argued Consumer Complaint No.24 of 2006 22 that patient was known anemic with known hyper dynamic circulation. The patient developed breathing problem and he was put on oxygen mask, but OPs did not care to attend the patient although the complainant requested Incharge of CCU to do something, as patient was suffering from breathlessness and his face was swollen. We have to examine this point whether non insertion of C.V.P. at that time in administering the IV fluids is a sine qua non and OPs are medical negligent in this regard or not. There is an affidavit of Amita Shyam Sunder Ex.CW-2 on the record, but she is not an expert witness and is only a lay person in medical science. The complainant relied upon affidavit of brother of Shyam Sunder since deceased, Dr. Vijay Kumar Sharma Ex.CW-3 on the record in support of her allegations. He is a Surgeon in some other hospital and not expert doctor in the above matters. To refute this averment of the complainant, the OPs tendered in evidence the affidavit of Dr. Sandeep Dhavan Ex.R1/14 and affidavit of Dr. Harsh Batra Ex.RW-4 on the record. Dr. Harsh Batra has stated in his affidavit that the patient was shifted to ICCU and he was given IV saline 1 liter from 2:00 p.m. to 3:00 p.m. and was started on injection dopamine infusion in infusion pump at the rate of 8mcg/kg/min. He was treating doctor of the patient and he has stated that IV fluids were never given to the patient in hasty manner, as alleged by the complainant. In fact, these measures had revived the patient from a BP of 70 mm of Hg to 104/50mm of Hg. His 2-D Echo done by Dr. G.S. Kalra at Consumer Complaint No.24 of 2006 23 3:00 p.m. on 03.09.2004 was suggestive of good LV function with no regional wall motion abnormality. He further stated in his affidavit that C.V.P. was not inserted in the patient because he was already showing all signs of recovery- rise in vital signs etc. He relied upon medical literature Ex.R-2/3 on the record that insertion of CVP is mandatory in refractory symptoms only. There is affidavit of expert witness Dr. Yashpal Sharma, Professor & Head Department of Cardiology PGI Chandigarh Ex.R-2/8 on the record. He has stated that he has examined the medical record of Shyam Sunder deceased and has stated that it is clear that he had undergone Coronary Angiography about two years prior to September 2003, which revealed that he had Ectatic Coronary Arteries. He further stated that on 03.09.2004 at 1:00 p.m., patient's systolic blood pressure fell to 70mmHg with fever for which patient was given intravenous fluids following which patient improved and his B.P. went up from 70 to 104/50 mmHg. He further stated that Echocardiography was performed in CCU on the patient, but it did not reveal any regional wall motion abnormality & left ventricular ejection fraction was normal and oxygen saturation was normal. He further stated that patient was improving with no evidence on fluid overload. This witness is expert witness in this branch of medical science that patient was not in refractory shock as is evidenced by the fact that BP was improving with standard doses of intravenous fluids and dopamine, the CVP line was hence not necessary. He Consumer Complaint No.24 of 2006 24 further stated that patient's heart rate was 98/minute and his BP fell to 90/60 mmHg. Respiratory rate of 26/minute and there was a drop of oxygen saturation to 80% by pulse oximetry. Patient was electively intubated and other supportive measures were undertaken as per medical protocol. However, the patient suddenly went into asystole for which cardiopulmonary resuscitation was done. The medical opinion of the case shows the findings of possibility of acute event with Thrombus in the major Ectatic Coronary Artery following which, patient went into acute pulmonary edema and cardiac arrest. The complainant has not led the evidence of any other cardiologist on the record that insertion of CVP line was necessary to control the BP of the patient at that time. The evidence of expert witness Dr. Yashpal Sharma Ex.R2/8 remained unrebutted by the complainant on the record. In addition to that, there are affidavits of G.S. Kalra, Senior Consultant and Interventional Cardiologist of OP no.2 Ex.RW- 3 and Ex.RW-3/A on the record, wherein he has also deposed on oath that CVP insertion was not necessary, because CVP is only mandatory in refractory shock, because the BP of the complainant was improving with fluids thereby given to him. There is categorical assertion of this witness in his above affidavit that the patient was already suffering from an infection another CVP would have been a risk to aggravate the same, since patient was showing signs of improvement and was not in fluid overload. The complainant could not point out any medical literature on the record that CVP insertion Consumer Complaint No.24 of 2006 25 was essential component of the treatment and OPs remained medically negligent or deficient in service in not resorting to it at that critical juncture. We do not accept the submission of the complainant on this point that OPs are negligent in this regard.
11. The next submission of the complainant is that when Shyam Sunder started complaining breathing problems and he was given oxygen mask, but OPs did not care to attend the patient. OP no.4 remained negligent in not attending the patient as put forth by the complainant. The complainant relied upon affidavit of Dr. Vijay Kumar Sharma Ex.CW-3, the brother of the deceased, but we find that he is a Surgeon, expert in surgery exclusively and not in the medicines branch. The onus is on the complainant to prove medical negligence on the part of OPs. The complainant has not examined any expert witness on the record to prove this fact. On the other hand, as discussed above, there are various affidavits of the expert witnesses relied upon by the OPs proving that standard medical treatment was given to the patient/deceased by the OPs in this case. We have examined the entire treatment record of the patient/deceased Shyam Sunder in this case as well, which is in line with medical standard practice.
12. It was further argued by counsel for the complainant that OPs are negligent in not checking the lungs of the patient, which were filled with the fluids. The counsel for the complainant also laid Consumer Complaint No.24 of 2006 26 emphasis on this point. We have discussed above that to control the falling blood pressure of the patient, he was given 200 ml normal saline IV fluid and then patient was shifted to CCU and was given IV saline 1 liter from 2:00 pm to 3:00 pm and was started on injection dopamine infusion in infusion pump at the rate of 8mcg/kg/min, which is a normal standard practice under medical text books. The record of the patient was maintained by the OPs from time to time. Symptoms exhibited by the patient have been recorded in the treatment record by the OPs. It cannot be said that IV fluids was not an essential component of the treatment of the patient or they were not sanctioned by the standard medical literature. Even as per the own case of the complainant, lasix injection was given to the patient to control his condition. The complainant has not disputed this fact that Dr. Vijay Kumar Sharma brother of the patient was present and lasix medicine was given to the patient to control his above condition. It has not been proved before us that it was not given in accordance with the prescribed protocol.
13. The death summary report of deceased Shyam Sunder has been prepared by Dr. G.S. Kalra, Consultant and Senior Interventional Cardiologist of OP Hospital of the patient in this case. The death summary report is re-produced as under:
"Mr. Shyam Sunder (UHID no.40202, IPD no.18541), 52 year old male, a know case of Thalassemia Intermedia, chronic Consumer Complaint No.24 of 2006 27 anemia, unstable angina with Hepatitis C positive, Post splenectomy 1 year back and Haemochromatosis with septicemia. He was admitted for interferon therapy 26.08.2004, at the time of admission BP was 150/80 mmHg & heart rate 90/min. Course in hospital: On 3rd Sept. at 1 pm patient complaints of retrosternal chest pain in the ward associated with breathlessness. His ECG showed St depression in Chest lead & patient developed hypotension with systolic pressure of 70mmHg. He was shifted to CCU for further management. In CCU oxygen saturation was 100% & with respiratory rate of 22/min. 2D Echo revealed normal LV function Mild MR, No RWMA. At 5 pm patient went into gross LVF after passing stools, immediately intubated, initiated on mechanical ventilation. Cardiopulmonary resuscitation was done. He developed bradycardia, TPI was done, and inotropes started.
Subsequently, he developed cardiac asystole and cardiopulmonary resuscitation continued. ABG showed severe metabolic acidosis for which injection sodabiocab 100 ml bolus was given. However, the patient's BP was unrecordable even on maximum inotropic support and CPR. The condition of the patient continued to deteriorate. Spontaneous cardiac rhythm could not be revived thereafter and in the absence of spontaneous cardiac, respiratory or brainstem activity, the Consumer Complaint No.24 of 2006 28 patient was declared dead at 6:15 pm on 03.09.2004. Final Diagnosis kept was:
. THALLESEMIA INTERMEDIA.
. CHRONIC ANEMIA.
. HEPATITIS C POSITIVE.
. UNSTABLE ANGINA.
. ACUTE CORONARY SYNDROME.
. ACUTE LVF.
. POST SPLEENECTOMY.
. HAEMACHROMATOSIS.
. SEPTICAEMIA.
. METABOLIC ACIDOSIS.
. CARDIORESPIRATORY ARREST.
It is, thus, clear from the death summary report of Shyam Sunder that he was suffering from Thalassemia Intermedia, chronic anemia, unstable angina with Hepatitis C positive, post splenectomy 1 year back.
14. The forceful submission of the complainant is that at the time of admission, the BP was 150/80 mmHg and heart rate 90/min of the patient and 2D Echo revealed normal LV function Mild MR. Suddenly the patient developed heart problem due to the negligent treatment of the OPs. Much emphasis has been laid down on this point by counsel for the complainant that OPs are negligent on this Consumer Complaint No.24 of 2006 29 point. It is proved fact on the record by death summary report Ex.C-3 of the patient that he was known case of Thalassemia Intermedia, chronic anemia, unstable angina with Hepatitis C positive, post splenectomy 1 year back. As per medical text books, 75 to 85% of people who have it develop a long term infection called chronic hepatitis C. It can lead to conditions like liver cancer and cirrhosis, or scarring of the liver. This is one of the top reasons people get liver transplants. Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form of hemoglobin, the protein in red blood cells that carry oxygen. The disorder results in excessive destruction of red blood cells, which leads to anemia. Anemia is a disorder in which your body doesn't have enough normal, healthy red blood cells (RBC). This disease is inherited, meaning that at least one of your parents must be a carrier of the disease. It is caused by either a genetic mutation, or a deletion of certain key genes. Thalassemia occurs when there is an abnormality or mutation in one of the genes involved in hemoglobin production. This genetic defect is inherited from your parents. Beta Thalassemia divided in two groups, Thalassemia major and Thalassemia Intermedia. Thalassemia major generally appears before a child's second birthday. The severe anemia related to this condition can be life-threatening. This form of Thalassemia is usually so severe that it requires regular blood transfusions. The treatment which is generally required consist of blood transfusions, bone Consumer Complaint No.24 of 2006 30 narrow, transplant medication and submission possible surgery to remove the spleen or gallbladder. The spleen of the complainant was removed in this case earlier. Coronary Artery Ectasia (CAE) or aneurismal coronary artery disease is dilatation of an arterial segment to a diameter at least 1.5 times that of the adjacent normal coronary artery (1). CAE can be found in 3-8% of angiographic and in 0.22% to 1.4% of autopsy series. It can be either diffuse affecting the entire length of a coronary artery, or localized. It is attributed to atherosclerosis in 50% of cases, whereas 20%-30% are considered to be congenital in origin. In the great majority of these patients, Ectasia coexists with coronary artery disease (CAD). Only 10% to 20% of CAE have been described in association with inflammatory or connective tissue diseases (I). Coronary dilatation is isolated Ectasia, in association with connective tissue disorders such as scleroderma, in Ehlers-Danlos syndrome, different types of ANCA- related vasculitis (2) and also in syphilitic aortitis and Kawasaki disease (3). In a small percentage of patients, CAE can be congenital in origin. Acquired CAE should be differentiated from coronary aneurysms following coronary interventions. Occasionally, large ulcerated coronary plaques can be misinterpreted angiographically as coronary aneurysms. Their true cause can be revealed by intravascular ultrasound (IVUS). There is no correlation between ecstasy at the coronary arteries level and ecstasy in other arteries of the peripheral vascular system, although they may co- Consumer Complaint No.24 of 2006 31 exist in some cases. As it is evident in the affidavits of Dr. G.S. Kalra and Dr. Yashpal Sharma of PGI, the patient had Ectatic Coronary Arteries. The patient strained at stools in bed and went into flash pulmonary edema. It has appeared in the evidence of expert witnesses contained in their respective affidavits on the part of the OPs that when the patient passed the stool on account stress, the patient went into flash pulmonary edema and cardiac arrest. The OPs did their best as per medical standard practice to save his life. We further find that OPs were fully qualified doctors and there is nothing on the record that they were not qualified persons and were not expert in the matter in which they have treated the patient in this case.
15. The Apex Court has held in "Jacob Mathew Vs. State of Punjab & another" reported in 2005(3)CPJ (SC)-9 that "an error of judgment on the part of a professional is not negligence per se. No sensible professional would intentionally commit an act or omission which would result in loss or injury to the patient as the professional reputation of the person is at stake. A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of a medical professional. So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not chosen to follow or resort to that Consumer Complaint No.24 of 2006 32 practice or procedure which the accused followed. A professional may be held liable for negligence when he was not possessed of the requisite skill which he professed to have possessed, or, he did not exercise with reasonable competence in the given case, the skill which he did possess. The standard to be applied for judging, whether the person charged has been negligent or not, would be that of an ordinary competent person exercising ordinary skill in that profession. It is not possible for every professional to possess the highest level of expertise or skills in that branch which he practices. A highly skilled professional may be possessed of better qualities, but that cannot be made the basis or the yardstick for judging the performance of the professional proceeded against on indictment of negligence". Even in "Kusum Sharma vs. Batra Hospital & Medical Research Centre" 2010(1) CPJ(SC)-29 , the Apex Court held that "a mere deviation from normal professional practice is not necessarily evidence of negligence. Higher the acuteness in emergency and higher the complication, more are the chances of error of judgment. Doctor in complicated cases have to take chance even if the rate of survival is low. Courts have to be extremely careful to ensure that professionals are not harassed unnecessarily. Negligence is the breach of a duty exercised by omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do. Consumer Complaint No.24 of 2006 33 Negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession". Herein in this case, we do not find that there is any unusual and abnormal practice which OPs have adopted or the act of the OPs was not professional or of a man of ordinary skill.
16. From the final summary sheet Ex.C-6 and death summary report Ex.C-3 of the patient, it was recorded that deceased was a patient of Thalassemia Intermedia, chronic anemia, unstable angina with hepatitis C positive, post splenectomy 1 year back and haemochromatosis with septicemia. The case of patient was a case of multi organ failure, he eventually died of heart/cardiac arrest as he could not bear the stress of passing the stool due to his failing body organs. A doctor never undertakes to cure the patient and he tries his best to treat the patient as per medical standard practice. Life is in the hand of god and not in the hands of treating doctor. Treating doctor can make best efforts in treating the patients as per standard medical practice only. We do not find that OPs are guilty of any medical negligence or deficient in service in this case, as alleged by the complainant because complainant has not examined any expert witness to prove that non-standard medical treatment was adopted by the OPs and that treatment was not recognized by the standard Consumer Complaint No.24 of 2006 34 medical literature at all or that OPs who treated the patient/deceased were either not qualified doctors.
17. As a result of our above discussions, we do not find any merit in the complaint of the complainant and the same is hereby dismissed with no order as to costs.
18. Arguments in this complaint were heard on 05.08.2015 and the order was reserved. Now the order be communicated to the parties.
19. The complaint could not be decided within the statutory period due to heavy pendency of court cases.
(J. S. KLAR) PRESIDING JUDICIAL MEMBER (H.S. GURAM) MEMBER August 12, 2015.
(MM)