State Consumer Disputes Redressal Commission
Amarjit Kaur vs Dr. Kuldeep Singh, Asso, Professor. on 17 May, 2016
FIRST ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.
First Appeal No.238 of 2013
Date of Institution: 04.03.2013
Date of Decision : 17.05.2016
Amarjit Kaur wife of late Sh. Avtar Singh, mother of Sh. Balbir Singh
(deceased) previously resident of Shaheed Udham Singh Nagar,
Sirhind Road, Patiala and now permanently resident of Village
Shutrana, Tehsil Samana, District Patiala.
.....Appellant/complainant
Versus
1. Dr. Kuldeep Singh, Associate Professor/Surgeon, Surgical
Ward/Department, Rajindra Hospital through Medical
Superintendent, Rajindra Hospital, Patiala.
2. Rajindra Hospital, Patiala through Medical Superindent, Rajindra
Hospital Patiala.
3. Insurance Company, if any (to be disclosed by OPs no.1 & 2
(Struck off, vide order dated 03.10.2013).
.....Respondents/opposite parties
First appeal against order dated
30.01.2013 passed by the District
Consumer Disputes Redressal
Forum, Patiala.
Quorum:-
Shri J. S. Klar, Presiding Judicial Member.
Shri J.S. Gill, Member.
Present:-
For the appellant : Sh. Vishal Sodhi, Advocate
For respondents no.1&2: None
For respondent no.3 : Struck off, vide order dated 3.10.2013 ................................................... J. S. KLAR, PRESIDING JUDICIAL MEMBER:-
The appellant of this appeal (the complainant in the complaint) has directed this appeal against the respondents of this appeal (the opposite parties in the complaint), challenging order dated 30.01.2013 of the District Consumer Disputes Redressal Forum, Patiala (in short the "District Forum"), vide which, the complaint of the complainant was dismissed.First Appeal No.238 of 2013 2
2. The complainant has filed the complaint under Section 12 of the Consumer Protection Act, 1986 (in short, "the Act") against the OPs on the averments that her son Balbir Singh met with an accident on 16.04.2009, near Murthal, District Sonipal, State Haryana and thereafter got admitted in P.G.I. Rohtak for treatment of fracture injuries on left thigh bone and lower limb bone. He was treated there for these injuries and later on shifted in Rajindra Hospital Patiala on 19.04.2009. The staff on duty of Rajindra Hospital checked the son of the complainant on 19.04.2009 and got him admitted in surgical ward no.4 of Rajindra Hospital Patiala, vide file CR No.8776. During treatment at Rajindra Hospital Patiala, the amount of Rs.4025/- was got deposited as CT scan charges, vide receipt no.4564 dated 19.04.2009 from complainant by the OP and at the time of admission at Rajindra Hospital, the complainant paid Rs.140/-, vide receipt no.175250 dated 19.04.2009, as admission/bed charges. The complainant again deposited Rs.140/- as bed charges, vide receipt no.175257 dated 20.04.2009 and she further deposited various charges for conducting X-rays and other lab tests and she further paid Rs.2500/- before operation, but no receipt has been issued to her. OP no.2 also charged Rs.920/- as file charges, vide receipt dated 18.03.2011. After examining the reports of X-rays, ultrasound and city scan, Dr. Kuldeep Singh OP no.1 conducted the surgery on abdomen of patient Balbir Singh on 20.04.2009 and immediately after surgery, the son of the complainant died under mysterious circumstances. It was further First Appeal No.238 of 2013 3 alleged that OP no.1 did not obtain specific written consent of the patient before operation, although the patient was quite normal and in good state of mind and was competent to understand and give consent. Even consent of complainant was not obtained, as she remained present with the patient for all times. OP no.1 and staff of OP no.2 remained silent regarding sudden death of the son of the complainant. Police was informed and reached the spot and cause of death was not given in the post mortem report. As per report of Medical Board dated 29.05.2009 by Department of Forensic Medicine and Toxicology, Government Medical College (Rajindra Hospital) Patiala, cause of death of patient was recorded as Pulmonary Embolism. It was further alleged that OP no.1 Dr. Kuldeep Singh and other medical staff, who conducted the surgery of the patient, did not record any breathing problem or body of the patient became severely blue before the surgery. The X-rays and city scan of the patient before surgery did not show any report regarding pulmonary embolism. The patient died due to cardiac arrest, but he was not a heart patient. The surgery was done by OP no.1 on 20.04.2009 from 11:30 AM to 1:40 PM. It was further averred that the general condition of the patient before surgery was found to be fit for surgery. It was further recorded that 'reflexes intact, patient awake and responding to VC and shifted to PR satisfactory. But, as per note given in the ward at 2:10 PM on 20.04.2009 that 'patient received from OT. Patient gasping. BP and PR unrecoverable. Immediate ICU call sent. Within half an hour First Appeal No.238 of 2013 4 period after the surgery, the condition of the patient became worst causing his death and it proved negligence of the surgeon, who conducted the surgery of patient Balbir Singh. It was further alleged that blood transfusion was not recommended by the surgeon, as the hemoglobin of patient was 8 gm, as per record of the hospital. The complainant has, thus, prayed that OPs be directed to pay Rs.4 lakhs alongwith interest 12% per annum from the date of death till realization for suffering loss due to death of her son and mental harassment, ii) to refund the expenses of medical treatment to the tune of Rs.50,000/- alongwith interest @12% per annum, iii) to pay Rs.20,000/- as litigation expenses.
3. Upon notice, OPs no.1 and 2 appeared and filed written reply by raising preliminary objections that complainant has concealed the true facts from the Forum. The complaint is alleged to be false and frivolous. On merits, it was averred that OPs has no knowledge regarding alleged accident of Balbir Singh and his treatment at PGI Rohtak. It was further averred that complainant did not produce the admission form of PGI Rohtak, but OPs got it produced with the reply to the effect that Balbir Singh left PGI Rohtak against medical advice. It was admitted in the written reply that Balbir Singh was admitted in Rajindra Hospital Patiala, but as far as the deposit of the amounts of Rs.4025/- as CT Scan charges and other charges are concerned, it is matter of record. It was denied that complainant paid Rs.2500/- before operation. It was averred that amount of Rs.920/- deposited by the complainant is also a matter of First Appeal No.238 of 2013 5 record. It was denied that Balbir Singh died under mysterious circumstances. It was further averred that written consent of his near relative was taken before surgery. It was denied that OP no.1 remained silent on the sudden death of Balbir Singh patient. It was further pleaded that Medical Board in the report dated 29.05.2009 never held any medical negligence on the part of OP no.1. It was vehemently denied that any medical negligence has been made out against the OPs in this case. A departmental enquiry was held by the higher authority regarding alleged allegations leveled against OP no.1 by the complainant, which was found false. Even the report of PGI Chandigarh found that there was no medical negligence on the part of OP no.1. It was denied that OP no.1 left operation theatre in haste. It was denied that no blood transfusion was given to the patient. It was further averred that one bottle of blood was given to the patient and it is recorded in treatment file. The OPs prayed for the dismissal of the complaint.
4. The complainant tendered in evidence affidavits Ex.C-1 and C-2 alongwith documents Ex.C-3 to C-20 and closed the evidence. As against it, OPs tendered in evidence affidavit and documents Ex.R-1 to Ex.R-6 and closed the evidence. On conclusion of evidence and arguments, the District Forum Patiala dismissed the complaint of the complainant. Dissatisfied with the order of District Forum, the complainant now appellant preferred this appeal against the same.
First Appeal No.238 of 2013 6
5. We have heard the learned counsel for the appellant and have also examined the record of the case. The name of respondent no.3 has been struck off, vide order dated 03.10.2013 of this Commission and none appeared for respondents no.1 and 2 in this appeal. The allegations of medical negligence and deficiency in service are involved in this case for adjudication. The matter can be decided with the aid of evidence on the record between the parties in this case. Ex.C-1 is the affidavit of Amarjit Kaur complainant on the record. She has alleged in this affidavit that her son met with an accident and got admitted in PGI Rohtak for fracture injuries on left thigh bone and lower limb bone and was discharged from PGI Rohtak. On one day of discharge, Balbir Singh patient again contacted the PGI Rohtak for high fever and abdominal pain and the PGI there demanded Rs.50,000/- for operation and complainant was unable to pay the huge amount at that time hence her son was shifted to Rajindra Hospital on 19.04.2009. She further deposed that patient Balbir Singh was admitted in surgical ward vide file CR No.8776 on 19.04.2009. She further deposed that during treatment at Rajindra Hospital Patiala, the amount of Rs.4025/- was got deposited as CT scan charges, vide receipt no.4564 dated 19.04.2009 from complainant by the OP and at the time of admission at Rajindra Hospital, the complainant paid Rs.140/-, vide receipt no.175250 dated 19.04.2009, as admission/bed charges. She further stated in her affidavit that she again deposited Rs.140/- as bed charges, vide receipt no.175257 dated 20.04.2009 and she further First Appeal No.238 of 2013 7 deposited various charges for conducting X-rays and other lab tests and she further paid Rs.2500/- before operation, but no receipt has been issued to her. OP no.2 also charged Rs.920/- as file charges, vide receipt dated 18.03.2011. She further deposed that after examining the reports of X-rays, ultrasound and city scan, Dr. Kuldeep Singh OP no.1 conducted the surgery on abdomen of patient Balbir Singh on 20.04.2009 and immediately after surgery, the son of the complainant died under mysterious circumstances. The complainant alleged medical negligence on the part of OPs in her affidavit. Ex.C-2 is the affidavit of Hardeep Singh Khaira on the record. He has also deposed in support of the case of the complainant. Ex.C-3 is the copy of the letter from Registrar Incharge C.R. Office, Rajindra Hospital Patialal to Advocate Jasbir Singh Sandhu regarding supply of attested copy of the treatment record. Ex.C-4 is the copy of case history/Bed Head ticket of patient Balbir Singh. The entire treatment provided to patient is recorded in it. Ex.C-5 is the receipt for payment of CT Scan Centre Rajindra Hospital Patiala of Rs.4025/-. Ex.C-6 is receipt for deposit of Rs.140/- and receipt for purchase of medicines are Ex.C-7 and C-8 on the record. Ex.C-9 is another receipt for deposit of payment of Rs.140/-. It is dated 20.04.2009. Ex.C-10 is the prescription slip for various tests. Ex.C-11 to C-14 are the receipts for payment of various tests. Ex.C-15 is the copy of post mortem report of Balbir Singh. Ex.C-16 is the copy of letter from Board of doctors of Medical College Rajindra Hospital Patiala to SHO, Police Station Ganour, First Appeal No.238 of 2013 8 District Sonepat, Hayana regarding cause of death of Balbir Singh. Ex.C-17 is the report of expert body of PGI Chandigarh dated 11.09.2011. Ex.C-18 is the report of expert body of PGI dated 30.03.2012. Ex.C-19 and C-20 are cutting of new papers regarding death of Balbir Singh.
6. As against it, OP no.1 Dr. Kuldeep Singh, Associate Professor filed his affidavit Ex.R-1 on the record. He denied any medical negligence on his part in this case. He stated that the complainant has not produced the admission form at PGI Rohtak, but it was obtained by the OPs and filed. The patient Balbir Singh left PGI Rohtak against medical advice. It is further stated that it is infact matter of record if complainant deposited CT scan charges or other charges before operation. He further stated that the written consent of the relative of the patient was taken, which was recorded in the bed head ticket before surgery. He denied this fact that OPs remained silent and refused to give any detail regarding operation circumstances, which resulted in sudden death of son of complainant. He further stated that even the report of PGI, Chandigarh found no negligence on the part of OPs. He further stated that surgery was conducted by him and his team without any fault. He also stated that one bottle of blood was given to the patient and treatment file has recorded this fact. The explanation sent by Dr. Kuldeep Singh OP no.1 to Principal Medical Council Patiala is Ex.R- 2 on the record. Ex.R-3 is the report of PGI Rohtak recording LAMA summary on 19.04.2009 of Balbir Singh patient. Ex.R-4 is the reply First Appeal No.238 of 2013 9 of Dr. Kuldeep Singh to Inquiry Officer. Ex.R-5 is the copy of letter sent by Principal of Medical College Rajindra Hospital Patiala to Public Information Officer, Pharmacology Department, Government Medical College Patiala. Ex.R-6 is the letter sent by Dr. Kuldeep Singh OP no.1 to Medical Superintendent Rajindra Hospital Patiala.
7. From appraisal of above referred evidence on the record and hearing the respective submissions of counsel for the parties, the District Forum found no medical negligence on the part of the OPs in this case and hence dismissed the complaint of the complainant. The submission of counsel for appellant is that no informed consent was obtained before surgery by OP no.1 and on this point OP no.1 is negligent. We have examined the bed head ticket record of the case on the file, vide Ex.C-4. It has recorded the consent of Amrik Singh uncle of complainant in writing. The consent was in Punjabi script. The condition of he patient was not good, as his abdomen was to be operated upon and hence the consent was given by his uncle, which cannot be said to be an invalid consent. On this point, the District Forum rightly repelled this contention of the complainant. It was valid consent more so when Balbir Singh has proved to have met with an accident and suffered fracture injuries and taken to PGI at Rohtak. He was suffering from abdominal pain and left there against LAMA and approached Rajindra Hospital Patiala for his treatment. Under these circumstances, we do not find it to be a case of lack of any informed consent. It was argued by counsel for the appellant that hemoglobin of the patient was 8gm First Appeal No.238 of 2013 10 and no blood transfusion was given to him. This point has been denied by Dr. Kuldeep Singh OP no.1 in his written reply as well as in his affidavit on the record. He has categorically stated that one bottle of blood was transfused at the time of surgery of Balbir Singh which fact is mentioned in the treatment record. The contention of the appellant on this point is again found without any valid force.
8. We have examined the material evidence on the record. The post mortem report is Ex.C-15 regarding the death of Balbir Singh patient. It is stated in it that cause of death would be declared after receiving report of histopathological examination (HPE) if viscera. Ex.C-16 letter dated 29.05.2009, which has recorded that the possibility of Pulmonary embolism, as immediate cause of death in this case, cannot be ruled out. The cause of death is, thus, stated to be pulmonary embolism by the Department of Forensic Medicine & Toxicology, Government Medical College (Rajindra Hospital) Patiala dated 29.05.2009 on the record, vide C-16 on the record. The cause of death has not been found due to inept surgery conducted by OP no.1. The cause of death is on account of pulmonary embolism. The first report of PGI dated 11.09.2011 is Ex.C-17 on the record. It is recorded in it that "in the presence of abdominal signs, the patient supposedly underwent laparotomy or suspected peritoneal sepsis. The intra-operative anesthesia record indicates that the patient remained stable throughout surgery, and was extubated at the end of the procedure . It is, thus, assumed that the patient was hemo-dynamically stable with normal vital First Appeal No.238 of 2013 11 parameters when the patient left the operation theatre at the end of the procedure. The patient was received in the recovery ward in a gasping condition, and thus, he seems to have suffered even during transit from the operating room to the ward. This even might have been an important cause related to the patient's death. There does not prima facie seem to be a case of death due to negligence as would be apparent from the report of the post-mortem examination." The second report of the expert body of PGI doctors is dated 30.03.2012 Ex.C-18 on the record. It has also been recorded in it that there does not seem to be a case of medical negligence directly contributing to the patient's death. The medical record is not indicative of medical negligence as the immediate cause of the patient's death. The expert body of doctors of PGI in their reports has not established any medical negligence or deficiency in service on the part of OPs in this case. The expert doctors have not proved it to be a case of medical negligence, as discussed above.
9. The death of Balbir Singh took placed on account of 'pulmonary embolism'. "Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has traveled from elsewhere in the body through the bloodstream (embolism). PE most commonly results from deep vein thrombosis (a blood clot in the deep veins of the legs or pelvis) that breaks off and migrate to the lung, a process termed venous thromboembolism (VTE). The risk of PE is increased in various situations, such as cancer or prolonged bed rest. Symptoms of pulmonary embolism First Appeal No.238 of 2013 12 include difficulty breathing, chest pain on inspiration, and palpitations. Clinical signs include low blood oxygen saturation and cyanosis, rapid breathing and a rapid heart rate. Severe cases of PE can lead to collapse, abnormally low blood pressure, and sudden death. Diagnosis is based on these clinical findings in combination with laboratory tests (such as the D-dimer test) and imaging studies, usually CT pulmonary angiography. Treatment is typically with anticoagulant medication, including heparin and warfarin. Severe cases may require thrombolysis with drugs such as tissue plasminogen activator (PA) or may require surgical intervention via pulmonary thrombectomy." It is, thus, evident from perusal of medical literature on Pulmonary embolism that it is a blockage of the main artery of the lung or one of its branches by a substance that has traveled from elsewhere in the body through the bloodstream (embolism) and the risk of PE is increased in various situations, such as cancer or prolonged bed rest. In this case, the patient suffered accidental injuries and received fracture therein. He was lying on the bed since then he developed pulmonary embolism causing death of the patient, after half an hour of the surgery conducted by OP no.1. The pulmonary embolism also develops on account of lying condition of patient due to prolonged bed rest on account of injuries/fracture. About 15% of all cases of sudden death are attributed to PE. The most common sources of embolism are proximal leg deep venous thrombosis (DVTs) or pelvic vein thromboses. Any risk factor for DVT also increases the risk that the venous clot will dislodge and First Appeal No.238 of 2013 13 migrate to the lung circulation, which may happen in as many as 15% of all DVTs. The condition are generally regarded as a continuum terms venous thromboembolism (VTE). Severe cases of Pulmonary embolism lead to sudden death as per medical literature cited before us.
10. In the light of above medical literature and the evidence adduced on the record, we do not find any medical negligence on the part of OPs in this case. The Apex Court has held in case "Kusum Sharma Vs. Batra Hospital" I(2010)CPJ-29(SC) that negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence. He would not be liable if the course of action chosen by him was acceptable to the medical profession. No doctor can assure the recovery to the patient from any complication as well as they performed their duty with reasonable skill according to medical standard practice and they are qualified in that matter and hence cannot be held medically negligent. The counsel for the appellant then referred to law laid down by the National Commission in case "M.C. Katare Vs. Bombay Hospital and Medical Research Centre and others"
2010(2) CPJ-128. We have examined this authority, in the cited authority; the patient walked into Bombay Hospital with complaint of pain in her right ankle for which she underwent surgical procedure for removal of fibular implant and right ankle arthrodesis, but came out dead from the said hospital. The National Commission found that since it was a case of ankle surgery, hence tests to confirm or rule First Appeal No.238 of 2013 14 out DVT should have been taken. The surgeon failed to alert the ICU doctor incharge. In the instant case, patient Balbir Singh complained of abdominal pain and surgery was completed without any fault and pulmonary embolism developed in him causing his collapse. The District Forum rightly observed that photocopy of the report of HPE signed by Assistant Professor Pathological Department Government Medical College Patiala attached with the report Ex.C-16 recorded that "findings compatible with postmortem clot". The surgeon, who conducted the surgery has not committed any medical negligence or deficiency in service on his part in this case. In the presence of abdominal signs, the patient supposedly underwent laparotomy for suspected peritoneal sepsis. The District Forum rightly dismissed the complaint of the complainant. We concur with the findings of District Forum and find no ground to differ with the findings of the District Forum in the order under challenge in this appeal.
11. As a corollary of our above discussions, we dismiss the appeal of the appellant by upholding the order of the District Forum Patiala.
12. Arguments in this appeal were heard on 12.05.2016 and the order was reserved. Now the order be communicated to the parties. The appeal could not be decided within the statutory period due to heavy pendency of court cases.
(J. S. KLAR)
PRESIDING JUDICIAL MEMBER
(J.S. GILL)
May 17, 2016 MEMBER
(MM)