State Consumer Disputes Redressal Commission
M.A.Sheriff,Cumbum,Theni Dist. vs Apollo Hospital Specialty & 2 Others, ... on 28 February, 2022
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IN THE CIRCUIT BENCH OF THE TAMIL NADU STATE CONSUMER
DISPUTES REDRESSAL COMMISSION, MADURAI.
PRESENT: THIRU.N. RAJASEKAR, PRESIDING JUDICIAL MEMBER
C.C.No.06/2013
Date of complaint filed : 06.12.2012
Date of orders pronounced : 28.02.2022
Mr.M.A.Sheriff,
S/o Late Mohideen Pitchai,
Door No.93, Sungam Street,
Cumbum,
Theni District - 625 516. Complainant
-Vs-
1. M/s. Apollo Speciality Hospital,
Lake View Road, K.K.Nagar,
Madurai-20
Through its Chief Operator and
Chief in Charge Dr.Rohini Sridhar. 1st Opposite Party
2. Dr.Rohini Sridhar,
Chief Operator and Chief in charge of
M/s.Apollo Speciality Hospital,
Lake View Road, K.K.Nagar,
Madurai - 20. 2nd Opposite Party
3. Dr.K.S. Palanirajan,
Senior Consultant (Nephrologist),
M/s.Apollo Speciality Hospital,
Lake View Road, K.K.Nagar,
Madurai -20. 3rd Opposite Party
Counsel for Complainant : Mr.V.R.Venkatesan, Advocate.
Counsel for Opposite Parties-1 to 3 : Mr.V.Ramakrishnan, Advocate.
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This complaint coming before us for final hearing on 20.10.2021 and on
hearing the arguments of both sides and upon perusing the material records this
Commission made the following:-
ORDER
THIRU. N.RAJASEKAR PRESIDING JUDICIAL MEMBER.
1. This complaint has been filed by the complainant under section 17 (1) (a) (i) of the Consumer Protection Act, 1986 praying this Commission to direct the opposite parties to pay the reasonable compensation amount of Rs.25,00,000/- (Rupees twenty five lakhs only) with cost to the complainant.
2. The case of the complaint in brief is follows: - The complainant‟s wife by name Nazeema aged about 41 years was brought to the opposite parties hospital only for consultation. Since she had swelling on her both legs, at the time blood sample was taken to find out the cause for swelling. Ex.A1 and Ex.A2 are the blood test report shown two different references. Ex.A1 is the earlier one issued at 10.25 A.M. shows the blood urea level is 16 and creatinine is 0.6 the same sample of blood was tested and the Ex.A2 issued at 5.26 P.M. on the same date i.e., 13.11.2004 shows the blood urea level was 72 the creatinine is 8.5. The opposite parties issued two different blood test report both Ex.A1 and Ex.A2 are the basic document for the conclusion arrived by the team of doctors, at the opposite parties to suggest the complainant‟s wife for kidney transplantation. In the complaint itself the complainant‟s wife was admitted in the 1st opposite party hospital for undergoing kidney transplantation operation and she also underwent the treatment under the 2nd opposite party and it was the 3rd opposite party who actually suggested to the complainant and his wife was in dire need of kidney transplantation operation. In 3 accordance with medical counseling offered by him, the operation was performed the complainant‟s wife on 17.12.2004 by the third opposite party is an utter failure. Since the kidney transplantation was not successfully done by the opposite party the victim left with no choice except to pull on her life by taking heavy drugs and to spent more than 18 lakhs in order to survival. The 3rd opposite party suggested that it would be better if the patient took ketologue tablet from the month of September 2009 and subsequently suggested a tablet „CUDO‟ and also prescribed other tablets such as Renodapt and Ketologue. After taking the tablets there was speedy increase in urea and creatinine level and complained of acute stomach pain and dysentery. The complainant was directed to contact Dr.Subba Rao of Apollo Hospital at Chennai. The victim was affected with HCV on 27.10.2010 after administering dialysis Ex.A10. The dialysis machine which is intended to be used for infected patients is utilized for the complainant‟s wife and due to that reason the victim is infected with HCV no treatment was given for HCV till her death.
The 3rd opposite party instructed to remove Foleys Catheter and stop the dialysis and further instructed his staff to conduct blood test to the complainant‟s wife for RP2, HB, TC, DC but without putting his signature and remarks were made on 30.10.2010 and the complainant‟s wife was shifted from ICU to the General ward as stable Clinically. On 01.11.2010 once again the dialysis was administered. On 03.11.2010 at about 11.40 A.M. the 3rd opposite party has directed his staff to conduct blood test for RP II, TC, DC, HB. The Dr.Angel Deepa has made a remark as PA/soft Chest Clear. On 04.11.2010 at about 12.15 P.M. the 3rd opposite party has advised the complainant‟s wife to take 1.5 liter of water and further directed his staff to take blood sample from complainant‟s wife to conduct the test for TC, DC, RP II, 4 Ru Calcium. On 04.11.2010 complainant‟s wife was discharged. In the discharge summary the fact of the complainant‟s wife was infected with HCV is concealed and failed to disclose the same.
On 01.12.2010 the complainant‟s wife suffered breathlessness and was again directed to get admitted in the emergency ward of the 1st opposite party hospital. She observed that such deterioration was not expected and the medicine might have caused such reactions and that could have been changed. Even after the said consultation with Dr.Subba Rao, the patient was not able to perceive any appreciable improvement in the health condition.
On 26.10.2010 the patient developed high fever having symptoms of severe abscess, vomiting, fever, and pain. The 3rd opposite party suggested for conducting blood test of RPI, Stool culture and sensitivity, ranging drop and advised to get an opinion from Dr.Rajesh Prabu Gastroenterologist. Complainant‟s wife (the patient) was admitted intensive care unit on 27.10.2010 at about 4.00 P.M. started necessary treatment. It was informed that the patient has to undergo dialysis through catheter. Blood was taken from the body of patient on 28.10.2010 after administering dialysis. The opposite parties have neglected to furnish a copy of the report of the blood result conducted on 27.10.2010. Two types of dialysis machines are used for administering dialysis (i.e.) one is for normal and another one is for infected patient the machine which is used for infected patient was used to the patient without any proper sterilization and obviously which was resulted that the HCV disease was transferred through the dialysis machine to the patient. In developing countries the primary sources of HCV infection are unsterilized injection equipment and infusion of inadequately screened blood and blood products.
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Complainant‟s wife was discharged from the hospital as she was okay on 04.11.2010. After the discharge the complainant‟s wife (the patient) became sick and her weight was considerably reduced to the maximum extent. The complainant has also obtained oral opinion from several doctors, and came to understand that once the patient is affected with HCV virus absolutely there is no chance for survival and the disease is not curable. Despite the complainant‟s request, his request was neglected and they administered dialysis against the wish of the complainant.
Initially the complainant felt that instead of giving proper drug the 3rd opposite party prescribed a tablet viz., „CUDO‟ for reducing serum creatinine in blood level which might have contributed to the death of his wife. On 02.12.2010 a pulmonologist namely Dr.M.Palaniappan visited belated and has not given any correct or complete opinion, the health condition of the patient. On 03.12.2010 the hospital authorities stated that the patient was not fit for CAPD and directed to take the opinion of the general surgeon. Till her death on 10.12.2010, neither the opinion of a general surgeon was sought nor the fitness for CAPD was tested, but CAPD was performed on the patient on 10.12.2010 (i.e.) the day of her death. On 05.12.2010, it was reported it is significant to note that on 05.12.2010 when the patient suffered acute Hepatitis but on the next day (i.e.) on 06.12.2010 the patient‟s health condition was stated as "Symptoms Better". Dialysis was performed the catheter deployed had slipped out owing to the negligent handling and due to the same around 350 ml., of blood leaked out and the patient was immediately shifted to critical care unit. The doctor impliedly admits that these problems for the patient arose because of the previous day‟s dialysis in which catheter slipped and about 350 ml., of blood leaked out which allowed the entry of a foreign substance like air 6 causing all these. It is to be noted that the abdomen of the patient was reportedly swelling on 08.12.2010. No attempt was made by the hospital to ascertain whether it was due to acute Hepatitis or Renal failure. It is astonishing to note that the hospital has reported that the patient was comfortable on 10.12.2010 (the day of her death). The hospital has stated that the patient had "Sepsis" (a serious blood borne disease) on 07.12.2010. Throughout the treatment was managed and supervised and followed up by the 3rd opposite party who was also equally negligent in not making a proper follow up and rendered a totally defective service. The entire treatment offered by the opposite parties to the complainant‟s wife was defective, deficient and with gross negligence which has caused the ultimately demise of the wife of the complainant.
Therefore, the complainant prays for, to pass an order directing opposite parties to pay the reasonable compensation amount of Rs.25,00,000/- (Rupees twenty five lakhs only) with cost to the complainant for the loss of his wife due to the gross and defective service and medical negligence on the part of the opposite parties.
3. The opposite parties filed in his written version is as follows-
The opposite parties very respectfully submit that the allegations in paragraph No.3 of the complaint that Mrs.Nazeema got admitted in the 1 st opposite party Hospital for undergoing kidney transplantation operation is true. The need and necessity for kidney transplantation operation was evaluated duly by the diagnosis by the doctors of the 1st opposite party and after a complete diagnosis, the necessity for kidney transplantation was suggested in respect of which the complainant cannot blame any of the opposite parties. As a matter of fact, the kidney transplantation 7 operation was performed by the third opposite party and his team of Doctors after a careful examination as well as investigation regarding the medical parameters and diagnosis and after proper evaluation. The compatibility of the donor kidney was also duly verified. As a matter of fact, even before the operation, it was suggested in clear terms to the complainant and his wife that the renal transplant surgery from a near relative donor has a long time survival of transplanted kidney and due to antigen mismatch unrelated donor‟s kidney transplantation may not have a long time survival. In the case of complainant‟s wife, she did not have a near relative donor for her transplant surgery and therefore, she underwent renal transplant surgery from other than near relative donor after authorization committee‟s approval. Since Mrs.Nazeema did not have any near relative donor, the complainant as well as Mrs.Nazeema took the option of going for renal transplant surgery from an unrelated donor. The donor was the husband of her sister who is not a blood relation. During the relevant point of time, her condition was also not suitable for a long term dialysis. As a matter of routine practice and as matter of prudence before the said transplantation procedure, the methodology, nature of the operation, consequences and chances of failure in view of the kidney of unrelated donor were duly discussed and informed to the complainant and his wife. It was after enlightening the complainant and his wife regarding the nature and consequences of the operation, they consented for the same and opted for surgery after knowing fully well about the consequences. It is totally false to allege that the third opposite party made assurances that the donated kidney could function well for at least 15 years without any problem. It is a medically known fact that no such assurances can never be 8 given in the case of kidney transplantation and more especially in cases where the donor is unrelated to the patient.
It was owing to the inherent health condition coupled with the performance of the transplanted kidney such variations have occurred which was then and there duly evaluated whenever the patient was referred to the opposite parties and adequate treatment was given. The admitted fact that after the kidney transplantation, urea and creatinine levels were evenly maintained only for five days themselves would show that there was no fault or negligence in the surgery. The fact that the transplanted kidney was not functioning properly was pursued and later diagnosed from 23.12.2004 when the serum creatinine level started to rise. However, admittedly Mrs.Nazeema died only on 10.12.2010 (i.e.) she survived for at least 6 years despite the fact that her donor was not a blood relation of her sister‟s husband and transplanted kidney was not functioning properly even from 23.12.2004, it was only due to proper care and treatment and medications, given and suggested by the opposite parties especially by the third opposite party. This single factor is an indicative to show that there was no deficiency in service rendered by the opposite parties. In the case of Mrs.Nazeema all efforts were made appropriately and in the right time, to find out the dysfunction of transplanted kidney. As a matter of fact, the dysfunction was expected owing to the fact that the donor was unrelated which was duly explained and discussed with the complainant and Mrs.Nazeema from the inception. These facts have been conveniently suppressed by the complainant.
During the transplantation surgery, it was found that warm ischemic was 1 minute and 35 seconds and total ischemic time was 42 minutes. These two 9 parameters were excellent in transplant surgery. After the transplantation, the patient had graft perfusion and transplanted kidney started pouring urine and graft function became normal on 18.12.2004. The serum creatinine level was 1.1 mg/d and remained normal till 22.12.2004. Thereafter, there was a sudden rise in serum creatinine level on 23.12.2004 and it was duly and fully evaluated. The Ultra Sona Gram and Doppler Test which were most important tests showed either rejection or ATN. But the patient also developed urinary tract infection which was also duly treated. The constant monitoring and due medication was also given which is a medically accepted fact. In the case of transplantation of kidney surgery, the following possible complications may happen:-
(i) Immediate transplant kidney failure due to surgical reasons.
(ii) Immediate failure due to non-surgical causes
(iii) Late complications of the transplant kidney.
(iv) Possible long term complications.
It is further submitted that, at present, there is no definite means or investigation available for predicting the renal allograft survival before transplantation especially in the cases where the donor kidney is unrelated to the patient. Therefore, complications which may possibly set in cannot be predicted and these facts were also duly informed to the complainant and his wife. Moreover, in the case of kidney transplantation, the outcome after surgery is decided by
(i) Surgical methods and results.
(ii) The choices of available immunosuppressive drugs.
(iii) The body‟s immune reactivity to the transplant kidney. 10
(iv) The side effect of all the drugs which cannot be avoided but minimized.
(v) The basic kidney discuss and it recurrence in the new kidney.
(vi) Non-immunological factors like control of hypertension, diabetes mellitus, urinary tract infection and other infections, weight gain, eating habits, exercise practice and hygienic precautions etc.,
(vii) Relatedness of the donor and other donor factors.
All the above events were duly considered and their implications were duly discussed with the complainant and his wife during pre and post operation periods. Finding that the serum creatinine level has suddenly risen, adequate treatment was given. It is pertinent to note that Ultra Sona Gram test was taken on 28.12.2004 showed normal study and cyclosporine level was high for the appropriate does of the drug. Hence, the drug dosage was reduced.
The opposite parties very respectfully submit that the patient was administered with routine transplant drugs consisting of Cyclosporine, Mycophenolate and Prednisolone. As the patient could not tolerate Cyclosporine instead of it tacrolimus was introduced. Despite this appropriate medications, there was no improvement as expected in her renal functions. Therefore, transplant kidney biopsy was done on 24.01.2005. The finding in the biopsy was not confirmatory and a reflected form of rejection and therefore, she was treated appropriately. During the follow up serum creatinine did not come back to normal despite all appropriate efforts. As the first biopsy was not conclusive, a second allograft renal biopsy was done on 25.02.2005. The second biopsy test showed 11 various findings which did not form any single diagnosis but satisfied a possibility of tacrolimus toxicity. It is pertinent to note that tacrolimus is the only potent drug in its group at that time to treat transplant kidney. Based on the second biopsy findings, all efforts were made to treat the patient symptomatically and to find out the exact reason, for the setback, it was decided to have a third transplant kidney biopsy and it was then on 27.06.2005. All the said three biopsies were done only with due consent of both the complainant as well as his wife and also after explaining the need and necessity. The third biopsy findings shown a diagnosis of Chronic Allograft Nephropathy (CAN).
It is pertinent to note that during relevant point of time no complaint or reservation was ever expressed by the complainant or his wife against any of the opposite parties or other doctors. The dysfunction of the transplant kidney is no one‟s error but it is patient‟s body reaction to the transplant kidney which no way could have been predicated before doing the surgery as no such tests exists for evaluating it.
These opposite parties submit that Chronic Allograft Nephropathy is a condition which results from immunological and non-immunological causes; Immunological causes are Rejection episodes, and non-immunological causes are multiple in their nature including hypertension, diabetes, extremes of weight gain, repeated infections, drug toxicity and basis kidney disease. In the case of Mrs.Nazeema she had CAN from multiple causes which can be seen from clinical findings which were post operative owing to the above narrated facts. Despite the fact that she had CAN her serum creatinine was 2.4 mg/dl in the month of February 2005 and it is only due to the meticulous treatment of the opposite parties which 12 has kept her kidney functioning for the subsequent five years. In fact a second opinion from Dr.B.Subba Rao, MD., DNB., Senior Nephrologist, Apollo Hospitals, Chennai was also sought for as requested by the complainant and he also advised to continue the same line of treatment and no fault or defect was ever pointed out as alleged by the complainant.
The opposite parties very respectfully submit that when Mrs.Nazeema was admitted in Emergency ward on 27.10.2010 and it was the specialist care which brought her back to health status to enable discharge on 04.11.2010. Similar efforts were taken with the all available medical team when she was admitted again on 01.12.2010 as she had renal, liver and brain involvement. All efforts were clinically and medically undertaken to revive the normalcy in the parameters. It is to be mentioned here that any failure in medical treatment does not mean improper or defect in treatment. It is a reflection of complexity of disease and the inability of our technology, system and the individual physiological failure to respond. The fact that the complainant‟s wife died 6 years later to the kidney transplantation operation despite developing CAN even in 2005 itself would show that a proper and meticulous treatment was given to her.
For the legal notice issued by the complainant a suitable reply adverting to the true and real facts was sent by the opposite parties. The fact remains that for CAPD fitness the opinion of general surgeon though suggested a better opinion from Urologist which would be appropriate and essential was duly obtained and CAPD was done. The complainant out of ignorance cannot find fault in the getting of better opinion instead of getting a superfluous and unnecessary opinion of general surgeon for conducting CAPD.
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The diagnosis of acute hepatitis is based on enzyme study and clinical suggestions based on blood test. The enzyme level may vary and may rise steeply on a day and may also fall drastically on another day. They cannot be the factors leading to the death. When dialysis was performed the catheter deployed had slipped out owing to the negligent handling and due to the same around 350 ml., of blood leaked out and the patient was immediately shifted to C.C.U. (Critical Care Unit).
No such event ever happened on 06.12.2010 and the same is nothing but an imagination of the complainant to correlate the opinion of Dr.S.N.Karthic. Dr.S.N.Karthick while evaluating the patient‟s condition on 07.12.2010 has found out development of neurological problems characterized by drowsiness with blurred vision, double vision, tiredness and extreme fatigue and has analysed the possibilities for the same as i) Encephalopathy - Metabolic reasons, ii) Vascular Event - Thalamic reasons and iii) Diseuqlaibrum Syndrome and suggested further investigations. The complainant cannot take advantage of the reference to Vascular event as the intrusion of a foreign body in to the blood stream by imaginarily alleging leaking of blood during dialysis on 06.12.2010. Even the deposited minerals in the blood vessels may at times cause such events leading to neurological problems. With regard to the letter dated 07.12.2010, it is submitted that in the said letter nothing has been stated by the complainant about the alleged leakage of blood during dialysis on 06.12.2010 which itself would show that the allegations of the leakage of blood during dialysis on 06.12.2010 is an afterthought. In response to the request of the complainant the 2nd opposite party called on both complainant and his wife whenever it was required and attended on their problems. 14
With regard to the Police complaint given by the complaint, the police authorities after a due enquiry have found that there was no truth in the complaint and decided not to take any action on the same.
The opposite parties very respectfully submit that at each and every stage of the treatment, the turn of events and the developments which took place, and the condition of the patient were duly informed to the complainant every now and then and the high risk consent was also duly obtained at every stages of the treatment from the complainant and the random allegations to the contra are highly ridiculous besides being imaginary.
The death of the complainant‟s wife cannot be in anyway attributed to any alleged medical negligence on the part of these opposite parties and absolutely there is not even an iota of medical negligence on the part of these opposite parties and on the contra, high degree of professional skill as was required in such type of cases was adopted and the death of the complainant‟s wife, which was most unfortunate was mainly due to the unique and inherent complications of her health condition and not due to any alleged fault or negligence on the part of these opposite parties. These opposite parties are reiterating with high degree of assurance that the treatment, that was afforded to the complainant‟s wife was of international standard and by following the medical protocol properly and the imaginary allegations leveled by the complainant, attributing medical negligence to the opposite parties are baseless, incorrect, besides being mudslinging in nature. In these circumstances, the opposite parties are not liable to make any payment towards damages to the complainant and the claim of Rs.25 lakhs towards damages for the alleged medical 15 negligence is baseless and untenable and nothing but an attempt made by the complainant making the most use of the unfortunate turn of event,.
Therefore, it is humbly prayed that this Commission may graciously be pleased to dismiss the complaint with costs and thus render justice.
4. The complainant examined himself as PW1 by filing proof affidavit and marked Ex A1 to Ex.A78 on the side of complainant. The second opposite party was examined as RW1 on the side of opposite parties Ex.B1 to Ex.B7 are marked on the side of opposite party.
5. Points for consideration are:
(1) Whether the entire treatment offered by the opposite parties to the complainant‟s wife was defective deficient and with gross negligence which caused the ultimately demise of the wife of the complainant?
(2) Whether the complainant is entitled for compensation as prayed for in the complaint?
6. Point No.1: As per averments in the complaint the complainant‟s wife by name Nazeema aged about 41 years was brought to the opposite parties hospital only for consultation. Since she had swelling on her both legs, at the time blood sample was taken to find out the cause for swelling. Ex.A1 and Ex.A2 are the blood test report shown two different references. Ex.A1 is the earlier one issued at 10.25 A.M. shows the blood urea level is 16 and creatinine is 0.6 the same sample of blood was tested and the Ex.A2 issued at 5.26 P.M. on the same date i.e., 13.11.2004 shows the blood urea level was 72 the creatinine is 8.5. The opposite parties issued two different blood test report both Ex.A1 and Ex.A2 are the basic document for the conclusion arrived by the team of doctors, at the opposite party to suggest the 16 complainant‟s wife for kidney transplantation. In the complaint itself the complainant admits his wife was admitted in the first opposite party Hospital for undergoing kidney transplantation operation. It was suggested by the third opposite party Dr. K.S.Palani Rajan, Senior Consultant (Nephrologist), M/s.Apollo Speciality Hospital, Madurai. The above doctor has not filed any proof affidavit. The second opposite party who is Chief Operator and Chief in-charge of the Apollo Hospital Dr.Rohini Sridharan alone filed her proof affidavit. In the written version the opposite parties stated that the need and necessity for kidney transplantation operation was evaluated duly after a due diagnosis by the team of doctors of the first opposite party and after a complete diagnosis, the necessity for kidney transplantation was suggested. To substantiate their written version, the opposite parties have not filed any piece of evidence to prove the health condition of the complainant‟s wife requires the kidney transplantation for her survival except the blood test reports Ex.A1 and Ex.A2. No other document was filed by the opposite parties. It is not the case of the opposite party the complainant has not filed the earliest documents which are available with him. If the documents are available with the opposite party they can file those documents to prove their written version that the complainant‟s wife health condition is required immediate Kidney transplantation. The Hon‟ble Apex Court held in Indian Medical Association -Vs- V.P.Shantha & Others AIR 1996 SC 550 held that "In general, a professional man owes to his client a duty in tort as well as in contract to exercise reasonable care in giving advice or performing services". The complainant alleged on the advice of the third opposite party he admitted his wife for the operation. The 3rd opposite party have not furnished the particulars, the names who are the members in the team to diagnosis and advising 17 the complainant for the kidney transplantation operation. In the absence of any piece of evidence or document would prove it was suggested, without evaluation or due diagnosis by the team of doctors.
7. The counsel for the complainant relied on citation AIR 2007 SC 1819 the claimant has to satisfy the court on the evidence that three ingredients of negligence, namely, (a) existence of duty to take care; (b) failure to attain that standard of care; (c) damage suffered on account of breach of duty, are present for the defendant to be held liable for negligence.
8. When the blood sample as shown it different range on the same day the opposite party ought to have conduct another blood test by taking blood sample afresh to verify the range of Blood Urea and Creatinine. The opposite parties came to a conclusion only on the basis of those levels are abnormal. No other test was conduct by the opposite parties even though they are claiming Super Speciality Hospital. It is pertinent to note that here the complainant‟s wife has not brought to the opposite parties hospital prior to the first visit, she has not referred by family doctor or any other doctor for consultation to the opposite parties hospital. The complainant himself brought his wife on seeing the swelling of her legs only for opinion. The transplantation was suggested by the third opposite party without exercising reasonable care in giving advice, the failure of act in accordance with the standards of reasonable competent medical man at the time on the part of the opposite parties would amounts to deficiency of their service in advising for kidney transplantation surgery on 17.12.2004.
9. On the advice of third opposite party the complainant's deceased wife was admitted in the opposite parties hospital on 15.12.2004 for kidney transplantation 18 surgery and brought the donor none other the victim‟s own sister's husband. The donor was also admitted in the same Hospital admitted in-patient for donation of kidney transplantation with the complainant‟s wife. The kidney transplantation surgery was performed by the third opposite party and with his team of doctors. The complainant alleged that the kidney transplantation was done by the opposite party is utter failure. By marking Ex.A4 dated 23.12.2004 in the report of Doppler Study - Transplant Kidney suggestive of medical complication (ATN/Rejection) another report Ex.A5 was also marked to the findings "Kidney reveals normal B-Mode" those documents would go to show the complication arose within six days after kidney transplantation surgery.
10. The complainant alleged that the victim left with no choice except to pull on her life by taking heavy drugs by spending more than 18 lakhs in order to her survival. If the kidney transplantation was successful spending huge amount would have been avoided. The guarantee was given to the victim regarding functioning of the transplanted kidney for peaceful life for 15 years.
11. The counsel for the opposite parties would contend that the kidney transplantation operation was performed by the third opposite party and his team of doctors after careful examination as well as investigation regarding the medical parameters and diagnosis and after proper evaluation. The compatibility of the donor kidney was also duly verified. It was suggested even before the operation in clear terms to the complainant and his wife that the renal transplant surgery from a near relative donor has a long time survival of transplanted kidney and due to antigen mismatch unrelated donor‟s kidney transplantation may not have a long time survival. The donor was the husband of the victim‟s sister who is not a blood 19 relation. During the relevant point of time, her condition was also not suitable for a long term dialysis.
12. Now the opposite parties duty bound to prove they have obtained informed consent for performing the kidney transplantation surgery either from the victim or from her husband. They have mentioned in para 4 of their written version "consent relative donor as a long time survival" in later part of the para they have mentioned as the donor is not a blood relation they have informed the importance of donor should be a blood relation. The opposite parties have not filed any document to prove that they have obtained informed consent from the complainant and his wife by informing the donor should be a blood relation to the patient and also not proved that they have obtained informed consent by informing the unrelated transplant Kidney may not have long term survival due to antigen mismatch.
13. The opposite party also admits transplanted kidney is not functioning the complainant‟s wife was discharged from the hospital. The complainant alleged that the opposite party hospital even contradictory statement is a fraudulent. Since, the report of Doppler Study dated 28.12.2004 when the Acute Tubular Necrosis (ATN) is a medical condition involving the death of tubular epithelial cells that form the renal tubules of the kidneys and the opposite party is mentioned that Doppler Study revealed that the transplanted kidney reveals normal is unbelievable. It is not possible in the medical field. The complainant marked Ex.A57 to Ex.A63 are shows biopsy reports showing - "One blood vessel showing Fibrinoid Necrosis" - "Focal ATN and Focal Concentric Thickening of the Blood Vessel Walls" - The possibility of Tacrolimus toxicity - "Changes with Dense Interstitial Lymphocytic Infiltrates and Moderate Tubular Atropathy - Consistent with Chronic Allograft Nephropathy" - 20
"Tacrolimus blood levels" - it is used to prevent organ rejection in transplant patients. Those reports show the opposite party gave treatment for the victim for rejection of transplanted kidney by prescribing some medicines.
14. The complainant‟s wife was brought to the opposite party hospital in the year 2010 on 27.10.2010 and taking in-patient treatment till 04.11.2010, she was brought to the hospital with complaints of Severe, Abscess, Vomiting, Fever, and pain. The third opposite party gave treatment for the complainant‟s wife. She was admitted in ICU by obtaining five risk consents. The second opposite party stated in the proof affidavit the complainant‟s wife survived for at least six years despite the fact that the transplanted kidney was not functioning properly even from 23.12.2004, it was only due to proper care and treatment and medications, given and suggested by the doctors of the opposite parties especially by the third opposite party.
15. The counsel for the complainant would contend that the second opposite party giving assurance and seeing the compatibility of the donor of kidney and other aspects only has convinced the complainant and suggested him for transplantation of kidney to his wife and now the second opposite party has strangely stated that unrelated transplant kidney may not have long-term survival due to antigen mismatch which are all created story for the purpose of the case. It means that kidney was transplanted for Mrs.Nazeema only after getting satisfied about the compatibility of the Kidney to her. But she died within six years of the operation. From this it can safely be concluded that either of the diagnosis and the opinion of the committee of expert doctors are incorrect or they are correct but the patient died because of deficient medical treatment in the hospital. Whatever be the thing 21 admittedly there was deficiency in the treatment of the deceased Nazeema in the opposite party hospital.
16. The counsel for the complainant relied on the following citations:
(1) (2005) 6 SCC - Jacob Mathew -Vs- State of Punjab and another - it is only applicable to cases of criminal medical negligence.
(2) (2018) (5) CTC 564 - Current State of Tamilnadu Cases (SC) - in the case of - Dr.S.K.Jhunjhunwala -Vs- Dhanwanti Kumar & Another - the above citation is not support the case of the complainant.
(3) II (2004) CPJ 14 (NC)- National Consumer Disputes Redressal Commission - in the case of - P.Venkata Lakshmi -Vs- Dr.Y.Savitha Devi - it is the case of remanded back for re-consideration not support the case of the complainant herein.
(4) II (2013) CPJ 18 (NC) - National Consumer Disputes Redressal Commission - in the case of Apollo Emergency Hospital -Vs- Dr.Bommakanti Sai Krishna and Another - the possibilities of infection is admitted in the revision petition
- the above citation is also not support the case of the complainant.
(5) IV (2012) CPJ 385 (NC) - National Consumer Disputes Redressal Commission - in the case of - S.Girija - Vs- Dr.A.Tulasi - "Due to the negligence on the part of the opposite party the complainant‟s had wife suffered the problems of undergoing several clinical and diagnostic tests. Apart from that she has suffered pain and agony while undergoing hysterectomy surgery, cystoscopy and VVF surgery". - The above citation is applicable to the case of the complainant to some extent.22
(6) (2010) 5 Supreme Court Cases 513 - in the case of - V.Kishan Rao -Vs-
Nikhil Super Speciality Hospital and Another- "Before forming an opinion that expert evidence is necessary, the Fora under the Act must come to a conclusion that the case is complicated enough to require opinion of an expert or that facts of the case are such that it cannot be resolved by members of the Fora without the assistance of expert opinion". In para 23 it was discussed as follows:- " Even though Bolam test was accepted by this Court as providing the standard norms in cases of medical negligence, in the country on its origin, it is questioned on various grounds. It has been found that the inherent danger in Bolam test is that if the courts defer too readily to expert evidence medical standards would obviously decline. Michael Jones in his treatise on Medical Negligence (Sweet and Maxwell), 4th Edition 2008 criticised the Bolam test as it opts for the lowest common denominator".
(8) III (2012) CPJ 29 (NC) - National Consumer Disputes Redressal Commission - in the case of - CHL.Apollo Hospital, Indore & Others -Vs- Ashish Sanyal & Others - "In view of the fact that counsel for petitioner was unable either to explain the reasons for the drastic drop in the hemoglobin count as noted above and the records produced by the petitioner also do not shed any light on this issue, we are inclined to agree with the findings of Fora below which are Courts of fact that the Petitioners/Doctors were deficient and negligent in the treatment of this patient". The above citation is applicable to the present case.
17. The counsel for the complainant relied on the following another citation:
The absence of informed consent for kidney transplantation surgery reported in Judgement of Hon‟ble Supreme Court of India.23
(1) In Civil Appeal No.2867/2012 - in the case of - Dr.Balram Prasad -Vs-
Dr.Kunal Saha & Others.
(2) In Civil Appeal No.692/2012 - in the case of - Advanced Medicare & Research Institute Limited -Vs- Dr.Kunal Saha & Others.
(3) In Civil Appeal No.2866/2012 - in the case of - Dr.Kunal Saha -Vs- Dr.Sukumar Mukherjee & Others.
(4) In Civil Appeal No.731/2012 - in the case of - Dr.Baidyanath Haldar - Vs- Dr.Kunal Saha & Others.
(5) In Civil Appeal No.858/2012 - in the case of - Dr.Sukumar Mukherjee
-Vs- Dr.Kunal Saha & Others.
Therefore, a lumpsum amount of Rs.10 lakhs is awarded to the claimant following the Nizam Institutes case (supra) laid in Kemp and Kemp on the quantum of damages, under the head of pain suffering of the claimants wife during the course of treatment. The above citation is applicable to the present complaint for awarding compensation as prayed by the complainant in the complaint.
18. The counsel for the complainant produced some other citations pronouncement of several State Commissions not considered.
19. By producing copies of Wikipedia websites - It is the admitted case of the opposite party that the transplanted kidney was not functioning due to rejection of organ she was survived for six years after the surgery only on medicines.
20. The complainant alleged that the third opposite party suggested the complainant‟s wife took Ketologue tablet from the month of September 2009 there was steady increase in the urea and creatinine level and there was no appreciable diminution in them. Whenever the complainant‟s wife was referred to the third 24 opposite party, instead of attending her hand and foot as is expected of a medical practitioner, no proper answer was given except making her to undergo various tests and stating that, such escalation is bound to happen and there was no reason to worry about the same. In the meantime, the third opposite party suggested a tablet named "Cudo" stating that the same is having miraculous medical effect and it was an imported tablet and that it would go a long way in reducing the burden of the kidney would prove to be an appropriate medicine for her ailments. The third opposite party also prescribed other tablets such as Renodapt and Ketologue besides Cudo and advised the complainant‟s wife to consume them „thrice a day‟. After taking such tablets the complainant‟s wife became fish out of water and complained of acute stomach pain and dysentery. On 17.07.2010 when the blood test was conducted it was found that the blood urea was to 71 and creatinine level ascended to 3.5. It was suggested by the third opposite party to drop the tablet Renodapt and take Ketologue and Cudo alone. The complainant was directed to contact Dr.Subba Rao at Chennai. The Dr.Subba Rao expressed his sympathies to them he simply observed that such a deterioration was not expected and the medicine might have caused such reactions and that could have been changed, instead of continuing with the tablet Cudo. After the consultation with Mr.Subba Rao the complainant was not able to perceive appreciable improvement in the health condition of his wife.
21. On 26.10.2010 the complainant‟s wife became totally unhealthy and developed high fever and thereafter she was admitted in the hospital on 27.10.2010 with the symptoms of Severe Abscess, Vomiting, Fever and Pain. The Dr.Rajesh Prabu at about 12 noon has seen the complainant‟s wife on 27.10.2010, and started necessary treatment and informed the patient has to undergo dialysis through 25 Catheter. Before undergoing the dialysis, the hospital authority ought to have conducted blood test for HIV, HCV. Though the opposite party has conducted for HIV, HCV conducted on 27.10.2010, but the blood was taken from the complainant's wife on 28.10.2010, after administering the dialysis.
22. The second opposite party stated in amended proof affidavit the tablet namely „Cudo‟ is a probiotic medicine used widely in the medical practice to reduce the Uremic burden. The other medicines such as Renodapt and Ketologue besides Cudo were prescribed by taking in to consideration of the complaints made then and there. The variations in blood urea and creatinine level on 17.07.2010 are mainly due to the inappropriate functioning of the transplanted kidney. However, it was suggested to drop the tablet Renodapt and take Ketologue and Cudo. The alleged meeting of the complainant had with Dr.Subba Rao is not known to any of the opposite parties. However, seeking an expert opinion is a common aspect. In the case of transplantation of kidney surgery, the following possible complications may happen:-
i) Immediate transplant kidney failure due to surgical reasons.
ii) Immediate failure due to non-surgical causes.
iii) Late complications of the transplant kidney.
iv) Possible long-term complications.
23. The opposite party found the dysfunction of the transplanted kidney and diagnosis the condition of the patient is "Chronic Allograft Nephropathy (CAN)" after taking biopsy test of the transplanted kidney three times respectively 24.01.2005, 25.02.2005 and 27.06.2005. The second opposite party stated in their proof affidavit that all those tests were done with the concurrence of the patient and the 26 complainant. There is no definite means or investigation available for predicting the renal allograft survival before transplantation especially in the cases where the donor kidney is unrelated to the patient. Therefore, the complications which may possibly set in cannot be predicted pre-operative. The complainant‟s wife had CAN from multiple causes despite the fact that she had CAN her serum creatinine is 2.4 mg/Dl in the month of February 2005 and it is only due to the meticulous treatment of the opposite parties which has kept her kidney functioning for the subsequent five years.
24. The vascular rejection was detected on 21.02.2005 itself the urea creatinine level to the complainant‟s wife was abnormal in Ex.A58 it discloses the malfunction of transplant kidney. Considering the condition of the patient dialysis was done on 27.10.2010 blood samples were taken at about 9.08 P.M. and its results revealed that HCV positive. On 28.10.2010 also at about 8.14 A.M. blood samples were taken and its results revealed that HCV positive. The opposite party produced Ex.B1 to Ex.B3.
25. The complainant alleged that prior to administering dialysis no symptom regarding HCV, after administering dialysis the patient is infected with HCV. The dialysis machine which is intended to be used for infected patients was utilized for the complainant‟s wife and due to that reason the victim was infected with HCV. No treatment was given to the victim for HCV till her date of death. The negligence leaves to the death of the victim. The victim was discharged from the hospital on 04.11.2010 though her blood urea level was 96 mg/dL and creatinine level was 4.7. In this situation, the opposite parties should have retained the patient in the hospital and continued treatment till the urea level and creatinine level become normal. By discharging the patient health condition the opposite parties have done what ought 27 not to have been done themselves negligence on the part of the opposite parties which contributed to the death of the victim.
26. In the discharge summary dated 04.11.2010 (Ex.A13) categorically stated that the patient has recovered from Acute Renal Failure. But, the Death summary dated 10.12.2010 (Ex.A29) mentioned that one of the factors that contributed to the death of the victim is "Acute Renal Failure".
27. The second opposite party stated in her proof affidavit all the machines always kept sterile and in between dialysis complete sterilization will be done meticulously. The allegation raised by the complainant using two types of dialysis machines are used for administering dialysis based on imagination. The HCV infection would not result in the immediate death within a short time of two months as the same is slow disease.
28. For performing dialysis was duly informed to the complainant and his wife as well as to his brother in law and due written consent was also duly obtained. Ex.B4 to Ex.B7 are marked on the side of opposite partly to prove those facts.
29. It is the admitted case of both parties that the complainant wife was infected with dreaded disease of HCV. In Ex.A64 blood test report shows Billirubin Total (Diazo) - 0.4 mg/dL, Billirubin Direct (Diazo) 0.1 mg/dL, Billirubin (Indirect) - 0.3 mg/dl report proved on 14.09.2010. The patient was not affected with HCV test report marked by opposite party as Ex.B5 shows on 27.10.2010 the patient Mrs.Nazeema was infected with HCV positive and another report Ex.B6 dated 28.10.2010 also shows the HCV infection is positive.
30. The complainant alleged that his wife might have been infected with HCV and was neglected to give treatment for HCV. These negligence has taken away the 28 life of his wife without giving any treatment to the disease of HCV. The HCV disease was transferred through the Dialysis Machines. The complainant came to understand that once patient is affected with HCV Virus, absolutely there is no chance for survival which is not curable disease his wife has not taken any treatment from any hospital except from the Apollo Hospital opposite party herein. The complainant‟s wife was not even in a position to walk on 06.11.2010, the opposite parties have advised to admit his wife immediately. Accordingly the complainant‟s wife was admitted in the hospital once again on 01.12.2010 haemodialysis done two times in a day on 02.12.2010. The complainant marked Ex.13 to Ex.A18 Hemoglobin level to the patient was increased considering which shows that the kidney is functioning properly. Despite the request of the complainant his request was neglected and the opposite parties administered the dialysis against his wish. On 29.10.2010 Dr. Subbaiah who was ICU in-charge doctor has seen the patient, and he mentioned creatinine raised 4.6 and further opinion has to obtain from Dr.Palanirajan and the patient needs dialysis. If the HCV is affected to any person, creatinine level will increase automatically. The Foleys Catheter was removed on 30.10.2010 next day on 01.11.2010, once again the dialysis was administered. On 02.11.2010, the third opposite party has directed their staffs to remove the Catheter and the same was removed.
31. In the discharge summary, it has been mentioned as Acute Renal Failure (Recover). In the entire discharge summary, the crucial fact of his wife was infected with HCV is concealed. On 01.12.2010 the complainant‟s wife suffered breathlessness and was again directed to get admitted in the emergency ward. There was a gradual deterioration in her health without any insignificant 29 improvement. On 06.12.2010 when dialysis was performed the catheter deployed had slipped out owing to the negligent handling and due to the same around 350 ml of blood leaked out and the patient was immediately shifted to CCU. (Critical care Unit). The incident allowed the entry of a foreign substance like air causing all these showing the opinion given by Dr.Soundararajan on 08.12.2010 showing HCV Positive and about the high risk involved for fixing CAPD cathedral. The above opinion is marked as Ex.A27. Dr. M.V.Ramesh Babu advised to inform Dr.Benet it was marked as Ex.A28. No attempt was made by the hospital to ascertain whether it was due to acute Hepatitis or Renal Failure.
32. The second opposite party stated in her proof affidavit that the necessary protocol for emergency was duly followed CAPD fitness the opinion of general surgeon suggested a better opinion from Urologist which would be appropriate and essential was duly obtained and CAPD was done. The getting of better opinion instead of getting a superfluous and unnecessary opinion cannot be found fault with. Dr.M Palaniyappan made an endorsement that he tested the patient on 11.12.2010 i.e., a day after her death on 10.12.2010 and has prescribed medicines for the following few days is only an error in the date given by the said doctor. It is trying to be used by the complainant to attribute negligence on the opposite parties. At each and every stage of the treatment, the turn of events and the developments which took place were also duly informed to the complainant and the high risk consent was also duly obtained at every stage of the treatment from the complainant. The death of the complainant‟s wife was most unfortunate was mainly due to the unique and inherent of her health condition and not due to any alleged fault or negligence on the part of the opposite parties.
30
33. The complainant alleged that the opposite parties have thus right from the beginning of the treatment, made him and his wife to believe their words and made his wife undergo kidney transplantation surgery by enticing and inducing and extracting as much money as possible from the patient. The subsequent post- operative treatment also not on alleviating suffering of the patient and ultimately committed gross negligence which has hastened her death. The entire treatment offered by the opposite parties was defective, deficient and with gross negligence caused the ultimately demise of his wife.
34. When the expected complications of rejection of transplanted kidney from not a blood related donor it should be advised only for survival of the patient. The opposite parties have to consider any other treatment for swelling of both legs. The complainant‟s wife did not have any pre-history of kidney problem and taking any treatment or dialysis warranting kidney transplantation. The opposite parties failed to prove the health condition of the complainant‟s wife at the time of advice given for kidney transplantation. The advice was given only on the basis of blood test reports taken in a single day, in a single sample of blood used for both tests. When the reports are contradictory the opposite parties are expected keep slow in giving the advice for transplantation of kidney. Now, the patient not survived after the kidney transplantation by spending huge amount. The expectation of the patient was defeated only on the advice for transplanting Kidney. The opposite parties ought to have considered the time of kidney transplantation may be at the time of the life of the patient is in critical. It should be proceeded only after getting informed consent by explaining the grounds of expected complications including rejection of transplanted organ received not from a blood relation.
31
35. Principles relating to consent: "A doctor has to seek and secure the consent of the patient before commencing treatment. The consent so obtained should be real and valid. The patient should have the capacity and competence to consent his consent should be voluntary and his consent should be on the basis of adequate information concerning the nature of the treatment procedure so that he knows what he is consenting to. The adequate information to be furnished by the doctor who treats the patient should enable the patient to make a balanced judgement as to whether he should submit himself to the particular treatment or not. This means that the doctor should disclose (a) nature and procedure of the treatment and its purpose, benefits and effect (b) alternatives if any available, (c) an outline of the substantial risks and (d) adverse consequences of refusing treatment. Consent given only for a diagnostic procedure, cannot be considered as consent for therapeutic treatment. Consent given for a specific treatment procedure will not be valid for conducting some other treatment procedure".
36. The complainant proved that the infection of HCV disease after administering dialysis. In Ex.A8, Ex.A9, Ex.A64 are clinchingly proved the victim affected with HCV in the opposite parties hospital. The opposite parties not able to disprove the fact the patient was infected with HCV disease not within their hospital.
37. The second opposite party stated in her proof affidavit the HCV infection even that true would not resulted in the immediate death within a short time of two months as the same is a slow disease. It is questionable whether the second opposite party has given such an opinion after considering the health condition of the complainant‟s wife since, she was initially approached the opposite party only with swelling of legs. Without considering other aspects of treatment the opposite 32 party proceeded with kidney transplantation which was utterly failed she was compelled leave with rejected organ within her body, for a considerable period the medicines are recommended for her are not given the expected result and her health condition was deteriorated she was compelled to administering dialysis which resulted with the infection of dreaded disease. The patient was infected with HCV disease she was admitted only in the hospital subsequent treatment also not useful for her survival ultimately the complainant‟s wife was died after spending of huge amounts with several complications. Therefore, the entire treatment offered by the opposite parties to the complainant‟s wife was defective, deficiency and with gross negligence which caused the ultimately demise of the complainant‟s wife and answered accordingly for the point for consideration no.1
38. Point:2 The complainant alleged that the opposite parties are squarely accountable and answerable for their medical negligence, which is the sole and whole cause for the premature and ultimately death of the wife of the complainant in spite of spending huge amount on the treatment and following all the instructions and advise of the third opposite party throughout. Though, no amount of monetary compensation will bring back the life of the deceased and beloved the wife of the complainant yet to prompt the opposite parties to realize their foibles and follies and to apprise them of the seriousness of the medical negligence and defective deficient service which they rendered to the wife of the complainant. The complainant claim Rs.25,00,000/- as compensation as per averments in the complaint. He has spent huge amount for the treatment of his wife to produce the receipts, prescription and documents and also produced the bills issued for the collection of expenses for giving treatment to the donor of kidney.
33
39. When the Commission is satisfied that the complainant is entitled to compensation for harassment or mental agony or operation which findings of course should be recorded carefully. The famous case of - 1994 AIR 787, SCC (1) 243 - in the case of Lucknow Development Authority -Vs- M.K.Gupta - Apex court - it is held that - "When the Commission has been vested with the jurisdiction to award value of goods or services and compensation it has to be construed widely enable the Commission to determine compensation for any loss or damages suffered by consumer which in law is otherwise included in wide meaning of compensation. The provision in our opinion enables a consumer to claim and empowers the Commission to redress any injustice done to him. Any other construction would defeat the very purpose of the Act. The Commission or the Forum in the Act is thus entitled to award not only value of the goods or services but also to compensate a consumer for injustice suffered by him".
40. In the complainant typeset page No.3 to 101 (Ex.A2 to Ex.A14), Page No. 221 to 255 (Ex.A22) and Page No.268 & 272(Ex.32 & Ex.A34) The complainant also lodged the complaint before the Police Commissioner against the opposite parties in Ex.A53.
41. The complainant himself spend huge amount of Rs.14,06,460.44/-ps. only for medical expenses for his wife. Even though the patient was survived for six years after performing kidney transplantation surgery as claimed by the opposite parties. She was survived only with medicines by spending huge money and she could not be survived in a normal condition. The kidney transplantation surgery was performed in the year 2004 and she was survived with number of problems and complications and died in the year 2010. The complainant is residence of Cumbum town which is 34 situated about 100 kilometers from the place of opposite parties‟ hospital. It is necessary to spend huge money for her travel with aid and other expenses also therefore, the complainant is entitled for claim amount of Rs.25,00,000/- as prayed in the complaint for compensation and answered accordingly for the point for consideration no.2.
42. In the result, the complaint is allowed and the opposite parties 1 to 3 are jointly and severally directed to
(a) pay Rs.25,00,000/- (Rupees twenty five lakhs only) as compensation for defective deficient and with gross negligence and,
(b) Rs.5,000/- (Rupees five thousand only) as costs to the complainant.
Time for compliance; Two months from the date of receipt of copy of this order, failing which the amount shall carry interest at the rate of 6% per annum from the date of order till its realization.
Sd/-xxxxxxxx N. RAJASEKAR, PRESIDING JUDICIAL MEMBER.
ANNEXURE
LIST OF DOCUMENTS FILED ON THE SIDE OF THE COMPLAINANT
Ex.A1 13.11.2004 Clinical Laboratory Report.
Ex.A2 22.12.2004 Medical bill of Kidney Donor.
Ex.A3 - Prescriptions and Drug Bills from 16.12.2004 to 30.12.2004.
Ex.A4 23.12.2004 Radiology Report.
Ex.A5 28.12.2004 Radiology Report.
35
Ex.A6 30.12.2004 List of In-Patient Bills.
Ex.A7 30.12.2004 In-patient Final Bill.
Ex.A8 27.10.2010 Billing Complaint.
Ex.A9 27.10.2010 Renal Package Report issued by the opposite party.
Ex.A10 27.10.2010 Bill was raised in respect of No.185809 for conducting blood
test with regard to HCV, HIV and other infected disease.
Ex.A11 28.10.2010 Report declaring HCV positive by the opposite party‟s hospital which was suppressed to the Complainant and same was obtained by the Complainant through Internet only after two years.
Ex.A12 04.11.2010 Renal Package Report and through which the opposite party informed the blood test result.
Ex.A13 04.11.2010 Discharge Summary.
Ex.A14 - Out Patient Bills of May to November 2010.
Ex.A15 06.11.2010 Blood Test Report.
Ex.A16 01.12.2010 Medical Bill given by the opposite party Hospital showing
to haemodialysis done two times in a day on 02.12.2010.
10.12.2010
Ex.A17 01.12.2010 Medical Bill given by the opposite party Hospital showing
to catheters used for haemodialysis on 06.12.2010.
10.12.2010
Ex.A18 02.12.2010 Diagnosis Reports and Consultation Requests.
Ex.A19 03.12.2010 Opinion given by Dr.Ramesh Babu stating that the patient
is not fit for fixing CAPD Catheter and advised to get
General Surgeon‟s opinion (which was never obtained).
Ex.A20 04.12.2010 Renal Package-I Test Report given by the opposite party
showing Bilirubin Quantity and S.G.O.T (AST) (IFCC),
SGPT (ALT) (IFCC) and ALP (Alkaline Phosphatase) (DEA-
Buffer) which are very high.
Ex.A21 - Medical Prescriptions From 10.01.2004 to 12.11.2010.
36
Ex.A22 01.12.2010 Medical Bills given by the Respondent.
to
10.12.2010
Ex.A23 05.12.2010 Micro Biology report.
Ex.A24 06.12.2010 Liver function Test showing false reports.
Ex.A25 07.12.2010 Opinion given by the Dr.S.N.Karthick stating about the
adverse reactions on the patient after the dialysis done on 06.12.2010.
Ex.A26 07.12.2010 Letter seeking permission from the management of hospital. Ex.A27 09.12.2010 Opinion given by the Dr.P.Soundararajan showing HCV Positive and about the high risk involved in fixing CAPD Catheter.
Ex.A28 09.12.2010 Dr.M.V.Ramesh Babu advising to inform Dr.Benet (which was never done) Ex.A29 10.12.2010 Death summary of Complainant‟s wife.
Ex.A30 10.12.2010 Death Certificate.
Ex.A31 20.12.2010 Letter sent by the Complainant to Dr.Rohini Sridharan with courier receipt.
Ex.A32 23.01.2011 Letter sent by the Complainant to the Administration Officer of the opposite party hospital requesting for the Haematology Reports with courier receipt.
Ex.A33 04.02.2011 Letter sent by the Complainant to the Administration Officer of the opposite party hospital requesting for the Haematology Reports and Renal Test Reports with courier receipt.
Ex.A34 17.02.2011 Insurance Form Charges Bill.
Ex.A35 27.03.2011 Notice to the Respondent.
Ex.A36 19.08.2011 Reply notice given to the Complainant. Ex.A37 14.03.2012 Complaint sent to the Chief Minister Cell, DGP,Commissioner of Police and DIG of Police, Madurai with Postal Receipts and Acknowledgement Receipts.
37Ex.A38 16.03.2012 Deputy Inspector General letter forwarded to the Deputy Commissioner and copy to the Complainant.
Ex.A39 26.03.2012 Chief Minister Cell sent a letter to the Complainant. Ex.A40 - Inspector of Police, Anna Nagar Police Station sent a calling letter to the Complainant.
Ex.A41 26.05.2012 The complainant receiving the calling letter. Ex.A42 27.05.2012 Through Advocate came to the Anna Nagar Police Station given a reply letter for complainant.
Ex.A43 20.07.2012 Complainant sent a complaint with the particulars to the Assistant Commissioner of Police, Anna Nagar Police Station, Madurai.
Ex.A44 06.09.2012 Letter sent by the Complainant to the opposite party hospital with Postal Receipt.
Ex.A45 01.10.2012 Complainant sent a RTI Act Letter to the Dean, Government Rajaji Hospital, Madurai.
Ex.A46 03.10.2012 Petitioner‟s Representation with Clean Copy. Ex.A47 25.10.2012 Complainant sent a RTI Act Letter to the Commissioner of Police, Madurai.
Ex.A48 30.10.2012 Government Rajaji Hospital and Chief Doctor to RTI Act reply letter to the Complainant.
Ex.A49 30.10.2012 The Commissioner of Police reply letter to the Complainant for RTI Act.
Ex.A50 02.11.2012 The Complainant sent a remaining letter to the Dean, Government Rajaji Hospital, Madurai.
Ex.A51 20.11.2012 Commissioner of Police sent a reply letter to the Complainant.
Ex.A52 04.02.2013 The Complainant sent a reminder letter to the Public Relation Officer, Government Rajaji Hospital, Madurai. Ex.A53 27.02.2013 The Complainant sent a remaining letter sent to the Commissioner of Police.
38Ex.A54 27.02.2013 The Public Relation Officer sent a Reply letter to the Complainant.
Ex.A55 18.03.2013 The Commissioner of Police sent a reply with the Doctor‟s reference Letter and Assistant Public Prosecutor‟s Legal Opinion to the Complainant.
LIST OF ADDITIONAL DOCUMENTS MARKED ON THE SIDE OF THE COMPLAINANT Ex.A56 23.12.2004 Copy of the Dr.Palanirajan, Apollo Hospital, Madurai add published by the „Dinamalar‟ daily Tamil newspaper.
Ex.A57 24.01.2005 Copy of the Department of Histopathology. Ex.A58 21.02.2005 Copy of the Doctor‟s Consultation Report reason for biopsy.
Ex.A59 25.02.2005 Copy of the Department of Histopathology. Ex.A60 23.06.2005 Copy of the Doctors request for reasoning Biopsy. Ex.A61 27.06.2005 Copy of the Department of Histopathology. Ex.A62 22.02.2006 Copy of the Laboratory Test Report issued by the "VIMTA LAB"
Ex.A63 18.10.2006 Copy of the Laboratory Test Report issued by the "VIMTA LAB"
Ex.A64 14.09.2010 Copy of the Department of BIO-CHEMISTRY Report issued by the "Apollo" Chennai.
Ex.A65 27.10.2010 Copy of the Initial Patient Assessment Record. Ex.A66 27.10.2010 Copy of the Progress Sheet from 27.10.2010 to 04.11.2010.
Ex.A67 27.10.2010 Copy of the In-patient Bill from 27.10.2010 to 04.11.2010 (Bill Nos. 1 to 288) Ex.A68 27.10.2010 Copy of the Doctor‟s consultation request from 27.10.2010 to 01.11.2010.
39Ex.A69 01.12.2010 Copy of the CT Report: Chest-Plain issued by the "KGS"
MRI, CT Scan and ultrasound Doppler Scan, Madurai referred by Dr.Palaniappan MD (Chest).
Ex.A70 03.12.2010 Copy of the Department of BIO-CHEMISTRY Report -
AMYLASE (SERUM) issued by the -Apollo" Chennai.
Ex.A71 05.12.2010 Copy of the Department of BIO-CHEMISTRY Report -
CLYCOSLATED HEMOGLOBIN (HABAIC) issued by the "Apollo" Chennai.
Ex.A72 08.12.2010 Copy of the Department of Hematology issued report in „Coagulation Profile‟.
Ex.A73 10.12.2010 Copy of Deposit receipt of the "Apollo Speciality Hospitals", Madurai.
Ex.A74 11.12.2010 Copy of the Dr.M.Palaniappan‟s Phamlet with prescription.
Ex.A75 22.11.2011 Copy of the RTI Reply letter sent to the Petitioner i.e. Ref.No.168/Neph.Dept/RGGH-2011.
Ex.A76 24.08.2012 Copy of the Petitioner‟s Representation to the Secretary of the Health Department, Chennai.
Ex.A77 03.09.2012 Copy of the Medical Education Department Letter in L.Dis.No.61881/H&D-1/2012 sent to the Petitioner.
Ex.A78 23.01.2014 Copy of the Petitioner‟s Representation to the Commissioner of Police and RTI Officer, Madurai.
LIST OF DOCUMENTS FILED ON THE SIDE OF OPPOSITE PARTIES Ex.B1 27.10.2010 Consent given for femoral catheterization given by the complainant.
Ex.B2 27.10.2010 High Risk Consent given by the complainant. Ex.B3 27.10.2010 Consent given by the complainant for Anaesthesia. Ex.B4 27.10.2010 Consent given by the complainant for Surgery. 40 Ex.B5 27.10.2010 Copy of the report of Department of Microbiology of the 1st opposite party.
Ex.B6 28.10.2010 Copy of the report of Department of Microbiology of the 1st opposite party.
Ex.B7 13.02.2011 Requisition and acknowledgement given by the complainant.
Dictated to the Steno-typist transcribed and typed by her corrected and pronounced by me on this the 28th day of February 2022.
Sd/-xxxxxxx N. RAJASEKAR, PRESIDING JUDICIAL MEMBER.