SMT. SUJATA VOHRA vs ISI ESCORTS & ORS.

The complainant, Smt. Sujata Vohra, filed this complaint under section 12 of the Consumer Protection Act 1986 alleging medical negligence against the ISI Heart Command and Research Centre, New Delhi, the opposite party seeking total compensation in the sum of Rs.58,00,000/- . 1. The Compliant: The brief facts: Smt. Sujata Vohra''s husband, Mr. Anil Vohra (the patient-since deceased), aged about 40 years, underwent angioplasty in the month of March 2000, and engaged in his routing office work. He was a Sales Manager in a Multi National Company and touring extensively about 3-4 times in a month, outside Delhi. He was hale and hearty and continued with his activities like sports, walking and swimming. On 05.12.2001, Mr. Anil Vohra suffered from fever, consulted his family physician on 08.12.2001, who diagnosed it as Empyema and advised him to get admitted in ISI Escorts Heart Command and Research Centre, (OP hospital). Accordingly, the patient went to OP hospital at 9-30 A.M. on 09.12.2001, ultrasound and X-ray were performed, which revealed pus in the pleural cavity i.e. Empyema. It was an emergency condition but, the OP took it casually, neglected to start immediate treatment, therefore, bacteria spread into the body through blood, leading to septicemia and cardiac shock. It was the deficiency on the part of the OP, who did not drain the pus immediately on emergency basis, despite early diagnosis. The Resident doctors present at that time, expressed their inability to drain out the pus in absence of any senior physician. The on duty doctor, turned a deaf ear to the innumerable requests made by the complainant to call for senior physician. It was only at about 4-30 P.M., the Sr. Physician, Dr. Mangla, came but at that time, the patient was more critical. The Senior Physician drained about 250 ml of pus from the right pleural cavity. It was drained without ultrasound guidance; therefore, it was not a complete drainage. It was further alleged by the complainant that, in spite of repeated requests and reminders that the patient was a cardiac patient, the OP doctors delayed the treatment. The doctor left the hospital for his evening party with a comment that "I know what to do and when". During the same night, the patient suffered a cardiac arrest resulting to 90% brain damage, it was not detected in time, even though the patient was in the ICU and ultimately, the patient died, on 10.12.2001 at 3.00 PM. Therefore, alleging serious lapses, negligence and indifferent attitude of the OP hospital staff, who delayed the treatment of complainant''s husband, which was the cause of further development of septicemic shock and cardiac arrest. The complainant filed a complaint before this Commission and prayed for total compensation in the sum of Rs.58,00,000/- under different heads, including the future maintenance of her family and children''s education in Delhi Public School.

Complainant has filed evidence by way of affidavit and interrogatories, along with the medical records, prescriptions and the bills of the OP hospital, the prescriptions given by her family physician i.e. Sanjay Clinic, the death summary and medical literature on pleural Empyema. She has also placed a certificate from Dr. Balbir Singh dated 16.04.2003. In support of her contention, medical literature from Medical Diagnosis & Treatment 1978, of Marcus A. Krupp -Milton J. Chatton- Maruzen Asian Edition was also produced.

The OPs filed written version and refuted all the allegations. OP submitted that the complaint was misconceived and relied entirely on the admission sheet of hospital, which was filled by the clerical staff subsequently, based on hospital records. The patient, on admission was properly investigated with x-ray and blood tests. Empyema was a provisional diagnosis mentioned in the admission sheet, but the same error crept into the death summary which was not made contemporaneously. The patient was suffering from fever for 5 days, prior to admission to the OP hospital; the family physician also diagnosed him as a case suspected of Acute Cholecystitis or Amoebic abscess.

Arguments from both the parties heard. Counsel for the complainant reiterated the facts in the complaint and vehemently argued that it was a gross negligence. The principal of res ipsa loquitor is applicable. Due to delay in diagnosis and treatment by the OP doctors, the patient''s condition deteriorated further, resulting to death.

Arguments advanced by the counsel for OP submitted that, complainant has concealed several ailments and relied only upon the discharge summary. As a usual practice, the discharge summary was not written by the treating doctor. The mention of Empyema Thoracius was an inadvertent mistake on part of OP. The OP Dr. P. S. Mangla, acted as per standard of practice, the patient was already suffering from fever for 4-5 days and he was in a septicemic condition. On clinical suspicion, the pleural tap was done.

I have perused the medical records on file. It is clear that the patient was suffering from high degree of Diabetes Mellitus. The Blood Sugar level on that day was more than 400 and on the next day, it was 321, therefore it is not acceptable that the patient was not diabetic. I do not think that, there was any delay in administration of treatment and doing pleural tap. The progress notes show that the patient taken to hospital at 10.20 a.m.in serious condition. He was examined by Dr. Dutta, who ordered certain blood investigations, chest x-ray and USG report. The Investigations were not conclusive of Empyema. Patient was put on antibiotics (Augmentin, Metrogyl). The patient was subsequently seen by Dr. Jhamb and then by Dr. Mangla. Dr. Mangla, is a qualified chest physician, examined the patient at about 4.00 p.m. and found that there was increased heart rate (Pulse 115/min) and fall in systolic blood pressure. There was rapid deterioration in the condition of the patient due to septicemia. Despite that, no investigational evidence of effusion or empyema was done by Dr. Mangla. Based on clinical suspicion preferred for pleural tap on right side, it reveals that 250 cc total of pus was aspirated. It was sent for culture and sensitivity tests, advised a CT scan of the chest to locate the precise site to insert drainage tube, if needed. The hospital progress sheet further revealed that, subsequently, patient became hypotensive (low BP) for which he was given ionotropic support but patient continued to be in septicemic shock. On 10.12.2001, in the morning, in the ICU, patient suffered a sudden cardio respiratory arrest, immediate resuscitative measures were taken and he was revived by DC conversion, intubation and by antiarrhythmic drugs. However, he continued to have recurrent Ventricular tachycardia/ventricular Fibrillation, further developed hypoxic brain damage and his BP fell rapidly low. Patient developed acute renal failure, serum Creatinine level rose to 6.0 mg/dl, Blood sugar was 321 mg%. The OP tried to resuscitate, but unfortunately the patient died at 10.00 p.m. on 10.12.2001.

The next point that the complainant alleged is that, the un-hygienic conditions in the hospital, precipitated the worsening condition of the patient. If the patient had been treated earlier, by draining the Empyema, there was more chance of his survival. The complainant has not put any cogent evidence in this regard. I have perused the certificate issued by Dr. Balbir Singh, in favour of the complainant, but nothing is forthcoming from it. The Certificate runs as follows: This is to certify that Mr. Anil Vohra was under my care for his cardiac problem, he had previously undergone angioplasty with stenting and was asymptomatic on follow-up, during his follow up visits, he underwent repeat angiogram which did not reveal any evidence of restenosis an exercise stress test was also performed and stable. I understand that he later developed empyema thoracis, this is a condition which results in pus collection in pleural space and needs urgent investigations and immediate treatment including prompt effective drainage. Delay in management of this condition can be fetal. The certificate did not mention anything about negligence in the treatment given by the OP.

In this context, I have referred a medical book, Harrison''s Internal Medicine and medical literature provided by both the parties. The sequence of events appears to be complications of septicemia, leading to acute renal failure, which was further precipitated by high diabetic status of patient. Therefore, I am of opinion that, OP was not negligent in the treatment, it was proper duty of care during the treatment of the patient and it was a reasonable practice. Bolam''s Case (1957)1 WLR 582). Hon''ble Supreme Court of India, Jacob Mathew vs. Punjab State (2005) 6 SSC 1= III (2005) CPJ 9 (SC), observed that, The subject of negligence in context of medical profession necessary calls for treatment with difference.?There is marked tendency to look for a human actor to blame for an untoward event, a tendency which is closely linked with desire to punish. Things have gone wrong and therefore somebody must be found to answer it. To draw distinction between blameworthy and the blameless, the notion of mens rea has to be elaborately understood. An empirical study would reveal that background of mishap is more complex than may general assumed. The inadequate of the system, the specific circumstances of the case, nature of human psychology itself and sheer chance may have combined to produce a result in which Doctors contribution is either relatively or completely blameless. Human body and its working is nothing less than a highly complex machine. Coupled with complexities of medical science, scope of misimpressions, misgivings, and misplaced allegations against doctor cannot be ruled out. One may have notions of best or ideal practice which is different from reality of how in real life doctor functions. The factors of pressing need and limited resources cannot be ruled out. Patient''s suffering was unfortunate but if people put the blame of anything on treating doctors with desire to punish for misgiving or misapprehension the balance will be upset. No doctor will take of the patient from the fear of untoward happening. To state that there was no medical negligence in the treatment of the Complainant/Patient, further I rely upon, judgment of the Hon''ble Supreme Court in Kusum Sharma and Ors. V. Batra Hospital and Medical Research Centre and Ors. [AIR 2010 Supreme Court 1050] and Smt. Vinitha Ashok V. Lakshmi Hospital and Ors. [1986-2002 Consumer 5521 (NS)]. Basically the principles enunciated in these judgments, inter alia , are: Negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence and merely because a doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chose by him was acceptable to the medical profession; and i. A doctor is not guilty of negligence if he has acted in accordance with a practice as proper by a responsible body of medical men in that particular art. Applying these principles in the instant case, the allegation of medical negligence on the part of Opposite Parties cannot be sustained, since it is amply clear from the medical records and the medical literature on the subject that the Complainant/Patient was treated by well-qualified professionals as per universally accepted medical standards for the treatment of such cases. > 10. In contrast, it is pertinent to note that, the OP accepted that empyema was a provisional diagnosis, which was entered in the admission sheet, it is not decisive, but due to clerical error and the same error crept into the death summary which also was not made contemporaneously, but was made subsequently. The medical record is a vital document; the act of hospital staff appears to be just a casual manner in the documentation. The hospital is liable for the wrong act of its employees. Accordingly, I consider that, even though the treating doctors treated the patient with reasonable care, there was no medical negligence, but the erroneous medical record like admission/discharge summary specifically proves administrative lapse. The hospital should be careful while issuing any document. The correctness should be checked either by Medical Superintendent or by Resident Medical Officer (RMO). Due to such negligence of the clerical staff, the complainant was compelled to file this complaint in 2002 and struggle for justice since then. Definitely, he and his family suffered mental agony and incurred expenses also. Therefore, the hospital is liable. Therefore, on the basis of forgoing discussion, the OP hospital shall pay total sum of Rs.5 lacs as compensation to the complainant, within 60 days, from the date of receipt of the order otherwise, it will carry interest @ 10% per annum, till its realization.