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B.K. Taimni, Member

1. This complaint has been filed by the complainant, Basudeo Prasad Maheswari, alleging medical negligence on the part of the opposite parties, namely, Apollo Hospital and Dr. M.C. Garg.

2. Very briefly the case leading to filing the complaint were that the complainant went to the first opposite party hospital on 20.2.1998 complaining of breathlessness, where after he was referred to second opposite party Dr. M.C. Garg. His ECG was done and the complainant was asked to come next day and got Holter ECG done. The second opposite party after seeing the ECG, Holter ECG and blood test reports, advised the complainant to get a permanent pace maker implanted costing about Rs. 1,25,000. Since this much money was not immediately available, the complainant requested sometime to arrange for the funds, whereupon he left for home-town on 2.3.1998. While at Lalitpur, his home-town, the complainant felt pain in the left side of the chest, upon which he contacted Dr. Ashok Saxena, a family physician, who advised him to rush to Jhanshi to consult Dr. Praveen Kumar, a Heart Specialist, whereupon he was admitted in Happy Family Nursing Home, Jhanshi on 2.3.1998. The complainant received treatment from Dr. K.K. Gupta at this nursing home. Dr. Praveen Kumar was also called to examine the patient, who confirmed the heart attack and the treatment of MI was given. The condition of the complainant worsened further and the complainant suffered a second severe heartattack on 3.3.1998, which in medical terminology is known as Adam Stroke Syndrome, which is a very critical stage. It is the case of the complainant that on the advice of opposite party No. 2, the Nursing Home at Jhanshi moved him about 8 kms. away, where a temporary pace maker was implanted and was brought back to Happy Nursing Home the same day. It is the case of the complainant that after second MI, the walls of the heart got damaged permanently and the V.H. function of the heart got reduced to 35%. The complainant again approached the opposite party on 7.3.1998 where he was admitted to Intensive Cardiac Care Unit (ICCU) where his pace maker was removed and another temporary pace maker was fitted. His temperature shot-up, which could not be controlled in spite of high doses of multiple antibiotics. The fever continued and on 14.3.1998, despite seeing no respite/improvement in the complainant's condition, the complainant was discharged with the advice to come back after the fever had subsided for elective permanent pacing. On 30.3.1998 the complainant felt pain in the chest and the complainant's son contacted the second OP who advised him to get the ECG done for which Dr. R.N. Sainee was called, who advised to get Angiography done. Whereupon, the second OP was contacted on phone for Angiography but the second OP said that there is no possibility, as nurses of OP No. 1 were going on strike. In these circumstances, the complainant was got admitted in National Heart Institute, New Delhi for Angiography and discharged on 24.4.1998. In the Angiography's report it was mentioned that there were blockade in the coronary arteries to the extent of 90%, 80% and 70%, for which the complainant was advised by-pass surgery of the heart, which was got done at Escort Heart Research Institute on 15.4.1998. Specific instances of medical negligence have been mentioned in paras 16 to 19 of the complaint, which reads as follows:

7. He was treated properly and given necessary aid and since he was under high doses of antibiotics, the patient was discharged on 14.3.1998. It has been further stated that this was a case of systematic bacterial infection due to staphylococcus and the fever was due to staphylococcus and not due to malaria as alleged in the complaint. It is also their case that in whole of the complaint there is no allegation of medical negligence on the part of the first OP.

8. The second OP filed separate written version. In this written version besides taking preliminary objections, on merits, it has been stated that the complainant has not come with clean hands before this Commission for the simple reason that complainant did not follow the medical advice given in time and switched over to various Doctors, Nursing Homes and Hospitals for medical treatment in between. It was his case that he examined the patient and gave the advice as per accepted scientific and medical norms. It was also stated that the complainant had mentioned to the OP of being diagnosed as a case of Mitrol Valve Prolopse (MVP) in 1995. He did not have any complaints in relations to respiratory or gastrointestinal system and had stated that he is on medication as Aspirin 1 tablet a day. He was examined and his cardiac vascular system revealed heart rate of 48/mt., sinus rhythm and BP 140/90 mmHg. Heart sounds were normal and there was no additional heart sounds or murmur audible. Lungs were clear with normal breath sounds. Abdomen and Central Nervous System examinations were essentially normal clinically there were no features of hypothyroidism. This has given a clinical impression that it was sinus bradycardia with effort intolerance which required further evaluation. Therefore, the complainant was suggested ECG, T3, T4, TSH, 24 Hours Holter monitoring, 2D echo Doppler, Haemogram, Urea electrolytes and Creatinine, and liver functions tests. The second OP reviewed the complainant on 24.2.1998 when based on the available clinical tests reports, OP found that sinus pauses upto 2.4 sees, with atrial premature beats runs of atrial premature beats and occasional premature ventricular beats. Whole of these findings was consistent with the diagnosis of sinus node dysfunction. He further clarified that the sinus node in a human heart is the site of pulse generator and when it does not function properly, it manifests the way, the Holter report has shown. It is in this background that the complainant was advised to undergo for permanent pace maker. The complainant was also advised to have 2D echo Doppler, but this was not followed by the complainant. It is further stated that when the complainant again came on 7.3.1998 in the first OP hospital when his heart rate was 92/mt, regular, BP 150/100 mmHg. The complainant was under sedation by Diazepam. Lungs showed bilateral crepts. CVS examination showed presence of S4 and no other abnormal functions were seen on systemic examination. The patient was in febrile condition as the complainant was already on temporary pacing, he was put on nitroglycerin, heparin and other cardiac medications. In the meantime complainant was left under close monitoring and observations of his vital signs especially temperature trend. In view of this background of developing thrombophletis at I/V site on 4th March, 1998 and later developing psychiatric symptoms followed by retention of urine, the possibility of systemic infection with bacteraemia was kept in mind. While in hospital, he coughed up very dirty thick (infective) blood tinched sputum and continued to run Pyrexia. All the investigations were done for cause of pyrexia. Repeated urine culture, blood culture, sputum culture, Haemogram including for malarial parasite, LFT, urea Creatinine, Creatinine, cardiac enzyme. Haemogram repeatedly showed high leukocyte count with raised neutrophils and high ESR suggestive of acute bacterial infection but no malarial parasites was demonstrated in the blood film. Initially, complainant was started on I/V augmenting (antibiotic) but upto 10th March, 1998 as no growth was reported in blood culture and he continued to remain febrile, combinations of antibiotics were started to treat him aggressively, keeping in mind specially that infection is likely to be introduced through the I/V route earlier on 4th March when he developed thrombophlebitis with fever and was treated with antibiotics and again antibiotics were continued in vie w of developing retention of urine followed by catheterisation. In all probabilities, the organisms were not sensitive to the antibiotics, he received at that-early stage and infection continued which was manifested later, with abnormal psychiatric symptoms, which can happen in elderly with systemic infections followed by retention of urine for which he was done catheterisation. As he was already on antibiotic, the culture may not show any growth of bacteria and one has to do repeated cultures from various sites through which the infection is likely to enter into the body and that is why sputum culture of the complainant was sent which showed mixture of organisms of doubtful pathogenecity. Urine culture was done on 8th March, 1998 which showed growth of staphylococcus aureus and aerobic spore bearers. On 10th March, 1998, as at the temporary pace maker site some discharge was seen with surrounding skin area oedematous and erythematous, this pace maker lead was removed and another temporary pace maker lead was inserted through a new site (left groin), in order to control the infection and a swab was taken from the site which was sent for culture. As the swab culture report initially was suggestive of gram positive cocci growth, most likely to be due to staphylococcus, colxacillin was added in place of augmentin. The detailed swab culture report confirming the growth of staphylococcus aureus and sensitivity test for various antibiotics, dated 14th March, 1998 did not arrive in the ward, by the time the patient already left the hospital. Urine examination also snowed 12-15 pus cells per high power field.

2. OP No. 2 failed to appreciate that breathlessness itself is a major symptom of heart disease and required proper investigation particularly so in a patient of 76 years.
3. OP No. 2 wrongly diagnosed that the complainant was suffering from sinus node dysfunction and required permanent pace maker whereas, complainant did not require any pace maker. Till date, no pace maker is fixed to the complainant. Had he followed the advise of OP Nos. 1 and 2, complainant would have remained exposed to heart attack and his ultimate death, since he did not need a pace maker at all.

19. The second point germane to issue, is that in the complaint filed before us, there is no reference that temporary pace maker was installed at Jhansi though. There is reference to this in his affidavit but we are constrained to observe that the complainant has been less than fair in his cross-examination when he stated, "I got temporary pace-maker implanted at Happy Family Hospital, Jhansi by Dr. K.K. Gupta. I do not remember the date of implantation of temporary pace maker but it was before 7.3.1998". As part of the same cross-examination, he later on states, "It is wrong to suggest that I jumped into misadventure to get treatment at Hospital at Jhansi where no proper arrangement and specialty was there to handle such cases and Pace Maker Implantation. The pace maker was not installed at Happy Family Hospital, Jhansi but it was installed, somewhere else, by some other doctor which was around 8 kms away from there. I was senseless at that time. I do not know the name of doctor who implanted the temporary pace maker. I do not know whether it was a clinic or a hospital where the pace maker was implanted. I do not know the name or the qualifications of the doctor who implanted the pace maker. It is incorrect to suggest that I got the pace maker implanted by an unqualified person".