State Consumer Disputes Redressal Commission
The Director, Indira Gandhi Hospital vs Abraham P Simon on 17 February, 2021
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION THIRUVANANTHAPURAM First Appeal No. A/14/563 ( Date of Filing : 06 Dec 2014 ) (Arisen out of Order Dated 21/12/2013 in Case No. cc/449/2010 of District Ernakulam) 1. the director, indira gandhi hospital kadavanthara p.o, ernakulam 682502 ...........Appellant(s) Versus 1. abraham p simon kochuveetil house, kochuveetil lane, kadavanthara p.o, ...........Respondent(s) BEFORE: HON'BLE MR. JUSTICE SRI.K.SURENDRA MOHAN PRESIDENT HON'BLE MR. SRI.T.S.P.MOOSATH JUDICIAL MEMBER SRI.RANJIT.R MEMBER SMT.BEENAKUMARI.A MEMBER SRI.RADHAKRISHNAN.K.R MEMBER PRESENT: Dated : 17 Feb 2021 Final Order / Judgement KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, VAZHUTHACAUD, THIRUVANANTHAPURAM APPEAL No. 563/2014 JUDGMENT DATED: 17.02.2021 (Against the Order in C.C. 449/2010 of CDRF, Ernakulam) PRESENT: HON'BLE JUSTICE SRI. K. SURENDRA MOHAN : PRESIDENT SRI.T.S.P. MOOSATH : JUDICIAL MEMBER SRI.RANJIT. R : MEMBER SMT. BEENA KUMARY. A : MEMBER SRI. K.R. RADHAKRISHNAN : MEMBER APPELLANT: The Director, Indira Gandhi Co-operative Hospital Ltd., Kadavanthra P.O., Ernakulam-682 502. (By Adv. S. Reghukumar) Vs. RESPONDENTS: Abraham P. Simon, Kochuveettil House, Kochuveettil Lane, Kadavanthara P.O., Ernakulam. (Party in person) Dr. George Thomas, M.D., Indira Gandhi Co-operative Hospital Ltd., Kadavanthra, Kochi-682 020. Dr. Ayyappan Pillai, Surgeon, Indira Gandhi Co-operative Hospital Ltd., Kadavanthra , Kochi-682 020. (By Adv. K. Raja Raja Varma for R2 & R3) JUDGMENT
HON'BLE JUSTICE SRI. K. SURENDRA MOHAN : PRESIDENT The 3rd opposite party in C.C. No. 449/2010 of the Consumer Disputes Redressal Forum, Ernakulam (hereinafter referred to as the District Forum for short) is in appeal against the final order dated 21.12.2013 allowing the complaint. As per the order appealed against, the District Forum has found that there was deficiency in service on the part of the appellant. Therefore, the appellant has been directed to refund the treatment expenses received from the complainant as well as the expenses for his treatment at Medical Trust Hospital, Ernakulam. A compensation of Rs. 25,000/- has also been ordered. The complainant is the 1st respondent herein. Respondents 2 & 3 are the opposite parties 1 & 2, the doctors who treated the 1st respondent. However, they have not been held liable to pay any compensation. Therefore, they have not filed any appeal.
2. The complaint was filed in the following circumstances:
The 1st respondent, Mr. Abraham P. Simon was admitted to the appellant's hospital with complaints of chest pain. He was found to have suffered a mild Myocardial Infraction. He was admitted to the Intensive Care Unit on the date of admission itself. During the period of his treatment in the ICU there was extravasation of the IV line. As a result, he developed cellulitis and later on septicaemia. Though he was given first line treatment by application of an ointment and antibiotics his condition worsened. His blood urea as well as creatinine shot up indicating Renal failure. He was initially treated by the 2nd respondent and later on by the 3rd respondent also. When the Renal failure was detected, he was advised to get the treatment of a Nephrologist and was referred to the Medical Trust Hospital, Ernakulam.
3. According to the 1st respondent he was brought to the Medical Trust Hospital, in a critical condition. He was treated there as an inpatient for a number of days. He had to undergo Dialysis a number of times and thereafter, skin grafting surgery. Thus he had to be an inpatient at Medical Trust Hospital from 11.11.2009 to 21.11.2009, 27.11.2009 to 30.11.2009 and 07.12.2009 to 11.12.2009. He had to incur an amount of Rs. 83756.41 as expenses for his treatment and an amount of Rs. 5,000/- towards bystander expenses.
4. The 1st respondent contended that the extravasation was mismanaged by the appellant. That was the reason why he had developed Cellulitis which went on to develop into Septicaemia. The complications created could be sorted out only with great hardship and expenses. Therefore he claimed a compensation of Rs. 5,00,000/- as well as the expenses for his treatment from the appellant and respondents 2 & 3.
5. The appellant and respondents 2 & 3 contested the complaint by filing their versions. According to them, there was no deficiency in service on their part. They had treated the 1st respondent, exercising due care and diligence. Extravasation of the IV line is an occurrence that is frequent in all hospitals. Extravasation was detected without delay and first line treatment was also given to the patient immediately. However, since the 1st respondent was a diabetic patient he did not respond to the antibiotics initially administered to him. That was the reason why the Cellulitis and the subsequent Septicaemia occurred. The Extravasation could also have been caused by the movement of hands of the 1st respondent. Therefore, according to them there was no lapse on their part in treating the 1st respondent and he was not entitled to claim any compensation from them.
6. The parties adduced evidence in support of the above pleadings. Exts. A1 to A8 series documents were marked on the side of the 1st respondent and PWs 1 to 3 were examined as witnesses on their side. The opposite parties produced Ext. B1 document and examined DWs 1 to 3 as witnesses on their side. Exts. X1, X1(a) and X1(b) have also been marked.
7. The District Forum considered the contentions of the parties in the light of the evidence on record. It has been found that, respondents 2 & 3, the doctors who treated the 1st respondent, could not be found fault with for any lapse. However, since the Extravasation had happened when the patient was admitted in the Intensive Care Unit, the appellant was responsible for the lapses that led to the complications that followed. Therefore, the appellant has been held liable to compensate the 1st respondent. It is aggrieved by the said order that this appeal is filed.
8. According to Adv. George Cherian who appears for the appellant Extravasation is a common occurrence in every hospital. Most often, it is caused by the movement of hands by the patient himself. In the present case also it is likely to have been caused due to the same reason. It was immediately attended to with first line treatment of application of an ointment and administration of antibiotics. However, the 1st respondent who was diabetic did not respond to the treatment and that was the reason for the development of Cellulitis and Septicaemia. According to the learned counsel, there was timely detection of all the complications. When renal failure was detected, the patient was immediately referred to the Medical Trust Hospital which has a Nephrology Department, for specialized treatment. The learned counsel placed reliance on Ext. B1 case sheet of the Co-operative Hospital, Ext. A1 lab result and Exts. A5 & A6 discharge summary of the Medical Trust Hospital to contend that the records clearly established the prompt action initiated by the appellant and his staff. Therefore the District Forum erred in finding deficiency in service on the part of the appellant and ordering compensation.
9. The 1st respondent was represented by his son. According to him the 1st respondent had subsequently suffered a stroke and is bedridden. Therefore he offered to make submissions on behalf of the 1st respondent who had been contesting the appeal by himself. According to him, the sequence of events clearly showed negligence on the part of the staff of the appellant. The 1st respondent had been admitted to the Intensive Care Unit where no bystander was allowed to enter. The patients were being attended to by the nursing staff on duty in the ICU. The Extravasation was not noticed by them for a long time. Even when they noticed it, they did not remove the cannula, which is the first step to be taken to contain and manage the complication. It was therefore that Cellulitis set in and later on it developed into Septicaemia. Even after the renal failure was detected the patient was retained in the hospital until the next day when he was referred to the Medical Trust Hospital. Therefore, it is contended that the District Forum was fully justified in granting reliefs to the 1st respondent.
10. We have heard the respective counsel elaborately. We have gone through the records of the case in detail. We have given our anxious consideration to the contentions advanced before us. The points in dispute falls within a very narrow compass. It is not in dispute that the 1st respondent was admitted to the appellant's hospital on 30.10.2009. Since it was found that he had suffered a mild Myocardial Infraction he was admitted to the Intensive Care Unit on the same day itself. It is not in dispute that the Extravasation had happened within the ICU where no bystander is allowed to enter. A patient is admitted to the ICU only in a situation where his medical condition requires "intensive care". It is for his safety that no bystander is admitted. The care inside the ICU is given entirely by the hospital staff. The staff comprising mainly of the nursing staff and the duty doctor are expected to take care of the patient by closely monitoring the changes in his condition so that immediate responses to such changes could be ensured. However, in the present case the Extravasation took place within the confines of the ICU. By the time it was noticed and remedial action taken, Cellulitis had set in. Later on Septicaemia developed. The sequence of events lead us to the irresistible conclusion that the staff in the ICU were negligent. Had Extravasation been promptly detected and attended to, the development of Cellulitis could have been avoided. Patients admitted to an ICU are expected to be closely monitored by the nursing staff and treated with prompt care and attention. That does not seem to have happened in the present case.
11. Though the appellant contends that proper care and attention had been given to the patient in the ICU, no witnesses who had direct knowledge of the said facts have been examined. The nurse who was on duty in the ICU at the relevant time or the duty doctor whose responsibility it was to attend to the patient in the ICU has not been examined as a witness. The only two witnesses examined on the side of the appellants are respondents 2 & 3 who have no knowledge of what happened inside the ICU. They had attended to the patient only when they were informed of the complication, at a later point of time. Their assertion that due care was given cannot be accepted as the actual state of affairs. Therefore, there is absolutely no evidence to justify a conclusion that proper care had been given to the 1st respondent by the appellant. At the same time, the fact remains that the extravasation took place within the confines of the ICU and was undetected or was not attended to, until Cellulitis set in. The sequence of events is clearly indicative of negligence. Therefore, the District Forum was fully justified in arriving at the conclusion that there was negligence on the part of the appellant. .
12. It is true that, after Septicaemia developed leading to renal failure of the 1st respondent, he was referred for specialized treatment to the Medical Trust Hospital. It was only after he was given dialysis and subsequent skin grafting surgery that he was able to regain his health. Therefore, we find no infirmity in the order of the District Forum granting compensation to the 1st respondent. We find that the compensation granted is very reasonable, being confined to return of the amount paid by him to the appellant for his treatment and the expenses that he had to incur for his treatment at Medical Trust Hospital. The compensation granted is only an amount of Rs. 25,000/-. We find no grounds to interfere with the quantum of compensation also.
For the foregoing reasons, the appeal fails and is accordingly dismissed.
JUSTICE K. SURENDRA MOHAN : PRESIDENT T.S.P. MOOSATH : JUDICIAL MEMBER RANJIT. R : MEMBER BEENA KUMARY. A : MEMBER K.R. RADHAKRISHNAN : MEMBER jb [HON'BLE MR. JUSTICE SRI.K.SURENDRA MOHAN] PRESIDENT [HON'BLE MR. SRI.T.S.P.MOOSATH] JUDICIAL MEMBER [ SRI.RANJIT.R] MEMBER [ SMT.BEENAKUMARI.A] MEMBER [ SRI.RADHAKRISHNAN.K.R] MEMBER