State Consumer Disputes Redressal Commission
Major Amanpreet Singh vs Ivy Hospital on 23 July, 2024
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH.
Consumer Complaint No. 772 of 2019
Date of institution : 21.10.2019
Reserved on : 09.07.2024
Date of Decision : 23.07.2024
Major Amanpreet Singh son of Late Sh. Major Singh, resident of 39-
A, Guru Nanakpura, O/s Chhatiwind Gate, Amritsar.
....Complainant
Versus
1. Ivy Hospital carrying on its Business at Airport Road, Amritsar
through its Chairman/MD/Director
2. Doctor Birinder Pal Singh Bajwa C/o Ivy Hospital carrying on its
Business at Airport Road, Amritsar
...Contesting Opposite Parties
3. Manjit Kaur wd/o L. Major Singh, resident of 39-A, Guru
Nanakpura, O/s Chhatiwind Gate, Amritsar.
4. Parminder Singh S/o L. Major Singh, now resident of 2418, N.
Schneider Ave Fresno California, 94737.
5. Rajinder Kaur D/o L. Major Singh, now resident of 2, Marsh
Close, Rushymead Leicester, United Kingdom.
...Performa Opposite Parties
6. United India Insurance Company Ltd., having office at SCO-12,
Ist Floor, Near Laj Dharamkanta, Sai Road, Baddi, District
Solan-173 205 (HP)
...Opposite Party
Consumer Complaint under Section 17 of
the Consumer Protection Act, 1986.
Quorum:-
Hon'ble Mrs. Justice Daya Chaudhary, President
Ms. Simarjot Kaur, Member
1) Whether Reporters of the Newspapers may be allowed to see the Judgment? Yes/No
2) To be referred to the Reporters or not? Yes/No
3) Whether judgment should be reported in the Digest? Yes/No Consumer Complaint No. 772 of 2019 2 Present:-
For the complainant : Ms. Nazuk S. Gupta, Advocate &
Sh. Yaseen Sethi, Advocate
For OP No.1 : Sh. Inderdeep Singh, Advocate
For OP No.2 : Sh. Nitesh Singhi, Advocate with
Dr. Birinder Pal Singh Bajwa
For OP Nos.3 to 5 : Service dispensed with
For OP No.6 : Sh. Vishwajit Bedi, Advocate
SIMARJOT KAUR, MEMBER :
The Complainant has filed the present Complaint against the Opposite Parties (hereinafter referred as OP No.1 and 2) under Section 17 of the Consumer Protection Act, 1986 (for short 'the Act'). OP No.6 has been impleaded being the insurer of OP No.1. OPs No.3 to 5 are the family members of the Complainant, accordingly, they are being impleaded as proforma OPs. Service upon them had been dispensed with vide order dated 16.12.2019.
2. The Complainant has averred that his father-Major Singh was suffering with the problem of Acute Cholecystitis with Cystic Duct Calculus. On 16.10.2018, he suffered pain in Epigastric Region, Vomiting, Nausea and Decreased Appetite. Detailed investigation of the problems was done at Shri Guru Ram Das Charitable Hospital, Amritsar. After ultrasound examination, CECT was done on the very next day. In the report of CECT, Complainant's father was found suffering from "Acute Cholecystitis with Cystic Duct Calculus". After coming to know about said problem, the Complainant preferred some Super Specialty Hospital instead of getting his father treated from Charitable Hospital. He approached OP No.1 Hospital and got his father admitted on 30.10.2018. OP No.2-Dr. Birinder Pal Singh Bajwa had conducted Laproscopic Cholecystectomy operation and assured for fast recovery and lower morbidity rate. The Complainant paid the expenses incurred to OPs No.1&2 as the treatment of his father. Consumer Complaint No. 772 of 2019 3 After the surgery, bleeding started from omental site of his father. He had also suffered an episode of Artrial Fibrillation. His father was shifted to ICU. In another CT Scan conducted on 02.11.2018, fluid collections in CB Fossa Region, right lateral abdominal wall and right lower abdomen, pelvic regions and surrounding small bowel loops in the mesentery were found. The hematoma was also found with mild hepatomegaly and right pleural effusion. During that period, the condition of the patient had started deteriorating day by day, which the OPs were unable to control. Later OPs advised the Complainant to shift his father to some other higher facility hospital. Upon such advice, the Complainant was ready to shift his father to some other Hospital. At that time, OPs obtained some signatures of the Complainant on blank papers. He got his father admitted in the Apollo Hospital, Amritsar on 02.11.2018 with the complaint of Severe Sepsis with Multiorgan Dysfunction. The said Hospital was also unable to treat the problems of the patient and referred the patient to Fortis Hospital, Amritsar. Accordingly, the patient was admitted in Fortis Hospital, Amritsar on 04.11.2018. He had faced with the problem of difficulty in breathing, fever for 3-4 days, abdominal distension and palpitation. In addition to it, there were several other problems diagnosed i.e. Bile Duct Injury with Biliary Peritonitis, Septic Shock, Acute Kidney Injury and Atrial Fibrillation. In the said Hospital on 04.11.2018 again CT Scan was done. In the report, moderate ascites with hemorrhagic mass/clot formation in mesentry was traced. On 08.11.2018, Ultrasound review was done, which showed multiple intra-abdominal collections, which were increasing in size and there was atrial fibrillation. Then Exploratory Laparotomy was performed whereby 4-5 litres of bile and blood was drained out, however, the condition of the patient did not improve. On 10.11.2018, suddenly there Consumer Complaint No. 772 of 2019 4 was a fall in BP and SPO2 level of the patient. He suffered major cardiac arrest and was declared dead.
3. It had been alleged by the Complainant that OPs had not informed him that there was a possibility of post-operative CBD injury. The operation was done by OPs No.1&2 in a very negligent manner and due to said act, his father had suffered with severe life threatening problems. Resultantly, the life of his father could not be saved. He had lost his father due to negligence on the part of OPs No.1&2. It was further submitted that OPs No.1&2 had failed to detect such complications well in time and had failed to treat him for the same. They have played with the human life just to extort money.
4. Said negligent act of OPs No.1&2 was brought to the knowledge of several authorities, whereupon the Board of Doctors was constituted. It has been alleged that before the said Board, OP No.2 had admitted that during the surgery, complications had taken place. He had also mentioned that 1300 cc secretions (bile with blood) were observed in the abdominal drain, so the patient was treated conservatively only. This fact had also been affirmed by Dr. Amandeep Singh Sandhu of Fortis Hospital, Amritsar, who treated the patient and Pigtail drain was put on 05.11.2018 and 1000 ml of fluid was drained out. Again on the next day, 4 to 5 litres of bile and blood mixed fluid was found present in the peritoneal cavity and also there was a leakage of bile duct from Porta Hepatis. It was also admitted that MODS had occurred because of injury sustained during Laproscopic Cholecystectomy. It was reiterated that OPs No.1&2 had concealed this fact that there could be post-operative complications. It was stated that it is always assumed that the Doctor educates the attendance of the patients regarding potential complications before the start of surgery. In the present case, it was the prime duty of OPs No.1&2 to inform the Consumer Complaint No. 772 of 2019 5 patient regarding complications and to cure the patient from the same. Due to CBD Injury, life threatening complications like Multi Organ Dysfunction occurred. It was pleaded that as per medical science to diagnose injury level, MRCP test is mandatory, which had not been done by OP No.2. From the Medical Record of Fortis Hospital, it was clear that the patient had suffered with Bile Duct Injury when the said Hospital was approached for admission. It clearly reveals that OPs No.1&2 had not done anything for two days during post-operative treatment. Such negligent act of OPs No.1&2 forced the Complainant to shift his father to other Hospitals. Further there were number of cuttings in the Consent Form, which showed the act of OPs and proved that the same were prepared afterwards to save themselves.
5. Alleging the act of OPs No.1&2 to be a case of medical negligence as well as deficiency in service and unfair trade practice, it was prayed that OPs No.1&2 be directed to refund Rs.61,293/-, Rs.43,439/- and Rs.3,88,805/-, the amount incurred on the treatment and Rs.50,00,000/- as compensation on account of act of medical negligence on the part of OPs No.1&2, Rs. 10,00,000/- on account of loss of love and affection of the father suffered by the Complainant and his other family members, Rs.2,00,000/- as litigation expenses.
6. Upon issuance of notice, OPs No.1&2 and 6 had appeared and filed their separate written replies. OPs No.3,4&5 are family members of the Complainant and impleaded only as proforma OPs.
7. OP No.1 in its reply had raised certain preliminary objections to the extent that the Complaint was misconceived and unwarranted. No negligence or deficiency in service could be attributed on its part. The OP No.1 being a Super Specialty Hospital was having best facilities, equipment and skilled staff. The surgery had been performed as per Consumer Complaint No. 772 of 2019 6 medical ethics and by taking all the necessary precautions. OP No.1 could not have assured 100% positive result after surgery. The Complainant had levelled false allegations of medical negligence upon OPs No.1&2 to malign their reputation and tried to extort money. No documentary evidence had been filed to prove any kind of medical negligence on the part of OP No.1. It is settled that Doctor and Hospital are not guilty of negligence if they have acted in accordance with the standard practice accepted as proper by the medical profession. On admission of the father of the Complainant with OP No.1 before the start of the surgery, all risks and post-operative complications had been informed to the Complainant as per medical condition of the patient. Thereafter, proper consents were taken. It was denied that OPs were not in a position to handle the condition of the patient, rather the Complainant on its own got the patient discharged in LAMA condition and shifted to other Hospital. No signatures were obtained on blank papers. Entire medical treatment was administered as per standard medical protocol and no medical negligence had occurred during treatment. The accusation of not identifying the problem timely was denied. OP No.1-Hospital prayed for dismissal of the Complaint with exemplary costs.
8. OP No.2 in its written statement took certain preliminary objections to the extent that the patient had taken treatment from number of Hospitals but the Complainant had not impleaded them as party in the Complaint, which is of utmost important for the just and proper adjudication of the Complaint. From the treatment/discharge summary of Sri Guru Ram Dass Hospital, Apollo Hospital and Fortis Hospital, Amritsar, there were number of missing links with regard to the kind of treatment received by the patient during admission into said Hospitals. Therefore, it was important to implead the other Hospitals to establish the missing links. The Consumer Complaint No. 772 of 2019 7 Complainant had intentionally concealed these records. The Complainant had levelled false and frivolous allegations against the OPs No. 1&2 without providing any documentary evidence of medical negligence. Rather he had indulged in derogatory actions by pasting defamatory material and pasting pamphlets at public places against OP No.2. It was pleaded that OP No.2 was qualified Surgeon, having done MBBS from MGM Medical College Kishanganj, M.S. (General Surgery) from HIHT University, Dehradun, he had worked as Senior Resident in General Surgery at Himalyan Institute of Medical Sciences and now worked in OP No.2 Hospital as Consultant Gen/Onco Surgery. He was having sufficient experience in his field.
9. It was pleaded that on 25.10.2018 the father of the Complainant-patient came to OP No.1 Hospital with the complaint of Epigastric Discomfort, Mild Pain, General Weakness and Nausea. In the Hospital, after examining and going through the report of CT Scan dated 17.02.2018 of the patient, he was advised blood investigations. He was further recommended to admit the patient in the Hospital. Patient was suffering from Acute Cholecystitis with Cystic Duct Calculus. Before admission in OP No.1 Hospital, patient had remained admitted in Sri Guru Ram Dass Charitable Hospital for the period between 16.10.2018 to 22.10.2018 he was having similar problem at that time. On 30.10.2018, patient was admitted in the OP No.1-Hospital and OP No.2 had sent him for pre-anesthetic assessment. As per the said check-up and the blood test reports, he was fit to be taken up for surgery. Before the start of the surgery, the wife and son of the patient had been explained about all the potential complications of the surgery. Accordingly, High Risk Consent Form was obtained from them with signatures. The surgery of the patient was critical because there were dense adhesions to fundus, body and Consumer Complaint No. 772 of 2019 8 neck of gall bladder. During surgery, adhesions were separated and cystic duct was ligated with liqa clips and also sutured and cut. Cystic vessel was identified and ligated with liqa clips and cut in between. Thereafter gall bladder was separated from liver bed, taken out and sent for Histopathology examination. Hemostasis was maintained and drain was inserted/fixed and the wound was closed. After surgery, the patient was shifted to Post Operative Recovery Room. On the same day at about 8.30 pm, staff of the OP No.1 Hospital informed OP No.2 about the distension in abdomen of the patient and 1300 ml blood/fluid had been drained out. OP No.3 noticing the condition of the patient, ordered to shift the patient to ICU. Paramedic staff was also ordered to arrange the blood. At 9.00-9.15 pm OP No.2 saw the bag attached with the drain on the bed side of the patient in ICU. It was got emptied to watch and observe whether there was any blood in the drained output. Paramedic staff was also directed to administer coagulants. In addition Blood was also transfused to the patient. There was no blood in the drained output after giving coagulants. The blood pressure and pulse of the patient could be recorded properly. Thereafter, OP No.2 asked the ICU staff for close observation of the patient. Serial HB estimation was done by the ICU Staff. They were asked to inform him immediately if any kind of emergency/abnormal circumstances arose. On 31.10.2018, the patient's BP was 130/80, Pulse 92/m, abdomen non-distended, bowl sound was present, drain was Nil. Seeing all these things, OP No.2 directed the concerned staff for blood investigations of the patient. As the patient had developed Basal Crepts, so on 31.10.2018 he was checked by Chest Specialist, who advised X-ray Chest. Again on 01.11.2018 the patient was checked by OP No.2. At that time, he was stable, BP was 120/70, 93/m I/O 2500/1700 ml and drain was nil. After improvement in condition, paramedic staff was ordered to remove Consumer Complaint No. 772 of 2019 9 the drain and directed to give blood transfusion. On the same day at about 11.45 pm, the patient had suffered sudden onset of Artrial Fibrilation. ECG was got done. OP No.2 asked the Medical Officer for Cardiac Consultation. Dr. Vaibhav, the Cardiologist checked the patient and had passed necessary directions to control the heart rate. On 02.11.2018 at 10.30 am, OP No.2 checked the patient and found that his condition was stable. Blood pressure was 130/80, pulse 88/m Temp. 100 I/O 2160/177 ml, meaning thereby all parameters were satisfactory. All the blood investigations were remarkable. Urine complete examination showed 10 to 15 pus cell. Due to the pus cells/regular monitoring, OP No.2 asked for CECT Abdomen for further course of action and to plan whether any surgical intervention was required. OP No. 2 noticed that there was improvement in the condition of the patient and he was responding to the treatment well. OP No.2 advised further hospitalization in ICU facility to the patient but the attendants were not willing to keep him in the OP No.1- Hospital. They decided to get the patient discharged in LAMA (Left Against Medical Advice) condition. They were informed that the shifting of the patient may cause deterioration in medical condition of the patient in transit but they did not listen to any medical advice. During treatment of the patient, OP No.2 had taken proper care and adopted highest medical practice as approved by medical field.
10. It was pleaded that it was clear that the attendants of the patient were prone to shift their patient into different Hospitals. Initially, he had taken treatment at Sri Guru Ram Dass Hospital, OP No.1-Ivy Hospital, Apollo Hospital and then in Fortis Escort Hospital, Amritsar. The Complainant had concealed the fact that patient had come in the OP No.1- Hospital as OPD patient on 25.10.2018 to show his CT Scan Report dated 17.10.2018. He was advised to get surgery of the patient conducted for Consumer Complaint No. 772 of 2019 10 removal of the gall bladder. He was also advised X-ray of the chest, ECHO and Complete Blood Count-CBC. X-ray showed Cardiomegaly and ECHO Grade-I Diastolic Dysfunction. Instead of approaching him immediately for surgery, he had come almost after 5 days i.e. on 30.10.2018. The attendants of the patient were informed about the procedure and complications involved during surgery. Thereafter, High Risk Consent Form had been signed by the relative of the patient. In the normal course, such type of surgeries take approximately one hour but in the case of patient it took longer than the normal course as there were dense fibrous adhesions between the gall bladder and omentum, adhesion were also present in calots triangle. This fact explains the delay of 2.30 to 3 hours in carrying out the surgery as alleged by the Complainant. Surgery was successful and patient was shifted to ward for post-operative care. It was denied that OP No. 2 was not able to treat the father of the Complainant. The Complainant himself took the patient against medical advice (LAMA) from OP No.1-Hospital and shifted him to Apollo Hospital. The patient remained admitted in Fortis Hospital and expired there on 10.11.2018. He had expired approximately 8 days after his discharge from OP No.1- Hospital. OP No.2 was diligent throughout the treatment of the patient and kept strict vigil on the condition of the patient. During the period when he was under his treatment, his condition was improving but the attendants of the patient got him discharged on LAMA.
11. It was further pleaded that the discharge summary of Apollo Hospital clearly shows that the patient was recorded with MODS condition, which was not in consonance with the actual condition/investigations of the patient. There was no mention whether any Radiological Investigation nor any MRCP/ERCP or any related surgery was planned or performed upon the patient, which was immediately required. Thereafter, the patient Consumer Complaint No. 772 of 2019 11 remained admitted in Fortis Hospital where CT Scan showed "Gross Ascitis" on 04.11.2018. Still no immediate MRCP/ERCP or surgery was performed upon him, which was urgently needed keeping into consideration the serious medical condition of the patient. Fortis Hospital wasted two days in taking emergent medical measures to stabilize the patient. Resultantly, there was accumulation of fluid in the abdomen of the patient. Thereafter USG guided pigtail drainage was put on 06.11.2018 to drain out the fluid. From the death summary of Fortis Hospital dated 10.11.2018, it clearly reveals that even though the blood/fluid was drained out but no surgical procedure/repair was performed in order to stop the leakage from the site. All the allegations levelled by the Complainant regarding medical negligence in treatment administered by him were false, frivolous, baseless and without any medical record. The treatment was given with utmost care and caution as per medical practice. The OP No.2- Doctor prayed for dismissal of the Complaint with exemplary costs.
12. OP No.6-United India Insurance Co. Ltd. in its written statement had admitted the fact that the OP No.1-Hospital was insured under the Errors and Omissions Policy No.1116052719P107548678, which was valid for the period w.e.f. 19.08.2019 to 18.08.2020. It was pleaded that if any act of negligence, error and omissions was fastened on Hospital or its staff only in that case their liability would arise. The Complainant had failed to prove any kind of medical negligence on the part of OPs No.1&2 rather as per the inquiry conducted by the Board of Directors, no medical negligence had been found on the part of OP No.2 or OP No.1-Hospital. The Complainant had failed to produce any documentary evidence showing that patient's death had any connection with the surgeries conducted by OP No.2 or in OP No.1-Hospital. Rather the Complainant had himself got his father discharged in LAMA condition Consumer Complaint No. 772 of 2019 12 from OP No.1 Hospital. In case of any liability arises, it would be limited as per terms and conditions of the policy in question. It was pleaded that there was no relationship of 'Consumer' and 'Service Provider' between the Complainant and this OP, therefore, the present Complaint be dismissed qua to him.
13. The Complainant through his GPA Gurpreet Singh had filed the rejoinder to the written statement filed by OP No.2. The main grievance of the Complainant was that due to negligent surgery of his father conducted by OP No.2 in OP No.1-Hospital Bile Duct Injury had been caused to the patient. With regard to contention of the OP No.2 that he had not annexed medical record of Sri Guru Ram Dass Hospital, it was submitted that he had already annexed the same with the Complaint. It was denied that any false and frivolous complaint had been lodged with the Police or Civil Surgeon, Amritsar. It was stated that he had chosen to get his father treated at OP No.1 Hospital being a Renowned Multi Specialty Hospital but the act and conduct of the said Hospital and its staff shattered his belief. The Complainant had thoroughly explained in his Complaint why he had chosen to shift his father to another Hospital. He had reiterated his stand taken in the Complaint for proving the medical negligence of OPs No.1&2.
14. OP No.2 by filing counter affidavit replied to the rejoinder of the Complainant. It was pleaded that Apollo Hospital and Fortis Hospital are necessary parties to be impleaded because when the patient left OP No.1 Hospital in LAMA condition, thereafter, he got himself treated at said Hospitals. Even Medical Board had opined that the treatment given by above Hospitals had great significance in evaluating the cause of death of the patient. However, the Complainant had deliberately withheld the IPD record of Sri Guru Ram Dass Charitable Hospital, Amritsar, which was Consumer Complaint No. 772 of 2019 13 necessary because prior to admission with OP No.1 Hospital, the patient had taken the treatment from the said Hospital. During treatment by OP No.2, the leakage had been stopped and drainage pipe had been removed on 01.11.2018, which proves that there was considerable improvement in the condition of the patient during treatment. The averments taken by the Complainant are in contravention to the documents on record.
15. All the parties have led their evidence in support of their respective versions by way of affidavits and documents.
16. During the pendency of the Complaint, Counsel for OP No.2 had filed number of Miscellaneous Applications i.e. M.A. No. 31 of 2021 (for production of documents), 32 of 2021 (referring the case for expert opinion), 33 of 2021 (placing on record counter affidavit by OP No.2), No.1135 of 2022 (for direction to Punjab Medical Council to submit the final report of inquiry) and No.177 of 2023 (bringing on record additional evidence). Reply to M.A. No.32 of 2021 was filed by the Counsel for the Complainant by raising objection with regard to leading expert opinion by OP No.2 at this stage.
17. We have heard the oral arguments of Counsel for the parties on the abovesaid applications. In M.A. No. 31 of 2021, OP No.2 has sought permission to produce the documents i.e. medical record relating to the patient, No.33 of 2021 for placing on record counter affidavit by OP No.2, No.1135 of 2022 for direction to Punjab Medical Council to submit the final report of inquiry and No.177 of 2023 for bringing on record final report dated 19.01.2023 passed by The Punjab Medical Council. As in all these applications, the prayer was to taken on record the medical evidence/facts relating to patient. Therefore, in our view the same are relevant documents, which are required to be scrutinized before passing the final decision in the present case. Accordingly, in the interest of natural Consumer Complaint No. 772 of 2019 14 justice, we allow all the above mentioned applications and the documents annexed with these applications are taken on record.
18. M.A. No.32 of 2021 has been filed by the Counsel for OP No.2 for referring the matter of medical negligence for obtaining expert opinion of the Medical Board.
19. As in the present case, detailed Report/Order dated 19.01.2023 is available, passed by the Medical Board constituted by Punjab Medical Council on the basis of PGIMER opinion, therefore, there is no need for referring the matter afresh to any other Medical Institute for obtaining expert opinion. Further in the case of "Dr. J.J. Merchant and others Vs. Shrinath Chaturvedi", 2002(6) SCC 635, Hon'ble Supreme Court observed that "the State Commission and District Forum (Commission) are headed by retired High Court Judges and officers of District Judge level, therefore, they are capable of dealing with even complex questions. Accordingly, we do not find any force in the arguments of the Counsel for the OP No.2 to refer the matter to any Medical Board, therefore, we dismiss the present application being meritless.
20. Ms.Nazuk S. Gupta, Advocate & Mr. Yaseen Sethi, learned Counsel for the Complainant had argued on the similar lines as mentioned in the Complaint and had reiterated her stand regarding the medical negligence of OPs No.1&2 i.e. Hospital and Treating Doctor. It was argued that the Complainant's father had been diagnosed with the problem of stones in Gall Bladder and was advised Laparoscopic Cholecystectomy Surgery. The Complainant preferred OP No.1 being reputed Hospital for said surgery, which was done on 30.10.2018. Intra- Operative and Post-Operative complications had arisen from the said surgery, which could not be controlled by the Super Specialty Hospital/OP No.1 where the patient was admitted. Due to the said reason his father had Consumer Complaint No. 772 of 2019 15 expired on 10.11.2018. It was argued that the Complainant and his mother noticed careless and negligent attitude of OP No.2 in treating the patient, so they decided to shift the patient to Apollo Hospital. As the condition of the patient had worsened at Apollo Hospital so they referred the patient to Fortis Hospital, Amritsar for further treatment. The Complainant adhered to the said advice and accordingly, got his father admitted in Fortis Hospital, Amritsar. It was argued that in normal circumstances LC surgery takes 30 minutes time but OP No. 2 took 5.30 hours (3.30 hours admitted by OP No.2), which in no case was the sign of a successful surgery. As the surgery was not properly conducted, therefore, post-operative complications had arisen. In post-operative period there was suspected bleed from Omental site. Due to omission in the process of surgery, OPs recommended for reoperation of the patient. This had been proved from PGIMER Medical Board report. Also it is clear from the medical record that post-operation complications were not properly handled by OPs No.1&2. From the medical record, it is clear that the patient died due to delay in treatment, which could be avoided. This fact had been proved from the Final Inquiry Report conducted by the CMO wherein it was observed that 'post operatively complication was not tackled in a manner it should have been leading to multi organ failure and septicemia and ultimately death of the patient. These findings proved the act of medical negligence on the part of OPs No.1&2. As per medical practice, it is incumbent upon the treating Doctor to watch over the condition of the patient post-operatively and circumvent the chances of any post-operative complications but OP No.2 failed to do his such duty. It was prayed that OPs No.1&2 be punished for such medical negligence and the Complainant be awarded the compensation as demanded in the Complaint.
Consumer Complaint No. 772 of 2019 16
21. Sh.Inderdeep Singh, Sh. Nitesh Singhi, Advocates, learned Counsel for the OPs No.1&2 & Dr. Birinder Pal Singh Bajwa- OP No.2 had argued on the similar lines as per the reply and version of the Doctor submitted before this Commission. OP No.2 had denied any kind of medical negligence in the treatment of the patient. They had reiterated their stand taken in the written statements. It was argued that OP No.2 was qualified and experienced Surgeon and he had treated the patient diligently, with reasonable care and skill. No act of these OPs tantamount to any kind of medical negligence. Before admission in OP No.1 Hospital, patient was admitted in Sri Guru Ram Dass Charitable Hospital for the period between 16.10.2018 to 22.10.2018. The patient approached the OP No.1 Hospital after suffering with the problem of "Acute Cholecystitis with Cystic Duct Calculus" so he was advised blood investigation. On 30.10.2018, patient was taken up for surgery and all the pros and cons of the surgery had been duly explained to the wife and son of the patient. Necessary High Risk Consent was taken. Surgery was difficult one but OP No.2 had completed the same with due care and caution. After surgery, OP No.2 decided to shift the patient to ICU and to arrange blood. On the next day, there was improvement in the condition of the patient so paramedic staff was directed to remove the drain and blood transfusion was recommended. On 01.11.2018 at about 11.45 pm, the patient had sudden onset of Atrial Fibrillation so his ECG was conducted. Dr. Vaibhav, Cardiologist was called, who after checking the condition of the patient had passed necessary directions. In the morning of 02.11.2018, condition of the patient was stable and report of his CECT Scan of abodomen was awaited. Instead of proper treatment that was being administered to the patient, the attendants decided against continuing with the ongoing treatment and they decided to shift the patient to other Hospital in LAMA. It Consumer Complaint No. 772 of 2019 17 was clearly informed to them that during shifting, there could be chances of further deterioration in the medical condition of the patient. Thereafter, patient remained admitted in Apollo Hospital for 2 days and they subsequently transferred to Fortis Hospital for 6 days and expired there. The Complainant himself pleaded that Apollo Hospital, Amritsar had failed to treat the patient so he shifted the patient to Fortis Hospital, Amritsar but for the reasons best known to him he had not impleaded both the Hospitals as party in the Complaint. The act and delay in treatment by said Hospitals is required to be examined before reaching to the conclusion of medical negligence, if any. At every stage, prognosis were explained to the family members of the patient. No negligence occurred in the treatment given by OP No.2. The Disciplinary and Ethical Committee of the Punjab Medical Council observed as under:-
"The patient condition was deterioration due to multiple hospital shifting and old delay in operation which was cause of death. Committee feels that no medical negligence was found on the part of first physician Dr. Barinder Pal Singh Bajwa and decided to close this case."
The said observations had been approved in the General Body Meeting of Punjab Medical Council on 10.12.2022. Going through the above findings, the Registrar, Punjab Medical Council passed order dated 19.01.2023 and exonerated OP No.2 from the allegation of medical negligence. The accusation of any delay or act of negligence were denied by the OPs No.1&2. They prayed for dismissal of the Complaint with exemplary costs.
22. Sh.Vishawajit Bedi, Advocate, learned Counsel for the OP No.6 had argued the OP No.1-Hospital was insured under the Errors and Omissions Policy No.1116052719P107548678. It was pleaded that their liability would only arise if any medical negligence or omissions was found in the treatment given by OPs No.1 or its staff. The Complainant had Consumer Complaint No. 772 of 2019 18 himself got his father discharged in LAMA condition from OP No.1 Hospital. As per opinion rendered by Punjab Medical Council, no medical negligence was found in the treatment of OPs No.1&2. It was pleaded that if this Commission decides against OPs No.1&2 with respect to any kind of medical negligence on their part and any liability on them is fastened, the same would be limited to the terms and conditions of the policy in question. Therefore, it was prayed that the present Complaint be dismissed qua to him.
23. We have heard the oral arguments raised by learned Counsel for the parties and have also carefully perused all the documents, medical literature and written arguments, version of the OP No.2 Doctor alongwith pictorial description and other relevant documents available on the file as well as the case law.
24. It is an admitted fact that patient-Major Singh, the father of the Complainant had suffered with medical problems of Epigastric Region and started Vomiting, Nausea and Decreased Appetite. Detailed investigation was done at Shri Guru Ram Das Charitable Hospital, Amritsar on 16.10.2018. In the report of CECT, the patient was diagnosed as "Acute Cholecystitis with Cystic Duct Calculus". Thereafter, the Complainant had approached OP No.1 Hospital on 25.10.2018. Subsequently, he got his father admitted in the said Hospital on 30.10.2018. OP No.2-Dr. Birinder Pal Singh Bajwa after going through the different reports had conducted Laproscopic Cholecystectomy operation of the patient. The allegation of the Complainant is that OP No.2 had taken more than the usual time in completing the surgery. Said surgery was carried out in a negligent manner as after surgery, the bleeding started from Omental site of his father. He had also suffered with an episode of Artrial Fibrillation. Thereafter, the other problems occurred and condition of the patient was Consumer Complaint No. 772 of 2019 19 deteriorating day by day. The patient left OP No.1 Hospital in LAMA condition and got himself admitted in Apollo Hospital, Amritsar. He remained admitted in the said Hospital for a period of two days i.e. 02.11.2018 to 04.11.2018. Thereafter, the patient was shifted to Fortis Hospital, Amritsar and ultimately expired on 10.11.2018 in Fortis Hospital, Amritsar.
25. The patient had taken the treatment from other Multi-Specialist Hospital's but in the Complaint, the Complainant had alleged allegations of medical negligence only against OPs No.1&2 as the primary surgery of his father was conducted at OP No.1 Hospital by OP No.2-Doctor on 30.10.2018.
26. Now the issue for adjudication before us is:-
(i) As to whether there was any medical negligence on the part of OPs No.1&2 in the post-operative medical complications, which had arisen during the course of surgery?
(ii) Whether the other Multi Specialty Hospital where the treatment was taken by the patient are also necessary parties to be impleaded in the Complaint and whether the Complaint is bad for non-joinder of necessary parties?
(iii) Whether the Complaint is required to be adjudicated qua OPs No.1&2 only?
27. To ascertain as to whether the OPs No.1&2 were negligent during the surgery of the patient and post-operative treatment, we have examined the following documents annexed by the parties with regard to treatment taken in OP No.1 Hospital. The details of which are as under:-
S. Name of Page Document Details
No. Hospital/Lab
1. Ivy Health & Life P.30 Admission Records & Final Summary Sheet
Sciences (P)
Ltd.
Consumer Complaint No. 772 of 2019 20
2. Ivy Hospital P.31 LAMA Summary
Procedure :- Laproscopic Cholecystectomy was
done under G.A. on 30.10.18 by Dr. Birinderpal
Bajwa
3. - do - P.36 Inpatient History and Physical Record
4. - do - P.39 Discharge Planning Form
5. - do - P.40-78 Doctors Daily Progress Notes/Sheet, Anesthesia
Record
6. - do - P.79 High Risk Drug Monitoring Chart
7. - do - P.80-86 Nursing Admission Assessment/Care Plan
8. - do - P.95- Special Consent to Receive Blood Transfusion,
102 General Consent, High Risk Consent, Consent to
administration of Anaesthesia, Consent for
Surgery
9. Ivy Hospital P.103 LAMA Form (Declaration For Leaving Against
Super Speciality Medical Advice)
Healthcare,
Amritsar
10. - do - P.104 Clearance for Surgery dated 30.10.18
11. - do - P.105 Patient and Family Education Record
12. - do - P.106 Patient Admission Consent
13. - do - P.109, X-ray Chest Report
110
14. - do - P.111 CECT - Abdomen dated 02.11.2018
15. Polo Labs Pvt. P.114 Lab Reports dated 25.10.2018 to 02.11.2018
Ltd.
16. Ivy Hospital P.129 Cardiac Critical Care Flow Chart
17. Sri Guru Ram P.161 CT Scan Report
Dass
28. The documents pertaining to the Admission of the patient in other Multi Specialty Hospitals where the patient previously/subsequently had taken treatment have been perused thoroughly. The reports/opinion of Punjab Medical Council and Expert Opinion of PGI have also been closely perused. The details of the relevant documents are as under:-
S. Name of Page Document Details
No. Hospital/Lab
1. Sri Guru Ram P.161 CT Scan Report
Dass Hospital,
Amritsar
2. Sri Guru Ram P.162 Discharge Summary dated 23.10.2018
Dass Charitable
Hospital,
Amritsar
3. Apollo Hospitals P.168 Discharge Summary dated 02.11.2018
4. - do - P.170 Transfer Summary
5. - do - P.171-209 Initial Admission Assessment & other Record
6. Fortis Hospital P.216, Death Summary/Death Certificate of Patient
220, 221 Major Singh
7. - do - P.219 Cardiopulmonary Resuscitation Record
9. - do - P.223 Triage History and Physical Sheet
10. - do - P.234- Progress Notes, Consent Forms,
Investigation/Lab Reports
11. PGIMER P.810-811 Medical Board Report dated 08.04.2021
Report
Consumer Complaint No. 772 of 2019 21
12. Punjab Medical P.27.08.21 Letter written by Punjab Medical Council to OP Council No.2-Doctor
13. OP No.2-Reply P.813-822 Reply dated 18.09.2021 given by OP No.2-Dr. Birinder Pal Singh to Punjab Medical Council
14. Punjab Medical P.19.01.23 Order passed by Punjab Medical Council Council
29. Before proceeding further with the discussion on the allegations of medical negligence by the Complainant, it is important to understand the medical terminology as used in various documents/medical literature produced by way of evidence by the parties. Said medical terms in common language are as below (source : google) :-
MEDICAL TERMS COMMON TERMS Acute Cholecystitis with Cystic Inflammation of the gallbladder that Duct Calculus develops over hours, usually because a gallstone obstructs the cystic duct Atrial Fibrillation When the Heart beats too slowly, too fast, or in an irregular way.
Exploratory Laparotomy Surgery to open up the belly area (abdomen) Laparoscopic Cholecystectomy Gall Bladder Removal Bleeding from Omental Site Bleeding in Abdomen Region Hematoma Clotted blood that forms in an organ, tissue, or body space Mild Hepatomegaly Enlarged Liver MODS Multi Organ Dysfunction Syndrome Severe Sepsis with Multiorgan Inflammation in multiple organs Dysfunction Peritoneal Cavity The space within abdomen that contains intestines, the stomach and liver Pigtail Drain Pigtail Catheter/Drainage is an angiographic flush catheter Porta Hepatis It is a deep fisher in the inferior surface of liver through which all neuro vascular structures (except hepatic veins) and also hepatic duct enter or leave the liver Calots Triangle It is a small anatomical space in abdomen Diastolic Dysfunction Occurs when lower heart chamber don't relax and fill blood properly Cardiomegaly It is usually a sign of enlarged heart
30. To deal with the allegation of medical negligence against OPs No.1&2 during the treatment, we have perused the medical record. It transpires that the patient went to the IPD of OP No.1 Hospital on 25.10.2018. Thereafter, the patient got himself admitted in the OP No.1- Hospital in emergency as he was suffering from upper abdomen problem Consumer Complaint No. 772 of 2019 22 and nausea for two days. The patient was examined and admitted by OP No.2 Doctor. All the relevant investigations were done at OP No.1 Hospital. The patient was taken up for surgery of Laparoscopic Cholecystectomy by the said Doctor. The Hospital had obtained various consents from the patient/his family members before taking the patient for surgery. The various consents were like General Consent, High Risk Consent, Consent for Anesthesia, Consent for Complications that could be occurred during the surgery. The patient i.e. Major Singh had himself signed the High Risk Consent Form on 30.10.2018. The witness to the consent was one Amanpreet Singh son of the patient i.e. the Complainant. In the High Risk Consent dated 30.10.18, the complications/risks which could be anticipated due to the medical condition of the patient like infection, bleeding, need for ICU Care have been mentioned. Further in the same consent it has also been mentioned that the concerned Doctor had explained the entire procedure to the patient as well as the witness in vernacular language. Therefore, it is clear that the patient and his attendants were not unaware of any complications that could arise during the process of said surgery. We have perused all the medical consents obtained by OPs No.1&2 but no cuttings regarding condition of the patient in said documents have been observed.
31. Another alleged negligence committed by OP No.2 was that it took much longer time to perform the said surgery. It has been stated that in normal circumstances surgeries such as Laparoscopic Cholecystectomy takes 30 minutes whereas the OP No.2 took 5½ hours to complete the surgery. As per the record the timing of surgery was between 10.00 am to 1.30 pm i.e. approximately 3½ hours. OP No.2 has cited the reason that the surgery took longer due to dense adhesions and disturbed anatomy of surrounding structures. The matter regarding prolonged surgery has Consumer Complaint No. 772 of 2019 23 also been dealt with in Medical Board Report of Postgraduate Institute of Medical Education and Research (page 984) annexed by the Complainant, wherein it has been categorically mentioned that "after detailed review of all the record the Board is of the opinion that, cholecystectomy complained in this patient was difficult one."
32. We have further perused the medical record of OP No.1 Hospital where it has been observed that the patient had left the OP No.1- Hospital on 02.11.2018 in Leave Against Medical Advice (LAMA). Said document had been signed by the Authorized Person i.e. Amandeep Singh (Complainant). In the said Form, the contents mentioned are as under:-
1. I have been informed of the possible / probable dangers to my (Name relation) health that may result from (His/Her) leaving the hospital at this time, including (name specific risks of departing).
1) Deteriorate the condition of patient
2) Bleeding
3) Infection
2. I recognize that the above listing of dangers may not be complete and that a fuller explanation of the consequences is available upon my request.
However, I do not wish any further explanation.
3. I assume the risk and accept the consequences on my / the patient's departure from the Ivy Hospital at this time and hereby release all health care providers, including the hospital and its staff from any liability for all effects that may result from discontinuance of treatment.
4. I have read and fully understood this document. All blank spaces were filled in and / or sections (illegible - ssed) out from to signature below.
33. From the abovesaid contents of High Risk Consent, it is clear that the allegation of the Complainant that blank papers were got signed from him is baseless because as per Condition No.4 (reproduced above), it is clear that he had signed properly filled up document. It also transpires that nowhere the Authorized Person responsible for patient had signed document under protest. Therefore, allegations of deficiency in service or unfair trade practice have not been proved.
34. From the above discussion, it is clearly established that the attendants of the patient did not let the OP No.2-Doctor to decide on further course of action i.e. re-operation, once complications had arisen in his medical condition. From the sequence of events, it is clear that CECT Consumer Complaint No. 772 of 2019 24 Abdomen as referred by OP No.2-Doctor was conducted on 02.11.2018 from which he could have taken decision for future treatment. However, the attendants of the patient decided to leave in LAMA on 02.11.2018 itself (p.103). Thereafter, the patient was taken to Apollo Hospital, where he remained admitted from the period between 02.11.2018 to 04.11.2018. The Doctors there resorted to conservative medical management. The Apollo Hospital transferred the patient to Fortis Escort Hospital, Amritsar on 04.11.2018 for further management. He remained admitted in the said Hospital from 04.11.2018 till 10.11.2018. The patient expired on 10.11.2018 i.e. after approximately 8 days from the date of discharge under LAMA from OP No.1-Hospital. Thereafter the patient underwent Ultrasound Guided Catheter Drainage of Left Paracolic (outside, adjacent to Colon) and Pelvic Collection (collection of infected fluid in the pelvic area) on 06.11.2018. The patient underwent Emergency Exploratory Laparotomy after taking high risk consent from the patient and his relative on 08.11.2018. Emergency Exploratory Laparotomy is a major operation that involves opening the abdomen. It allows the surgeon to view the organs inside and repair any emergency problem that could have occurred. It is a time sensitive abdominal surgery associated with high rate of mortality (source : google). The patient was admitted in ICU of the said Hospital. The condition of the patient started deteriorating there. The Doctor there planned CRRT (Continuous Renal Replacement Therapy). The CRRT is a special type of Dialysis that is done on unstable patient. The patient expired on 10.11.2018 at 4.00 am. The cause of death was mentioned as:-
(i) Septicemia Shock i.e. life threatening condition that happens when blood pressure drops to a dangerously low level after infection.
(ii) AKI - Acute Kidney Injury
(iii) Cardiac Arrest.
Consumer Complaint No. 772 of 2019 25
35. The above sequence of admission of the patient to the various Hospitals establishes that once the patient got himself discharged under LAMA on 02.11.2018, he was treated at two Multi Specialty Hospitals between 02.11.2018 to 10.11.2018. On 10.11.2018 he eventually expired.
The Complainant has not impleaded the two Multi Specialty Hospitals i.e. Apollo Hospital and Fortis Escort Hospital, Amritsar. Learned Counsel for the Complainant was specifically asked regarding not impleading the said facilities/hospitals as party in the Complaint. It was submitted that the Complainant do not want to do so as the primary negligence had occurred at OP No.1-Hospital under the supervision of OP No.2 Doctor. However, it is felt that the case cannot be adjudicated unless the Doctors at the said Hospitals are impleaded and their version is heard.
36. It is true that no complaint can be defeated by reason of misjoinder or non-joinder of parties as provided under Order-1, Rule-9 of the CPC but at the same time the Court is required to deal with the matter in controversy so far as regards the rights and interest of parties actually before it. In the instant matter, the continuous treatment was taken by the patient at different Hospitals and the stand of OP No.2 is specific that these Hospitals and their version are necessary to be taken into consideration before deciding the complaint on merits. The plea of non- joinder was raised by OP No.2 at the initial stage. Since the matter relates to medical negligence, therefore, non-joinder of these parties cannot be ignored. The treatment was given by a different Hospitals, therefore, it is not possible to fix liability of one person without hearing the stand of all concerned parties, as in matters relating to medical negligence, liability cannot be fixed or ascertained without hearing all concerned. Inspite of the fact that the OP No.2 took the plea of non-joinder at the initial stage of the proceedings yet the Complainant did not implead them. Hence, in our Consumer Complaint No. 772 of 2019 26 opinion the Complaint prima-facie is defective for lack of non- joinder of necessary parties. The preliminary/subsequent treatment given by other Hospitals cannot be separated from the treatment undertaken by the patient in OP No.1 Hospital where the patient was admitted under OP No.2 and got his surgery of Laparoscopic Cholecystectomy done. Therefore, the conclusion with respect to medical negligence cannot be arrived at without taking into consideration the role of all the Hospitals. It is true that the failure to implead any party does not per-se entail the dismissal of a suit but subsequently, it was held in "Parbati Sham Achary Vs. Smt. Manasi Devi", AIR 1977 Ori 139 that necessary parties are those in whose absence, the Court cannot pass an effective decree at all. In the instant matter, in our view no effective order can be passed without impleading the other Hospitals i.e. Sri Guru Ram Dass Charitable Hospital, Apollo Hospital and Fortis Escort Hospital, Amritsar and considering their role into the act of negligence as alleged by the Complainant, which led to the demise of his father. Thus, the submission of OPs No.1&2 that the Complaint is bad for mis-joinder of parties is correct.
37. We have gone through the contents of Medical Board Report of PGI, Chandigarh, the proceedings of which took place in pursuance of the request from Punjab Medical Council, Education Bhawan, Sector 69, Mohali, Punjab - 160062 for the expert opinion regarding the complaint against Dr. Barinder Pal Singh S/o Charan Singh as alleged by Sh. Major Amanpreet Singh S/o Sh. Major Singh vide letter No. PMC/2021/6882 of 2021 titled as Complaint against Dr. Barinder Pal Singh S/o Charan Singh as alleged by Sh. Major Amanpreet Singh S/o Major Singh. The Board concluded its report with the following observation:-
"After detailed review of all the records the board is of the opinion that, cholecystectomy complained in this patient was difficult one. The surgeon was Consumer Complaint No. 772 of 2019 27 suspicious of complication of the surgery in the immediate post-operative period and discussed the possibility of re-operation with the patient attendants. However, reoperation was not carried out by the primary operating surgeon and the reasons for the same was not mentioned in the record. Patient went to multiple hospitals and finally, he was operated on 08.11.2018 at Fortis Escorts Hospital. By the time, patient condition further deteriorated. But from the records there is no evidence that why re-operation was delayed at multiple levels."
38. In continuation to the abovesaid report, we have gone through the final Report/Order of the Punjab Medical Council passed on dated 19.01.2023, vide Endst. No. PMC/2023/6779-82, wherein it has been mentioned that expert opinion has been obtained from the PGIMER, Chandigarh vide Letter No. EV(9)PGI-MS/MA-63/21 dated 15.05.2021. The said Report has been concluded with the following observations:-
"The patient condition was deterioration due to multiple hospital shifting and old delay in operation which was cause of death. Committee feels that no medical negligence was found on the part of first physician Dr. Barinder Pal Singh Bajwa and decided to close this case."
39. We have also perused the pictorial charts submitted by OP No.2-Doctor, which clearly shows that the Gall Bladder is closely surrounded by "Common Hepatic Ductor, Common Bile Duct and Cystic Duct" i.e. the anatomy of the said organ is complicated. It has been mentioned in the medical literature submitted by the OPs No.1&2 that the frequency of complication associated with Laparoscopic Cholecystectomy varies from 0.5 to 6%. The incidence of Intraoperative Complications (IOC) and Post-operative Complications (POC) were more common in males compared to females and this difference was statistically significant. Intraoperative complications and postoperative complications associated with laparoscopic cholecystectomy are more common in patients with older age, male gender, with increased levels of markers of inflammation and in cases of acute cholecystitis. The occurrence of more than one complication is more common in males compared to females. Consumer Complaint No. 772 of 2019 28
40. Thus, it is a proven fact from report/opinions of Medical Boards' that the surgery of the patient was very risky/difficult. It had been stated by OP No.2 that during surgery he noticed that there were dense adhesions to fundus, body and neck of gall bladder. OP No.2 had separated the Adhesions and Cystic duct and Cystic vessel were identified and ligated with liga clips and also sutured and cut. Gall Bladder was separated from liver bed and taken out. Thereafter, it was sent for histopathology examination. Hemostasis (Source:
google - it is a process to prevent and to stop bleeding from blood vessel) was maintained and drain was inserted and fixed wound was closed. Thereafter the patient was shifted to Post-operative Recovery Room and his condition had improved. The Doctor was satisfied that the patient was fully conscious and stable. His BP was recorded as 120/70 mm Hg, 93/min (p.54). However, at 11.45 pm on 01.11.2018, patient had sudden onset of Atrial Fibrillation so his ECG was done. OP No.2 was informed by the attending staff. Dr. Vaibhav, Cardiologist had also seen the patient on request of OP No.2-Doctor and he had passed necessary directions. On 02.11.2018 when OP No.2 checked the patient at 10.30 am, his condition was stable and his blood pressure was 130/80.
Pulse 88/m, Temp. 100, I/O 2160/77 ml (p.62). Blood investigations were remarkable. Therefore, it can be deciphered from the aforementioned parameters that the condition of the patient was stable till the time he was under the treatment of OP No.2-Doctor but he got himself discharged on LAMA. The aforesaid medical condition which has been recorded in the Daily Progress Notes has not been challenged by the Complainant at any stage.
41. A specific query was put to the learned Counsel representing to the Complainant for not impleading Sri Guru Ram Consumer Complaint No. 772 of 2019 29 Dass Charitable Hospital, Apollo Hospital and Fortis Escort Hospital, Amritsar as party in the Complaint. To that query, it was categorically stated that the said Hospitals are not necessary parties as no act of negligence could be attributed to them, therefore, there is no need to implead them.
42. In the light of the above discussion and circumstances presented before us during the course of arguments, we are of the view that the role of other Hospitals i.e. Sri Guru Ram Dass Charitable Hospital, Apollo Hospital and Fortis Escort Hospital, Amritsar are necessary to be examined for reaching to the right conclusion with respect to the allegations of the Complainant. Accordingly, the present Consumer Complaint is dismissed, being bad for non-joinder of necessary parties.
43. Since the main case has been disposed off, so all the pending Miscellaneous Applications, if any, are accordingly disposed off.
(JUSTICE DAYA CHAUDHARY) PRESIDENT (SIMARJOT KAUR) MEMBER July 23, 2024.
as