State Consumer Disputes Redressal Commission
Umakant Rajaram Chauhan vs Dr Anil M Gupta on 6 November, 2020
BEFORE THE CONSUMER DISPUTES REDRESSAL COMM ISSION
GUJARAT STATE AT AHMEDABAD.
COMPLAINT No. 42 of 2011
Umakant Rajaram Chauhan
14, Takshshila Park,
Opp. Neelkamal Society,
Nr. Galaxy Avenue, Naroda,
Ahmedabad. .....Complainant
Vs.
1.Dr. Anil M. Gupta C/o. Parth Prasutigruh & Medical Hospital, Nr. Krushna Tower, B/s. Priya Talkies, Nr. National Highway-8, Krishnanagar, Ahmedabad.
2. Anand Surgical Hospital Ltd.
Dr. Narendra Sanghvi, Janta Chambers, Nr. Saijpur Tower, Naroda Road, Ahmedabad.
3. Dr. Rajesh Mishra
4. Nidhi Hospita C/o. Nidhi Hospital "Shrikunj" Stadium Commerce Road, Navrangpura, Ahmedabad.
5. United India Insurance Co. Ltd.
D. O. II, Handloom House, 3rd Floor, Ashram Road, Ahmedabad. .....Opponents Appearance: Mr. Rajiv Mehta, Ld. Advocate for the Complainant Mr. M. K. Joshi, Ld. Advocate for the Opponent Nos.1, 2, 3 and 4 Ms. S. A. Dave, Ld. Advocate for the Opponent No. 5 Coram: (Shri S. N. Vakil, Member) (Shri J.Y. Shukla, Member) Order by Shri S.N. Vakil, M ember Order dated 06.11.2020
1. This is against Medical Negligence.
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2. Case of the Complainant- Umakant Rajaram Chauhan is that his wife Kalpanaben, aged 45 years, had cough and fever during mid-October 2010, and consulted local and family physician-an ayurvedic doctor Bhagirath Pandya who gave her treatment and advised her rest. After about 3-4 days of treatment, she complained of difficulty in breathing and as a result was hardly able to have adequate sleep during night hours. Upon advice of Dr. Bhagirath Pandya, he and his wife approached the Opponent No.1 -Dr. Anil M. Gupta at his clinic on 25 th October, 2010, asked him for thorough examination and suitable line of treatment. He on preliminary examination, straightway advised for hospitalization and assured him that although her hemoglobin level is on lower side, he will manage it if the complainant make arrangement for two bottles of A+ve group blood, which he arranged for without any loss of time from Indian Red Cross Society. He informed that usually blood can be supplied at the hospital where all other facilities are available also. On 26th he (Dr. Anil Gupta) advised for hospitalization at hospital of Anand Surgical Hospital Ltd. - the Opponent No.2. The complainant, when heard it for the first time, immediately inquired from Dr. Anil Gupta and asked him to explain in detail about her actual condition. However, he then also said that just because she complains for temporary breathlessness, and to bring her confidence, she is to be transferred to the said well equipped Anand Hospital. When asked about who will look after her, he replied that he himself will take care and treat her, and therefore nobody should worry about her condition. Dr. Gupta talked with the Anand Hospital, where she was taken on 26th at about 1 P.M. She was first examined by doctor on duty, who informed the complainant that she seems to have 2 internal infection as a result of which her hemoglobin level is reduced. When the complainant reported this fact to Dr. Anil Gupta, he laughed and said why are you worrying, I am here to treat her. Then he administered blood bottles. Soon thereafter she complained for pain near chest. The staff of the hospital informed this to Dr. Gupta even then he continued to brought from Adarsh Voluntary Blood Bank, with the blood supply, even on the next day. The doctor on duty again drew complainant‟s attention and asked him to put it to the knowledge of Dr. Gupta, which when he so put, Dr. Gupta in turn replied that information is correct up to certain extent but not wholly true and he is competent enough to meet with these circumstances. The complainant upon this assurance, agreed to wait for necessary response of the treatment at the hospital, and agreed to pay necessary charges through cashless mediclaim facility. Dr. Gupta, thereafter recommended certain analytical/ pathological test and prescribed some diagnostic investigations. They were carried out, and on its perusal, Dr. Gupta for the first time, confirmed that her complaint for pain near chest may be due to slight damage to her lung and it causes breathlessness. The complainant alleged that because of administration of blood, it might have increased hemoglobin levels to some extent but on the otherhand Dr. Gupta informed him that her kidney is got damaged, her abdomen now shows distention and some free gas had been observed in it. Thereafter, Dr. Gupta recommended for test pertaining to dengue IgG which was carried out at Divine Micropath Laboratory on 29 th and it was found that she was positive. This clearly indicates that internal infection that was observed by the doctor on duty had caused serious damages to her and it seems to have been gone unnoticed by 3 Dr. Gupta. Because of carelessness and casual approach of Dr. Gupta, the underlying cause of her illness seems to have not diagnosed properly and resultantly she is suffering lot and her real treatment is thus delayed. Before any line of treatment is thus selected, the said ailment had caused further damaged to her health. Once having come to know about the internal infection, Dr. Gupta was expected to treat her cautiously but he continued with the same line of treatment except few minor change with regard to administration of medicine here and there, which he did just to make a show that he had altered the line of treatment. After about 3-4 days, when Dr. Gupta observed that his line of treatment is not getting any positive response and condition of the patient is not within his control he then called Dr. Rajesh Mishra - the Opponent No.3 for consultation. He visited the hospital, examined her and advised for shifting her from the said hospital to Nidhi Hospital - Opponent No.4. When he asked Dr. Mishra whether he would be in position to put her in a better cure, he replied that he had a vast experience in the field and Nidhi Hospital is having all facility to meet all emergencies. When asked about requirement of fund to meet with the probable expenditure, he having incurred huge expenditure, Dr. Mishra informed it would not be more than Rs. 35 - 40 thousand, but it will be nothing against the value of her life, and advised that MRI would be necessary for which also she is required to be shifted to Nidhi Hospital, being nearest and proper place, where all other facilities pertaining to medical treatment would be available easily. The complainant, although not satisfied with the answers given, unwillingly consented to shift her to Nidhi Hospital on 1st November, 2010 at 9 P.M. MRI was done at Infocus Diagnostics 4 which confirmed that her condition was deteriorated and was requiring critical care unit facility. Dr. Gupta, when she was being shifted, gave telephonically Dr. Mishra details of the treatment he gave and her history. On reaching Nidhi Hospital, Dr. Mishra examined her and found that she had fever and not able to respond to command to move her leg or hand. Therefore he suggested for ventilator support and oxygen was started, series of medicine was prescribed with nil by mouth. He said that some pus like fluid had been observed and a tube has to be inserted to drain it out. Next he informed of increase of creatinine above normal, and few pathological tests are required to find out exact cause. Considering all those reports of tests, carried out at Nidhi Hospital Lab only, he said that surgeons opinion would be necessary, at whose instance Dr. Popat and Dr. Kharod were called. Despite continuous supply of oxygen, ventilator support, lot of medicine through i.v route, patient‟s condition was deteriorating and Dr. Mishra was not doing anything except passing time, justifying it by saying that one has to wait for few hours after treatment for appropriate response. On the contrary, creatinine level further increased and to overcome this, he changed some medicines. A day after, he informed him that now he was got little success and she has started obeying his command to some extent. To prove it and to win her confidence he tried to demonstrate but failed, for which gave explanation that she has capability but she is not willing to respond. For about a week she was kept at Nidhi Hospital without any fruitful gain, without any positive signs of recovery or improvement in her condition, and just passing time, it is alleged, for charges. He being dissatisfied asked Dr. Mishra on the face whether he is able to cure or he‟ll have to think of 5 other alternatives, upon which Dr. Mishra replied that despite his e fforts he is not getting adequate response and is unable to say at this moment about the future prognosis. Under this compelling circumstances, he asked for discharge therefrom, bill for Rs. 2,60,961/- was raised, upon scrutiny where of he found that they are so many items which were not supplied it was reduced to Rs.2,19,593/-and refunded the balance Rs. 2,38,407/- having already been deposited. Dr. Mishra was well aware that her condition is critical and it would not be possible for him to treat and cure her even then he accepted the patient, made a show that he can do better just to extract money, did treatment, the complainant willing got her discharged and shifted her to Civil Hospital, Ahmedabad, where she was under care of Dr. Ashaben Shah. She examined and informed the relatives that she is suffering from high grade infection due to delayed treatment - a condition known as septicemia, treatment papers suggest that no proper care has been to control infection and it has been spread all over now. She also informed that if the infection had been controlled at initial point of time the condition would not have been worsened to this extent. Even after strenuous efforts by doctor at the Civil Hospital she died on 12th November 2010 at 12:50. The carelessness, sheer negligence and casual approach on the part of Dr. Gupta and Dr. Mishra resulted into failure to diagnose the underlying cause which has ultimately resulted into her death. Handsome professional fees and carelessness show that they were interested in fees only, for which unethical attitude he reserves right to take approach the competent authority. For these deficiency in services, he claims, alleging her services to the family at 2/3 of Rs.10,000/-, her age as 45, longitively to 75 years, multiplier of 20, 6 (Rs.6,500/- x 12 x 20 =) Rs. 15,60,000/- and medical expenses of Rs. 5,00,000/- incurred i.e. Rs. 20,60,000/-; interest thereon and costs, from all the opponents jointly and severally.
3. Defence of Dr. Anil M. Gupta vide written version is of total denial. There is no fault, imperfection or shortcoming or inadequacy in quality, nature and manner of performance required to be maintained by or under any law for the time being in force. She was under treatment of Dr. Bhagirath Pandya, an Ayurvedic doctor for 10 days for cough and fever. As she was not responding and developed breathlessness, he referred her to him on 25.10.2010 for E.C.G. She came with some tests reports and she was immediately, attended to. The ECG was showing tachycardia and on clinical examination, she was obese and had bilateral ronchi & creps and mild distention of abdomen. Looking to her poor general condition and report the provisional diagnosis of septicemia + anemia was made. Therefore, she was advised to get admitted in the hospital and explained the proposed line of treatment and pros and cones also. The patient and his relatives agreed to that and therefore, she was admitted in his hospital, blood and urine samples were sent for pathological tests (CBC, RBC, S.Creatinine, SGPT & Urine -R&M). Looking to the condition of the patient, he told the complainant to arrange for the blood. Necessary treatment with injections started immediately. On 26.10.10, the test reports were also suggestive of septicemia + anemia. The X-ray chest and 2D Echo were also done and the report was suggestive of COPD & pleural effusion. Therefore, looking to poor general condition of the patient he advised to shift her to a well equipped hospital (OP.2) for which the patient and her relatives were agreed and the patient 7 was shifted to Anand hospital on 26.10.2010. She was shifted there on 26.10.2010 for further treatment under his care, arranged for the two bottles of blood and that was transfused, and she was monitored round the clock and necessary medicines were given with another blood transfusions. Pathological test and certain investigations were also carried out as per accepted medical norms. He also suggested for the Dengue test which was carried out on 29.10.2010. The same was found positive. He thereafter, had taken the advice of Dr.Rajesh Mishra -OP.3 (Intensive care specialist). He conveyed all the details of treatment and the history of the patient to the opponent no.3 doctor. The opponent no.3 visited his Hospital. The opponent no.3 examined the patient and approved the line of treatment and suggested few changes. He also advised to shift the patient to the opponent no.4 hospital under his care. The patient and her relatives agreed for th at the patient was shifted to OP.4 hospital. He submits that he had treated as per accepted medical practice and therefore not a guilty for any negligence or deficiency in service. It is denied that he availed benefits of mediclaim insurance facility of the complainant using unfair means and in unethical manner, or that did not take reasonable care while treating her, or that ultimately death of her has caused irrecoverable loss to him and he is feeling loneliness at his young age. He was in constant consultation with the doctor on duty at Anand Surgical Hospital and the doctor on duty was given treatment to the patient as per his advise. It is denied that the doctor on duty informed the complainant that patient seems to have internal infection as a result of which her hemoglobin level is reduced. It is denied that he first time confirmed damage to lung after seeing the report. In fact, as per 8 clinical findings on 25.1.2010, she had ronchi & creps and the provisional diagnosis was septicaemia + Anaemia. That was confirmed as stated above by blood reports and X-ray and Echo. Because of monitoring and the follow-up tests reports, it was found that her liver and kidney function was distorted and that was explained to the complainant off and on. As patient was not responding much to the treatment he carried out Dangue Test on 29/10/10 and that was positive. He denies that the internal infection that was observed by the doctor on duty, had caused serious damages to her and it seems to have been gone un-noticed by him. Immediately Dr.Mishra, intensive care specialist was consulted. He denies that because of carelessness and casual approach of opponent no.1, the underlying cause of illness of her seems to have not diagnosed-properly and resultantly she is suffering lot and the real treatment is thus delayed. He denies that before any real line of treatment is thus selected, the said ailment had caused further damage to the health of her. He denies to have continued with the same line of treatment except few minor changes with regard to administration of medicines here and there. He denies that despite receiving consideration, the opponent remained careless all throughout and failed to e ven diagnose the underlying cause of sufferance. He denies that either willingly or otherwise, he never disclosed correct facts and tried to suppress the ailment from which she was suffering and thereby deprived the complainant to take reasonable, appropriate and timely decision in a prudent manner which could have saved her life. He denies that her life could not be saved just because he remained careless and negligent in performing their parts of duties, and that there was deficiency in service.
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4. Defence of Opponent No.2 the Anand Surgical Hospital Ltd. is of total denial. As per the record she was brought to Anand Hospital on 26.10.2010 from Dr. Gupta‟s Nursing home as per instructions of Dr. Gupta and was admitted under his care. She was immediately attended by the duty doctor and thereafter she was exclusively under care of Dr. Gupta till her discharge. The hospital is providing all infrastructures to the consultant doctor and the medical treatment is provided strictly as per the consultant‟s instructions by the hospital staff. The hospital has provided only infrastructure and paramedical services and has not played any role as far as her Medical treatment was concerned. There is no negligence and no deficiency in service, unfair trade practice, no fault, imperfection or shortcoming or inadequacy in quality, nature and manner of performance required to be maintained by or under any law for the time being in force. There is no merit in the complaint and the complainant is not entitled to get any amount by compensation nor any of the reliefs against this opponents.
5. Defence of Opponent No.3-Dr. Rajesh Mishra vide written version is of total denial. Dr. Anil Gupta narrated history and clinical and other reports and asked her to visit at Anand Hospital on 29.10.2010. In response he visited the patient, took detailed history and went through the indoor case papers carefully and examined the patient. It was found that she had fe ver with sepsis, was going in multi organ failure and therefore he suggested more investigations including MRI and advise some changes in medicines. On 01.11.2010 Dr. Gupta told him that condition of patient was not improving and therefore he advised to shift her at Nidhi Hospital under his care. Accordingly, the relatives admitted in Nidhi Hospital ICU in 10 emergency on 01.11.2010 at 9:40 P.M. under the care of this present Opponent No.3. She was having fever, coughing and common cold, vaginal bleeding off and on and breathlessness since last 15 to 20 days as per the history given by the relatives of the patient. She was known case of Asthma and Obesity Hypoventilation Syndrome. She was immediately attended after clinical examination, was advised to get admitted in ICU and he explained the proposed line of treatment and pros and cones also. The relatives agreed to that and therefore she was admitted in ICU. On admission her vitals were T: 102 F, Pulse; 120/min, Respiratory Rate: 26/min, BP: 80/40 mm of Hg. Abdomen was distended, Bowel Sounds were absent (Paralytic lleus), CNS examination showed no response to verbal commands, moving all IV limbs on painful stimuli, Pupils: unequal (Rt>Lt) reacting to light. Her Dengue Serology was detected +ve at Anand Surgical Hospital (history given by patient's relatives). Laboratory Investigations were carried out. USG Abdomen was also carried which showed changes of paralytic ileus, mild inter bowel free fluid and mild spleenomegaly. MRI of Brain was also carried out which showed white matter edema with remote possibility of encephalopathy. As per the investigations and reports, treatment was started as per accepted medical norms in form of Entotracheal Intubation, Ventilatory support of VCV with help of Fentanyul and midazolam infusion and with 60% oxygen, central line (CVS) was put, IV Antibiotics (Inj. Meropenem (500 mg) 8 hourly, Inj. Forcan (100ml) OD, Inj. Acivir (500) OD, T. Fluvir (75) OD, Moxicip (400) Od) supportive treatment (Inj. Fosolin (150mg) 8 hourly, Inj. Rabicip (20mg) , inj. Perinorm (10mg) 6, inj Neodrol (1 gm), Inj. Mannitol (100ml), Inj. H Actrapid iv started according to sliding scale, Iv Fluids 11 inform of Inj. Ns, Inj. RL was started, Inj noradrinaline, Inj dobutamine was also started. Inj. Neostigmine infusion was started. Ryle's tube insertion and catheterization was also done. Cross reference of Dr. Bhavin (Consulting Surgeon) was also made, who advised conservative line of treatment and X- Ray Abdomen- supine, which showed significant dilatation of bowel loops. Next day the patient was treated on supportive line treatment, Culture for urine, Blood, stool was sent. Cross reference of Dr.Pranay Kharod (Neurologist) was done for CNS evaluation. The diagnosis of the patient was post viral immune mediated Multiorgan failure with encephalitis. Cross reference of Dr.Sunil D. Popat was also made who advised to reduce RT feeding to 50ml /2 hours. As patient was carrying high risk for DVT, prophylaxis started inform of pneumatic compressive device (DVT Pump). On 3rd day the patient was drowsy and not following Verbal Commands, however responding to DPS. Intermittent fever was noted through the day. On 4th day Laboratory reports were carried out. On 5th day the general condition of the patient showed improvement and patient was partially following verbal commands. On 6 th day, intermittent fever noted and patient was drowsy not following verbal commands. Neostigmine were omitted. Weannin trial was done. On 7 th day High grade fever noted which was treated by Inj. Perphalgan. She was drowsy and was not following verbal commands, responding to DPS. Ventilator switched to VCV mode. On 8th day Patient was drowsy, having intermittent fever. No significant change in the treatment was made by patient's treating consultant. Patient's urine output was 1 L to 1.5 L throughout her total hospital course. ABG were monitored and being corrected on regular basis. On 9 th day patient was on ventilator (VCV 12 mode), Drowsy, Disoriented, not following verbal commands. Patient's general condition was critical but stable which was explained to the relatives of the patient. The patient was discharged on 9.11.2010 at 1: 00 p.m. and shifted to Civil Hospital, Ahmedabad as per relative's request. He treated her as per accepted medical practice and therefore, not a guilty for any negligence nor deficiency in service nor unfair trade practices. He denies that the he availed benefits of mediclaim insurance facility of the complainant using unfair means and in unethical manner, and did not take reasonable care while treating the patient; that when complainant asked him that whether he would be in position on a be tter cure, he replied that he had vast experience in this filed and hospital is having all facilities to meet with the emergencies; that the probable expenditure would not be more then Thirthy Five or Forty Thousand; that he was not doing anything but passing time; that he was well aware from the very beginning as patient‟s condition is critical and it would not be possible for him to treat and cure even then he accepted the patient and just to extract more money he made a show that he can do better; that he did treatment only on a trial and error base; that despite receiving consideration, he remained careless all throughout and failed to even diagnose the underlying cause of sufferance; either willing or otherwise; that he never disclosed correct facts and tried to suppress the ailment from which she was suffering and thereby deprived the complainant to take reasonable, appropriate and timely decision in a prudent manner which could have saved her life; that her life could not be saved just because he remained careless in performing his part of duties. There is no negligence and deficiency in service nor unfair trade practice; 13 nor any fault, imperfection or shortcoming nor inadequacy in quality, nature and manner of performance required to be maintained by or under any law. She was treated as per accepted medical practice and therefore he is not a guilty for any negligence or deficiency in services or unfair trade practices.
6. Defence of Opponent No.4- Nidhi Hospital vide written version is of total denial. As per its record, she was brought to Nidhi Hospital on 01.11.2010 at 9:10 A.M. from Anand Hospital as per instructions of Dr. Rajesh Mishra (Opp. No.3) and she was admitted under his care. She was immediately attended by Dr. Mishra till her discharge on request. The Hospital is providing all instructions to the consultant doctor and the medical treatment is provided strictly as per the consultant‟s instructions by hospital staff. It is not true that the hospital has issued any bill of Rs.2,60,961/- at the time of discharge on request. The hospital bill was Rs.2,19,593/- and hence the balance amount was refunded to him. She was under
contineous care of Dr. Rajesh Mishra and the hospital provided necessary paramedical services as per accepted medical practice till the discharge was made on request. She was under exclusive medical care of Dr. Mishra and the hospital has provided only infrastructure and paramedical services and has not played any role as far as her medical treatment was concerned. It is denied that it initially issued bill of more amount. There was no negligence and or deficiency in service or unfair trade practice on the part of the hospital. Complaint deserves to be dismissed.
7. Defence of the United India Insurance Co. Ltd. vide written version is of total denial. There is no negligence on the part of Dr. Rajesh Mishra for whom the policy 14 No.060200/46/09/35/00000/674 for the period from 19.03.2010 to 18.03.2011 was. The Insurance Co. was not joined for six years. Policy No. 060200/46/09/35/00000/674 on 17.11.2011 with the Opponent No.4. Hence the Insurance Co. is not liable to pay any compensation. Hence complaint deserves to be dismissed against the Insurance Co.
8. HearSd Advocate Mr. Rajiv Mehta for the Complainant, Mr. M. K. Joshi for the Opponent Nos. 1, 2, 3 and 4 and Ms. S. A. Dave for the Opponent No.5- United India Insurance Co. Ltd.
9. Case papers for Dr. Anil Gupta reveals:
1/11 31/10 30/10 29/10 28/10 27/10 26/10 25/10
HB 13.1 11 9.6 RBC 6.8
TC 10,500 6,500 8,900 CBC 22,900
DC S. Na+
PC L 0.96 0.99 T.M 1.56
PSMP
S. 2.60 0.94
Creatinine
O2 91 94 74
Saturation
%
Paracites
Liver Enlarge Enlarge
Kidney Enlarge Enlarge
Ilius
10. Dr. Anil Gupta in interrogatory answers to the effect that he owns hospital at Krishnanagar; knows Dr. Bhagirath Pandya who occasionally refers him patients; the complainant consulted him for the first time for treatment of his wife on 25 th October; she came walking and with reference note of Dr. Pandya. He immediately examined him; it is standard practice to make note of relevant points of the complaints and clinical symptoms or ailments observed by doctor when the patient 15 is examined for the first time. Page 13 is the same note he made the same day. She came with reports of CBC, blood urea, S. Creatinine, S. Protein, Bl. Glucose and Urine. Diagnosis was COPD + Anemia as per history, clinical findings and investigation reports including ECG, and he advised hospitalization. He has not placed on record case papers of treatment during indoor hospitalization, and case papers are attached. He advised blood transfusion as her Hb was only 7g. and ECG was showing Tacchycardia. It is not true that patient‟s relatives arranged blood bottles on 25th and answers that they brought bottles on 26th at Anand Hospital. He prescribed pathological investigations on 26th and done on the same day. On the basis of pathological investigations, he advised for shifting her to Anand Hospital where 2D Echo was done. It is not that always supplying blood through transfusion would increase internal load and denies that in such a condition the patient may feel pain at chest. Before shifting to the Anand Hospital he gave reference note as well as informed them over the phone. The reference note is on record Pg.14. He admits that when she reached Anand Hospital she was examined by doctor on duty and the doctor on duty had recorded her condition in indoor case papers. It was never asked for however he has produced it here. In Anand Hospital total 4 PCV (blood) was given to the patient. It is true that there was no symptoms or signs of Liver and Kidney damage prior to her hospitalization at his hospital. He denied that her condition was deteriorated only after hospitalization at his own hospital or that he carelessly ignored the information supplied by the doctor on duty at Anand Hospital. He denies that mere clinical findings of ronchi and crepts is not sufficient to diagnose case of septicemia and answers that the ronchi and crept were one of 16 the diagnostic features of septicemia. It is true that pathological investigation carried out at Anand Hospital revealed reduction in total blood counts and answers that it was on 28.10.2010. He denies that he consulted Dr. Rajesh Mishra only when himself found that condition of the patient has set on for irreversible phase. Fever, tachycardia, anaemia not responding to standard treatment were the circumstances that led him to think of possibilities of Dengue. The dengue test was carried out on 29th October only. Medical Officer prepared discharge card and handed it over to her relatives with reference note at page 23. In question that when she shifted to Nidhi Hospital she was not able to respond verbal commands he answers that she was semi conscious. Her abdomen was distended from the day of admission and remained so. To the question that while writing reference note to another hospital or doctor, a referring doctor mentions treatment given and brief history as to condition of the patient he answers not always. He denied that because of his casual approach she had suffered and that because of his carelessness and negligence, her condition deteriorated and lost her life untimely.
11. Discharge summary of Nidhi Hospital signed by Dr. Rajesh Mishra-Opponent No.3 shows date of admission as 01.11.2010 (21:40) and of discharge on 09.11.2010 (13:00). Reason for admission as fever, Unconsciousness, Abdominal distension. Diagnosis on Admission as dengue fever, brain white matter oedema, paralytic lleus. Diagnosis on discharge as dengue fever with white mater oedema with ARDS with ARF with obstructive sleep apnea + paralytic lleus. It further goes to record that Mrs. Kalpanaben Umakantbhai Chauhan, a 45 years old female patient (normiotonsive, nondiabetic, Obese), shifted from Anand Surgical Hospital was 17 admitted in Nidhi Hospital ICU in emergency on 01/11/2010 at 9:40 p.m. under care of Dr. Rajesh Mishra (M.D.). She was having c/o (history given by pt's relatives) fever, coughing and common cold, vaginal bleeding (off & on) and breathlessness since last 15 to 20 days Pt. was Kn/c/o Asthma and Obesity Hypoventilation syndrome. On Admission her vitals were: T: 102" F. Pulse:
120/min, Respiratory Rate 26/min, BP: 150/80 mm of Hg. Abdomen was distended, Bowel Sounds were absent (Paralytic lleus), CNS examination showed no response to verbal commands, moving all IV limbs on painful stimuli, Pupils unequal (Rt>Lt) reacting to light. Her Dengue Serology was detected +ve at Anand Surgical Hospital (history given by pt.'s relatives). Laboratory Investigations were suggestive of thrombocytopenia (PC: 46,300/c mm), normal Leucocyte count (TC:
8990/c.mm), altered RFT (creat: 3.58 mg%), altered LFT (S. Bilirubin: 2.7 mg% Direct>Indirect, SGPT: 615 U/L, SGOT: 589 U/L), Hyperglycemia (280 mg %), high CPK total (448.2 U/L), high LDH (1881.8). USG Abdomen showed changes of paralytic ileus, mild interbowel free fluid and mild splenomegaly. MRI Brain showed white matter oedema with remote possibility of encephalopathy. Treatment was started in form of Entotracheal Intubation, Ventilatory support on VCV with help of Fentanyl and midazolam infusion and with 60% oxyge n, IV Antibiotics (Inj Meropenem (500 mg) 8 hourly, inj. Forcan (100ml) OD, Inj. Acivir (500) OD, T. Fluvir (75) OD, Moxicip (400) Od) supportive treatment (Inj Fosolin (150mg) 8 hourly, Inj. Rabicap (20mg) IV Neodrol (1 gm) OD, Inj. Mannitol (100ml) 8 hourly, Inj. H. Actrapid s/c started according to sliding scale, Iv Fluids inform of inj. Ns, inj. Rl was started inj. Neostigmine infusion was started for paralytic ileus Ryle's 18 tube insertion and catheterization was done. Cross reference of Dr. Bhavin Patel (G Surgeon) was made, who advised conservative Rx and X Ray Abdomen -supine. which showed significant dilatation of large bowel loops. Next day her TC was 6,360/c mm, PC 45, 800/c mm, S Creat 3.72 mg% S. K 3.1/mEgl, ABG within normal limits. One spike of fever (102 F) was there which was treated by inj. Perphalgan Cuiture for urine, Blood, Stool was sent Cross Reference of Dr. Pranav Kharod (Neurologist) was done for CNS evaluation. His Diagnosis was post viral immune mediated Multiorgan failure with encephalitis. Cross Reference of Dr. Sunil D. Popat (MS FRCS, FIAGES) was also made who advised to reduce RT feeding to 50m/2 hours. Dulcolax suppositories protein, electrolyte and fluid correction, As Pt was carrying high risk for DVT, prophylaxis started in form of Pneumatic compressive de vice (DVT Pump). CVP Line (Rt IJV) was inserted. Pt was intubated and was put Ventilator (VCV mode). As Hyperglycemia was persistent insulin was started in infusion. Inotropes were constantly required to maintain BP Dose of Meropenem increased and Tab. Moxicip and Inj Acivir were omitted. Day: 3 Pt was drowsy, not foliowing V/C, however responding to DPS. Intermittent fever was noted throughout the day. TC was 10,900/c mm, PC 62.900/c mm and S. Creat was 4.69 mg% RBS were <200 mg% S Na+: 145 e/mEql, S K+: 4.9 mEq/l, Stool Culture showed growth of Enterococcus and klebseilla. Urine culture showed growth of Candida inj Viatran (1.5 gm) IV BD was added according to the culture reports. Day 4 Laboratory Reports were: TC: 12,800/c mm, PC. 76,400/c.mm. Creat 4.15 mg%, ABG within normal Limits. Bilirubin 14. Na+: 146.0 mEq/L, K+ 4.37 mEq/L, RBS<200 mg%. No significant change was there in pt.'s CNS 19 examination. Tab. Erythromycin (250 mg) 6 hourly started. Inj Forcan was replaced by Inj Amphomyl (100mg) OD and T. Vorifit (200 mg) 1 OD. Day 5 Pt.'s general condition showed improvement. Pt was partially following verbal commands, however was disoriented. Laboratory Investigation showed: TC: 15,200 lc.mm, PC:
74,000/c mm, Creat 3.44 mg%, Na+: 149 9 mEq/L. RBS were near 200 mg%. Same treatment was given for the whole day. T‟ Piece trial was given for 5 hours. Day 6 Intermittent fever was noted toady. Pt was drawsy, not following verbal commands. Lab. Findings TC 13,300 /c.mm, PC: 78,000 /c.mm, Creat: 2.9 mg%, Na+: 150 mEq/L, K+: 3.6 mEq/L. lonotropes were stopped with better haemodynamics, Inj. Meropenem, T. Vorifit and Inj. Neostigmine were omitted. Winning trial was given inform of SIMV Mode. Day 7 High grade fever with stable haemodynamic noted today, which was treated by Inj Perphalgan Pt was drowsy and was not following verbal commands, responding to DPS Lab Reports showed TC 19,500 /c. mm, PC:
1, 32,000 /c.mm, Creat 3.16 mg%, Na+: 161.9 mEq/L. Ventilator switched to VCV mode Inj. Meropenem was restarted as per advice by Dr. Rajesh Mishra. Day: 8 Pt was drowsy, having intermittent fever. Lab reports: TC: 17,800 /c.mm, PC: 90,800 /c.mm, Creat: 3.56 mg%. NA+: 156 mEq/L, K+: 3.92 mEq/L. No significant change in the treatment was made by pt's treating Consultant. Pt's urine output was around 1L to 1.5 L throughout her total hospital course. Her Total Count, electrolytes and ABG were monitored and being corrected on regular basis. Day 9 Pt was on ventilator (VCV mode), Drowsy, Disornented, not following verbal commands. Lab reports: TC: 21700 /c.mm, PC: 69,500 /c.mm, Creat: 3.15 mg%. Patient's general condition was critical which was explained to the relatives of her. 20 Pt was discharged today [i.e 09/01/2011 (? 09/11/2010) at 1.00 p.m.] and was shifted to CIVIL Hospital, Ahmedabad as per relatives request.
12. Case papers of Dr. Rajesh Mishra Shows:-
9/11 8/11 7/11 6/11 5/11 4/11 3/11 2/11 1/11
HB 11.50 11 11.80 11.80 11.20 11.60 12.20 10.80 12.50 TC 21700 17800 19500 13300 15200 12800 10900 6360 8990 DC PC L 69500 90800 49000 78000 74000 76400 62900 45800 46300 PSMP S. 3.15 3.56 3.16 2.90 3.44 4.15 4.69 3.72 3.58 Creatinine O2 93.00 99.4 98.9 98.9 99.5 Saturation % Paracites Liver Normal Kidney Normal Ilius
13. In interrogatory questions Dr. Rajesh Mishra answers to the effect that he agrees that it is a standard practice that when medical consultant visits any hospital in response to call/reference given to him, he will make note regarding his observation as to clinical findings and his advice in the treatment/ case papers. He examined her for the first time at Anand Hospital on 29.10.2010. Before filing reply to this complaint, he has referred his case papers and notes. He cannot say whether the indoor hospitalization record of Anand Hospital is part of the record of this case or not. He has placed his notes on record at page 25. He agrees that it is usual practice, before suggesting any treatment, visiting consultant refers previous records of treatment including nursing record. It is not always necessary to put on record which confirms that patient had abdominal distention on 25.10.2010. 21 Distention of abdomen can be always recognized by clinical examination. To the question distention of abdomen is one of the sign which may be given clue for onset/spread of infection he answers not always, where distention of abdomen can be observed there could be many other circumstances like ascities, intestinal obstruction, paralytic ileaus and even due to Gas or Fat. He agrees that when all doctor sees distention of abdomen, he/ she has to find out the real cause for distention of abdomen and then to take corrective measures for the same. On page 25 in this record is which he has made at Anand Hospital regarding condition of the patient. Peritoneum is considered sterile area. He advised shifting her to Nidhi Hospital on 01.11.2010, when Dr. Gupta told him on phone that patient was not improving. He told relatives that Nidhi Hospital has all the facilities to meet with emergencies but to the question for expenditure would be around 35,000/- he answered it cannot be said as it depends upon many factors like number of days. While shifting of patient he referred for MRI. He saw the MRI report and it was suggestive of deterioration of her condition. When patient reached Nidhi Hospital, he found she had fever. She was not able to follow oral commands. To the question whether he informed relatives that insertion of tube to drain out fluid he answers that the question is not clear and asked to drain what. If creatinin level becomes abnormal, he would check urine output, Urine R & M, Hemodynemics, ABG, S. Sodium & Potassium etc. He agrees that altered functioning/damage to kidney can be confirmed through creatinine level and adds most of the times. He denies that spread of infection can also be recognized from studying creatinin level he answers that not really, other parameters need to be seen. To the question it is necessary for 22 a doctor to treat patient to put infection under control his answer is doctor can try but cannot give guarantee. He agrees that to control infection it is necessary to know/ascertain type of bacteria causing infection. To the question respiratory distress can be observed in case of advance stage of infection he answers yes in systematic infection. Infection can paralyze ileal movement but not in all cases. It is not always that septicemia is the advance stage of infection spread but it is suggestive of blood spread. If infection is not controlled timely it can cause septic shock. He denies that inadequate supply of oxygen to brain tissues can cause inflammation to mennings and also white matter of brain he answers that not to meanings but brain yes. To the question drainage of accumulated fluid can be done to combat infection he answers that it is one of the methods but not possible always. The diagnoses of Dr. Kharod was multi organ failure with encephalitis. To the question when septic shock occurs patient gradually looses consciousness he answers is not always. He admits that serum creatinin never regained normal value after admission of Nidhi Hospital. To the question after onset of infection when fever appears inference can be drawn that patient leads towards advance stage he answers not really - it can be due to improving immune response and patient might be getting better. He denies that 2D, Echo and color Doppler dated 26/10 does not suggest any cardiac ailment requiring special care and answers that it was suggestive that patient needed bipap to support breathing. He disagrees that reduction in HB count, immunity of the patient is at risk. To the question to improve HB, antibiotics and blood transfusion can be solicited he answers that not antibiotic but blood can if B.T. is possible. He denies that culture report would be 23 helpful in suggesting measures to control infection and answer not to control but to treat. He has not gone through the case papers relating to her treatment at Civil Hospital, Ahmedabad. Cardio respiratory Arrest and Cardiac Arrest both are different conditions. Infection can cause damage to renal system but it depends on severity. In this case renal failure was due to infection but root cause was complicated dengue. Advance ARDS is not always advance stage of infection. When she was shifted to Civil Hospital she had gross abdominal distention and peristalsis were absent. He does not know whether after admission to Civil Hospital tracheostomy was done or that respiratory distress eased thereafter. He denies that her condition never improved after admission to Nidhi Hospital. He denies that no diligent efforts were made to overcome infection and answers that every possible measures were taken to control and treat the infection as per standard medical practices. He denies that infection affects the immunity of the patient and answers that it is vice versa, it affects immunity and poor immunity affects infection control and treatment. He denies that immunity if lost, it is difficult to regain and therefor it is accepted that prevention is better and answers that it can be regained depending upon condition of patient. As to the bill of Rs.2,60,961/-, that it was settled at Rs.2,19,513/- and that it was settled against the deposited amount of Rs.2,38,407/- he answers that he does not know. It is a matter between hospital and the complainant. He denies that because of carelessness and negligence he failed to put infection under control. To the question that she lost her life due to vide spread septicemia he answers that he does not know because she did not die under his care.
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14. For the complainant it is argued that in the first medical paper dated 25.10.2010 by Dr. Anil Gupta there is no mention of Septicemia and mild distention (page 13) whereas its copy as produced at page 218, also dated 25.10.2010 in which the letterhead shows „Tele Fax‟ in a different font and spelling than the same „Tele Faks‟ as appearing on page 13 and therefore one at page 218 is a brought up one. It is not acceptable for reason that the page 218 is reconstructed one from medical papers. It is not any correction in the original one. Letter pad of both are quite different.
15. Now, certificate by Civil Hospital where she died, gives in the Colum of cause of death Immediate cause: acute cardio respiratory arrest, Antecedent cause: Acute renal failure + Acute Respiratory Distress Syndrome + septicemia shock + multiple organ dysfunction + septic shock, and other significant cause: Septicemia. In Civil Hospital the diagnosis on admission was dengue + encephalopathy + ARDS + ARF + MODS + Polylytic illious.
16. Dr. Mishra, in his answers to the interrogatory to question No. 43 denies that renal failure was due to infection and answers that root cause was complicated dengue.
17. Now, she was under treatment of Dr. Pandya for 10 days for cough, fe ver; after 4 days complained of difficulty in breathing, was referred by him to Dr. Anil Gupta for ECG. She goes to Dr. Anil Gupta, on 25.10.2010 walking with reports of CBC, blood urea, S. Creatinine, S. Protein, Bl. Glucose and Urine, was diagnose d of COPD + Anemia as per history, clinical finding, and investigation reports including ECG, advised blood transfusion HB being 7g and ECG showin g tachycardia. On clinical examination she was obese and had bilateral ronchi & creps and mild 25 distention of abdomen. Looking to her poor general condition and report the provisional diagnosis of septicemia + anemia was made. Mere clinical findings of ronchi and creps were one of the diagnostic feature of septicemia. She was admitted in the hospital. Blood and urine samples were sent for pathological tests (CBC, RBC, S. Creatinine, SGPT and Urine R & M). The complainant was asked to arrange for blood, and necessary treatment with injection started immediately as alleged. Considering test reports on 26.10.2010 which were suggestive of septicemia + anemia, and X-Ray chest and 2D Echo show COPD & mild pleural effusion, and her condition being poor, she was advised to be and shifted to the Anand Hospital, on 26.10.2010. There doctor on duty as admitted examined her and noted her condition in indoor case papers. Pg. 258 thereof shows patient admitted with complain of dyspnoea since 5 days, fever since 2 days. H/o. severe chest pain before 2 days. P/H/O LSCS 3 times in past obesity. No H/O DM + HT + IHD. H/o allergic bronchitis and findings (pg 255) the same day reads PA: Distended. He admitted there was no symptoms or signs of liver and kidney damage. She remained in Anand Hospital from 26.10.2010 to 01.11.2010, four bottles of blood were transfused. On 26.10.2010 her HB was 6.8, WBC count 22,900, platelet count 1.56 lacks, O2 saturation 74%, mild cardiomegaly in transverse diameter, Right CP angle observed as obscured to favour minimal right pleural effusion without pulmonary congestion or oedema or consolidation, collapse or emphysema but with findings as suggestive of COPD. On 28.10.10 HB was 9.6, WBC 8,900, S. Creatinine 0.94, liver showed mild enlargement, Grade 2 Fatty Infiltration, IVC and Hepatic Veins dilated to suggest congestive changes, Gallbladder Wall Oedema ( 7 26 mm) mild spleenomegaly, mild right pleural effusion, and both Kidneys as enlarged were seen but without any e vidence of free fluid or of any dilated bowel loop. Fever, tachycardia, anemia not responding to standard treatment were the circumstances that led him to think of possibilities of dengue, the test whereof was carried out on 29.10.2010 only. It showed Dengue IgG and IgM both positive , the same day. On 29.10.2010 her HB was 11, WBC 6,500, Platelet count was 0.99 lac, O2 saturation was 94. He thereafter took advice of Dr. Rajesh Mishra (Intensive Care Specialist), who came and examined. He suggested some changes he alleges. On 31.10.2010 her HB was 13.1, WBC 10,500, platelet count 0.96, and O2 saturation was 91. USG Abdomen: showed dilated bowel in abdomen, no significant peristalsis, minimal interbowel free fluid, gaseous prominence of bowel loops in abdomen, minimum right pleural effusion, Grade 2 Fatty liver with normal size, enlarge both Kidneys with increased echogenicity, Mild GB Wall Obedema, CBD normal, PV dilated measuring 14 mm, mild Spleenomegaly, enlarged U turn in pelvis and pancreas normal. To the question (14) to Dr. Mishra as to when did he advise for shifting her to Nidhi Hospital, his answer is on 01.11.2010, when Dr. Gupta told him on phone that patient was not improving. Dr. Anil Gupta to the question that when she shifted to Nidhi Hospital, she was not able to respond to verbal commands he answers that she was semi conscious; that her abdomen was distended from the day of admission and remained so. On admission to Nidhi Hospital on 01.11.2010, her HB was 12.50, WBC 8,990, platelet count 46,300, S. Creatinine 3.58, reason for admission as fe ver, unconsciousness, abdominal Distension, CNS no response to verbal commands, moving all IV Limbs on painful 27 stimulus, Dengue fever detected at Anand Hospital, was having history of fever, coughing and common cold, vaginal bleeding (off & on) and breathlessness since last 15 to 20 days. Dr. Mishra answers that Distention of abdomen can always be recognized by clinical examination. To the question No.9 that distention of abdomen is one of the sign which may be giving clue for onset/spread of infection inside abdomen he answers not always. When distention of abdomen can be observed there could be many other circumstances like ascities, internal obstruction, paralytic illeus and even due to gas or fat. And agreed that when doctor sees distention of abdomen, he/she has to find out the real cause for distention of abdomen and then to take corrective measures for the same. Diagnosis on discharge from Nidhi Hospital was Dengue Fever with white matter obdema with ARDS with ARF with obstructive sleep apnea + Paralytic illeus.
18. In Arun Makil‟s Case (Infra) Hon‟ble Supreme Court held:
25. The requirement of carefully monitoring a patient in such a situation is stipulated both by the guidelines of the world Health Organization on which the appellant has placed reliance as well as in those incorporated by the Directorate of the National Vector Borne Diseases Control Programme in 2008.
26. The WHO guidelines indicate that Dengue is a 'systemic and disease which usually consists of three phases i.e. febrile, critical and recovery. There had been a precipitous decline in the patient's platelet count the day she was 28 admitted to the hospital. The WHO guidelines inter alia state as follows:
"2.1.2 Critical phase ......
Progressive leukopenia (3) followed by a rapid decrease in platelet count usually precedes plasma leakage. At this point patients without an increase in capillary permeability will improve, while those with increased capillary permeability may become worse as a result of lost plasma volume. The degree of plasma leakage varies. Pleural effusion and ascites may be clinically detectable depending on the degree of plasma leakage and the volume of fluid therapy. Hence chest X-ray and abdominal ultrasound can be useful tools for diagnoses.
The degree of increase above the baseline haematocrit often reflects the- se verity of plasma leakage."
Clause 2.3.2.2 of the WHO guidelines deals with patients who should be referred for in- e hospital management (Group B).
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"Patients may need to be admitted to a secondary health care centre for close observation, particularly as they approach the critical phase. These include patients with warning signs, those with co-existing conditions that may make dengue or its management more complicated (such as pregnancy, infancy, old age, obesity, diabetes mellitus, renal failure, chronic haemolytic diseases), and those with certain social circumstances (such as living alone, or living far from a health facility without reliable means of transport)."
If the patient has dengue with warning signs, the action plan should be as follows:
Obtain a reference haematocrit before fluid therapy. Give only isotonic solutions such as 0.9% saline, Ringer's lactate, or Hartmann's solution. Start with 5-7 ml/kg/hour for 1-2 hours, then reduce to 3-5 ml/kg/hr for 2-4 hours, and then reduce to 2-3 ml/kg/hr or less according to the clinical response (Textboxes H, J and K).
30
Reassess the clinical status and repeat the haematocrit. If the haematocrit remains the same or rises only minimally, continue with the same rate (2- 3 ml/kg/hr) for another 2-4 hours. If the vital signs are worsening and haematocrit is rising rapidly, increase the rate to 5-10 ml/kg/hour for 1- 2 hours. Reassess the clinical status, repeat the haematocrit and review fluid infusion rates accordingly.
Give the minimum intravenous fluid volume required maintain good perfusion and urine output of about 0.5 ml/ kg/hr. Intravenous fluids are usually needed for only 24-4s hours. Reduce intravenous fluids gradually when the rate of plasma leakage decreases towards the end of the critical phase. This is indicated by urine output and/or oral fluid intake that is/are adequate, or haematocrit decreasing below the baseline value in a stable patient.
Patients with warning signs should be monitored by health care providers until the period of risk is over. A detailed fluid balance should be maintained. Parameters that should be monitored include vital 31 signs and peripheral perfusion (1-4 hourly until the patient is out of the critical phase), urine output (4- 6 hourly), haematocrit (before and replacement, then 6-12 hourly), blood glucose, and other organ. functions (such as renal profile, liver profile, coagulation profile, as indicated).
Patients should be monitored by health care providers for temperature pattern, volume of fluid intake and losses, urine (volume output frequency), warning signs, haematocrit, and white blood cell and platelet counts (Textbox L). Other laboratory tests (such as liver and renal functions tests) can be done, depending on the clinical picture and the facilities of the hospital or health centre."
According to Clause 7.1 of the guidelines of the Directorate of the National Vector Borne Diseases Control Programme (2008), the basic hospital includes the following:
mosquito-free environment in hospital close monitoring of patient vitals, input and output, oxygen saturation, sensorium early identification of warning symptoms requires close monitoring and signs and symptoms 32 avoid NSAID and intramuscular injections psychological support for patient and family."
The presence of the following signs and management
symptoms requires close monitoring and management
(Clause 7.2):
respiratory distress
oxygen desaturation
severe abdominal pain
excessive vomiting
altered sensorium, confusion
convulsions
rapid and thready pulse
narrowing of pulse pressure less than 20 mmHg
urine output less than 0.5 ml/ kg/h
laboratory evidence of
thrombocytopenia/coagulopathy, rising Hct,
metabolic
acidosis, derangement of liver/ kidney function
tests."
19. She presented with mild distention abdomen on 25.10.2010. 2D ECO and color Doppler study concluded findings suggestive of COPD on 26.10.2010 which inter alia noted right CP angle is obscured to favour minimal right pleural effusion. Now 33 pleural effusion and ascities were clinically detectable depending on degree of plasma leakage and the volume of fluid therapy. Hence the chest x-ray and obdomenal ultra sound can be useful tools for diagnoses for dengue as indicated by WHO, accordingly to which symptom and sign of respiratory distress, and oxygen desaturation (74% on 26.10.2010) requires close monitoring and management, vide Arunkumar Manglik‟s case (Supra). No such diagnose was made out therefrom for dengue nor any further test to rule it out. She presented with COPD, breathlessness and fever. Dr. Gupta‟s provisional diagnose was of septicemia + anemia. She was 45 years of age. Thus far she was not diagnosed of dengue and seems to have been treated for sepsis, anemia, COPD, but not for dengue, which he doubted only on 29th . He doubted it from very fever, tachycardia, anemia not responding to standard treatment as answered by him. The root cause of sepsis, pleural effusion, abdominal distension was not tried to be found out vide WHO guidelines under clause 2.1.2 critical phase for dengue vide Arunkumar Manglik‟s case (Supra), nor treated the dengue that way at least before it was detected on 29.10.2010. For the complainant it is shown from Harison‟s Principles of Internal Medicine that sepsis is direct cause of COPD. It is argued for Dr. Anil Gupta that you should think of 2010 medical filed, there was no specific medicine to treat dengue infection, if you think you may have dengue fever, you should use pain relievers with acetaminophen, avoiding medicine with aspirin, vide its writeup submitted. The argument is not acceptable. It is for the reason that in Arun Malik‟s case death of dengue fever was on 15.11.2009, and in its para 25 guidelines were referred to of 2008, and that of WHO in para 26 gives stagewise management of the 34 dengue, not only just as argued. Now, failure to use due skills in diagnosis with the result that wrong treatment is given would be negligence, vide Malay Kumar Ganguly‟s Case, III 2009 CPJ 17 (SC) Para 177 (iv), Dr. Kunal Shah Vs. Dr. Sukumar Mukharjee, IV 2011 CPJ 414 (NC) 157 (iv). When she did not respond to treatment of Dr. Gupta he doubted of dengue which in a test were found positive the same day on 29th . The suggestions that Mr. Mishra made on 29th also did not work, hence he telephoned him on 1st November. She was being shifted subconscious from Anand Hospital to Nidhi Hospital, there she was diagnosed on admission of dengue fever, brain white matter oedema, paralytic ileus on 01.11.2010; was found with remote possibility of encephalopathy, on discharge on 09.11.2010, she was diagnosed of dengue fever with white matter Obedema with ARDS with ARF with obstructive sleep apnea + Paralytic ileus. This shows the plight of her condition for failure to diagnose dengue and treat the dengue. All these clearly prove negligence of Dr. Gupta-Opponent No.1.
[in his study by Pradip Teparrukkul et al. published at National Library of Medicine in 2017 „Management and outcomes of severe dengue patients presenting with sepsis in a tropical country‟ he concludes: number if adult patients who died of dengue are misdiagnosed as severe sepsis and septic shock. Diagnosis of dengue based on clinical feature alone is difficult. Rapid diagnostic tests may need to be routinely used in adult patients presenting with sepsis and septic shock in tropical countries. This approach could improve diagnosis and management of those patients.] 35 This cannot be nor has been used in the present judgment for negligence to avoid by hindsight.
20. Pain by blood transfusion does not lead to conclusion of negligence, it being common.
21. Dr. Gupta has admitted his patient in Anand Hospital. It is not that the patient directly admitted into Anand Hospital and it in turn called Dr. Anil Gupta for the treatment. Therefore for the negligence for Dr. Gupta Annad Hospital cannot be held vicariously liable. There is nothing to find any negligence on the part of Anand Hospital. Accordingly Anand Hospital cannot be held liable.
22. Dr. Kunal Shah‟s case (Supra) holds in its para-157 (i) that no guarantee is given by any doctor or surgeon that patient would be cured. Case papers of Dr. Rajesh Mishra from 1.11.2010 to 9.11.2010 shows that HB was above 11 nearing 12 or above 12 also, WBC on admission was 8990 next day 6360 then continue to rise to 10900, 12800, 15200, 13300, 19500, 17800, 21700; platelet count on first two days were 46300 and15800 respectively and then rose to 62900 to 78000 on 06.11.2010 then fell to 49000 on 07.11.2010; rose to 90800 on 08.11.2010 and decreased to 69500. Throughout O2 saturation was above 98 except on 09.11.2010 at 93 but S. Creatinine was 3.58, 3.72, 4.69, 4.15, 3.44, 2.90, 3.16, 3.57 and 3.15 respectively. From these figures it cannot be said that Dr. Mishra failed to do which he ought to have done or did which he ought not have done without which it is difficult to find any negligence with Dr. Rajesh Mishra, or to hold that he was doing nothing or just passing time or just making show or that too to earn money only. His evidence has shown that her WBC, platelet and O2 Saturation was brought 36 under control, Liver and Kidney were brought to normal. S.Creatinin was not coming under control, her CNS was getting poorer and that she was not responding the treatment. It also shows that he was doing his best, did not accepted with a knowledge that he can do nothing nor approached casually. Accordingly, Dr. rajesh Mishra-Opponent No.3 is held not liable at all.
23. Dr. Mishra has treated his patient in Nidhi Hospital only, Nidhi Hospital has not admitted patients of its own and then inturn called Dr. Mishra for the treatment. Under the circumstances for any negligence, if any, of Dr. Mishra. Nidhi Hospital cannot be held liable.
24. There is no proof that Nidhi Hospital first prepared inflated bill knowingly or mala fide. Therefore even if there was any bill for higher amount and then reduced upon complainant‟s bring it to its notice, that by itself is not sufficient to hold Opponent No.4 or 3 of any unfair trade practice or so.
25. Now for the complainant it is argued that all the medical papers are not placed on record by the Opponent, as for example with the questionary Dr. Anil Gupta puts some papers on record. He refers to correspondence wherein they were asked to provide medical papers. Therefore for this professional misconduct he argued that all the four opponents should be held liable. The argument is not acceptable for the reason that the complaint has not pleaded it as any ground.
26. She was housewife. Her contribution to the family at Rs.10,000/- and by deducting therefrom 1/3 Rs. 6,500/- towards the same is found reasonably put. The complaint pleads her to be of 45 years. In papers of Civil Hospital, she was shown 46 years of age as also in admission case paper of Anand Hospital. Therefor, 37 she would fall within the age group 46 and 50 years attracting multiplier of 13 vide Sarla verma‟s case and Pranay Shety‟s case. Therefore, the compensation would be Rs.6,500 x 12 x 13 = 10,14,000/-. In our estimation Rs.4 lakhs towards medical expense needs to be added and not Rs.5 lakhs as pleaded. It is for the reason that there is no proof of any actual figure to have been paid for the treatment by Dr. Anil Gupta. The number of days of treatment with him being 8, short by a day than with Dr. Mishra whose bill was Rs.2.16 lakhs. Therefore, the total compensation on the line of the complaint would be Rs.14,14,000/-.
27. Opponent No.5 is not the insurer for Opponent No.1, hence the Insurance Company-Opponent No.5 is not liable, Opponent No.2 to 4 having been found not liable.
28. It would be just to grant interest at 6% as rate of interest on FD for a year is to be awarded vide Kausunama Begum‟s case, and is being reducing.
29. The complaint deserves to be partly allowed for which following final order is passed.
FINAL ORDER
i) Complaint No. 42 of 2011 is partly allowed.
ii) The Opponent No.1 do pay the complainant Rs.14,14,000/- (Rupees Fourteen lacks fourteen thousand only) together with interest at the rate of 6% from the date of complaint 17.06.2011 till realization.
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iii) Opponent Nos. 2 to 5 are held not liable.
iv) No order as to costs.
v) Copy of the judgment and order be provided to the parties free of costs.
Pronounced in the open Court today on 6th Day of November, 2020.
(J.Y.Shukla) (S.N.Vakil)
Member Judicial Member
K.S.Patel
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