State Consumer Disputes Redressal Commission
Dr. P. Subbukani, M.B.B.S., M.Ch., ... vs Velammal Medical College Hospital ... on 19 March, 2024
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IN THE CIRCUIT BENCH OF THE TAMILNADU STATE CONSUMER DISPUTES REDRESSAL
COMMISSION, MADURAI.
Present: THIRU. S.KARUPPIAH, PRESIDING JUDICIAL MEMBER
C.C.No.39/2018
Date of complaint filed : 10.12.2018
Date of orders pronounced : 19.03.2024
1. Dr.P.Subbukani, M.B.B.S.,M.CH.,
2. Mr.S.Nishanth,
S/o Dr.P.Subbukani,
3. Ms.S.Nandhini,
D/o Dr.P.Subbukani,
All the complainants are residing at
No.792/2, Roja Street,
Ayyappan Nagar,
Iyer Bunglow,
Madurai - 625 014. Complainants
-Vs-
Velammal Medical College Hospital
Research Institute,
Through its Dean,
Velammal Village,
Madurai - Tuticorin Ring Road,
Anupanadi, Madurai - 625 009. Opposite Party
Counsel for Complainants - 1 to 3 : Mr.M.Karthick, Advocate.
Counsel for Opposite Party : Mr.S.Mariappa Murali, Advocate.
This complaint came before me for final hearing on 05.01.2024 and on hearing
the arguments of both sides and upon perusing the material records this Commission
made the following:-
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ORDER
THIRU.S.KARUPPIAH, PRESIDING JUDICIAL MEMBER (OPEN COURT).
1. The complainants' case: The complainant one Dr.Theivanai since deceased was the wife of the first complainant, and mother of the second and third complainants. On 07.04.2018 the patient Theivanai suffered giddiness and palpitation. So she was admitted at A.R.Hospital then she was discharged on 14.04.2018 from A.R.Hospital. Again she was admitted at Mithra Hospital on the same day, and later discharged on 20.04.2018 with a referral letter to the opposite party hospital. The above deceased suffered continuously from a disease called SLE (Systemic lupus erythematosus). She was referred for better management and for advanced care of her above disease. The opposite party Hospital management assured the complainants, that they had an expert Rheumatologist in their panel and can avail his service. Only Rheumatologist can treat the above disease. Eventhough the patient was admitted in the hospital from 20.04.2018 to 18.05.2018, no Rheumatologist attached with the hospital have treated the patient. On the other hand the complainant procured the service of one Rheumatologist and he found the hospital authorities, had withdrawn the medicines administered for SLE without knowing the consequences. So the condition of the patient become deteriorated. The complainants shifted the patient to Apollo hospital and after prolonged treatment she was discharged on 11.07.2018. However the above patient died on 10.11.2018. As the opposite party did not take proper care, and did not provide medical treatment they have committed medical negligence. Hence the complainants filed a consumer complaint seeking the opposite party to pay 3 Rs.25,00,000/- as compensation for mental agony, and to refund of Rs.4,49,000/- towards treatment expenses, and to pay Rs.11,32,004/- towards the complainant paid at M/s.Apollo Hospital, and to pay Rs.5,00,000/- towards subsequent medical and other allied expenses after discharge from M/s.Apollo Hospital and also Rs.50,000/- as costs of the proceedings.
2. The opposite party in their written version submitted that their hospital is a very well equipped hospital with specialists doctors in all fields. The complainant and deceased are all doctors. They very well know that a Rheumatologist was attached with the hospital but they pressurized the opposite party to allow them to have the service of a Rheumatologist of their choice. So that a Rheumatologist of the complainant's choice was allowed to see the patient and prescribe medicines. The Rheumatologist's instructions medicines were thoroughly followed by the opposite party. The patient was admitted in the opposite party hospital, not only for her SLE disease, but, infact, at the time of admitting in the opposite party hospital she had severe debilitating complication of the disease (Posterior Circulation Stroke) even before she was presented to opposite party hospital. MRI Brain was taken, which showed left AICA and PICA acute infarct. Patient had abdominal pain. CT Abdomen was taken which showed Renal calculus and left nephrostomy was done and pus was sent for culture sensitivity which showed extra pulmonary TB and started on ATT. So she was treated well in the hospital for the above disease. She need continuous medical supervision. But inspite of that the complainants requested for discharge and she was discharged against medical advice. So there is no 4 medical negligence or carelessness on their part and requested this Commission to dismiss the complaint.
3. In this complaint, the complainants were examined as PW1 by filing proof affidavit and Exhibits A1 to Ex.A12 were marked. No documents were marked on the side of the opposite party.
4. In this case, both sides filed their written arguments and their oral arguments were also heard by this Commission.
5. Both the learned counsels took much effort to bring forth all the facts of their respective cases. The learned counsel for the complainants would submit that even before admission in the opposite party/hospital the deceased Theivanai was treated by A.R.Hospital and Mithra Hospital and at the time of admission in the opposite party/hospital her condition was very stable. The above patient was admitted only for the treatment for her disease SLE. The above disease SLE which is auto-immune in nature for the bodies, where bodies shown immune system attacks various organs or cells of the body causing multi system damage. The above disease has to be attended and can be treated only by a Rheumatologist. The opposite party made the complainants to believe that they are having specialists in Rheumatologist. But actually they did not took adequate care. By non administering medicines without advice of any Rheumatologist, the condition of the patient become worst and she again suffered severe second episode of brain infarction. At least at the time was also she has to be evaluated by Rheumatologist immediately, but it was not done by the opposite party 5
6. The complainants' counsel further narrated that the patient was not attended by Rheumatologist. But they came to know on oral advice through phone the opposite party withdraw certain medicines to the patient. As per the case of the complainants only the opposite party requested to arrange for a Rheumatologist. So the complainants availed the services of Dr.K.Seerala Boopathy on 25.04.2018 to assess the health condition of the patient. On his visit the Rheumatologist chided the opposite party doctors for stopping the SLE medicines on oral orders over phone without personal examination. Even thereafter the opposite party was not diligent in monitoring the health condition of the patient become bad to worst. So the complainants decided to get discharge from hospital and then they admitted the patient in Apollo Hospital.
7. The learned counsel for the complainants further referred the discharge summary given by previous hospitals which were marked as Ex.A1 and Ex.A2, and the discharge summary of the opposite party/hospital which is marked as Ex.A3 after referring all the discharge summaries the learned counsel submitted that the discharge summary issued by the Apollo Hospital proved the pathetic condition of the patient at the time of discharge from the opposite party hospital.
8. The counsel went on to describe at the time of discharge from the opposite party/hospital the patient was in a coma condition. So the above deterioration of status of health was due to poor medical care exhibited by the opposite party who made the complainants to believe that they are having a specialist Rheumatologist in their panel. Hence he requested the Commission to allow the petition.
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9. On the other hand the learned counsel for the opposite party/hospital submitted that the patient was a known case of SLE for more than 6 years and she was admitted in the hospital not for her SLE treatment alone. At the time of admission and treatment her condition was so critical and she was monitored in the ICU. Since the patient already suffered brain infarction, she was treated by all the specialists in the hospital particularly Neurologist and Urologist namely Dr.Sivakumar, and Dr.Sathish. When the patient was in ICU, Intensivist Dr.Bharath, and Director of Critical cares Dr.Selvakumar also monitored the patient. Above all, the whole treatment was co-ordinated by Physician Dr.Prabhusamy, Patient was also treated by ENT surgeon Dr.S.Rajavel, Gastroenterologist, Dr.A.C.Arun, and Endocrine surgeon. So the above patient was given due care by a panel of expert doctors. As admitted by the complainant himself SLE disease affects many parts of the body and hence in the impugned system so not only Rheumatologist, but as per the condition of the patient different field experts have to monitor the patient medically this was done systematically by the opposite party and it is not correct to allege that the patient was not attended by Rheumatologist. As admitted by the complainant himself the hospital had one Dr.Subramani, a renowned Rheumatologist in their panel. But the complainants want a Rheumatologist of their choice so that the opposite party permitted to have such the assistance of Rheumatologist Dr.K.Seerala Boopathy. It is not correct to allege that medicines were withdrawn without any proper care and it leads to poor health of the patient. So they requested this Commission to dismiss the complaint.
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10. Now the point for consideration is: Whether the opposite party/hospital committed any deficiency in service?
11. Point: As per the pleadings and arguments of learned counsel for the complainants it is visualized by this Commission that the following factors have been cited as deficiency on the part of the opposite party.
(i) The opposite party promised the complainants that they have Rheumatologist in their panel, but no such Rheumatologist attended the patient.
(ii) The opposite party an oral advice from one Rheumatologist withdraw medicines prescribed for SLE.
(iii) The above withdrawal leads to further deterioration in health of the patient.
(iv) The complainant was asked by opposite party to bring a Rheumatologist and the Rheumatologist chided the opposite party for withdrawing medicines for SLE.
(v) The opposite party did not provide the complainant the medical records.
12. This Commission try to address the above issues one by one. As per the allegations of the complainants the opposite party convince the complainants as if they are having an expert Rheumatologist in their panel. The above allegations itself is un- acceptable and seems to be improbable because the complainants are not a layman like any other ordinary consumer. On the other hand they are also renowned doctors. They very well aware of the panel doctors and the facilities available in the opposite party/hospital. Only after knowing fully well and evaluating , they admitted the patient in the hospital . As such, there cannot be any misrepresentation on the part of the opposite party with regard to their medical facilities. Even otherwise the patient was 8 admitted in the hospital from 20.04.2018 till 18.05.2018 i.e., 29 days. If the complainant felt that there was no Rheumatologist attached with the hospital and the service of Rheumatologist is alone necessary they can very well get discharge and admit the patient in another hospital. So keeping the patient for 29 days in the hospital amounted to their acquaintance, implead satisfaction with the facilities of the hospital.
13. Furthermore the complainant at the time of admission in the opposite party/ hospital was diagnosed as follows as evidenced from Ex.A3:
"Mrs.Theivanai 58 years old female, euglycemic, hypertensive known case of SLE on treatment came with the complaints of giddiness and increased frequency of micturition, Left Nephrostomy done on outside hospital and found to have extrapulmonary TB and started on ATT. Patient got admitted in our hospital for further evaluation and management".
From this it came to light, she was not admitted in the hospital for exclusive treatment of SLE. But because of her above disease, she suffered other complications also.
14. Moreover as per Ex.A1 & A2 she was not treated for SLE, but for her giddiness and palpitation in A.R.hospital and in the Mithra hospital, she was treated for lower urinary tract symptoms and found to have right hydro uretronephrosis. The patient was planned for cystoscopy/Right RGP and stenting. So the above treatments in earlier hospitals were not for SLE and the treatment was not given by any Rheumatologist. Only the expert opinion of Dr.K.Seerala Boopathy was obtained as evidenced from Ex.A1. So from the above two discharge summaries, it is brought to the knowledge of this Commission that mere presence of Rheumatologist is not sufficient. For the above 9 disease it needs a combined treatment from expert doctors in all fields such as Urologist, Neurologists Physician and Cardiologist etc., Their services were clearly provided by the opposite party.
15. In the complaint Para No.3 itself the complainant admitted that the opposite party had engaged the services of one Rheumatologist as their panel doctor, he was not present on the date. So whenever it is required by the opposite party they can avail the service of Rheumatologist. Moreover the complainant further alleged the opposite party withdraw certain medicines prescribed to the patient by Rheumatologist. It is his specific allegation that under the instructions through phone by one Rheumatologist without physically examined the patient the course of treatment was changed. From the above averments it is also clear that the opposite party on necessity availed the services of Rheumatologist. So there cannot be any misrepresentation or false hope given by the opposite party.
16. The next contention that the opposite party has withdrawn the medicines prescribed for SLE is deeply perused by this Commission. The opposite party in their written version mentioned that "On admission the patient was on immune suppressants like T.Micofinolate mofetil, T.Predmet & T.Hydroxy choloroquine. Dr.Prabhusamy had a detailed discussion with rheumatologist Dr.Subramani,T.Hydroxycholorquine was continued and T.Predmet was changed to Inj.Dexamethasone and T.Micofinolate mofetil was stopped. The change in the medications was done as injectable form have better more predictable action than tablet forms". The above statement was not contradicted by the complainants and the complainants fail to elicit how the course of 10 treatment and medicines differed from earlier medication to the patient and how this change in injectable form adversely affected the patient.
17. Furthermore within a week Dr.K.Seerala Boopathy, Rheumatologist the choice of the complainant visited the hospital and advised medications. The above factors have been clearly proved by the detailed treatment particulars marked by the complainant himself as Ex.A9. In Ex.A9 Progress Sheet, Dr.K.Seerala Boopathy, Rheumatologist, advise,
- Repeat LFT every 3 days
- Repeat Urine & Blood C/S.
- To stop Heparin after 3 days.
- Stop Mannitol tomorrow.
There is no proof filed by the complainant that the above Dr.K.Seerala Boopathy found withdrawal of medicines by the opposite party had affected the patient and he chided the opposite party hospital. Particularly there is no proof filed to assume that there was withdrawal of medicines which lead to deterioration in health condition of the patient. Further the complainant also failed to obtain proof affidavit from the Rheumatologist Dr.K.Seerala Boopathy and mark the same. So the allegations that the opposite party arbitrarily withdraw the medicines for SLE found not proved.
18. Moreover it is trite principles of law, that genuine differences of opinion may emerge in the medical field. Simply because one line of treatment was not approved by other side will not automatically lead to any allegations of medical negligence. What is expected from the opposite party is due care for the ailments. Ofcourse there may be 11 change in medication which can genuinely happened according to the diagnosis of the treating doctors. The Supreme Court of India in Samira Kohli .Vs. Dr.Prabha Manchanda & Anr relied the passage from Hunter .Vs. Hanley (1955SC200), a Scottish case. In that decision, Lord President Clyde held:
"In the realm of diagnosis and treatment there is ample scope for genuine difference of opinion and one man clearly is not negligent merely because his conclusion differs from that of other professional men, nor because he has displayed less skill or knowledge than others would have shown. The true test for establishing negligence in diagnosis or treatment on the part of a doctor is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would be guilty of if acting with ordinary care."
and the Apex Court finally concluded that the difference in adopting procedures or in administering medication will not amount to deficiency or medical negligence. When the patient was suffered due to the severity of SLE , then the above specific problems have to be attended first. For example, if the patient suffered any brain infarction then Neurologist alone to be consulted and he alone the best person to advise the course of medication. So, as a team of doctors the above combined work of the opposite party cannot be found fault.
19. The Apex Court and NCDRC in many cases reiterated the standard of care as expected from the doctor. Particularly the Hon'ble Supreme Court in Jacob Mathew .Vs. State Of Punjab & Another on 5 August, 2005 held as follows:
"Negligence is the breach of a duty caused by omission to do something which a reasonable man guided by those considerations which ordinarily regulate 12 the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do.
So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed. When it comes to the failure of taking precautions what has to be seen is whether those precautions were taken which the ordinary experience of men has found to be sufficient; a failure to use special or extraordinary precautions which might have prevented the particular happening cannot be the standard for judging the alleged negligence. So also, the standard of care, while assessing the practice as adopted, is judged in the light of knowledge available at the time of the incident, A medical practitioner is not liable to be held negligent simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another. He would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field.
Simply because a patient has not favourably responded to a treatment given by a doctor or a surgery has failed, the doctor cannot be held straightway liable for medical negligence by applying the doctrine of res ipsa loquitur. No sensible professional would intentionally commit an act or omission which would result in harm or injury to the patient since the professional reputation of the professional would be at stake".
The above conclusion is squarely applicable to this case and it is followed by this commission too..
20. In fine what is explicitly inferred is the treatment given by the opposite party was as per the medical standard and no proof filed by the complainant that the patient's health condition became deteriorated only because of the treatment. On the other hand it is elicited from the progress report which meticulously described the status of the 13 patient each and every day, that due care was provided and some days the patient was conscious and obeyed the commands, and in some other days the patient did not respond well. It all happened because of the nature of the disease and not because of any treatment much less any wrong treatment provided by the opposite party.
21. The complainant further alleged that he was not given the treatment particulars, which on the face of it false since the complainants themselves marked Ex.A9. So the above allegations also baseless. It is not out of place to mention that the complainant admitted the patient in Apollo Hospital twice as per Ex.A5 &Ex. A6. But in both the discharge summaries though Rheumatologist was shown as Primary Consultant but there are other consultants like Neurologist, ENT, Medical Gastro Entrologist, General Surgeon, Pulmonologist, Urologist attended the patient. The same kind of specialists were also attended the patient in the opposite party/ hospital. So the allegations of the complainants against the opposite party on the basis of their own documents, were not proved.
22. Moreover a Three Judge Bench of The Hon'ble Supreme Court in the case of Jacob Mathew .Vs. State of Punjab [(2005) 6 SCC 1] held as follows:
There is a marked tendency to look for a human actor to blame for an untoward event, a tendency that is closely linked with a desire to punish. Things have gone wrong and therefore somebody must be found to answer for it. An empirical study reveals that background to a mishap is frequently far more complex than may generally be assumed.
So it is a human tendency to blame a person when the things went unexpected. In this case also being a doctor the complainants alleged his fellow professionals for the loss 14 suffered by their family. This Commission also felt sorrow for their tragedy but there is no iota proof in their allegations leveled against opposite party. As such the complaint is liable to be dismissed. Hence the complaint is dismissed without cost and answered the points accordingly.
23. In the result,
1. The complaint is dismissed.
2. No cost.
Dictated and pronounced in the open court to the Steno-typist transcribed and typed by her corrected and pronounced by me on this the 19thday of March 2024.
Sd/-xxxxxxxx S.KARUPPIAH, PRESIDING JUDICIAL MEMBER.
ANNEXURE
List of documents marked on the side of the complainant
Ex.A1 14.04.2018 Discharge summary of A.R.Hospital.
Ex.A2 20.04.2018 Discharge summary of Mithra Hospital.
Ex.A3 18.05.2018 Discharge summary of opposite party.
Ex.A4 01.04.2017 Medical Insurance Policy.
Ex.A5 11.06.2018 Discharge summary of Apollo Hospital.
Ex.A6 12.09.2018 Discharge summary of Apollo Hospital.
Ex.A7 10.11.2018 Death extract of Dr.Theivanai.
Ex.A8 22.11.2018 Legal heir certificate of Dr.Theivanai.
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Ex.A9 20.04.2018 Case sheet of Dr.Theivanai issued by the opposite party.
Ex.A10 18.05.2018 Bill for payment of Rs.4,49,584/- at opposite party hospital. Ex.A11 13.06.2018 Receipt for payment of Rs.5,79,121/- at Apollo Hospital. Ex.A12 12.11.2018 Receipt for payment of Rs.4,89,622/- at Apollo Hospital.
List of documents marked on the side of opposite party.
-Nil-
Sd/-xxxxxxxx S.KARUPPIAH, PRESIDING JUDICIAL MEMBER.
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