State Consumer Disputes Redressal Commission
Rohit Kapoor vs P.G.I Chandigarh. on 20 February, 2015
Daily Order STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UNION TERRITORY, CHANDIGARH Consumer Complaint No. 147 of 2014 Date of Institution 03/11/2014 Date of Decision 20/02/2015 Rohit Kapoor s/o Late Col.R.K.Kapoor, resident of House No.1573, Sector 7-C, U.T., Chandigarh. Mrs.Promila Kapoor w/o Late Col.R.K.Kapoor, resident of House No.1573, Sector 7-C, U.T., Chandigarh. Ms.Sonali Bakshi w/o Sh.Vijay Bakshi, resident of House No.25B, Skynet Enclave, Zirakpur. .......Complainants V E R S U S Post-Graduate Institute of Medical Education & Research (PGI), Sector 12, Chandigarh, through its Medical Superintendent/Director. Department of Neurosurgery, Post-Graduate Institute of Medical Education & Research (PGI), Sector 12, Chandigarh, through its Head of Department. Department of Nephrology, Post-Graduate Institute of Medical Education & Research (PGI), Sector 12, Chandigarh, through its Head of Department. Dr.Dandapani, Department of Neurosurgery, Post-Graduate Institute of Medical Education & Research (PGI), Sector 12, Chandigarh, through its Head of Department. Dr.Ankur Kapoor, Department of Neurosurgery, Post-Graduate Institute of Medical Education & Research (PGI), Sector 12, Chandigarh, through its Head of Department. Dr.Vinay K.Sukhija, Department of Nephrology, Post-Graduate Institute of Medical Education & Research (PGI), Sector 12, Chandigarh, through its Head of Department. ...... Opposite Parties BEFORE: JUSTICE SHAM SUNDER (RETD.), PRESIDENT SH.DEV RAJ, MEMBER
SMT.PADMA PANDEY, MEMBER Argued by:
Sh.Pankaj Chandgothia, Advocate for the complainants.
Sh.Rajesh Garg, Sr.Advocate alongwith Ms.Nimrata Shergill, Advocate for the Opposite Parties.
PER PADMA PANDEY, MEMBER In brief, the facts of the case, are that Col.R.K.Kapoor (now deceased), who was 64 years of age, admitted in a private hospital on 23.01.2013 for urinary infection and was discharged on 26.02.2013. The doctors of private hospital suspected that the patient was suffering from Bone TB of Spinal Cord. The case summary, as prepared by the doctor of private hospital, is Annexure C-1. It was stated that after discharge from the private hospital, the patient remained at home for about 19 days, but continued to suffer from severe pain in the back and in the legs. It was further stated that several doctors were consulted and an Urologist opined that the patient might have possible infection of the Central Nervous System as his urea, cretinin was not high & sodium was not too low. Thereafter, the patient was taken to PGI and admitted there in the Emergency Ward under CR No.2013 0177 7941 on 17.03.2013. Copies of the PGI Out Patient Card for emergency ward is Annexure C-2 and Out-Patient Record is Annexure C-3. It was further stated that due to serious condition of the patient, he was admitted under the Department of Neurosurgery, PGI and allotted a private ward on 5th floor vide admission card (Annexure C-4). A series of tests were performed by the doctors of Opposite Party No.2 department. The prescriptions and test results are collectively annexed as Annexure C-5 whereas the progress of treatment as also the progress record is Annexure C-6.
2. It was further stated that on account of the delusional state of mind of the patient, Opposite Party No.2 in consultation with Opposite Party No.3, put the patient under dialysis, which was done on 23rd March but he did not gain consciousness. Opposite Parties No.2 and 3 attempted another round of dialysis on the patient on 26th March but he started vomiting blood on reaching the dialysis centre and, therefore, was brought back to the Neurosurgery Department. In view of the serious condition of the patient, the HOD of Nephrology Department visited the patient and simultaneously the Neurosurgery Department, put a request to shift/transfer the patient to the Nephrology Department because the immediate pressing problem at that time was the urinary/kidney problem but the Nephrology Department refused to take over the patient saying that the spinal cord problem of the patient was to be treated by the Neurology Department. It was further stated that the patient was suffering from various problems of different organs of the body and that was why he was admitted in Multi-Specialty Hospital i.e. Opposite Party No.1 but the above series of events showed that the very purpose of admitting the patient to such an institute stood defeated.
3. Thereafter, the patient's condition turned critical and he had to be moved to the ICU of Opposite Party No.2 and peritoneal dialysis was carried out. However, during the course of this treatment, the patient developed lung infection and the development of the new infection during intensive care at a Premier Hospital is itself, amounted to prima-facie negligence. It was further stated that the main problem of suspected Spinal Cord TB continued to be non-diagnosed, yet the patient was continued under ATT, which actually is the course when TB is confirmed. The adoption of hit-and-trial method in this regard by the Premium Institute, once again showed the callousness and apathy of the Institute staff and doctors. The logic given by the doctors was that if he was suffering from Bone TB, the results would show by six weeks and if not then they would have clarity by 15th April. It was further stated that the patient was weaned away from Oxygen and it was said that Bone TB treatment took about 9-12 months and no useful purpose would be served by keeping him in the hospital.
4. It was further stated that it was strange as to how the doctors had concluded that the patient had Bone TB without any test result and also because inspite of over eight weeks of medication, he was not showing any improvement. The patient was discharged from the ICU and shifted to the private room. The Opposite Party's Institute and its doctors time and again tried to prevail upon complainant No.1 to get his father discharged, from the hospital, and the insistence increased from 10th April onwards and the pressure was created almost daily. It was further stated that the life of the patient was important to his son and family but the doctors of the PGI tried to evade their responsibility and tried to leave a person to die. It was further stated that on 4th May, the patient stopped passing urine and he had an intake of about 2600 ml on that day but the output was poorly low at only 800 ml, making it a gap of 1800 ml, which means this much was retained inside the body. On 5th May, the patient lost consciousness and was visited by a Nephrology Surgeon in the morning. There was some brain-storming session between Opposite Parties No.2 and 3, but to no effect. The complainant was told that a central line would be put for which PTI test was carried out.
5. The patient was moved from the private room to emergency theatre for insertion of central line. It was further stated that Neurosurgery Department had written in the patient file that he had suffered renal failure and, therefore, he should be taken over by the Nephrology Department but none of such written notes were acted upon. Complainant No.1 was told that it was difficult to shift the patient, in this condition, but this seemed to be only a false plea because if the patient could be shifted from a private room to operation theatre, he could also be shifted from one department to another and in all this process, 36 hours were wasted and the patient continued to be unconscious.
6. It was further stated that on the next day i.e. 6th May, the consultant Neurosurgeon got candid with complainant No.1 and told that Opposite Party No.3 had refused to accept the patient. Complainant No.1 asked to write this on the file and after a lot of insistence, this was so written. It was further stated that Opposite Party No.4 made his junior to write the notes and also asked complainant No.1 to sign but he refused. It was further stated that the above sequence of events would clearly demonstrate that the patient was left to die, without any proper and required treatment. It was further stated that if the PGI was unable to provide adequate and proper medical care to the patient, it should have referred him to some other hospital, which also it failed to do so. The patient died on 09.05.2013 due to lack of proper and effective treatment in the PGI. It was further stated that hospital of the Opposite Parties did not give to the complainants, the complete medical file of the patient and the said documents had to be obtained through the RTI process, which resulted in further harassment to them (complainants). It was further stated that the Opposite Parties were guilty of medical negligence. It was further stated, thus, they were deficient, in rendering service, as also, indulged into unfair trade practice. When the grievance of the complainants was not redressed, left with no alternative, a complaint under the Consumer Protection Act, 1986 (hereinafter to be called as the "Act" only), was filed.
The Opposite Parties were served and put in appearance on 09.12.2014. They in their written statement stated that deceased Col.R.K.Kapoor had multiple serious illnesses even before admission. The patient had been suspected to have Tuberculosis of the Spine based on clinico-radiological findings and was started on anti-tubercular treatment (ATT) in a private hospital, much before his admission in PGIMER. It was further stated that in addition to the aforesaid problem, the patient also had acute chronic kidney disease (renal failure) and was on dialysis, urinary infection (Urosepsis/UTI), Pneumonia (Chest Infection), Septic Shock, Diabetes Mellitus, Hypertension, Depression, Metabolic Acidosis, Liver Dysfunction and Anemia, as per the discharge records of the private hospital. It was further stated that the patient was brought to PGIMER emergency on 17.03.2013 and admitted in private ward on 18.03.2013 (Annexure R-1). It was further stated that when the patient needed regular monitoring on 23.03.2013, he was shifted at once to Neurosurgery Ward, where he could be monitored round the clock. Thereafter, he needed ICU care on 25.03.2013, for which, Neurosurgery ICU bed was provided promptly against all constraints. It was further stated that with the treatment provided by PGI, there was improvement, so that the patient could be shifted out on 10.4.2013 to Neurosurgery Ward and later on 11.04.2013 back to private ward. The patient was quite stable for 24 days and subsequently, when his condition worsened on 06.05.2013, he was quickly transferred to Neurosurgery ICU. It was further stated that inspite of best efforts, the condition of the patient continued to deteriorate and he succumbed to multiple organ dysfunction. It was further stated that the patient had presented with altered sensorium and renal dysfunction, a tentative diagnosis of uremic encephalopathy was made and he was initiated on dialysis. It was further stated that the patient was shifted back from dialysis room to the ward for the management of blood in vomitus, as that was a priority at that point of time. After managing the problem, the patient was commenced on peritoneal dialysis. The treatment, however, was not compromised in any way. It was further stated that patient had multiple serious problems requiring multidisciplinary approach to treatment and various Consultants of Department of Nephorology attended the patient regularly including Dr.Vinay Sakhuja, Dr.K.L.Gupta, Dr.Raja Ramachandran and Dr.Vivek Kumar. It was further stated that the patient required ICU during the stay at the hospital and proper round the clock care was provided at the Neurosurgery ICU. Had the patient been transferred to Nephrology, which does not have ICU facility, such care would not have been feasible. It was further stated that, all the required Nephrology services, including dialysis, were offered to the patient as and when required.
It was denied that the treatment was ever refused or stopped or compromised. It was further stated that patient with multiple illnesses usually kept under one department and other departments managed the patient under the admitting department. The location of the patient was determined as per the bed availability and logistics. It was further stated that the documented consultation of various doctors of various specialties including Neurosurgery, Nephrology, Urology, Internal Medicine, Pulmonary Medicine, Gastroenterology, Hepatology, Cardiology, Endocrinology and Psychiatry indicated the high level of coordination among the treating team. It was further stated that the patient had chest infection, urinary infection and septic shock even while getting treated prior in the private hospital, as per the discharge summary. The patient had diabetes mellitus, renal failure and paraparesis. It was further stated that the patient with diabetes mellitus, renal failure and paraparesis was immunologically weak and, therefore, predisposed to develop multiple infections including lung infection. The development of infection in this setting could not be attributed to negligence on the part of treating team. It was further stated that anti-tubercular treatment (ATT) started before in a private hospital based on clinical grounds and radiological investigations, had resulted in clinical improvement, as per the discharge records of the private hospital and the admission notes of PGIMER. After the patient was admitted in PGIMER, several additional investigations were performed to arrive at a confirmatory diagnosis, including CECT of chest and abdomen, FNAC and culture. CECT was suggestive of tuberculosis. The FNAC report was descriptive in nature. It was further stated that as per the standard practice, ATT had to be continued, especially when there had been a clinical response to ATT, with no evidence pointing to any other diagnosis. The patient continued to show improvement initially, so that he could be shifted out of ICU, further reaffirming the diagnosis. It was further stated that as the culture report took more than 6-8 weeks, it was received after the patient's death and could not be of much help. Moreover, a negative culture does not rule out the diagnosis of Tuberculosis, since the sample was sent several weeks after start of ATT. It was further stated that in accordance with the established standards, it was considered highly appropriate to continue ATT, in consultation with several other specialists. It was further stated that after admission in PGIMER, he had to be shifted to ICU, following which, there was further improvement and so the patient was shifted out of ICU and later to private ward. At this stage, pursuant to the acceptable standards of clinical practice, the attendants of the patient were explained about continuing ATT at home. It was denied that the complainants were pressurized to get the patient discharged. It was further stated that Nephrologist assessed the patient on 5.5.2013 and diagnosed that the fluid level was not in excess, as the central venous pressure was only 1 cm of saline. The patient was advised fluids as per the hydration status, and was duly followed. There was coordination between Nephrology and Neurosurgery Department doctors and the central line was placed after taking adequate precautionary measures. It was further stated that placement of a central line is important for assessment of hydration status in a critically ill patient with renal failure. As the procedure involves placement of a catheter in the central vein, it is carried out in OT where resuscitation facilities were available.
It was further stated that the patient had been suffering from renal failure even before admission. The Nephrology Residents and Consultants saw the patient on a regular basis. The patient was seen by Prof.K.L.Gupta on 21st March, by Prof. Vinay Sakhuja on 22nd, 23rd, 25th, 26th, 27th, 28th, 30th March and 1st April, Dr.Raja saw the patient on 23rd and 31st March, Dr.Vivek Kumar saw the patient on 3rd April. It was further stated that the patient was critically ill and needed round the clock intensive care monitoring. The Department of Nephrology did not have an ICU facility and, hence was managed at Neurosurgery Department, where the ICU facility was available. All the required Nephrology services including dialysis were offered to the patient, as and when required and transfer to Nephrology would not have affected the ultimate outcome in this patient. It was further stated that there was no misconduct or refusal to treat the patient. As per standard clinical practice, requests were made by Neurosurgery Department for transferring the patient to Nephrology, but could not be done due to bed constraints and logistics. After admission in PGIMER, he was managed appropriately in concurrence with several senior doctors from different specialties including Neurosurgery, Nephrology, Urology, Internal Medicine, Pulmonary Medicine, Gastroenterology, Hepatology, Cardiology, Endocrinology and Psychiatry, as per the clinical situation and lab reports. It was further stated that the diagnosis of tuberculosis of the spine was made in a private hospital based on clinical-radiological findings, and was started on ATT much before the patient's admission in PGIMER. Moreover, the liver dysfunction had been recorded even in the discharge summary of the private hospital, and the patient was on modified ATT, which was continued, as per the documented consultation of several specialist doctors. It was further stated that death certificate was provided as per the Institute's policy. The CR file of the patient was a part of the hospital record and could not be handed over, as it was against the policy of the Institute. However, detailed records could be obtained by the patient by filing an application in the office of the Medical Superintendent, which in the present case was done by the complainants. It was further stated that when the patient was stable enough (around 24 days) to be discharged, the refusal of the complainants to take him home indicated their satisfaction with the treatment provided. It was further stated that neither there was any deficiency, in rendering service, on the part of the Opposite Parties, nor they indulged into unfair trade practice.
10. The Parties led evidence, in support of their case.
11. We have heard the Counsel for the parties, and have gone through the evidence and record of the case, carefully.
12. The Counsel for the complainants, submitted that Col.R.K.Kapoor (now deceased), who was 64 years of age, was admitted in a private hospital on 23.01.2013 for urinary infection and was discharged on 26.02.2013. He further submitted that the doctors of private hospital suspected that he was suffering from Bone TB of Spinal Cord. He further submitted that after discharge from the private hospital, the patient remained in his house for 19 days but continued to suffer from severe pain in the back and in the legs. He further submitted that the patient was ultimately, got admitted in the Emergency Ward of the Post Graduate Institute of Medical Education &Research (PGIMER), Sector 12, Chandigarh on 17.03.2013, as per Annexures C-2 and C-3. He further submitted that seeing the serious condition of the patient, he was then admitted in the Department of Neurosurgery, PGIMER and allotted a private ward on 5th Floor. He further submitted that a number of tests were conducted on the patient. He further submitted that, thereafter, in consultation with Opposite Party No.3, the patient was put under dialysis by Opposite Party No.2 on 23.03.2013 but he did not regain consciousness. He further submitted that Opposite Parties No.2 and 3 attempted another round of dialysis on the patient on 26th March but he started vomiting blood on reaching the dialysis centre and, therefore, was brought back to the Neurosurgery Department. He further submitted that as per Annexure C-7 dated 05.05.2013, Department of Neurosurgery was of the view that the patient needed Nephrology care for both Renal failure and also Urosepsis and the patient has to be taken over by the Nephrology team for further management. He further submitted that Nephrology Department did not take over the patient, as a result whereof, proper treatment could not be given to him. He further submitted that the doctors told the attendants of the patient that he should be taken away from the hospital against their wishes. He further submitted that the Opposite Parties, did not conduct the requisite tests, to find out the real problem, with which Col.R.K.Kapoor was suffering and, as such, proper diagnosis could not be made by them (Opposite Parties). He further submitted that if the PGI was unable to provide adequate and proper medical care to the patient, it should have referred him to some other hospital, which also they failed to do so. He further submitted that there was medical negligence on the part of the Opposite Parties, resulting into the death of Col.R.K.Kapoor on 09.05.2013. He further submitted that the Opposite Parties are separate and distinct from each other and being separate legal entities, one Opposite Party could not file written statement on behalf of all the Opposite Parties. . He further submitted that the hospital of the Opposite Parties did not give the complete medical file of the patient to the complainants, and the same had to be obtained through RTI. He further submitted that the Opposite Parties were deficient, in rendering service, as also, indulged into unfair trade practice.
13. The Counsel for the Opposite Parties, submitted, that Dr.S.S.Dhandapani, Asstt. Prof. Deptt. Of Neurosurgery, PGIMER, Chandigarh in answers to written interrogatories, clearly stated that the Counsel representing PGI has already adopted for other Opposite Parties and, as such, he had filed joint reply on behalf of all the Opposite Parties and the contention of the Counsel for the complainants that separate replies should have been filed in the absence of common authorization was wrong. He further submitted that the deceased (Col.R.K.Kapoor) had multiple serious illnesses even before admission in their hospital. He further submitted that the patient had been suspected to have Tuberculosis of the Spine based on clinico-radiological findings and started on anti-tubercular treatment (ATT) in a private hospital, much before his admission in PGIMER. He further submitted that the patient also had acute chronic kidney disease (renal failure) on dialysis, urinary infection (Urosepsis/UTI), Pneumonia (Chest Infection), Septic Shock, Diabetes Mellitus, Hypertension, Depression, Metabolic Acidosis, Liver Dysfunction and Anemia, as per the discharge records of the private hospital. He further submitted that the patient was brought to PGIMER emergency on 17.03.2013 and admitted in private ward on 18.03.2013 (Annexure R-1). He further submitted that when the patient needed regular monitoring on 23.03.2013 he was shifted at once to Neurosurgery Ward, where he could be monitored round the clock and, thereafter, he needed ICU care on 25.03.2013, for which, Neurosurgery ICU bed was provided promptly against all constraints. He further submitted that the patient was quite stable for 24 days and subsequently, when his condition worsened on 06.05.2013, he was quickly transferred to Neurosurgery ICU. He further submitted that the patient required ICU during the stay at the hospital and proper round the clock care was provided at the Neurosurgery ICU. He further submitted that the patient with multiple illnesses usually kept under one department and other departments managed the patient under the admitting department and the location of the patient was determined, as per the bed availability and logistics. He further submitted that the patient had chest infection, urinary infection and septic shock even while getting treated prior in the private hospital, as per the discharge summary. He further submitted that the patient with diabetes mellitus, renal failure and paraparesis are immunologically weak and, therefore, predisposed to develop multiple infections including lung infection. He further denied that the complainants were pressurized to get the patient discharged. He further submitted that the patient had been suffering from renal failure even before admission. He further submitted that the nephrology residents and consultants saw the patient on regular basis. He further submitted that the Department of Nephrology did not have an ICU facility and, hence the patient was managed in Neurosurgery Department, where the ICU facility was available and all the required nephrology services including dialysis were offered to the patient, as and when required and transfer to Nephrology would not have affected the ultimate outcome in the patient. He further submitted that the CR file of the patient was a part of the hospital record and, as such, could not be handed over to the complainants and the detailed records could be obtained by the patient by filing an application in the office of the Medical Superintendent, which in the present case was done by the complainants. He further submitted that there was no medical negligence on the part of the Opposite Parties.
14. The first question, that arises for consideration is, as to whether, Opposite Party No.4 was legally competent to file written statement on behalf of all the Opposite Parties and if not, whether the same could be taken into consideration. During the pendency of the complaint, the Counsel for the complainants took an objection regarding joint reply filed on behalf of all the parties and requested for issuing direction to each of the Opposite Party to file separate reply/affidavit because they are separate and distinct from each other, being separate legal entities. He further submitted that neither a joint reply nor a joint affidavit could be filed on behalf of separate legal entities, unless there is a specific and expressed authority granted in this regard. He further submitted that in the present case, there is no such authority granted to Dr.Dhandapani, who filed the reply and affidavit because the affidavit is even otherwise defective, as it did not mention the full name and designation of Dr.Dhandapani. He further submitted that even in his affidavit, Dr.Dhandapani did not mention about the authorization by the other parties to file reply/affidavit on their behalf. On the other hand, Counsel for the Opposite Parties submitted that Dr.S.S.Dhandapani, Asstt. Prof. Department of Neurosurgery, PGIMER, Chandigarh was duly authorized by the Director of PGIMER, to sign the reply/affidavit/application etc. In this regard, Counsel for the Opposite Parties has placed, on record, noting at page 122, which reads as under :-
"x x x x x x The complaints have impleaded (1) PGIMER, through its MS/Director, (2) HOD-Nerurosurgery (3) HOD - Nephrology (4) Dr.Danadapani (5) Dr.Ankur Kapoor, Deptt. of Neurosurgery and (6) Dr.V.Sakhuja, Deptt. Of Nephrology. Parawise comments of the Deptt. Of Neurosurgery and Nephrology, PGI are being called separately.
In view of above, DDA/DPGI is requested to please :-
allot this case to Sh.Rajesh Garg, Senior Advocate who is dealing with consumer cases on behalf of the Institute.
authorize the HOD/Dr.S.S.Dhandapani, Asstt. Prof. Department of Neurosurgery sign the reply/affidavit/application etc. sign the power of attorney in favour of Ms.Nimrata Shergill, Assisting Advocate in the o/o of Sh.Rajesh Garg, Sr.Advocate."
The aforesaid noting was duly signed/approved by the Director, PGI on 24.11.2014 and from this document, it is amply proved that Dr.S.S.Dhandapani, Proff. Deptt. of Neurosurgery was duly authorized to sign the reply/affidavit/application etc. on behalf of all the Opposite Parties. Even all the doctors, as mentioned in the memorandum of parties, are working under one reputed Institute i.e. Post-Graduate Institute of Medical Education & Research (PGI), Sector 12, Chandigarh and taking care of the patients. So, we are of the considered opinion that there is no need to file separate replies and affidavits by the Opposite Parties and, as such, the objection raised by the Counsel for the complainants in this regard, has no relevance, at all and the same is rejected.
15. In Kusum Sharma & Others Vs. Batra Hospital & Medical Research Centre & Others, 2010(2) Civil Court Cases 015 (S.C.), the Hon'ble Supreme Court observed as under:-
"(1) Negligence is the breach of a duty caused 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. 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 highest level of expertise or skills in that branch which he practices. A highly skilled professional may be possessed of better qualities, but that can not be made the basis or the yardstick for judging the performance of the professional proceeded against on indictment of negligence."
16. In the case of Jacob Mathew (Dr.) Vs. State of Punjab & Anr.-III (2005) CPJ 9 (SC), it was held by the Apex Court, that a physician would not assure the patient of full recovery in every case. A surgeon cannot and does not guarantee that the result of the surgery would invariably be beneficial much less to the extent of 100% for the person operated upon. The only assurance which such a professional can give or can be understood to have given by implication is that he is possessed of the reasonable skill, in that branch of profession, which he is practising and while undertaking the performance of the task entrusted to him, he would be exercising his skill, with reasonable competence.
17. In Laxman Balakrishan Joshi Vs. Trimbak Bapu Godbole and Anr.-AIR 1969 SC 128, the Apex Court laid down the criteria for determination of the professional duty of a medical man. The Hon'ble Supreme Court held that 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 himself certain duties viz. a duty to care, in deciding whether, to undertake the case, in deciding what treatment to give or duty of care, in administration of that treatment.
18. In applying the principle of law, mentioned above, to the facts of the present case, it is to be seen, whether the doctors of the PGIMER, who attended the patient from the date of admission i.e. 17.03.2013 to the date of his death i.e. 09.05.2013, were guilty of any medical negligence or not. After giving our thoughtful consideration, to the rival contentions, raised by the Counsel for the parties and the evidence, on record, we are of the considered opinion, that there was no medical negligence on the part of the Opposite Parties and the complaint is liable to be dismissed, for the following reasons.
19. Admittedly, the deceased Col.R.K.Kapoor admitted in Alchemist Hospital on 23.01.2013 due to high grade fever with shivering and severe weakness for the last 5 days and he was discharged on 26.02.2013 vide discharge summary (Annexure C-1). It is also evident from the said record that the patient was a known case of diabetes mellitus, hypertension, chronic kidney disease. Annexure C-2 is a copy of Out Patient Card for emergency ward. From this document, it is proved that the patient was admitted in the Postgraduate Institute of Medical and Research, Chandigarh (PGIMER) on 17.03.2013. Annexure C-3 is a copy of the Out Patient Record. Annexure C-4 is a copy of the admission card dated 18.03.2013. From this document, it is proved that due to serious condition of the patient, he was admitted in the Department of Neurosurgery, PGI. Thereafter, series of tests were performed by the doctors of Opposite Party No.2, and prescriptions and tests results are Annexure C-5 (Colly.). Copies of the treatment and progress record of the patient are Annexure C-6.
20. There is no doubt in our mind that Dr.S.S.Dhandapani, Asstt. Prof. Department of Neurosurgery, PGIMER, Chandigarh was duly authorized by the Director of PGIMER to sign the reply/affidavit/application etc. He has submitted in his affidavit that the patient was managed appropriately with documented consultation of several doctors of various specialties of the institute including Neurosurgery, Nephrology, Urology (as mentioned in pages 41 and 42 of the complaint), Internal Medicine (pages 68 and 69 of the complaint), Endocrinology (pages 59 and 70 of the complaint), Cardiology (pages 62 and 64 of the complaint), Pulmonary Medicine (page 61 of the complaint), Psychiatry (page 43 of the complaint), Gastroenterology (pages 82 and 84 of the CR file), Hepatology (page 100 of the CR file), Critical Care Anesthesiology (pages 91 and 92 of the CR file) Radiology, and no doubt the deceased (Col.R.K.Kapoor) had multiple serious illnesses even before admission to PGIMER. The patient had been suspected to have Tuberculosis of the Spine based on clinic-radiological findings and started on Anti-tubercular Treatment (ATT) in a private hospital much before his admission in PGIMER. The patient was also suffering with Chronic Kidney Disease (Renal failure) on dialysis, urinary infection (Urosepsis/UTI), Pneumonia (Chest Infection), Septic Shock, Diabetes Mellitus, Hypertension Depression, Metabolic Acidosis, Liver dysfunction and Anemia, as per the discharge record of the private hosptial. The patient was brought to PGIMER Emergency on 17.03.2013 and he was admitted in private ward on 18.03.2013 as a special case circumventing the normal waiting time (Annexure R-1). He needed a regular monitoring and, therefore, on 23.03.2013 he was shifted to Neurosurgery Ward, where he was monitored round the clock. The patient needed ICU care on 25.03.2013, for which, Neurosurgery ICU bed was provided promptly against all the constraints. With the aforesaid treatment provided to the patient, there was improvement, so that he could be shifted out on 10.4.2013 to Neurosurgery Ward and later on 11.04.2013 to private ward. His condition was quite stable for 24 days. Subsequently, when the condition of the patient worsened on 06.05.2013, he was quickly transferred to Neurosurgery ICU but inspite of best efforts, he continued to deteriorate and succumbed to multiple organ dysfunction.
21. It is pertinent to mention here that the patient was managed with documented consultation of several doctors of various specialties with the highest level of coordinated multidisciplinary management. On various occasions, the family members were explained about the seriousness of the patient's conditions.
22. Dr.S.S.Dhandapani, Asstt. Prof. Department of Neurosurgery, PGIMER, Chandigarh further stated that there was readiness of the treating team in managing the patient as per the situation and in fact, they were racing against time and worked at breakneck speed in the best interest of the patient. The patient required dialysis and, as such, on 23.03.2013, he was put under dialysis for about 3 ½ hours, after which the patient did not gain consciousness and, thereafter, the Opposite Parties moved him from the private room to the general ward of Neurosurgery, so that he could be monitored on 24 hour basis by Neurosurgeons. On 26.03.2013 when the Opposite Parties administered another round of dialysis, the patient started vomiting blood on reaching the dialysis centre and, therefore, he was brought back to the Neurosurgery Department. The Opposite Parties submitted that the stand taken by the complainants that the Nephrology Department refused to take over the patient saying that the patient's spinal cord problem was to be treated by the Neurology Department, was wrong for the reason that the patient had multiple serious problems requiring multidisciplinary approach to the treatment.
23. It is also pertinent to note that various consultants of Department of Nephorology attended the patient regularly including Dr.Vinay Sakhuja, Dr.K.L.Gupta, Dr.Raja Ramachandran and Dr.Vivek Kumar. The patient required ICU during the stay at the hospital and proper round the clock care was provided at the Neurosurgery ICU. Had the patient been transferred to Nephrology, which did not have an ICU facility, such care would not have been feasible. All the required Nephrology services including dialysis were offered to the patient as and when required in the Neurosurgery ICU itself. It is proved from the evidence on record that the patient with multiple illnesses is usually kept under one department and other departments managed the patient under the admitting department. The location of the patient was determined as per the bed availability and logistics. The documented consultation of various doctors of various specialties including Neurosurgery, Nephrology, Urology, Internal Medicine, Pulmonary Medicine, Gastroenterology, Hepatology, Cardiology, Endocrinology and Psychiatry indicated the high level of coordination among the treating team. The allegation of the complainants that the development of lung infection was during the course of the patient's stay in PGIMER does not warrant any merit because even before admission to the PGIMER, he was having chest infection, urinary infection and septic shock even while getting treated prior in the private hospital, as per the discharge summary. The patient had diabetes mellitus, renal failure and paraparesis and, as such, he was immunologically weak and, therefore, predisposed to develop multiple infections including lung infection. Therefore, the development of infection cannot be attributed to negligence on the part of the doctors of PGIMER. Dr.Dhandapani denied the callousness and apathy of the Institute doctors. It was proved from the affidavit of Dr.Dhandapani, Opposite Party No.4 and the documentary evidence that it was incorrect on the part of the complainants to say that the patient was continued under ATT by the PGIMER but the correct situation was that the patient had already started on ATT even before coming to PGIMER and, as such, PGIMER was not negligent by placing him under ATT, while being treated there.
24. As per the standard practice, Anti-tubercular Treatment (ATT) had to be continued especially when there had been clinical response to it (ATT), with no evidence pointing to any other diagnosis and in consultation with several specialists, it was considered highly appropriate by PGIMER to continue ATT, which is a standard practice.
25. From the evidence on record it was not proved that any doctor in PGIMER treating the patient was evading his responsibility or was deficient in service since there had been a clinical improvement in the condition of the patient, as a result of ATT, as per the discharge records of the private hospital and the admission notes of PGIMER. The duty doctor at the PGIMER was always vigilant about the intake-output balance. The Nephrologist assessed the patient on 5.5.2013 and diagnosed that fluid level was not in excess, as the central venous pressure was only 1 cm of saline. The patient was advised fluids as per the hydration status, and was duly followed.
26. Dr.Dhandapani further stated in his affidavit that the patient had been suffering from renal failure even before the admission. The Nephrology residents and Consultants saw the patient on a regular basis. The patient was seen by Prof.K.L.Gupta on 21st March, by Prof. Vinay Sakhuja on 22nd, 23rd, 25th, 26th, 27th, 28th, 30th March and 1st April, Dr.Raja saw the patient on 23rd and 31st March and Dr.Vivek Kumar saw the patient on 3rd April. The patient was monitored round the clock. He further stated that the Department of Nephrology does not have an ICU facility and, hence the patient was managed in Neurosurgery Department, where the ICU facility was available. All the required nephrology services including dialysis were offered to the patient, as and when required and transfer to Nephrology would not have affected the ultimate outcome of this patient. As per standard clinical practice, requests were made by Neurosurgery Department for transferring the patient to Nephrology, but it could not be done due to bed constraints and logistics. PGIMER never compromised with the treatment of the patient.
27. In view of the above discussion, on the basis of the evidence on record, it is crystal clear that the PGIMER was not negligent in treating the patient. The very fact that the PGIMER is a multi-specialty hospital, which treats patients with various disorders under one roof and head according to as per its established norms and logistics. In the instant case, where the patient, who was admitted with various organ disorders, which required a coordinated method of treatment, was treated by the team of specialists in PGIMER, without any compromise, keeping in view the decade old tradition of affording best treatment from the best brains. The only insistence of the complainants was that the patient be transferred from Neurology Department ICU to Nephrology Department ICU, without knowing the fact and the method of treatment and logistics of PGIMER, which had explained clearly that there was no appropriate ICU at the Nephrology Department and all the critical care and the treatment was possible at the Neurosurgery ICU. It may be stated here that when Nephrology Department did not have any ICU facility, then the question to shift the patient to Nephrology Department did not arise. It is clearly proved that number of doctors of Nephrology visited the ICU of Neurosurgery Department and as and when the patient required dialysis, they did it in the ICU of Neurosurgery Department. When such facility was provided by the Nephrology Department to the patient in the ICU of other department, then it is clearly proved that the doctors of PGIMER coordinated with each other and worked like a team to provide best facility to the patients. The mere contention of the complainants to the contrary, does not prove any medical negligence on the part of the Opposite Parties and, accordingly, the complaint is liable to be dismissed.
28. For the reasons, recorded above, the complaint is dismissed, with no order as to costs.
29. Certified Copies of this order be sent to the parties, free of charge.
30. The file be consigned to Record Room, after completion.
Pronounced. Sd/- 20/02/2015 [JUSTICE SHAM SUNDER [RETD.] PRESIDENT Sd/- [DEV RAJ] MEMBER Sd/- [PADMA PANDEY] MEMBER rb