Shiv Kumar Bhuwalka vs Belle Vue Clinic

ON 16.09.2000 at 03.00 pm, Mr. Shiv Kumar Bhuwalka, the Complainant No.1, met with a road accident. On the advice of his family physician, he got admitted to Belle Vue Clinic (OP) at about 05.40 p.m. Dr. Shaikh Hassan Iqbal, Orthopedic Surgeon (in short, ''Dr. Iqbal'') was his treating doctor, he advised for X -ray, CT Scan and Blood Test, specific medicines and for proposed operation kept the patient nil by mouth. Thereafter the operation was delayed due to negligence of hospital staff. The Complainant further alleged that Dr. Iqbal, who operated him apprehended and confessed to him that a permanent damage to his nerve or to the hip might occur due to delayed operation. It was due to improper management of medical services from Belle Vue Clinic which is to be held responsible. During the course of hospitalization, there was superficial infection in the operative wound of patient, an extensive 2nd surgery for 2 1/2 hours was performed. Therefore, the patient had prolonged stay in the Belle Vue Clinic. Thus, it indicates deficiency along with negligence in the service of the management of OP and lack of responsiveness towards its patients. He was discharged on 12.10.2000, without complete cure, i.e. he was unable to move or walk an inch of distance. Thus, he had lost all his physical strength to stand upon his feet. The Complainant -1 was holding the post of Director in several profit oriented businesses and regularly earning about Rs.38,000/ - per month. Due to negligence of OP he suffered physical loss/ disability and financial hardship. The complainant further alleged that the publicly declared objectives and advertisements of Belle Vue Clinic are misleading. Complainant No. -1 had a bitter experience and painful feeling of facing negligence, inaction, latches and deficiency in service of the management of Belle Vue Clinic. Copy of objectives of the Belle Vue Clinic has been annexed as Annexure ''B''. In addition to this, the Complainant alleged that on 22nd September, 2000 at about 08.00 a.m. when the patient tried to lift his body with the help and/or support of the over -head -rod, the said support and/or the over -head -rod, suddenly broke from its base, resulting in severe unbearable pain and injury to him. His wife, who was standing very close to the bed, was also injured due to the incident on her right eyebrow. Thus, it was the known maintenance of essential equipment and gadgets. On enquiry, the Manager Administration, (OP -4) avoided to reply the specific allegations about the breaking of rod. OP -4 was rude in his behavior with the family member of the patient. Moreover, he was reluctant to respond to the queries of the patient or his father Mr. Shyam Sundar Bhuwalka. Further, the Belle Vue Clinic is the most expensive Nursing Home of the city devoid of proper facilities. Hence, on the basis of those allegation the complainants filed a complaint against the OPs for seeking a total compensation of Rs.2,51,00,000/ - under different heads as mentioned in the prayer clause.

THE Manager (Administration) Mr. T.N.Bhattacharjee, filed the written version. It is submitted that OP provides facility to the doctor for their patient''s hospitalization, surgery and nursing care. There is neither fixed panel of doctors nor OP recommends any doctor. The doctors who admit their patients are being fully aware of the facilities available with OP. The operation was performed by Dr. Iqbal , it was patient''s own choice. Dr.Iqbal had recommended the admission of the Complainant No. 1. The sequence of events, evident from the medical records of the Complainant No. -1 [Exhibit RW -1/1] show that there was no delay in performing the operation. There was delay due to necessary investigations that had been prescribed by the attending surgeon and the neurologist before operation. The said tests were carried out by the Respondent''s staff to the best of their capacity, considering the staff timings and the equipment available. The operation was successfully carried out. The OPs denied any negligence during treatment or during hospitalization. OPs further submitted that they have not advertised or represented that they have 24 hour emergency services. Arguments:

HEARD both the Counsel for the parties. The learned Counsel for the Complainant vehemently argued that due to gross negligence of OP, there was delay in conducting the operation. He relied upon the letter issued by Dr. Iqbal to the Medical Superintendent. The counsel submitted that, the patient was taken to the Operation Theatre at about 09.00 p.m. where the attending Surgeon Dr. Iqbal denied and/or refused to operate the patient, he became angry for non -compliance of his early instructions and advice due to the negligence, and irresponsiveness of the management of the said clinic. Dr. Iqbal, immediately, at 09.30 p.m. informed the Medical Superintendent, in writing, that the patient was sent to the Operation Theatre without a) Antiseptic Dressing and b) X -ray plates of spine. Dr. Iqbal then requested the Medical Superintendent to look into the matter at the earliest to regularize the above irregularities with the least possible delay. Thus, it was the callousness, negligence and latches on the part of the management of the said Clinic. The OP clinic was deficient in providing proper medical care to the patients, the staff was not co -operative, and the equipment / hospital beds were ill maintained. Hence, the patient suffered superficial infection of surgical wound, which subsequently prolonged his stay in the hospital, incurred huge expenses. The arguments advanced by Ms. Indu Malhotra, the Learned Counsel for the OPs that, the Belle Vue Clinic provides only infrastructure facilities to the doctors like operation theatre, hospitalization, nursing care, laboratory etc. There is no panel of doctors or consultants. The entire treatment of complinant -1 /patient was done by concerned doctors as per the standard protocol. There was no delay in performing operation. The time was consumed for necessary investigations like CT Scan, X -ray, Laboratory tests. Also, the x -ray chest was advised by the doctor, prior to operation i.e., at about 11 pm. The counsel has brought my attention to the Annexure M (Discharge Summary) and the relevant medical documents, the medical report (Annexure X) issued by Dr. Iqbal. For the convenience, the counsel filed the synopsis regarding the Sequence of Treatment of the patient/complainant -1. Reasons/Observations:

I have perused the entire medical record of treatment from 16.09.2000 to 12.10.2000. Also perused interrogatories and its reply filed by both the parties. Medical record clearly revealed that, on 16.09.2000, the patient was admitted to Belle Vue Clinic at 5.50 p.m. with the history of RTA at 03.30 p.m. Clinically, there was a foot drop. X -ray revealed fracture of posterior column of Acetebulum leading to central dislocation of right hip. The patient was advised for other investigations like 3D -CT Scan, X -rays Pelvis and both the hips, the routine pre -operative blood investigations. The patient was given medicines and also emergency first aid, advised for antiseptic dressing and to arrange 3 units of blood.

PERUSED the letter written by Dr. Iqbal to the Medical Superintendent on 16.09.2000 at 09.30 p.m., which expressed about the dissatisfaction regarding not sending the antiseptic dressing and X -ray plates of spine at the Operation Theatre. I consider that it is not relevant to the treatment aspect, because thereafter, Dr.Iqbal and Dr.Ajay Aggarwal advised for X -ray chest, at 11.20 p.m., hence there was further delay. Finally, operation was conducted at midnight instead of 09.30 p.m. which ended up at 04.00 a.m. Medical records showed the post -operative period was uneventful. The patient was given physiotherapy from 20.09.2000 and he showed good improvement at the time of discharge on 21.10.2000. In this regard, it is more relevant to observe clinical notes of 10.10.2000, as follows: The patient made to walk holding walker. Started training of shifting over the R1 by + both areas. Did well. Uneventful.

IT is also pertinent to note that on 25.10.2000, a medical report was issued by Dr. Iqbal, for the clarification (Annexure A). The Relevant paras are reproduced as follows: "Mr. Bhuwalka was referred to me by Dr. S. M. Rahaman on 16.09.2000 at about 04.40 p.m.

I was informed by Dr. S. M. Rahaman, over the telephone that Mr. Bhuwalka had met with an accident, while driving his car, at about 03.00 p.m. and had broken his pelvis.

I examined Mr. Bhuwalka and received his X -ray plates at about 05.00 p.m. and found that he had:

Fracture of the pelvis involving the acetabulum and ischiopubic ramus.

Central dislocation of hip.

Sciatic nerve palsy

All on the right side."

His other examination and past history were not very alarming except:

He was overweight.

, He was suffering from Hypothyroidism.

After the usual resuscitation protocols i.e. IV Fluids, analgesics requisition of blood, introduction of indwelling catheter, etc. the hip was relocated by me in the patient''s room. The plan was to do:

Neurolysis if required of sciatic nerve.

Open reduction and Internal Fixation of the pelvic fracture.

Repair of capsule muscles of the hip joint.

Under General anesthesia at 09.00 p.m. on 16.09.2000.

For the 1st procedure, i.e. neurolysis, opinion and help of Dr. Ajay Agarwal (consultant neurosurgeon) were sought. Meanwhile X -ray and CT Scan of the pelvis was advised along with X -ray of the chest by me and X -ray of the Cervical Spine, Dorsal Spine and Lumbo Sacral Spine were advised by Dr. Agarwal.

Dr. Agarwal was quite happy about the sciatic nerve i.e. there was no evidence of any direct injury and I stabilized the pelvis with 2 pelvic reconstruction plates (Stainless Steel, Mfg. Synthes).

During the postoperative period, there was evidence of superficial infection (wound swab taken) and the wound was re -explored on 28.09.2000 and the wound debridement was done. The rest of the post operative period was uneventful.

Physiotherapy, including CPM was started from 18.09.2000.

Mr. Bhuwalka will be reviewed by me in the 2nd week of November, 2000 at his residence; meanwhile he should continue doing his exercise as advised by the physiotherapist.

Therefore, on bare perusal of the report it is clear that, Dr.Iqbal had no complaints about the hospital facilities.

THE occurrence of infection of superficial wound was not a negligence of either doctor or hospital. The medical records clearly showed that, the doctors in OP hospital performed regular dressing of the superficial wound. The swabs were sent for culture and sensitivity, prior antibiotics were given. Regular H2O2 + betadine and wound debridement was done on 28.09.2000. Therefore, the doctors have not deviated from the standard of practice. Also, I do not find any lacunae or short comings in the hospital infrastructure, Operation Theatre, the nursing care, the facilities for investigations, etc. It is surprising to note that the Complainant had not made a single allegation against the treating doctor, even otherwise, I don''t find any evidence or complaints from the doctors about any shortcomings of the Belle Vue Clinic.

REGARDING the allegation of due to fall of support rod aggravated patient''s backache and also injury to the right eye, it should be borne in mind that the patient was hefty, weighing more than 80 kg. Such accident was quite possible if patient tried to raise himself, without assistance. It was self inflicted injury, nothing to do with non maintenance. In my opinion, the prolonged stay in the hospital was due to superficial infection of operated wound, and the patient was discharged after healing of wound only after satisfaction of Dr.Iqbal.

THE counsel for complainant submitted that the complainant was holding post of Directors of several reputed companies, lost his huge earning due to prolonged hospitalization. He is still not improved, unable to walk and attend his work. But, on perusal of medical record, it clearly proves that physiotherapy advised for strengthening of abductors and the patient was advised for weight bearing with walker from 10.10.2000. Moreover, it is pertinent to note that; complainant -1 had not produced any cogent evidence to prove his health status/ disability which prevented him from attending his work. Nothing is on record that he was remained in house till date.

THE doctrine of Respondent superior is applicable to impose liability on hospitals for the negligence of their employees and on doctors for the negligence of their nurses. The Corporate liability theory is premised on the notion that a hospital owes a duty directly to its patients to render quality medical care and to protect its patients'' safety. The hospital fulfils its duty by acting affirmatively to protect its patients from incompetent or negligent treatment. In this instant case, in my opinion, neither Doctrine of Respondent Superior nor the Corporate Liability is applicable, because the OP - Belle Vue Clinic was a well equipped hospital, having every infrastructure suitable for the doctors to treat their patients efficiently.

IN my opinion, the operation was performed on the patient under the guidance and advice of his own doctors i.e. Dr.Iqbal and Ajay Agrawal. Those doctors were not recommended by the OP hospital, and the said doctors were well acquainted with the facilities available with OP. The doctors did not make any complaint against hospital facilities or lapses. The sequence of events, evident from the medical records of the patient [Exhibit RW -1/1], the chart and affidavit of evidence amply show that there was no delay in performing the operation. Since various tests prescribed by the attending surgeon and the second opinion were sought, about 1/2 hour prior to the operation caused delay. Thus it was not an inordinate delay or negligence. It was a planned surgery. Even, the OP hospital as such has not advertised for 24 hour emergency services. Thus, there was no deficiency in service or any negligence from Belle Vue Clinic (OP) as well as from the doctors who treated the complainant.

ON the basis of forgoing discussion, the complainant failed to prove negligence or any deficiency in service from the OP, therefore, the complaint is hereby dismissed. The parties are directed to bear their own cost.