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3. Along with other medicines, the patient was also administered medicine Sintrom which is an anti-coagulant which was being administered till 7th Oct., in the dose of 2.00 mg but on the afternoon of 8.10.91, it was increased to 2.5 mg. According to the Complainant, he asked the accompanying doctors "if the patient is doing well with 2.00 mg by he should be given 2.5 mg.". According to the Complainant, the accompanying doctor replied that it was to take a trial. On the third day of the increased dose of sintrom i.e. 11.10.91, the urination lessened, breathing trouble started, lungs-congestion noticed. It is the complainant's case that perhaps OP No. 2 was experimenting the increased dosage using her late husband as a guinea-pig. The Complainant's husband was shifted back to ICU on 13.10.1991. On that day about 9.30 PM to the complainant noticed marked swelling on the right part of the body and when it was brought to the notice of the attending doctors, it was completely ignored. The Complainant was also requested to supply another bottle of blood on 13.10.91 which she could not organise and this blood was donated by an attending doctor. According to the complainant, the swelling which was denied by the OP No. 2 is a clear case of negligence on his part. It is her case that on the morning of 16.10.91, 'Tracheotomy' was done on the deceased without telling her and also in the absence of the complainant. Profuse bleeding was noticed after about 2 hours of Tracheotomy. The bleeding stopped after 5.30 PM. After that, the patient was always in poor condition. The complainant states the surgeon OP No. 2, Dr. Stanley left the country immediately after seeing the patient on 15.10.91. According to the complainant no clear answer was forthcoming from the doctors meaning thereby they were hiding some negligence on the part of the doctors. On 17.10.91 when the complainant's brother-in-law arrived at Vellore the deceased had a low blood pressure. She was also told that her husband was suffering from jaundice and she was also told that he cannot tell her how long her husband would survive. The condition of the deceased improved on 20.9.91 based on readings like blood pressure and heart-beat rate and heart pumping, and urination was better. On 21.10.91 when the complainant went to ICU she saw one doctor giving suction to her husband and the computer reading was haphazard. The BP was 71. Seeing this the complainant got little upset and asked the reason for this whereupon the attending Doctor requested the complainant to wait outside. It is after that the doctors came out and told the complainant about the sad demise of the complainant's husband. On 22.10.91, the hospital handed over the body for cremation. According to the complainant the head portion from the armpit was fully covered with bandage except the face. A doubt arose in the complainant's mind that the internal organs were removed without the knowledge of the complainant which is strictly against the medical rules and Hindu cremation rituals. According to the complainant she had paid an advance of Rs. 85,000/- and another Rs. 10,000/- obtained from PMs Relief Fund while the total bill raised by the OP was Rs. 1,95,355/-. The deceased was survived by his wife - the complainant and two small children. They have claimed Rs. 15.72 lakhs as compensation from the Hospital for the various acts of negligence.

4. The OP in the reply while completely denying the negligence and various allegations levelled by the complainant stated that the deceased Radhakant Rout had gone to the Vellore Hospital for the first time in 1985. The hospital record indicates that the deceased had valvular disease of the heart since 1979 and the developed progressive breathlessness on - exertion since 1984. The deceased also had fever with joint pains in 1965 symptomatic of rheumatic fever, hand been on prophylactic penidure (pencillin preparation) injection from 1979 irregularly. On cardiac investigation he had physical findings consistent with a diagnosis of rheumatic heart disease with tight mitral stenosis with pulmonary hypertension and mild aortic regurgitation in sinus rhythm (heart beat was regular.). He under went closed heart surgery in 1985 and after an uneventful postoperative period, was discharged on 19.10.1985 with an advice to carry on with the prescribed medication and to visit the hospital every year for check up. The patient came for the check up in Oct-86 and he was advised to come in the next year. Meantime, the OP Hospital received a letter from one Dr. P.C. Barma who was a physician at the District Head Quarters Hospitals, Puri, Orissa informing them that the deceased Shri Raut had upper respiratory tract infection with chest infection and his cardiac status had deteriorated. The deceased came to the Vellore hospital again in 1987. Where after investigation it was found out that consequent to respiratory tract infection which he had suffered earlier, his cardiac status had deteriorated and other symptoms were also deteriorating. Proper medication was given and he was asked to come for check up after two years and for this he returned in Oct-89 when after full investigation, it was felt that he now had significant aortic regurgitation with left ventricular hypertrophy (enlargement) and mitral regurgitation. His cardia status was assessed as Class - II and was advised double valve replacement as soon as possible. Then there was a long correspondence in Jan-90 between the deceased and the hospital for the date to be fixed; but some how, the deceased kept postponing and finally he was seen only as an out-patient 19.2.91 and it was noted that his cardiac status had deteriorated further. he was again advised double valve replacement. After several postponement of dates the deseased finally arrived on 9.9.91. He was operated on 23.9.91 by OP No. 2. He was brought to ICU on 23.9.91 and semi-ICU on 25.9.91. Post operatively, he developed a mild fever and a high heart rate but this was brought under control by 30.9.91. He was started on the anticoagulant drug Sintrom initially at a dosage level of 1 mg per day while checking his prothrombin time periodically. By 7.10.91 his condition had stabilised and he was transferred back to the original bed in which he was admitted in the Private ward and all the necessary medication, including sintrom were continued. On 11.10.91 the deceased had developed fever and it was diagonised to be a case of chest infection. On 13.10.91, the deceased's condition further deteriorated wherein pulse rate recorded was over 140/min and a drop in blood pressure. The deceased was transferred to semi-ICU on 13th October, 1991. It became clear that one of the known complications of double valve replacement in patients with advanced valvular disease of long duration was developing in the deceased, as a result of which the patient was having inadequate output of blood from the left ventricle into the aorta because of long infection which was causing breathing problem and 'tracheotomy' was done in order to help the deceased to breathe better. He was still unable to breathe and hence he was maintained on a respirator. However, in spite of the best efforts and all necessary medicines and supportive measures, the patient unfortunately died on 21.10.91. It was also their case that in 1989 the estimated cost of surgery was Rs. 85,000/- but with the passage of time, in 1991 as per the hospital procedure, the cost was revised and it was increased to Rs. 1,10,000/- which was charged from him. It was also stated by the OP that heart surgery has its own risk. OP also stated that it is well recognised that when an artificial valve is implanted in the body of any individual, the clotting tendency occurs and in order to prevent this various anticoagulant medicines are used which in this case was Sintrom. The decision to increase Sintrom from 2.00 mg to 2.50 mg was based purely on the 'prothrombin (P) time' which needs to be kept at one and a half time ratio. As on 8.10.91 PT time was 16 seconds for the 'patient' and 13 seconds for the 'control' as the deceased had not achieved the desired one knout half times ratio, dosage of Sintrom was increased to 2.5. mg. Again when the requisite ratio was achieved on 12.10.91, the dosage of Sintrom was reduced to the maintenance dose on 14.10.91. The allegation about the alleged swelling on the right part of the body and sweating were denied by the OP. The OPs also denied that at the time of giving suction, Dr. Das had done something wrong or was careless. Published literature on 'double-valve replacement' shows that in a total of about 2000 cases reported upto 1992 the mortality during the first month after operation was about 9%. This morality increases when a second operation is done after an initial mitral valvotomy to about 12.5%. According to the OP there was no negligence on the part of the OP vis-a-vis, the treatment and post-operative care done by the OP hospital and doctors.. Hence this complaint needs to be dismissed. IN the rejoinder filed by the complainant, the complainant reiterated the points earlier and held the hospital for negligence resulting the death of her husband. The Complainant also alleges tampering with the Hospital record to hide the negligence on the part of Hospital and its Doctors, respectively.

8. On behalf of the Complainant she herself argued the case. She stated that the patient had gone to Vellore who was a healthy youngman. He had gone for open-heart surgery to Vellore on 9.9.91. According to her, increase in the dosage of sintrom from 2.00 mg to 2.5 mg on 8.10.91, using her late husband as guiena pig to study the effects of increased dosage on heart patients, is the heart of the matter. It is this act of omission or commission which proves the negligence on the part of the hospital which resulted in the death of her husband. She was present at the time when increased dosage of sintrom was prescribed; when she questioned this increase, the doctors did not respond to this. On 11.10.91 temperature again started going up and the breathing problem started on 13.10.91. This was on account of increased dosage of sintrom. Alongwith the breathing problem, urination problem also started as a result of increased dosage of sintrom, yet they did not stop the medicine. On 14.10.91 about 9.00 to 9.30 PM she noticed that the deceased was put on heart-lung machine. She noticed sweating as well as swelling on the right side and she brought this to the notice of the treating doctors but it was ignored by them. She was again asked to organise blood on the night of 13.10.91. According to her, blood is not a commodity which can be got from outside, that evening, blood had to be donated by one of the attending doctors. According to her Tracheotomy was done to hide the negligence as there was breathing problem with the deceased. She argued that the OP No. 2 Dr. John left for foreign tour without making proper arrangements for the patient. There was excessive bleeding noticed by her on 21.10.91 and the sucction procedure was adopted by Dr. Das without the help of any nurse. She also argued that the record maintained by the hospital was improper and does not show that the Tracheotomy had been done. The fact of heavy bleeding after Tracheotomy has not been recorded. According to her even though according to Hospital record sintrom was stopped on 15.10.91 yet the Hospital record shows that the sintrom was administered even on 16.10.91. Even though Dr. John was in Vellore on 15/10, 16/10 he did not visit the patient. She also argued that the initial costs of operation was placed at Rs. 85,000/- yet it was increased to high figure. She also argued that she was given the dead body and she was not sure whether some organs have been removed.

11. According to him, no negligence has been proved against the Respondents. Hence, the complaint need to be dismissed.

12. We have perused the lengthy material on record and heard the arguments. We found that the Complainant has alleged several acts of negligence, some of them could be dealt in brief. The Complainant alleges that Tracheotomy was done on the deceased on 13.10.91 but she was not informed and was done while she was away. The OPs have replied that as the patient was experiencing breathing deficiency as a result of lung congestion, thus in order to ease the breathing facility for the patient, Tracheotomy was done. In our view there is no negligence in this regard as the complainant has neither produced any material or examined any witness to state that all such actions need to be done by the Doctors in her presence. Entry to this effect exists in the Hospital record with which the complainant was confronted. Non mention of bleeding in the Hospital record can not be said to be amounting to negligence. In any case the haemoglobin on 17th October, 1991 on the day Tracheotomy was done, was 10.5 mg, on 18/10 it was 9.2 gm on 19/10 it was 11.2 gm which rebuts any relationship with excessive bleeding and the ultimate end. Doctors are supposed to perform what is in the interest and good for the patient. It is not the Complainant's case that Tracheotomy should not have been done at all. Another act of negligence is stated to be that at the time of giving suction, Dr. Das did it alone without the help of a nurse. OP has clearly stated that it is not necessary for the Doctor to be assisted by a nurse at the time of giving suction. No contrary evidence or literature/authority has been put up before us in this regard by the complainant. We do not find any merit in this allegation. Another allegation ut forward by the complainant relates to reported swelling and seating on the right side of the deceased on 14.10.91, when she noticed it and brought to the notice of the doctors, they did not pay any heed to it. OPs have denied any such thing. There is no evidence to support this point. Even if it is accepted to be true, complaint does not state in any clear term as to what did it result in and what was the negligence knout its have bearing on the ultimate end. No. material/evidence is on record in this regard in the absence of which we are unable to accept the allegations of negligence. Asking her for a bottle of blood at about 9.30 PM on 13.10.91 is also alleged to be an instance of negligence on the part of the Hospital. The fact remains that the deceased did not have to wait for the blood and it was organised and administered to the deceased in time without her help. We do not see any negligence in this regard. Allegation on the escalation of Hospital fees certainly cannot be viewed as medical negligence. It is not even remotedly connected with that. It has been explained by OPs that cost of Surgery, on which the complainant relies related to 1989, whereas the cost of Surgery was revised by the Hospital and only the current/pravelant charges were proposed to be recovered. We do not wish to delve into it as it is not even remotely connected with medical negligence resulting with the death of complainant's husband. However, we hope that keeping in view the facts of the case Resp. Hospital should not press for the recovery of outstanding dues. Allegation of departure of Respondent No. 2 before the discharge of the deceased has also been made. We see that Res-2 attended on the patient on 16th October and left for the overseas trip on 19th. It is no one's cause that the patient was not being properly attended to. There were experienced and well qualified Doctors/Staff in the Hospital to lookafter and attend to the deceased. We do not see any negligence in this regard. Another allegation relates to the apprehension on the part of the Complainant that since the body of the deceased was handed was in a wrapped condition, some vital organs could have been removed by the Respondent Hospital. This has been vehemently denied by the OP. Since the patients in such cases are supplied the necessary inputs through several tubes, and in this case tracheotomy was also done, it cannot be expected of any good hospital to hand over the body in an otherwise unacceptable position. Complainant has not put forward her grounds of apprehension nor is there any evidence or proof in this regard. Hence, we find ourselves not inclined to accept this as an act of negligence. In any case this has nothing to do with medical negligence resulting in the unfortunate death of the Complainant's husband.