State Consumer Disputes Redressal Commission
M/S. Sanjukta Curatives (Nursing Home) vs Jyoshna Rani Ghose & Others on 31 December, 2007
STATE CONSUMER DISPUTES REDRESSAL COMMISSION:ORISSA:CUTTACK
STATE CONSUMER DISPUTES REDRESSAL COMMISSION:ORISSA: CUTTACK
FIRST APPEAL NO.711 OF 2005,
AND
FIRST APPEAL NO.746 OF 2005
From an order dated 28.09.2005
passed by the District Consumer Disputes Redressal Forum, Cuttack in
C.D. Case No.247 of 2004
FIRST APPEAL NO.711 OF 2005
M/s.
Sanjukta Curatives (Nursing Home),
Represented
through its owner
Dr.
Baidyanath Mishra, At- Bajrakabati
Road,
P.S- Mangalabag, P.O- Buxibazar,
Town/Dist-
Cuttack.
Appellant
-Versus-
1. Jyoshna
Rani Ghose,
Wife of Late Bijay Kumar
Ghose.
2. Biswajit
Ghose.
3. Debasis
Ghose.
4. Sibasis
Ghose.
5. Ashis
Ghose.
6. Jyotimayee
Ghose.
Sl.
Nos.2 to 5 are sons of Late Bijay Kumar
Ghose
and Sl. No.6 is the daughter of
Late
Bijay Kumar Ghose.
All
are resident of Sidheswarasahi,
P.O-
Tulasipur, P.S- Lalbag, Town/Dist- Cuttack.
Respondents.
For the Appellant : M/s. B.C. Das
& Assoc.
For the Respondents : M/s.
S. Mohanty & Assoc.
FIRST APPEAL NO.746 OF 2005
1. Jyoshna
Rani Ghose,
Wife of Late Bijay Kumar
Ghose.
2. Biswajit
Ghose.
3. Debasis
Ghose.
4. Sibasis
Ghose.
5. Ashis
Ghose.
6. Jyotimayee
Ghose.
Sl.
Nos.2 to 5 are sons of Late Bijay Kumar
Ghose
and Sl. No.6 is the daughter of
Late
Bijay Kumar Ghose.
All
are resident of Sidheswarasahi,
P.O-
Tulasipur, P.S- Lalbag, Town/Dist- Cuttack.
Appellants.
-Versus-
M/s.
Sanjukta Curatives (Nursing Home),
Represented
through its owner
Dr.
Baidyanath Mishra, At- Bajrakabati
Road,
P.S- Mangalabag, P.O- Buxibazar,
Town/Dist-
Cuttack.
Respondent.
For the Appellants : M/s. S. Mohanty
& Assoc..
For the Respondent : M/s. D.P. Parija & Assoc.
P
R E S E N T :
THE HONBLE SHRI JUSTICE R.K. PATRA,
PRESIDENT
A
N D
SHRI
SUBASH MAHTAB, MEMBER.
O R D E R
DATE: - 31ST DECEMBER, 2007.
The complaint was filed in the District Forum alleging medical negligence against the nursing home called Sanjukta Curatives (hereinafter mentioned as nursing home), represented by its owner Dr. Baidyanath Mishra. The District Forum held that the case of the complainants has been well established and, accordingly directed the nursing home with Dr. Baidyanath Mishra as its head to pay compensation of rupees 3,00,000/- together with cost of rupees 1,000/-. Being aggrieved by the said order, the nursing home has filed First Appeal no.711 of 2005. The complainants have filed First Appeal no.746 of 2005 contending that the compensation awarded by the District Forum is inadequate. Both the appeals being analogous, they were heard together and are disposed of by this common order.
2. Before going into the merit of the case, we may state that no oral evidence was taken in the District Forum. Considering the allegations made in the complaint, we examined the complainant no.3 (Debasis Ghose) who was cross-examined on behalf of the nursing home. Dr. Baidyanath Mishra had filed affidavit-evidence. He was cross-examined by the counsel of the complainants. We also obtained expert opinion from the Professor and Head of the Department of Medicine, S.C.B. Medical College and Hospital, Cuttack. Copy of his opinion was handed over to counsel for both parties. Misc. Case no.1892 of 2007 was filed on behalf of the complainants saying that the report submitted to this Commission does not bear any seal, name and designation and, therefore, Prof. Prasanna Kumar Das, Head of the Department of the Medicine should be summoned for being cross-examined. The submission of the counsel for the complainant that the report was not signed nor did it bear any seal has no basis. Such submission was made without being properly instructed.
Had the counsel verified the records, he would not have made such submission. The report was submitted by Dr. Prasanna Kumar Das, the then Professor & Head of the Department of Medicine, S.C.B. Medical College, Cuttack in official letter no.1095 dated 30.10.2007. It was signed by him and his opinion which was enclosed to the forwarding letter was also signed by him. When this fact was brought to the counsels notice he stated that he was merely supplied with the copy of the report and not the forwarding letter. The xerox copy which was given to him bore the initial of the doctor. The counsel is an officer of the Commission. As an advocate he owes a duty to make submission with responsibility on getting proper instructions. If he found that the report was not signed by him, how could he mention in paragraph 1 of the petition as follows;
That Prof. Prasanna Kumar Das, H.O.D. Medicine of S.C.B. Medical College and Hospital, Cuttack has submitted a report in pursuant to the order of this Honble Court.
We, accordingly, rejected the prayer as we considered it to be without merit. The counsel also did not submit any other reason for summoning him. It was open to the complainants to give contra expert opinion which they did not do. The case was adjourned to 26.12.2007 for hearing. On that date, the counsel for the complainant did not appear. We heard counsel for the nursing home and reserved order. Meantime, a memo was sent through post for adjournment on the ground that the counsel for the complainants is bedridden by enclosing a medical certificate. It is unfair on the part of the counsel to send the memo by post. If he wanted adjournment bonafide he could have got it mentioned through some of his friends or even by the complainant no.3 who was attending the proceedings earlier. The memo was sent by post to take the obvious plea that he was not heard. For the above reason, we reject the memo.
3. The person who died on 14.09.2003 in the nursing home was Bijay Kumar Ghose (hereinafter referred to as patient).
Complainant no.1 is his widow.
Complainant nos.2 to 6 are their children. Their case is that the patient was an operator (Group-C) under Telecom Department, Cuttack and was drawing salary of rupees 9,939/- per month. On 13.09.2003, he was admitted in the nursing home at 8.30 p.m. due to urinary troubles. Two hours after his admission, Dr. Baidyanath Mishra started medical check-up and treatment. The patient was kept in charge of a pharmacist who drained some food particles from his abdomen (stomach) through a syringe and tube. The attendants of the patient insisted that the doctor should be called, but no doctor was called. His blood pressure had fluctuating reading and on the next day morning at about 6.30 a.m., he died due to medical negligence.
4. The nursing home denied the allegation. Its case is that the doctor and his staff compounder were attending the patient. He was given best treatment taking into consideration his health condition. After his death, his family members raised hue and cry, for which police came and referred the matter to a Medical Board who opined that there was no negligence in treating the patient.
5. Perusal of the impugned order would show that the District Forum has not recorded finding of negligence against the doctor.
It held that the case of the complainants being based on preponderance of probability is well established.
6. Complainant no.3 Debasish Ghose is the son of the patient. He was examined on behalf of the complainants. He stated in his evidence that his father was taken to the nursing home on 13.09.2003 between 8 p.m. to 9 p.m. After some time of their arrival, a room was allotted to them.
Around 10.30 p.m., Dr. Baidyanath Mishra came and asked them to show medical papers of the patient. After going through them, he advised to get his urine and blood tested. He told them that the patient was all right and there was nothing to be worried and asked the sister of the nursing home to put him under saline. Thereafter he left. Around 12.30 a.m., there was inflammation in stomach. At that time, one Madan Mohan Mandal was there and he was requested to summon the doctor. Instead of doing it, he asked the complainants for papers and after going through them, he told that there was nothing to be worried and he replaced the saline. At about 1.30 a.m. when his father became restless, Mandal was requested to inform the doctor who was staying in the same premises.
According to the witness, Mandal told him that he himself is a doctor and there was no need to call Dr. Mishra.
He thereafter examined the stomach with stethoscope and called for another person to bring one syringe, bottle and one pipe. He inserted the pipe through nose of the patient and brought out water and some food particles from the stomach. He enquired whether the patient had taken any food. He was told that he had taken apples. Mandal told them that he had food poisoning and after removal of the food particles, his health had improved. After that, he left the room. Since the patient was found asleep, they themselves took rest in the same room. Around 5.30 a.m., her mother cried seeing colour of the body of the patient becoming blue. They immedicately called Mandal and after examining the patient, he called Dr. Baidyanath Mishra around 6.15 a.m. On arrival, the doctor told them that the patient was already died. He stated in his evidence that he lodged F.I.R. against the doctor alleging negligence. In the cross-examination, he stated that except saline, no medicine was given to him. The doctor did not suggest to take any medicine. He however admitted that in the bed head ticket at page-2, there is an endorsement 9.30 p.m., injection power safe 2 m.g. and injection human actrogin. He further stated that his father was suffering from diabetes, but he could not say the duration. He admitted that four days prior to the date of occurrence, his father had gone to Dr. A.K. Baliarsingh for consultation. He also admitted soon after the admission of his father, bed-head ticket was hung on the bed but he cannot say what were written therein. He further stated that they had taken the patient for better treatment because of the fact that Dr. Baidyanath Mishra is a renowned doctor.
He admitted that the doctor came and after examining the patient, recorded necessary endorsement in the bed-head ticket. He also stated prior to the date of occurrence, his urine and blood were examined, but he cannot say on whose advice such tests were done. He admitted that his father had urinary problems. On the date of occurrence, there was scanty urination and this was the reason why he was taken to the nursing home.
He further stated that his father had gone earlier for treatment to Dr. A.K. Baliarsingh who was one of the members of the Expert Body. He admitted that he gave it in writing that there was no necessity to have postmortem examination over the dead-body of his father.
7. Dr. Baidyanath Mishra who filed affidavit-evidence was cross-examined by the complainants. In his affidavit, he stated that the patient was brought to the nursing home on 13.09.2003 at about 9 p.m. in a serious condition by his wife and sons. His (doctors) nephew Sanjeev Mishra who came along with them introduced complainant no.3 to be his close friend. On being requested by the complainant no.3, the patient was provided with a stretcher and he was taken inside the nursing home and was allotted a bed. After collecting the history and treatment previously given to him from his son he recorded the same in the bed-head ticket.
He affirms that he personally examined the patient clinically, measured blood pressure and temperature and advised for certain tests which were recorded in the bed-head ticket. He noticed that the mental condition of the patient was not clear and was delirious and was having difficulty in respiration. He was with a catheter and he was suffering from urinary tract infection and there was frequent involuntary urination in the bed which he recorded in the bed-head ticket. In the nursing home, only three tests could be possible (random blood sugar, ICT for malaria and pulse oximetry tests) as it was night. There was no facility available in Cuttack for other tests during night. He prescribed 5% D.N.S., 2 bottles with insuline (human actrapid), 10 units in each bottle and injection power cef 2 gms. i.v. 12 hourly. The treatment was started soon after the tests (by 9.30 p.m.) and were recorded in the bed-head ticket which was hung on the bed of the patient. At about 11.30 p.m., his associate Dr. B.K. Mishra who is also a specialist in Medicine came to the nursing home to replace him for night duty. He advised ICT to be conducted to ascertain if the patient was affected with malaria as he was suffering from fever with rigour. On examination, he (the deponent) formed an opinion that the patient was probably suffering from septicemia which he recorded in the right hand side of the first page of the bed-head ticket. Dr. B.K. Mishra also agreed with him that the patient might be suffering from septicemia. He also recorded on the left side of the first page of the bed-head ticket.
Before he left the nursing home at midnight, he instructed the pharmacist Mandal to keep watch over the patient as he was very serious. He stated that there are two rooms in the nursing home for doctors, besides a duty room for the pharmacist and other staff. All these rooms are located within a distance of only a few feet from the patients cabin. They are all connected with intercom. At about 3 a.m., the patient complained of abdominal pain and distension. On the advice and under the direct supervision of Dr. B.K. Mishra, Mandal the pharmacist introduced a Ryles tube into the stomach of the patient and extracted 900 ml. of fluid from his stomach. After extract of stomach contents, the patient felt comfortable.
His B.P. rose to 100/70 mm. hg. which was good sign. At 3.30 a.m., 500 ml. of I.V. Fluid (RL) was given to the patient. Thereafter the patient felt comfortable and went to sleep. He denies that Ryles tube aspiration started at 1.00 a.m. and continued for three hours. He asserted that Dr. B.K. Mishra was in his duty room inside the nursing home upto 5.30 a.m., when he went to his living room in the first floor to attend the call of nature and refresh himself. At 6 a.m. Mandal informed Dr. B.K. Mishra over intercom that the temperature of the patient has suddenly rose to 1040F who advised him to start cold sponging which was done by Mandal. While cold sponging was going on, the patient suddenly collapsed. Dr. B.K. Mishra immediately reached the bedside and after examining the patient declared him dead. He further stated in his affidavit that after this, complainant no.3 Debasis Ghose, his brothers and other companions became furious and unruly, started damaging costly articles of the nursing home and they chased to assault Dr. B.K. Mishra and Mandal who rushed to the upstairs to save their lives and closed the door from inside. He immediately telephoned the police who arrived within half an hour in the nursing home. He reiterated in the cross-examination that he was on duty till 12 midnight and thereafter his son Dr. B.K. Mishra was on duty, although this fact was not mentioned in the written version. He also stated that the treatment given to the patient were recorded in the bed-head ticket. At 9.30 p.m., he was administered with injection and as twelve hours had not expired, there was no occasion to give next injection. At the time of admission of the patient, the SPO2 was normal. He was not asked go elsewhere for treatment and it was not considered necessary. He asserts that he had seen the patient twice before he left the nursing home in the midnight and his son Dr. B.K. Mishra remained on duty till the next day morning.
8. At this stage, we may refer the opinion rendered by the Expert Committee which was constituted due to the hue and cry raised on behalf of the complainants. The Committee comprised of Dr. A. Devi, HOD, Medicine, Dr. A. Baliarsingh, HOD, Endocronology and Dr. Nirupama Samantray, HOD, FM&T. The Committee in its report stated as follows :-
A patient named Bijaya Ku. Ghosh, aged 53 years was admitted to Sanjukta Curative on dt. 13.9.2003 at 9.30 p.m. (as there is a mention in bed head ticket that patient has received Amikacin 500 mg at 3 pm ). He was a case of Diabetes Mellitus and 22 units before dinner, along with Glyrce 2 mg.
Listril (2.5) mg. Tozaar 50 mg.
Dynapress (0.4) mg. once daily each.
Along with above medications he was receiving Gatimac (400( mg. grom 3.9.2003 prior to hospitalization and catheter was given for in voluntary micturation. He presented with altered sensorium and shortness of breath and was admitted to Sanjukta Curative with a provisional diagnosis of Septicemia. During admission his temp. was 990F and blood pressure was low i.e. 80/60 mm hg.
He was advised investigation like RBS, Blood Urea, Creatinine, Sodium, Poatassium, Urine routine and microscopic examination along with blood oxygen tension measurement, followed by treatment with 5% DNS 2 bottles along with Insulin H Actapid 10 units, Injection Powercer 2 gm IV. His random blood sugar at 9.15 pm was 253 mg/dl. ICT was negative and oxygen tension was 95%. On dated 14.9.2003 at 3 a.m. patient was examined and blood pressure was better 100/70 mm Hg and abdomen was distended for which Ryles tube as piration was done and aspirated 900 ml.
Again patient was re-examined by staff at 6 a.m. when temperature was 1040F and called for the doctor at 6.30 a.m. After this there is no mention regarding death of the patient in the bed head ticket or any cause of death has been mentioned.
The treating Physician of Sanjukta Curative has initiated proper and adequate treatment. There is no mention about the death of the deceased in the bed head ticket.
However, the opinion regarding the cause of death may kindly be obtained from the treating physician.
Sd/- Illegible Sd/- Illegible Sd/- Illegible Prof. A. Devi, Dr. A. Baliarsingh Dr. N. Samantray Prof & HOD, Medicine Assoc. Prof & HOD Assoc. Prof & HOD SCN Medical College, CTC Endocrinology, FM&T.S.C.B.M. SCBMCH, Cuttack H, Cuttack As mentioned above, this Commission by order dated 13.07.2007 sought opinion from the Professor and Head of the Department of Medicine, S.C.B. Medical College and Hospital, Cuttack. All relevant papers were made available to him. On perusal, Dr. Prasanna Kumar Das who was then Professor and Head of the Department of Medicine in S.C.B. Medical College and Hospital, Cuttack submitted his report which is as follows;
1. Copy of the prescription & bed head ticket of late Bijay Kumar Ghosh aged 53 yrs reveals the following:
(a) Mr. Ghosh was a diabetic on Human mixtard insulin twice daily and a hypertensive on listril & Tozar. He was admitted on 13.9.2003 at 9.30 P.M. with complains of fever with rigor 3 days and shortness of breath. BP-80/60 mm and altered sensorium. Pt. was on catheter, had UTI, with partial treatment. Diagnosed as UTI with Septicemia provisionally.
(b) He was given DNS with Insulin neutralization (H. Actrapid 10 units in each bottle) and antibiotics Powercef 2 g.m. I.V. 12 hrly.
(c) His blood sugar was 253 mg/dt at 9.15 P.M. and Spo2-95% and ICT-Neg.
(d) At 3 A.M. on 14.9.2007 Ryls tube aspiration done for abdominal distention.
(e) At 6 A.M. on 14.9.2007 Pt. had 1040F temp and sponging done.
(f) Patient died around 6.15 A.M. on 14.9.2003 and the cause of death was ascribed to be Septicemia due to uncontrolled Diabetes Mellitus & urinary tract infection.
(g) The time from admission to death ( 9.30 p.m. of 13.9.2003 to 6.15 a.m. of 14.9.2003) is 8 hrly & 45 minutes.
2. The medical expert Committee report given on 03.3.2004 by Prof. A. Devi the then H.O.D. Medicine, Dr. A.K. Baliarsinha, H.O.D. Endocrinology and Dr. Nirupama Samantaray, H.O.D. F.M.T. opined that the treating physician of Sanjukta Curative has initiated proper and adequate treatment.
OPINION:-
From the bed head ticket, cause of death certificate by Dr. Baidyanath Mishra & expert Committees report---- It is event the pt. Mr. Ghosh had uncontrolled diabetes and with evidence of fever, fall of B.P., hyperventilation, and abdominal distention was possibly having septicemia. The line of management initiated by the doctors at Sanjukta Curative was proper, but the time period was too short to get a beneficial response in a diabetic septicemic case.
There is no reason as to why we should not accept the report of Dr. Das. He is an expert in his field and there is nothing to doubt his credibility and competency.
It may be noticed that in the report of the Expert Committee which was submitted on police requisition, it was clearly indicated that the treatment initiated was proper and adequate. Dr. A.K. Baliarsingh, one of the members of the Committee had treated the patient prior to his admission in the nursing home. It assumes importance because he knew the condition of the patient. They unanimously opined that the treatment initiated at the nursing home was proper and adequate. Their opinion finds support from Dr. Prasanna Kumar Das, the former H.O.D. of the Medicine Department. The allegation of the complainants that no medicine etc. were prescribed is not true.
The bed-head ticket contains entries as to what medicines were prescribed and what treatment was given to the patient. The allegation that Mandal posed himself as doctor and treated the patient is not substantiated. On the other hand, the bed-head ticket shows that the patient was first examined by Dr. Baidyanath Mishra and after his departure in the midnight, his associate Dr. B.K. Mishra was looking after the patient. The refusal of the complainant no.3 to get the post-mortem examination of the dead-body indicates that they were not anxious to know the cause of the death. Considering the facts and circumstances and keeping in view of the opinion of the experts, we have no hesitation to hold that the complainants have failed to make out of a case of medical negligence.
9. In the result, we set-aside the impugned order and dismiss the complaint. As a result, First Appeal no.746 of 2005 filed by the complainants is dismissed and First Appeal no.711 of 2005 filed by the nursing home is allowed.
Records received from the District Forum may be sent back forthwith.