A.Sambi Reddy vs K.K.R.ENT HOSPITAL AND RESEARCH INSTITUTE

THE complainant''s son Master Harish Reddy had an occasional slight discharge of a watery liquid from his left ear when he was about 9 years old. THE Doctor said that there was a small hole in the ear and the slight discharge of watery liquid was only due to that. To consult the Specialists the complainant brought his son to the 2nd opposite party ENT Doctor who is the owner of the 1st opposite party Hospital. THE 2nd opposite party Doctor said that the small hole in the ear drum should be plugged. He further advised that the complainant''s son has to go in for an operation. Since the complainant had the only son he was hesitant for the operation. However, after some time he took his son to the 2nd opposite party. THE complainant was told that if the operation is not performed it was likely that his son would lose his hearing ability. THE complainant''s son was admitted in the 1st opposite party Hospital on 16.7.1991. He was taken to the operation theatre at 9.15 a.m. on 17.7.1991. According to the complainant he was informed by the 2nd opposite party that the operation was a minor one and will be completed within one and a half hours. But even after one and a half hours the complainant and his relations who were waiting outside the operation theatre were not informed anything about the operation. THEy grew panic at 11 a.m. This position continued up to 3 p.m. when the 2nd opposite party informed the complainant that his son after administration of anaesthesia and even before the commencement of the surgery had entered coma stage which continued and the patient should be shifted to Vijaya Health Centre. THEreafter an Ambulance from the Vijaya Health Centre was sought for and the patient was shifted to Vijaya Hospital at 3.50. p.m. THEre Dr. T.J. Cherian told the complainant that damage to brain has occurred and unless it is set right the boy will not recover. Till 20.7.1991 the boy was given treatment. THEn Dr. Cherian after coming to know that the complainant was an employee of the Railways and considering the difficulty for the complainant in paying the medical charges in the Vijaya Hospital, suggested for the boy to be transferred to Railway Hospital, Perambur. It was done. In spite of best efforts in Perambur Hospital the boy expired on 23.7.1991 at 1.15 p.m. It transpired later from the report of the 2nd opposite party, that xylocaine and adrenaline injections had been administered to the patient after local anaesthesia was given, and the patient after developing certain symptoms suddenly stopped breathing and pupils started dilating and nearly after five and a half hours the 2nd opposite party Doctor had chosen to inform the complainant about the position and suggested transfer of the boy to Vijaya Hospital. If he had informed earlier the complainant would have taken a decision to transfer the boy much earlier. Thus the opposite parties have been negligent and careless in their service rendered. THE 2nd opposite party had not given test dose before administering anaesthesia. THE 2nd opposite party Doctor had delayed much in referring the patient to the Vijaya Hospital. THE patient as a boy of 13 years was quite healthy but for the minor problem in the left ear, and only because of the negligence and carelessness on the part of the 2nd opposite party the boy died. THE patient boy was his only son and there is no chance of having another son since he had undergone sterilisation operation. For Hospital expenses alone he has spenta sum of Rs. 50,000/-. On these allegations the complainant has made a claim for Rs. 9,00,000/- as compensation with interest thereon @ 18% p.a.

IN the written version the opposite parties contended that the High Court has issued an order of stay of the proceedings and therefore the matter cannot be heard. They denied that the 2nd opposite party told the complainant that the surgery was a minor one, and contended that on the other hand he was informed that the operation would take about 3 to 4 hours and he was also informed about the serious consequences that may ensue. They further contended that the complainant was informed that if the operation is not performed the patient may lose hearing ability and it may also lead to other complications which may prove fatal. The 2nd opposite party is a leading ENT Specialist practised in INdia and also abroad and only after hearing his reputation the complainant had brought his son from Andhra Pradesh to Madras. The patient was found to have unsafe and dangerous type of ear infection in the left ear. The complainant was informed about the possible complications that may arise due to operation. He was also informed that there was no guarantee of improvement of hearing. After taking all precautions the patient was taken to the Operation Theatre. Skin incision was taken and an appropriate piece of the fascia was removed and was kept aside for use later in the surgery. The patient who was quiet so far suddenly complained of headache and vomiting sensation. He then stopped breathing followed by broclycardia and then a few minutes complete cardiac arrest. The operation was stopped immediately and endotracheal tube was passed and it was connected to the boyles apparatus, and oxygen was administered. The patient was resuscitated by administering various drugs through the I.V. lineand external cardiac massage IN about 5 or 6 minutes the heart started breathing and the patient started breathing of his own. Thereafter the pulse rate became regular, and stabilized at about 70, blood pressure was recorded at 110/80. Through out the necessary drugs namely (1) Sodabicard (2) INtra cardiac adrenaline and steroids and antibiotics were given. At that time the 2nd opposite party came out and informed the complainant about the situation, told him that the patient would regain conscience soon. But since conscience was not regained within the expected time, attempts were made to contact the Neuro Physician. Dr. G. Kumaresan, Professor of Neurology of Government Hospital and Dr. Deepak Arjundas another Neurologist was also contacted. Dr. Kumaresan came and saw the patient at 2 p.m. and advised I.V. Mannitol 300 MIX 8 Hrly INj. Decadron 1 CC.IV Tid, INj. Ranitidine and Amp. Im. Bd. INj. Epsolin 150 mg, solowly IV 8th Hrly. But Dr. Deepak Arjundas also came later at 2.30 p.m. and he endorsed the treatment advised by Dr. Kumaresan, and he advised for shifting the patient to Vijaya Health Centre and after contacting the Vijaya Health Centre the patient was transferred there. It is further contended that the Cardiac Arrest is a condition in which the heart suddenly stops to beat and perform its function. This can occur during general anaesthesia, local anaesthesia even in minor procedure like catheterization of urine or giving an injection etc., it is not possible to predict before hand which patient is going to develop cardiac arrest and when. Immediately after the heart beat stopped, resuscitation was done and Neuro Specialists were also contacted. Resuscitation was successfully done within half an hour. Every half an hour the complainant was being informed about the position. The Hospital was fully equipped and there was nothing wanting for the operation. For the operation in question ordinarily only local anaesthesia is given and not general anaesthesia, and the 2nd opposite party Doctor was fully qualified for giving such anaesthesia. Test dose of anaesthetic was given and it was found that the patient was not allergic to Xylocaine. IN these circumstances, there was no negligence or deficiency in service on the part of the opposite parties and hence the complaint is liable to be dismissed. The first question that arises is whether it is true that there was negligence or deficiency in service on the part of the 2nd opposite party Doctor as alleged in the complaint. Even here it may be stated that in the written version it is mentioned that there is a stay order passed by the High Court restraining hearing this matter, but during the course of the enquiry the learned Counsel for the opposite party declared that this point is not pressed.

Now it is not disputed that but for the hole in the ear drum in the left ear because of which there was slight discharge of watery liquid, the boy who was 13 years old was quite alright. It is even according to the complainant that after consulting Doctors in Nellore and Vijayavvada he came to Madras to consult the 2nd opposite party Doctor who was an ENT Specialist. It is not disputed that the 2nd opposite party Doctor is a highly qualified person and he has been a successful, Doctor. However, the case of the complainant is that in the particular matter i.e., the performance of the Doctor in the Operation Theatre in this case, he was negligent and this was the cause of the death of the boy. It is pleaded that the 2nd opposite party Doctor is an ENT Specialist but he is not a qualified person to give anaesthesia. It is common case that local anaesthesia was given and not general anaesthesia. The contention of the 2nd opposite party is that he was fully qualified to give local anaesthesia. The complainant does not tell us on what basis he says that the Doctor was not competent to give local anaesthesia. In this respect, it was argued on behalf of the opposite parties that only local anaesthesia is given during nose operation and dental surgery and the Doctor, does the operation himself gives the local anaesthesia. This contention of the opposite parties is not rebutted as incorrect. It is not categorically stated by the complainant that in this particular case only general anaesthesia should have been given and not local anaesthesia. Therefore we find no negligence in giving local anaesthesia and the 2nd opposite party himself giving anaesthesia. It is then pleaded that test dose has not been given before anaesthesia was administered. This also is stated without any basis. The 2nd opposite party asserts that it was only after test dose of anaesthetic was given, the local anaesthesia was administered. It is however argued that in Ex. A3 history sheet given by Vijaya Health Centre nothing about test dose having been given by the 2nd opposite party Doctor is mentioned. But for that reason alone, it cannot be said that in fact no test dose was given. It is not incumbent that such particulars must be mentioned in the history sheet given by a referring Hospital, or in the referring letter. Therefore the case of the complainant that no test dose was given cannot be accepted as true. It is the further case of the complainant that he has not been given information about the true critical position that developed during the operation. But as to this also the opposite parties would submit that this plea is false and the complainant was kept informed of the developments. The true question is whether the opposite parties were negligent and careless in the treatment given by them to the patient and the question whether the complainant was being informed of the development inside the operation theatre is not very material to hold that the opposite parties were negligent. It is then argued that the opposite parties have considerably and carelessly delayed in seeking the aid of Neurologists. This is also denied by the opposite parties. It is the definite case in the written version that soon after the heart beat stopped the Doctor resorted to resuscitation efforts and immediately steps were taken to con tact the Neurologists through phone and as soon as the Neurologists were contacted they came to the Hospital. A Doctor would try to treat and save the patient to the best of his ability, and only when he feels that the matter is beyond his competence, he would try to seek the help of more competent persons. It is not as if the Doctor must have such more competent persons ready and available always from the beginning of the treatment or operation. Similarly when the necessity arises Ambulance will be immediately requisitioned and therefore the opposite parties cannot be found fault by saying that for getting the ambulance delay should have occurred. It is also said that necessary equipments to meet the emergencies like that occurred in the present case were not available in the first opposite party hospital. This plea also i s refuted by the opposite parties by saying that all the necessary amenities were provided in the Hospital and the 2nd opposite party Doctor was doing numerous operations for about 25 years now.

THE opposite parties submit that cardiac arrest is a condition in which the heart suddenly stops to beat and perform its function and this can occur during general anaesthesia, local anaesthesia and even in procedure like catheterization of urine or giving an injection etc., and it is not possible to predict before hand which patient is going to develop cardiac arrest and when. This has not been categorically repudiated as incorrect by the complainant''s side. In this case, no one has been examined as an expert witness. This being the case the said submission made by the opposite parties cannot be rejected as unbelievable or incredible. Taking all these circumstances into consideration, we are unable to hold that the opposite parties have been guilty of negligence or deficient in their service. It therefore follows that the complaint has to be dismissed.

WE order accordingly. However, there will be no order as to costs. Complaint dismissed.