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State Consumer Disputes Redressal Commission

Dr. Bhavana Royazada vs Kims Super Speciality Hospital (P) Ltd. ... on 12 January, 2018

                CHHATTISGARH STATE
       CONSUMER DISPUTES REDRESSAL COMMISSION,
                 PANDRI, RAIPUR (C.G.)

                                       Complaint Case No.CC/2012/18
                                            Instituted on :17.12.2012

Dr. Bhavna Royazada, W/o Dr. Avijit Royazada,
Aged 38 years,
Assistant Professor, C.I.M.S.
R/o : Bilaspur (Chhattisgarh)                      ... Complainant.

          Vs.

1.   KIMS Super Speciality Hospital (P) Ltd.,
     Near Agrasen Chowk, Magarpara,
     Bilaspur (C.G.)

2.   Dr. V.K.G. Rajsekar, MD, DM,
     KIMS Super Specialty Hospital (P) Ltd.
     Near Agrasen Chowk, Magarpara,
     Bilaspur (C.G.)                             .... Opposite Parties

PRESENT: -

HON'BLE SHRI JUSTICE R.S. SHARMA, PRESIDENT
HON'BLE SHRI D.K. PODDAR, MEMBER
HON'BLE SHRI NARENDRA GUPTA, MEMBER

COUNSEL FOR THE PARTIES:

Shri D. Dutta, Shri R.K. Bhawnani and Shri G.V.K. Rao, Advocates for
the complainant.
Shri Mukesh Sharma, Advocate for the O.P. No.1.
Shri Rajkamal Singh, Advocate for O.P. No.2 along with O.P. No.2 Dr.
V.K.G. Rajsekar.


                            ORDER

Dated : 12/January/2018 PER :- HON'BLE SHRI JUSTICE R.S. SHARMA, PRESIDENT. The complainant filed this consumer complaint under Section 17 of the Consumer Protection Act, 1986 against the OPs seeking following reliefs :-

// 2 // (1) The amount of Rs.90,00,000/- (Rupees Ninety Lakhs) to be awarded against the opposite parties as compensation.

(2) The cost of the suit and any other relief, which this Commission deems fit be awarded.

2. Briefly stated the facts of the complaint of the complainant are that the complainant is the doctor and she is working as Assistant Professor in C.I.M.S. Bilaspur. The O.P. No.1 is the hospital and O.P. No.2 is the doctor who treated the complainant. On 29.03.2012, the complainant had chest pain and her ECG was done in the nursing home, it showed T inversion from V1 to V6. The consulted Cardiologist at KIMS Hospital, Dr. V.K.G. Rajsekar, O.P. No.2, who is MD, DM, Cardiologist. The O.P. No.2 did ECG and 2D Echo, Echo was normal study. The O.P. No.2 advised Coronary Angiography without doing TMT tests. On 02.04.2012, Coronary Angiography of the complainant was done and O.P. No.2 told the complainant that it was absolutely normal and complainant will not have any cardiac problem for next 50 to 60 years. The report or CD of ECHO and angiography was not given to the complainant for records on 02.04.2012. The complainant had severe midsternal chest pain within three hours of the procedure after reaching home. The complainant's husband informed the O.P. No.2 immediately, who advised tablet Nitrocontin and Rablet. The O.P. No.2 told the husband of the complainant that pain was due to Esophageal Spasm or Gastritis and // 3 // heart is normal and no need to come to hospital Pain was relieved in one hour after the medication and injectable painkillers were also given, which was again informed to the O.P. No.2. Next days the patient had no chest pain and joined the duties at C.I.M.S. On 11.04.2012, the complainant suffered severe chest pain, dyspnea and hypotension. The Echo was done of the complainant on 11th April by Dr. Pawan Agrawal and it was found that EF was 35%, hypokinetic Lateral wall and Apical Region and LV dysfunction due to heart attack. Trop T was Positive. Complainant had acute coronary syndrome s. The O.P. No.2 was informed and complainant was shifted to KIMS for treatment The complainant's coronary angiography was done in midnight of 11th April, left main coronary artery was found blocked by large thrombus and LAD was found 100% blocked, the O.P. No.2 gave injection Reporo (Abeiximab) through intracoronary route to dissolve the thrombus completely, Intra Aortic Balloon Pump was put and the complainant was shifted to ICU without focusing and diagnosing the cause of big thrombus and securing the culprit injured left main coronary artery by PTCA and putting any stents immediately or for next days. O.P. No.2 explained the etiology being vasculitis, autoimmune disease and hypercoagulable state but not the injury. He did not mention the Left main artery dissection which gets worsened to large dissection of left main branch which was afterwards reported by renounced cardiologist of MAX and Medanta Hospital, // 4 // Delhi. The complainant was recovering uptill 12th April, but in the midnight of 12-13th April, complainant was given injection Lasix on advise of O.P. No.2 and the urine output of complainant increased to high level upto 5 litres, complainant started sinking and went into shock due to input output imbalance , as there was no central line and complainant was on 20G IV Cannula and constantly vomiting. The O.P. No.2 admitted the complainant at 10 AM on 13th April, at that time blood pressure was very low and the complainant was collapsing, multiple blood transfusions were given and lots of IV fluids was also given to increase BP and maintain CVP of 14 cmH2O which is hazardous in severe left ventricular failure patients as evident by ECHO. On 14th and 15th April, the complainant was dyspenic and restless after this episode. The complainant was given higher antibiotics like Cefipime Tazobactum combination, Ticolanin 400 mg BD, Meropenum 1 Gm TDS in spite of no evidence of any infection. Due to multiple transfusions of IV fluids complainant's condition was getting worse. X-ray and ultrasonography was showing fluid in lungs bilaterally, oxygen saturation was dropping between 88 to 90%. The complainant and her family members were not satisfied with the treatment and ICU care, so they decided to shift to Shree Narayana Hospital, Raipur for better ICU care. Uptill this time O.P. No.2 had never disclosed the exact cause of the large thrombus in the Left main coronary artery to be the trauma which was not there nine days back.

// 5 // When the complainant's husband who himself is a doctor decided to shift to Raipur Shree Narayana Hospital, then only while shifting to the Ambulance, the O.P. No.2 disclosed that he was planning to do check angiography, it was never discussed with family members during five days stay. Revascularization procedure done was declared as the final and successful treatment previously. It was never disclosed and diagnosed that the cause is injury to the coronary artery. As complainant's angiography was done on 2nd April and angiography done after nine day was itself check angiography, there was no need for third angiography within a short span of 10 days. The O.P. No.2 all the time explained the reason for this coronary event was vasculitis and autoimmune disease but not the injury due to CAG during the stay at hospital. The complainant vasculitis profile was sent to Religare lab on his advice. All the reports were normal. Dr. Rajshekhar insisted that complainant is 100% alright and her cardiac function will recover to near normal in future. He never suggested that any further treatment or intervention is required in future for definitive treatment. The O.P. No.2 refused for immediate stenting and continued the injection Reopro (Abeximab) infusion for three days which is recommended for maximum 24 hours in medical literature and prolonged use may cause severe blood loss which happened in this case resulting in femoral hematoma. The Reopro injection is used as an adjunctive therapy for PTCA within hours. This therapy is nt the // 6 // first line definitive treatment if PTCA is not done within hours. When complainant was shifting to Raipur, the O.P. No.2 gave a summary and promised that detailed discharge documents will be sent later. Complainant's BP was very low and there was panic situation, O.P. No.2 informed that he wants another check angiography. There was no consent or discussion done with family members for further check angiography during five days stay and no mention of the visible injury to Left main coronary artery. There was no need for repeat Check angiography, as definitive treatment should have been done during the CAG on 11th April midnight itself. If it would have been diagnosed, discussed and disclosed to the family member on right time on 11th April only, it would have been corrected by angioplasty and stenting then and there. The complainant was shifted to Shree Narayana Hospital, Raipur under Dr. S.A. Kale and Dr. Sunil Gounial. IV fluids were stopped and complainant recovered smoothly. The complainant took their opinion for CAG, they refused because they were suspecting trauma during first angiography, it was not a wise decision to do intervention in a traumatized vessel immediately, so Dr. Gounial advised for CT coronary angiography after stabilization of patient's condition, which is non invasive procedure. The complainant was discharged on 20.04.2012 from Shree Narayana Hospital. The complainant's liver enzymes were elevated due to very high doses of antiplatelet drugs given by party No.2 at KIMS. The complainant was // 7 // extremely lethargic and it took one and half months to recover. On 11th April, high risk consent was given by the complainant's husband. Blood pressure was 90 mmHg systolic and IABP support was give, if O.P. No.2 would have given sincere look to the screen, he would have not missed the large dissection of the artery which was misdiagnosed and left unattended for whole of ICU stay. It was not expected from such a qualified and experienced cardiologist as he has mentioned in his biodata. Temporary TIMI 3 flow was declared as the successful treatment but the cause of injury was neither diagnosed nor corrected by putting stent and doing angiography. Due to jaundice and liver pathology other cardiologists at Shree Narayana Hospital could not do any active intervention. After coming from Raipur the complainant and her husband consulted O.P. No.2, he did 2D Echo which showed 55% EF and apical hypokinensa. Complainant complaint of mild chest pain but the O.P. No.2 said nothing to worry about. The O.P. No.2 never talked of CAG or infact any intervention he said that you are fine and you are not labelled as a coronary patient and you have recovered completely. He did not accept the possibility of trauma to the coronaries. O.P. No.2 convinced O.P. No.1 also that complainant has recovered completely by his treatment. During follow up with O.P. No.2 in May, complainant informed him that injury to left main coronary artery can be a diagnosis for acute coronary syndrome as per the advice of Cardiologist at Raipur which was strictly denied by Dr. // 8 // Rajsekar, he did 2D ECHO and declared normal heart condition against did not mention check angiography or cardiac intervention at that time also. The complainant did follow up with O.P. No.2 Dr. Rajshekhar in June, 2012 also. At that time also he said you are fine now. When complainant complaint of tiredness, he told that it was due to depression, again Echo was done, no report was provided, but it was declared normal. The O.P. No.2 advised TMT after two weeks and never revealed anything about trauma during the procedure nor did he mention check angiography. O.P. No.2 convinced the complainant that cardiac function is absolutely normal, treatment is complete and no need for any intervention or CT angiography. The complainant fatigue was gradually increasing and in July, she was feeling constant heaviness in chest and chest pain on exertion. The complainant and her husband went to Delhi and consulted Dr. Rajeev Rathi, Consultant Cardiologist at Max Hospital. CT Coronary Angiography was done which revealed "Dissection of left main coronary artery and LAD with intimal flap extending along superior aspect of lef main into proximal LAD 1/3rd with true lumen filling patent LAD with diminished distal opacification. Significant 70% stenosis in left main and stenosis 40% in proximal 1/3rd LAD." 2D Echo revealed 45% EF and Hypokinetic Mid anterior septum, distal septum, apex, distal anterior wall. PTCA with stenting of two vesels LMCA and LAD was done at Medanta Hospital, Delhi. They took // 9 // high risk consent and consent for CABG. They also explained use of lifelong antiplatelet and risk of stent thrombosis and the risk of CABG in future. The O.P. No.2 did coronary angiography of the complainant without specific indications. Complainant's 2D ECHO was normal then also he advised CAG. Ideally TMT test should be done before and if it is positive than only CAG should be advised. The O.P. No.2 did not give due consideration to the complainant's symptoms of severe chest pain after CAG on 2nd April. He was adamant that heart is normal, CAG was normal, so nothing could happen. He should have attended the complainant. High doses of inj. Reopro was given for more than recommended duration. It is written in books that it should be given for 12 hours and maximum of 24 hours, but it was given for more than 48 hours. The antibiotics were given irrationally and in more than recommended doses like Cefepime and tazobacum 2 gm 6 hourly in absence of any infection. To conceal the facts about the disease O.P. No.2 did not provided printed reports of Coronary angiography on 2nd April, 2012, 2D Echo done on 14th May, 2012, 2D Echo done on 21st June, 2012. The O.P. No.2 did not disclose on 11th April that it was an accidental case of Left main artery dissection. He should have accepted that it was due to his mistake, complainant being a doctor herself would have understand it and have taken proper treatment for its management that and there. The O.P. No.2 gave Reopro injection to dissolve the thrombus in the Left main coronary // 10 // artery while doing angiography on 11th April midnight and he ignored the trauma to LMCA which was cause of that large thrombus. Injection Reopro was incomplete treatment for coronary dissection which was clearly evident in CD. Ideal treatment was immediate PTCA with stenting which was not done at that time, the complainant was already on IABP support. The incomplete treatment was given for coronary dissection and it was not disclosed to complainant, no further treatment was suggested. Treatment given by the O.P. NO.2 was considered final treatment. This incomplete treatment endangered life of the complainant which resulted in poor heart function (EF = 45%) after three months. The O.P. No.2 not only hid the diagnosis from the complainant but also befooled them by suggesting wrong diagnosis like autoimmune disease, vasculitis etc. mentioned in the summary. The O.P. No.2 mentioned in the discharge summary that he was planning check angiography, but it is a contradictory statement because check angiography was already done on 11th April, midnight. The complainant was admitted in the hospital of O.P. No.1 for four days, O.P. No.2 did not mention check angiography during that period. He mentioned it only when complainant was on the verge of shifting. The complainant came to know about the serious injury to coronaries at Max Hospital, Delhi and Medanta Hospital, Gurgaon. Cardiologists at both the hospitals told that dissection was clearly evident in the CD of 11th April and definitive treatment was stenting // 11 // not the dissolution of thrombus. O.P. NO.2 who claims to be very experienced Cardiologist missed the dissection whiling doing angiography. It is unforgivable offence on part of such experienced Cardiologist, who did the first angiography and dissected the LMCA missed it again even after heart attack leading to a permanent damage to the heart of the complainant. The O.P. No.2 has concealed the facts regarding treatment and has committed unfair trade practice. The O.P. No.2 has done the work against the medical profession and against the ethics of Medical Council. The O.P. No.2 has done the medical negligence for which the complainant will suffer for rest of her life. Complainant suffered lots of mental and physical trauma due to negligence of O.P. No.2. The O.P. No.2 has given improper CCU care including over dosage of antibiotics and antiplatelets (Reopro) which was highly toxic and very expensive. O.P. No.2 did concealment of disease, improper guidance for further treatment, endangering the life of the complainant by advising TMT test at the stage when complainant left main CA was 80% block. According to the guidelines it is strictly contraindicated and dangerous for life of complainant. The complainant because of the negligent treatment given by the OPs is suffering not only from her hearth but she is at risk of loosing job and has suffered economic loss of herself and her husband. The complainant has suffered mental harassment in these days because of the negligence done by the OPs. The complainant has surrendered // 12 // her Non practicing allowance and was earning through private practice, which she is unable to do due to loss of health. She will not be able to perform her duties and practice in full capacity for life long as a professional doctor. Hence the complainant filed instant complaint and prayed for granting reliefs as prayed in the relief clause of the complaint.

3. The O.P. No.1 filed its written statement and averred that the reports and CD of procedure carried out on 02.04.2012 was supplied to the complainant. The treatment record of the patient was supplied to the patient's husband when he consulted at the hospital after a long period from date of receiving the patient against medical advice on 13th April, 2012. The diagnosis and treatment carried out at hospital from 11th April to 15th April. The Echo report issued by Dr. Pawan Agrawal was based on his own evaluation and expertise. When she reported to Cardiologist O.P. No.2 and on evaluation of the patient the O.P. No.2 provided best available treatment in treatment in treating the patient in the hospital. No adverse has been reported by further treating hospitals where patient was treated immediately after left hospital against medical advice on 15th April, 2012. The prescriptions issued by the O.P. No.2 in treating the patient, the patient was discharged against the medical advice of O.P. No.2 and at the own discretion of attendants of patient who happens to medical professional. The status of the patient's condition was discussed with attendants of the patient.

// 13 // The treating doctor is best judge of line of treatment as per his diagnosis and treatment plan check angiography planned by the O.P. No.2 was in accordance with experience and expertise of O.P. No.2. The patient was suffering from heart disease and blood thrombus are formed in said disease, without waiting for stability of the patient during course of admission from 11.04.2012 to 15.04.2012 attendants of patient got patient discharged from hospital against the medical advice. Nothing adverse in line of treatment can be evaluated from the record of Narayana Hospital, Raipur submitted along with complaint. As medical science is fast developing and variation in doses of drug has variable effect on every patient, in present case patient was responding to drug and has shown positive effect in the present case. As the attendants without giving proper intimation for discharge and got patient relieved from the record of the hospital against the medical advice at their own risk without intimation to consultant and hospital for getting discharge card and collection of reports from all departments of the hospital. According to the prevailing medical practices, the patient has been removed from hospital without considering the situation of the patient and proper effect of line of treatment given to patient in hospital. The patient was brought in critical condition, it was priority of hospital and its consultant to stabilise the patient, and OPs had done their best to save life of patient, as patient had responded to treatment, hence, check // 14 // angiography was planned after giving proper time to patient to be established for procedure. According to prevailing medical practices and facts have to be evaluated from the technical expert opinion. Any unfair trade practice has not been adopted by the O.P. No.1 in treatment of the patient. The hospital has carried out instructions of treating specialist in treatment of patient. The patient has suffered due to decision taken by her attendants, for their own whims and fancies and not following instructions of treating doctor for disease suffered by patient. It is not in personal knowledge of the O.P. No.1 as the patient has not been reported for follow ups after discharge. If any damage has been caused to the heart of patient, it was due to the disease suffered by the patient and its effect not because of the treatment carried out at the hospital of the O.P. No.1. The O.P. No.1 is not responsible for any compensation to patient for want of any deficiency in services on their part. The bills raised by the hospital have not been paid by the patient and her attendants. As the patient was discharged against medical advice of the treating doctor and bills were not concealed by the hospital and same cannot be treated as deficiency in services on the part of hospital as patient has not paid her dues. Patient has suffered losses due to her own negligence in getting her treated properly. The patient has to suffer for disease suffered by her and not because of her treatment carried out at hospital. The hospital has not deliberately concealed anything about the status of // 15 // patient at the time of treatment. The complaint is liable to be dismissed against the O.P. No.1.

4. The O.P. No. 2 has filed his written statement and averred that the instant complaint filed by the complainant under Section 17 of the Consumer Protection Act, 1986 is baseless, false and misconceived and it appears to be filed with only to grab money by arm twisting by putting the opposite parties in fear of maligning their reputation. The complainant has made false averments in the complaint and therefore the same deserves to be dismissed with exemplary cost. The O.P.NO.2 is M.D. (Medicine) and D.M. (Cardiology) from PGI, Chandigarh and he possess Six Years Post D.M. experience in the field of Cardiology. He was working as full time employee and Senior Consultant Interventional Cardiology and Head of Department of Cardiology in the KIMS Super Speciality Hospital, Bilaspur (herein after referred as "KIMSSSH") at the time of alleged complaint. It is worth-mentioning that the O.P. No.2 was neither having any private clinic nor practicing in any other hospital in accordance with the rules by the KIMSSSH. Previously he has worked as Cardiologist in reputed hospitals viz NIMS Hyderabad, Consultant Interventional Cardiologist, Manipal, Cardiologist in Super Speciality Vijayawada, Senior Consultant Interventional Cardiologist in Global Hospital, Chennai and Director Interventional Cardiology in Chettinad Super Speciality Hospital, Chennai. The present complaint is totally baseless and flagrant abuse // 16 // of the process of law to harass and defame the O.P. No.2 and the KIMSSSH. Actually, the complainant has utilized the professional services of the KIMSSSH and took the emergency lifesaving treatment for saving her life at a life threatening emergency situation and she successfully recovered because of efforts and proficiency of O.P. No.2 and the KIMSSSH facilities. However, due to her own personal prejudice and confusion she did not complete the treatment schedule and she left the custody of the O.P. No.2 / KIMSSSH against medical advice in a stable condition without any formal discharge on 15.04.2012 morning and got admitted in Narayana Hospital, Raipur at her own preference for further management and thereafter shifted from one to other hospital for treatment by her choice. Even in Narayana Hospital, the complainant did not gone for Angioplasty / stenting whereas, she alleges on O.P. No.2 / KIMSSSH that her immediate stenting was not done. Inspite of the fact her life was saved by the emergency treatment given by O.P. No.2 at KIMSSSH when the complainant presented in life threatening situation inching towards death second by second, she make all false allegations and presented twisted story due to after thoughts. This act of the complainant itself shows that the present complaint is frivolous and vexatious and is liable to be dismissed with exemplary costs under the provisions of Section 26 of the Consumer Protection Act, 1986. The husband of the complainant Dr. Avijit Royazada, who himself // 17 // practices as Cardiac Expert in Bilaspur, Chhattisgarh, approached O.P. No.2 on 25.03.2012 along with the ECG of his wife, namely Dr. Bhavana Royazada, who also is a Doctor by profession and is working as Assistant Profession in CIMS Hospital, Bilaspur. Dr. Bhavana Royazada had complained of recurrent chest pain for the past few days. Having examining ECG, Dr. Avijit Royazada was asked to bring the patient Dr. Bhavana Royazada for proper checki up. She attended KIMSSSH on 29.03.2012 and narrated recurrent rest angina type chest pain during since last one week. She told the O.P. No.2 that she is already on antianginal medications prescribed by her husband Dr. Avijit Royazada. Since, there was certain significant ST-T changes in the Anterior leads of the ECG suggesting myocardial ischemia, the complainant was diagnosed as a case of unstable Angina. The 2D Echocardiography performed was normal, as there are cases wherein it can be normal in unstable Angina. Considering the condition of the patient it was advised that she need admission and coronary angiography for evaluation of the coronary artery disease and for which necessary risk and benefit of procedure were fully explained. The complainant and her husband both being doctors wanted to give a though to such admission, however, she was advised to continue the medical treatment. No proper OPD registration was done by the complainant neither any consultation fees nor any other fees for Echocardiography was paid by them neither to O.P. NO.2 nor to // 18 // KIMSSSH. Since they were doctors, hospital management at their request allowed them without any fees. The chest pain occurring at rest of recent unset suddenly along with typical ECG changes suggestive of serious coronary artery disease causing ischemia has to be considered seriously of underlying coronary artery diseases and has to be investigated by coronary angiography and treated accordingly as the disease is unstable and can be precipitated by any factor to the development of heart attack (Myocardial Infarction). Moreover when rest ECG has already demonstrated ischemic changes, additional stress test to induce same ischemic changes is not necessary. So it is very important to do coronary angiography in a patient who presents as Recent Onset Angina with typical ischemic changes in the Rest ECG with the diagnosis of Unstable Angina for evaluation for Coronary Artery Disease and TMT is normally contra indicated in such clinical conditions. The complainant visited the hospital along with her husband on 02.04.2012 at 04.00 PM for getting the coronary angiography done as she felt chest pain inspite of annti-anginal medicines and as per her information last episode occurred on the previous day 01.04.2012. Since she was already accompanied by the blood reports done in their Nursing Home, which were normal, she was admitted in the hospital on 02.04.2012 and coronary angiography was done in the conventional way through the right radial route. There was no complication during the procedure. Her husband being // 19 // a physician practicing Cardiology was allowed to remain inside the Catheterization Lab to witness the entire procedure as a special privilege as he is a Doctor himself. The angiography shown normal Epicardial Coronary Arteries with good flow and patient did not had any symptoms during procedure. No fresh changes were noticed in ECG or hemodynamic status. The patient has paid Registration fee and consultation fees in the OPD of KIMSSSH. The patient admission fees and the angiography charges including the doctor's professional charges for the procedure was made free by the KIMSSSH under the authority of the employer of O.P. No.2 and KIMSSSH entertained the discount request from the complainant and made totally free the entire procedure cost and admission fees. After the angiography, the Complainant was shifted to CCU with the strict orders to have close monitoring of vitals for at least 6 hours by the CCU team as a routine. The results of the angiography were grossly normal which was informed to the complainant and husband. However, she was advised medical treatment and close follow up. After the angiography procedure the complainant was absolutely fine without any symptoms and the vitals were stable. Though, the patient was required to stay at least for 6 hours but when the O.P. No.2 came for round in the CCU at about 08.45 PM to see her, it was found that the patient has already left on her own before the completion of schedule monitoring time. Even the request of the Nurse was turned down by // 20 // the husband of the complainant on the plea that his patients are waiting for him in his Nursing Home therefore he has to go to attend them. Since the O.P. No.2 is seriously concerned about the health of his patient, therefore, at around 10.00 PM he contacted the husband of the complainant on phone so as to inquire about the patient. It was reported that she is fine and they will come for follow up. The O.P. No.2 remained in the hospital till 11.30 P.M. However, the patient remained fine throughout even for the subsequent days and there was no complaint about any post procedure problems. On 04.04.2012 morning around 10.00 A.M., the complainant's husband contact the O.P. No.2 over the phone and reported about the episodes of chest pain and it was also informed that the pain is of same nature as she used to have before angiography. As an immediate measure O.P. No.2 advised him to give Tab Nitrocantin immediately and bring her to the hospital for check-up. But the complainant did not report to the hospital and when contacted in the evening it was informed by the complainant's husband that the pain is completely relieved in one hour after taking the tablet and they will come later for check-up. It is quite common in patients with coronary artery disease to have such kind of pain and the immediate and complete response to the tablet goes against any serious event like heart attack. In that case the pain cannot be relieved and the patient's condition would have worsened so that she would have turned up anyhow to the hospital, however, that did // 21 // not happen. Anyhow for want of the present matter, this cannot be further discussed here because the patient did not turn up to hospital for check up at that time. Subsequently she did not report to the hospital OPD or emergency until the second admission on 11.04.2012. On 11.04.2012 the O.P. received a call from husband of the complainant that the complainant has been admitted in the KIMSSSH in a very sick state through emergency with diagnose of Extensive Acute Myocardial Infarction (Major Heart Attack) and they requested him to come. At that point of time the O.P. No.2 was delivering CME Lecture amongst doctors of Korba City that is around 100 KMs away from KIMSSSH. Noticing the aforesaid emergency he left the said meeting and rushed to KIMSSSH accompanied by Chairman of the KIMSSSH Dr. Krishna Korba by Car cancelling all his scheduled programmes for next day in Korba. When they reached KIMSSSH around 11.45 PM the found that complainant was already being treated by Dr. Avijit Royazada and Dr. M.P. Samal of Apollo Hospital in the Catheterization Lab of the KIMSSSH where the other Doctors were also present. The complainant was found to be severely sick with chest pain, sweating, her blood pressure was 80/60. O.P. No.2 confirmed the diagnosis of Acute Myocardial Infarction (Heart Attack) with Cardiogenic Shock Killip IV Type. This clinical condition (Major Heart Attack) is very life threatening with almost above 90% risk for mortality or death. Myocardial Infarction (Heart Attack) is a condition where the heart // 22 // muscle is suddenly damaged due to the abrupt cut off of blood supply to the heart muscle due in blockage in the vessel. The aim of any treatment either medical or interventional is to open the blocked artery either by a clot removing drug (thrombolytic) or by Primary angioplasty and to establish a good blood flow. Since the patient was in very critical life threatening state, it was advised for immediately coronary angiography and lifesaving coronary intervention to open the blocked vessel immediately. Dr. Samal from Apollo Hospital, Bilaspur was there in the Catheterization Lab during the entire procedure actively involved in decision making combined along with the O.P. No.2. The Procedure was performed by O.P. No.2 and Dr. Samal, who kind heartedly doing the necessary help during the procedure, who himself is an Interventional Cardiologist from Apollo Hospital. He was very co-operating and was actively involved in the discussions during the procedure and was also generously giving assistance by taking care of IABP etc. The O.P. NO.2 also discussed the issue with Dr. Samal in the best interest of the patient. He was actively involved in the patient care from the beginning to the time complainant left the KIMSSSH visiting her every day and advising the treatment also. Taking notice of the high risk, necessary consent for emergency angiography and angioplasty was obtained and coronary angiography was done through right femoral route. Shockingly it showed Left Main Coronary Artery full of thrombus, proximal LAD totally // 23 // occluded with thrombus (Left Main Coronary Artery (hereinafter referred as LMCA). The LMCA is the main blood vessel supplying 75% of the heart muscle and most vital for the life, any significant disturbance in the blood flow across Left Main Coronary Artery can lead to massive Myocardial Infarction (heart attack) and if there is serious occlusion may lead in death. The thrombus was extending into the Proximal Circumflex Artery also. It is a night mare for any interventional Cardiologist to experience such a critical condition. Angiography showed a Highly Unstable patient in life threatening situation and must complicated anatomy in the LMCA carrying highest mortality more than 90% even in routine hours even in the best centre of the world with all surgical back up. Considering the complicated extraordinary status it was felt that it is highly risky to do angioplasty and stenting of unprotected LMCA, that too when the patient presented with acute Myocardial Infarction with cardiogenic shock. The patient was not in a condition to be transported anywhere and each second had planned to do angioplasty and stenting along with the IAPB support as no other option available except to open the infarct related artery immediately by emergency angioplasty immediately to save the complainant's life. O.P. No.2 had to work very fast to save the dying patient and the entire team was working fast and even Dr. Samal was also generously and must graciously helping connecting the IABP etc. Since the stenting has to be done // 24 // from LMCA, covering entire proximal Lower Anterior Discending (Hereinafter referred as LAD) upto the Mid LAD, it was assessed that it would required 2 stents. The O.P.No.2 had asked his team to prepare the necessary hardware for the purpose. Meanwhile due to the heavy thrombus burden in LMCA, LAD and Left Circumflex Artery (hereinafter referred as LCX) as a first step in order to reduce the thrombus (the blood clot) burden injection of Acbiximab (Repro) Glycoprotein lib illa block a potent anti platelet drug was given Intracoronary Bolus. It is recommended by standard guidelines that whenever thrombus load is high to reduce the complications associated with angioplasty in the presence of heavy blood clots (thrombus) which can dislodge distally or which can block the stent. No reflow etc. leading to catastrophic consequence. In her letter, the complainant has mentioned "after removal of block by Inj. Reopra, as it was life threatening situation, I was shifted to CCU." The question arises that then why she and her husband suddenly requested for discharge from KIMSSSH on 15.04.2012. The complaint in the said complaint clearly admitted that "Dr. Rajsekar was all the time insisting for check angiography" and she also mentioned that she took the decision along with other consultants not to go for third intervention immediately. That shows that the complainant initially agreed upon the decision of staged procedure and subsequently changed their mind that was not even informed or discussed with O.P. No.2 and suddenly // 25 // they made an exit from the treatment plan without the consent of O.P. No.2. Had she complied with the treatment plan and underwent check angiography, further treatment either PTCA or CABG surgery, she would have been referred to any surgical centre at that time itself. Moreover, the complainant would have been given a complete final diagnosis including the cause (etiology) like Spontaneous Coronary Artery Dissection. However, unfortunately this could not be completed because of the refusal of the patient and her sudden voluntary exit from the treatment plan and medical custody of O.P. No.2. The O.P. No.2 has kept the Catheterization Lab alert 24 hours during the days of her treatment in KIMSSSH that in case if the condition of complainant deteriorates suddenly because of re- occlusion of Left Main Coronary Artery, but such an event never happened and the complainant was progressively and smoothly improving as expected. It is also important to note that if the ReoPro could not have opened the blocked vessel and established good TIMI III flow, then there was no other choice other than going ahead with PTCA and Stenting to save the life of the complainant, however, risky it could have been. But fortunately nature favoured by giving excellent response to the ReoPro drug, which made O.P. No.2 to take a decision of staging this procedure after stabilization. This converted a potentially very high risk procedure in unplanned emergency sitting to a well planned low risk stenting procedure in hemodynamically stable // 26 // patient and avoided all Catastrophe and risk of mortality during this midnight of the 11th April, 2012. Moreover at a time when the critical analysis was done and the treatment plant was drafted carefully in the best interest of the patient on 11.04.2012 midnight. O.P. No.2 had no choice of knowing that the complainant would suddenly refuse or exit from the treatment plan, all of a sudden on 15.04.2012. The O.P. No.2 would say that it is the best result of Acbixinab (ReoPro) anyone can ever expect. Had O.P. No.2 had proceeded with introduction of guide wire, balloon without ReoPro in the presence of thrombus, it might have encountered with Catastrophe due to dislodgement of thrombus present in the Left Main Artery blocking entire blood flow. Subsequently, when the O.P. No.2 showed the said Angiogram CD later to some senior Indian and International Cardiologists, during conferences, all of them appreciated it as the best result of ReoPro drug ever seen and opined that it was the right decision taken at that point of time. The Senior Cardiologists were of the view that such an excellent result show that the thrombosis (clot) was fresh and may be of less than 4-6 hours duration before the procedure. Extensive medical research and published literature in almost all the international cardio medical journals and all the cardiology textbooks uniformly mention one undisputable fact that the only factor which determines survival in acute emergency and also recovery of heart function in long term depends on only one factor i.e. opening of the // 27 // infarct related artery (patency of the artery) and the TIMI III flow . IN the case of the complainant, this main target of successful treatment i.e. opening of the infarct related artery and establishment of TIMI III flow was achieved by the emergency procedure done by the O.P. No.2 in the midnight of 11.04.2012. It is worth mentioning that no other procedure was done subsequently elsewhere when patient sustained heart attack and even in Raipur hospital only the medical treatment was continued without any further procedure related with the heard. The success of the procedure done by the O.P. No.2 was evident by patient's survival out of that massive heart attack and also by the recovery of her heart function upto 60% (normal function) in the month of May - June, 2012. This good improvement would not have been possible if the procedure was not done with due expertise and care in the midnight of 11.04.2012. Despite the above successful treatment/procedure given by the O.P. No.2 that at least deserved admiration, the present false complaint has been filed against the O.P. No.2 and the KIMSSSH with ulterior motives and gross malafides without joining other hospitals as party in the matter, which clearly shows that it is motivated so far arm twisting with the threat and fear of maligning the reputation of the O.P. No.2 and KIMSSSH. All through the time when the patient was really sick and was given proper treatment the O.P. No.2 was being appreciated and complemented for his outstanding performance. Now when the // 28 // patient recovered from heart attack, this false complaint has been filed even without any expert opinion on the case. Thus, the complaint is liable to be dismissed. After the emergency procedure in Catheterization Lab the patient was shifted to CCU for stabilization with IABP support Team of doctors including the O.P. No.2, Intensivist Dr. Shailesh and other physicians including the complainant's husgand and Cardiologist Dr. Samal, those were actively involved in the case management. The patient had the progressive recovery in CCU and ultimately stabilized. It is fact that has been admitted by the complainant herself in her complaint to the Medical Council that she was nicely recovering after the procedure done by the O.P. No.2. On 13.04.2012 morning 9.30 A.M., patient had sudden hypotension due to vasovagal attack must likely due to pain stimulus. Vasovagal attack is very common in such post cardiac catheterization patients. Patient had hypotension and bradycardia. O.P. No.2 was informed who rushed to CCU and diagnosed the situation correctly and immediately introduced arterial and venous sheaths immediately and treated her with IV atropine and Fluids. Patient had instantaneous improvement which further confirms the diagnosis of vasovagal attack. Patient had arterial sheath and central venous sheath already introduced. Subsequently Internal jugular central venous sheath was put by the Intensivist Dr. Shailesh. Subsequently, the complainant never had hypotension at any time and // 29 // was progressively improving. Considering the patient had all intravascular sheaths, central venous line and IABP with all high potential for infection, as per the standard practice, prophylactic combination of antibiotics were given broad spectrum to cover gram positive, gram negative aerobic and anaerobic and also atypical bacteria. Sepsis is a major killer in such critically all patients. Patient was already critically ill and allowing the sepsis to develop and then treat, could have been very dangerous and irrational in Critical Care setup. All antibiotics were given as per the requirement of the condition and patient derived potential benefit out of it and did not develop any harm due to antibiotic. Since it was decided to stabilization the patient and to do check angiography with or without immediate intervention based on check angiography findings it is very important to administer potent antithrombotic treatment during this critical period. It is very important to administer Glycoprotein llb llla blocker along with Aspirin and clopidogrel. Although other glycoprotein llb llla blockers like Tirufiban can be started the complainant showed no response to the Tirufiban administered by the order of the Cardiologist Dr. Samal and the patient showed excellent response only to the ReoPro. This kind of miraculous response to ReoPro was very rare and moreover it is an extraordinary situation. So it is decided to use the same drug which has removed the blood clots for extended period of time at the night dose 0.125pg/kg/mt only.

// 30 // Ultimate the potent antithrombotic treatment including ReoPro not only helped to save the patient's life by opening the block vessel in acute emergency but also prevented re-occlusion and kept the vessel opened permanently without any episodes of re-occlusion of Left Main Artery leading to any catastrophic second heart attack without any bleeding complication. The survival of the complainant that day was possible only because O.P. No.2 applied his expertise, knowledge and experience in handling such complicated cases and has exercised due care, skill and diligence in handling the complainant at a life threatening situation. The badly motivated complainant instead of showing thankfulness made all the malafide complaints due to after thought to defame and grab money from the OPs by putting them in fear of professional / financial loss. The most common renal complication in any patient with massive heart attack and hypotension is renal failure and decreased urine output. Because of the efficient treatment offered by O.P. No.2 and his team in CCU patient successfully prevented from developing renal failure. However, she was found to be very volume sensitive urination and required adequate replacement of fluids to maintain the blood pressure as her urine output was on higher side. Although the cause could be multi- factorial like recovery from acute tubular necrosis due to hypotension she had earlier before admitting into KIMS. Due to dopamine infusion etc. although the patient was managed by the team including // 31 // Intensivist. Nephrologist's consultation was taken and as per their advice fluids were restricted and antibiotics were changed. Since the patient progressively shown good recovery in cardiac status and hemodynamic status remained stable all drugs given for BP support were gradually reduced and stopped one by one. She was taking normally breathing on her own, taking oral fund normally and was recovering nicely. It was provisionally planned that if patient is out of all drugs of BP support and maintains normal BP on her own without any support, it is planned to do check angiography on 16.4.2012. Patient/complainant was absolutely stable. She was conscious and fully oriented. Her BP = 110/70 on very minimal dose of ionotrope on the process of tapering (drug for BP support) HR 86/mt. RR 20 / mt.SPo2-96% Chest was clear. Femoral puncture site was clear (no hematoma) and distal pulses were palpable. Her blood reports on 15.04.2012 morning were Hb-11.8 gm TLC -7400 Na-134 K-4.3 S. Creat

- 0.85 Blood Urea - 28. This was the best possible outcome any one can imagine just 3 days after massive heart attack in a life threatening state even in the best centers of the word. This fact that the complainant was in stable state is further supported by her admission stable vital parameters mentioned in the discharge summary of Narayana Hospital submitted by the complainant herself to this Commission. The O.P. No.1 & O.P. No.2 waited for the complainant to recover and become stable so that she can be shifted. The O.P. No.2 // 32 // received a call around 10.00 AM on 15.04.2012 Sunday morning from the CCU nurse that the complainant is asking for discharge at request. The O.P. No.2 has given the instructions not to discharge since the treatment has not been completed and it is not safe to discharge. The O.P. No.2 was surprised inspite of good improvement why the complainant is asking for discharge without completing the treatment. The O.P. No.2 immediately rushed to the hospital. By the time already the patient was making arrangements to leave the hospital. No prior information or permission from the O.P. No.2 (treating doctor) was taken and the complainant's husband requested the KIMSSSH management / O.P. No.1 to relieve the complainant from CCU as they want to take her to another hospital in Raipur. It was mentioned that he has received all reports and Cos. At the time the patient was being taken the O.P. No.2 saw the patient and found that the Patient appeared absolutely stable. Vitals and reports were as good as mentioned above. The complainant was normally taking with her colleagues and friends. The O.P. No.2 called the complainant's husband to give him the medical advice but initially he shown reluctance and was busy in making arrangements. Finally he came and told the O.P. No.2 that he is satisfied with the cardiology treatment in the KIMSSSH but for want of better facilities and CCU care he is shifting to the Narayana Hospital, Raipur. O.P. NO.2 has explained Dr. Avijit Royazada, who himself practising as Cardiac // 33 // physician in Bilaspur, the nature of the Left Main Coronary Artery disease and said that although the patient is recovering but the treatment is incomplete and she needs check angiography and further definitive treatment of PTCA or CABGS which should be planned accordingly. O.P. No.2 further advised that shifting at this stage would hamper her progress as shifting her out of the critical care so early and stopping vital drugs may cause any adverse cardiac events, cardiac arrhythmia, arrest etc. Mobilizing her legs and taking in ambulance may cause bleeding from IABP puncture sites and may lead to blood loss or haematoma etc. The complainant's husband was adamant on taking the patient away and he said he will take the patient at his own risk. The O.P. No.2 advised not to discharge and not to shift in that condition. O.P. No.2 has not given any instructions or orders to the CCU team to discharge the patient even at their request also. But it was a self discharge against medical advice, allowed by KIMSSSH perhaps because the patient and her husband was doctors and her family was adamant, the Hospital may explain further on the discharge issue because the complainant / her husband ultimately took the discharge from the Chairman of the KIMSSSH. As because there was n prior information and the patient left all off a sudden, obviously no discharge summary was ready. It was a Sunday even then the patient's family was instructed to wait for getting the summary ready and to collect it. The patient's husband was in hurry // 34 // to shift the patient since the ambulance was waiting. Even then in the best interest of the patient, O.P. No.2 asked the clinical team to prepare a short summary with clear advice regarding the further treatment. He asked the team to mention Admission in CCU and check angiography within 48-72 hours for the Left Main Coronary Artery disease and further definitive treatment revascularization based on check-Angio findings. Lateron the O.P. No.2 prepared and delivered a detailed discharge summary to the KIMSSSH for issuing to the complainant. The O.P. No.2 has also given his personal mobile number to the complainant's husband and told him he can be called for any enquiry about the clinical details or treatment if required by the Cardiologist in Raipur hospital. However, no one called him in this regard. After the complainant left O.P. No.2 custody on her own against medical advice and refusing further treatment under O.P. No.2 was completely relieved from the responsibility of primary doctor incharge for the treatment of her by the complainant herself. Thereafter willingly by her choice she shifted the responsibility to various hospitals such as Narayana Hospital, Raipur, Apollo Hospitals, Bilaspur, Max Hospital, Delhi, Medicity Medanta, Gurgaon etc. In such scenario, there was no further information from the complainant about her progress and she was under follow up of other doctors. In this scenario, suddenly, the complainant came along with her husband to the Cardiology OPD in KIMSSSH in May, 2012 and // 35 // requested for Echo assessment. When O.P. No.2 politely declined by quoting the reason it will be interference in the other doctor's follow up. As they are Doctors themselves they requested Chairman of KIMSSSH and also the O.P. No.2, therefore, they had to honour the request and so they did the Echo-Cardiography. Echo-Cardiography was done in presence of the complainant's husband Dr. Avijit Royazada. The Echo showed very good improvement in heart function with recovery of heart function to normal levels EF upto 55%. The ECHO was recorded in CD and both the report and CDS were with Dr. Krishna, the Chairman of the KIMSSSH those might have been delivered to the patient. When the O.P. No.2 enquired about the check angiography, it was told since her liver enzymes were elevated during treatment in the Narayana Hospital due to the administration of statins, they were waiting for it to settle down and thereafter they are planning for check angiography in Delhi only. When the complainant requested O.P. No.2 to suggest some good hospitals, he suggested Premier Govt. Institutions like PGI, Chandigarh, AIIMS, Delhi, NIMS Hyderabad etc. Complainant/Patient's husband requested the O.P. to maintain secrecy from everyone including the complainant about the need of check angiogram and further treatment because the patient who herself is a Doctor may get depressed and upset and in any case that is already advised and it is in process. In the month of May - June, when they come , she told O.P. No.2 she is // 36 // perfectly all right and doing her routine work, still she has not underwent check angiography. The O.P. No.2 always insisted for check angiography and further evaluation for definitive treatment CABG surgery or PCI Angioplasty by stressing about the importance of Left Main Artery disease. The complainant's husband asked whether they can go for TMT as she has improved. The O.P. No.2 insisted for check angiography first and said that if felt necessary, the TMT can be done by modified low workload protocol under strict supervision but Check angiography would be better. However, the O.P. NO.2 prescribed the TMT as requested by the complainant's husband keeping options open so that when they come from TMT he may still be able to convince the patient for check angiography. But in any case, alike earlier, the advice of the O.P. No.2 was once again not followed by the complainant and they returned neither for check angiogram nor for modified low workload protocol TMT therefore prescribing TMT or not has nothing to do with the case. The O.P. No.2 at the relevant point of time was a full time salaried employee of O.P. No.1 and there were many other medical practitioners and experts including O.P. No.2. Consulting Doctors at KIMS including further the husband of the complainant Mr. Avijit Royazada, Dr. Samal of Apollo Hospital, Bilaspur, Experts at Narayana Hospital, Raipur, Max Hospital and Medanta Hospital. However the complete records of treatment diagnostic, reports optical discs, films and even Experts // 37 // Opinion regarding alleged medical negligence are not filed by the complainant along with the instant complaint. The complainant and her husband being a fellow medical professionals consulted O.P. No.2 at KIMSSSH and were advised well free of charges. However, the complainant gave history of recurrent chest pain at rest for one week inspite of medications prescribed by her husband Dr. Avijit Royazada. It is not necessary to do TMT before Angiography in all cases but it is very important to do coronary angiography as evaluation of underlying CAD in a patient who presents as Recent Onset Angina with typical ischemic changes in the Rest ECG with the diagnosis of Unstable angina for evaluation for coronary artery disease and the TMT is contraindicated in such clinical condition. Moreover, when rest ECG has already demonstrated ischemic changes, additional stress test to induce same ischemic changes is not necessary. The complainant did not meet O.P. No.2 when she left on her own after angiography. In fact O.P. No.2 went to CCU of KIMSSSH at 8.30 PM to see her and found she had already left on her own. The coronary angiography procedure was over by 4.45 PM and complainant shifted to CCU for 6 hours observations. The hospital record and the computerized bill of O.P. No.1 showed that the complainant left the hospital at 7.45 PM. So within 3 hours the complainant was in the hospital and no such complaints were noted by hospital staff. In the complaint to the Medical Council, Chhattisgarh, the complainant // 38 // admitted that she had chest pain after three hours of the procedure but before this Commission she submits that within three hours after reaching home. This clearly shows her attitude to make false complaints against the O.P. No.1 and O.P. No.2. The O.P. No.2 after detailed clinical analysis adopted the best line of treatment according to the prevailed situation, to stabilize the patient with IABP, to give time for the stunned myocardium (heart muscle) to recover its function to improve the overall status of the patient so patient will be fit for any kind of procedure either CABG or Angioplasty. The complainant was totally asymptomatic after the procedure and joined duty and doing well for 9 days. So the reason of Myocardial infarction given by the complainant is totally misconceived and misinformed there cannot be dissection which may cause implications like Myocardial Infarction after 9 days of occurrence during the angiography procedure done on 02.04.2012. As per the initial treatment plan and advice of O.P. No.2 (check angiography after stabilization to decide further definitive treatment) patient underwent a later stage (after leaving the custody of O.P. No.2 against medical advice) CT coronary angiography in Delhi Max Hospital and Conventional check angiography in Mediciti Medanta followed by definitive treatment of angioplasty and stenting to LMCA as an alternative procedure against the standard of care CABG Left Main disease. The Discharge Summary submitted by the complainant before this Commission clearly mentioned to do check // 39 // angiography within 48.72 hours of stabilization and further definitive revascularization treatment (angioplasty or CABC) based on check angiography. The Cardiologists at Max and Mediciti Medanta has mentioned that Dissection of LMCA leading to ACS (Acute Coronary Syndrome, Acute Myocardial Infarction) as the cause of heart attack. This opinion is not required to be debated because the O.P. NO.2 or any other Cardiac Surgeon / expert would have also given the same opinion only if he has advantage of having the check angiography (CT or conventional) findings which O.P. No.2 advised earlier when the patient was under his custody and refused by the complainant / her husband. However, the Max and Medici Cardiologists did mention the cause as "dissection" only and not any "injury caused by angiogram". The complainant's case is an identical and exemplary case in Cardiology in many aspects the clinical presentation and the response to the Reopro or even the strategy of successful management during the life threatening crisis and is likely to be published in international Medical Journals. It appears that the complainant is under misconception that the diagnostic Coronary Angiogram caused dissection or injury on 02.04.2012 which led to the massive heart attack on 11.04.2012 evening which is totally incorrect because if it was the Catheter induced dissection of Left Main Coronary Artery caused on 02.04.2012 she could have suffered massive heart attack immediately during angiogram or within 24 hours of the angiography procedure on // 40 // 02.04.2012 itself. In the morning of 13th April, 2012, the complainant had sudden onset of hypotension due to vasovagal attack which was immediately diagnosed and treated by O.P. No.2. Until 09.30 AM, the complainant maintained normal BP and heart rate and suddently she developed hypotension and relative bradycardia due to vasovagal attack. It was promptly and immediately diagnosed by the O.P. No.2 and the right treatment for vasovagal attack i.e. Inj. Atropine and IV fluids were immediately administered with simultaneous insertion of central arterial and venous sheaths through right femoral route. There was instant improvement in heart rate and BP and the patient was stabilized and become normal. The patient cannot show improvement immediately by the treatment of vasovagal attack if the hypotension is due to any other cause. There were no clinical signs of volume overload too. Infact it was felt that the complainant was more volume sensitive and if the maintenance IV fluids were restricted she was developing hypotension. So the treating team including the Intensivist planned to follow input=output to maintain the balance. On 13.04.201, patient's Hb was 7.8 gm. It was due to mechanical haemolysis induced by IABP which is a common side effect of IABP. IABP was already removed and packed cell transfusion 4 units were given and her HB improved to 11.8% In the total case history of the complainant whenever there was any problem to the complainant, the O.P. NO.2 gave due consideration and always immediately attended // 41 // the case and saved her life even during midnight odd hours of 11.04.2012 by putting expert professionalism and efforts. Both these incidents were clearly mentioned by complainant herself to the Medical Council of Chhattisgarh. After the successfully emergency procedure in cathlab on 11.04.2012 midnight, the complainant / patient was progressively improving and almost recovering from cardiogenic shock in CCU (except for one episode of vasovagal attack which was instantaneously treated and she improved). The complainant was breathing normally on her own and taking and taking food normally, talking with her relatives. She was never in respiratory distress or restless. The complainant having treated so aggressively with emergency revascularization procedure on 11.04.2012 midnight followed by minute to minute monitoring in CCU and already kept the Catheterization Lab 24 hours alert in case of any deterioration to shift the patient for check-Angio and angioplasty immediately. If what the complainant is falsely alleging like she was dyspenic, restless and oxygen saturation was dropping 88-90% which are obvious signs of deterioration in such critically ill patients of Left Main Coronary Artery disease with Acute Myocardial Infarction with cardiogenic shock if such situation would have actually happened the O.P. NO.2 and the Intensivist team of KIMSSSH would not take any risk and she would have been given at least Non invasive ventilator support at the earliest stage since any drop in oxygen saturation is not // 42 // permitted which may adversely affect the heart function. If such a serious drop in oxygen saturation with respiratory distress, she would have deteriorated further and landed in serous carding respiratory problems requiring mechanical ventilator support along with emergency angiogram and angioplasty to save her life. But on the contrary to her false allegation in paragraph 10 of the complaint, her vitals were satisfactory, respiratory rate heart rate and blood pressure were within normal limits and she was talking normally and taking oral food. The complainant was never given any mechanical ventilator support for any respiratory distress. In fact the patient was continuously recovering as expected and it was their wilful choice to shift her to another hospital and there were neither any medical requirement to shift her immediately to any other hospital nor it was advised by the treating team including the O.P. No.2. The complainant utilized the services of O.P. NO.1 and O.P. No.2 for treatment of life threatening situation and once complainant recovered they wanted to shift to another hospital, which they considered best. From the records submitted by the complainant herself, she went from one hospital to another hospital to satisfy herself. All antibiotics were prescribed to the complainant as there was a potential demand, as prohylaxis and early treatment of intravascular infection. The patient was on multiple direct intravenous and intra-arterial catheters, urinary catheters while she was critically ill due to cardiogenic shock. Complainant's X-ray // 43 // and ultrasound showed minimal fluid only in the pleural space not inside the pulmonary alveolar space, so called 'pulmonary edema' which can cause respiratory distress or failure causing de-saturation upto 880# saturation as patient falsely dscribed. The patient gave history of plueritic type of chest pain on 10.04.2012 which was totally hided by the complainant to this Commission and Medical Council of Chhattisgarh. The complainant clearly submitted in paragraph 10 at two places that the decision to shift from KIMSSSH to Narayana Hospital, was taken by the patient's husband, who himself a practicing doctor and physician as a Heart and Kidney Specialist. It not the decision of either O.P. No.2 or the other treating doctors of KIMSSH to discharge and shift the complainant to the hospital in Raipur. It was purely their wilful planned decision without any prior information to either O.P. NO.2 or O.P. No.1 may be to evade payment of fees and other charges of KIMSSSH. Even after CT Angiogram and other tests the Medicity Medanta has not given the exact cause of dissection in the LMCA. The patient after successful recovery from Myocardial Infarction left the KIMSSSH within 4 days against medical advice without check angiogram therefore without check angiogram it was not possible to find out the exact cause of large thrombus or dissection. It is totally false allegation that at the verge of shifting to Narayana Hospital, the complainant's husband was informed about check angiogram to be done. In fact it was already planned to stage // 44 // angioplasty in the midnight of 11/12.04.2012. In her complaint, the complainant herself admits that the trauma to the LMCA was not therefore for nine days after first Coronary Angiogram conducted on 02.04.2012. No revascularization procedure was done on 11.04.2012 and it was only the emergency life saving reperfusion procedure that achieved the target as an emergency measure and it was decided to stabilize the patient in the CCU and to do check angiography and further revascularization procedure either CABG or angioplasty according to the final decision based on check angiography findings. This entire treatment plan was discussed with the complainant's husband and family on 11.04.2012 itself and also mentioned in the inpatient records. Emergency angiograms and reperfusion proc report and in the discharge ticket submitted by the complainant herself. Though the emergency life saving reperfusion procedure as considered beneficial and successful, it was never declared as final and need for further definitive treatment either CABG or angioplasty according to the check angiogram findings was advised and always stressed. The O.P. NO.2 clearly stressed the important of Left Main disease and further check angiography should be done within 48 to 72 hours of the stabilization was clearly mentioned in the discharge tick et submitted by the complainant. Contrary to the averments in the present complaint, the complainant in her complaint letter to the Medical Council of Chhattisgarh, she made allegations that the O.P. // 45 // No.2 was always insisting for staying back in KIMSSSH and to undergo check angiography. The O.P. NO.2 never told or insisted that complainant was 100% alright and in fact it was advised to the complainant for check angiogram within 48-72 hours after stabilization and then go for definitive procedure either PTCA or CABGS as per requirement. The O.P. No.2 never refused for immediate stenting but looking to the critical condition and unstable condition, especially when the vessel was opened resulting in complete perfusion, he wanted to postpone the risky procedure after stabilization in CCU with IABP. As per the line of treatment, check angiogram was planned after stabilization before definitive treatment of PTCA or CABGS can be finalized. It was never declared by the O.P. No.2 that the procedure done one 11/12-04-2012 was final and complete. There was no situation or scope between to reach a finding that the cause of disease was due to injury to the Coronary Artery. There is no limitation for doing check angiogram. The complainant is under misconception that check angiogram was not required. The complainant gave history of chest pain and being treated as pleurisy / pneumona one day prior to heart attack i.e. on 10.04.2012. This history cannot be ignored and definitely all possibility of systemic disorders like vasculitis to be considered. However it was only considered as possibility and the process of diagnostic evaluation of the underlying cause was started simultaneously along with life saving critical care treatment CCU. The // 46 // O.P. No.2 never declared or insisted that the complainant was 100% right and her cardiac function will recover to near normal in future without PTCA of CABGS. The liver enzymes were completely within normal limits when the complainant was under the custody of O.P. No.2 in KIMS. She was given Antiplatelet drugs Aspirin Clopidogel and Reopro in the commended doses, not at high doses which were vital for her survival. Inj Reopro does not have any side effect as per the medical legislature. Narayana Hospital discharge summary completely omitted statins and continued the antiplatelet agents, aspirin and clopidogrel implying that it was staitin induced hepatitis. The treatment details from Apollo Hospital, Bilaspur, Gastroenterologist have been totally hided and not submitted to the Commission. This fact has been wilfully suppressed in the instant complaint. The complaint is based on false and fabricated allegations. It is frivolous and baseless that deserves to be dismissed with exemplary costs as per the provisions of Section 26 of the Consumer Protection Act,1986.

5. The complainant has filed documents. Annexure A/1 is Electrocardiogram done on 29.03.2012 at KIMS Hospital, Bilaspur, Annexure A/2 is 2D Echo done by Dr. Pawan Agrawal on 11.04.2012, Annexure A/3 is USG done at KIMS on 12.04.2012, Annexure A/4 is X-ray done at KIMS on 13.04.2012, Annexure A/5 is Discharge Tickket of KIMS Hospital dated 15.04.2012, Annexure A/6 to A/8 are Bills of // 47 // Injection Reopro dated 12.04.2012, Annexure A/9 is Bill of Injection Reopro dated 13.04.2012, Annexure A/10 is Bill of Injection Reopro dated 14.04.2012, Annexure A/11 is Religare Lab report of vasculitis profile, Annexure A/12 is Discharge ticket of Shree Narayana Hospital, Raipur dated 20.04.2015, Annexure A/13 is Report of Bilaspur Diagnostic Centre dated 14.05.2012, Annexure A/14 is Report of Apollo Hospital, Bilaspur dated 15.05.2012, Annexure A/15 is report of Apollo Hospital, Bilaspur dated 15.05.2012, Annexure A/16 is Report of Sai Baba Heart and Kidney Centre, Bilaspur dated 21.05.2012, Annexure A-17 is OPD ticket of KIMS Hospital dated 14.05.2012, Annexure A/18 is bill given by KIMS Hospital dated 06.06.2012, Annexure A/19 is OPD ticket of Max Hospital dated 21.06.2012, Annexure A/20 is Transthoracic Echo-Doppler Report in Max Hospital, Delhi dated 20.07.2012, Annexure A/21 is 2D Echo Report of Max Hospital, Delhi dated 20.07.2012, Annexure A/22 is CT angiography report of Max Hospital, Delhi dated 21.07.2012, Annexure A/23 is OPD ticket of Medanta Hospital, Gurgaon dated 21.07.2012, Annexure A/24 is Discharge Ticket of Medanta Hospital dated 25.07.2012, Annexure A/25 is Certificate issued by Medanta Hospital dated 13.08.2012, Annexure A/26 is bill given by KIMS Hospital dated 04.09.2012, Annexure A/27 is Call detail of airtel mobile of Dr. Avijit Royazada dated 02.04.2012.

// 48 //

6. The O.P. No.1 has filed Admission record and related documents, Bed Head records.

7. The O.P. No.2 has filed document. Annexure OP-2-1 is Expert Opinion provided by Dr. Bali, Annexure OP-2-2 is Notice received from Chhattisgarh Medical Council, Annexure OP-2-3 is copy of complaint made by the complainant Dr. Bhavana Royzada, Annexure OP-2-4 are copies of the academic credentials of the O.P. NO.2, Annexure OP-2-5 are copies of a prescription file of complainant's husband Dr. Avijit Royazada. Annexure OP-2-6CD is medical opinion report (with self seen and signed CD of complainant Bhavana Royazada) given by Dr. Kapil Bhargava MD, DM, Professor and Head of Department of Cardiology, Ravindranath Tagore Medical College, Udaypur, Rajasthan. Echo dated 29.03.2012, 14.04.2012, 14.05.2012 and 21.06.2012 of the complainant at KIMSSSH )P) Ltd., CAG dated 02.04.2012 of complainant at KIMSSSH (P) Ltd., PTCA dated 12.04.2012 of complainant at KIMSSSH (P) Ltd.

8. Shri D. Dutta and Shri R.K. Bhawnani, learned counsels appearing for the complainant has argued that on 29.03.2012, the complainant was having chest pain and her ECG was done in the Nursing Home, it showed T Inversion from V1 to V6. The complainant consulted O.P. No.2 Dr. V.K.G. Rajsekar, Cardiologist, who is working with the O.P. No.1 Hospital. The O.P. NO.2 advised the complainant for coronary angiography without conducting TMT // 49 // tests. On 02.04.20112, coronary angiography of the complainant was done and the O.P. No.2 told the complainant that she was absolutely normal and the complainant will not have any cardiac problem for next 50 to 60 years. The Report or CD of Echo and Angiography were not provided to the complainant on 02.04.2012. Again the complainant was having severe midsternal chest pain within three hours after reaching the home. The husband of the complainant informed the O.P. No.2 , who advised to take medicine Tablet Nitrocontin and Rablet. Thereafter, the complainant again suffered severe chest pain, dyspnea and hypotension on 11.04.2012. Dr. Pawan Agrawal, conducted Echo on 11.04.2012 in which it was found that EF was 35%, hypokinetic Lateral Wall and Apical Region and LV dysfunction due to heart attack. The complainant was admitted in the O.P. No.1 Hospital on 11.04.2012. The Coronary Angiography was done in the intervening night of 11/12-04-2012. Left Main Coronary Artery was found blocked by large thrombus and LAD was found 100% blocked. The O.P. No.2 gave injection Reopro through intracoronary route to dissolve the thrombus completely. The O.P. No.2 explained the etiology being vasculitis, autoimmune disease and hypercoagulable state but not the injury. On 14th and 15th April, 2012, the complainant was dyspenic and restless after this episode. The complainant was given higher antibiotics like Cefipime, Tazobactum combination, Ticcoplanin 400 mg BD, Meropenum 1 GM TDS in spite // 50 // of no evidence of any infection. The complainant and her family members were not satisfied with the treatment given by the O.P. No.2, therefore, the complainant was shifted to Shree Narayana Hospital, Raipur. The O.P. No.2 had never disclosed the exact cause of the large thrombus in the Left Main Coronary Artery to be the trauma which was not there nine days back. The O.P. No.2 all the time explained the reason for this coronary event was vasculitis and autoimmune disease but not the injury due to CAG during the stay at hospital. When the complainant was shifting to Raipur, the O.P. No.2 did not give detailed discharge documents and no consent was taken for conducting angiography. The complainant was admitted in Shree Narayana Hospital, Raipur where Dr. S.A. Kale and Dr. Sunil Gounial checked the complainant and the complainant took their opinion for CAG, but they refused because they were suspecting trauma during first angiography, it was not a wise decision to do intervention in a traumatized vessel immediately, so Dr. Gounial advised for CT coronary angiography after stabilization of patient's condition , which is non invasive procedure. The complainant was discharged from Shree Narayana Hospital, Raipur on 20.04.2012 but the condition of the complainant was not good and Temporary TIMI 3 flow was declared as the successful treatment but the cause of injury was neither diagnosed nor corrected by putting stent and doing angioplasty. The complainant's fatigue was gradually increasing and in July, 2012 she // 51 // was feeling constant heaviness in chest and chest pain on exertion, therefore, the complainant went to Delhi and consulted Dr. Rajeev Rathi, Consultant Cardiologist at Max Hospital. CT Coronary Angiography was done which revealed "Dissection of left main coronary artery and LAD with intimal flap extending along superior aspect of left main into proximal LAD 1/3rd with true lumen filling patent LAD with diminished distal opacification, Significant 70% stenosis in left main and stenosis 40% in proximal 1/3rd LAD. Thereafter the complainant went to Medanta Hospital, Delhi. Looking to facts and circumstances of the case it appears that the O.P. No.2 had concealed the facts regarding treatment and commit unfair trade practice. The O.P. No.2 has worked against the medical profession and against the ethics of Medical Council. Due to negligent act of the O.P. No.2, the complainant suffered mental and physical agony. The O.P. No.2 is working with the O.P. No.1, therefore, the O.P. No.1 is also liable for the negligent act of the O.P. No.2. This Commission called Expert Opinion form Medical Board of Dr. B.R. Ambedkar Memorial Hospital, who gave their opinion. On the basis of expert opinion and record of the other hospitals, it appears that the O.P. No.2 committed medical negligence. The complainant is entitled to get compensation from the OPs, as mentioned in the prayer clause of the complaint. The complaint filed by the complainant be allowed. They placed reliance on literature Cardiology Drug Guide, 2010 - Glycoprotein llb-lla // 52 // Antagonists, literature on Percutaneous Intervention for Left Main Coronary Stenosis, Literature on Loop diuretics, Dr. D.K. Majumdar Vs. Anjana Basu Roy and Ors. 2017 (3) CPR 204 (NC); Thayira Begum and Anr. Vs. Padmini Nursing Home and Ors. 2017 (3) CPR 603 (NC); Sita Ram Srivastava Vs. Sanjai Gandhi Post Graduate Institute of Medical Sciences, 2017 (1) CPR 502 (NC); Post Graduate Institute of Medical Education & Research (P.G.I.) and Anr. Vs. Mamta Rani @ Babli and Ors. 2017 (1) CPR 464 (NC); Sunil Vs. Om Multispeciality Hospital and Research Centre Pvt. Ltd., 2016 NCJ 210 (NC); Asha Abbhi Vs. Kanpur Medical Centre Pvt. Ltd. & Ors. 2016 NCJ 228 (NC); Dr. Manoj Jain Vs. Vinod Sahu & Anr. 2016 NCJ 237 (NC); Dr. Monica Singla & Ors. Vs. Tej Bhan Taneja & Ors. 2016 NCJ 452 (NC); Ritu Garg Vs. Dr. Vineet Sharma & Anr. 2016 NCJ 688 (NC); Savitri Devi Vs. Dr. Pramila Gupta, 2017 (2) CPR 737 (NC).

9. Shri Mukesh Sharma, learned counsel appearing for the O.P. No.1 has argued that the treatment record of the complainant was provided to the complainant's husband. The diagnosis and treatment carried out at hospital from 11th April to 15th April, 2012. On the basis of Echo Report issued by Dr. Pawan Agrawal was based on his own evaluation and expertise. The O.P. No.2 is an expert Cardiologist and he provided better treatment to save the life of the complainant. No adverse has been reported by further treating hospital where complainant was treated immediately after leaving the hospital against // 53 // the medical advice on 15th April, 2012, against the O.P. No.2. No medical negligence was committed by the O.P. No.2. The O.P. No.1 is a hospital where the O.P. No.2 has treated the complainant, therefore, the O.P. No.1 is not liable to pay any compensation to the complainant. The complaint is liable to be dismissed against the O.P. No.1.

10. Shri Rajkamal Singh, learned counsel appearing for the O.P. No.2 has argued that the O.P. No.2 is a well qualified Interventional Cardiologist and he followed the Medical Protocols. The O.P. No.2 has not committed medical negligence. The O.P. No.2 has properly treated the complainant and save her life. The complainant and her husband both are doctors by profession. The husband of the complainant is M.D. Medicine. The complainant and her husband have used print and visual T.V. media for extracting money from the OPs. The complainant without furnishing the complete truth and medical records of other hospitals has filed the instant complete before this Commission on the false ground and the allegations made by the complainant are totally false. The complainant sought the professional services of the Cardiologist of KIMS Hospital, Bilaspur Dr.V.K.G. Rajasekar, (O.P. No.2) on two occasions. On 02.04.2014 for diagnostic Coronary Angiography for her complaints of recurrent chest pain with ECG changes suggestive of Unstable angina, which was not subsiding with optimal medical treatment given by her own // 54 // husband and on 11.04.2012 when she was admitted in life threatening emergency facing imminent death due to massive heart attack with cardiogenic shock. After examining the screening test reports like ECG, ECHO and blood reports with their consent, the angiography was performed on 02.04.2012 as per the standard protocol following all standard protocols as per standard cardiology practice. The coronary angiography procedure was done smoothly without any complications and the complainant was absolutely stable during post procedure monitoring and she walked out of the hospital on her own and went home without any problems. The procedure was performed in presence of the complainant's husband. No complications occurred during the procedure or during post procedure monitoring in the hospital, is also not disputed by the complainant. The angiography revealed essentially normal epicardial coronary arteries and did not show any significant blocks, so accordingly she was advised medical treatment and follow up, but the complainant did not come for follow up with O.P. No.2 afterwards till she was admitted through emergency on 11.04.2012. The complainant was admitted all of a sudden on 11.04.2012 night with life threatening extensive myocardial infarction. It was totally unexpected even, mere natural accident due to her disease but it can never occur as a complication of the angiography procedure which was perform 9 days earlier . There is not even a single case reported in the medical literature supporting the // 55 // complainant's false allegation that Myocardial infarction can occur as a complication of the coronary angiography procedure even 9 days after the procedure. Myocardial or death can occur rarely as complications of Coronary angiography, either during the procedure or within 24 hours. The complainant was having chest pain after 9 days of performing procedure and the complainant herself got herself discharged from the O.P. No.1 Hospital against the Medical Advice. Even the record of Shree Narayana Hospital, Raipur, Max Hospital, Delhi and Medanta Hospital, Delhi does not prove that the procedure adopted by the O.P. No.2 is wrong procedure and the complication was occurred due to Angiography done by the O.P. No.2. The Expert Report was sought by this Commission from Dr. B.R. Ambedkar Memorial Hospital, Raipur and the report was sent by Medical Board consists of Dr. D.P. Lakra, Professor, Department of Medicine, Dr. B.R. Ambedkar Memorial Hospital, Raipur, Chairman, Dr. R.K. Patel, MD, Associate Professor, Department of Medicine, Member, Dr. S. Varma, MD, Associate Professor, Department of Medicine, Member, Dr. B.L. Bansal, MD, DM, Assistant Professor, Department of Medicine, Member and Dr. S. Gupta, Director Prof. & Head, Department of Medicine, Pt. J.N.M. Medical College & Dr. B.R. Ambedkar Memorial Hospital, Raipur (C.G.). In their report the have specifically mentioned that it is suggestive and no definitive opinion can be given by the Medical Board. The O.P. No.2 obtained expert report of Dr. // 56 // Kapil Bhargava, MD (General Medicine), Professor and Head, Department of Cardiology, R.N.T. Medical College, Udaipur, in which he specifically mentioned that the treatment given by the O.P. No.2 to the complainant, is proper and correct. It shows that the O.P. No. has not committed any medical negligence. Therefore, the complaint is not entitled to get any compensation from the O.P. No.2 and the complaint is liable to be dismissed against the O.P. No.2. He placed reliance on Medical Literature on Latrogenic LMCA Dissection and Intramural Haematoma caused by Diagnostic TCC, Medical Literature on Emergency Stenting of unprotected LMCA, Medical Literature on Left Main Stem Coronary Artery Dissection during CAG, Medical Literature on Complications of Coronary Arteriography, Medical Literature on Diagnostic Cardiac Catheterisation Discharge Instructions, Medical Literature on Spontaneous Coronary Artery Dissection, Medical Literature on Periprocedural Mycordial infarction, Medical literature on catheter Induced LMCA spiral dissection; Medical Literature on SCAD treatment, Medical Literature on CT angiography, Comparison of Clinical Interpretation with Visual Assessment and quantitative Coronary Angiography in patients undergoing Percutaneous CI, literature on Immediate Vs. Delayed stenting in acute myocardial infarction : a systematic review and meta - analysis. He also placed reliance on Kusum Sharma and Ors. Vs. Batra Hospital and Medical Research Centre and Ors., I (2010) CPJ 29 (SC); Consumer Case No.909 of 2017 - Binod // 57 // Choudhary and Ors. Vs. Tata Memorial Centre and Ors. decided by Hon'ble National Commission on 17.07.2017; First Appeal No.320 of 2016 - Kamal Sharma Vs. U.S. Dhaliwal and Ors. decided by Punjab State Consumer Disputes Redressal Commission, Chandigarh on 11.05.2017; Jacob Mathew Vs. State of Punjab and Anr. III (2005) CPJ 9 (SC).

11. We have heard learned counsels appearing for the parties and have also perused the documents filed by them in the complaint case.

12. It is admitted fact that the complainant Smt. Bhavana Royazada and her husband namely Dr. Avijit Royazada both are doctors by profession and the complainant is posted as Assistant Professor in C.I.M.S. Bilaspur. It is also admitted fact that the complainant went to the O.P. No.1 KIMS Hospital when she was having chest pain and her coronary angiography was conducted by the O.P. No.2 on 02.04.2012.

13. The complainant pleaded that due to Coronary Angiography done by the O.P. No.2, the complainant suffered problems and the angiography was done by the O.P. without obtaining her consent and without following the medical protocols. It is also pleaded that initially the complainant obtained ECG and ECHO Report from Nursing Home and thereafter she went to O.P. No.1 Hospital.

14. Now we shall examine whether the OPs committed medical negligence ?

// 58 //

15. In a case of medical negligence, what is expected of a doctor is ordinary skill, care and expertise and not an extraordinary or super human skill, judgment or expertise. Simply, because a mishap had occurred, neither the hospital nor the doctors can be made liable. A doctor is not guilty of negligence if he has acted in accordance with the practice accepted as proper by a responsible body of medical men skilled in that particular art. A doctor or a hospital is expected to take reasonable care in administration of the treatment. What is the duty of a doctor is to take care and caution while giving the treatment as per the established medical practice. If he has acted in the said manner, no question of deficiency would arise. Now we shall examine whether O.P. No.2 has not conducted angiography of the complainant according to the medical norms ?

16 The complainant has filed Echo-Doppler Report dated 11.04.2012 issued by DR. Agrawal Heart, Diabetes and Medical Clinic, Bilaspur which is marked as Annexure A-1, in which it is mentioned thus :-

"Patient's Name Mrs. Bhawna Royazada, Age 37 years : Sex : F : Date :

11.04.2012 Referred by Dr. Avijit Royazada, MD MEASUREMENTS (In millimetre) Parameter Pt's value Normal Parameter Pt's value Normal Aortic root 31 20-37 LVID ed 55 37-54 Left 35 19-40 LVID es 40 22-40 // 59 // Atrium IVS (cd) 09 6-12 LVPW ed 09 5-10 E-F Slope 72 EPSS 12 mm/sec.

MITRAL VALVE :

Morphological data :-

      AML - Normal                                   PML - Normal

      Leaflet mobility - Normal                      Calcification - Nil

      Sub valvular Apparatus - Normal

      Doppler Data :-

      Max Flow Velocity (in mt/sec : E=0.96:A = 0.49

      Color (flow mapping :-

      Mitral regurgitation : Nil


AORTIC VALVE :


      Morphological data :

Number of cusps : TricuspidSeparation of cusps-Full Cusp opening - Normal Closure line - Central Thickening : Normal Calcification - Nil Doppler Data :

Max Flow velocity - 0.92 mt./sec Color flow mapping :

Aortic regurgitation : Nil PULMONARY VALVE :

Morphological data - Normal Doppler Data -

// 60 // Max Flow Velocity : 0.98 mt. /sec.

Color flow mapping :

Pulmonary regurgitation : Nil.

TRICUSPID VALVE :

Morphological data : Normal Doppler Data :

Max Flow Velocity : - 0.37 mt / sec.

Color flow mapping :

Tricuspid regurgitation : - Nil Right Ventricle : Normal Size. Adequate systolic function.

Right Antrium : Normal Size Left Artium L Normal Size No Clot.

Left Ventricle : High Normal size. RWMA :- mid anterior septum, mid anterior wall, apical 2/3rd of IVS, LV apex and lateral wall are severally hypokinetic. Severe LV systolic dysfunction. LVEF - 35% IVS :- Intact IAS : Intact.

Pulmonary artery :        Normal Aorta : Normal


Pericardium :             Normal. No pericardial effusion.


Conclusions :


         -   RWMA AS MENTIONED IN THE TEXT

         -   PSEUDONORMALIZATION                 OF     MITRAL       INFLOW
             PATTERN

         -   SEVERE LV SYSTOLIC DYSFUNCTION - LVEF - 35%"
                                       // 61 //

17.     The complainant has filed            Sonography Report (Abdomen)

dated 12.04.2012 issued by O.P. No.1 Hospital, which is marked as Annexure A-3 in which it is mentioned thus :-

"AORTA AND PARA AORTIC REGION : Aorta and IVC appear normal in diameter. No evidence of any pre and para aortic hymphadenopathy seen.

IMPRESSION :- USG abdomen findings reveal :

- Mild right sided and minimal left sided pleural effusion."

18. The complainant has filed Discharge Summary of KIMS Hospital, Bilaspur which is marked as Annexure A-5 in which it is mentioned thus :-

"Diagnosis : Acute coronary syndrome : NSTEMI/Cardiogenic shock.

CAD : Thrombus in Left Main and LAD MID LAD total Cut off.

Minimal thrombus in LCX also.

Etiology : ? Coronary thrombosis ? Coronary VAsculitis ?

Hypercoagulable state.

Intracoronary Reopro Bolus given LAD recanalized with TIMI III flow.

IABP support given. Patient recovered.

Plan. Since the TIMI III flow achieved it is decided to stabilize the patient in CCU. Since the patient is stabilized, it is decided to do check angiogram after 2 days and to decide about further coronary intervention based on Check angio. Meanwhile the patient's family wanted to shift to Raipur for personal reasons. So the patient is discharged at request.

Brief Summary :

Mrs. Bhavana, aged 37 years female, Doctor (Anaesthestist) by profession presented to Emergency with H/o Chest pain associated with HTN, BP 90/70.

// 62 // She had chest pain 10 days prior, underwent CAG by radial rouse which revealed normal coronaries.

Emergency CAG this time showed thrombus in left main, Proximal to mid LAD total cut off with thrombus. Minimal thrombus in Lcx also opening Blood pressure was 90/70.

Cathlab Procedure :

LCA was hooked with JL 3.5 Coronary guiding Catheter infra coronary bolus of Reopro (ABciximab) was given followed by injection 0.125 mg/1gm/mt 48 hrs. Immediately after infra coronary bolus LAD reanalyzed and residual thrombus in left main. Since the TIMI III flow achieved and patient is hemodynamically stable and IABP support was given. It is decided to continue Reo for 48 hours stabilize her in ICU and to do check angiogram after 48 - 72 hours depending on the status. To decide about further head for any coronary intervention after check angio.

In CCU she was given IABP support, lonotopes with Noradrenaline /Dopamine, Reopro injection, IV fluids, Normal O2, Antibiotics Fluids and electrolytes are replaced as per the monitoring.

IABP support taped and removed in 24 hours. Dopamine tapered and stopped in next 24 hours. At the time of discharge at request she was recovery low dose 3 - 5 mg, Noradrenaline.

Her status at the time of discharge BB : 106/70, HR : 86 / mt, PR, 26 / mt. Chest : clear.

Patient recovered well. The treatment episodes nreathlessness. Received 3 units of Blood and 3-4 units of FFP.

Bed Side Echo :

RWMA LAD territory Apex and Anterior Wall Hypokinesia Mild LV dysfunction LYEF 42% No MR / AR /TR No clot vegetation /effusion.

Advice at the time of discharge :

Admission in Cardiac CCU T. Aspisol 150 mg once daily Tab. Clopilet 75 mg twice daily Tab. Carloc 3.125 mg 1.o.0 // 63 // T. Crestor 20 mg 0-0-1 Tab. Nikoran 10 mg 1-0-1 Tab. Trivedon MR 1-0-1 Inj. Magnex 2g IV 6th hrly, Inj. Clindamycin (Dolacin 600 mg IV bd) Inj Pasumac 500 mg IV od IV fluids and electrolytes replacement as per monitoring.

Monitor CVP/Vitals/SPo2 Plan Stabilize in CCU for 24-48 hrs., to do check angiogram after 48-72 hrs. To decide further need of Coronary Intervention / revascularization procedure based on Check Angiogram."

19 The complainant has filed Discharge Summary Card of Narayana Hospital, dated 20.04.2012, which is marked as Annexure A- 12 in which it is mentioned thus :-

"DIAGNOSIS :

Cad, Anterior wall MI, Mild LV Dysfunction, Hepatitis.

Condition on Discharge :

Improved.

REMARKS :

Review after 6 weeks or SOS Advice - 1. Repeat LFT and Serum Potassium after 5 days.

2. CT Angiography (Coronaries) 6 weeks.

3. Rest 6 weeks."

// 64 //

20. The complainant has filed Discharge Summary issued by Medanta Hospital, , which is marked as Annexure A-24, in which it is mentioned thus :-

"Reasons for admission :

For Stabilization and management Diagnosis :

Coronary artery disease Dyslipidemia Procedure done :

CORONARY STENTING (XIENCE PRIME LL) TO LM LAD DONE WITH IVUS GUIDANCE ON 23.07.2012 CLINICAL SUMMARY :

History of Presenting Illness :

Patient is normotensive, non diabetic Female. She presented with complaints of chest pain associated with angina and dyspnoca on exertion since 1 week. Her coronary angiography was done which revealed coronary artery disease. She was admitted here for further evaluation and management.

Allergy Tab Atorva Physical Examination :

On admission patient's pulse rate was 62 / min, BP 90/60 mm Hg and general, physical examination and systemic examination were unremarkable.

Course in the Hospital :

Patient was admitted here for stabilisation and evaluation for which investigations were done. Her Coronary stenting to LM LAD done with IVUS guidance on 23.07.2012. The procedure was uncomplicated and well tolerated. She responded well to given treatment and managed conservatively. Now she is being discharged in stable condition with following advice.

// 65 // Activity :

Symptom Limited.

Diet :

As advised.

Other Advices :

- Revision with Dr. Praveen Chandra in Cardiology OPD with prior appointment."

21. The complainant has filed Literature on Percutaneous Intervention for Left Main Coronary Artery Stenosis, in which it is mentioned thus :-

"EMERGENCY INTERVENTION FOR UNPROTECTED LEFT MAIN CORONARY ARTERY STENOSIS :

Procedure - Related Complications LMCA dissection after coronary angiography or an interventional procedure is a rare but serious complication. Careful observation or elective CABG may be a reasonable approach for a non-flow limiting dissection. Emergent CABG or bailout stenting should be performed for a flow limiting dissection of the LMCA. A retrospective observational study showed that bailout stenting for LMCA dissection was successful in all cases and had very favourably long term outcomes."

Ref. Taxtbook of Interventional cardiology Topol Page No.409-411 which states that LMCA dissection is an emergency and should be treated with PTCA / CABG never left unprotected.

..if it was vasovagal shock according to OP2. Ref. Oxford textbook of practical drug therapy Page No.201.

.. ref. Acute Coronary syndromes 345 & 348, shows that Reopro is beneficial for short duration.

.. ref Harrison's text book of internal medicine Page no.1405. It states that CAG should be done when TMT is positive or worsening LV // 66 // function in 2D Echo. Otherwise it is a risky procedure it should not be done casually."

22. The O.P. No.2 has filed Comparison of Clinical Interpretation with Visual Assessment and quantitative Coronary Angiography in patients undergoing Percutaneous, which is placed at page no.120 filed along with written arguments, in which it is mentioned thus :-

"Abstract :

Background ...

Methods and Results - We compared clinical interpretation of stenosis severity in coronary, lesions with an independent assessment using quantitative coronary angiography (OCA) in 175 randomly selected patients undergoing elective percutaneous coronary intervention (PCI) at 7 U.S. Hospitals in 2011....

Key words : Angiography, health policy and outcomes research, quality improvement."

23. The O.P. No.2 has filed literature on Immediate Vs. Delayed stenting in acute myocardial infarction : a systematic review and meta

- analysis, in which it is mentioned thus :-

"Conclusions : Delayed stent implantation is associated with better angiographic outcomes. Randomised trials are required to assess whether delayed stenting translates into better long term cardiac outcomes.

Discussions : In our experience deferred stenting is safe and has the potential to reduce no reflow and thereby reduce infarct size."

// 67 //

24. The O.P. No.2 has filed literature on Angiogram Discharge instructions filed along with written arguments at page no.63, in which it is mentioned thus :-

"How will I care for myself at home ?

Activity

- You may resume showering 24 hours after the angiogram.

- Do not swim or take a tub bath for 7-10 days after your procedure.

- Rest in bed for 24 hours except to go to the bathroom or eat a meal.

- Avoid strenuous physical activity including lifting more than 10 pounds, bending or stooping for 4 days after your procedure."

Incision :

- Many patients will not have an incision. There is generally a tiny puncture wound in the groin or bend of the arm. If there is dressing still in place when you go home remove it in the shower the next day."

25. The O.P. No.2 has filed literature on "After a Coronary Angiogram or Angioplasty Procedure - Discharge Information for Patients" in which it is mentioned thus :

"Care of the wound site :

Your procedure will most likely have been performed from either the blood vessel in your wrist or at the top of your leg and it is common to be a bit bruised afterwards. If this is uncomfortable then take painkillers such as paracetamol.

Do not take painkillers that conain aspirin.

// 68 // Travelling by aircraft :

................

- After an angiogram or routine angioplasty, you may be able to fly after 2 days.

- After an uncomplicated heart attack, you may be able to fly after 3-10 days.

- After a more significant or complicated heart attack, delay flying for 4-6 weeks."

Repeat narrowing :

After the angioplasty has been performed, the same area may become narrowed again because of scar tissue. This is a process called resenosis........"

26. The Expert Report was sought by this Commission from Dr. B.R. Ambedkar Memorial Hospital, Raipur and the report was sent by Medical Board consists of Dr. D.P. Lakra, Professor, Department of Medicine, Dr. B.R. Ambedkar Memorial Hospital, Raipur, Chairman, Dr. R.K. Patel, MD, Associate Professor, Department of Medicine, Member, Dr. S. Varma, MD, Associate Professor, Department of Medicine, Member, Dr. B.L. Bansal, MD, DM, Assistant Professor, Department of Medicine, Member and Dr. S. Gupta, Director Prof. & Head, Department of Medicine, Pt. J.N.M. Medical College & Dr. B.R. Ambedkar Memorial Hospital, Raipur (C.G.). In the Expert Report it is mentioned thus :

"Committee of three Medical Specialists and One Cardiologist as per order No.2015 / 17819 of the Director, Divisional Medical Board is in // 69 // receipt of documents, provided from page 1 - 129. This Committee is giving its observations taking into consideration the provided clinical medical documents / notes / medical reports only.

1. Document A-1 : There is photocopy (poor quality) of an electrocardiogram dated 29.03.2012 which shows ST-T changes in lead 2, lead 3, V1-V4, on the basis of which diagnosis of ischaemic heart disease cannot be ruled in or ruled out. Subsequent management on the basis of this ECG cannot be commented upon by the Committee on the basis of accompanying documents.

2. Document A-2 : Echocardiography report dated 11.04.2012 Aggarwal Har, Diabetes and Medical Clinic suggested evidence of moderate to severe LV dysfunction due to RWMA in LAD territory.

3. Document A-5 : As per the undated provisional, unsigned, discharge document (A-5/P-28) available, patient was diagnosed as CAD/ACS/NSTEMI/Cardiogenic Shock. Angiography revealed presence of a thrombus in LMCA and LAD with MID LAD cut- off. Patient was treated with GP2b/3a inhibitor for 48 hours along with antibiotics, anti platelets, statins, anti anginals, vasopressors, IABP support and Blood and FFP transfusions. Bed side echocardiography revealed moderate LV dysfunction with RWMA in LAD territory. Subsequently patient is discharged on request.

4. Document A-12 : Discharge card of Shree Narayana Hospital, Raipur, dated 20.04.2012 suggested diagnosis of CAD, AWMI, Mild LV Dysfunction, Hepatitis.

5. Document A-14 : OPD card of Max Hospital, New Delhi dated 20.07.2012 mentioned left main coronary dissection with thrombus with reference to an undated Coronary Angiogram.

6. Document A-22 : Dated 21.07.2012, CT Angiogram report at Max Hospital, New Delhi, revealed :

6.1. Dissection of left main and LAD with internal flap extending along with superior aspect of left main into the // 70 // proximal LAD 1/3rd with true lumen filling patent LAD with diminished distal opacification. 6.2. Significant 70% stenosis in Left Main and 40% stenosis is proximal 1/3rd LAD.

6.3. RCA and LCx were normal.

7. Document A-24 : Dated 25.07.2012, Discharge Ticket of Medanta The Medicity, Gurgaon, Revealed CAD, Dyslipidemia and procedure of coronary stenting. CAD dated 23.07.2012 shows left main dissection flap with 90 stenosis, flap extending upto LAD, Stenting LMCA and LAD was done with XIENCE prime stents under IVUS guidance."

27. The O.P. No.2 obtained expert report of Dr. Kapil Bhargava, MD (General Medicine), Professor and Head, Department of Cardiology, R.N.T. Medical College, Udaipur, dated 15.03.2017, in which it is mentioned thus :-

"The Medical records of the patient Dr. Bhavana Royazada admitted in KIMS Hospital, Bilaspur on 02.04.2012 and again on 11.04.2012, the cine images of the angiography procedure performed on 02.04.2012 and the Revascularization procedure performed on 12.04.2012 were reviewed and herewith my expert opinion is submitted.

Admission on 2.4.2012 for coronary angiography : As the patient had history of recurrent chest pain associated with ST-T changes in anterior leads of the ECG suggestive of Recent onset angina, it was appropriate to advise coronary angiography and the procedure was performed on 2.4.2012 and the patient went home normally on her own without any complications. The coronary angiography was normal and Medical treatment was advised appropriately.

// 71 // Admission on 11.4.2012 Midnight for treatment of Acute Extensive Anterior wall Myocardial Infarction with Cardiogenic Shock :

Considering the critical condition of the patient, the patient was promptly taken up for immediate emergency angiography and life saving primary angioplasty immediately. The emergency angiography showed Left Main Coronary artery full of thrombus with Proximal LAD total cut off. Extensive Anterior wall Myocardial infarction with LVEF 25% complicated by cardiogenic shock associated with the kind of complicated angiographic picture of Left Main disease (high syntax score of more than 34 indicating highly complex lesion) is usually associated with high mortality and survival of such patients is less even in best centres of the world.

This kind of angiographic picture in such patients with Acute anterior wall myocardial infarction could be due to plaque rupture with acute thrombosis and the patient was rightly taken up for Emergency Life saving primary angioplasty considering the critical condition of the patient.

However, during PCI, immediately after intracoronary bolus of Reopro (Abciximab) even before stenting, there was complete dissolution of thrombus with establishment of TIMI III flow in the culprit vessel LMCA and LAD. Intra Aortic Balloon Pump was already inserted. With IABP insitu along with the successfully established TIMI III flow right option was chosen to shift the patient to IC for stabilization of the patient. Once the patient is stablised check angiography can be done to reassess the coronary anatomy and to decide about further revascularization procedure.

Currently there is lot of evidence available in the literature for not going immediate stenting in Acute MI with heavy burden lesions (Defer AMI trial). However, it is the discretion of the Interventional // 72 // Cardiologist to decide the strategy depending on the clinical condition of the patient according to the evidence available from the current literature.

It is evident from the Medical records that once the patient is reasonably stabilized the patient left to another hospital on 15.4.2012 on their own risk without undergoing further check angiography or revascularization procedure in KIMS Hospital.

In nutshell, under the life threatening critical circumstances in the mid night of 11.04.2012 and subsequently in the CCU of KIMS Hospital, I could see that the patient was given due care with diligence with reasonable expertise which is evident from the progressive recovery of the patient and Ejection fraction improved from LVEF 25% (due to myocardial infarction) to subsequently LVEF 55-60% during follow-up as a result of the successful establishment of TIMI III flow by the procedure performed on 12.4.2012. Survival of these kind of complicated cases with this kind of complicated angiographic picture with extensive thrombosis in LMCA is not predictable even in the best centres of the world the best efforts too.

The angiography picture of 12.4.2012 is very much consistent with fresh acute myocardial infarction with development of fresh thrombus which is further evident by successful effective dissolution by intracoronary abciximab itself. Old organised thrombus cannot be dissolved by abciximab. This angiography picture is really a complicated one and the cause of dense thrombus could be plaque rupture with extensive thrombosis or plaque rupture leading to Spontaneous coronary artery dissection itself.

Usually catheter induced LMCA dissection leads to immediate development of thrombus and abrupt closure of vessel (LMCA) with immediate development of chest pain, hypotension and ECG changes and it can lead to cardiac arrest if not treated immediately with urgent // 73 // PCI and stenting or emergency CABG. In this case the angiography performed on 02.04.2012 is essentially normal and patient went home normally and further she was able to do her office work normally for next 9 days. I do not think the angiography procedure performed on 2.4.2012 (9 days earlier) is the cause for the plaque rupture / dissection of LMCA with thrombosis resulting in Acute Myocardial Infarction and is not at all consistent with the natural history of catheter induced LMCA dissection. In my opinion, it looks like a Spontaneous fresh acute Myocardial infarction and it could be due plaque rupture leading to spontaneous dissection.

I agree with the line of treatment adopted and I do not feel there is any medical negligence on both the occasions and infact the patient was treated effectively which resulted in significant improvement of the patient's condition also."

28. In cases of medical negligence, opinion of Medical Board carries value. In this case, the report of the Medical Board is annexed and the Medical Board consists of Dr. D.P. Lakra, Professor, Department of Medicine, Dr. B.R. Ambedkar Memorial Hospital, Raipur, Chairman, Dr. R.K. Patel, MD, Associate Professor, Department of Medicine, Member, Dr. S. Varma, MD, Associate Professor, Department of Medicine, Member, Dr. B.L. Bansal, MD, DM, Assistant Professor, Department of Medicine, Member and Dr. S. Gupta, Director Prof. & Head, Department of Medicine, Pt. J.N.M. Medical College & Dr. B.R. Ambedkar Memorial Hospital, Raipur (C.G.). The Medical Board did not give any definite opinion regarding the treatment given by the O.P. No.2. Dr. Kapil Bhargava, who is also MD (General Medicine) // 74 // Professor and Head, Department of Cardiology, R.N.T. Medical College, Udaipur gave his opinion that the line of treatment adopted by the O.P. No.2 is correct.

29. In Dr. Laxman Balkrishna Joshi v. Dr Trimbak Bapu Godbole and another, AIR 1969 Supreme Court 128, Hon'ble Supreme Court has observed thus :-

"11. The duties which a doctor owes to his patient are clear. A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires : (cf. Halsbury's Laws of England, 3rd ed. Vol. 26 p. 17). The doctor no doubt has a discretion in choosing treatment which he proposes to give to the patient and such discretion is relatively ampler in cases of emergency..........."

30. In this context it is relevant to cite case of Kusum Sharma & ORS. Vs. Batra Hospital & Research Centre & ORS.(Supra), in which the conclusions under different case laws on the subject of medical negligence have been summarized as under :-

// 75 // 'Para" 90" In Jacob Mathew's case (supra), conclusions summed up by the Court were very apt and some portions of which are reproduced hereunder:

(1) Negligence is the breach of a duty caused by omission to do something which is a reasonable man guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do. The definition of negligence as given in Law of Torts, Ratanlal & Dhirajlal (edited by Justice G.P. Singh) referred to hereinabove, holds good. Negligence becomes actionable on account of injury resulting from the act or omission amounting to negligence attributable to the person sued. The essential components of negligence are three: 'duty', 'breach' and 'resulting damage'.

(2) Negligence in the context of medical profession necessarily calls for a treatment with a difference. To infer rashness or negligence on the part of a professional, in particular a doctor, additional considerations apply. A case of occupational negligence is different from one of professional negligence. A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of a medical professional. So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed.

(3) The standard to be applied for judging, whether the person charged has been negligent or not, would be that of an ordinary competent person exercising ordinary skill in that profession. It is not possible for every professional to possess the // 76 // highest level of expertise or skills in that branch which he practices. A highly skilled professional may be possessed of better qualities, but that cannot be made the basis or the yardstick for judging the performance of the professional proceeded against on indictment of negligence.

Para "94'. On scrutiny of the leading cases of medical negligence both in our country and other countries especially United Kingdom, some basic principles emerge in dealing with the cases of medical negligence. While deciding whether the medical professional is guilty of medical negligence following well known principles must be kept in view:

I. Negligence is the breach of a duty exercised by omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do.

II. Negligence is an essential ingredient of the offence. The negligence to be established by the prosecution must be culpable or gross and not the negligence merely based upon an error of judgment.

III. The medical professional expected to bring a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires.

IV. A medical practitioner would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field.

// 77 // V. In the realm of diagnosis and treatment there is scope for genuine difference of opinion and one professional doctor is clearly not negligent merely because his conclusion differs from that of other professional doctor.

VI. The medical professional is often called upon to adopt a procedure which involves higher element of risk, but which is honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure. Just because a professional looking to the gravity of illness has taken higher element of risk to redeem the patient out of his/her suffering which did not yield the desired result may not amount to negligence.

VII. Negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession.

VIII. It would not be conducive to the efficiency of the medical profession if no Doctor could administer medicine without a halter round his neck.

IX. It is our bounden duty and obligation of the civil society to ensure that the medical professionals are not unnecessary harassed or humiliated so that they can perform their professional duties without fear and apprehension.

// 78 // X. The medical practitioners at times also have to be saved from such a class of complainants who use criminal process as a tool for pressurizing the medical professionals/hospitals or clinics for extracting uncalled for compensation. Such malicious proceedings deserve to be discarded against the medical practitioners.

XI. The medical professionals are entitled to get protection so long as they perform their duties with reasonable skill and competence and in the interest of the patients. The interest and welfare of the patients have to be paramount for the medical professionals."

31. According to the complainant, she was got admitted in Shree Narayana Hospital, Raipur, Max Hospital, New Delhi and Medanta Hospital, Gurgaon, but the doctors of the above hospitals did not give any opinion regarding the medical negligence committed by the O.P. No.2. The above hospitals also did not mention in their reports that the injury caused to the complainant is due to angiography conducted by the O.P. No.2.

32. Initially the complainant was having chest pain on 29.03.2012, then the complainant consulted with O.P. No.2. The O.P. No.2 did ECG and 2D Echo and the Echo was normal study.

33. According to the complainant before conducting coronary angiography, TMT test is necessary, but TMT is not always essential before conducting angiography.

// 79 //

34. According to the complainant, her consent was not obtained by the O.P. No.2 before conducting coronary angiography. In Paper Book Part "A" filed by the complainant at page No.282 and 283 general instructions and consent for angiography are annexed. In General Instructions, signatures of the complainant Dr. Bhavna Royazada and Interpreter are present. In the consent for angiography also, the signatures of the complainant and O.P. No.2 are present. It appears that before conducting angiography, the consent of the complainant was obtained by the O.P. No.2.

35. According to the complainant , due to coronary angiography conducted by the O.P. No.2, the complainant suffered severe chest pain on 11.04.2012, but the complainant has not produced any material evidence that the chest pain suffered by her was due to coronary angiography done by O.P. No.2 on 02.04.2012. The complainant herself got discharged herself from the O.P. No.1 Hospital against medical advice, whereas the complainant and her husband both are doctors and they very well know regarding complications, even then they got discharged the complainant from the O.P. No.1 Hospital and the complainant was got admitted in Shree Narayana Hospitals, Raipur. Dr. S.A. Kale and Dr. Sunil Gounial, did not give any finding regarding the wrong treatment given by the O.P. No.2.

// 80 //

36. The complainant has utterly failed to prove that the complainant suffered chest pain, dyspnea and hypotension due to coronary angiography done by the O.P. No.2. On the basis of Expert Opinion, it cannot be held that the O.P. No.2 has committed any medical negligence which treating the complainant. Therefore, the complainant has not succeeded to prove that the OPs have committed any medical negligence, hence the complainant is not entitled to get any compensation from the OPs.

37. Therefore, the complaint filed by the complainant against OPs, is liable to be dismissed, hence the same is dismissed. Parties shall bear their own costs.

(Justice R.S. Sharma)       (D.K. Poddar)         (Narendra Gupta)
      President                 Member                  Member
   12 /01/2018               12 /01/2018            12/01/2018