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Judgment
AMRIK Singh aged 52 was examined in the PGI, Chandigarh, on 6.4.93 and as a consequence of diagnosis, Splenic Abcess was found. The operation was conducted on 20.4.93. The wife and other members of the family of aforesaid AMRIK Singh were informed that the operation was successful. However, the patient allegedly developed trouble and he died on the following day i.e. 21.4.93. AMRIK Singh was carried to his native Village ''Seh'', District Ludhiana, where he was cremated the same day. On 23.4.93 relatives and friends reached the cremation ground for collecting the last remains of the deceased. A ''scissors'' utilised by Surgeon was collected from the last remains of AMRIK Singh, deceased. The complainants have alleged that the ''scissors'' remained in the body and the negligence of the doctors was the cause of death; that a news item appeared in The Tribune dated 24.4.93. The cause of death declared by Dr Sanjay Aggarwal, Joint Registrar, PGI, Chandigarh, was Cardiaorespiratory arrest. The complainants allege that the deceased was a well placed agriculturist, having good health and the complainants have been deprived of his love and affection. His Card No. was 350599 and Bed No. was MMW-59. The compensation of Rs. 10.00 lacs which also includes expenses incurred has been claimed.
IN a reply filed on behalf of the respondents, by Dr. B.N.S. Walia, Director, PGI, Chandigarh, it has been averred that the Grievances Committee, PGI, Chandigarh, considered the matter and its findings were that there was no negligence involved as the patient was seriously ill. The instrument found in the abdomen was ''forceps'' and not ''scissors'' and it was put to stop further flow of blood, done in order to save the life of the patient. It is averred that as the patient died soon after operation, the instrument could not have caused an problem to the patient. It has also been averred that ''Amrik Singh was seriously ill even before starting the operation had collapsed thrice on the operation table during operation and all the times he was revived. The fourth heart arrest could have been fatal and in order to avoid that, abdomen of the deceased was closed leaving behind the clamp on the artery and he was sent to the recovery room where he died on account of fourth heart-arrest. The operation was performed by Dr. B.V. Parveen, the senior-most Senior Registrar of Unit-III. The abdomen was closed with mass ligatures. The deceased was shifted to recovery room at about 10.45 p.m. because he had Cardiac arrest during surgery. The ''artery forceps'' and ''sponges'' were left inside the abdomen knowingly to stop bleeding from the splenic bed. This has further been averred that this practice is well recognised. The post-mortem was not allowed on the deceased by relatives. It has further been averred that the complaint should be dismissed with costs. It may also be added here that a sum of Rs. 365/- was deposited on behalf of the patient at the time of the admission. This did not include the operation fee. Amrik Singh, the patient (now deceased) was admitted to PGI, Chandigarh, on 6.4.93 on account of Splenic Abcess with Septicaemia. He remained an indoor patient and was under observation of several doctors including Dr. S.M. Bose. He was taken to Operation Theatre on 20.4.93 at about 6.30 p.m. and was operated upon by Dr. B.V. Parveen, the Senior-most Registrar of Unit-Ill. According to the respondents'' the patient had as many as three cardiac arrests during surgery and he was ultimately shifted to recovery room at about 10.45 p.m. The surgical procedure was hurried up. The Artery Forceps and Sponges were left inside the abdomen. This action on the part of the respondents has not been denied and in fact it has specifically been admitted with the plea that it was done to stop bleeding from the splenic bed. The recovery of the forceps PI, at the time of collecting the last remains of the deceased, is well established from the sworn testimony of Gurmel Singh and Shamsher Singh, the son and brother of the deceased respectively, which has not only gone unrebutted but in fact fortified by the reply of the respondents.
The length of this forceps is 15 centimetres and its width is 6 centimetres. It is Annexure P 1 and was collected from the ashes of the deceased after his cremation. A photo impression of the forceps is given in the margin. In this case, Dr. Sanjay Aggarwal, respondent-3 had signed the death notification form on 21.4.93. He has signed and filed the reply alongwith the co-respondents. Dr. B.V. Parveen, the Seniormost Registrar of Unit-III who allegedly performed this operation, has also not been examined by the respondents to justify their act of leaving this forceps inside the body of the patient. The only piece of evidence which the respondents have relied upon is an affidavit of Dr. S.M. Bose which contains a mention that Artery Forceps applied to the splenichilum was clamped upon the Arteries and this was deliberate action by the Surgeon as a last resort to give the patient a chance for life. It also contains a further mention that it was not a case where a surgical team inadvertently forgot to take out an instrument while completing the operation. It is useful to reproduce relevant part of para 7 of the affidavit of Dr. S.M. Bose dated 9.2.95, which is an under xx xx xx xx xx "In the operation note Ex. P. 4, it has been clearly mentioned that abdominal sponges were used to pack splenic bed and one artery forceps applied to the splenichilum which means that one of the arteries was clamped with the instrument known as Artery Forceps. This note proves that it was a deliberate action taken by the surgeon as a last resort to give the patient a chance for life. Unfortunately he did not respond. It is clearly not a case where a surgical team inadvertently forgets to take out an instrument while completing an operation."
We have seen the operation notes which shows that Dr. B.V. Parveen, Dr. K.K. Mukerjee and Dr. Virender acted as surgeons. The names of Anaesthesiologists and sisters have also been mentioned separately. These contain a mention that the patient had three cardiac arrests after start of operation. The patient was revived. The third arrest was towards the end of surgery and it was also revived and he was shifted to Emergency Recovery Room and put on ventilation. According to report of Dr. Kanchan the procedure terminated due to cardiac arrest and sponges left inside. She has nowhere mentioned that the forceps was kept inside. A perusal of all these proceedings clearly show that these were recorded long after the completion of the operation and no surprise after the death of the patient. If there was such a large team of doctors and other medical attendants, there was no reason why operation notes were not recorded in the manner the events took place, the learned Counsel for the respondents has drawn our attention to a medical pamphlet containing an article on "Abbreviated Laparotomy and Planned Reoperation for Critically Injured Patients" which contains a mention that multiple towel clips have been utilised for survival of the patients. These were cases of critically injured patients. The learned Counsel for the respondents could not draw our attention to any authority where retention of 15 centimetres long and 6 centimetres in width forceps was kept at or near the splenic region instomach of the patient in his interest. It shall be useful to refer to a part of the cross examination of Dr. S.M. Bose which is as under: "Q. Is it correct that according to the medical jurisprudence no foreign body should be kept inside the body after completion of the operation under any circumstances? A. I don''t think it is correct because scores of operations are being done where foreign bodies of many types and many shapes are left in the interest of the patient, for example an artificial hip or knee joint heart valve, plates, nails, mesh, tube graft, etc. etc." May be that knee joint or an artificial hip is provided as a kind of replacement. In his reply to this question, the medical specialist could not justify placing/storing of this quite a long forceps in the body. The patient had been undergoing an operation which was considered essential in his interest. However, leaving the long forceps inside the delicate part was not at all justified and claiming its justification appears to be adding insult to the injury in the case now in hand. It may be useful to refer to para 10 of the affidavit of Mr. Shamsher Singh, a brother of the deceased, which is as under : "10. That the deponent went to the doctor Shri B.M, Bose who was head of the unit on 24.4.93 alongwith his nephew and a relative Shri Gajjan Singh, son of Gobind Singh and showed him the scissors and asked him as to the reason for the sudden death of the father of the nephew, namely Shri Amrik Singh, but the doctor refused to talk to them and also flatly refused to hand over the medical case file of the deceased and asked the deponent to leave the hospital immediately. It is apposite to mention here that the conduct of the doctor with the deponent and his accompanying relatives amounts to guilty conscious and proves that the doctor was recklessly careless and negligent in performing the operation on the deceased due to which the death occurred."
Whenever a guardian of the patient/deceased wants to collect some relevant information, he is entitled to it. The Medical Officer Incharge, whether in a Government hospital or in a private hospital, is bound to supply the information in respect of the treatment given to the indoor patient everyday.
IT is pertinent to mention that whereas the operation notes are in the hand of Dr. Kanchan, Junior Resident, a three line note given against a mark (*) on first page of the report is in a different hand. A separate note by another individual has been given, which reads as under: "Had 3 cardiac arrest intra op - the first a short while after start of operation - revived, had another arrest towards the end of surgery (about 1 hour) - revived - about ./ closed and patient had 3rd cardiac arrest while closing the abdomen - revived, and shifted to Emg. Rec - put on ventilator."
All this shows this was not recorded till 10.30 p.m. on April 20, and appears to have been prepared at a later stage. IT has not been explained why any physician from the department of Cardiology was not summoned to deal with the situation. It has also been brought to our notice that on a complaint sent by relative of the deceased to the Government of India, an inquiry was instituted and the report of the Inquiry Committee. was considered as Agenda Item No. 7/BC/93, and reads as under : "AGENDA ITEM NO. 7/BC/93 Complaint of Shri Harpreet Singh regarding death of Shri Amrik Singh Sarpanch after his operation at PGI, Chandigarh. The Grievances Committee examined the complaint, the comments of Prof. S.M. Bose who looked after the patient and the case file of the patient. The Committee was of the opinion that the forceps and the sponges were left behind in this desperately sick person in an attempt to save his life. These were to be removed at a second operation as soon as the patient''s condition stabilised which unfortunately did not happen. These facts have already been recorded in the case file. The artery forceps did not in any way contribute to the patient''s death. Such abbreviated stage operations are recognised and even advised in international journals of repute."
However, this Commission finds that this unilateral report does not find support from the facts on record as seen above. Having regard to the facts narrated above, it cannot be said that there was no negligence in handling this case on the part of the team attending on this patient. The negligence is writ large on record. Accordingly, this Commission comes to the conclusion that deficiency in providing necessary services to the patient is well established on the record. After taking into account the fact that the deceased was aged 52 years and supposed to be otherwise in satisfactory health, compensation of Rs. 1.20 lac shall be payable by respondent-1. Out of it, a sum of Rs. One lac to complainant-2 Smt. Pritam Kaur, the widow, and the remaining sum shall be equally payable to complainants-1 and 3 the mother and son of the deceased respectively. As regards costs, it is assessed as Rs. 3,000/- and shall be paid by all the three respondents equally. These payments shall be made within three months.
ANNOUNCED. The order be communicated to the parties free of charges. Complaint allowed with costs.