State Consumer Disputes Redressal Commission
Sushma Dua & Ors. vs Ganga Ram Hospital on 8 August, 2022
FA/1177/13 SUSHMA DUA & ORS. VS SGRH & ORS DOD: 08.08.2022
DELHI STATE CONSUMER DISPUTES REDRESSAL
COMMISSION
Date of Institution: 07.11.2013
Date of hearing: 29.04.2022
Date of Decision: 08.08.2022
FIRSTAPPEAL NO. 1177/13
IN THE MATTER OF:
1. SUSHMA DUA
W/O LATE SURENDER KUMAR DUA
2. RAJAT DUA
S/O LATE SURENDER KUMAR DUA
3. SUPRIYA DUA
D/O LATE SURENDER KUMAR DUA
ALL RESIDENTS OF:
C-13, NFL TOWNSHIP, PANIPAT, HARYANA.
(Through: Mr. K.C. Bajaj, Advocate)
...APPELLANTS
VERSUS
1. SIR GANGA RAM HOSPITAL
THROUGH MEDICAL SUPERINTENDENT,
RAJINDER NAGAR, NEW DELHI- 110060.
(Through: Mr. Subhash Kumar, Advocate)
2. CITY HOSPITAL
AFFILIATED TO SIR GANGA RAM HOSPITAL,
THROUGH HOSPITAL INCHARGE,
B-1/1, NEA, PUSA ROAD,
NEW DELHI.
(Through: Mr. Kapil Kher, Advocate)
3. CHHABRA HOSPITAL
THROUGH ITS MEDICAL SUPERINTENDENT,
1A, NARAIN SINGH PARK
PANIPAT, HARYANA.
(Through: Mr. Aditya Vikram, Advocate)
...RESPONDENTS
DISMISSED PAGE 1 OF 16
FA/1177/13 SUSHMA DUA & ORS. VS SGRH & ORS DOD: 08.08.2022
CORAM:
HON'BLE JUSTICE SANGITA DHINGRA SEHGAL
(PRESIDENT)
HON'BLE SH. RAJAN SHARMA, MEMBER (JUDICIAL)
Present: None for the Parties.
PER: HON'BLE JUSTICE SANGITA DHINGRA SEHGAL,
PRESIDENT
JUDGMENT
1. The facts of the case as per the District Commission record are:
"The complainant No.1 is the widow and complainant No.2 and 3 are the children of Late Shri Surender Kumar Dua. Shri Dua was working as Deputy Manager (Chief Chemical Analyst) at National Fertilizers Ltd. plant at Panipat. Shri Dua fell ill and got treatment from Chhabra Hospital, Panipat and then from City Hospital and Sir Ganga Ram Hospital, New Delhi. He died in the hospital on 24.08.2008.
The complainants have pleaded medical negligence on the part of the hospitals. Consequently, they filed the complaint before the Hon'ble State Commission as per provisions of Consumer Protection Act, by raising a demand of Rs.50,00,000/- as compensation for harassment, pain and mental agony and cost of litigation.
The Hon'ble State Commission, passed an order on 04.02.2009 and held that compensation in any case, would not be more than Rs.20,00,000/- and the matter was transferred to the District Forum for disposal on merit. That order was confirmed by the Hon'ble National Commission.
On 17.08.2008. Shri Surender Kumar Dua was admitted into Chhabra Hospital, Panipat for the treatment of fever. There, he had to undergo tests for DISMISSED PAGE 2 OF 16 FA/1177/13 SUSHMA DUA & ORS. VS SGRH & ORS DOD: 08.08.2022 Malaria, Typhoid, Dengue and Platelet Counts. The serology tests were found negative for Malaria. The doctor without a proper diagnosis of the disease of the patient, started treating him for Malaria.
The second serology report, dated 18.08.2008 again confirmed that patient was not suffering from Malaria. Still, the doctor continued to treat the patient and administered him Falcigo (a known anti-malaria drug). The Platlet had decreased to 1,28,000/cu mm. The Deugue virus serology test provided negative primary/secondary infections. But no other specific alternative dagnosis method was used in order to obtain confirmation of Dengue virus infection. The doctor prescribed and started administering Quinine. It was inspite of the fact that there were already two negative tests for Malaria. The patient was administered 6 doses of 300 mg of quinine on 19/20.08.2008. It resulted in severe swelling of the body, rashes, low urine output and under performance of kidneys.
On 19.08.2008, the test also revealed that it was not a case of Typhoid. The Platlet counts had decreased to 1,22,000. The side effects of Nausea, vomiting and diarrhoea damaged the pancreas, nerves, eyes and lever and kidneys. The hospital was not able to manage the ailment of patient and referred the patient to Sir Ganga Ram Hospital (in short the SGRH) for further management as latest Platlet counts was found inadequate at 81,000/cu.mm.
Vide referral slip, dated 20.08.2008 as prepared by Chhabra Hospital, the patient was tranferred to SGRH, New delhi. The Doctor Incharge at the emergency ward of SGRH directed the complainant No.1 to better take the patient to City Hospital (Affiliated to SGRH/OP-
2). The complainants had insisted for treatment of the patient in SGRH. The complainants were forced to shift the patient in City Hospital.
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The admission into City Hospital, was nothing more than a money making exercise. The hospital was not equipped with required medical facilities nor was having efficient doctors to control the deteriorating condition of the patient. The junior doctor hardly took care of the patient. The doctor opined that patient was suffering from Typhoid. Even the earlier serology report contradicted the opinion. The Senior Doctor, Dr. Pooja Khosla left on leave without deciding any diagnosis or deputing another senior doctor for the patient. On presumptive diagnosis of fever and dengue, the doctor started treating the patient.
The complainant No.1 visited the MS of SGRH and informed him about the plight of the City Hospital. Then, MS allowed a room to the patient and after discharge from the City Hospital, the patient was shifted to SGRH on 22.08.2008. The City Hospital was deficient in service as it failed to detect the route cause of the deteriorating health of the patient. The Platlet counts of the complainant was falling at a fast rate yet the doctors did not administer any blood transfusion. The family members of the patient several times insisted for the blood transfusion in SGRH. The platlet of the patient dropped to 27,000 and the patient developed Hypotension with swelling all over the body with dyspnoea, low urine output. The family members of the patient donated blood in the blood bank.
The doctors had all the prior reports and feedbacks and all symptoms of thrombocytopenia, were visible in the patient but the doctors kept treating the patient for an unknown virus. They neglected to revive the platelet count of the patient which had dropped to 21000 on 23.08.2008 from 200000 on 17.08.2008. The normal rage of platelets should be 150000 to 450000.
The patient Shri Surender Kumar Dua was declared dead at 3.30 PM on 24.08.2008. The final DISMISSED PAGE 4 OF 16 FA/1177/13 SUSHMA DUA & ORS. VS SGRH & ORS DOD: 08.08.2022 diagnosis in Death Summary was stated as "Fever with thrombocytopenia with multi-organ failure".
The doctors at Chhabra Hospital administered quinine to the patient inspite of two negative test reports of Malaria. The drug was adminstered in an extremely high potency, being 6 tablets of 300 mg each. The City Hospital neglected the massively deteriorated condition of the patient and kept treating him for unknown virus. The doctor at SGRH continued the game of wild guess while treating the patient.
The City Hospital and SGRH least cared to combate with the side effect of the quinine overdose in the patient. There has been deficiency in medical service and medical negligence by all the three hospitals. The family of the patient was made to spend exhorbitant amount on the treatment of the patient but it was the lack of proper treatment that finally proved fatal. The patient was expected to survive for at least further twenty five years. His life was shortened by the negligence of the hospitals. The complainants have claimed Rs.50,00,000 as compensation for causing harassment, pain and mental agony and personal loss. Out of that amount, Rs.30,00,000/- has been claimed by the widow and the children has claimed Rs. 10,00,000/ each. The cost of litigation have also been claimed."
2. The District Commission after taking into consideration the material available on record, passed the judgment dated 09.10.2013, whereby it held as under:
"The Ld. Counsel for the complainant has vehemently urged that doctors of all the three hospitals under whom the patient was under treatment, committed grave medical negligence. There were negative reports of malaria but still, the doctor in Chhabra hospital firstly administered Falcigo and later on six doses of 300 mg of DISMISSED PAGE 5 OF 16 FA/1177/13 SUSHMA DUA & ORS. VS SGRH & ORS DOD: 08.08.2022 quinine on 19-20.08.2008. The same resulted in severe swelling of the body, low urine output and non- performance of the kidneys. The city hospital and SGRH were least concerned to combat the side/effect of the quinine overdose in the patient. The platelets were reduced drastically but no effort was made for transfusion of the blood. The doctors treated the patient on the basis of the symptom of the ailment and committed the Negligence, which untimely resulted in the death of the patient.
The Expert Committee, MAMC did not examine the medical record of the patient as was made available by Chhabra Hospital and did not address the points raised in the complaint. The committee ought to have listed adverse side effects of quinine. It should have discussed the possibility of the patient having developed adverse side effects due to mal administration of quinine, especially considering that the patient was suffering from viral fever and not malaria. The committee should have assisted the Forum by stating whether all persons have the same sensitivity to unnecessary quinine exposure and the committee ought to have assisted the Forum by simply stating in clear simple words as to whether the information regarding symptoms present on the death certificate are or can be correlated to quinine overdose or not.
The complainants have relied upon various legal pronouncements and the medical literature. That literature is particularly about the administration of the quinine and its side effects. The doctor of Chhabra Hospital has also placed on the file the medical literature in support of the plea of the hospital that even if there is negative test but there are symptom of malaria even then the quinine can be administered. Only one tablet of 300 mg was given to the patient. If more doses would have been given or as the doses as suggested by the DISMISSED PAGE 6 OF 16 FA/1177/13 SUSHMA DUA & ORS. VS SGRH & ORS DOD: 08.08.2022 complainants had been gven, even then, there could not have been side effect of quinine. The doctors treated the patient to the best of their ability. The City Hospital and SGRH have urged that there was no negligence on their part. They provided the best medical facility and medicines to the deceased patient. The Expert Committeee examined all the aspect of the treatment given to the patient and opined that there was no medical negligence. The hospitals have also relied upon the legal pronouncements.
On the basis of various legal pronouncements, the criteria for considering the case of medical negligence, has been laid down by the Hon'ble Supreme Court of India in its various judgements, including the case of Jacob Mathew Vs State of Punjab: 2005 CTJ 1085. It has been laid down that:
(1) Negligence in the context of the medical profession necessarily calls for a different treatment; and additional considerations are to be taken into account such as:
(a) A simple lack of care, an error of judgement or of an accident is not proof of negligence on the part of a medical professional.
(b) As long as the doctor follows a practice acceptable to a medical profession of the day, he cannot be held liable merely:
i) becaue better treatment, alternative course or method is available.
ii) more skilled doctor would not have chosen that practice or procedure, whish was followed by the doctor in the instant case.
(2) Failure to use special or extraordinary precautions, which might have prevented the particular happening cannot be the standard for judging the alleged negligence. In other words, precautions taken, which DISMISSED PAGE 7 OF 16 FA/1177/13 SUSHMA DUA & ORS. VS SGRH & ORS DOD: 08.08.2022 the ordinary men of experience has found to be sufficient, can be considered as sufficient; (3) Standard of care as per the practice adopted should be judged in the light of knowledge available at the time of accident and not at the time of trial: (4) Non-use of particular equipment and the resultant negligence must be considered in the light of the availability of the equipment at the time of the incident and not at any other time. In other words non-incident will not be constitute negligence; (5) Liability of a medical professional arises on two grounds; namely
(i) Either he was not possessed of the requisite skill which he professed to have possessed; or
(ii) He did not exercise with reasonable competence in the given case, the skill which he did possess.
The present complaint case, is to be considered in the light of the above observations of the Hon'ble Apex Court.
On the basis of the pleadings and the medical record, we have not found that the doctors of three hospitals under whom the patient was treated, were not possessing the requisite skill which they professed to have possessed. The complainants have not placed on the file any document to confirm that the treating doctors did not have requisite skill and qualifications. The whole case of the complainants revolves around the fact that the doctor at Chhabra Hospital had administered quinine to the patient though there was negative test of malaria. On account of the overdose of the quinine, the patient suffered side effects. Neither of the hospitals took necessary steps to control the side effect and to remove the adverse effect of the overdose of the quinine. Hence, the doctor did not exercise the reasonable competence and skill in treating the patient.
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The complainants and Chhabra Hospital have placed on the file the medical literature in support of their respective contensions. about the circumstances under which the quinine should be administered and the side effect of the medicine.
The Forum appointed an Expert Committee to examinie medical record to find out the medical negligence on the part of the hospitals. The matter was referred to the MS of prestigious Maulana Azad Medical College, New Delhi. The Medical Supdt. formed a committeee of three senior and eminent doctors. The doctors were occupying high position as Professor and Assistant Professors. They must have reached to such position on the basis of their study of medical literature as well as their long experience in medical science.
There is nothing on the record to suggest that the doctors of the Committee have gained something from the hospitals to absolve them from alleged medical negligence. The complainants have not filed expert opinion of any doctor. If there would have been expert opinion of the doctors, who would have been more eminent and experienced than the doctors of the committee, then the Forum was to look into that report also. On the basis of medical literature, the Forum cannot hold that the doctors of the committee did not examine the record properly. It is particularly so because the Chhabra Hospital has also placed on the file the medical literature which confirms that in the given case, the administration of quinine was not undesirable. The members of the committee in their long medical career, must have gone through the medical literature as relied upon by the complainants and the OPs. On the basis of their qualification and experience, the doctors examined the record and concluded that it was not a case of medical negligence. The objections to the report of the DISMISSED PAGE 9 OF 16 FA/1177/13 SUSHMA DUA & ORS. VS SGRH & ORS DOD: 08.08.2022 expert committee, raised by the complainants do not have substance, particularly because those objections are not supported by any medical expert opinion. The observations and conclusion of the committee have already referred in the earlier part of the order. The committee even considered the case that the patient was administered six doses of 300 mg of quinine and has held that it was a standard treatment and not a case of overdose. The committee concluded that the deceased patient suffered from some infective disease process that progressed to Septicemia and DIC which resultant multi organ failure. Sometime, it happens in medical terms when the root cause suffered by the patient, may not be diagnosed in spite of Efforts of the treating doctors.
We find that the conclusions of the committee were based on the available record of Chhabra Hospital. Though, the medical record of city Hospital and SGRH was not available, yet the committee found that the contentions, raised by the complainants were examined by the committee but it did not find it a case of medical negligence.
We believe the report of the Expert Committee as the committee was independent and was not under influence of the OPs' hospital and their doctors. The committee examined the report throughly.
We do not find that the doctors/hospital committed any medical negligence or that they did not exercise reasonable competence of the skill, which they possessed. The doctor treated the patient as per standard procedure. The complaint had got not merit and The same is rejected"
3. Aggrieved by the aforesaid judgment of the District Commission, the Appellants/ Complainants have preferred the present appeal contending that the District Forum over-relied on the medical DISMISSED PAGE 10 OF 16 FA/1177/13 SUSHMA DUA & ORS. VS SGRH & ORS DOD: 08.08.2022 committee's report and failed to apply its judicial mind. The Appellants further contended that the District Commission failed to consider that the reason of death was the overdosage of quinine.
4. The Appellants also contended that no efforts were made by the Respondents to remove the allergic effect of quinine from the body of deceased patient which led to the cause of his death in the present case. Pressing the aforesaid contentions, the Appellants prayed for setting aside the judgment of the District Commission.
5. The Respondents, on the other hand, filed reply to the present Appeal individually whereby denying all the allegations made by the Appellants and submitted that there is no error in the impugned judgment as the entire material available on record was properly considered by the District Commission before passing the said judgment.
6. We have perused the Appeal, Reply of the Respondents and the Impugned Judgment.
7. The question for consideration before us is whether the Respondents are guilty of medical negligence in treating the deceased patient (i.e. husband of Appellant no. 1 and father of Appellant no. 2 & 3).
8. On perusal of record, we find that the deceased patient was admitted in the Hospital managed by the Respondent no. 3 (hereinafter called as 'Respondent no. 3') on 17.08.2008, where he was tested negative for the Malaria. However, the symptoms reflects that it might be Malaria and also the medical literature says that in case high fever with chills there is a high probability DISMISSED PAGE 11 OF 16 FA/1177/13 SUSHMA DUA & ORS. VS SGRH & ORS DOD: 08.08.2022 that patient might be suffering from malaria, therefore, the Respondent no. 3 had started the procedure followed in the treatment of Malaria and advised him administer quinine 300mg which is a basic practice followed by the medical practitioners. Also, the platelets of the deceased patient were decreasing gradually. Therefore, the dengue, typhoid and other tests were also done by the Respondent no. 3 to diagnose the actual cause of depletion in the platelet count but the said test was also reported as negative.
9. It is pertinent to mention here that the Respondent no. 3 accepted that they had given the 600 mg of quinine to the deceased patient which is again an admissible medical practice followed by the medical practitioners and when the Respondent no. 3 observed that the deceased patient got allergic reaction from the quinine, he substituted the said drug with a safer and more effective parental medicine falcigo (a known anti-malaria drug). The Appellants on the other hand rebutted the said contention by stating that during the course of treatment, the deceased patient was administered with 6 doses of quinine 300mg. However, no document has been furnished by the Appellants to strengthen their contention except a medicine receipt where doctor advised Appellants to purchase 6 doses of quinine 300 mg which can be seen from the slip attached as annexure on page no. 120 of the present Appeal.
10. Further, discharge slip vide dated 20.08.2008, was also issued by the Respondent no. 3, wherein, the Respondent no. 3 has prescribed the 2 tablet of Falcigo (a known anti-malaria drug) DISMISSED PAGE 12 OF 16 FA/1177/13 SUSHMA DUA & ORS. VS SGRH & ORS DOD: 08.08.2022 which was substituted by them after observing allergic reaction from Quinine.
11. It is pertinent to mention here that the Appellants have attached a copy of the medical literature as Annexure C-8/6 with the Complaint wherein a column illustrating the side effect of Quindine has clearly mentioned that a severe allergic reaction like Severe allergic reactions (RASH; hives; itching; difficulty breathing; tightness in the chest; SWELLING of the mouth, face, lips, or tongue); dark urine; dizziness or lightheadedness; fainting; fast, slow, or irregular heartbeat; headache; hearing changes or loss of hearing: mood or mental changes; pale stools; ringing in ears; severe or persistent stomach PAIN: VISION changes; yellowing of the skin or eyes can be occurred in the patients administrating quinine drug.
12. To resolve this issue, the Medical Expert Opinion was also taken by the Ld. District Commission, wherein a report was submitted by the concerned stating that no overdose of quinine was administered in the present case and symptoms like swelling of body and low urine output could have been the manifestations of sepsis with DIC (Disseminated intravascular coagulation). Therefore, it is clear from the report that no negligence exists on the part of Respondent no. 3.
13. As far as the liability of Hospital managed by Respondent no. 1 & 2 (hereinafter called as 'Respondent no. 1 & 2') is concerned, the patient was referred by the Respondent no. 3 to the Respondent no. 1 on 20.08.2008 but due to the shortage of bed at that time, the patient was admitted by the Respondent no. 2 wherein, on the basis of previous medical history as provided by DISMISSED PAGE 13 OF 16 FA/1177/13 SUSHMA DUA & ORS. VS SGRH & ORS DOD: 08.08.2022 Respondent no. 3, the Respondent no. 2 started the treatment of Dengue as the platelet count was continuously decreasing and advised necessary investigation/tests namely, complete hemogram, MP serology, Dengue serology, ESR, LFT, KFT, Blood Sugar, Chest X-ray, Ultrasound of whole abdomen, blood culture, urine and urine examination. Further the patient was shifted to the Respondent no. 1 Hospital on 22.08.2008, wherein the doctor examined the patient and standard treatment was followed on the basis of presumptive line wherein, fluid management, supportive treatment and platelets transfusion were done as prescribed in the medical practice. Also, the medicines/drug namely IV Monocef, Syscan, IV Fluids and other supporting treatment was started by the Respondent no. 1. Despite that, on 23.08.2008 the platelet count of the patient was dropped to the extent of 27,000 due to which the patient was given 6 units of platelet transfusion and was shifted to ICU and then on ventilatory support.
14. In spite of all the above measures taken by the Respondents, the patient could not survive and expired due to the cardiac arrest on 24.08.2008.
15. Keeping in view of the above situation, we find no negligence on part of the Respondents as the patient was treated with due care and caution by the Respondents and the treatment was done in accordance with the medical practice followed by the doctors while treating the patient of similar condition.
16. To strengthen our view, we deem it appropriate to refer to a landmark precedent titled as "Achutrao Haribhau Khodwa v.
DISMISSED PAGE 14 OF 16 FA/1177/13 SUSHMA DUA & ORS. VS SGRH & ORS DOD: 08.08.2022
State of Maharashtra" reported as 1996 (2) SCC 634, wherein the Hon'ble Supreme Court has observed that:
"14. The skill of medical practitioners differs from doctor to doctor. The nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. Medical opinion may differ with regard to the course of action to be taken by a doctor treating a patient, but as long as a doctor acts in a manner which is acceptable to the medical profession and the Court finds that he has attended on the patient with due care skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence.
15. In cases where the doctors act carelessly and in a manner which is not expected of a medical practitioner, then in such a case an action in torts would be maintainable. As held in Laxman's case (supra) by this Court a medical practitioner has various duties towards his patient and he must act with a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. This is the least which a patient expects from a doctor."
17. From the above discussion, we find no infirmity in the judgment dated 09.10.2013 passed by the District Consumer Disputes Redressal Forum (Central), Kashmere Gate, Delhi-110006.
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Consequently, the present Appeal stands dismissed with no order as to costs.
18. Application(s) pending, if any, stand disposed of in terms of the aforesaid judgment.
19. A copy of this judgment be provided to all the parties free of cost as mandated by the Consumer Protection Act, 1986. The judgment be uploaded forthwith on the website of the commission for the perusal of the parties.
20. File be consigned to record room along with a copy of this Judgment.
(JUSTICE SANGITA DHINGRA SEHGAL) PRESIDENT (RAJAN SHARMA) MEMBER (JUDICIAL) Pronounced On:
08.08.2022 DISMISSED PAGE 16 OF 16