State Consumer Disputes Redressal Commission
Dr. M.E.Koshti vs Dr. Umesh Khanna & Ors. on 15 June, 2011
Daily Order
BEFORE THE
HON'BLE STATE CONSUMER DISPUTES REDRESSAL
COMMISSION, MAHARASHTRA, MUMBAI
Complaint
Case No. CC/98/67
DR. M.E.KOSHTI
14, NITYANAND NAGAR NO.2, ANDHERI(E), MUMBAI-400069.
...........Complainant(s)
Versus
1. DR. UMESH KHANNA
M-1, JAYKAR SMRUTI, AAREY RD, GOREGAON (W),
MUMBAI-400062.
2. Dr.Mrs. Khanna
M-1, Jaykar Smruti, Aarey Road, Goregaon (W),
Mumbai-400 062
3. B.K. Kidney & G.I. Centre
M-1, Jaykar Smruti, Aarey Road, Goregaon (W),
Mumbai-400 062.
4. Suvarna
General Hospital
Kastur
Park, Shimpoli Road,
Borivali (W), Mumbai-400 092.
............Opp.Party(s)
BEFORE:
Hon'ble Mr. P.N. Kashalkar PRESIDING MEMBER
Hon'ble Mrs. S.P.Lale Member
PRESENT:
MR. U.B.WAVIKAR, Advocate for the Complainant
Mr. Y. C. Naidu - Learned Advocate for Opposite
Party No.1
Mr. A. V. Patwardhan - Learned Advocate for the
Opposite Parties Nos.2 & 3
Smt. Geeta Handa Khanuja - Learned Advocate for
the Opposite Party No.4
ORDER
Per Hon'ble Mr. P. N. Kashalkar, Presiding
Judicial Member This is a complaint filed by Dr. M. E. Koshti, against Dr. Umesh Khanna; Dr. Mrs. Umesh Khanna; B. K. Kidney & G. I. Centre; and Suvarna General Hospital; alleging medical negligence on the part of the Opposite Parties. According to the Complainant, his wife
- Smt. Leela M. Koshti; went into severe coma on 17/10/1997, in the clinic of the Opposite Parties Nos.1 & 2, by name - B. K. Kidney & G. I. Centre; the Opposite Party No.3 herein. The Complainant's wife was taking treatment for her kidney trouble in the hospital known as 'Unity Clinic', at Andheri (West); since 7/6/1994. Dr. Sanjeev Khanna was attached to that Unity Clinic. Dr. Sanjeev Khanna introduced the patient to Dr. Umesh Khanna - the Opposite Party No.1; in the month of June-1994 and on recommendation of Dr. Sanjeev Khanna; Dr. Umesh Khanna - the Opposite Party No.1; got the Complainant's wife admitted in the Opposite Party No.3 Clinic, run by the Opposite Parties Nos.1 & 2. But, it is the grievance of the Complainant that the Opposite Parties continued to neglect his wife on 17/10/1997 and 18/10/1997, with the result that ultimately, the Complainant's wife died. According to the Complainant, his wife was taking treatment from Dr. Umesh Khanna - the Opposite Party No.1; for 3 years. When-ever the Complainant's wife was feeling weak; she was given 01 - 02 bottles of blood with dialysis. For more than 15 times, during the period of 3 years, blood was given to the Complainant's wife. The Complainant pleaded that his wife improved considerably when she was taking dialysis intermittently and as & when required, blood was also given to her. On 30/4/1997, the Complainant's wife - Mrs. Koshti; was feeling pain in her chest. Dr. Umesh Khanna - the Opposite Party No.1; advised her to check blood and to get herself admitted in his clinic. Accordingly, the Complainant's wife got herself admitted in the clinic of the Opposite Party No.1. Nurse took her E.C.G., at 11:45 a.m. The Opposite Party No.1 immediately transfused one bottle of blood without dialysis though he knew that the Complainant's wife was a patient of kidney trouble. Immediately after blood transfusion, the Complainant's wife started complaining of increased chest pains but, the Opposite Party No.1 ignored it and said not to worry about it. The Complainant states that on 1/5/1997, the patient again suffered chest pain, which was unbearable, and so, the Opposite Party No.1 called a cardiologist, who took an E.C.G., of Mrs. Koshti and the cardiologist advised Dr. Umesh Khanna
- the Opposite Party No.1; to transfuse one bottle of blood to Mrs. Koshti, with dialysis. Accordingly, the Opposite Party No.1 transfused the blood with dialysis to Mrs. Koshti, which reduced her chest pains.
According to the Complainant, he was required to pay an amount of `400/- as the fees of cardiologist.
[2] According to the Complainant, on 17/10/1997, his wife
- Mrs. Koshti; was advised by the Opposite Party No.1 to get herself admitted to his clinic for a gastroscopy and transfusion of two bottles of blood with dialysis. Accordingly, the Complainant's wife was admitted on 17/10/1997 at about 10:00 a.m. But, according to the Complainant, during the period from 10:00 a.m. to 06:00 p.m., nothing was done, except that the Opposite Party No.1 examined the patient at 11:30 a.m. and told her not to worry about her health and she would be alright as usual after transfusing two bottles of blood. At about 06:00 p.m. Gastroscopy was done by the Opposite Party No.2, who is the wife of the Opposite Party No.1 and thereafter, both the doctors went home.
According to the Complainant, at about 08:00 p.m., in the night, said doctor, on telephone, gave duty nurse a direction to give one more bottle of blood without dialysis to the patient - Mrs. Koshti. It was about 09:00 p.m. By that time, the Complainant's wife started feeling disturbed and uneasy.
At about 11:00 p.m. said doctor, on telephone, told the nurse again to give another bottle of blood without dialysis. Nurse on duty did accordingly. After about midnight, there was no one in the clinic and only one nurse, by name - Mrs. Sally; was attending the Complainant's wife. The Complainant states that due to second blood transfusion, condition of the Complainant's wife deteriorated very much. The patient was feeling disturbed and uneasy. The Complainant asked the duty nurse to call the doctor, but the nurse stated that the patient might be having a headache and the Complainant should not worry about the patient. However, after midnight onwards, the Complainant's wife started going into coma and the Complainant could not get services of the said doctor during that period and the Complainant was left with simply seeing that the condition of his wife was slowly and gradually sinking.
The Complainant pleaded further that on 18/10/1997 at about 03:00 a.m., his wife had gone completely into coma. He found that she had no sensation and she was hardly breathing and the Complainant apprehended that due to cardiac arrest and because of severe loss of oxygen not reaching to brain, the patient had gone into coma.
According to the Complainant, his son, by name - Dr. Abhijit Koshti; who is also a M.D., came from Bhivandi to see his mother at 08:15 a.m. to 18/10/1997. The Complainant's son was shocked to see the condition of his mother. He called Dr. Umesh Khanna
- the Opposite Party No.1; to the clinic. Accordingly, Dr. Umesh Khanna came at about 10:00 a.m. and advised the Complainant to remove the patient to Suvarna General Hospital - the Opposite Party No.4; at Borivali, Mumbai.
Accordingly, the patient was taken and admitted in the Opposite Party No.4 Hospital in Intensive Cardiac Care Unit (ICCU) but, there was no progress. Doctors in the Opposite Party No.4 Hospital told the Complainant and his son that the patient had very little respiration and showed their inability to do anything. Therefore, the Complainant and his son were compelled to take the patient to Bhivandi in the clinic of the Complainant's son. The patient was given oxygen by the Complainant's son, at his clinic at Bhivandi, but it was of no use and ultimately, on 19/10/1997 at around 05:30 a.m. the patient died.
[3] According to the Complainant, his deceased wife was alright on 17/10/1997 and she had climbed the steps of the said clinic, where she was admitted but, due to negligence on the part of the Opposite Parties in transfusing the blood without dialysis, his wife expired. The Complainant pleaded that the Opposite Parties Nos.1 & 2, in their clinic, showed utter negligence in not attending the patient since 17/10/1997 from 07:00 p.m. till 18/10/1997 up to 10:00 a.m. inspite of repeated demand of the Complainant to attend and examine the patient. The Opposite Parties left the condition of the patient to deteriorate throughout the whole night of 18/10/1997 and was left in the care of one nurse on the duty. The Complainant alleged that the Opposite Parties Nos.1, 2 & 3, were responsible for the death of his wife, aged 68 years and but for negligence in service on the part of the Opposite Parties Nos.1, 2 & 3, she would have survived for number of years. The Complainant alleged that the blood was transfused to his wife without dialysis, which amounted to negligence. According to the Complainant, these Opposite Parties had not taken due & proper care of the patient and they were guilty of deficiency in service in discharging their professional duties. The Complainant's wife suffered injury and death due to lack of care and reasonable skill and hence, the Opposite Parties Nos.1 & 2, both were guilty of negligence. They failed to exercise reasonable care in carrying out their professional skills, diagnosis, advice and treatment.
These Opposite Parties had transfused two bottles of blood without dialysis to the kidney patient (the Complainant's wife), and therefore, she lost her life. The Complainant, therefore, filed present consumer complaint, claiming damages of `10,00,000/-, from all the Opposite Parties, together with interest thereon @ 24% p.a. The Complainant also prayed that he was entitled to get refund of all bills, he was required to pay while his wife was in the hospital of the Opposite Parties. The Complainant also claimed `15,000/- as compensatory costs.
[4] Dr. Umesh Khanna - the Opposite Party No.1; filed his written version and took up preliminary objections that case involves complicated questions of facts, and therefore, it should be adjudicated by Civil Court and not by Consumer Commission. The Opposite Party No.1 also pleaded that based on presumptions & conjectures, without any valid medical opinion, complaint has been filed alleging medical negligence on his part and thus, present complaint is totally misconceived. According to the Opposite Party No.1, he acted with due care & caution, diligence and competence while attending the Complainant's wife. He had exercised high degree of care and competence while attending the Complainant's wife and there was no negligence of any kind on his part.
He acted with the prevalent standards of reasonably competent medical person while attending the Complainant's wife. According to him, the patient - Smt. Leela M. Koshti (the Complainant's wife), was undergoing a treatment for Chronic Renal Failure (CRF) in the year 1994. The patient's son - Dr. Abhijit Koshti; brought her to the Opposite Party No.1 and informed him that he had discussed the case of the patient at length with Dr. Sanjeev Khanna and a decision was taken to refer the patient to the Opposite Party No.1 since, the Opposite Party No.1 was his college-mate and the Opposite Party No.2 was a class-mate of Dr. Abhijit Koshti and Dr. Abhijit Koshti had a great confidence in the Opposite Party No.1, who was then attached to Unity Nursing Home, as a Consulting Nephrologist. The Opposite Party No.1 pleaded that since the patient was the mother of a fellow doctor, who was known to both the Opposite Parties Nos.1 & 2, they did not charge the patient any consulting or visiting fees nor he charged anything when the patient was admitted in his nursing home and he had given special devotion and attention while treating the patient - Mrs. Koshti. The Opposite Party No.1 pleaded that the patient was suffering from hypertension leading to nephrosclerosis resulting into chronic renal failure with associated atherosclerosis and Ischemic Heart Disease (I.H.D.).
According to the Opposite Party No.1, when he was attached to Unity Nursing Home, the patient attended as an outdoor patient and prescriptions and medicines were handed over to the patient. Patient later on came to be admitted in B. K. Kidney & G. I. Centre, Goregaon.
The patient, in her then prevailing clinical setting, required haemo-dialysis twice a week with medication. The Opposite Party No.1 intensively treated her and her renal functions gradually improved and instances of haemo-dialysis were reduced.
According to the Opposite Party No.1, the patient was on haemo-dialysis for a period of 1 to 02 years. The Opposite Party No.1 pleaded that the fact that the Opposite Party No.1 could manage the patient without dialysis is the single most important proof of exceptionally good medical treatment the patient received at his hands.
The Opposite Party No.1 further states that Dr. Abhijit Koshti and his family members had repeatedly commended the Opposite Party No.1 for that purpose. The Opposite Party No.1 pleaded that blood transfusion sometimes is urgently given when blood loss was significant or patient has severe anemia. He also pleaded that blood transfusion can be given on OPD basis or on an in-patient basis. Dialysis is administered alongwith blood transfusion in a patient of stable Chronic Renal Failure who is not on regularly dialysis only when the clinical setting of the patient requires the same e.g. Uraemia, Pericarditis, Hyper Valumnia, Peripheral neuropathy, Hyper catabolic State etc. are manifest. Dialysis cannot be administered as a prophylactic measure while blood transfusion is carried out in such patients. He further pleaded that patients with good urine output, having no uremic symptoms and having low level of urea, creatinine etc. do not require dialysis. However, if they have severe anemia and are especially losing blood they would require blood transfusion depending upon the patient's individual clinical setting. He pleaded that in the case of renal anemia in an elderly patient having unstable heart with complication of bleeding in stomach, haemo-dialysis is a relative contraindication. Anti-coagulant is needed to be administered and patients suffering from bleeding disorder is required to be given blood transfusion otherwise their condition may result in hypo-tension and cardiac arrest. So, it is for the physician to decide depending upon clinical examination of the patient, including urine output, fluid status, level of uremic toxins etc., before deciding to go in for dialysis with or without blood transfusion. The Opposite Party No.1 pleaded that patient - Mrs. Koshti was admitted on 17/10/1997 with a history of bleeding in G.I. Tract and a gastroscopy revealed angiodysplasia or telangiectasia of the stomach - which is a known association with chronic renal failure and is notoriously difficult to treat. This condition results in frequent and profused bleeding in the patients with chronic renal failure, as such patients are known to have underlying coagulation defects.
[5] The Opposite Party No.1 further pleaded that on 17/10/1997, the patient was admitted with a complaint of Melena and hematemesis. She was promptly attended and necessary investigations were carried out. Medications were administered to counter the bleeding.
Gastroscopy was done and it revealed that blood was oozing from the stomach site and a diagnosis of telangectasia (angiodysplasia) was made by the Opposite Party No.2. Biochemical tests revealed that serum creatinine was only 3.2 mg% and blood urea was only 75 mg% and the value of potassium was 3.7 mEq/1. Thus, the patient did not require dialysis. R. T. aspiration also confirmed bleeding from the stomach and hence, one bottle of blood was transfused with necessary medication to achieve stability and to avoid complication of less blood supply reaching vital organs like heart and brain. Blood transfusion was uneventful. However, very low level of Hb. (4.5 gm.) necessitated a second bottle of blood which was started at 10:00 p.m. According to the Opposite Party No.1, patient developed a febrile reaction leading to fever with chills and body ache. The RMO and the Opposite Party No.1 examined the patient's vital parameters and promptly instituted the therapy for the same. Injection Paracetamol was administered to the patient and the patient then went to sleep. As per normal practice, the R.M.O. visited the patient during his morning round and he found the patient to be drowsy but arousable.
He examined the patient and clinically suspected Hypoglycemia. Hence, on the advice of the Opposite Party No.1, the patient was administered 25% glucose I.V. Further investigations were conducted and blood sugar level of 194 mg% was revealed.
R.M.O. contacted the Opposite Party No.1 and told him that inspite of adequate correction of blood sugar, there was rise in blood sugar. The Opposite Party No.1 thereafter immediately rushed to the nursing home and duly attended the patient. The Opposite Party No.1 diagnosed the condition of the patient as cerebro-vascular accident consequent to her prevailing co-morbid conditions. The Opposite Party No.1, therefore, advised shifting the patient to an Intensive Cardiac Care Unit in any other hospital having advanced diagnostic and therapeutic facilities.
According to the Opposite Party No.1, he had a detailed discussion in this regard with the Complainant and Dr. Abhijit Koshti. The Opposite Party No.1 has pleaded that he had managed to procure a bed in Lilavati Hospital but, the Complainant and his son told the Opposite Party No.1 that cost of treatment at Lilavati Hospital would be high, and therefore, they decided to shift the patient to the Opposite Party No.4 Hospital, for which the Opposite Party No.1 arranged for an ambulance. In the ambulance, the Opposite Party No.1 personally accompanied the patient. While going there, C.T. Scan was done at Dr. Gala's C. T. Scan Centre at Malad. C.T. Scan revealed multiple lacunar infarcts in brain. Patient was then taken to the Opposite Party No.4 Hospital, where the patient was examined by a neurologist - Dr. Shirsat; and Dr. Lokre, a physician and cardiologist and it was revealed by clinical diagnosis that the patient was suffering from a stroke resulting in brain stem infarct. The doctors at the Opposite Party No.4 Hospital, including the Opposite Party No.1, did their best to treat the patient. However, the patient's son - Dr. Abhijit Koshti; secured her discharge against medical advice and took the patient home in view of her generalized atherosclerotic disease and multiple problems. According to the Opposite Party No.1, he learnt that the patient passed away in the nursing home of Dr. Abhijit Koshti. The Opposite Party No.1 pleaded that he had taken utmost care & reasonable skill in treating the patient and he had taken due care & caution looking to the best interest of the health of wife of the Complainant. The Opposite Party No.1 raised a contention to the effect that the allegations of negligence are baseless and false, and therefore, he prayed that the complaint may be dismissed with costs.
[6] Dr. Mrs. Molina Khanna - the Opposite Party No.2 herein; is the wife of the Opposite Party No.1. In her written version, she pleaded that she is a highly qualified gastroenterologist. According to her, the Complainant has not made specific allegations of commission or omission against her but, she has been impleaded as a party to the complaint proceeding in the array of the Opposite Parties merely because she happens to be the wife of the treating doctor viz. the Opposite Party No.1. The Opposite Party No.2 further pleaded that she was asked to carry out process of gastroscopy on the patient on 17/10/1997.
The procedure was performed under local anesthesia. It revealed telengectasia and accordingly, report was submitted.
According to her, said procedure was carried out with due diligence and skill and there was no negligence on her part in doing the said procedure. She further pleaded that the complaint be dismissed as there were no justifying grounds for claiming any relief against her.
[7] B. K. Kidney & G. I. Centre - the Opposite Party No.3; is a nursing home run by the Opposite Parties Nos.1 & 2. In its written version, it pleaded that their nursing home is attached with highly qualified doctors having established practice. It is a nursing home with ten beds with specialty in gastroenterology, nephrology and urology. It is pleaded that said nursing home has equipments and facilities for diagnosis and treatment of chronic renal failure. Nursing home pleaded that the complaint is based totally on presumptions & conjectures drawn by the Complainant and not based on any cogent & valid documents and medical opinion.
It is pleaded that the complaint is absolutely frivolous and it may be dismissed under Section-26 of the Consumer Protection Act, 1986; with exemplary costs. The Complainant has nowhere mentioned specific omissions or commissions on the part of the Opposite Party No.3 Nursing Home in respect of services rendered. So, the Complainant has no cause of action to file a consumer complaint against it. It pleaded that the complaint is absolutely false and has been filed just to extract unconscionable bargain. The Opposite Party No.3 Nursing Home pleaded that the Complainant's wife was admitted in the nursing home on 1/5/1997, as an indoor patient and she was discharged on 4/5/1997. During this period medical treatment and care was given by the treating doctors with diligence and utmost care. Again the patient was admitted on 16/9/1997 and was discharged from the nursing home on 20/9/1997. During this period, same care & caution was taken by the treating doctors. Again the patient was admitted on 17/10/1997 and was transferred to the Opposite Party No.4 Hospital on 18/10/1997. During this period also, the patient was treated with utmost care and caution. It is pleaded that the patient was coming to their nursing home since the year 1994, initially, as an outdoor patient. Even at that time, due care & caution was taken. The Opposite Party No.3 Nursing Home has given a chronology of the treatment given to the patient on 17/10/1997 and on 18/10/1997 till the patient was shifted to the Opposite Party No.4 Hospital. The Opposite Party No.3 thus, pleaded that there is no negligence of any kind on its part and the complaint may be dismissed with costs.
[8] Suvarna General Hospital
- the Opposite Party No.4; has also filed its separate written version and contested the complaint.
According to the Opposite Party No.4 Hospital; it is a charitable hospital duly registered and it has got 70 consultants for various specialties. It took up a defence that the Opposite Party No.4 Hospital is free from responsibility for the deceased, as the patient was withdrawn from medical care against medical advice. The Opposite Party No.4 Hospital admitted that the patient was admitted in the Opposite Party No.4 Hospital but, pleaded that at that time the condition of the patient was unstable having suffered a fresh stroke.
The patient was admitted at 12:30 p.m. in an unconscious state. The patient's blood pressure was 100/80 and her pulse was 112 per minute and her pupils were bilaterally equal and reacting to light. The patient was not responding to painful stimuli and the planters were upgoing. The patient was, therefore, admitted to the Intensive Care Unit (ICU) and under the care of the Opposite Party No.1 and the treatment was promptly initiated. It is further pleaded that by way of an abundant caution, the Opposite Party No.4 Hospital, on the advice of the Opposite Party No.1, further called a neurologist by name - Dr. A. Shirsat and a general physician by name - Dr. V. S. Lokre. On examination of the patient it was found that the patient's Hemoglobin value was 5.7 gms%. The total WBC count was 18,700/cmm and Blood Urea Nitrogen was 118 mg%, while Creatinine was 3.7mg%. The patient was suffering from severe anemia infection and fresh stroke.
When examined by Dr. A. Shirsat, he opined that the patient was in deep coma. Pupils mid posed, sluggishly reaching to light. Dolls eye movement absent. Bilat hemiplegia. Reflexes bilaterally exaggerated. Both plantars up going.
Diagnosis brain stem infarct.
It is pleaded that on the basis of this opinion, antibiotics, dialysis and monitoring of the blood sugar was done of the patient. Dr. V. S. Lokre and Dr. A. Shirsat both were of the opinion that the patient had brain stem infarct and the prognosis was poor. These two doctors suggested to the relatives of the patient, including the Complainant, that aggressive resustative measures like putting the patient on the ventilator had to be done.
However, the Complainant, who himself is a doctor by profession, told them that he wanted to take the patient away against medical advice. In the clinical notes, it has been clearly mentioned on 18/10/1997 by the patient's son - Dr. Abhijit Koshti, as - "We do not wish to do any interventional treatment and I would wish to take my mother home against medical advice." This note was signed by the patient's son, by name - Dr. Abhijit Koshti. In the light of this note, the Opposite Party No.4 pleaded that the Complainant or his relatives cannot blame the Opposite Parties for negligence when they had gone against medical advice. The Opposite Party No.4 pleaded that the Complainant's son being a medical practitioner should have known better before forcibly taking his mother from medical care and taking his mother from Borivali to Bhivandi, when her condition was critical. The condition of the patient had deteriorated on 18/10/1997.
The patient had been under the treatment of the Opposite Party No.1 for more than a period of 3 years.
In fact, it is pleaded by the Opposite Party No.4 Hospital that due to shifting away from a specialized medical care to a small maternity home of Dr. Abhijit Koshti, the patient had expired. It pleaded that the patient was a high risk patient, as she was in severe anemia, she had chronic renal failure, Ischemic Heart Disease, gastrointestinal bleeding, fresh brain stem C.V.A. (infarction) and in such a condition, the patient should not have been shifted to Bhivandi from Borivali.
The Opposite Party No.4 Hospital pleaded that the complaint as filed against it is absolutely false and frivolous and may be dismissed with compensatory costs.
[9] All the parties filed their respective affidavits in support of their respective pleadings.
[10] We heard Mr. U. B. Wavikar - Learned Advocate for the Complainant; Mr. Y. C. Naidu - Learned Advocate for the Opposite Party No.1; Mr. A. V. Patwardhan - Learned Advocate for the Opposite Parties Nos.2 & 3; and Smt. Geeta Handa Khanuja - Learned Advocate for the Opposite Party No.4.
[11] Looking to the pleadings of the parties, we are finding that basically grievance of the Complainant is against the Opposite Party No.1 and since the wife of the Opposite Party No.1, the Opposite Party No.2 herein, together own and manage the Opposite Party No.3 Nursing Home, they have been impleaded as the parties to the complaint in the array of the Opposite Parties and since the patient was also admitted in the Opposite Party No.4 Hospital, in ICU, it has also been impleaded as a party to the complaint. But as far as the Opposite Party No.4 Hospital is concerned, we make it very clear at this stage itself that the Opposite Party No.4 Hospital cannot be held to be guilty of medical negligence of any kind for the reason that the patient, when brought to the Opposite Party No.4 Hospital on 18/10/1997, was a high risk patient since the patient was suffering from severe anemia, chronic renal failure, Ischemic Heart Disease, gastrointestinal bleeding and fresh brain stem infarcts. C. T. Scan of the patient on 18/10/1997 showed that the patient had chronic heart disease. Patient was under the care & treatment of the Opposite Party No.1 for a period of more than 3 years and she was a patient of renal failure, which was also managed for 3 years. From the fact that the patient was forcibly taken away against the medical advice of the Opposite Party No.4 Hospital and made to travel from Borivali to Bhivandi on 18/10/1997 made the patient's condition more critical and on the following day the patient died in the hospital of Dr. Abhijit Koshti at Bhivandi. Thus, we agree with Smt. Geeta Handa Khanuja - Learned Advocate for the Opposite Party No.4 Hospital; that the Opposite Party No.4 Hospital cannot be held responsible for the death of the patient as the patient was discharged against the medical advice, which is clear from the documents on the record. So, there is no question of fastening any liability on the Opposite Party No.4 Hospital.
[12] As regards the Opposite Parties Nos.2 & 3 are concerned, there is also general allegation but no specific allegation is made to the effect that the Opposite Party No.2 - Dr. Mrs. Khanna; or the B. K. Kidney & G. I. Centre - the Opposite Party No.3; were in any way guilty of medical negligence. The Opposite Party No.2 simply performed the gastroscopy, which is a diagnostic test and there is no negligence ascribed or attributed to the Opposite Party No.2, who had conducted the said test. She did nothing else. There is very general allegation that the doctors in the Opposite Party No.3 Nursing Home were not careful to take care of the patient admitted by the Complainant. But it is to be remembered here that general allegations have got no meaning because the patient was rightly monitored in the Opposite Party No.3 Nursing Home, run by the Opposite Parties Nos.1 & 2 and various case-papers produced on the record clearly point out that the Opposite Parties Nos.2 & 3 had done their jobs properly.
[13] As regards the Opposite Party No.1, there is same allegation of medical negligence. The Complainant's first grievance is that no technical or qualified person for taking E.C.G. was employed by the Opposite Party No.1. However, reply to this allegation by the Opposite Party No.1 is that in the year 1998, there was no educational institution, which offered educational course for taking an E.C.G. of the patient. Taking E.C.G. involves making the patient comfortable in the bed/emergency trolly; exposing patient's torso; connecting leads at designated points on the patient's torso and patient's ankles; putting on the E.C.G. machine, which then automatically pointing out the ECG reading; putting off the E.C.G. machine; disconnecting the leads; instructing the patients to dry up and making necessary arrangements for the patient to be taken away; taking the E.C.G. readings print-out from the machine and delivering the same to the concerned doctor for his clinical evaluation and opinion. So, according to the Opposite Party No.1, it was a simple task, which is imparted in all hospitals of India without employing qualified technician or qualified person to take E.C.G. of the patient. Even the Complainant, who himself is a doctor and his son is M.D., running a hospital at Bhivandi also employ lay persons to do E.C.G. of patients in their hospital. What is important to note is the fact that the Complainant has not made out a case that the E.C.G. report taken of his wife in the nursing home of the Opposite Party No.1 was in any way defective or wrong.
So, making general allegations is not sufficient to prove medical negligence on the part of the Opposite Parties Nos.1 to 3.
[14] Next contention of the Complainant appears to be that the Opposite Party No.1 transfused blood to the patient without dialysis and without application of mind. The Complainant alleged that the patient had gone into coma as a result of negligence of the Opposite Party No.1 in giving the blood without supervision of doctors or applying medical mind. The Opposite Party No.1, through his learned advocate, argued before us that blood can be transfused to a patient with chronic renal failure without dialysis - (i) whenever blood transfused is urgently required for severe anemia or bleeding from any site/hemorrhage; (ii) whenever patient has chronic renal failure and is not on regular dialysis; (iii) whenever the degree of azotemia or the clinical condition does not merit dialysis and on the contrary, dialysis is relatively contraindicated in cases of elderly patient, Ischemic Heart Disease, bleeding from any site (amongst other). It was submitted before us that in the case of patient - Mrs. Koshti; dialysis was not required when blood transfusion was given because all the three conditions mentioned above were present in her case. The Complainant has not adduced any expert evidence.
The Complainant is relying upon his own affidavit. But the Opposite Party No.1 has adduced on the record two affidavits of experts.
One is of Dr. Bharat Shah, who had gone through the complaint and documents, written versions on the record and case-papers before giving his opinion as an expert. In paragraph (02) of his affidavit, Dr. Bharat Shah testified that he is a qualified and trained nephrologist having experience of 18 years. In paragraph (03) of his affidavit, he asserted that blood transfusion can be administered to a patient with chronic renal failure without dialysis - (a) whenever blood transfusion is urgently required for severe anemia or bleeding from any site; (b) whenever patient has chronic renal failure and is not on regular dialysis; and (c) whenever the degree of azotemia or the clinical condition does not merit dialysis. He further stated that in the case of Mrs. Koshti, - (a) dialysis was not required when blood transfusion was given because patient was non-oliguric with moderate azotemia and was not on regular dialysis; (b) blood transfusion has not caused increase in urea. In his medical opinion, increase in urea in this case was due to bleeding in stomach (breakdown of blood product into urea); and (c) medically blood transfusion cannot lead to development of stroke. Dr. Bharat Shah also further stated that the patient Mrs. Koshti had chronic renal failure with many co-morbid conditions such as Ischemic Heart Disease, cerebrovascular ischemia, severe anemia, bleeding talengectasia in stomach etc. and hence, keeping in mind the clinical setting of the patient she was treated appropriately at all times and she was given proper medical treatment by Dr. Umesh Khanna
- the Opposite Party No.1.
[15] Another affidavit is of Dr. Kirti L. Upadhyaya, is also a practicing nephrologist and after seeing the case-papers of the patient, complaint and written versions filed on the record, he opined that in his considered opinion any patient suffering from chronic renal failure and not requiring dialysis can be transfused blood for severe anemia without giving dialysis concurrently. He further stated that he did not agree with the statement of Dr. M. E. Koshti - the Complainant; that dialysis should have been given alongwith blood transfusion on 17/10/1997 for the reasons - (a) Patient's urea and creatinine values did not warrant it; and (b) patient was non-oliguric and not on regular dialysis. In paragraph (05) of his affidavit, Dr. Kirti Upadhyaya also opined that looking to the condition of the patient, since she was known patient of chronic renal failure with co-morbid conditions including Ischemic Heart Disease, Lacunar infarct, bleeding talengectasia, severe anemia, etc., and keeping in mind the clinical setting of the patient, she was treated appropriately at all times.
[16] These two doctors are experts in the field and since expert evidence conclusively establish that blood transfusion can be given to any patient even if the patient is suffering from chronic renal failure coupled with other diseases when blood transfusion is required to be given to such a patient in view of severe anemia.
She was having gastrointestinal bleeding as has been confirmed by the Opposite Party No.2 Doctor in her gastroscopy. So, the patient was required to be given blood transfusion to save her life and it is very clear that every time when blood is required to be transfused a patient of chronic renal failure it need not be given with dialysis.
So, there is no merit in the contention of the Complainant that the Opposite Parties were guilty of medical negligence because they had given blood transfusion without concurrently conducting dialysis to the patient
- Mrs. Koshti. So, on this count not fault can be found with the Opposite Parties Nos.1, 2 & 3 or as against the Opposite Party No.1 primarily. We are, therefore, finding that the allegations of medical negligence made by the Complainant and his son, through affidavits against the Opposite Party No.1 or for that matter as against the Opposite Parties Nos.2 & 3 are baseless and without any basis and have been disproved by the expert evidence adduced by the Opposite Parties in terms of affidavits of expert doctors, namely - Dr. Bharat Shah and Dr. Kirti Upadhyaya.
[17] In these circumstances, we are finding that the allegations of the Complainant against all the Opposite Parties are appearing to be devoid of any substance and the patient - Mrs. Leela Koshti, died primarily because she was a known patient of chronic renal failure with co-morbid conditions including Ischemic Heart Disease, Lacunar infarct, bleeding talengectasia, severe anemia, etc., and also because of the fact that the Complainant had, against medical advice, in a very critical condition, removed the patient from the Opposite Party No.4 Hospital from Borivali to Bhivandi at the hospital of Dr. Abhijit Koshti, where on the very next morning the patient breathed her last. So, the blame, if any, can be shouldered by the Complainant and his own son for the unfortunate death of the Complainant's wife and none of the Opposite Parties can be held responsible for the death of the patient - Mrs. Leela Koshti.
With this, we proceed to pass the following order:-
ORDER The complaint stands dismissed.
No order as to costs.
Pronounced on 15th June, 2011.
[Hon'ble Mr. P.N. Kashalkar] PRESIDING MEMBER Hon'ble Mrs. S.P.Lale] Member kvs