ANOOP KUMAR vs CHAITANYA HOSPITAL

-BRIEFLY stated the facts are that complainant who belonged to a respectable family was blessed with a female child which was later on named as Arshia. After delivery, the child had developed jaundice and was treated in Mamta Hospital, Sector 18-C, Chandigarh where she was fully cured. The said hospital recommended that the child should be got checked for heart problem. Accordingly she was got checked from Pediatrician Cardiologist of Indraprastha Apollo Hospital, New Delhi. After examination by the said hospital, the child was found to be suffering from following ailments: Systolic Capital function-LV Ejection Fraction-60%. Conclusion: (1) Complete AV Canal Defect Type-A Rastelli. (2) Mild right AV valve with regurgitation. (3) No Lvoto. (4) Pulmonary Hypertension. (Report is at Annexure C-1)

DUE to aforesaid ailments, the physical growth of the child was slow but her condition was regularly monitored by Dr. Vikas Kohli, Pediatrician Cardiologist of Apollo Hospital, New Delhi and the child was growing smoothly and was very active and playful. It was next averred that abruptly on 21. 9. 2006, the child developed cold and was examined by a local doctor who prescribed certain medicines but her condition became serious and the doctor recommended her to be taken to hospital and as such she was taken to Government Medical College and Hospital, Chandigarh where she was admitted for pneumonia and treatment was started after due investigation. The child showed immediate reaction to the treatment and started showing signs of improvement, but for pneumonia no other problem was found in the child. The condition of the child improved day-by-day and fever subsided because the infection of pneumonia was reduced. After watching for about six days and finding no new complaint, the child was shifted to private ward of the hospital and was kept in special ward only to watch stability of the child. However, on 29. 9. 2006 the child was x-rayed and was taken to emergency ward for re-checkup. During this process, it was found that pneumonia had reoccurred slightly and the child had picked up fever but her condition was controlled till 2. 10. 2006 by 6. 00 p. m. Thereafter, her condition became somewhat alarming and the child was shifted to emergency ward at about 8. 30 p. m. OP No. 4 Dr. Pankaj instead of examining the child for the problem, immediately asked for taking liquid from the backbone of the child (CSF) in order to see whether the fever had travelled to the brain of the child which was objected by the complainant as the child was admitted for pneumonia and there were no other symptoms but OP No. 4 did not take it lightly and got signed from the mother of child refusal for CSF. OP No. 4 did not attend the child, although she was crying and he pretended to be busy in other patients and his attitude showed that he was not interested to attend the child and as such they had no other alternative but to request OP No. 4 to relieve the child, so that she could be taken to some other hospital. Accordingly OP No. 4 gave discharge certificate Annexure C-3 and took about 45 minutes to do so and also wrote on it that the patient had been taken against medical advice. Certainly there was dereliction of duty and negligence on the part of OP No. 4 which resulted in deteriorating condition of the child and failed to exercise a standard care to the patient and ultimately she was taken to Chaitanya hospital where Annexures C-1 and C-2 were also shown. At that time she was suffering from slight pneumonia but was active and playful mood and the child was shifted at about 1. 00 a. m. on 2nd/3rd October, 2006 from the Medical College and Hospital, Chandigarh to the hospital of OP No. 1 and OP No. 3 was specifically told that the child should be attended and treated by OP No. 2 and he should not attempt or treat the child for any ailment and further he was informed that under no circumstances the child should be allowed to cry or to be in distress for more than 2-3 minutes because of her ailment. However, OP No. 3 did not call OP No. 2 and instead himself started examining the child and thereafter he removed the prick fixed by the Medical College and Hospital in the evening and wanted to fix the needle at some other place of the body of the child and this act of OP No. 3 was totally unwanted and the explanation given to the complainant was that the prick was not properly fixed. The child was constantly crying and he could not fix the needle at any other place for an hour and the child continued crying. The complainant asked OP No. 3 not to make the child cry but he did not listen and asked the complainant to take away the child or let him treat the child in the way he wanted. Thereafter cries of the child stopped and the complainant visited that room where OP No. 3 stated that the child was sinking and likely to suffer heart attack and then OP No. 3 took the child to intensive care unit and nobody was allowed to see the child till 2. 00 a. m and then a declaration was made that the child had died on account of heart attack. OP No. 3 concealed the fact of heart attack and he made the child to cry in room No. 105 and that too in the absence of OP No. 2, the senior child specialist.

It was further averred that OP No. 3 failed to grasp alarming critical situation of the child when limbs of the child were immobilised and the child was finding difficult to breath and intermittently opening her mouth for grasping for breath in the room. He was well aware that the child was suffering from pneumonia, pulse and blood pressure were fluctuating while in the room and no instrument was available there and OP No. 3 in spite of protest persistently made the child to cry for an hour when the child was having difficulty in respiration and thus failed to take reasonable care in the circumstances above and ultimately the child died.

ALLEGING deficiency in service on behalf of OP Nos. 3 and 4, the complaint was filed on 16. 11. 2006 and claimed compensation of Rs. 21,50,000 as detailed in para-31 of the complaint. Op No. 1 was made liable vicariously for negligence and unfair medical practice adopted by Op Nos. 2 and 3 and further they were employees of Op No. 1. Complainant on 12. 1. 2007 made statement that he did not want to proceed against Op No. 4 as he had settled the matter with him. As per application and statement at the bar, proceedings against Op No. 4 Dr. Pankaj were dropped. However, Ops Nos. 1 to 3, 5 and 6 contested the complaint.

OP Nos. 1 to 3 in their written reply denied the allegations of the complainant. They stated that relatives of the baby were dissatisfied even with the services at Bedi Nursing Home where the child was delivered and instead of admitting the child for treatment of jaundice as advised by the child specialist there (Mamta Nursing Home) complainant went to some other hospital for admission where the child was detected to have heart problem. They denied that the child was growing normally and smoothly as she was being given medicines digoxin and diuretics which were meant for the treatment of heart failure by Pediatric Cardiologist and as such growth of the child with the intake of aforesaid medicines was a big question mark. They next stated that the discharge summary prepared by the Government Medical College and Hospital, Sector 32, Chandigarh showed that the child''s condition which was serious initially had improved and thereafter it had deteriorated after 10 days stay of the child in the hospital. The child was sick on admission to Government Medical College and Hospital, Sector-32, Chandigarh and her condition further worsened the next day when she developed shock on 23. 9. 2006 which meant that her cardiac function had deteriorated and her heart was not able to pump blood sufficiently and her blood pressure had fallen. The child was serious and for this reason, she was kept in emergency ward for 6 days and the child was admitted for 10 days and was given IV fluids and injection of antibiotics and multiple needle pricks must have been given to the child for drawing blood samples for various investigations as well as for injection and administration of IV fluids and thus the child had many needle punctures done at Government Medical College and Hospital, Sector 32, Chandigarh to find and canulate the same but after some time of usage, the said vein was temporarily damaged and could not be used for administration of IV fluids and injections, hence, a new vein must be canulated. They next stated that on 29. 9. 2006 the X-ray of baby showed reoccurrence of pneumonia and fever started again which showed that the child had caught some new bacteria in the hospital. The condition of child must have worsened significantly on 2. 10. 2006 when the child was shifted back to emergency and she was advised CSF analysis and this was done, so, that doctor could observe whether infection had spread to brain suspecting meningitis, pre-encephalitis which was very serious disease but the relative of child did not allow to conduct CSF. The child was under aggressive treatment for heart failure and pneumonia with suspected infection pathology of brain for which CSF examination was necessary but could not be done as it was refused by the relatives of child and got her discharged from the Government hospital. They denied that at the time of admission the child was playful, conscious and was suffering from pneumonia only. The medical record of Pediatric Cardiologist Dr. Vikas Kohli was not disclosed to the attending Pediatrician and was admitted on the basis of LAMA history of Government Hospital. They further stated that the child was promptly treated and took about two to three minutes for OP No. 3 to insert and fix a new canula which was essential to start medication immediately and every treatment was given. The child was put on ventilator which is a machine through which oxygen reached the blood and all parts of the body. The child already had congestive heart failure in Government College and Hospital. In the ICU the child was constantly monitored and the heart rate and ECG monitoring was constantly displayed on the monitor which could not be generated artificially. Thus, to say that the child had died before being shifted to ICU is totally false and malicious. They further stated that death of the child was because of severe pneumonia, probably septicemia and heart failure. They also stated that OP No. 2 had seen the child at 2. 30 a. m. and again examined the child in the morning. Thus, they prayed that the complaint should be dismissed. Respondent No. 6 (New India Assurance Co. Ltd.) also filed written reply. It stated that there was no deficiency or negligence on behalf of OP No. 2 who had not treated the patient. The child was treated by OP No. 3 who was on duty and no assurance was ever given by OP No. 2 to be personally involved in all aspects of treatment of the child and as such stated that there was no deficiency on the part of OP No. 2, hence complaint should be dismissed. Complainant filed rejoinder to the written reply of OP Nos. 1 to 3.

PARTIES adduced their evidence by way of affidavits and documents.

WE have heard Counsel for complainant Sh. H. S. Awasthi, Counsel for OP Nos. 1 to 3 Sh. Pardeep Bedi, Sh. R. K. Bashamboo, Advocate for opposite party No. 5, Ms. Sunita Aggarwal, Advocate for opposite party No. 6 and carefully gone through the file. It is mentioned by complainant in para-2 of the complaint that the child was got checked by Pediatric Cardiologist of Indraprastha Apollo Hospital, New Delhi and after examination, the child was found to be suffering from following ailments: systolic Capital function-LV Ejection Fraction-60%. Conclusion: (1) Complete AV Canal Defect Type-A Rastelli. (2) Mild right AV valve with regurgitation. (3) No Lvoto. (4) Pulmonary Hypertension.

It is mentioned in the complaint itself that due to misbehaviour of OP No. 4 the child was shifted to Chaitanya Hospital-OP No. 1 on the night intervening 2/3. 10. 2006. Annexure C-3 discharge summary shows that the patient was taken against medical advice. It is further mentioned in it that OP No. 4 wanted to conduct CSF but that was refused by the attendants, therefore, attendants of the child interfered with the treatment which was to be given by OP No. 4 and as such free hand was not allowed to him to treat the child. In para-7 of the complaint, it is mentioned that on 29. 9. 2006 the x-ray of baby showed reoccurrence of pneumonia and fever started again. This showed that the child had got some new bacteria, may be in the hospital. So, condition had worsened on 2. 10. 2006 after 6. 00 p. m. and as such the child was taken from special ward to emergency ward at about 8. 30 p. m. OP No. 4 had advised for taking liquid from backbone of child (CSF) for the purpose of seeing whether the infection had travelled to brain of the child suspecting meningitis-pre-encephalitis which was serious disease but he was not allowed to do so.

THE main allegation of complainant is that OP No. 3 did not call OP No. 2 but instead himself started examining the child and thereafter he removed the prick fixed by Government Hospital by stating that it was not fixed properly and started searching blood vein for the prick and was unsuccessful. The child continued crying and it took about one hour to refix the needle in the canula. It is difficult to believe that OP No. 3 could not find vein for about one hour and child continued crying. OP Nos. 1 to 3 have categorically denied this fact and stated that it took about 3 to 5 minutes to find the vein and to fix needle in the canula. At the request of complainant, treatment papers of the child were sent for expert opinion to Dr. K. K. Talwar, Director, Professor and Head, Department of Cardiology and he got opinion of Dr. Rohit Manoj Kumar, pediatric cardiologist in the Department of Cardiology dated 20. 2. 2007, which is as under: "suspected trisomy 21 with endocardial cushion defect. The child''s weight at five months is only 3. 5 kgs. Indicates that the child is not thriving well. In such children pneumonia is common complaint. Child was admitted in GMCH-32, Chandigarh with severe pneumonia as required IV antibiotics and vasopressor. Child developed reoccurrence/worsening of infection and for this CSF was planned but family refused. Child was shifted to private hospital and there chest infection worsened and child died. There was no heart attack, such children die of respiratory infection and CCF. There are two major problems of this disease. CCF and pneumonia causing significant morbidity and mortality in these children. For preventing this complication early surgery is advised between 3-6 months of age for such children. Hope this information will help you. "

ACCORDING to the said doctor, the child was admitted in GMCH-32 with severe pneumonia and required IV antibiotics and vasopressor. The child developed reoccurrence/worsening of infection and for this CSF was planned but the family refused. The child was shifted to private hospital and chest infection worsened and child died. There was no heart attack. Such children die of respiratory infection and CCF. There were two major problems of this disease CCF and pneumonia causing significant morbidity and mortality in the children. He has further suggested that for preventing such complications, earlier surgery was advised between 3-6 months of age for such children. Therefore, the child had died not due to heart attack but had died due to respiratory infection and CCF and further CCF and pneumonia were responsible for death of the child. Hence, it cannot be said that the child was made to cry for one hour which led to heart failure but on the other hand, she had died due to respiratory infection and CCF. The complainant has not produced any expert evidence that there was any negligence or lack of due care and caution on the part of OP No. 3 at any stage. Counsel for complainant contended that they had deposited hospital charges in Chaitanya Hospital for treatment by OP No. 2 but OP No. 2 had not seen the child. It is true that in the receipt consulting doctor has been mentioned to be OP No. 2 but OP No. 3 is also a well qualified doctor who was there to treat the child and OP No. 2 has also stated in the reply that he had visited the hospital at about 2. 30 a. m. to see another emergency, then he had seen the complainant''s child and advised to observe SPO2 of the child and in case condition deteriorated, to shift her to ICU. He further stated that after about one and a half hour the child''s condition had deteriorated because the mother had given breast feeding despite advice to keep the child away from breast feeding. Of course in the detail summary respondents 1 to 3 had stated that the death of child was due to severe pneumonia, probable septicemia and heart attack but the expert doctor stated that it was due to pneumonia and CCF. It is true that complainant''s child had died and the complaint is based merely on sentiments but we are unable to find that there was any gross negligence on the part of OP Nos. 1 to 3 to treat the child. Emotional upheaval of distraught parents is understandable but doctor cannot be made a scapegoat of such acts of nature. It has not been proved on file that medical complications were the direct result of negligence of OP No. 3. Hence, the complaint is dismissed.

COPIES of this order be communicated to the parties, free of charge. Complaint dismissed.