A.S.MOHANAN vs Joseph George

THIS is a complaint filed under Section 12 of the Consumer Protection Act, attributing medical negligence on the part of the Opposite Parties and claiming a total compensation of Rs. 10,75,186.50.

THE material allegations in the complaint are as follows : THE deceased T.K. Suni, wife of the complainant was working as Junior Hindi Teacher in G.U.P.B.S., Kumbanad and the complainant was working as Postal Assistant in P&T Department. While so, the deceased got promotion to the cadre of H.S.A. in Government High School, Kokkathode and she was relieved on 29.11. 1995 from the G.U.P.B.S. Kumbanad. After availing joining time on 4.12.95 by 6 a.m. the deceased proceeded to join in the new post at Kokkathode accompanied by the complainant. While waiting for the bus the deceased felt a slight giddiness and so, the journey was postponed and they returned home. By 5 p.m. on 4.12.1995 the complainant took the deceased to Dr. Nanoo for consultation whose residence was about 3 kilometres from the complainant''s residence by the complainant''s motor cycle. On examination it was found that the deceased had a slight low blood pressure and at the advice of the doctor, she was taken to Poyanil Hospital, Kozhencherry by car accompanied by Dr. Nanoo. She was admitted to the casualty ward of the hospital by 5.45 p.m. She was given drips and was told that she would get relief after the drips. By 6.30 p.m. the deceased was taken to the I.C.U. and when asked why she was being taken, the doctor told the complainant that it was for a detailed checkup and there was nothing to worry. THE complainant was permitted to visit the deceased and a room just near the I.C.U. was also allotted to him by the hospital authorities. By about 8 p.m. it was observed that Dr. Prameela Philip, whom the complainant also knew, came to examine the deceased and on enquiry it was told that there was nothing wrong with the patient. By 9 p.m. Sri. Raju Thomas, a friend of the complainant came to the hospital to enquire about the condition of the patient. He had come to the hospital on getting news from Dr. Nanoo and as advised by him the complainant repeatedly requested the doctors especially to Dr. Raji K. Jacob to inform him the actual condition of the patient. On repeated requests. Dr. Reji told the complainant that the E.C.G. of the patient was taken and there was symptoms of heart attack. Such a news was shocking to the complainant and the complainant enquired about the possibility of moving the patient to a nearby hospital where there was a cardiologist and other modern facilities. But he was told by the doctor that though they did not have a cardiologist, they too had the facilities and the medicines that were given were enough to save the patient. THE complainant and his friend made enquiries with the Pushpagiri Hospital, Thiruvalla and he was informed that if the patient was moved alongwith Oxygen and drips accompanied by some medical personnel, they could do something to save the patient. When this fact was told, the second Opposite Party and staff of Poyanil Hospital, Kozhencherry, discouraged the complainant and assured the complainant that everything would be done to save the patient. By 10 p.m. Dr. Reji again came out and told the complainant that diagnosis had been confirmed after consultation with some other senior doctor of some other hospital and an injection worth Rs. 3,800/- had to be given to the patient. By 10.15 p.m. the complainant insisted to see the patient and after several requests the complainant was allowed to see her. At that time the patient was seen like sleeping and he was told that it was due to the effect of the injunction given to her. By 10.30 p.m. some one from I.C.U. came out and told that Suni''s condition was very serious and if anybody wanted to see, could see her. THE complainant with his child rushed to the I.C.U. and it was seen that Suni was being given Oxygen. Though the child was shown to her, there were no reactions on her face. THE complainant was shocked to see his wife in such a condition and when asked about the condition, Dr. Reji told the complainant that he was sorry and left the room. THE complainant alleged that it was on account of deficiency in service, improper care and attention by the Opposite Parties, the patient died. A version was filed by the Opposite Parties denying the allegations that there was any negligence on the part of the Opposite Parties. It was admitted that on 14.12.1995 about 5.00 p.m. Dr. Nanoo brought the deceased to their hospital and she died at 11.15 p.m. that night on account of ventricular fibrillation, due to massive myocardinal infarction. It was further averred on further examination, the patient was ill-looking, pale, sweating profusely, pulse not palpable. Blood Pressure not recordable, chest clear, heart sounds muffled. The averments that the patient had slight low blood pressure, are contrary to facts. The Blood Pressure of the patient was not recordable at 5.50 p.m. the patient was brought to the hospital. The patient was given I.V. fluids, injection Efcorlin and injection Decona by the casualty Medical Officers namely Dr. Valsamma Paul and Dr. Varghese Pothen and the patient was immediately taken to intensive care unit of the hospital and the second Opposite Party, the consultant physician was immediately informed. It was also averred that the Poyanil Hospital is modern, 100 bedded hospital, established in 1988. It has all modem facilities including a five bedded intensive care unit with cardiac monitors, defibrillators. Ventilator etc. and all cardiac drugs. The hospital has also 16 doctors including 2 consultants in General Medicine, 3 Gynaecologists, a Paediatrician, a Surgeon an Orthopaedic Surgeon and other specialists. The second Opposite Party is a consultant in General Medicine and holds the degrees of B.Sc., M.B.B.S., and M.D. (General Medicine) and he is an experienced Physician and is fully competent to handle emergency cardiac cases. In fact, on an average more than thousand patients are treated each year in the Intensive Care Unit of the hospital. The averments that some one assured that the patient would be relieved, after the drips, is wholly baseless and without substance. The patient was in a critical condition and no one had given or would give any such assurance, especially, when the patient was rushed from the casualty to the Intensive Care Unit. The second Opposite Party saw the patient at 6 p.m. and there was improvement in the Blood Pressure on examination systolic was 90 mm. This was due to the emergency drugs administered by the casualty medical officers. The second Opposite Party advised for an E.C.G. and carry out routine investigations and to continue I.V. fluids. The complainant saw the patient and he was not given any assurance regarding her condition and she was taken to the I.C.U. since the condition of the patient was serious. In the I.C.U. the patient had been given emergency drugs to revive her ailing heart and to bring up her Blood Pressure. The complainant and Dr. Nanoo were informed about the serious nature of the condition of the patient. Meanwhile a second opinion was also obtained from Dr. S. Joseph, a Senior Consultant in General Medicine attached to the Muthoot Medical Centre, who was shown the E.C.G. of patient and he was given her case history and clinical picture. He concurred with the opinion of the second Opposite Party and suggested continuation of the same line of management. The second Opposite Party remained in the I.C.U. with the patient throughout observing and monitoring her condition. Dr. Prameela Philip, the consultant Gynaecologist was called, to examine the patient, to rule out any serious Gynaecological condition. The Gynaecologist examined the patient at 7.45 p.m. and ruled out any Gynaecological condition, to cause such a severe degree of shock. The complainant and others were told that what she required was immediate resuscitative measures, without wasting time. This treatment was given to her and a team of doctors and staff were constantly engaged in reviving her from fatal disease. The complainant and his people were informed that they could shift the patient to any other hospital, but the condition of the patient was so precarious that there was a high degree of risk involved in shifting. In fact, even if transportation of such a patient was attempted, it would have to be in an ambulance fitted with defibrillators and cardiac monitors and with competent medical personnel. Such ambulances were not available in Thiruvalla, Kozhencherry or nearby areas in 1995. Everything possible was done and even the administration of costly drugs was done without insistence on payment. The patient had been given life saving drugs such as injection Streptokinase, Dopomine drip and she was on oxygen. When she had signs of fibrillation, she was given defibrillatory measures by a team of doctors and staff of the hospital. At about 9.30 a.m. the patient developed Ventricular dysrhythmias and the patient was immediately put on Xylocard, but with poor response. Later the patient developed complications one after another. She developed malignant ventriculars, tachycardia and fibrillation. All these were tackled, using standard appropriate procedures, under the direct supervision of the second Opposite Party. In spite of the best efforts of the second Opposite Party and a team of doctors and paramedical staff of the hospital the patient died at about 11.45 p.m. There was no deficiency on the part of the Opposite Parties. The Opposite Parties did everything possible to save the life of the patient.

On behalf of the complainant he was examined as PW 1, and Exts. P 1 to P 9 were marked. On behalf of the Opposite Parties the second Opposite Party was examined as RW 1 and Exts. R 1, R 2 and R 3 were marked.

THE following points arise for consideration. (i) Whether there is any deficiency in service on the part of the Opposite Parties in the treatment and management of Suni wife of the complainant, ? (ii) If so, what is the relief to which the complainant is entitled ? (iii) What is the order as to cost ?

The complainant has filed an affidavit in terms of the averments contained in the complaint and he was examined as PW 1 and was cross-examined by the Opposite Parties. In the cross-examination it was admitted that patient was taken to Dr. Nanoo''s residence situated 3 kms. away from the complainant''s residence on a motor-bike. This has been stated in the complaint as well. He also stated that Dr. Nanoo told him that it is necessary to take drips. It was in the car of Dr. Nanoo they went to the hospital of the Opposite Party. It was also admitted that it was Dr. Nanoo himself who took the patient to the hospital. There are some general allegations that the second Opposite Party has not qualified to treat the patient, that the complainant was not told the condition of the patient in spite of repeated requests and that in spite of requests made by them to remove the patient to a hospital having better facilities, suggestion was not accepted by the Opposite Parties. However, we do not find any definite allegations indicating that there was want of care on the part of the Opposite Parties. Ext. R 1 is the case sheet of the patient and that would show that the second Opposite Party and a team of doctors and paramedical staff of the Opposite Party were constantly attending to the patient and the second Opposite Party was in the hospital throughout administering and giving instructions from time-to-time about the medicine to be administered and injections to be given and all other procedures to be adopted to save the patient. The very fact that the patient was taken to the I.C.U. immediately after the examination at the casualty itself would indicate that the condition of the patient was very serious. It was Dr. Nanoo who took the patient to the hospital and Dr. Nanoo was there for more than two hours. Ext. R 1 would show that what is stated in the version regarding her condition is true. Her BP was not recordable, she was ill looking, pale, sweating profusely, pulse not pulpable chest clear, heart sounds muffled etc. It is also seen that a life saving injection Streptokinase was also given. The evidence of RW 1 and the affidavit filed by him given descriptions of the treatment given by the doctors in the hospital, and the care and attention they took and the emergency procedures adopted by them to save the life of the patient. After careful examination of the evidence we are unable to see any deficiency on the part of the Opposite Party. Learned Counsel for the complainant pointed out that RW 1 admitted that after an ECG was taken at 6.15 only an ECG was taken at 9.25 p.m. The injection Streptokinase was given only at 8 p.m. and it does not appear that ECG was taken before the injection which was necessary according to RW 1. We do not find merit in this contention. ECG was admittedly taken at 6.15 p.m. under the second Opposite Party monitor and other doctors and staff were eager attending on the patient. We do not find any deficiency in not taking any other ECG in between 6.15 p.m. and 9.25 p.m.

AS regards the contention that there is failure to take the patient to a better hospital for treatment, it has to be noted that the removal of a patient who was in critical condition to any other hospital would be risky. She was already in the ICU. Further RW 1 stated that they would not have advised to remove the patient from that hospital to another hospital at that stage and there was no request from complainant for such removal. It is also seen an experienced general physician was at the hospital for consultation. We are also unable to accept the contention that the second Opposite Party is not qualified to treat the patient. He has got post graduation in general medicine and has attended several cases of this nature. It would have been a matter of grave deficiency if he failed to treat the patient at that stage and compelled the complainant to take the patient to take to any other hospital where there is a cardiology department. The case of the complainant is that the condition of the patient was not serious cannot be true in view of the fact that it is only on account of the serious condition that Dr. Nanoo took the patient in his own car and remained in the hospital for 1 hours. The foregoing discussions would show that there is no merit in the complaint. We accordingly dismiss the complaint. However, we direct the parties to bear their respective costs. Complaint dismissed.