Ratna Ganguly & Anr vs Ramakrishna Mission Seva Pathishthan & 3 Ors

Binoy Kumar, Presiding Member

The present Complaint has been filed under Section 21(a)(i) of the Consumer Protection Act, 1986 by Smt. Ratna Ganguly, wife of Mr. Tushar Ganguly (since deceased) (in short, the “patient”) and Mr. Dipak Kumar Ganguly, father of the patient (Complainants Nos. 1 and 2 respectively) against Ramakrishna Mission Seva Pratishthan and three Doctors (Opposite Parties Nos. 1 to 4 respectively) for the alleged gross medical negligence causing untimely death of the patient.

The facts leading to filing of the present Consumer Complaint are that in the evening of 07.07.2016, on the complaint of pain in chest and upper portion of both arms, the Complainant No. 1 and her brother took the patient to the Emergency of Ramakrishna Mission Seva Pratishthan Hospital, the Opposite Party No. 1 at 8.35 pm on the same day. It was alleged that initially Dr. Anup Roy, the Opposite Party No. 2 attended to the patient, but after prescribing ECG and X-ray chest and except giving two injections, no proper attention was given to the patient. The ECG report could not be properly analysed as no Cardiologist was called to examine the patient. Seeing the normal ECG, the Opposite Parties asked the patient to come to the OPD of the Hospital on the next day. Noticing the pain in the chest of the patient increasing further, the Complainant No. 1 and her brother requested the Opposite Parties to admit the patient to relieve him of the pain. Meanwhile, the Opposite Party No. 4 Doctor prescribed Trop-T test at 9.35pm. It was alleged that even after the report of Trop-T test came ‘positive’ indicating severe heart problem, the Opposite Parties refused to admit the patient saying they did not have ICCU bed available in the hospital. It was alleged that the condition of the patient got critical by that time and was gasping for breath, but the Opposite Parties, despite availability of all the facilities in Emergency and further in violation of medical ethics, did not provide oxygen to the patient, indirectly forcing them to shift the patient to some other hospital.  At around 10.15pm, when the condition of the patient further deteriorated, he was taken to B1 ward and was administered injections Adrenaline, Atropine and Norad, but it was too late and the patient was declared dead at 10.55pm. It was alleged that the patient died due to heart attack in the Emergency ward, which, despite being fully equipped, the patient was not taken care of. It was also alleged that no standard medical protocol was followed by the Opposite Parties for the patient. Alleging medical negligence resulting into the untimely death of the patient, the Complainant No. 1, being the wife and the Complainant No. 2, being the father of the patient, filed the present Consumer Complaint praying for the compensation to the tune of Rs. 2,77,75,233/- with interest @ 12% per annum with cost of litigation on account of deficiency of service and medical negligence.

The Opposite Parties, in their reply, denied negligence on their part and pointed the allegations made by the Complainants as baseless. It was stated that when the patient arrived at the Emergency of the hospital, the attendants were immediately informed of the likelihood of this case to be of heart attack and that no beds were vacant at that time in the Cardiac Care Unit (CCU). The vitals of the patients were stable but as the ECG and Trop T tests showed Acute Myocardial Infarction (AMI), immediately the required doses were administered to the patient and was advised admission. The patient and the attendants were repeatedly informed about the critical situation of collapsing at any moment, with the patients of AMI, may arise at any moment advising to take the patient to some other hospital due unavailability of the beds in CCU in their hospital. While attending to other patients, the Medical Officer noticed the patient developing shortness of breath and immediately responding to the situation, got the patient administered moist O2, started IV fluid and after informing the Opposite Party No. 3, on his advice over phone, admitted the patient in the General Medicine Ward B1, where he was attended by other doctors. When the patient was seen collapsing, gasping for breaths and no pulse or BP was recordable, despite limited facilities in General Medicine Ward, necessary steps were taken to revive the patient, but eventually the patient expired at 10.55pm. It was stated that the patient and the attendants wasted their valuable time by not going to some other hospital, even after knowing that there were no vacant CCU beds in their hospital. The Opposite Parties further submitted that the Complaints filed the Consumer Complaint to defame their Hospital and prayed for dismissal of the Complaint.

Heard the learned counsel for both the sides.

The learned counsel for the Complainants submitted that the Opposite Parties Nos. 2 and 4 were doctors in the Opposite Party Hospital are responsible for medical negligence and manipulation of records. His main argument was that there was a delay in conducting the Trop-T test and not administering the life-saving drugs when the patient had evidently suffered a cardiac arrest and further the Cardiologist was also not informed on time. This is a clear case of medical negligence for which he is seeking appropriate compensation from the Opposite Parties as the patient died of cardiac arrest while being under treatment with the Opposite Parties.

The learned Counsel further submitted that the Opposite Party No. 2 Dr. Anup Roy was the treating doctor when the patient was brought to the hospital with chest pain and pain in upper hand at 8.35pm on 07.07.2016. The Opposite Party No. 2 prescribed medicines for gastric problem. The ECG report, though, had signs of cardiac problem, was reported as ‘normal’ by one Dr. Tanmoy Chatterjee of Opposite Party No. 1 Hospital. The patient was still in pain and thereafter, the Opposite Party No. 4, Dr. Ankit Roy prescribed Trop-T test, which proved positive. He submitted that the doctor, on seeing the report, asked the patient to be taken to another hospital. The Cardiologist was informed only at 10.30 pm, but it was too late and the patient died shortly. It is his arguments that life-savings drugs could have been given instead of Zerodol and Pan40, which should not have been given in case of heart-attack. Even when Trop-T test was positive, ecosprin should have been administered, but was not done and it was interpolated in the hospital record later. The learned Counsel also submitted that the averments of the Opposite Parties Nos. 1 to 3 in their written statement is misleading as wrong timings have been indicated regarding the administration of Trop-T test, which has been mentioned as 8.45 pm, whereas the bill of Trop-T test kit purchased from the hospital placed on record clearly records 21 hrs 39 minutes, which is 9.39pm. There is manipulation of medical records as in the medical record, the administration of Trop-T and the administration of ecosprin and clopidogrel drugs have been done at 8.45 pm. In fact, it is his argument that no ecosprin and clopidogrel has been administered as no bill for the purchase of the same has been filed. He submitted that all the medicines and disposables were purchased by him from the hospital for which details have been given but these do not include the two life-saving drugs.

The learned Counsel for the Complainants further submitted that the West Bengal Medical Council (in short, WBMC) on an Appeal filed by the Complainants in their Order dated 11.07.2020 had confirmed the earlier Order of the Ethics  Committee dated 25.02.2020 in which no medical negligence was substantiated against the Opposite Parties, but such conclusion was arrived at on the assumption that the ECG and TROP-T test were done at 8.45 pm indicating myocardial infarction and the Cardiologist was informed. Since the TROP-T test done much later and the Cardiologist, who in his own deposition before the WBMC had submitted that he was informed of the patient having cardiac arrest over phone at 10.30 pm, the conclusion of WBMC placed on wrong assumption and cannot be taken as a relevant document.

The learned Counsel for the Opposite Parties submitted that the Complaint is not maintainable as the service that was provided by the Opposite Parties to the patient was free of charge. He further submitted that the hospital in question is not a super speciality hospital and there was no bed in the ICU of the hospital at the time when the patient was brought in. Further, the attendants of the patients were told to take him to a super speciality hospital as the hospital is a charitable one with limited facilities. However, all care was taken and there is no medical negligence on the part of the Opposite Parties.

After hearing the arguments of the learned Counsel for both parties and on perusal of records, the first issue to be decided is whether the Complaint is maintainable on the ground that no fees were charged for the treatment undertaken by the Opposite Parties. From the record, it is seen that though the hospital is a chargeable institution, the fact is that the Complainants had to make payment for the drugs and the other disposables as ordered by the doctors for which the bills have been filed by the Complainants. So, I consider the Complaint to be maintainable as payment has been done to the hospital for the drugs and disposables.

The second issue is whether there was any manipulation of record on the part of the treating doctors being the Opposite Parties Nos. 2 and 4. In so far as the manipulation of record is concerned, I notice that there is variation in what has been stated in the written version of the Opposite Parties Nos. 1 to 3 for having administered Trop-T test and administration of ecosprin and clopidogrel. As per the evidence produced by the Complainants, Trop-T test kit was purchased at 9.39 pm from the hospital, whereas, in the written statement, it has been stated that the same was administered at 8.45 pm. It has also been recorded in the hospital record. On a careful perusal, it appears to have been an interpolation as no sufficient spacing is seen. To this extent again, I am in agreement with the learned Counsel for the Complainants that the hospital record has been manipulated.

The third question before me is whether there was any medical negligence on the part of the treating doctors being the Opposite Parties Nos. 2, 3 and 4. I also noticed that the ECG report while indicating some variation was reported by the Cardiologist, Dr. Tanmoy Chatterjee as ‘normal’ ECG. Though, Dr. Tanmoy Chatterjee has not been made a party in this Complaint, it is clear that his report has been wrongly made and to this extent, he is definitely deficient to the extent to be of being absent minded while writing the report.

The patient was admitted in the hospital at 8.35 pm with the complaint of chest pain and pain in hands and was immediately referred to the Medical Registrar on Call, who is the Opposite Party No. 4.   Most of the treatment was done by him till the patient died at 10.55 pm on the same day on 07.07.2016.   The seriousness of the case was known to the treating doctors, more so on seeing the ECG report around 8.45 pm.   This is not denied by the Opposite Parties.   It is also a fact that the Opposite Parties asked the patient to be shifted to another super speciality hospital.   The Complainants did not take the patient to another hospital in view of his serious condition. It is also a fact that the Cardiologist on role (Opposite Party No. 3) was informed about the critical condition of the patient only at 10.30 pm, if I go by the deposition made by him before the WBMC and 8.45 pm, if I go by the written statement filed by the Opposite Parties. When the Trop – T test, as given in the statement of the Opposite Parties, was conducted at 8.45 pm and assuming it to be true, then the Opposite Parties and in particular, the Opposite Party No. 4, should have informed the Cardiologist ( Opposite Party No. 3 ) at that time itself. So the delay from 8.45 pm to 10.30 pm is not properly explained by the Opposite Parties.   Taking  the  ground  in  such  circumstance  that  the  hospital  is ill equipped makes no sense when there is a proper Specialist  Cardiologist  available with the hospital. This is again another reason for holding the Opposite Parties deficient in service of medical negligence. The matter was also referred to AIIMS, New Delhi for their expert opinion, who have found that “there is no gross medical negligence in regard to attending to the patient, however, a repeat ECG could have been done at 20-30 min of presentation to confirm the evolution of heart attack, which is usually recommended”. No such course of action was undertaken as the Cardiologist was not properly consulted and briefed about the critical state of the patient. The patient should have been treated on the advice of the Cardiologist. From the record available and submission made by the learned Counsel for the Opposite Parties, it is not clear whether and when the Cardiologist was informed about the state of the patient and what advice was given by him and whether any follow up action like administration of certain procedure or drugs were taken. Evidently, the expert opinion of AIIMS, New Delhi has also found deficiency on this count with the Opposite Parties.

Now, the question is which of the Opposite Parties is held for medical negligence and what should be the kind of compensation to be paid by them. In so far as the hospital is concerned, being a charitable institution and not directly involved with the treatment of the patient, attributing medical negligence would not be appropriate, considering also that they already had a Cardiologist on roll. In so far as the Opposite Party No. 2 is concerned, he was only the first Responder, who immediately had referred the patient to the Opposite Party No. 4. So attributing any medical negligence on him would be out of question. In so far as the Opposite Party No. 3 is concerned, he is the specialist Cardiologist working for the hospital. As per the written version of the Opposite Parties, the Cardiologist was informed about the patient, but it is not known from the record available and even from the submissions made by the learned Counsel for the Opposite parties what advice he gave to the Opposite Party No. 4 or any other Doctor in the hospital considering that the TROP-T test was positive, indicating some kind of cardiac arrest. If the doctors were aware about the gravity of situation at 8.45pm, based on the TROP-T test and the ECG report, in such a situation, the Cardiologist should have come to the hospital to attend to the Doctor. For not attending to the patient in such a critical state and knowing fully well that he is the only competent doctor to treat such a patient available in the hospital, it is a clear case of deficiency of service on his part. His presence should have been enough to remove any allegation of deficiency of service against him considering that he can do any treatment only within the limitation of that hospital, but it has to be kept in mind that he is a Cardiologist qualified for treating such patients and therefore, his absence will be considered as the deficiency of service.  In this regard, I am relying on the written statement filed on behalf of the Opposite Parties which predates the WBMC report and the deposition of the Cardiologist that he was informed only at 10.30 pm. Further, WBMC report absolving the doctors of negligence is based on the assumption that the Opposite Party No. 3 was informed of the patient’s condition at 8.45 pm.

In so far as the Opposite Party No. 4 is concerned, I hold the Opposite Party No. 4 responsible for the following deficiencies:

a.  not recording the medical report correctly and for making wrong entries specially in so far as the time of administration of Trop-T is concerned;

b.  not informing and summoning the Cardiologist within time, knowing fully well that the case was serious and that the Trop-T showed positive results.

Finally, the question before me is what should be the compensation to be paid by this Opposite Party. It is a fact that the deceased patient was 40 years old and the sole earning member in the family of four members and was employed with a Public Sector company, earning around Rs. 40,000/- per month. It is also to be noted that the Opposite Party No. 4 is a post-graduate trainee and therefore, cannot be asked to pay the compensation as demanded by the Complainants. It is an unfortunate incident in which the patient died of acute myocardial infarction which could be serious in nature and to this extent expecting the Opposite Party No. 4 to have provided the required treatment with his level of knowledge and experience would be to expect much. I am constrained to consider only a token compensation to be paid by the Opposite Party No. 4 in the circumstances of the case.

In view of the aforesaid discussion, the Complaint is partly allowed by holding the Opposite Parties Nos. 3 and 4 deficient in service and for medical negligence in treating the patient who died of cardiac arrest. For this deficiency of service and medical negligence, the Opposite Parties Nos. 3 and 4 are directed to pay Rs. 7 lakh and Rs. 3 lakh respectively to the Complainants within six weeks of this Order, failing which the same shall be paid along with the interest @ 6% per annum from the date of the issue of this Order.

Pending applications, if any, stand disposed of.