State Consumer Disputes Redressal Commission
Shri Rakesh Kumar Aggarwal vs Escorts Heart & Super Speciality ... on 28 February, 2017
2nd Additional Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB
SECTOR 37-A, CHANDIGARH
First Appeal No. 672 of 2013
Date of institution: 19.6.2013
Date of order reserved:15.02.2017
Date of Decision: 28.02.2017
1. Shri Rakesh Kumar Aggarwal s/o Late Shri Brij Mohan Lal, resident
of Flat Number 6492, Sector B-9, Vasant Kunj, New Delhi - 110070
2. Mrs. Punam Aggarwal w/o Sh. Madhusudan Aggarwal (daughter),
resident of House No. 1064, Sector 16, Faridabad, Haryana.
3. Mrs. Indu Gupta wife of Shri Pardeep Gupta (daughter), resident of
NK 11-241, Charanjit Pura, Jalandhar City, Punjab.
Appellants Nos. 1 to 3 are dependents and legal heirs of deceased
Shri Brij Mohan Lal s/o Late Shri Sham Lal Aggarwal, resident of
Lawian Mohalla, Batala.
Appellants/Complainants
Versus
Escorts Heart & Super Speciality Institute Limited, Majitha Verka Bye Pass
Road, Amritsar.
Respondent/OP
First Appeal against the order dated 3.4.2013
passed by the District Consumer Disputes
Redressal Forum, Amritsar.
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member
Mrs. Surinder Pal Kaur, Member
Present:-
For the appellants : Sh. Parteek Gupta, Advocate
For the respondent : Sh. Jatinder Nagpal, Advocate
First Appeal No. 672 of 2013 2
Gurcharan Singh Saran, Presiding Judicial Member
ORDER
The appellants/complainants (hereinafter referred as complainants) have filed the present appeal against the order dated 3.4.2013 passed by the District Consumer Disputes Redressal Forum, Amritsar (hereinafter referred as the District Forum) in consumer complaint No. 119 dated 28.2.2007 vide which the complaint filed by complainant was dismissed.
2. Complaint was filed by complainant under the Consumer Protection Act, 1986 (in short 'the Act') against respondents/opposite party (hereinafter referred as Op) on the averments that family members of the complainant (hereinafter referred as patient) called Dr. R.K. Gupta of Manik Nursing Home on 23.2.2005, who prescribed some oral medicines and continued the treatment on 1.3.2005. She was advised to take to Op Hospital for check up. She was admitted there on 1.3.2005. On 2.3.2005, the patient quite recovered from her ailment and was given to understand that she will be discharged on the next day. Op performed ECG and Heart Echo of the complainant, which was reported to be normal. However, the Op suggested to undergo an angiography costing Rs. 15,000/-. Although this suggestion was resisted by the patient as there was no necessity of angiography and it was referred just to earn Rs. 15,000/- but on insistence of Op, complainant deposited a sum of Rs. 15,000/- on 3.3.2005. The angiography was performed negligently and carelessly as enormous flow of blood came from the cut made by the Doctor. No steps were taken to arrange for the stoppage of the blood and no First Appeal No. 672 of 2013 3 intimation was given and patient was shifted to ICU. Only for a limited time, the family members could go to the ICU. Moreover, the patient was made to have on Oxygen mask, therefore, unable to communicate with their family members. Haemoglobin of the patient was quite normal at the time of angiography and it dropped drastically and blood was transfused. Further it caused bed sores. Lastly Op expressed its inability to offer any treatment for the bed sores and she was discharged on 18.3.2005. Entire treatment of the patient after 2.3.2005 was due to negligent performance of angiography by Op. After that she took treatment in Sir Ganga Ram Hospital, New Delhi on 22.10.2015 and was discharged on 29.11.2005. She was again admitted there on 7.3.2006 and was discharged on 10.3.2006. She was again admitted on 17.3.2006 and was discharged on 19.3.2006 and lastly on 21.5.2006 and discharged on 26.5.2007. She was lastly received treatment in that hospital on 27.5.2007 and expired at New Delhi on 6.7.2007. The complainant spent approximately Rs. 5 lacs for treatment in Sir Ganga Ram Hospital, New Delhi. Although loss to the complainant is more than Rs. 20 lacs but she has restricted her claim to Rs. 20 lacs and Rs. 25,000/- as litigation expenses. Respondent be also directed to refund the bill amount of Rs. 1,40,000/- alongwith interest @ 12% p.a.
3. During the pendency of the complaint, complainant died and she was represented by her husband. Lateron Brij Mohan Lal also died and complainants were impleaded as his legal heirs.
4. Complaint was contested by Op, who in their written reply took the preliminary objections that complaint in this Forum was not First Appeal No. 672 of 2013 4 maintainable as it did not disclose any negligence or deficiency in service on the part of Op as developing of Haematoma at the site of angiography is known complication. On merits, Dr. R.K. Gupta of Batala had a talk with Dr. H.P. Singh, Medical Superintendent of Op Hospital. On 1.3.2005, patient Nirmal Aggarwal, 70 years old lady came to Op Hospital with a problem of breathlessness for the last 5 days with the history of Orthopnea and Odeama feet and was a known case of diabetes for the last 15 years and Hypertensive for the last 10 years. Echo Cardiography of the patient was done on 1.3.2005. On 2.3.2005, renal Doppler was done, which showed bilateral renal parenchymal disease of Grade-I with no renal artery stenosis. Keeping in view the history given by the patient, it was necessary to know whether she had any underlying coronary artery disease, accordingly, coronary angiography was done on 3.3.2005 after explaining everything, condition of the patient with its complications and implications and the patient voluntarily gave consent for the procedure. Angiography showed multiple plaques in LAD and LCX artery. Distal LAD showed 60% blockade and circumflex OM1 showed 70% Ostial disease. Patient was conservatively treated as the patient had respiratory depression, therefore, she was intubated and put on ventilator support. She was also transfused 12 units PRBC, 10 units SDPC and 2 units of FFP. The complainant responded well to the treatment and his platelet counts was normalised. Her subsequent stay in the hospital was uneventful and was discharged on 18.3.2005. It was denied that any fear was created in the mind of family members of the patient. There First Appeal No. 672 of 2013 5 was absolutely no malafide in recommending coronary angiography. It was denied that it was referred only to earn Rs. 15,000/- from the patient or her family members. The bill was raised according to the treatment given to the patient. It was denied that Haemoglobin of the patient had dropped drastically. There was no endless flow of blood without any detection. Nobody in Op Hospital expressed its inability to treat the patient. It was again reiterated that haematoma at the site of angiography is known complication of the procedure. The particulars of further treatment at New Delhi have not been given. The patient was looked after very well during her stay in the Op Hospital. The allegations made in the complaint are baseless. No case of medical negligence is made out against Op. Complaint is without merit, it be dismissed.
5. Before the District Forum, the parties led their respective evidence.
6. In support of his allegations, the complainant had tendered into evidence affidavit of Brij Mohan Ex. C-1, receipts Exs. C-2 to C-7, bills Exs. C-8 & 9, discharge slip Ex. C-10, treatment slip Ex. C-11, laboratory report Ex. C-12, consultation charges Ex. C-13, bill Exs. C-14 to 17, letter Ex. C-18, bill Ex. C-19, advertisement Ex. C-20, discharge card Ex. C-21, laboratory report Ex. C-22, diagnosis slip Ex. C-23, letter Ex. C-24, affidavit of Rakesh Kumar Ex. C-25, laboratory report Ex. C-26, discharge summary Exs. C-27, bill Ex. C- 28, discharge summary Ex. C-29, discharge slip Ex. C-30, bill Ex. C- 31, discharge summary Ex. C-32, bill Ex. C-33, laboratory report Ex. C-34, laboratory reports Exs. C-35 to 44. On the other hand, the OP First Appeal No. 672 of 2013 6 had tendered into evidence affidavit of Dr. H.P. Singh, Med. Supdt. Ex. R-1, medical record Ex. R-2.
7. Originally complaint was decided by the District Forum vide its order dated 1.4.2009 and dismissed the complaint for want of pecuniary jurisdiction. Its First Appeal No. 676 of 2009 was filed before the State Commission, which was decided on 19.8.2010. Appeal was accepted, it was held that the complaint false within the pecuniary jurisdiction of the District Forum. It was remitted back to the Forum for its decision on merits.
8. After remand of the complaint and going through the averments made in the complaint, written reply filed by Op, evidence and documents on the record, the complaint was dismissed as no case of medical negligence is made out against the Op.
9. Appeal No. 672 of 2013 was filed before this Commission, which was dismissed in default vide order dated 14.12.2015. However, in its Revision Petition No. 807 of 2016 preferred before the Hon'ble National Commission, in the interest of justice the impugned order passed by this Commission was set-aside and appeal was remanded back to this Commission to decide it on merits.
10. We have heard the counsel for the appellants Sh. Parteek Gupta, Advocate and counsel for the respondent/Op Mr. Jatinder Nagpal, Advocate and have carefully gone through the record of the District Forum.
11. It has been argued by the counsel for the Op that the District Forum erred in holding that there was requirement of doing angiography. There was excessive blood loss of the patient, which First Appeal No. 672 of 2013 7 was direct result of angiography. The District Forum also gravelly erred in holding that development of haematoma at the site of angiography is known complication. The District Forum also ignored the record that in the hospital of Op, the patient was held to be HCV +ve whereas it was held HCV -ve in Sir Ganga Ram Hospital. Excess dose of Lasix was given. Therefore, the order passed by the District Forum is liable to be set-aside.
12. It was argued by the counsel for the respondent/Op that as per the pleadings of the complainant, the patient originally took the treatment with Dr. R.K. Gupta of Manik Nursing Home, Batala and its OPD slip is 24.2.2015 (Ex. C-23). On diagnosis, she was having CHF and HD, diabetic hyper sensitive and accordingly, oral treatment was given to him and on 1.3.2005, she was referred to Op Hospital. Keeping in view the complaints of the patient that she was facing breathlessness for the last 5 days, being diabetic and hyper sensitive, angiography was recommended to explore everything about the condition of the patient, whether there was any underline coronary artery disease or not and accordingly, it was recommended and with the consent of the patient, it was done on 3.3.2005. Angiography showed multiple plain in LAD & LCS distal LAD showed 60% blockade. DM-I showed 70% distal disease of the patient was treated conservatively. In case his haemoglobin had fallen, blood units were transfused. In case the patient developed bed sores or blisters, it was due to the fact that the patient was in old age obessy suffering from diabetic hypertension and other diseases and was not outcome of angiography. Whatever treatment was required, it was given by Op First Appeal No. 672 of 2013 8 Hospital. There was no negligence on the part of Op Hospital. Complaint was rightly dismissed by the District Forum. Order passed by the District Forum be affirmed.
13. It was argued by the counsel for the appellants/complainants that the patient Nirmal Aggarwal as on 1.3.2005 was more than 70 years old with history of heart problem, obesity and hyper tension etc. And the Op ignored the condition of the patient and carried out aggressive treatment in the form of angiography, as a result of that there was increase in Urea and Creatine. When the patient was referred to Op Hospital before that she had been taking the treatment with Manik Nursing Home (Regd.), Batala with Dr. R.K. Gupta and his OPD slip is 24.2.2005 where the problem recorded by that Doctor, CHF (Congestive heart failure) and IHD (Ischaemic Heart disease) alongwith diabetic hypertension and conservative treatment in the form or medicines was given by the Doctor. She was also referred to ECG but during the period of one week, the condition of the patient was not stable, therefore, as a precautionary measure, the patient was referred to Escort Heart, which is a teritiary hospital. The patient was brought to Op hospital. At that time she was feeling heaviness in head i.e. breathlessness, swelling of feet and she was recommended for stabilization. On 1.3.2005, Echo test was done. In case heart muscles do not receive any adequate Oxygen, it will increase, it was 50.5 whereas normal is 0-25, therefore, it was double then the normal. It was repeated on 2.3.2005 and it was 48.7. Echo report is 55. Although normal is 60(-) 6.2%. On 2.3.2005, renal doppler was also done, which showed First Appeal No. 672 of 2013 9 bilateral renal parenchymal disease of Grade-I with no renal artery stenosis. Since the patient was not stabilizing, therefore, to rule out underlying coronary artery disease, coronary angiography of the patient was referred, which showed multiple plaques in LAD and LCX artery. Distal LAD showed 60% blockade and circumflex OM1 showed 70% Ostial disease. Patient was treated conservatively. Seeing the symptoms of the patient, the angiography was done to rule out any underlying coronary disease, therefore, in case the Doctor has referred and got done the angiography keeping in view the condition of the patient before undergoing the procedure, consent of the patient was taken. It cannot be said that it was not required. The complainant in his complaint as well as in the written arguments has stated that it aggravated the problem in the increase of urea, creatine, bed sores, blisters etc., however, he has not examined or referred any medical literature that in the given circumstances, angiography was not required. The angiography was performed by well qualified and experienced Doctor. For angiography, puncturing of the femoral artery through which cathetral inserted is required. It is only a diagnostic technique and not surgery. As the patient was having difficulty to pass deoxygenated blood through arteries, therefore, on the basis of evidence on the record in case to rule out any underlying coronary artery disease that procedure cannot be said to be a case of medical negligence.
14. With regard to increase in urea, creatine, haematoma, bed sores etc., the counsel for the complainant has referred to the test reports. In the patient file (Ex. R-2) and in the column of Bio- First Appeal No. 672 of 2013 10 Chemistry as on 1.3.2005, urea was 39.6 and creatine 1.42 and on 3.3.2005, it was 46.6, Urea and creatine 1.65. On 7.3.2005, urea increased to 119.5 and creatine 3.6. On 12.3.2010, urea 142.0 and creatine 2.10. On 18.3.2005 when the patient was discharged, Urea was 111.0 and creatine 1.46. Therefore, creatine level was controlled during the treatment in the Op Hospital and it was almost at the same level in which the patient had come to the hospital. For increase in urea, it is pertinent to mention here that renal Doppler was done on 2.3.2005 and B/L Grade-I renal parenchymal disease was found, therefore, it may be high due to some renal problem. Otherwise, this fact was not challenged by the complainant in his complaint, therefore, it cannot be challenged for the first time in appeal. Further the complainant has not produced any evidence that the medicines given by the Op were not upto the mark. Then it depends patient to patient how it respond to the treatment. Ops have done the angiography and increase of urea could not be said to be result of angiography. It may be due to other symptoms in the body and counsel for the complainant has not been able to pin point what type of bad treatment has been given by the Op, which resulted in increase in Urea. So far as haematoma, bed sores or blisters are there, it is pertinent to mention here that the patient is more than 70 years old lady, hypertensive diabetic and family history of Ischaemic Heart disease (IHD). She was known case of hyper tension for 10 years. In case this haematoma or any bed sore can be happen, it can be complications of the procedure and cannot be assigned as a case of medical negligence.
First Appeal No. 672 of 2013 11
15. An other fact has been highlighted by the counsel for the complainant that in the report of Op, it has been referred as HCV +ve whereas in the report of Sir Ganga Ram Hospital, it has been referred as HCV -ve. The report of Sir Ganga Ram Hospital is Ex. C-27. It is mentioned only in the discharge summary but the counsel for the complainant has not placed any diagnostic report wherein HCV was found negative. Moreover, Op Hospital has referred only in their record, on the basis of diagnostic report. It is so mentioned in the discharge summary Ex. R-2. Here also this fact was not challenged by the complainant in his complaint so that Ops could have placed on the record the report of Diagnostic Centre either of their own or any other Centre. When this fact was not challenged in the complaint, then complainant is debarred to take this plea in the appeal.
16. We are of the opinion that the District Forum has discussed in detail all aspects of the case and when they have rightly come to the opinion that no case of medical negligence is made out in view of our discussion referred above. We are of the opinion that the order passed by the District Forum is justified and we affirm it.
17. Sequel to the above, we do not see any merit in the appeal and the same is dismissed with no order as to costs.
18. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
19. Order be communicated to the parties as per rules.
(Gurcharan Singh Saran)
Presiding Judicial Member
February 28, 2017. (Surinder Pal Kaur)
as Member
First Appeal No. 672 of 2013 12