S. VEERASAMY vs MURUGAIYAN

THE case of the complainant is as follows: THE complainant was working as Loadman in Godrej Private Company Ltd. Due to the family quarrel on 3.5.2002, he attempted to commit suicide by consuming three seeds of yellow Oleander. Immediately, he was taken to a private nursing home and he was given treatment by the opposite party No. 1. On 4.5.2002, he was advised to go to Jimper Hospital for further treatment, on which day, he was admitted in the opposite party No. 2 hospital. While he was taking treatment in the hospital, his right hand has developed swelling and he was suffering from severe pain on his right hand. On 9.5.2002, his right hand was amputated by the doctor of opposite party No. 2. Only because of the negligence and careless act of the doctor of opposite party No. 2 hospital, the complainant''s right hand was amputated. THE complainant was hale and healthy and because of the wrong treatment given by the opposite parties, the complainant''s life became miserable. THE complainant was the only bread-winner of his family and because of the loss of his right hand, the complainant''s entire family was suffering physically. THE complainant estimated the compensation to Rs. 7 lakhs towards pain and suffering, loss of income and permanent disablement. THE opposite parties are vicariously liable to pay compensation of Rs. 7 lakhs.

THE case of the opposite party No. 1 is as follows: THE opposite party No. 1 treated the complainant on 3.5.2002. THEre is no specific antidote available for this poison and only supportive treatment is available throughout the world. THE opposite party No. 1 treated the complaint by giving stomach wash and administered atropine injection, whenever the heart rate came down. THE heart rate of complainant during treatment was 70-80 irregular at times and B.P. was around 110/60 and was irregular at times. In spite of the treatment, the complainant was dehydrated, vomiting and had diarrhoea. Under these circumstances, the opposite party No. 1 referred the complainant to opposite party No. 2 on 4.5.2002. He has given the correct treatment which was also followed by the 2nd opposite party. THE complainant was treated by the 2nd opposite party and he was finally operated on 16.5.2002 by 2nd opposite party and his right hand below the elbow was amputated due to gangrene formation in order to save the life of the complainant. THErefore, the 1st opposite party is not liable to pay compensation to the complainant. THEre is no averment in the complaint against the opposite party No. 1 regarding any negligence in treatment or of any deficiency in service. The case of the 2nd opposite party is as follows: The complaint is not maintainable in law. A single crushed seed of this poison can be sufficient to cause death in an adult. With the intake of large amount of poison i.e., large number of crushed seeds and delay in bringing the patient to the hospital, very few survive even with best management. In such cases, the death is usually due to toxic effects on the heart in the form of cardiac conduction blocks rhythm disturbances and electromechanical dissociation, leading to abnormal ineffectual beating of the heart causing cardiac failure and death. There is no antidote available for this poison and only supportive treatment can be given. The standard management protocol for this condition is treatment with chronotropic (atropine) and ionotropic drugs to boost blood pressure and improve circulation. In the event of failure of medical management temporary cardiac pacing is done as a life saving procedure. In this procedure a shielded wire is passed into the heart through a blood vessel and through this wire, electric impulse is given to stimulate the heart to pump blood. It has become a standard life saving procedure for this condition of patients as Jimper. The complainant was admitted on the evening of 4.5.2002. At the time of admission, he was critically ill with abnormal low body temperature, irregular pulse and very low blood pressure. As per standard treatment protocol, he was managed with chronotropic and ionotropic drugs without which it was not possible to save his life. The echocardiography of the heart showed presence of blood clot in the left ventricle of the heart. Development of gangrene of the right hand appears to be due to embolization of this blood clot. Sudden stoppage of blood flow in an artery in such a manner leads to the development of gangrene. The blood clot in the heart can form due to cardiac dysfunction and abnormal beating pattern of the heart as a result of cardiotoxity developing from the poison. This is a known complication of all the types of cardiac dysfunction resulting from intake of the cardiotoxic poison like yellow Oleander. The blood clot which obstructed the blood vessel in the right hand has been caused by the cardiac toxity and its resultant complications arising as a result of intake of the Oleander seeds with the intention of deliberate self harm i.e., suicide and not by negligent and improper treatment. Once gangrene is formed and the distal parts are dead, it is imperative to amputate the right hand, below the elbow in order to save the life of the patient. Hence, the best available treatment has been administered to the complainant. The complainant is not entitled to any compensation for his own act of consuming Oleander seeds to commit suicide.

No oral evidence was let in by either of the parties. Exs. C1 and C2 are marked by the complainant. Exs. R1 to R4 are marked by the opposite party.

THE points for determination are: (1) Whether the opposite parties are guilty of deficiency in service in giving treatment to the complainant? (2) Whether the complainant is entitled to compensation? If so to what quantum?

Point No. 1 : It is admitted that the complainant, who was employed as a Loadman in Godrej private company attempted to commit suicide by consuming three seeds of yellow Oleander and that he was treated by the 1st opposite party on 3.5.2002 and that from 4.5.2002, the complainant was given treatment in the 2nd opposite party hospital and that during the course of the treatment, the right hand below the elbow was amputated.

IT is the case of the complainant that due to the negligence and careless act of the doctors, his right hand was amputated. Before adverting to the crucial points involved in the dispute, it would be relevant to refer to the documents filed by the parties. Ex. R4 is the letter given by 1st opposite party to 2nd opposite party dated 4.5.2003. IT is stated therein that the complainant was admitted and that he was given injection atropine and the beating of heart rate was 70-80 irregular at times and that he has diarrhoea and vomiting. IT is contended by the 1st opposite party that he treated the complainant by giving stomach wash, administered atropine injection whenever the heart rate came down. IT is the contention of both the opposite parties that there is no specific antidote available for this poison and only supportive and symptomatic treatment is available throughout the world. IT is the case of the 1st opposite party that in spite of the treatment, the complainant was dehydrated, vomiting and had diarrhoea. The circumstances under which the complainant was referred to the 2nd opposite party i.e., Jimper Hospital by the first opposite party doctor are clearly stated in the counter. Ex. R1 is the medical record produced by the 2nd opposite party. IT shows that the complainant was suffering from giddiness, vomiting when he was admitted in the hospital. Ex. R2 is the medical record showing the nature of treatment given to the complainant. Ex. R3 is the admission record of the complainant. IT shows that the complainant was suffering from severe cardio toxicity, cardiogenic shock and that gangrene formed in his right hand and ultimately his right hand below the elbow was amputated. IT is the specific case of the opposite parties that in order to save the life of the complainant, his right hand was amputated. The 2nd opposite party has also given the reasons for amputating his right hand. IT is contended by the 2nd opposite party that death will usually occur due to toxic effects on the heart in the form of cardiac conduction block. IT is also admitted by the 2nd opposite party that the complainant was administered with chronotropic and ionotropic drugs without which it was not possible to save his life. The averments in the counter that echocardiography of the heart showed the presence of blood clot in the heart which resulted in the development of gangrene and that the sudden stoppage of blood flow in an artery leads to development of gangrene cannot be disputated. IT is also alleged that cardiac dysfunction will result in blood clot area. The above averments in the counter are not denied by the complainant. IT is nowhere alleged in the complaint that the nature of the treatment given by the opposite parties was not proper and that it is not in accordance with the medical procedure. The stand taken by the opposite parties is also supported by the Medical literature. The article, "Acute Yellow Oleander" relied on by the opposite parties will show that the deliberate ingestion of yellow Oleander seeds has recently become a popular method of self harm. In the article ''Epidemic of self-poisoning with seeds of the yellow Oleander tree in Northern Srilanka'', it is observed that Oleander seeds contain cardiac glycosides that cause vomiting, dizziness and cardiac dysrhythmias such as conduction block affecting the sinus and AV nodes. It is further observed, thus: ''Ingestion of the seeds produces a clinical picture very similar to that of digoxin poisoning: vomiting, diarrhoea, dizziness, bradycardia, sinus and AV node block and other cardiac dysrhythmias (Sreeharan et al, 1985; Saravanapavananthan and Ganeshmoorthy 1988; Micromedex 1995) Fatal, DG shock-resistant, ventricular fibrillation or refractory cardiogenic shock may ensue is severely poisoned patients. Many patients with moderate poisoning show PR interval prolongation and progression to AV dissociation that must be treated with temporary cardiac pacing.'' If we examine the stand taken by the opposite parties with reference to the above fact, we have no hesitation in holding that the question of negligence or carelessness would not and did not arise in this dispute.

IT has to be stressed at this stage that the complaint does not contain any particulars as to the nature of treatment given to the complainant. IT is nowhere stated that there was departure from standard treatment which is expected to be done by the medical practitioner in the case of poisonous cases. IT is nowhere stated in the complaint that the first opposite party was guilty of wrong and improper treatment. On the other hand, it is specifically alleged in the complaint that only because of the negligent and careless act of the doctor of the 2nd opposite party hospital, the complainant''s right hand was amputated and in the same para it is vaguely stated that wrong treatment was given by the opposite parties. IT is admitted by the complainant that he was given treatment by the 1st opposite party in the private nursing home on 3.5.2002. In the proof affidavit filed by the complainant, it is alleged in the paragraph No. 3 that only because of the negligent and careless act of the doctor or O.P. No. 2, his right hand was amputated. In the second page, it is vaguely alleged that due to the act of the opposite parties, his life and his entire family life has been spoiled. IT is thus seen that the complainant has not come forward with clear and definite version about the part played by the first opposite party doctor. IT is not clearly stated that his right hand was amputated only due to the wrong treatment given by the 1st opposite party when he was admitted in the nursing home on 3.5.2002. As already stated, it is nowhere stated in the complaint that the nature of the treatment given by the 2nd opposite party hospital is not in accordance with the accepted and established medical procedure. In the absence of any such specific pleadings, it is not open to the complainant to contend that due to the negligence of the opposite parties, his right hand was amputated.

IT is contended on behalf of the complainant that the procedure proscribed by the Medical Council is not followed by the doctor and that the 1st opposite party did not have any facility for conducting operation and that when the 1st opposite party has no facility to give treatment to this kind of poisoning, the treatment given to the complainant on 3.5.2002 cannot be stated to be in accordance with the medical procedure and that the very fact that he referred the complainant to Jimper Hospital will show that the first opposite party doctor did not have any skill or facility to give treatment to this kind of poisoning. IT is also contended by the Counsel for the complainant that there is delay in giving treatment to the complainant. On the other hand, it is contended by the opposite party that it is nowhere pleaded in the complaint that due to wrong treatment given by the 1st opposite party hospital, the right hand was amputated. The above contention cannot be accepted for the following reasons. As already stated, the complainant is unable to fasten any liability on the 1st opposite party when he was treated on 3.5.2002. IT is not stated in the complaint as to how and to what extent, the treatment given by the 1st opposite party was not in accordance with the medical procedure. On the other hand, the admitted material will show that it is the complainant who attempted to commit suicide by consuming yellow Oleander seeds, which is poisonous. IT cannot be disputed that this kind of poisoning will affect the heart and vein, as a result of which gangrene will form. Therefore, the 1st opposite party was justified in giving the initial and primary treatment and then referring the complainant to the hospital. IT cannot be disputed that if the right hand was not amputated, the complainant would have met with his death. Therefore, we have no hesitation in holding that the 2nd respondent hospital has given treatment in amputating the right hand in order to save the life of the complainant. Thus, looked at from any angle, the contention of the complainant that his right hand was amputated due to negligence act of the opposite parties cannot be accepted. The learned Counsel for the complainant relies upon certain decisions to substantiate his case. The duties which a doctor owes to his patient are stated by Apex Court in the decision reported in AIR 1969 SC 128. The facts of the above case will show that death of a patient was due to shock resulting from reduction of the fracture attempted by the doctor without taking the elementary caution of giving anaesthetic to the patient. The decision reported in AIR 1990 Andhra Pradesh 207, relates to the negligence of anaesthetist, who after administering anaesthesia exposed the patient for about 3 minutes to room temperature and failed to administer fresh breaths of oxygen. The above decision will not apply to the facts of this case.

The decision reported in AIR 1985 Madhya Pradesh 150, will not apply to this case. The facts of the above case will show that operation was performed by the civil surgeon in ill-equipped hospital without doing necessary investigation.

AS already stated, it is nowhere alleged in the complaint that the nature of the treatment given by the opposite partie''s doctors are not approved by the Medical Council. The learned Counsel for the opposite party relies upon certain decisions to substantiate their plea that the question of medical negligence does not arise in this case. In III (2004) CPJ 20 (NC), the National Commission has held that in the absence of expert opinion, negligence is not proved.

THE National Commission in I (1999) CPJ 13 (NC), has held that the onus of proving negligence is on the complainant. THE Apex Court in I (2002) CPJ 4 (SC), has held that a doctor will not be guilty of negligence if he has acted in accordance with the practice accepted as proper by a responsible body of medical men. In this case, the complainant has not adduced any evidence in the shape of expert opinion to prove that the treatment and practice adopted by the opposite party doctors are not in accordance with the established medical procedure. As already stated, the complaint is bereft of material particulars regarding the nature and extent of negligence on the part of the doctors. For the above reasons, we hold that the complainant failed to prove that his right hand was amputated due to the negligence of the opposite party doctors. Therefore, we hold that the doctors of the opposite party are not deficient in service in giving treatment to the complainant. This point is answered against the complainant. Point No. 2 : In view of our finding in point No. 1, we hold that the complainant failed to prove that the opposite party doctors are guilty of deficiency in service. Therefore, we hold that the complainant is not entitled to any compensation.

IN the result, the complaint is dismissed. No cost. Complaint dismissed.