State Consumer Disputes Redressal Commission
Sri Vijendra Singh vs Max Balaji Hospatil & Ors. on 30 July, 2013
IN THE STATE COMMISSION : DELHI (Constituted under Section 9 clause (b)of the Consumer Protection Act, 1986 ) Date of Decision: 30.07.2013 Case No. C-08/05 SRI VIJENDRA SINGH - COMPLAINANT A-89, Harijan Basti, Kondli, Delhi-110096. Versus 1. MAX BALAJI HOSPITAL -OPPOSITE PARTIES 108 A Indraprastha Extension Opp Sanchar Apartments, Patpargaj, Delhi 110092. 2. Dr. Ashok Sabharwal Max Balaji Hospital, 108 A Indraprastha Extension Opp Sanchar Apartments, Patpargaj, Delhi 110092. 3. DR. S.K. TIWARI Max Balaji Hospital, 108 A Indraprastha Extension Opp Sanchar Apartments, Patpargaj, Delhi 110092. CORAM : S.A. SIDDIQUI - MEMBER (JUDICIAL) S.C. JAIN - MEMBER
1. Whether reporters of local newspapers be allowed to see the judgment?
2. To be referred to the Reporter or not?
S.Q. SIDDIQUI (ORAL)
1. Through this complaint, Sri Vijendra Singh has prayed for issue of direction to OP Hospital to pay a sum of Rs. 63,97,468/- as compensation and Rs. 15,000/- as cost of litigation.
2. It has been stated in the complaint that the complainant Vijendra Singh is a resident of Harijan Basti, Kondli and works as a Peon in All India Radio.
Respondent-1 is a private commercial hospital which is a unit of Balaji Medical and Diagnostic Research Centre registered under the provisions of the Societies Registration Act 1860. Respondent-2 & 3 are surgeons/doctors working with Respondent-1 who performed the surgery/operation on Mr. Naveen Kumar.
3. The Complainants son Naveen Kumar was an employee with the Housing and Urban Development Corporation (HUDCO).
On 8.11.2006 around 9.00 pm near the area Naveen Kumar was stabbed in the abdomen.
Immediately thereafter he was rushed to nearby Lal Bahadur Shastri Hospital (LBSH) by 9.15 pm where preliminary treatment was given and the medical examination was carried out. Copy of the medical record is annexed and marked as Exhibit A. Since LBSH was ill-equipped to bring appropriate medical treatment in critical cases like this, complainant and other relatives decided to move Naveen Kumar injured to a better Hospital. Therefore, Naveen Kumar, being critically injured was taken to Max Balaji Hospital OP-1 at around 9.45 pm. However, the doctor on duty in the emergency ward of OP Hospital did not attend the complainants son immediately and remained busy with other patients in the ward.
At around 10 p.m., doctor on duty examined the complainants son sent him to dressing room. The complainant was asked to complete necessary formalities for admission of the injured son in the Hospital. The admission formalities of the complainants son was done by around 10.17 pm. By around 10.15 pm, relatives and friends of the complainant had reached the OP Hospital. Since the condition of the Naveen Kumar was critical, the complainant asked the doctor on duty to commence operation. The complainant was informed by the doctor that surgeons were on their way and will be reaching shortly. When half-an-hour passed and surgeon did not reach, the complainant again enquired regarding commencing of emergency operation. He was again informed that surgeons were about to reach. It was only around 11.45 p.m., after two hours of arrival of the injured complainants son was moved into the ICU for emergency operation. Operation was performed by Dr. Sabharwal and Dr. Tiwari, Respondent-2 & 3 respectively.
Unfortunately, after operation, complainants son did not survive and was declared dead at 3.30 am on 09.11.2006.
Record of the OP Hospital is annexed as Exhibit B (colly). Subsequently, dead body was taken to LBSH for postmortem examination and PM Report is annexed and marked as Exhibit C. The OP Hospital issued a bill for a sum of Rs. 93,468.37, copy of which marked as Exhibit D.
4. It was alleged that the injured Naveen Kumar was in a critical condition, which warranted emergency medical treatment but two hours were wasted. The inordinate delay in providing prompt emergency medical treatment by the OP Hospital clearly amounts to gross medical negligence and the complainant was compelled to take legal recourse and therefore present complaint was filed. It has further been stated that in this regard, a medical opinion on the basis of the facts of the case were obtained by Dr.Sanjay Kumar in the form of an affidavit, which is being annexed and marked as Exhibit E. The untimely death of the complainants son has caused severe mental agony and pain apart from causing financial loss to the poor family. The deceased was supporting his wife, complainant and his mother who were residing together. The salary and income details of the deceased with HUDCO is annexed and marked as Exhibit F.
5. The OP Hospital and doctors are clearly guilty of deficiency of service within the purview of the Consumer Project Act, 1986 (herein after called the Act). The complaint is maintainable and the Commission has jurisdiction to entertain and adjudicate upon the complaint.
6. The OPs filed their written statement. The plaint allegations were denied.
It was alleged that the complaint was malafide, perverse and untenable and is liable to be dismissed. The complainant has not come with clean hands. He has deliberately tried to suppress the facts. It has been wrongly alleged that LBSH was inadequately and grossly ill-equipped. LBSH is 100 Bed Hospital + 12 beds in nursery + 5 beds in Labour Room and 12 beds in causality and 24 hours emergency and casualty services are available. It was also wrongly alleged by the complainant that his son was brought to OP Hospital around 9.45 pm. Discharge Summary of LBSH (4/5 KMs away from the OP Hospital) has recorded the fact that patient left LBSH at around 9.50 pm. They could not have reached the OP Hospital prior to leave from LBSH. It has further been falsely alleged by the complainant that the doctor on duty in the emergency ward did not attend the patient.
As a matter of fact, the patient moved at the triage of the OP Hospital at about 10.00 p.m. and casualty medical officer immediately attended. The patient/inured was examined and was immediately put to IV fluids, administered haemaccel, put him to oxygen, took the blood samples for investigation; and simultaneously gave emergency call to Respondent 2 & 3.
The CMO planned the treatment and procedure and filled up the admission request Form at 10.10 pm and the patient was formally admitted in the Hospital at 10.17 pm.
7. It has further been stated that Dr. Ashok Sabharwal and Dr. S.K. Tiwari (Respondent 2 & 3) reached the hospital at about 10.17 pm with the registration/admission of the patient. Both the doctors/surgeon examined the patient read the Discharge Summary of LBSH; while all resuscitation measures were being done and action was also taken for urgent surgical intervention which began at 10.50 pm. Efforts were done to replace the blood loss and haemaccel infusion was increased. Antibiotics were given along with oxygen therapy. Urinary bladder was catheterized. Simultaneously Anesthetic were called, action was also on hand for urgent surgical intervention which began at 10.50 pm. It was denied that surgical procedure started only at about 11.45 pm i.e. 2 hours after being brought to the OP Hospital. The complainants son was moved to the ICU for the emergency operation.
He was not taken to ICU to cut short the delay. As per surgical register of the OP Hospital, the patient was brought in the operation room at 10.50 pm. Thus, the complainant has unnecessarily and most immorally dragged the OPs in a frivolous complaint and he should be severely dealt with. The complainant has suppressed the material facts and deliberately not filed discharge summary of the LBSH. The real facts were that prior to patient admission at OP Hospital, he was taken to LBSH at 9.20 pm on 08.11.2006 with MLC made there with alleged history of stab injury right side abdomen. Patient was in severe hemorrhagic shock due to massive blood loss caused by stab injury. His Blood Pressure was not recordable. His pulse was not palpable. His SPO2 was 80%. The patient had multiple abdominal tauma involving the small intestine, large intestine, left kidney, rigt lobe of liver, inferior vena cava. The patient had gross haematuria (blood in urine). His condition was very critical. After some treatment at LBSH, his attendants left LBSH at 9.50 pm Against medical advice at their own risk.
Thereafter, the patient was brought to triage of OP No. 1 hospital on 08.11.2006 at about 10.00 pm for further treatment and management of the case. At arrival to OP Hospital, he was immediately attended by CMO on duty. The patient was found profusely bleeding and had hypotension. His BP was 60/40. The CMO on duty ordered for the investigations, blood samples were taken and sent for the investigation. Simultaneously, treatment was started by infusing IV fluids and Haemaccell to maintain requisite volume of blood. The patient was put on oxygen. Urinary bladder catheterized which revealed haematuria. Antibiotics were given. After being informed immediately, Dr. Ashok Sabarwal and Dr. S.K. Tiwari arrived who are well qualified surgeons.
Apart from being experienced, they are dedicated doctors. The complainant consented for surgery at about 10.30 pm. Thus the patient was shifted to operation thereafter within 50 minutes on arrival at triage. Thereafter, Anesthetist made the patient stable for the operation by infusing further IV fluids. It was denied that there has been any lack of care or medical negligence involved. There has been no negligence whatsoever all due care and caution were exercised in treating the patient. It is not a case of deficiency of any kind on the part of the Hospital or the Doctors, therefore, complaint is without merit and deserves to be dismissed with cost.
8. Parties led their evidence by way of the affidavit in support of their cases.
9. Complainant filed rejoinder wherein the facts stated in the complaint were reiterated. The complainant also filed evidence by way of affidavits of Dr. Sanjay Kumar, CMO at the Lok Nayak Jai Prakash Narayan Hospital, New Delhi (LNJP), Sh. Mukesh Kumar, Son-in-Law of Sh. Vijendra Singh, Ms. Reena Kumari, Daughter of Sh. Vijendra Singh, complainant, Ms. Asha Singh, Mother of the deceased and wife of the complainant. Sh. Sham Lal, Colleague of injured, Sh. Gajender Singh, family friend of Sh. Vijendra Singh, Complainant.
10. OPs also filed evidence by way of affidavit of Dr. Bobby Anand Chaurasia, Medical Supdt., Max Balaji Hospital OPW-1, Dr. Ashok Sabharwal, OPW-2, Dr. S.K. Tiwari, OPW-3 along with other documents besides expert opinion from MAMC, New Delhi, was also filed.
11. We have heard Ld. Counsel for the parties and perused the record.
12. It was argued on behalf of the complainant that his son Naveen Kumar, 26 years, was stabbed on 08.11.2006 at around 9 pm near Kondli. He was immediately rushed to Lal Bahadur Shastri Hospital (LBSH) by 9.15 pm. Preliminary treatment was given. Since LBSH was not adequately well-equipped to handle serious cases like this, Naveen Kumar was brought to the OP Hospital at 9.45 pm where doctor on duty in the emergency ward did not attend the injured, who was critical, till 10.10 pm. He was attended at about 10.10 pm and operation started at around 11.45 pm. Thus, the Hospital and its staff committed inordinate delay of over two hours in starting proper treatment. There has been misstatement on the part of the OP Hospital regarding timing of starting the operation. The point of dispute according to the complainants Ld. Counsel was that there was unjustified and inordinate delay in providing necessary life saving treatment. The complainant and his family members and friends decided to leave the LBSH because it was not well-equipped to deal with such cases on an urgent basis. Since complainants son was critically injured, he decided to admit his critically injured son to a better equipped hospital such as Max Balaji. Injured was brought to the OP Hospital at 9.45 pm. Relatives reached there at about 10.15 pm. Emergency surgery procedures began much after around 11.00 pm Emergency surgery was performed on Naveen Kumar injured after a lapse of about 2 hours after bringing him to the Hospital. It was emphasized that Hospital was surely at fault in not providing prompt emergency medical treatment for which the Hospital was duty bound. Inexplicably delay in providing requisite treatment and surgery procedure greatly lessened the chances of survival of the critically injured Naveen Kumar. Two hours delay was inexcusable particularly in a Private Hospital like Max Balaji. Provisions should have been made for availability of standby surgeon during the night. Losing ones son is the biggest tragedy a father can bear and it gives immense mental agony and pain. There has been deliberate misstatement on the part of the OP Hospital regarding timing of the operation and the time when it commenced. It is not the case of the complainant that the doctors who performed surgery procedures were incompetent or negligent. Hospital and its staff were certainly unjustified in making inordinate delay in starting life saving treatment which should have been much prompt. Therefore, Hospital and its staff were certainly guilty of deficiency and medical negligence.
13. It was also argued that affidavit of Dr. Sanjay Kumar clearly suggest that Hospital was negligent if it failed to start the operation for two hours from the time patient was brought to it.
Also expert opinion of Maulana Azad Medical College (MAMC) was entirely based on the documents submitted by the OP Hospital and thereby making it conform to the time line provided by the OP Hospital.
14. On the other hand Ld. Counsel for the OP argued that the patient was brought to the LBSH in critical condition. He was managed appropriately. Unfortunately, the complainant and his relatives decided to take him to the other Hospital against medical advice. The patient arrived at Max Balaji Hospital in critical condition at 10.10 p.m. He was immediately given resuscitative measures before being transferred to OT for surgery. The surgery started at 11.10 pm, an hour after his arrival to the Hospital. The expert Committee felt that this much of time spent in resuscitation and making operative arrangement was appropriate for an injury of this magnitude. Informed consent from the father was taken before surgery. Anesthetic and operative procedures were on as per accepted standards. Ld. Counsel argued and drew our attention towards the expert opinion given by the Committee, MAMC, which did not find any evidence for medical negligence. The only grievance of the complainant was that the Hospital and its staff made inordinate delay in providing necessary treatment which was totally baseless and false and in order to substantiate this false allegation, complainant has made wrong allegations and gave wrong timings. The complainant wrongly alleged that LBSH was not adequately equipped or it was ill-equipped. The complainant further left the LBSH against medical advice at their own risk. The complainant has further wrongly alleged that injured was brought at OP Hospital around 9.45 pm. Discharge summary of the LBSH (4/5 KMs away from Max Hospital) recorded the fact that patient left LBSH at 9.50 p.m., and therefore it was not possible for the complainant to have reached the OP Hospital at 9.45 pm. The complainant, therefore, made wrong allegation that emergency doctor did not attend the patient till 10.00 p.m. It was argued that patient arrived at triage of OP Hospital at about 10 p.m., and casualty medical officer (CMO) immediately attended. He was examined, the discharge summary of LBSH was read and patient was immediately put to IV Fluids administered haemaccell. He was also put to oxygen. His blood samples were taken for investigation and simultaneously gave emergency call to respondent-2 & 3 and filled up the admission request Form at 10.10 p.m. The doctors/surgeons arrived at 10.15 pm and operation was immediately started. All steps towards emergency surgical procedure were taken. Patient was stabilized. His pulse rate, blood pressure, Volumes of IV Fluids and haemaccell were enhanced. Antibiotics were added and oxygen was continued/enhanced. In view of the fact that kidney of the patient was damaged, he was put to catheraziation. The dressing put up by LBSH was removed. Pack in the wound which was bleeding was redress.
Anasthesiacs were called. The attendants were asked to arrange for 4 units of blood. It was also wrongly alleged that injured was taken to ICU around 11.45 pm for emergency operation. As a matter of fact, the Surgical Register of the Hospital shows that patient was straightway brought to OT/surgical room at 10.50 pm. At 11.00 p.m., high risk informed consent was obtained. At 11.10 pm Anesthetist made the patient stable for the operation by infusing further IV fluids and surgery started. The operative procedure performed on the patient was in line with the standard line of treatment. Patient was transfused four units of whole blood. Operation completed at 2.50 a.m. and the patient was shifted to ICU where inspite of all efforts of resuscitation he expired at 3.30 p.m due to cardiac arrest. Affidavits of Dr. Bobby Anand Chaurasia, Dr. Ashok Sabharwal and Dr. S.K. Tiwari were filed. The entire medical record of the patient with surgical registered which are duly maintained in ordinary course of business were filed. Expert Opinion dated 2.6.2011 sent by MAMC was also available on record also supports the OPs in entirety. There has been no negligence whatsoever either on the part of the Hospital, its staff or the surgeons. Prompt and requisite medical treatment was provided to the complainants son. The medical opinion of Dr. Sanjay Kumar filed by the complainant was not reliable as it was based on hear-say evidence and cannot be read in evidence. Incorrect information was provided by the complainant to Dr. Sanjay Kumar who started his opinion If such information is accurate Besides number of judicial opinion, Honble National Disputes Redressal Commission and Honble Supreme Court were available in support of the OPs arguments. The complaint, therefore, has no force and deserves to be dismissed with cost.
15. As per documentary evidence available on record, Naveen Kumar, 26 years was stabbed on 08.11.2006 at about 9.00 p.m near Kondli.
He was brought to Lal Bahadur Shastri Hospital (LBSH) by the complainant at 9.20 p.m. Naveen Kumar was critically injured, was in a state of shock. His pulse was less and BP less. Immediate resuscitation was undertaken alongwith the packing of the wound after reducing the bowel inside the abdomen. The relatives took him to Max Balaji Hospital at 9.50 p.m against medical advice. He reached at OP Hospital at 10.10 p.m.
16. On arrival, his pulse was 86/min and BP was 80/60mm of Hg. After resuscitation he was shifted to OP. Anesthesia was started at 11.00 p.m and surgery was started at 11.10 pm. Surgery was completed at 2.50 am and anesthesia ended at 3.00 am and the patient was shifted to ICU. As per expert opinion report, Exploratory laparotomy was performed through stab wound. The findings were noted as follows:
(1) Gush of fresh blood as soon as pack was removed (1.5 to 2 liters) (2) Clotted blood in paracolic gutter (3) Rent in Inferior venacava (1/2 cm) (4) Multiple perforation in lleum and jejunum extending to mesentry (5) Complete tear of Mid transverse colon.
(6) Injury Rt. Lobe of liver (7) Injury to left kidney Lower Pole 2/3rd transected.
Nephrectomy along with all the appropriate procedures was done.
Adequate amount of intra operative fluids were given.
Later patient developed cardiac arrest and failed to revive after CPR.
He was declared dead at 3.30 am on 9.11.06.
17. The Expert Committee constituted by MAMC has made the following observations:
(a) Patient was brought to LBSH in critical condition. He was managed appropriately. However, the patients relatives decided to take him to other hospital against medical advice.
(b) The patient arrived in critical condition at Max Balaji Hospital 10.10 pm. He was given immediate resuscitative measures before being transferred to OT for surgery.
(c ) Surgery started at 11.10 pm, an hour after his arrival at the hospital. The Committee feels that this amount of time spent in resuscitation and making operative arrangements is appropriate for an injury of this magnitude.
(d) Informed consent from the father was taken before surgery.
(e ) Anaesthetic and Operative procedures were all as per the accepted standards.
The Committee did not find any evidence for medical negligence.
18. In the opinion of the Committee, surgery started at 11.10 p.m., an hour of his arrival at the Hospital. The Committee was of the opinion that the amount of time spent in resuscitation and making operative arrangements is appropriate for an injury of this magnitude.
19. Hospital records are maintained in ordinary course of its functioning. There is nothing on record to suggest that the Hospital records were manipulated. The weight of evidence available on record heavily supports the version of OP-1 to the effect that the Hospital took one hour in its starting the emergency operative procedure and during intervening one hour necessary preparatory works were complete. When Naveen Kumar was brought to the OP Hospital, his condition was critical. After examination, measurements of BP, Pulse and necessary resuscitation, he was shifted to OT where Anaesthesia was started at 11.00 pm and as per hospital record, the surgery was started at 11.10 pm and was completed by 2.50 am. In all it took one hour in operating/starting surgery and there is no ground to differ from the opinion given by the Expert Committee that one hour delay was appropriate time for preparation in case of injury of this magnitude. The allegations of the complainant that injured was brought to OP Hospital around 9.45 pm and operation started around 11.45 pm after a lapse of two hours do not find support from documentary evidence.
According to discharge summary of the LBSH, complainant along with patient left the Hospital at 9.50 p.m. against the medical advice at their own risk. The assertion of the complainant that he along with patient reached at OP Hospital at 9.45 pm, therefore, appears to be incorrect. He could not have reached the OP Hospital before 9.50 pm, which was recorded as time of discharge. In all probability, he could not have reached the OP Hospital before 10.00 p.m. Under these circumstances, it is difficult to believe the assertion of the complainant that it took 2 hours in all starting the emergency surgery. From the available record, one hour time was lost before the surgery started and looking into the magnitude of the injury, the Expert Committee of the MAMC has found it appropriate and sufficient in making preparations.
20. In view of the above facts and circumstances, we cannot record a finding of deficiency or medical negligence on the part of the OP Hospital, its paramedical staff or the doctors/surgeons.
21. It is unfortunate that despite all efforts and prompt actions, the valuable life of a young person could not be saved. We fully agreed with the sentiments expressed by the counsel for the complainant that it was a biggest tragedy for the complainant losing his son, is a greatest loss in ones life which gives immense pain and agony to the kith and kins/family members of the deceased.
22. In excusable delay on the part of the doctors or the Hospital cannot be overlooked and pardoned but we have also to bear in our minds the difficulties faced by the Hospitals and doctors in providing prompt and quick remedy and relief to the suffering people who come to them day and night with a ray of hope that needful will be done. Honble National Commission and the Honble Supreme Court have taken cognizance of such facts and circumstances and have performed a balancing act which was utmost necessary. In Kusum Sharma Vs Batra Hospital and Medical Research Centre AIR 2010 Supreme Court 1250. It has been held: It is a matter of common knowledge that after happening of some unfortunate events, there is a marked tendency to look for a human factor to blame for an untoward event, a tendency which is closely linked with the desire to punish. Things have gone wrong and therefore, somebody must be found to answer for it. A professional deserves total protection. It was also observed that in some of the cases, accidents do occurred. In some of the cases, ailments are such which cannot be cured. In some of the cases, unknown intervening circumstances sets in.
23. In view of the above facts, circumstances and the legal position, we come to the conclusion that the complaint fails and is liable to be dismissed.
ORDER Accordingly, the complaint fails and is hereby dismissed.
However, in view of peculiar facts and circumstances of the case, the parties shall bear their own costs.
24. A copy of this judgement and order as per the statutory requirements be provided to the parties free of cost and thereafter the file be consigned to Record Room.
(S.A. SIDDIQUI) MEMBER (JUDICIAL) (S.C. JAIN) MEMBER rn