State Consumer Disputes Redressal Commission
Dr Ajith vs Santhosh Kumar on 23 November, 2023
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION THIRUVANANTHAPURAM First Appeal No. A/13/101 ( Date of Filing : 22 Jan 2013 ) (Arisen out of Order Dated 24/01/2013 in Case No. CC36/12 of District Kollam) 1. DR AJITH KARTHIKAPALLY VILLAGE, ALAPUZHA KERALA ...........Appellant(s) Versus 1. SANTHOSH KUMAR KAMALALAYAM PO, ALAPUZHA KERALA ...........Respondent(s) BEFORE: HON'BLE MR. JUSTICE SRI.K.SURENDRA MOHAN PRESIDENT SRI.RADHAKRISHNAN.K.R MEMBER PRESENT: Dated : 23 Nov 2023 Final Order / Judgement KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM APPEAL No.88/2013 & APPEAL No.101/2013 COMMON JUDGEMENT DATED: 23.11.2023 (Against the Order in C.C.No.36/2006 of CDRF, Kollam) PRESENT: HON'BLE JUSTICE SRI. K. SURENDRA MOHAN : PRESIDENT SRI. AJITH KUMAR D. : JUDICIAL MEMBER
SRI. RADHAKRISHNAN K.R. :
MEMBER APPEAL No.88/2013 APPELLANTS:
1.
The Administrator, Parabrahma Speciality Hospital & Research Centre, Oachira, Kollam
2. The Secretary, Oachira Parabrahma Temple, Oachira
3. The Director, Oachira Parabrahma Speciality Hospital & Research Centre, Oachira (by Adv. G. Jayakumar) Vs. RESPONDENTS:
1.
Santhoshkumar R., S/o Ramakrishna Pillai, 'Kamalalayam' represented by his Power of Attorney Holder A.T. Mony, W/o Unnikrishnan, 'Kuttiparambil Thekkethil', Mahadevikad Muri, Karthikappally Village, Alappuzha
2. Gayathri, D/o Santhoshkumar, represented by the 1st petitioner the father and guardian residing at (by Adv. Kallada M. Balachandran)
3. Dr. Ravikumar, Regn.No.11649 (T.C.), 'Kozhikode House', T.C.9/2160, Sasthamangalam P.O., Thiruvananthapuram
4. Dr. Ajith, M.B.B.S., Medical Officer, Parabrahma Speciality Hospital & Research Centre, Oachira, Kollam
5. Dr. Girija, Gynaecologist, Parabrahma Speciality Hospital & Research Centre, Oachira, Kollam (by Adv. P.R. Neelakandan Namboodiri for R4 & R5) APPEAL No.101/2013 APPELLANTS:
1.
Dr. Ajith, S/o Radhakrishnan, Ayillya, Cheravally, Kayamkulam Village, Karthikappilly Taluk Alappuzha, P.O. Kayamkulam - 690 502
2. Dr. Girija, D/o M.N. Neelakandan Namboodiripad, Kaleekal Madom, Krishnapuram Village, Karthikappilly Taluk, Alappuzha, P.O. Krishnapuram - 690 533 (by Adv. P.R. Neelakandan Namboodiri) Vs. RESPONDENTS:
1.
Santhosh Kumar R., S/o Ramakrishna Pillai, 'Kamalalayam' P.O. Kayamkulam - 690 502 represented by his Power of Attorney Holder A.T. Mony, W/o Unnikrishnan, 'Kuttiparambil Thekkethil', Mahadevikad Muri, Karthikappally Village, Alappuzha
2. Gayathri (Minor), represented by father Santhosh Kumar, 'Kamalalayam' P.O. Kayamkulam - 690 502 (by Adv. Kallada M. Balachandran)
3. Dr. Ravikumar, S/o Prabhakaran, 'Kozhikode House', T.C.9/2160, Sasthamangalam P.O., Thiruvananthapuram
4. The Administrator, Parabrahma Speciality Hospital & Research Centre, Oachira, Kollam
5. The Secretary, Oachira Parabrahma Temple, Oachira
6. The Director, Oachira Parabrahma Speciality Hospital & Research Centre, Oachira (by Adv. G. Jayakumar) COMMON JUDGEMENT HON'BLE JUSTICE SRI. K. SURENDRA MOHAN : PRESIDENT Both these appeals are directed against final order dated 24.12.2012 in C.C.No.36/2006 of the Consumer Disputes Redressal Forum, Kollam (the District Forum for short). Appeal No.88/2013 is filed by opposite parties 2, 3 and 4 in C.C.No.36/2006 while Appeal No.101/2013 is filed by opposite parties 5&6. As per the order appealed against, the District Forum has found that the appellants in both the appeals were liable for the negligent treatment of the wife of the 1st complainant and mother of the 2nd complainant that resulted in her death. The parties shall be referred to herein in the manner in which they are referred to before the District Commission.
2. The deceased Smt. Lakhsmi Santhosh, aged 24 years was the wife of the 1st respondent in both the appeals. The 2nd respondent is her minor daughter. She was working as a staff nurse at the VSM Hospital, Thattarambalam, Mavelikkara. She was included in the PSC rank list and was expecting an appointment in Government service. On 14.12.2004 she and her husband were on their way to attend a marriage at Vavvakkavu. On the way, she felt some pain at the left side of her abdomen. She and her husband therefore approached the Parabrahma Speciality Hospital & Research Centre, Oachira, which was on her way to Vavvakkavu and consulted the duty doctor at 8 a.m. She was given an injection and medicine and the pain subsided. The duty doctor, the 1st appellant in A 101/2013 directed Lakshmi to consult the Surgeon also. After preliminary check-up the Surgeon directed the patient to consult the Gynaecologist who is the 2nd appellant in A 101/2013. Since she suspected presence of kidney stone she advised for an x-ray after taking enema. Accordingly, she was given enema and thereafter, allegedly for curing her tiredness she was administered IV drip. When the drip was halfway through the same was disconnected and x-ray was taken. She and her husband took tea and light refreshment at the canteen and went to the third floor by foot and continued the IV drip. Meanwhile, blood test result was obtained and was found to be normal. Then a nurse came and administered an injection through the IV set. Suddenly Lakshmi began to struggle for respiration. The duty doctor was immediately informed. She was immediately taken to the Intensive Care Unit and administered oxygen. Then the Consultant Physician, Dr. Ravikumar who attended the patient in the ICU advised the 1st complainant that it was necessary for her to be taken to a hospital where ventilator facility was available. Immediately, the VSM Hospital, Thattarambalam, Mavelikkara was informed of the situation. They sent their ambulance and the patient was shifted to the VSM Hospital, Thattarambalam. The mother of Lakshmi along with the 1st complainant were waiting outside the ICU at VSM Hospital. Then a duty nurse from the ICU came out and disclosed that Lakshmi Santhosh was dead. According to the complainants, the patient had died at the Parabrahma Speciality Hospital at about 11.30 a.m. But, her death was suppressed by the doctors, Dr. Ravikumar, Dr. Girija and Dr. Ajith from the complainant and her dead body was unnecessarily shifted to VSM Hospital in an ambulance in order to give an impression that she was alive. The said drama was played by the doctors in order to put the blame of negligence on some others and to hide their culpable negligence. Lakshmi Santhosh died due to the culpable negligence of the doctors of Parabrahma Speciality Hospital & Research Centre who administered Ampicillin Injection through I.V. without giving test dose. The deceased was an energetic young lady who was working as staff nurse and was waiting for better prospects in Government service. The complainants lost her love and affection and consortium. They are suffering mental agony and are aggrieved by the culpable negligence of the doctors. The 1st complainant lost his wife and the 2nd complainant lost her beloved mother in her infancy, which would affect her adversely in her future life. The mother of the deceased lost her life blood, all due to the negligence of the opposite parties for which they are jointly and severally liable to compensate. The hospital is vicariously liable to pay the compensation. The deceased being an earning member of the family drawing Rs.3,500/-(Rupees Three Thousand Five Hundred) per month from her job, awaiting appointment in Government service, being included in the rank list of the PSC, the complainants claimed a compensation of Rs.20,00,000/-(Rupees Twenty Lakhs) in their complaint.
3. The 1st opposite party filed version contending that the complaint was not maintainable either in law or on facts. The Forum lacked territorial and pecuniary jurisdiction to entertain and adjudicate upon the dispute. The alleged death of Lakshmi Santhosh occurred at VSM Hospital, Mavelikkara, which is outside the territorial jurisdiction of the Forum. The definitions of complainant, complaint and consumer dispute as defined under Section 2(1) of the Consumer Protection Act, 1986 (the Act for short) do not cover the claims arising under the present dispute and that the complainant was not a consumer and the dispute in the complaint was not a consumer dispute. As per the out patient records (OP records for short) maintained by the 2nd opposite party in the usual course of business, the parties came at 8.02 a.m. at the casualty of the opposite party and met the duty doctor. After examining the patient, the duty doctor noted that there was tenderness over the left hypochondrium and he also noted bowel sounds. He advised injection Cyclopam 1 Ampoule IM for abdominal colic. He also gave syrup Digene 5ml stat thrice daily and Rabeprazole 20mg stat. The two medicines prescribed were antiulcer drugs. The 1st opposite party has never worked as duty doctor of the 2nd opposite party hospital. The 1st opposite party was working as the Consultant Physician of the 2nd opposite party hospital from 08.08.2004 to 25.12.2004. The patient was first seen by the duty doctor of the 2nd opposite party hospital and the patient was referred to the Surgeon. From the OP records it is clear that the Surgeon Dr. Sivaramakrishna Pillai saw the patient and he has written a query of Pelvic Inflammatory disease and referred the patient to Gynaecologist Dr. Girija. After examination of the abdomen of the patient she noted tenderness of the left loin and she has written renal cholic and admitted the patient. The above is clear from the OP records. The 1st opposite party has never worked as a duty doctor. From the IP records, it is understood that Ampicillin 500mg IV was given to the patient after test dose injection. Pantodac IV, Ringer lactate 2 pints were given on the advice of the Gynaecologist. From the IP records it is seen that the Gynaecologist had advised plain x-ray KUB, after enema and blood routine TC, DC, ESR and Haemoglobin. As advised by the Gynaecologist Ampicillin was administered on the patient after test dose by 11 a.m. and at about 11.15 a.m. the patient was seen by the casualty Medical Officer by name Dr. Ajith. He administered injected Dexona and injection Efcorlin and O2 inhalation and the patient was shifted to ICCU and Dr. Ajith has recorded in the IP record that the matter should be informed to the Physician, Anaesthetist, Surgeon and Gynaecologist. According to the Gynaecologist Dr. Ajith had given injection Diazepam and the patient was intubated by the Anaesthetist Dr. Mathew. Thereafter, on the advice of Dr. Ajith injection Efcorlin 2 vials was given and IV fluids given which is clear from the IP record. According to the 1st opposite party, he saw the patient for the first time at about 11.35 a.m. after completion of all the above mentioned modulations of treatment by various doctors. When the doctor saw the patient at ICCU the patient had already been intubated and Ambu Bag respiration had been given and the ECG monitor was showing cardiac activity. At 11.35 a.m. the 1st opposite party examined the patient and found that the patient's pulse was not palpable, BP not recordable, pupils not reacting to the light. In order to increase the BP Dopomine was given on the advice of the 1st opposite party. The patient was shifted to VSM Hospital as per the request of the husband. Considering the request, the Gynaecologist referred the patient to the VSM Hospital. In view of the critical condition of the patient, to expedite the procedure at VSM Hospital the 1st opposite party accompanied the patient to the VSM Hospital and the patient was admitted to the ICCU alive and in the presence of the 1st opposite party. The doctors at VSM Hospital administered injection Adrenaline Intratracheal and Intravenous and the patient was connected to the ventilator. The 1st opposite party was present in the ICCU at VSM Hospital for nearly one hour. It is contended by the 1st opposite party that the VSM Hospital would not have admitted the patient, had she been brought dead, as alleged in the complaint, especially considering the fact that the deceased as well as her mother were working in the said hospital as staff nurses. Had the deceased been taken to the hospital dead the VSM Hospital would definitely have noted the said fact in the case sheet and should have informed the Police. It is further submitted by the 1st opposite party that the husband and relative of the deceased returned to the 2nd opposite party hospital and forcibly obtained a certificate in the form of a death certificate. Immediately thereafter, the 1st opposite party filed a complaint before the Oachira Police Station. The same, numbered as 638/04 is pending investigation. On the basis of a complaint made by the 1st complainant at the Karunagappally Police station, the Police registered crime no.378/2004 which is also pending investigation. According to the 1st opposite party, reasonable care and attention was given to the patient and there was no negligence or deficiency on the part of the 1st opposite party.
4. The 2nd opposite party filed a separate version contending that the complaint was not maintainable. The complainant was not a consumer as defined under the Act and therefore the complaint was liable to be dismissed on the said ground alone. The District Forum had neither territorial jurisdiction nor pecuniary jurisdiction in the matter. The death occurred at VSM Hospital, Mavelikkara, outside the territorial jurisdiction of the District Forum. The claim also exceeded the jurisdiction of the Forum. The 2nd opposite party is not properly represented. The Administrator is not competent to represent Sri. Oachira Parabrahma Hospital. The hospital belongs to the Oachira Parabrahma Temple which is administered by an elected body as per its constitution. The Working Committee of the temple Administration Board as per its decision dated 15.09.2000 appointed Dr. Sivaramakrishna Pillai as Director of the Hospital and conferred power on him regarding appointment, administration etc. In the same meeting the Executive Committee of the Administrative Board was constituted as the governing body of the hospital. Neither the Director nor Chairman of the governing body are impleaded to represent the hospital. Therefore, according to the 2nd opposite party the complaint was bad for nonjoinder of necessary parties. The deceased Lakshmi had consulted the duty doctor of Parabrahma Hospital on 14.12.2004. All other facts are within the knowledge of the complainant and have to be proved by them. Neither was there any medical negligence nor lack of reasonable care on the part of the doctors of the 2nd opposite party and the said allegations are all absolutely false. It is true that on 14.12.2004 the patient was seen by the duty doctor in the casualty. After examining the said patient, the doctor took second medical opinion by referring the patient to a surgeon who in turn referred to a Gynaecologist to rule out any gynaecological problem. The Gynaecologist suspected the case to be one of renal colic and admitted the patient. The Gynaecologist advised patient x-ray KUB (after enema) and blood examination. The Gynaecologist advised to give Ampicillin injection (after test dose), Pantodac injection and I/V fluids and also advised Urology consultation. The statement that the Gynaecologist confirmed that the deceased Lakshmi had no serious problem is totally false and made with ulterior motives and in fact there was no occasion which warranted such a statement since the progress of investigation and tests were underway. Further statement that Dr. Ravikumar was the duty doctor and he advised to consult the surgeon is also false. The further statement that the deceased went out on foot to take tea and light refreshment is also not true since the patient is not allowed to go out without prior permission. The nurse gave the injection Ampicillin after giving test dose as advised by the Gynaecologist. Test dose was given at 10.05 a.m. and since no signs of reaction were traced full dose of injection Ampicillin was given at 11 a.m. By 11.15 a.m. the patient complained of dyspnea and duty nurse informed the duty doctor who in turn examined the patient and he suspected the patient was having fits. Therefore, the duty doctor directed the patient to be taken to the ICU and immediately the matter was reported to the Gynaecologist, Physician and Surgeon. Thereupon, Dr. Ravikumar (Physician) came to the ICCU, confirmed that the patient was having fits and Diazepam injection was given. The patient was intubated by the Anaesthetist, IV fluids and Efcorlin injection was also given. Subsequently, the duty doctor came to know from the bystander that she was an epileptic patient, which was not revealed at the time of admission. Later on, the doctors learned that the deceased Lakshmi was a chronic epileptic patient under the treatment of a Neurologist of VSM Hospital and she was exempted from taking night duty. It is true that Dr. Ravikumar had advised the 1st complainant to take the patient to a hospital where ventilator facility was available. The 1st complainant also wanted the deceased to be taken to VSM Hospital since she was a staff of that hospital. Thereupon, she was transferred to VSM Hospital, Thattaramabalam, Mavelikkara where her mother was also working. It is true that Dr. Ravikumar had also accompanied the patient in the ambulance of the said hospital. Except the aforesaid facts, all other averments in the complaint are totally false and hence denied. At VSM Hospital she was treated in the ICCU. The Specialists at the VSM Hospital were confident of saving the life of the patient. But, after 2 p.m. the patient was declared dead. The allegation that the patient actually died at Parabrahma Hospital and only the dead body was shifted to VSM Hospital is totally wrong and misleading. Had that been the case the VSM Hospital doctors and authorities would have recorded it as a case of "brought dead" and informed the police and also requested for postmortem, especially in view of the fact that the deceased as well as her mother were working in the very same hospital as staff nurses. Moreover, the hospital records at VSM Hospital revealed that they had treated the patient. No one will ever treat a dead body. The true facts are as stated above and since the death occurred, in the VSM Hospital, Mavelikkara the District Forum had no jurisdiction to entertain the complaint. The complaint was bad for non-joinder of necessary parties. The husband of the deceased Lakshmi Santhosh and other relatives had forcibly obtained a signed paper in the form of a death certificate from Dr. Ravikumar. Regarding the incident he had filed a petition, Petition No.638/2004 before the Oachira Police Station and the matter was under investigation. Further, the police authorities under the supervision of the Deputy Superintendent of Police, Karunagappally were conducting an investigation into the alleged death as crime no.378/04. The original records were taken over by the Sub Inspector of Police, Karunagappally on 21.12.2004 and all original records relating to the incident are with them. Dr. Ravikumar was not the concerned doctor and the statements in the certificate shows that it was obtained by force. The patient died at VSM Hospital at Mavelikkara and the certificate alleged to have been received from Dr. Ravikumar will not bind the opposite party since he has no right to issue such a certificate. The Parabrahma Hospital doctors, including Dr. Ravikumar, as well as nurses and other staff had provided reasonable care and attended the patient in time and also took second opinion as and when warranted and investigated the case at regular intervals properly. The hospital is having trained staff and infrastructure and referred the case to another hospital as and when the need arose. Dr. Ravikumar also accompanied the patient to the referred hospital. Thus, the doctors as well as other paramedical staff exercised fair, reasonable and competent degree of skill in the exercise of their profession. Apart from that the doctors prescribed proper diagnostic and pathological tests such as blood tests x-ray etc., the Parabrahma Hospital doctors including Dr. Ravikumar as well as nurses and other staff followed standard medical practice and adopted well recognised methods and techniques of treatment and kept proper records of the treatment. There was no laxity in extending proper and reasonable care and hence at no point of time when the deceased was under their care was any injury caused by medical negligence. Therefore, there was no deficiency in service and the management of the hospital is not vicariously liable for the alleged incidents.
5. Opposite parties 3 and 4 filed version contending that there was no negligence or deficiency in service on the part of the opposite parties. As submitted in the version filed, by the 2nd opposite party there was no medical negligence or lack of reasonable care on the part of the doctors of the Parabrahma Hospital. Reasonable care and treatment was given to her. The duty doctor later came to understand that the deceased was an epileptic patient under the treatment of the Neurologist at VSM Hospital. The patient died at the VSM Hospital. The allegations of the complainant that the patient died at Parabrahma Hospital is false. The hospital records of VSM Hospital reveal that they had treated the patient. Since the death occurred at Mavelikkara, the District Commission had no jurisdiction to entertain the complaint. The husband of deceased Lakshmi and other relatives forcibly obtained a signed paper in the form of a death certificate from Dr. Ravikumar. Regarding that matter Dr. Ravikumar had filed a petition before the Oachira Police Station and the matter was under investigation. The alleged death was also under investigation. The original records were taken over by the Sub Inspector, Karunagappally. Dr. Ravikumar was not the concerned doctor and he was not competent to issue such a certificate. It will not bind the other opposite parties. The Parabrahma Hospital Authorities including the concerned doctors, nurses and other staff had provided reasonable care to the deceased. The authorities followed standard medical practice and adopted well recognised methods and techniques. There was no negligence or deficiency in the treatment of the deceased. No amount was received by the Hospital for the treatment of the deceased. Since there was no negligence or deficiency in service, the opposite parties are not liable to pay any amount as compensation.
6. Opposite parties 5 and 6 filed version contending that the complaint was legally and factually not maintainable. They admitted the statements in paragraph 3,4 and 5 of the complaint and denied the statements in paragraph 6,7,8 and 9. They raised the question of non-joinder of necessary parties. The hospital in which the deceased was admitted and treated and death occurred must be a necessary party. According to them, the deceased was not shifted to the VSM Hospital on their request but on the request of the 1st complainant. Opposite parties 5 and 6 had done their best to protect the life of the deceased. The death that occurred was beyond their control. There is no liability for opposite parties 5 and 6. The amount claimed in the complaint is very high and not sustainable in law. The complainants have not raised any objections and had not insisted for a postmortem examination of the body. They prayed for the dismissal of the complaint.
7. The parties went to trial on the above pleadings. On the side of the complainant PWs 1 to 4 were examined and Exhibits P1 to P10 documents were marked. There is no oral evidence on the side of the opposite parties. Exhibits B1 and B2 documents were marked. Exhibits X1 to X5 were marked by the District Forum. After the close of evidence, the matter was heard.
8. On a consideration of the evidence on record and the contentions of the parties, the District Forum found that the complainants had succeeded in establishing negligence on the part of opposite parties in treating the deceased. Therefore, the complaint has been allowed and opposite parties 2 to 6 are directed to pay a total amount of Rs.15,00,000/-(Rupees Fifteen Lakhs) as compensation to the complainants together with an amount of Rs.10,000/-(Rupees Ten Thousand) as costs of the proceedings. The opposite parties have been directed to pay the amounts jointly within two months and in default, interest @9% has also been awarded. Both these appeals are filed against the said order.
9. The only question that arise for consideration in these appeals is whether the appellants were negligent in treating the deceased Lakshmi Santhosh. According to the counsel for the appellants, the death of the deceased has not taken place at the Parabrahma Hospital, Oachira but at the VSM Hospital, Mavelikkara. Therefore, the District Commission had no territorial jurisdiction to entertain the complaint. Though the complainant had placed reliance on Exhibit P5 the death certificate issued by Dr. Ravikumar, who was the 1st opposite party before the District Commission, the same was obtained by the husband and the relatives of the complainant forcibly, he had also submitted a complaint to the Police with respect to the said incident. Therefore, the District Commission erred in placing reliance on the said certificate. The counsel refers to Exhibit X1, case sheet of the VSM Hospital wherein it is recorded that the deceased died at 2 p.m. Nowhere in Exhibit X1 is it shown that the patient was brought dead to the VSM Hospital. According to the learned counsel, the fact that injection Adrenalin, intra tracheal, intravenous were administered along with the cardiac massage and the fact that the patient was connected to the ventilator clearly establishes that she was not brought dead to the VSM Hospital. According to opposite parties 2 and 3, who are the doctors of VSM Hospital, if a patient is brought dead, they used to make an endorsement to the said fact and inform the Police. PW1, the mother of deceased Lakshmi had deposed in favour of VSM Hospital since she was obliged to do so as both herself and the deceased were staff nurses in the said Hospital. PW2 has stated in his cross examination that he was having a moral obligation to see that the complainant's case was won. Therefore, it was contended that PW2 was an interested witness.
10. The contentions of counsel for the appellants are refuted by counsel for the complainants 1 and 2 who represents the original complainants. According to the learned counsel, though a number of contentions are being raised by the appellants, absolutely no evidence was adduced by them before the District Commission. Therefore, this is a case in which there is evidence only on one side. Though it is alleged that Exhibit P5 certificate was forcibly obtained from Dr. Ravikumar, he has not even chosen to mount the witness box to swear to the said allegation. Therefore, it is contended that the same is only to be rejected. Smt. Lakshmi Santhosh, aged 25 years, a perfectly healthy lady had walked into the Parabrahma Hospital complaining of pain in her lower abdomen at 8 a.m. in the morning. But by 11.30 a.m., she was dead. Her death was a direct result of negligence in the treatment administered to her. Ampicillin injection was administered to her without proper testing. Therefore, she developed anaphylactic reaction. Though Adrenaline injection was necessary to have been administered to counter the reaction, the same was not done. Instead, she was intubated and Diazepam injection was administered, which aggravated her condition and led to her death. However, without declaring her death the appellants advised her to be shifted to the VSM Hospital for being provided with ventilator support. But, when PW2, the Cardiologist examined her, he has noted in Exhibit X1 case sheet that at 12.40 p.m. that she had no pulse, the pupils of her eyes were dilated, laterally fixed and not reacting to light and that the monitor showed persistent asystole. It is clear from the above that she was dead when she was brought to the VSM Hospital. It is also pointed out that the Apex Body headed by the Director of Health Services which enquired into the death of Smt. Lakshmi Santhosh has found collective negligence on the part of all the appellants. Exhibit X2 file is clear on the above aspect. Therefore, according to the counsel, the District Commission was fully justified in finding negligence on the part of the appellants and ordering payment of compensation. He therefore prays for dismissal of both the appeals.
11. We have considered the contentions advanced before us anxiously. We have also carefully perused the Lower Court Records called for and produced before us. This is an unfortunate case in which a young lady aged twenty five years, mother of a child aged one and half years had lost her life unexpectedly, plunging her family into grief and despair. As rightly contended by the counsel for the respondents 1 and 2, the appellants herein have not adduced any evidence in support of the contentions raised in their version. Neither the authorities of the Hospital nor the doctors who treated the deceased have chosen to enter witness box or to swear to the case pleaded by them. The District Commission has placed reliance on Exhibit P5 death certificate issued by the 1st opposite party in the complaint. Though it is contended that the certificate was issued under duress, there is absolutely no evidence to support the said contention. Though it is contended that a police complaint had been submitted with respect to the said incident, it is obvious that the Police have not found any material to initiate any further action. Therefore, the veracity of Exhibit P5 remains unchallenged. Dr. Ravikumar who issued the certificate has not chosen to testify to the circumstances under which the same was issued. In addition, a perusal of Exhibit X1 shows an endorsement made at 11.35a.m. that the patient was intubated with Ambu Bag Respiration, no pulse is palpable, heart sounds not audible, pupils not responding to light. The above entries in Exhibit X1 further supports the case of the respondents that the patient was dead at that time itself. Though it is true that the deceased was shifted to the VSM Hospital thereafter, according to PW2 Doctor James F. Shallam, the Cardiologist at VSM Hospital who examined the deceased, when he saw the deceased, her pulse was not felt, heart sound was not heard, her pupils were laterally dilated and not reacting to light and the monitor showed asystole. To a pointed question as to whether the patient was dead when he examined her, he has replied that she was dead, but the time of death was uncertain. All the above circumstances clearly establish the fact that the deceased Lakshmi Santhosh had died at the Parabrahma Hospital, Oachira and therefore the District Commission had territorial jurisdiction to entertain the complaint. For the same reason, the contention of the appellants that there is non-joinder of a necessary party in not impleading VSM Hospital on the party array of the complaint is also rejected.
12. The next aspect that requires consideration is whether the appellant were negligent in treating the deceased. As already noticed above, the deceased was a young, twenty five year old, healthy lady who was working as a staff nurse. She had attended duty on the previous day also, according to the complainants. She had pain in the lower abdomen at 8 a.m. in the morning when she was proceeding to attend a marriage, along with her husband. It was in the above circumstances that she came to the duty doctor at the casualty of the Parabrahma Hospital. She was examined by the duty doctor and was advised Injection Cyclopam 1 Ampoule IM for Abdominal Colic. She was also given Dygene Syrup and Rabiprazole 20mg tablet. It is stated that she was feeling better thereafter, but the duty doctor referred her to the Surgeon. One fails to understand why the patient had to be referred to a Surgeon. But, there is also no explanation forthcoming. After examination of the deceased the Surgeon referred the deceased to the Gynaecologist, Dr. Girija with a written query of Pelvic inflammatory disease. The Gynaecologist on examination of the deceased, noticed tenderness of the left loin and she suspected renal colic and admitted the patient. She also prescribed Ampicillin 500mg I.V., to be given after test dose, injection Pantodac I.V. and Ringer Lactate 2 pints I.V. She also advised plain x-ray KUB after enema and blood test routine, TC, DC, ESR, Haemoglobin. According to the appellants, Ampicillin was administered to the patient after test dose by 11 a.m. and at 11.15 a.m. the patient was seen by the casualty Medical Officer, Dr. Ajith. He gave her injection Dexona. By then the patient had developed anaphylactic reaction. Thereupon, injection Efcorlin was given, oxygen inhalation was started and the patient was shifted to the ICU. The patient was also intubated. As per the Inpatient records, Dr. Ajith gave injection Diazepam 1 Ampoule I.V. It was thereafter the 1st opposite party Dr. Ravikumar saw the patient. At 11.35 a.m. the 1st opposite party examined the patient and found that her pulse was not palpable, blood pressure not recordable, pupils not reacting to light. It is clear from the above recording that, the patient was not alive at 11.35 a.m.
13. The above sequence of events clearly show that the appellants were grossly negligent in treating the deceased. The deceased who was young and otherwise healthy had walked into the hospital seeking treatment for pain in her lower abdomen. The duty doctor had prescribed medicines and she had started feeling better but for reasons unknown, she was referred to a Surgeon and the Surgeon in turn referred her to a Gynaecologist. The Gynaecologist suspected renal colic and prescribed Ampicillin I.V., without even ascertaining what her condition was. Ampicillin is an antibiotic to which many people develop reaction. Though there is an instruction in the nursing records that it was to be administered after test dose, it is not clear whether test dose was given and whether there was any reaction on her skin after the test dose. Be that as it may, it is not in dispute that she developed anaphylactic reaction of dyspnea meaning breathlessness. When such reaction occurred it was necessary to have stopped the Ampicillin injection and administered Adrenalin which is the antidote for anaphylactic reaction. In the case of the deceased, Adrenalin injection was not given which amounts to gross negligence. Finally, after she was taken to the VSM Hospital, Mavelikkara the records show that she was given Adrenaline, which was after her death.
14. According to the medical records of the deceased, she was intubated and shifted to ICCU. Thereafter, her blood pressure started falling. The medical records show that at 11.15 a.m. pulse and blood pressure of the deceased was not recordable. She was also given Diazepam Injection which is a contra indicated drug to anaphylactic reaction. The patient was not given cardio pulmonary resuscitation. All the above circumstances hastened her death. However, without recording the fact that she was dead, she was shifted to VSM hospital. It is evident that the said procedure was adopted by the appellants to wash their hands off and wriggle out of their liability. The Apex Body that inquired into the circumstances under which death of the deceased occurred has identified collective negligence on the part of the hospital and the doctors who treated her, as evident from X2 report dated 27.02.2010. Exhibit X3 is the file relating to the said enquiry. We do not find any reason to doubt the correctness of Exhibit X2 report in view of the details referred to above, gathered from the materials on record. Though a contention is attempted to be put forward that the deceased was an epileptic patient, absolutely no material is available to support the said contention. If she was under treatment of a Neurologist at VSM Hospital, nothing prevented the appellants from examining him as a witness in the case. Even assuming that she was an epileptic patient, it cannot be presumed that her death was attributable to the said condition of hers. Nor will such condition of hers mitigate the liability of the appellants.
15. As already noticed above absolutely no evidence has been adduced by the appellants on their side. The medical records produced as Exhibit X1 shows that no history of the patient was recorded before admitting the deceased to the hospital. No condition warranting the administration of the antibiotic Ampicillin has been found recorded. When Ampicillin was administered in full, she developed anaphylactic reaction. Immediately, administration of Ampicillin should have been stopped and administration of Adrenalin injection should have been started, which is the antidote for anaphylactic reaction. The said standard procedure was not adopted. Instead, she was administered Diazepam, which is a sedative. When the patient developed breathlessness, cardio pulmonary resuscitation ought to have been given, which was not done. The Anaesthetist who intubated the patient left the scene without making an endorsement in the treatment record. All the above circumstances indicate any absence of care and gross negligence in the treatment of the deceased. The District Commission has therefore correctly come to the conclusion that it was without any proper diagnosis that the deceased was admitted to the hospital and prescribed Ampicillin full dose. It was the anaphylactic reaction that was not properly managed that resulted in her death. Opposite parties 2 to 6 are therefore liable to compensate the complainants. The compensation granted by the District Commission can only be accepted as reasonable, taking into account the magnitude of the loss caused to the complainants. The 1st complainant has lost the society of his wife. The 2nd complainant child has lost the love, care and affection of her mother at a tender age. Therefore, we confirm the amount of Rs.15,00,000/-(Rupees Fifteen Lakhs) ordered to be paid as compensation and the amount of costs imposed by the District Commission.
16. In view of the above, both these appeals are dismissed. These appeals have been pending before this Commission for the past ten years. Complainants have thus been deprived of even the compensation ordered to be paid by the District Forum all these years. Therefore, respondents 1 and 2 shall also be entitled to the costs of this litigation which is fixed as Rs.15,000/-(Rupees Fifteen Thousand). The statutory deposit made by the appellants at the time of filing these appeals shall be disbursed to respondents 1 and 2. They shall appropriate an amount of Rs.15,000/-(Rupees Fifteen Thousand) towards the costs ordered to be paid in these appeals and the balance amount towards the amounts ordered to be paid to them as compensation.
JUSTICE K. SURENDRA MOHAN :
PRESIDENT AJITH KUMAR D. :
JUDICIAL MEMBER K.R. RADHAKRISHNAN :
MEMBER SL [HON'BLE MR. JUSTICE SRI.K.SURENDRA MOHAN] PRESIDENT [ SRI.RADHAKRISHNAN.K.R] MEMBER