Smt. Paramjeet Kaur vs Dr. S.K. Bansal & Ors

Dr. S.M. Kantikar, Presiding Member

This complaint has been filed under Section 21(a)(i) of the Consumer Protection Act, 1986 by Mrs. Paramjeet Kaur, the widow of late Rajinder Singh, (hereinafter referred to as ‘the Complainant’) against the Maharaja Agarsain Hospital (OP-2), Dr. S.K. Bansal  (OP-1), Dr. Kailash Nath Singla (OP-3) & Sunder Lal Jain Hospital (OP-4), for the alleged medical negligence caused by OPs, resulting in the death of the Complainant’s husband.

The Complaint: -

2.1 The husband of Complainant, Rajinder Singh (since deceased, herein-after-referred to as ‘the Patient’), was admitted on 21.09.2005 at Maharaja Agrasain Hospital (OP-2) for the surgery for removal of stone. Initially, Dr. Kamlesh Nath Singla (OP-3) examined him and assured that a panel of competent doctors was available at OP-2 Hospital, and they will operate upon him. The surgery was fixed for the next day on 22.9.2005 and the pre-screening tests were conducted on the advice of Dr. S. K. Bansal (OP-1). The OP-1 performed the laser procedure alone, but no other doctors were present. It was alleged that at OP-1, the basic facilities and necessary drugs were not available in the Operation Theatre (OT). The family members were asked to purchase medicines from the market as and when necessary.  Several prescriptions were issued on various occasions from OT, which cost the patient Rs. 50,000/-, therefore, the patient was left in a critical stage for want of medicines.  In the OT, the patient was crying and shouting due to extreme pain. The OP-1 informed the Complainant that he removed the stone partially and the remaining would be removed after a month. The patient was discharged with tubes fitted inside the body. However, it was alleged that due to surgical mistake, the patient’s bladder got damaged and urine was collected in the abdomen. The patient was then shifted to OP-4 Hospital since there was no ICU facility in OP-2 Hospital. The OP-1 was also the treating doctor at OP-4 Hospital. The patient died at around 5.40 p.m. on 23.09.2005.

2.2 The Complainant further alleged that the medical records were tampered and certain entries were made to suppress negligence. Despite several written requests, OP 2 and 4 did not supply the medical records. The Complainant took an opinion of medical expert  on 12.12.2005, which revealed medical negligence of the OP-1. It was alleged that, the OP-1 falsely assured the Complainant about the adequate medical facilities. The  post-surgical care and ICU facilities were inadequate. Being aggrieved, the Complainant filed a complaint before this Commission and prayed for total compensation of Rs. 1,46,44,560/- from the Opposite Parties.

Defense:

3.1 The Opposite Parties filed their respective written statements along with medical references from the textbooks. They have denied allegations of medical negligence.  The preliminary objection of maintainability was raised. The complaint was bad for misjoinder/non-joinder of necessary parties as the Urologist - Dr. R.K. Chaudhary had not been impleaded as a party. Therefore, the complaint is liable to be dismissed.

3.2 Reply by OP-1 (Dr.S.K.Bansal)

The OP-1 submitted the patient was brought to the hospital on 21.9.2005 at 10.00 p.m. and was admitted with the complaints of dribbling and burning of urine and intestinal pain off and on. He was admitted under care of OP-3 Dr. Kailash Nath Singla and Dr. R. Arora. The patient was chronic alcoholic with Acid Peptic Disorder (Gastritis) and having single urinary bladder calculus (stone).  He was also taking ante-depressant drug Tab. Tryptomer.

3.3.  On 22.9.2005, the patient was given option for open surgery versus endoscopic surgery.  The patient opted for endoscopic surgery and accordingly at 6.00 pm, Dr. R. Choudhary (Urosurgeon) with the use of pneumatic lithotripter, the stone was removed in pieces and the Foleys catheter was inserted in the bladder. At 10.00 p.m., the patient became restless, high pulse rate and tachycardia. The oxygen saturation was 98%.  The Foleys catheter showed 50 ml. of blood tinged urine.  Therefore, the patient was kept in the OT for monitoring.  At 11.00 p.m., the patient was conscious and oriented.  The urine output was 400 ml. in 1 ½ hours.  Inj. Mol and cold sponging was advised.  At 11.30 p.m. the patient became febrile - temp of 1020F.  The possibility of bladder perforation was suspected and two drains were inserted preemptively in the intra-peritoneal and extra-peritoneal cavity but no drainage of fluid seen from both the drains.  Thus, possibility of perforation was ruled out.  In the midnight, the patient became restless, febrile (1020F) and tachycardia ( pulse 130 / minute).  The urine output was 150 ml. in one hour.  The condition of the patient was explained to the relatives and at 1.00 a.m., injection IV Fortum 2 gm. IV and  Voveran were given.  The emergency USG was done by Dr. Urvashi Jain, which did not reveal any free fluid in the abdomen, thus there was no evidence of bladder perforation.  By 2.00 a.m., the temperature increased to 1040F in spite of all treatment.  Septicemia was suspected and explained to the relatives. The O2 saturation was falling; therefore for critical management and ventilator support, it was decided to shift the patient to ICU of Sunder Lal Jain Hospital (OP-4). At 3.00am on 23.09.2005, the patient was shifted to OP-4. He was intubated and put on ventilator. The patient was constantly monitored for septicemia and ARDS. At 3.45 a.m., the patient landed into septic shock. The In-charge Dr. Renu Paliwal examined the patient, started inotropic support.  The patient was reviewed by Dr. Atul Goswamy, the Urologist at OP-4. The culture of urine and both the drains were sent. In the evening, the patient stopped responding inotropic support and resuscitation was instituted. In spite of best efforts, the patient could not be survived and he expired at 5.40pm on 23.09.2005.

3.4  Reply by OP-2 (Maharaja Agarsain Hospital)

The OP-2 Hospital submitted that it is a charitable organization operating on a "no profit & no loss" basis, therefore, the Complaint is not maintainable against them. As per the USG report, there was no rupture in the urinary bladder. The patient developed septicemia after surgery, which can occur with instrumentation of the urinary tract, which has a high mortality rate[Campbell's Urology' 8th Ed., Vol-I]. It was submitted that the patient was a chronic alcoholic with low immunity, making it difficult for doctors to control the infection. The patient was shifted to Sunder Lal Jain Hospital with the consent of the complainant and her relatives. The complaint is seeking compensation of Rs. 1.45 crores, which the hospital considers excessively high.

3.5  Reply by OP-3 (Dr. Kailash Nath Singla)

The OP-3 also submitted that his role was limited, he has referred the patient to OP-2, hospital  . The surgery was performed by team of doctors namely  Dr. R. Chaudhary, Urosurgeon, Dr. Bansal, the surgeon and Dr. Rajeev Gupta, anesthetist. He denied that the surgery was performed wrongly.

3.6  Reply by OP-4 (Sunder Lal Jain Hospital)

The OP-4 denied any negligence or deficiency during the patient's treatment.  The hospital is well-equipped and having modern facilities. The patient was not operated on in OP-4, but was transferred from OP-2 for ICU management. At the time of admission, patient already had developed septicemia. The attending medical staff took all necessary steps to treat the patient. The patient's death was due to septicemia, which led to ARDS.

3.6.1  Dr. Renu Paliwal, the ICU In-charge of OP-4, submitted that Dr. Manjit Kaur (M.B.B.S.) was not qualified to opine on this matter, since she is not a surgeon/urologist/intensive care physician. The opinion given by Dr.Manjit Kaur was misleading incorrect and contrary to the facts and standard medical practice.

Arguments:

4.1 Heard the arguments at length from both the sides, parties have filed their brief notes of written arguments. The learned Counsel for OP-1 submitted that Dr. S. K. Bansal, the OP-1, was expired during the pendency of the case. The learned Counsel on both the sides reiterated their evidence on record. They have filed medical literature on the subject and textbook references.

Findings & Conclusion:

5.1 The point for consideration is whether the OP-2 has adequate facilities to treat the instant patient.  It is pertinent to note that the OP-2 hospital is a charitable multi-specialty hospital. The contention of the Complainant  that certain medical supplies and medicines were asked to bring during operation, but  on the record there is  no cogent evidence in this regard. In my view, it was not proximate cause of patient’s sufferings or the outcome of surgery.  The cysto-lithotripsy surgery was uneventful. It was performed by Dr. R. K. Choudhary and Dr. S. K. Bansal, however, only Dr. S. K. Bansal was impleaded in the Complaint. The Anesthesia was administered by the Anesthetist Dr. Rajeev Gupta after proper pre-operative assessment. The patient  administered sub- arachenoid block followed by general anesthesia. The patient responded well to the anesthesia and regained consciousness.  as anticipated.

5.2 Post-operatively, throughout night the patient was monitored, but suddenly the condition of the patient started deteriorating. In the midnight, Dr. Urvashi Jain, the Sonologist was called and USG was found to be normal. It ruled out possibility of rupture in the bladder. The patient was under continuous monitoring in the ICU. In my view, the treating doctors have treated the patient as per the reasonable standards of care. Despite all efforts to treat septicemia and ARDS, the patient expired. In my view, no negligence is attributable to the OPs.

5.3 The father-in-law of the deceased sought an opinion from Dr. Manjit Kaur in the instant case. I have perused the opinion given by Dr. Manjit Kaur dated 12.12.2005. She commented that ‘complication can occur in every surgery, but treatment of complication is necessary at time. Patient Rajinder Singh died because of delayed treatment of complication and mismanagement in ICU’. I have carefully perused the opinion. It is pertinent to note that Dr. Manjit Kaur was M.B.B.S. and she cannot be considered as an expert. Her professional expertise was not consistent with the Surgeon OP-1, who was MS in Surgery. In the instant case, the medical record is clear that the team of Senior doctors were present round O’ clock to save the life of the patient. Moreover, the opinion of Dr. Manjitt Kaur deliberately omitted to comment on the emergency USG report done by Dr. Urvashi Jain at 1.00 a.m. in the midnight. There was no rupture in the urinary bladder of the patient as no free fluid was seen in the abdominal cavity.

5.4.  I would like to rely upon the law laid down by Hon’ble Supreme Court on medical negligence. In Kusum Sharma v. Batra Hospital case [(2010) 3 SCC 480] it was observed that:

"It is a matter of common knowledge that after happening of some unfortunate event, there is a marked tendency to look for a human factor to blame for an untoward event, a tendency which is closely linked with the desire to punish. Things have gone wrong and, therefore, somebody must be found to answer for it. A professional deserves total protection. Here, removal of malignant abdominal tumor by surgical operation adopting an anterior approach in preference to posterior approach, though failed to save the life of the patient, was not held to be negligent.”

5.5 The recent decisions of Hon’ble Supreme Court in the case S. K. Jhunjhunwala vs. Dhanwanti Kaur and Another[(2019) 2 SCC 282] held that in every case where the treatment is not successful or the patient dies during surgery, it cannot be automatically assumed that the medical professional was negligent. Recently in the case of Dr. (Mrs.) Chanda Rani Akhouri & Ors. vs Dr. MA Methusethupathi & Ors.[ 2022 LiveLaw (SC) 391], it was observed that:

it clearly emerges from the exposition of law that a medical practitioner is not to be held liable simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another.

5.6 Based on the foregoing discussion, the complainant failed to prove any failure of duty of care from the team of treating doctors.  The patient was treated as per the reasonable standard of practice. The death of patient can’t be attributable to the negligence. The Complaint is dismissed.

There shall be no order as to costs.