ANJANA VERMA vs ASHOK KUMAR THAKUR

COMPLAINANT-Mrs. Anjana Verma is the wife of Chandra Shekhar Verma who died in course of treatment in the clinic of O.P. No. 3 (Proforma O.P.). Opposite party No. 1 is Dr. Ashok Kumar Thakur, a Cardiologist and O.P. No. 2 is Heart Hospital of which O.P. No. 1 is Medical Director.

THE brief fact of the case is that on 11.9.1999 the complainant''s husband, after morning walk complained uneasiness and pain in chest. Complainant contacted O.P. No. 1 on phone who suggested some medicine and asked her to bring the husband to Heart Hospital by 8.30 a.m. She reached the Heart Hospital at about 9 a.m. O.P. No. 1 examined her husband. THE patient returned back, as he was feeling normal and also attended his office on that date. At about 3.45 p.m. on the same date complainant received a telephonic message from the office that her husband was feeling chest pain, thereafter, he was again taken to the Heart Hospital (O.P. No. 2) and examined by O.P. No. 1 and admitted him in the hospital for monitoring. He was shifted in the ICU. At about 7.20 p.m. the complainant was informed by hospital authority that her husband was suffering from heart attack and ECG etc. has again been done. THE patient was "thrombolysed" with STK with injection to the patient. It is the contention of the complainant that in such cases blood clotting from the arteries are to be removed which requires surgery and if the patient does not respond by the process of STK the course left is surgery. On 11.9.1999 a heart conference was going on in Patna. Several specialist including Dr. Gambhir was available in Patna. THE facility of angiography and other surgery was available at O.P. No. 3 hospital and in the P.M.C.H. but O.P. No. 1 did not immediately refer the patient to these places. After injection of STK, six hours period is said to be "golden period" for heart patient and if proper surgery is done during this period, there is chances of survival; but this golden period was not utilised by O.P. No. 1. THE patient was not properly monitored by O.P. No. 1 in his clinic. THE patient ought to have been advised to be removed to the hospital where surgical facility was available latest by 10.30 p.m. on the same day, but they waited till 5 a.m. in the next morning he was referred to Jeevak Heart Hospital for angioplasty but by that time the heart tissues of the patient were died. It is alleged by the complainant that the patient was removed to the clinic of O.P. No. 3. He was admitted there and the hospital authorities performed coronary angiography and subsequently PTCA (angioplasty). THEreafter, the patient was put on ventilator but the patient could not survive and died due to cardiac arrest at about 1 a.m. on 14.9.1999. It is the case of the complainant that it was the negligence on the part of O.P. No. 1 and O.P. No. 2, which led to the death of complainant''s husband. If the patient had been referred to O.P. No. 3 at the earliest when STK was administered to him on 11.9.1999, there was every chance of his survival. The complainant alleged negligence in his duty against O.P. No. 1 and deficiency in service against O.P. No. 2. As per relief claimed by the complainant her husband aged 51 years died in prime of his age, and in all she claimed compensation of Rs. 13,20,000/-.

The complainant produced the relevant papers of the hospital of O.P. Nos. 2 and 3 in support of above contentions. Affidavit has been filed on behalf of the complainant by one Vandana Kumar, w/o Pradip Kumar Sinha who stated that she was present throughout with the deceased in the clinic of O.P. No. 1. She is sister-in-law of deceased Chandra Shekhar Verma. Her affidavit is reproduction of the complainant''s case. She stated that O.P. No. 1 negligently treated the deceased and did not adopt the line of treatment which he should have adopted. He was retained in the hospital of O.P. No. 1 with ulterior motive and if referred to surgical unit of any other hospital at the earliest, the patient could have survived.

ANOTHER affidavit is of Shailendra Prakash Sinha who is brother-in-law of late Chandra Shekhar Verma. His contention is that when he visited the Jeevak Heart Hospital (Proforma O.P.) he learnt from the doctors that had the deceased been transferred to this hospital about 4-5 hours earlier, there was possibility of giving proper treatment to him. Admittedly both are relations of complainant. There is no affidavit or expert opinion on her behalf. O.P. Nos. 1 and 2 have jointly filed the show cause stating therein that no case of negligence or deficiency in service is made out against them. O.P. No. 1 is an experienced and renouned cardiologist in Patna. He was formerly Director of Indira Gandhi Institute of Cardiology. O.Ps. have adopted standard medical process and line of treatment required in the instant case. The complainant''s husband was successfully treated for heart ailment earlier by O.P. No. 1 from 25.4.1999 to 1.5.1999 and was discharged when recovered. This fact has been concealed by the complainant with ulterior motive. The deceased was habitual smoker and consumed alcohol. He was advised by O.P. No. 1 to go to Escorts Heart Hospital, New Delhi for coronary angiography and further advanced treatment by Dr. Seth considering his young age and heart blockage; but there is nothing on record to show that complainant''s husband ever went to Delhi and consulted Dr. Seth nor she produced any such paper from the Escort Hospital. On 11.9.1999 after initial treatment in the morning the patient was advised to go home and take rest. He was not advised to attend office. Contrary to this advise, the deceased went to the office where he developed chest pain. O.P. No. 1 asked him to come to the hospital immediately. He was brought in the hospital at about 5 p.m. and the diagnosis was of unstable angina. After ECG thrombolysis was started promptly which is a standard procedure in the type of such cases. The patient was also given other appropriate medicine as adopted in the standard medical institute. The allegation of the complainant that O.P. allowed the patient negligently to go into cardiogenic shock has been made with ulterior motive. The patient has responded to thrombolysis and the pain in the chest appreciably lessened. Therefore, referring the patient immediately to O.P. No. 3 was not practicable. It was O.P. No. 1 who has suggested the complainant''s family members that Dr. Gambhir, if available in Patna may be consulted. It is imagination of the complainant that if the patient was referred earlier to O.P. No. 3, he could have been saved. O.P. No. 1 has adopted the line of treatment and the management of the patient which is followed throughout the world as set up by the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, which is the benchmark all over the world for the patient with acute myocardial infarction. In the said guidelines it is mentioned that a patient can undergo angioplasty within twelve hours of the onset of symptoms, i.e., heart attack. From the bed head ticket of the deceased, the first attack occurred at about 7.30 p.m. and thrombolysis was initialized after consulting the O.P. immediately (Annexure-1). From the same Annexure it is clear that second attack occurred at about 1 a.m. O.P. No. 1 had consultation with Dr. Pradhan of O.P. No. 3 hospital for urgent angiography and angioplasty at about 5.30 a.m. on 12.9.1999. Thus, O.P. had followed the guidelines as required and referred the patient for urgent angiography and angioplasty before twelve hours period (Annexures-1 and 2). The Intensive Care Unit of O.P. No. 2 is most sophisticated and best equipped to deal with emergency. The patient was continuously monitored after his admission on 11.9.1999 till he was discharged in the morning of 12.9.1999. O.P. No. 1 has himself consulted Dr. Pradhan of O.P. No. 3 when he felt that angioplasty could be possible remedy which is clear from the discharge summary of the patient dated 12.9.1999. The patient''s attendant Dr. Verma was also informed regularly about these developments by O.P. No. 1 himself. Under such circumstances, when O.P. No. 1 was taking due care and precaution in the treatment of the deceased the allegation of negligence and deficiency in service is maliciously false with ulterior motive. These allegations have been made to malign the reputation of O.P. No. 1 who is practising in the field for about 40 years and he is a known cordiologist of the country .

IT is further case of the O.P. Nos. 1 and 2 that at the time of discharge of the patient on 12.9.1999 he was stable with recorded blood pressure of 90/70 and his heart rate was 100 per minute (Annexure-2). The standard procedure and guidelines as laid down in the field of cardiology in dealing with the such cases have been followed in the instant case. The O.P. No. 1 with a team of doctors engaged with O.P. No. 2 have done utmost care in handling the case. No paper or an expert opinion have been produced on behalf of the complainant to show that line of treatment followed by O.P. Nos. 1 and 2 was wrong and negligent which was the cause of the death of complainant''s husband. On behalf of the O.P. Nos. 1 and 2 besides Annexures-1 and 2, photostat copies of eminent books of medical science on American line of treatment, as referred to above, have been annexed in support of the contention. The O.P. No. 3 (Proforma O.P.) has also filed show cause in pursuance of the notice. Its case is that deceased Chandra Shekhar Verma (the patient) was referred to Jeevak Heart Hospital from Heart Hospital (O.P. No. 2) for emergency angiography and angioplasty. Dr. A.K. Thakur-O.P. No. 1 had telephoned Dr. Ajeet Pradhan, Chief Cardiac Surgeon of Jeevak Hospital at his residence at about 5.30 a.m. on 12.9.1999, that he was referring the patient whose condition was serious for urgent coronary angiogram and angioplasty. Dr. Thakur also enquired if Prof. (Dr.) Gambhir (Head of the Cardiology at G.B. Pant Hospital, Delhi) was still around. Dr. Pradhan replied that he had already left but some of the Cardiologist of Delhi are available there. The patient was brought to Jeevak Hospital at about 6 a.m. on 12.9.1999 on being referred by O.P. No. 2. The examination of the patient revealed that he had recent acute anterior wall myocardial infarction and was in left ventricular failure and cardiogenic shock.

IT is further case of O.P. No. 3 that patient was admitted for emergency coronary angiogram and for other treatment. After informing the patient''s attendant that the procedure in such case was a high risk one with a mortality of 40% but they were also informed that under such condition of the patient to adopt this procedure is necessary to save the life. They were also told about the cost of such treatment though there was no guarantee of the success of the procedure in view of the condition of the patient. After taking high risk consent from the patient''s wife, emergency coronary angiogram was done followed by primary PTCA. The PTCA was completed at about 10 a.m. Intra balloon pump was put and the patient was put on the ventilator. During course of treatment at 1 a.m. on 13.9.1999 the patient had a cardiac arrest. All resuscitative measures failed and the patient was declared dead at 2.15 a.m. The patient''s critical condition was noted at the time of his admission. The high risk involved was explained to the wife of the patient and other family members and with their consent all medical help were given to the patient as available and required in such circumstances but inspite of all efforts made sincerely the patient did not survive. However, in its show cause it is not mentioned that the patient was referred to Jeevak Heart Hospital at late stage or the line of treatment adopted at O.P. No. 2 was wrong or there was any negligence on the part of O.P. Nos. 1 and 2. The learned lawyer of O.P. No. 3 had frankly submitted that except the facts mentioned in the show cause, he has nothing to add in the argument. O.P. No. 3 is not in a position to say that the patient was not properly treated by O.P. No. 1 at O.P. No. 2. On the other hand, the learned lawyer submitted that while referring the patient to Jeevak Hospital-O.P. No. 1 had talked about the condition of the patient with O.P. No. 3 and mentioned the line of treatment adopted at O.P. No. 2.

FROM the perusal of the complaint petition and the show cause filed on behalf of the parties, it appears that the main allegation of the complainant against O.P. Nos. 1 and 2 is that on 11.9.1999 the patient was admitted in the Heart Hospital of O.P. No. 2 in the evening and O.P. No. 1 examined the patient and ECG was done at about 5.15 p.m. and 7.30 p.m. The complainant was informed that her husband has suffered heart attack and he was thrombolysed with STK which was injected to the patient as evident from the money receipt granted by O.P. No. 2, but inspite of the fact that the patient was thrombolysed with STK he was not immediately referred to Jeevak Heart Hospital situated nearby. O.Ps. negligently waited the patient to go in cardiogenic shock (para-7 of the complaint petition). Another contention of the complainant is that as per authoritative books of the medical science six hours period after injecting STK is termed as "golden period" and the patient suffering from heart attack due to blockage can be saved during this period if surgical method is adopted. According to the complainant O.P. No. 1 wasted the "golden period" of six hours and negligently waited for improvement in the patient though he knew that condition of the patient was deteriorating. At last, he referred the patient to O.P. No. 3 at about 5.30 p.m. on 12.9.1999 when it was too late. The angiography and angioplasty were done at O.P. No. 3 but since the golden period has lapsed the risk factor increased and ultimately the patient died. Except this allegation there is no other allegation of negligence or deficiency in service alleged against O.P. Nos. 1 and 2. From the show cause filed on behalf of O.P. Nos. 1 and 2 it is crystal clear that husband of the complainant was a heart patient from before. He was admitted in the hospital of O.P. No. 1 from 25.4.1999 to 1.5.1999 for heart problem. This fact has been suppressed by the complainant. The patient was brought to the Hospital of O.P. No. 1 in the morning of 11.9.1999. After examination by O.P. No. 1 he was advised to go back home and take rest, but the patient attended his office where he complained uneasiness at about 3.15 p.m. The complainant contacted O.P. No. 1 on phone who advised to rush to his hospital where he was brought and was treated in the manner as indicated above. This fact is admitted that O.P. No. 1 has contacted Dr. Pradhan of Jeevak Hospital and asked him that he was referring him for immediate heart surgery. O.P. No. 1 has also enquired whether Dr. Gambhir of Delhi Hospital, who has come to Patna, was available for medical help. The patient was brought to the clinic of Jeevak Hospital in the morning of 12.9.1999 but after angioplasty, he died the next day. These facts speak for themselves that there was good relationship in between the deceased-patient and O.P. No. 1. He was treating him since 25.4.1999 and the patient had faith in the efficiency of O.P. No. 1.

From the facts discussed above it is clear that the patient was administered all the necessary medicines required under such condition and when O.P. No. 1 was satisfied that now angiography and angioplasty are necessary then he himself talked to Dr. Pradhan and referred the patient to his hospital.

WE have heard the learned Counsels for the parties. Perused the material on record. The affidavits filed on behalf of the complainant are of no help to her case. From their content it is not proved that O.P. Nos. 1 and 2 were negligent in treating the patient or they did not adopt the line of treatment required to be adopted under facts and circumstances of the case. They have expressed their opinion that had the patient been referred to O.P. No. 3 earlier there was chance of his survival. Their opinion does not constitute expert evidence on the basis of which we can arrive to the conclusion that O.P. Nos. 1 and 2 were negligent in referring the patient for further treatment to O.P. No. 3. There is absence of expert opinion in support of their opinion. From the material on record the vital question arises for our consideration is : (i) Whether there was any deficiency in service or negligence on the part of the O.P. Nos. 1 and 2 within the meaning of Section 2(i)(g) of the Act while treating the complainant''s husband ? (ii) Whether the complainant is entitled to any relief ?

BOTH the points are discussed together for convenience. In this case it is not alleged that O.P. No. 1 is unqualified doctor and O.P. No. 2 is ill-equipped hospital. On the other hand the complainant and her husband had faith in O.P. No. 1, therefore, he was under his treatment since long for heart ailment. Lord Denning pointed out in the famous case of Hucks in v. Cole, (1968) 118 New Law Journal Page-469 as follows : "A charge of professional negligence against a medical man stood on a different footing to a charge of negligence against the driver of a motor car. It affected his professional status and reputation. The burden of proof was correspondingly greater. As the charge was so grave, so should the proof be clear. With the best skill in the world, things some times went amiss in medical treatment or surgical operations. A doctor was not to be held negligent simply because something went wrong. He was not liable for mischance or misadventure or for any error of judgment. He was not liable for taking one choice out of two or for favouring one school rather than another. He was only liable when he fell below the standard of a reasonable competent practitioner in his field so much so that his conduct might be deserving of censure or inexcusable". The complainant has not adduced expert opinion to prove that O.P. No. 1 adopted the line of treatment below the standard line of treatment.

IT has been held in several decisions of the National Commission and Hon''ble Supreme Court that a doctor is not liable for negligence because someone-else of better skill and knowledge would have prescribed a different treatment or operated in different way, nor is he guilty of negligence if he has acted in accordance with a practice accepted as proper by a reasonable body of medical men skilled in that particular art although a body of adverse opinion also existed among medical men. The Hon''ble Supreme Court in the case of Dr. Laxman Balkrishna Joshi v. Dr. Trimbak Bapu Godbole, AIR 1969 SC 128, has held the above view which is still considered to be a land-mark judgment for deciding a case of negligence. Tailor in his book Medical Jurisprudence has mentioned that in a case of medical negligence since the charge is so grave so should the proof be clear. Therefore, it was incumbent upon the complainant to prove that O.P. No. 1 was negligent in the line of treatment which he adopted and due to negligence the life of the deceased patient could not be saved. C.P.J. Volume-1, page-145 relied upon. A Judge can find a doctor guilty only when it is proved that he has fallen short of the standard of reasonable medical care. The contention of the complainant that it was expected from O.P. No. 1 to adopt better line of treatment and he should have referred the patient earlier after injecting STK is only a presumption of the complainant not corroborated by expert opinion. To demand more of from the doctor is too harsh a rule. In the law of negligence, the best whether the consequences were reasonably foreseeable is a criterion alike of culpability and of compensation. The Hon''ble Supreme Court in the case of A. Hari Bhuvu & Ors. v. State of Maharasthra, 1996 SCC 634 and another case of Indian Medical Association (supra), has held that the skill of medical practitioners differ from doctor to doctor. The very nature of the profession is such that there may be more than one cause of treatment which may be advisable for treating a patient. Courts would be indeed slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. Medical opinion may differ with regard to the course of action to be taken by a doctor treating the patient but as long as doctor acts in a manner which is acceptable to the medical profession and the Court finds that he has attended on the patient with due care, skill and diligence and if the patient still does not survive, it would be difficult to hold the doctor to be guilty of negligence.

IN the instant case the complainant has not adduced any expert medical evidence to prove her contention that line of treatment adopted by O.P. No. 1 was not correct or it was not adopted with due care, skill and diligence. On the other hand the bare facts of the case prove beyond doubt that O.P. No. 1 who is a qualified doctor, has adopted the line of treatment which is best available in the present medical science for treating a heart patient and there is nothing on record to show that he did not promptly attend the patient and adopted the line of treatment required under such circumstances. The complainant has made only allegation that O.P. No. 1 should have referred the patient some hours earlier to Jeevak Hospital is no ground to hold that it was an act of negligence on the part of the O.P. No. 1 who in his opinion, when thought necessary to refer the patient to Jeevak Hospital, he himself contacted Dr. Pradhan of Jeevak Hospital in the early hours of morning (at 5.30 a.m.) and after consultation with Dr. Pradhan, he referred the patient. This alone shows that O.P. No. 1 was sincere and was attending the patient even at 5.30 a.m. when normally doctor attends his clinic at about 8 a.m. It is unfortunate that inspite of treatment the complainant''s husband died due to cardiac failure but there is nothing on record to show that O.P. No. 1 treated him in his hospital negligently or there was any deficiency in the service of O.P. No. 2 in monitoring the patient. The line of treatment was with the standard rule of medical practitioner to be adopted under given facts and circumstances. It is known fact that a doctor is not an insurer, he does not warrant that his treatment will succeed or that he will perform cure. It is commonly known that even after giving best available treatment by an expert doctor some untowards happen. For this result, a doctor can not be held responsible nor he is liable for any compensation.

After considering the facts, circumstances and the material on record, we are of the view that no case of negligence or deficiency in service is proved against O.P. Nos. 1 and 2. Therefore, they are not liable for any compensation as claimed by the complainant.

IN the result, after considering the whole aspect of the matter on merit, we do not find merit in the complaint case. It is, accordingly, dismissed. There shall be no order as to cost. Complaint dismissed.