Postgraduate Institute Of Medical Education And Research, Chandigarh vs BIMLA DEVI

THE simple question to be decided in this case is that whether the Postgraduate Institute of Medical Education and Research, Chandigarh (in short the Institute'') was negligent in not performing the surgery on Shri Inder Pal Singh (deceased) husband of the complainant Smt. Bimla Devi. Though a cheque for Rs. 1,57,000 as an advance for the surgery was deposited on 23.5.2005, and a reminder was sent by the Welfare Officer of Air Force Station, Chandigarh on 7.9.2005, stating that till the date of that letter the patient has not been given the date for his surgery. The patient died on 19.6.2006. The simple answer to this question is that there was gross negligence on the part of the PGI, Chandigarh.

THE facts of the case in brief is that Shri Inder Pal Singh (Deceased) was the husband of Smt. Bimla Devi - the complainant, was admitted in the Institute due to heart problems on 19.3.2005 vide CR No. 142612 and was discharged on 25.3.2005, as the Doctors of the Institute suggested Mr. Singh to undergo bypass surgery and was asked to deposit Rs. 1,57,500. Accordingly a cheque bearing number 466656 for the same amount drawn on SBI, AFS, Chandigarh, was deposited on 23.3.2005, itself. The said cheque was duly encashed by the Institute, but in spite of that the complainant alleged that no date for the surgery was given. The complainant''s case is that Shri Inder Pal Singh visited the Institute several times and requested the concerned doctor to fix the date for surgery but there was no positive response. He visited the Institute lastly on 7.6.2006 and he died on 19.6.2006 due to severe heart attack at his house. It is submitted by the complainant that if her husband had been operated well in time he could have survived. Alleging deficiency in service the complainant claimed Rs. 18 lakh as compensation along with interest @ 9% per annum with Rs. 10,000 as cost for litigation.

THE Institute contested the case before the District Forum and admitted the factual position of the admission of Shri Inder Pal Singh before the Institute. They also admitted that they had encashed the cheque of Rs. 1,57,500 as an advance payment towards the surgery. It is the case of the Institute that Shri Inder Pal was advised to undergo either PYCA+stenting or bypass surgery as per decision after coronary angiography and was given an estimate of Rs. 1,75,000 on 19.3.2005. However, the patient came for follow -up in April 2005, when he was advised to undergo ECHO for revaluation to see the latest LV Function. Thereafter he did not visit the Institute and has been taking treatment from outside. Accordingly, there was no negligence on the part of the Institute. The District Forum after hearing the parties accepted the complaint partially and directed the Institute to pay a sum of Rs. 5,80,000 as compensation along with interest @ 9% per annum from the date of filing of the complaint i.e. 11.9.2006 till the date of payment. Dissatisfied by the order of the District Forum dated 21.9.2007, the Institute had filed an appeal before the State Commission. The State Commission observed that Inder Pal Singh visited the emergency with complaint of pain in abdomen, swelling feet and severe degree of breathlessness on 17.3.2005 and was admitted in PGI on 19.3.2005. He was seen in the emergency by Junior Resident Doctor Mr. Gaurav and Sr. Resident Doctor Mr. Jagpal and Cardiology Senior Resident doctor Mr. Sukhdev Singh and diagnosed of HTN, DM 2, Old IWMI, Dilated Cardiomypathy (ischemic) severe LV systolic dysfunction with LVEF 25%, CCF with congestive hepatomegaly, ACS -NSTEMI and associated COAD with history of smoking and chronic alcohol intake. The Cardiology Consultants Dr. Y.P. Sharma and Dr. Ajay Bahal had observed as under: "Since the ventricle function of the heart was very poor with an efficiency of 25% only and accordingly he was planned for coronary angiography followed by coromary resvascularization under IABP cover by either PTCA + stenting/or bypass surgery."

THE State Commission came to the conclusion that the amount was received for the surgery on 23.3.2005 and the Institute did not conduct the surgery in time. The amount was refunded after the death of the patient which clearly shows that there was an emergency and it was the duty of the Institute to give some date, keeping in view the condition of the patient and seriousness of the disease. Accordingly, the State Commission concurred with the reasoning given by the District Forum and dismissed the appeal.

DISSATISFI ED by the order of the State Commission, the Institute had filed this revision petition before us. The learned Counsel for the petitioner submitted that the main dispute is that there has been an urgency to perform the surgery and the patient required further test including the ECHO. There have been number of other patients who have been waiting for the surgery naturally being a big Institute which is taking care of several patients from several States, but the surgery could have been performed only as per the turn of the patient. Though patient was advised to undergo surgery it was not mentioned that it was an emergency. They wanted the patient to stabilize and then take up his case for surgery. Learned Counsel submitted that after April 2005, the patient did not come for follow up, and he might have gone to an other department of the Institute but he did not visit the Central Registration Unit. The main fault is that the patient did not undergo ECHO test. He strongly relied upon the one paragraph of the State Commission''s order, which is reproduced below: "The case of the appellant is that after discharge, Inderpal visited only once on 18.4.2005 for follow up and did not visit thereafter. However, case of respondent (complainant) is that her husband had been visiting PGI regularly for follow up and the stamps fixed on the card bore testimony to that fact. A perusal of stamps shows that those are not of PGI because PGI either fixes the stamp with a square or under the stamp designation of doctor concerned is mentioned as is clear from photocopies of OPD Card produced of some other patient. The PGI has also produced on file copy of the new out patient register Annexure A 2 which shows that Central No. 142612 i.e. Inderapal attended PGI for following only on 18.4.2005. The copies of new out -patient register of other dates namely 23.4.2005, 7.4.2005, 7.6.2005 and 6.8.2005 have also been produced on file which showed that the patient Inderpal did not attend as there is no entry in the new out patient register concerning Central No. 142612. Accordingly, there is no negligence on the part of the PGI - Institute.

AS against this, the learned Counsel for the complainant -respondent submitted that as it is clear from the records that cheque was given on 23.3.2005 this was followed by a letter from the Air Force Authorities urging the Institute to perform the surgery early. If there was a queue and surgery could not be conducted on time then the amount should have been refunded within a month. But on the other hand, the amount was refunded only after the demise of the patient. The Institute should have replied in response to the letter of the Air Force Authorities that they could not take up the case. Then the patient could have been got admitted to Army Hospital and surgery could have been performed. The money remained with the Institute for one year and three months.

THERE is no dispute that the complainant''s husband was suffering from serious heart ailment. It is also not disputed that on 23.3.2005 an advance payment of Rs. 1,57,500 was given for the treatment of the deceased. It is also clear from the records that this amount has been encashed by the Institute. The patient (Inder Pal) was suffering from serious ailment and required emergency surgery as is evident from the fact that the detailed diagnosis at the Institute indicated urgency of surgery.

LETTER dated 7.9.2005 of the Welfare Officer, Air Force, Chandigarh addressed to the Director of PGI, Chandigarh is reproduced below: "Medical Treatment: Shri Inderpal (395647) Sir, The above named individual who is an employee of this deport and suffering from heart disease has put up the following points for your kind consideration. (a) He has drawn an amount of Rs. 1,57,500 as medical advance for his heart operation as advised by your Institute vide our cheque No. 466656 dated 23.3.2005 issued in favour of your Institute. The cheque was deposited in your Institute but till now he has not been given date for his surgery. (b) It is also requested by him that expenditure for his treatment as OPD patient may also be adjusted through the amount deposited in your Institute. In view of the above facts your Institute is requested to look into the matter as above individual is having serious heart ailment."

THE Institute neither cared to reply to this letter nor they have given the date indicating when they will be performing the surgery or that they are unable to perform the surgery. The Institute has also not produced any affidavit about the list of the patients who are in queue for such surgery. The records produced by the petitioner before us indicate that the patient had visited the Institute of Department of Cardiology on several days some of which are reproduced below: 8.3.2005, 18.4.2005, 28.4.2005, 2.5.2005, 24.8.2005, 27.9.2005, 27.10.2005, 1.12.2005, 30.12.2005, 31.1.2006, 3.4.2006, 7.4.2006, 6.5.2006 and 7.6.2006, etc., some more dates are not legible.

IT may be possible that he has not visited the Central Registry on these dates. There are doctor''s initials on all the above dates advising continuation of the medicines as prescribed. These are the documents produced by the Institute itself along with their revision petition. Hence, we have no reasons to disbelieve them. This abundantly proves that the patient has gone to the hospital on several occasions.

LEARNED Counsel for the petitioner only referred to page 84 wherein there is a seal of having paid Rs. 10 on 18.4.2005, but on the same page, there are other seals enumerated above stating from 27.10.2005 and ending with 7.6.2006 wherein continued medication has been advised. So we are convinced that the patient had visited the Institute on several occasions and the Institute has thoroughly neglected to fix a date for surgery.

IN our view the allegation of the Institute is that the patient did not bring the ECHO report is a lame excuse and is an after thought Institute could have admitted the patient and kept him under observation and arranged for conducting the ECHO Cardiogram and performed the surgery soon thereafter and could have saved the precious life of the patient, which they have not done.

IN Smt. Savita Garg v. The Director, National Heart Institute, IV (2004) CPJ 40 (SC)=VI (2004) SLT 385=(2004) 8 SCC 56, the Apex Court has held that "once a claim petition is filed and the claimant has successfully discharged the initial burden that the hospital was negligent, and that as a result of such negligence the patient died, then in that case the burden lies on the hospital and the doctor concerned who treated that patient, to show that there was no negligence involved in the treatment".

IN Laxman Balkrishna Joshi v. Trimbak Bapu Godbole and Anr., AIR 1969 (56) SC 128, the Hon''ble Apex Court has held that "the duties which a doctor owes to his patient are clear. A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioners must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law require : (cf. Halsbury''s Laws of England 3rd ed. Vol. 26 p. 17)".

THE ratio of these cases is squarely applicable to the case on hand.

ACCORDINGL Y , we do not see any material irregularity or jurisdictional error in the order passed by the Fora below warranting interference. Therefore, we dismiss this revision petition. The Institute shall pay Rs. 25,000 as cost. The amount of Rs. 3 lakh, deposited in this case shall be released to the respondent, after proper verification without delay by the Registry, of this Commission. The Institute shall pay the balance amount to the respondent within four weeks from the date of pronouncement of this order.

NOW the issue to be decided is whether any responsibility can be fixed on the negligent doctors and staff.

IN Lucknow Development Authority v. M.K. Gupta, III (1993) CPJ 7 (SC)=(1994) 1 SCC 243, the Apex Court has held as under: "Today the issue thus is not only of award of compensation but who should bear the brunt. The concept of authority and power exercised by public functionaries has many dimensions. It has undergone tremendous change with passage of time and change of socio -economic outlook. It is unfortunate that matters which require immediate attention linger on and the man in the street is made to run from one end to other with no result. The culture of window clearance appears to be totally dead. It is, therefore, necessary that the Commission when it is satisfied that a complainant is entitled to compensation for harassment or mental agony or oppression, which finding of course should be recorded carefully on material and convincing circumstances and not lightly, then it should further direct the department concerned to pay the amount to the complainant from the public fund immediately but to recover the same from those who are found responsible for such unpardonable behaviour by dividing it proportionately where there are more than one functionaries".

ACCORDINGL Y , the Director of the Institute if deemed fit may conduct an inquiry into the whole episode and fix the responsibility on the concerned doctors and other functionaries of the Institute for their negligence and recover full or part of this amount from the concerned persons. The revision petition is disposed of as per the above directions. R.P. dismissed.