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Judgment
The instant Revision Petition is being preferred against the Order passed by the Haryana State Consumer Dispute Redressal Commission, Panchkula (hereinafter referred to as the "State Commission") in Appeal No. 643 of 2011, wherein the Order of District Consumer Disputes Redressal Forum, Faridabad (hereinafter referred to as the "District Forum") was upheld and the Petitioner was held liable for negligence and deficiency in service.
Heard the arguments from both the sides. Perused the entire record on file.
The Complainant Mr. Vijay Bhatnagar (herein after referred to as the 'Patient') was initially diagnosed as suffering from the Rheumatic Heart Disease with severe Mitral Regurgitation (RHD with MR). Subsequently, he was also diagnosed as 'Coronary Artery Disease' (CAD). The treatment could be the Mitral Valve Replacement (MVR) and Percutaneous Transluminal Coronary Angioplasty (PTCA). The main question revolves around whether the instant patient firstly needed to undergo the treatment for MR or the treatment for CAD.
Both the fora held the Opposite Party liable for negligence and allowed the Complaint.
The facts of the case are drawn from the relevant observations made by the State Commission as reproduced below:
"It is admitted case of the parties that the complainant was suffering from heart problem for which she was getting treatment from Dr. P.C. Saxena of Medical College, Allahabad. It has also come on the, record that Dr. Saxena, Head Cardiology had advised the Complainant to get her Mitral Valve replaced for which the Complainant was referred the Complainant to Escorts Heart Institute, Delhi for change of Mitral Valve of her heart. Complainant thought that Escort Hospital & Research Centre, Faridabad was the branch of Escort Heart Institute, New Delhi and for that reason she contacted Escort Hospital & Research Centre, Faridabad where Dr. Rishi Kumar Gupta and Dr. Vikas Chopra examined the Complainant and opined that prior to Operation Angiography was required and therefore Angiography of the Complainant was done on 12.08.2005. After conducting Angiography, the treating doctors at Escort Hospital & Research Centre, Faridabad opined that there was no regurgitation trouble with Mitral Valve and there was blockage of two arteries of the heart, of the Complainant which could be cured by Angioplasty. Accordingly, Angioplasty of the Complainant was done on 13.08.2005. But still the Complainant did not get any relief from the disease from which she was suffering prior to Angioplasty.
Thereafter, the Complainant got treatment at Saraswati Heart Care at Allahabad w.e.f. 18.12.2005 to 24.12.2005 and from 24.01.2006 to 31.01.2006 in Nazareth Hospital. The treating doctors of both the above said hospitals opined that the trouble was due to Mitral Valve."
Admittedly, initially at Allahabad, the Cardiologist Dr. Saxena, diagnosed the patient as a Rheumatic valvular heart disease with severe Mitral Regurgitation and mild Mitral Stenosis (for short RHD with severe MR and mild MS). The ECHO done at Allahabad confirmed the diagnosis. Dr.Saxena referred the patient to Escort Hospital, New Delhi; but the patient went to Escort Hospital at Faridabad instead of New Delhi which was the branch of Escorts Hospital, New Delhi. The Cardiologist therein performed coronary angiography and done PTCA (Angioplasty) for two vessels. They advised no need for surgical treatment for Mitral Regurgitation and only medical management was suggested.
We have perused the ECHO report done at Escort Hospital, Faridabad which was reported as "MS and MR, the Ejection Factor (EF) 55%". After the PTCA performed at the Escorts, Faridabad the patient did not get relief and thereafter during 18.12.2005 to 31.01.2006 again consulted two hospitals in Allahabad. Both the hospitals i.e. Saraswati Heart Care and Nazrat Hospital opined that the existing heart problem was due to Mitral Valve Disease. Thereafter, in the month of April, 2006, the patient consulted the Cardiologist, Dr. Balbir Singh at Escort Hospital, New Delhi, who suggested to immediately get the mitral valve changed. Subsequently, the patient consulted the Cardiologist Dr. Naresh Trehan, who also advised same treatment of Mitral Valve Replacement (MVR).
We have perused the medical literature "Treatment review in the case of mitral valve regurgitation". The initial treatment for MR is discussed as below:
"Initial treatment
Initial treatment for chronic mitral valve regurgitation depends on whether you have symptoms and how severe the regurgitation is. If you don't have symptoms and you only have mild-to-moderate regurgitation, your doctor may only monitor your heart and valve function with an echocardiogram.
The echocardiogram uses painless ultrasound waves to check how well your heart is pumping blood (ejection fraction) and to measure the size of your left ventricle. The smaller the ejection fraction, the harder your heart must work to pump a sufficient volume of blood.
Surgery is recommended when ejection fraction drops below 60% and/or your left ventricle is larger than 40mm at rest. If you need surgery, your doctor may suggest repairing or replacing your mitral valve to avoid further heart damage. When you begin to have symptoms, the regurgitation is advanced, and you will need surgery to prevent heart failure."
(emphasis supplied)
On careful perusal of the ECHO report, the patient was suffering from severe MR and the EF was 55% (i.e. below 60%). Therefore, to avoid further heart damage or to prevent heart failure, the replacement of mitral valve was imminent prior to PTCA. The mitral valve replacement is major open heart surgery. In the instant case, the patient was also suffering from CAD. Thus, the most preferred and beneficial treatment would be MVR along with CABG (bye-pass) instead of PTCA. The medical literature and the recommended current practice guidelines; every symptomatic functional mitral regurgitation (MR), or ischemic MR, is traditionally an indication for cardiac surgery. The patients with moderate regurgitation are more likely to benefit from the combined CABG plus either mitral annuloplasty or mitral valve replacement in CAD patients with MR. Based on the entirety, we are of the considered view that the doctors at Escort, Faridabad have not followed the reasonable standard of practice and it was failure in their duty of care.
We find the concurrent findings of both the fora are well reasoned and determined the negligence on the part of Petitioner.
For the reasons stated above, we do not find merit in the instant Revision Petition and the same is dismissed.