State Consumer Disputes Redressal Commission
Umesh Saxena vs Shyam Lal Nursing Home & on 19 November, 2007
IN THE STATE COMMISSION : DELHI IN THE STATE COMMISSION : DELHI (Constituted under Section 9 clause (b)of the Consumer Protection Act, 1986 ) Date of Decision: 19 -11-2007 Complaint Case No. C-64/1998 Mr. Umesh Saxena , Complainant S/o Late sh. R.K. Saxena, Through R/o 3148, Lal Darwaza, Mr. Naveen Kr. Bazar Sitaram, Choudhary, Delhi-110006. Advocate. Versus 1. Shyam Lal Nursing Home & Opposite Party No.1 Medical Research Centre Pvt. Ltd., 19, Ansari Road, Daryaganj, Delhi-110002. 2. Dr. Dr. V.K. Srivastava,, Opposite Party No.2 C/o Shyam Lal Nursing Home & Through Medical Research Centre Pvt. Ltd. Ms. Rashmi Virmani, 19, Ansari Road, Daryaganj, Advocate. Delhi-110002. 3. Dr, (Mrs.) Saroj Pandey, Opposite Party No.3 C/o shyam Lal Nursing Home & Medical Research Centre Pvt. Ltd., 19, Ansari Road, Daryaganj, New Delhi-110002. CORAM : Justice J.D. Kapoor- President Ms.Rumnita Mittal - Member
1. Whether reporters of local newspapers be allowed to see the judgment?
2. To be referred to the Reporter or not?
JUSTICE J.D. KAPOOR, PRESIDENT (ORAL) Complainant has alleged medical negligence and deficiency in service on the part of OPs and has claimed compensation of Rs.8,11,865/-.
2. Briefly stated, case of this complainant is that on February 19, 1997 at or around 3 P.M., the complainant suddenly felt uncomfortable and beginning of a chest pain escalated into severe chest pain radiating to left arm accompanied by sweating and numbness of face. The complainant was admitted by the OP No.1 at about 3.50 p.m and taken to ICU where the OPs administered Fortwin and Phenargan injections and allegedly gave the complainant Zolax tablets as a result of which the complainant lost consciousness and went into coma. The complainant continued in the state of coma till the night of February 21, 1997. In the early morning hours of February 22, 1997, to his utter shock and dismay brother of complainant was informed by Dr. (Mrs.) Saroj Pandey, OP No.3, that the complainants condition had deteriorated and that he was going to die in the next few hours. OPs did not inform the complainants brother earlier that the OPs were not capable of handling such cases. Dr. V.K. Srivastava, OP No.2, after preliminary observations suggested that in view of the complainants condition, complainants brother should forthwith take the complainant to a hospital, which was properly equipped. The complainant was admitted in the Apollo Hospital at around 5.30.a.m. and immediately upon arrival, life saving treatment was commenced by Apollo Hospitals doctors. Complainant finally regained consciousness on 5th March, 1997. The complainant had to also undergo a heart bye-pass operation. The OP s wrongful and negligent acts of commission and omission amount to medical negligence and deficiency of service as the OP s did not provide adequate and proper service and medical treatment but subsequently left the job incomplete and refused to provide any service or treatment as a result of which the complainant had to be rushed to another hospital at the last moment.
3. On the contrary OP No.2 denied any negligence and averred that immediately on admission of the complainant the following investigations and measures were taken to stabilize the condition of the patient:-
(i) Blood sample was taken before starting intravenous drip for Blood Sugar which was 109 mg per cent (to rule out diabetes).
(ii) Cardiac enzymes (CPK, CPKMB-SGOT were done and also requested for 20-02-1997 at 8 am) were taken which helps in confirmation of diagnosis of Myocardial Infarction (Heart Attack).
(iii) Blood sample was sent for kidney function i.e. urea and creatinine-
On admission full monitoring of pulse, blood pressure, temperature, respiratory rate, urinary output was done.
Liquid diet was allowed. Fluid and fluid intake and output chart was maintained on an hourly basis by the nursing staff in the ICU.
Besides this, other medication commenced included Intravenous Ranitin 50 mg eight hourly to prevent gastric ulcer/stress ulcer formation in stomach.
Zolax tablets was given to allay the anxiety and control the restlessness.
ASA 50 GR (low dose Aspirin tablet) 1 tablet daily was given (to prevent clot formation in the coronary artery).
Instructions were given to watch cardiac monitor which included blood pressure and rhythm disturbances (complication of heart disease/heart attack).
(iv) After managing the patient, the doctor personally spoke to the patients brother and relatives who were present and explained about the illness and his condition and steps taken, investigation done and possible future course of illness and complications, including risk to life.
(v) INVESTIGATION REPORT:
By evening investigations reports on the complainant were ready which showed * CPK 114 mg/dl CPK (MB) 26 mg/dl * SGOT 25 units/I SGPT 32 units/I * Urea 23 mg/dl Serum Creatinine/.70mg/dl
4. Further that on 19-02-1997 8.30 PM :
Prof. M.P. Gupta also saw the case. In the evening Prof. M.P. Gupta (Ex. Prof. Cardiology, Maulana Azad Medical College and G.B. Pant Hospital and Honorary Senior Consultant Cardiologist at Shyam Lal Nursing Home, Head of the Deptt. Of Cardiology, Sr. Ganga Ram Hospital, Delhi) was requested to see this patient and give his opinion and advice. He saw the complainant same evening and his comments were noted in case file in his own writing. It inscribes as Dr. M.P. Gupta Thanks for reference Examined and reviewed.
IHD Angina (Ischaemic Heart Disease with heart pain) Non-specific S-T change.
No M.I. (Myocardial Infarction that is no Heart Attack).
Enzymes WNL (within normal limits).
Well sedated 110/70 (BP), 100 regular (Pulse).
No. CHF (Congestive Heart Failure).
No. S3 or murmur (abnormal added sounds).
Lungs clear (no congestion in lungs) Advice X-ray Chest PA.
Add Carvediol 1-1-1(tablet to be taken three times a day).
Repeat enzymes CM (in the morning).
5. Thus, according to the learned counsel as per his observations, Prof. M.P. Gupta was agreeable and fully satisfied with the diagnosis and the line of management. As per his advise one tablet of carvediol three times a day was commenced and X-ray chest was done in the morning.
10. Learned counsel further contended that OP No.2 has gained vast experience in various fields of medicines and specialized in and have been practicing, cardiology since the year 1974 as elaborated in para 3 of his affidavit.
(i) That on 19-02-1997 at 3.30 p.m. complainant came to the OP No.1-hospital and was seen by OP No.2 as well as the resident Doctor. He was admitted with the complaint of chest pain, sweating and numbness for half an hour. He gave history of anginal attacks in the past. Hs family history revealed mother and father diabetic with Ischaemic Heart disease and that the complainant was a smoker and a drinker. The clinical examination of the complainant revealed the following:-
Patient was tense conscious afebrile (normal temperature).
Pulse rate 110 per minute regular.
Blood pressure 120/70 mm of mercury.
No pallor (paleness).
No jaundice (yellowish discoloration of eyes).
No cyanosis (no bluish discoloration of tongue, lips, nails suggesting poor oxygenation of blood).
No pedal oedema (no swelling of the feet).
Respiratory rate 20 per minue.
Chest both lungs clear (no congestion).
Cardiovascular system, central nervous system per abdomen examination-nothing abnormal detected.
(ii) That his clinical impression was Ischaemic Heart disease with Angina. The complainant was advised hospitalization. Immediately on admission, the complainant was taken to ICU where he was also examined by OP No.2, apart from being examined by the resident Doctors. Salient feature of history were obtained from the complainant and his brother as per notes contemporaneously recorded in case sheet. History revealed that patient had been suffering from Ischaemic Heart disease with Angina (heart pain due to lack of blood supply to heart muscle) for the last 3-4 years, and he used to have exertional angina on and off. He also mentioned that he was having pain in chest on and off since last night (18th) which got much worse on 19-02-1997 and was associated with sweating and restlessness. Family history revealed, that complainants father had suffered from Ischaemic Heart disease and Myocardial Infarction and died at the age of 48 years, while his mother had suffered with Diabetes and died at the age of 62. This history taken from the complainant and his brother indicated that he had been suffering from chest pain of heart original for the last three to four years and was having angina on exertion, but no previous records were shown.
(iii) That on admission clinical examination revealed that The patient was in agony and restless.
The heart rate was 88 per minute.
Blood pressure was 120/70 mm of mercury.
Cardiovascular, Respiratory, Abdominal examination normal.
(iv) Immediate management of the patient was started in ICU and consisted of Access to the venous line. Intravenous line started.
Intravenous 5% dextrose with Nitroglycerine drip was started (to improve the coronary circulation).
Injection Fortwin (15 mg) along with Phenergan 50 mg (half intravenously and half intramuscularly given to relieve the heart pain and agony).
Cardiac monitor was attached (for continuous heart beat monitoring).
100% oxygen inhalation was commenced through mask and nasal catheter.
The ECG was done immediately which was seen by the OP No.2 and reported as ST depression II, III, AVF, V5, V6 no changes of Acute Myocardial Infraction. ECG was ordered for 9 pm also.
(v) Following investigations were done:-
a.
Blood sample was taken before starting intravenous drip for Blood Sugar which was 109 mg per cent (to rule out diabetes).
b.
Cardiac enzymes (CPK, CPKMB-SGOT were done and also requested for 20-02-97 at 8 am) were taken which helps in confirmation of diagnosis of Myocardial Infraction (Heart attack).
c.
Blood sample was sent for kidney functions i.e. urea and creatinine.
(vi) That on admission full monitoring of pulse, blood pressure, temperature, respiratory rate, urinary output was done. Liquid diet was allowed. Fluid and fluid intake and output chart was maintained on an hourly basis by the nursing staff in the ICU. Besides this, other medication commenced included:-
Intravenous Ranitin 50 mg eight hourly to prevent gastric ulcer/stress ulcer formation in stomach.
Zolax (mild tranquilizer) tablets was given to allay the anxiety and control the restlessness.
ASA 50 GR (low dose Aspirin tablet) 1 tablet daily was given (to prevent clot formation in the coronary artery).
(vii) Instructions were given to watch cardiac monitor which included blood pressure and rhythm disturbances (complication of heart disease/heart attack). After managing the patient, the OP No.2 personally spoke to patients brother and relatives who were present and explained about the illness and his condition and steps taken, investigation done and possible future course of illness and complications, including risk to life.
By evening investigations reports on the complainant were ready which showed:-
CPK-114mg/dl CPK (MB) 26 mg/dl SGOT 25 units/l SGPT 32 units/l Urea23 mg/dl Serum Creatinine/70mg/dl.
(viii) That on 19-02-1997 at 8.30 p.m. Prof. M.P. Gupta, Ex-Prof, Cardiology, Maulana Azad Medical College and G.B. Pant hospital and Honorary Senior Consultant Cardiologist at Shyam Lal Nurshing Home, Head of the Deptt. Of Cardiology, Sir Ganga Ram Hospital was requested to see the patient and give his opinion and advice.
He saw the complainant the same evening and his comments were noted in case file in his own writing. It inscribes as Examined and reviewed.
IHD Angina (Ischaemic Heart Disease with heart pain) Non-specific S-T change.
No. M.I. (No Myocardial Infraction that is o Heart Attack).
Enzymes WNL (within normal limits).
Well sedated 110/70 (BP), 100 regular (pulse).
No CHF (No Congestive Heart Failure).
No S3 or murmur (abnormal added sounds).
Lungs clear (no congestion in lungs) Advice X-ray Chest PA.
Add Carvediol 1-1-1 (tablet to be taken three times a day).
Repeat enzymes CM (in the morning).
(ix) That as per observations of Prof. M.P. Gupta, he was agreeable and fully satisfied with the diagnosis and the line of management. As per his advise one tablet of carvediol three times a day was commenced and X-ray chest was done in the morning. OP No.2 saw the patient at 10.20 p.m. on 19-09-1997. Patient was having persistent chest pain. On examination Bilateral Crepitations all over both lungs fields (congestion and fluid collection in both lungs secondary to complication of Ischaemic Heart Disease) were observed. ECGs done at 3.30 p.m., 8.30 P.M. and 10.00 P.M. were reviewed. ECG done at 10.00 p.m. also showed appearance of Q wave VI-V4 and ST depression and T-inversion in chest leads as well. CPK and CPK (MB) reports were seen. This life threatening complication of Left Ventricular Failure was managed immediately and following, amongst other, steps were initiated:-
Propped up position (patients position between 45 degree to 60 degree which helps in easing off the breathing difficulty.
100% continuous oxygen inhalation with nasal catheter and mask (to improve the oxygenation of blood and relieve the respiratory distress).
Intravenous Frusemide (lasix) 80 mg was given (it relieves the congestion of the lung and increases the Urinary output and in turn helps in breathing) which is the main stay of the treatment.
Injection Pethidine and Phenargean were given intramuscularly to relieve the persistent pain and as a sedation.
Intravenous Nitro Glycerine was continued.
Strict intake output chart was maintained.
Continuous monitoring of heart beat, blood pressure, ECG monitoring, respiratory rate was maintained.
Advice was given by OP No.2 to get an X-ray chest PA, Cardiac enzymes CPK, CPK (MB), LDH, SGOT, ECG for 20th morning.
(x) That patient responded to the treatment and management satisfactorily and over night his condition was stable and was attended by resident medical doctor on duty. At midnight as per his notes Patient had repeated attacks of chest pains.
Sedation and analgesic were repeated.
Pulse was 120 per minute.
Blood pressure 96/80Chest crepitations present.
Cardio Vascular System and Central Nervous System was normal.
He advised to stop Nitro Glycerin Drip temporarily (due to fall of blood pressure) and to continue rest of the treatment.
(xi) That complainant was again examined by him at 12.15 a.m. when his pulse was 124 per minute and blood pressure 110/70, chest crepitations present and the Nitro Glycerine Drip was restarted (slowly). From admission till 20-02-1997 morning patient has been attended by nursing staff on 13 occasions (as per nursing notes). Nitro Glycerine drip was continued. Doctors attended the patient on 8 occasions. As per the notes the patient was conscious and was having pain in chest on and off. He accepted orally water, dalia etc. on several occasions. He passed urine on four occasions and his urinary output was 1100 cc (normal) in 16 hours that is till 20-02-1997 morning.
(xii) That in the morning of 20-02-1997 the patient was attended by the resident medical doctor and he noted down in his comments No recurrence of chest pains.
Pulse 118 per minutes.
BP 100/80 mm of mercury.
Chest crepitations present.
Cardio Vascular and Central Nervous System examination was normal.
His total fluid intake was 1250 cc and urinary output was 1100 cc.
He advised to continue same treatment.
An ECG was done in the morning, which showed ST elevation in V2-V5 suggestive of Acute Antero Septal Mycardial Infraction.
All investigations were done.
(xiii) That complainant was seen by OP No.2 on 20-02-1997 at 8.45 A.M. who reviewed the morning ECG which showed changes in Acute Antero-Septal Myocardial Infraction changes VI-V4 (confirmed the heart attack). Clinical examination revealed Tachycardia (fast heart rate) and crepitations both lung fields better than last night. No history of duodenal ulcer or bleeding tendency. Following investigations were advised and carried out:-
Prothrombin Time (to rule out any bleeding or clotting defect), PTTK (to rule out any bleeding or clotting defect).
Platelet count (to rule out any bleeding or clotting defect).
Liver function test : Serum Bilirubin, SGOT, SGPT.
Cardiac Enzymes :CPK, CPK (MB) and LDH.
Kidney function tests : blood ruea and creatinine.
Random Blood Sugar.
Urine routine and microscopic examination.
X-ray chest.
(xiv) That in view of acute Antero-Septral Myocardial infraction, young age of the patient, no history of duodenal ulcer, bleeding tendency was excluded and congulation profile was done and since the patients clinical condition was satisfactory and stable, his blood pressure was maintained at 110/80 mm of mercury, it was decided after discussing with his brother and relatives (who had already given consent for the treatment) in the interest of the patient to give benefit of Thrombolysis (reperfusion therapy).
Since Myocardial Infraction had evolved, patient was stable, vital signs were maintained IV Streptase (Streptokinase) 15 lakhs unit in 100 cc was given in one hour at 9 A.M. on 20-02-1997 along with Efcorline 200 mg and Avil injection 1 ampule was given intravenously to prevent allergic reaction to Streptokinase. No untoward reaction or complication of the said drug except mild transient Hypotension (fall of blood pressure, which is a usual feature after this injection) was noticed. ECG done later did not show any change except changes of acute Anteroseptal Myocardial Infractin. Injection Longiprin 3500 i.e. Subcutaneous twice daily to start after six hours of Streptokinase injection (which helps in preventing the clot formation) was advised. Instruction was given to watch for Arrythmia (Disturbance of heart rhythm). During the day patient was attended by RMO. At 1 P.M. as per notes -
General condition satisfactory.
Pulse regular (Tachycardia).
BP 90/76 mg of mercury Temperature normal.
Chest bilateral crepitation.
(xv) That in the evening at 6.45 p.m. the patients general condition was satisfactory as can be seen from the following observations:-
Pulse rate 124 minutes.
BP 90/62 mg of mercury Temperature normal.
Chest bilateral crepitating.
At 11 p.m. on 20-02-1997 the resident doctor attended the patient and noted General conditions satisfactory.
Pulse rate 130 per minute.
BP 90/70 mm of mercury.
Temperature normal.
Chest bilateral crepitatins.
No chest pain but patient had shivering for which injection Efcorlin 100 microgram was given intravenously.
(xvi) It is apparent from notes that on 20-02-1997 whole day and night patient was stable except chest pain on and off, mild left ventricular failure (crepitatins persisting). He was drowsy but rousable and the blood pressure fluctuated between 90 and 100 mm systolic. He was attended by nursing staff on 24 occasions when BP, pulse, respiratory rate and intake-output chart was maintained.
(xvii) That OP No.2-Doctor was called to see the patient by the resident medical doctor on duty at 2.00 A.M. of 22-02-1997 and his observations were Pulse 150 per minute.
BP 80 mm systolic.
Chest crepitatins present.
Cardiovascular system examination S1-S-2 presents.
After examination, ECG done which showed extensive anterior myocardial infraction.
IHD Acute Anteroseptal MI with Cardiognic Shock and LVF (Heart failure).
Waxing and waning condition.
Prognosis poor, explained to relatives.
ECG (2 am) V1-V6 ST elevation and T inversin, (Extensive anterior MI-further extension) Vomitted once?
Haemetemesis.
Tachycardia and Hypotension.
Chest bilateral Creptitations.
Treatment Patient under the effect of sedatin, continue same Dopamine drip.
100% oxygen inhalation.
Ryles tube in situ-check for GI bleed.
Continue Ranitin.
(xviii) After managing the patient at 2 a.m. OP No.2 explained the condition of the patient and prognosis to patients brother and relatives. Complainants relatives were informed and advised by OP No.2 that the complainants condition was waxing and waning situation and required invasive procedures and surgical interventions (coronary angiography/angioplasty/bypass surgery) and that the same should be performed at a hospital equipped to perform such procedures and interventions. In the interest of the complainant, the OP No.2 advised them to approach Escort/Apollo/Pant hospital (specialized invasive cardiology and cardiac surgical centers) for further continued management and invasive procedures and surgical interventions. On the request of the relatives, for further management of the complainant, it was decided to shift the complainant to Apollo hospital and accordingly the cardiac ambulance (its team with doctor) was called from Apollo Hospital and he was shifted to Apollo hospital on 22-02-1997 in the early hours.
6. In support of administration of two medicines namely Fortwin/Phenargan as a result of which complainant allegedly lost consciousness and went into coma, the counsel for the OPs has contended that these medicines were given to the patient for relief of chest pain as per medical literature-
Relief of pain and Anxiety.
Oxygen and Narcotics. The pain and anxiety which accompany a myocardial infarction stimulate an excessive autonomic nervous system response. This increases the metabolic demands of the myocardium. Oxygen administered by mask or nasal prongs is used routinely. The most effective means of alleviating or at least reducing pain is to reestablish patency of the occluded coronary artery. Unfortunately, reperfusion techniques remain the drug of choice in initial attemps to relieve pain.
Meperdine (Demerol), or preferably morpine sulfate, should be administered slowly intravenously at 15-min intervals until pain is sufficiently reduced or toxicity appears. The dose of meperdine is 25 to 50 mg and the dose of morphine is 4 to 8 mg. The reduction of pain and anxiety produced by these drugs will reduce the metabolic demands of the myocardium and may aid in limiting the size of the infarction.
7. As regards prescription of injection Streptokinase the learned counsel referred to the medical literature Chapter 52B Pharmacologic Therapy of Atherosclerotic Coronary Heart Disease that such an injection is given for chest pain verging on the heart problem.
Effect of Thrombolytic Therapy on Infract Size Morbidity, and Mortality (Chapters 53C, 101 and 134).
The most important advance in the treatment of acute myocardial infarction in this decade has been thrombolytic therapy. Although a large number of thrombolytic agents are undergoing clinical trails, only treptokinase and recombinant tissue plasminogen activator (rt-PA) have been approved for use in the United States.
The initial success of thrombolytic therapy was with intracornary streptokinase, in which clot lysis was achieved in approximately 75 percent of the patients with acute myocardial infarction. Based upon results from experimental myocardial infarction and from clinical trials in man, it is now apparent that, in most cases to limit infarct size thrombolytic therapy should be administered within 4 hours of onset of myocardial infarction. The intravenous administration of streptokinase results in clot lysis rates of 35 to 50 percent.
Indications, Dose Regimens, and side effects of Thrombolytic Agents (see Chapters 53C, 101 and 134.
Studies are still ongoing to define precisely which patients with acute myocardial infarction would benefit from thrombolytic therapy. However, the following guidelines reflect current knowledge:-
1.
Intravenous thrombolytic therapy is preferred over intracoronary therapy because the intravenous route can be given at all local emergency rooms and delay caused by performing ciardiac catheterization outweighs any therapeutic benefit of delivering the agent directly intracoronary(Table 52-B2).
2. At present rt-PA is recommended as the thrombolytic agent of choice, but streptokinase is an acceptable and less expensive alternative, especially in patients treated early (in two hours or less after symptoms develop).
8. Final report showing blockage of three arteries shows that they should not have reached because of the administration of aforesaid medicines or injection.
9. In order to show negligence as to the wrong treatment given by the OP hospital at the time of admission of the complainant the complainant has produced and proved the following documents:-
(i) Ex. PW 1/16 is discharge summary of OP No.1 showing Blood Pressure as 120/80 and pulse as 110 at the time of admission.
(ii) Ex. PW 1/17 is the admission slip of Apollo Hospital wherein the blood pressure has 45/30 and the pulse rate as 48.
(iii) Ex. PW1/38 is the discharge summary Apollo Hospital.
10. Main contention of learned counsel for the complainant revolves around the sudden fall in the blood pressure and pulse rate. The reading of blood pressure and pulse rate by the Apollo hospital shows that the blood pressure and pulse rate was decreased due to administration of wrong medicine and injection which was not a proper cure for chest pain. It is further contended that the complainant was discharged at 2.00 A.M. for going to Apollo Hospital and this itself is evidence showing that condition of the complainant was not normal nor was the blood pressure or pulse rate shown in the discharge summary correct. It was shown with a view to absolve itself from the deficiency whereas the facts remains that when the complainant was being taken to Apollo hospital he went in coma and was immediately put on ventilator.
11. To ascertain the medical negligence, certain criteria have been drawn by us from various decisions starting from Bolams case and followed by catena of decisions of Supreme Court. These can be summed up in the form of following queries? Decision will depend upon the answers:-
(ii) Whether the treating doctor had the ordinary skill and not the skill of the highest degree that he professed and exercised, as everybody is not supposed to possess the highest or perfect level of expertise or skills in the branch he practices?
(iii) Whether the guilty doctor had done something or failed to do something which in the given facts and circumstances no medical professional would do when in ordinary senses and prudence?
(iv) Whether the risk involved in the procedure or line of treatment was such that injury or death was imminent or risk involved was upto the percentage of failures?
(v) Whether there was error of judgment in adopting a particular line of treatment? If so what was the level of error? Was it so overboard that result could have been fatal or near fatal or at lowest mortality rate?
(vi) Whether the negligence was so manifest and demonstrative that no professional or skilled person in his ordinary senses and prudence could have indulged in?
(vii) Everything being in place, what was the main cause of injury or death. Whether the cause was the direct result of the deficiency in the treatment and medication?
(viii) Whether the injury or death was the result of administrative deficiency or post-operative or condition environment-oriented deficiency?
References :-
(i) Bolams case reported in (1957) 2 AII ER 118, 121 D-F
(ii) Sidway V. Bethlem Royal Hospital Governors and Others 643 All England Law Reprots (1985) 1 All ER.
(iii) Maynard V. West Midlands Regional Health Authority 635 All England Law Reports (1985) 1 All ER.
(iv) Whitehouse V. Jordan and Another 650 All England Law Reports (1980) 1 All ER.
(v) Indian Medical Association Vs. V.P. Shantha & Others (1995) 6 SCC 651.
(vi) Jacob Matthew Vs. State of Punjab and Another (2005) SCC (Crl.) 1369.
12. As is apparent, the deficiency in service by service provider like hospital is of varied kinds. In common parlance, medical negligence is understood as negligence of the treating doctor as to the line of his treatment being not as per medical procedure, or deficiency or negligence in operating the patient causing complications of various kinds. Similarly, there is medical negligence on the part of the doctor who undertakes the treatment of a patient for a disease which he is not competent to deal with or does a thing which he is not required to do and does not do a thing which he is required to do. However, the definition of deficiency provided by Sec. 2(1)(g) of the Consumer Protection Act, 1986 is so wide that it also takes in its fold the administrative deficiencies of the hospital. For instance, not providing blood to a patient who could die if blood transfusion is delayed for some time or not providing oxygen cylinder for want of which the patient is likely to suffer, some time fatal, or admitting the patient in the Nursing Home or hospital knowing it well that the doctors who are specialized and skilled for treating the patient are not available for some reason or the other. Sometimes, sanitary conditions of the hospital are so bad that it contributes to the worsening condition of the patient. Sometimes, the wherewithal and paraphernalia of the hospital who have very high reputation and claims themselves to be a five star or seven star hospital are not adequate.
13. After according careful consideration to the rival claims and contentions of the parties we deem that the main grievance of the complainant is that when he walked in the OP nursing home with a pain in the chest he was administered wrong medicine namely Fortwin and Phenargan injections and Zolax tablets as a result of which he lost consciousness and went into coma,. The counsel has referred to the discharge summary prepared by OP No.1-Hospital which showed that the blood pressure of the complainant was 120/80 and pulse rate was 110 showing that the complainant was having normal pulse rate and normal blood pressure and also general condition as satisfactory. If it was so how and for what reason the blood pressure/pulse became so low that he started sinking. No convincing explanation has been provided by the learned counsel for OP nor from the medicalliterature referred her. There is no other inference as drawn by Apollo that this phenomenon was solely due to wrong medicine particularly the injections of Fortwin and Phenargan or administering the medicine Zolax. Otherwise no patient being referred to another hospital for further treatment with blood pressure of 110/80 and pulse rate of 110 and his general condition being satisfactory would on reaching the said hospital record blood pressure 45/30 and pulse rate 48. Immediately life saving treatment was started. He regained consciousness on 05-03-1997 i.e. after about 10-12 days.
In this regard the discharge summary issued by Apollo Hospital shows that the patient was received at the Hospital with acute Antero-Septral Myocardial Infraction and was managed with IABP life saving medicine.
14. From the aforesaid facts we find the OP guilty for limited deficiency in administering injection or medicine Zolax which instead of alleviating the livid pain caused restlessness and as a result patient was shifted to Apollo hospital and was given life saving treatment there. Fortunately the life of the complainant was saved after more than 10-12- days long treatment.
15. Taking over all view of the matter and the nature of deficiency, sufferings and mental agony, expenses incurred by the complainant, we deem that lumpsum compensation of Rs. 50,000/- would meet the ends of justice.
16. Payment shall be made within one month from the date of receipt of this order.
17. Complaint is disposed of in aforesaid terms.
18. Copy of the order, as per the statutory requirements, be forwarded to the parties free of charge and thereafter the file be consigned to Record Room.
19. Announced on 19th November, 2007.
(Justice J.D. Kapoor) President (Rumnita Mittal) Member jj