National Consumer Disputes Redressal
Smt. Vimla Rana, vs Mahesh Hospital & Anr., on 1 December, 2017
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI CONSUMER CASE NO. 230 OF 2014 1. Smt. VIMLA RANA, W/o Shri Hira Singh Rana, C-192, Gali No. 4, West Vinod Nagar, DELHI - 110092. ...........Complainant(s) Versus 1. MAHESH HOSPITAL & ANR., D-937, Patparganj Society Complex, Near Engineer's State, West Vinod Nagar, Inraprastha Extention, DELHI - 110092. 2. Dr. Mahesh Aggarwal, D-937, Patparganj Society Complex, Near Engineer's State, West Vinod Nagar, Inraprastha Extention, DELHI - 110092. 3. United India Insurance Company Limited. Office No. 7, Ground Floor, 150, BBC Complex, Kilokri Ring Road, Opp. Maharani Bagh, New Delhi - 110 014 ...........Opp.Party(s) BEFORE: HON'BLE MR. JUSTICE V.K. JAIN,PRESIDING MEMBER
For the Complainant : Mr. Dharmender Sharma, Advocate
Mr. Prashant Kumar Sharma, Advocate For the Opp.Party : Mr. Sandeep Kapoor, Advocate with
Ms. Yavanica Kapoor, Advocate for OP-1&2
Mr. Anand Vardhan Sharma, Advocate for
OP-3
Dated : 01 Dec 2017 ORDER
JUSTICE V.K. JAIN, PRESIDING MEMBER (ORAL)
The daughter of the complainant was admitted to opposite party No.1 Mahesh Hospital on 27.6.2012 in a very critical condition with complaint of severe abdominal pain for last six days and nausea and vomiting for two days. At the time of admission, her BP was not recordable and she was shivering. Before taking her to the Mahesh Hospital, the complainant had taken her for an ultrasound test at Suvidha Diagnostic Centre, which had found a well-defined Heterogenous Adnexal mass of 60x47 cm in the right Adnexa. She was admitted in emergency and exploratory laparotomy was performed on her at 12.00 noon. As per the finding in the procedure, she was suffering from miliary Tuberculosis all over her intestine with plastic adhesions and multiple perforations in the intestine. She was discharged from Mahesh Hospital on 28.6.2012 and was admitted to LNJP hospital. She died in LNJP hospital on 14.7.2012. Alleging medical negligence in the treatment of her daughter, the complainant is before this Commission seeking compensation quantified at Rs.1.00 crore. It is inter-ala alleged in the complaint that the relative of the complainant had objected to the opening of the stomach of the deceased without conducting proper medical test and ultrasound. It is also alleged that ICU and ventilator facility was not available in the hospital nor was there proper light in the operation theatre. It is also alleged that the hospital did not have proper nursing staff and ward boys.
2. The complaint has been resisted by the opposite party No.1 Mahesh Hospital and opposite party No.2 Dr. Mahesh Aggarwal who have alleged that Mahesh Hospital is a well-equipped modern center, duly registered with Directorate of Health Services and opposite party No.2 Dr. Mahesh Aggarwal is a qualified and experienced Surgeon, practising for the last 32 years. It is alleged in written version filed by the aforesaid opposite parties that when the daughter of the complainant was brought to the hospital her pulse was not palpable and her BP was not recordable. Generalized tenderness with rigidity and guarding was present all over the abdomen and she was diagnosed as a case of Peritonitis with Septic Shock Infection and pus in abdominal cavity with widespread toxins / poison in the blood. It is pointed out in the reply that her ultrasound had shown a right side Heterogenous Adnexal Mass measuring 60 x 47 mm, probably an Ovarian Cyst. After explaining her condition to her mother, the family members were asked to whether they would like to take her to a higher center such as LNJP hospital. Considering the condition of the patient, they decided to admit her in Mahesh Hospital. She was operated and Exploratory Laparotomy was done which revealed extensive miliary tuberculosis in the intestine with multiple perforations and faecal peritonitis. All perforations were closed and thereafter the abdomen was closed in layers after leaving the drain. The patient was thereafter conscious, and oriented. Her uncle was thereafter told that she might require referral and dialysis but the family decided to wait till morning. The patient was then transferred to LNJP hospital. It is also pointed out that as per the documents of LNJP hospital, the patient was not well for last 3-4 months and had abdominal pains, besides fever and loss of weight. It is also stated in the written version filed by the opposite parties that the complainant had made a complaint against them to Delhi Medical Council which referred to matter to its Ethics Committee. The Medical Council, vide its order dated 31.5.2013, held that prima-facie no case of negligence was made out on the part of the Doctor Mahesh Aggarwal in the treatment administered to the daughter of the complainant at Mahesh Hospital. Being aggrieved from the order passed by the Delhi Medical Council, the complainant approached the Medical Council of India by way of an appeal. The said appeal was also dismissed.
3. The complainant has examined, as his witnesses two Doctors of LNJP hospital. In his statement Dr. Pammi Chawdhry, simply proved the MLC of the deceased and did not say a word about the alleged negligence of the opposite parties. The other witness is Dr. Pawanindra Lal.
4. Dr. Pawanindra Lal, Professor of Surgery in LNJP Hospital was Co-Unit Head of the Surgical Unit with Dr. N.S. Hedke and the deceased daughter of the complainant was under the treatment of their unit at LNJP Hospital. He inter-alia told this Commission that exploratory laparotomy is an operation conducted in emergency to explore the abdominal cavity with an intent to find the cause of acute abdomen. Some of the question put by the complainant to Doctor Pawanindra Lal and the answer given by the witness to those questions are relevant for the purpose of deciding this complaint and read as under:
"Q. Is any investigation required before undertaking exploratory laparotomy?
Ans. Some investigations may be undertaken before such an operation however a large number of times, it is the clinical findings in combination with blood reports that may suggest the diagnosis of acute abdomen requiring an exploratory laparotomy. Thus, it is not always necessary to get any investigations done before undertaking this procedure, though if he feels necessary, the doctor may require further investigations before undertaking the procedure.
Q. Is it correct that on account of MRI Scan and CT scan having become available, these investigations should have been done before this procedure?
Ans. It is not correct.
Considering the condition of this patient it was advisable to undertake this procedure only in a hospital equipped with an ICU.
Q. Considering the record of the treatment of this patient at the previous hospital, do you find any negligence in her treatment in the previous hospital?
Ans. Considering the condition in which the patient came to this center, exploratory laparotomy was the right procedure to be performed on her and I do not find any negligence on the part of the previous hospital in treatment the patient.
Q. What is the meaning of Miliary Tuberculosis?
Ans. Miliary Tuberculosis is a condition in which tuberculosis has spread to the whole of the body.
Normally it takes several days to weeks or even months for the tuberculosis to spread for one organ to the entire body of the patient. However, in this case the tuberculosis of the intestine had got burst in a day or two and if this happens, the condition of the patient may deteriorate suddenly due to release and spread of fecal matter. The mortality rate is very high who present themselves with such conditions".
5. It is evident from the statement of Dr. Pawanindra Lal that there was absolutely no negligence in the treatment of the deceased daughter of the complainant at Mahesh Hospital. It is also evident that exploratory laparotomy was the right procedure to be performed on her. It was not necessary to subject the patient to a MRI Scan and / or CT Scan before undertaking the said procedure. He clearly stated that it is the clinical finding in combination with blood reports that may suggest the diagnosis of acute abdomen requiring exploratory laparotomy and it is not always necessary to get any investigations done before undertaking this procedure. Therefore, it was not necessary for opposite party No.2 to subject the patient to further investigation before undertaking the exploratory laparotomy on her. In any case the patient had already been subject to ultrasound test at Suvidha Diagnostic Centre and a Heterogenous l mass of 60x47 cm had already been detected in her Adnexa region.
6. This is also the case of the complainant that no ICU was available in Mahesh Hospital at the time his daughter was admitted and exploratory laparotomy was performed on her. When this plea was taken before this Commission on 02.11.2017, the opposite parties maintained that they did have an ICU and they drew the attention of this Commission to the Lab/Xray/Ultrasound report of the deceased dated 28.6.2012 wherein the facilities available were described and one of the facilities shown was ICU. The opposite party was therefore directed to file affidavits of Dr. Ajay Bedi, who was an Anesthetist associated at the time the procedure was performed upon the deceased and Dr. Nidhi, another doctor, associated with Mahesh Hospital at the relevant time. They were also directed to file attested copies of the documents submitted for registration of the Mahesh Hospital, if ICU rate charged were notified in said documents.
7. The opposite parties have accordingly filed affidavits of Dr. Ajay Bedi and Dr. Nidhi both of them of whom are clearly stated in their affidavits that well-equipped 3-Bedded operational ICU was available in Mahesh Hospital on 28.6.2012. The opposite parties have also filed the Schedule of Charges, which they had submitted to the Government of NCT of Delhi and ICU rates have been clearly notified in the aforesaid Schedule of charges with effect from 01.1.2010. It thus stands proved from the affidavits of Dr. Ajay Bedi and Dr. Nidhi Ray that Mahesh Hospital did have a functional 3-bedded ICU on the date the procedure was performed on the daughter of the complainant. Therefore, it cannot be said that the procedure was performed in a hospital without having ICU facility.
8. Thus neither the complainant has been able to prove that the opposite parties should have subjected her daughter to further investigations before undertaking exploratory laparotomy on her nor has he been able to prove that Mahesh Hospital did not have an operational 3-bedded ICU. No negligence at all in the treatment of the deceased at Mahesh Hospital has been proved by the complainant. As noted earlier, neither Delhi Medical Council nor the Medical Council of India has found any negligence on the part of the opposite parties in the treatment of the daughter of the complainant.
9. The learned counsel for the complainant has relied upon the decision of this Commission in Madan Lal & Ors. Vs. Dr. R.K. Chaudhary & Ors. IV (2016) CPJ 370 (NC) , where this Commission held the hospital to be deficient in service inter-alia on the ground that the patient had been diagnosed with Fibroids in Uterus without proper examination. However in the present case the deceased had already been subjected to ultrasound test at Suvidha Diagnostic Centre. More importantly, Dr. Pawanindra Lal, Professor of Surgery at LNJP Unit who is a witnesses of the complainant has clearly stated that it is the clinic finding in combination of blood report that may suggest the diagnosis of acute abdomen requiring an exploratory laparotomy and it is not always necessary to get any investigation done before undertaking this procedure though the treating doctor if he feels necessary may require further investigation before undertaking the procedure. The Judgment relied upon by the learned counsel for the complainant therefore is of no help to him.
11. For the reasons stated hereinabove, I find no merit in the complaint, which is accordingly dismissed with no order as to costs.
......................J V.K. JAIN PRESIDING MEMBER