BHAJAN LAL GUPTA vs MOOL CHAND KHARATI RAM HOSPITAL

THIS complaint has been filed by the parents of deceased, late Vijay Kumar, who, it is alleged to have woken up on 27th June, 1992, at about 4.30 a.m. with the complaint that he could not move his legs and felt pain. When the initial massage, etc. by family members did not help to subside the pain, they called a local Doctor who gave the initial diagnosis that the complaint was psychological. That time, late Vijay Kumar complained that his legs were almost dead and he was feeling very weak. At that point, the Doctor advised that the deceased be removed to hospital. Accordingly, the deceased was taken to the hospital, respondent No. 1, at or around 6.30 a.m. and was admitted in the casualty. A lady Doctor examined him there and left saying that she will send for some another Doctor. About 10 minutes later, one male Doctor came from Neurology Department and examined the patient and took his ECG, temperature and blood pressure. While the Doctor was still examining the patient, i.e. the deceased, he developed breathing trouble when an oxygen mask was put on his face. But this was pulled away by the deceased saying that it was no help and was making his breathing more difficult. In the light of this, the said Doctor opined that the patient be removed to ICU and got the patient removed to ICCU. The Doctor followed the patient to ICU, but not finding him there, located him in ICCU and got the patient shifted to ICU. In the meantime, the Doctor-in-Charge, respondent No. 4, Dr. H.K. Chopra, under whom the admission had been effected after being brought in by the elder son of the petitioner, went to check up and examine the said patient. After examination, Dr. H.K. Chopra confirmed that the patient should be shifted to ICCU under the charge of Dr. H.K. Chopra, respondent No. 4. A Junior Doctor from the Neurology Department was also summoned as the deceased had developed breathlessness and complained of pain in the other parts of the body also and was restless. That Junior Doctor from the Neurology Department put some hand- operated instrument in the mouth of the deceased to assist him in respiration for a minute or so. At that stage, Doctor H.K. Chopra, respondent No. 4, opined that respondent No. 5, Dr. M.S. Gulati, a Senior Consultant in Neurology should also be consulted and his opinion be taken. Dr. Gulati, respondent No. 5, arrived and examined the patient at about 9.00 a.m. and after examination wrote out his diagnosis and prescribed medicines as under : "27/6 Seen the case. Sudden onset of weakness of all four limbs since last night. Previous history of attack of weakness +/ - in feet x 6 months. N.Ex. - - Conscious but restless. - Pupil small, equal and react to light. - Fundus - Discs could not be focussed, as he is constantly moving eyeballs. - No apparent cranial nerve palsy. - Motor System - Total loss of movement of lower limbs except toes. Motor Power - 0 to 1 shoulder Girdle muscles. 2-3 Distal muscles of upper arm. Kj - - Aj ++ ++ P Upper limb jerks - depressed Sensation - Normal Sphincter - Normal Prob. Diag. (1) Acute Infective Polyneuritics (2) Hypopottasiumic Paralysis (3) ??? My. gravis Suggest - Fundus Ex. - without chemical dilatation or pupils 0 after that C.S.F. exam. - Methyl Prednisilon 500 mg. I/V in Drip over 6 hours. - Ryle tube - Nil orally except allurdox gel 3 - Tsp 6 hourly. - To consider plasma pharesis - Careful watch for respiratory Distress. If so, intubate without delay. Eray Chest Look for - Vital capacity Xray C Spine Blood Gases Mental confusion Early synosis Ampicillin 500 mg. 6 hourly Thanks Sd/- 27.6.1992"

HE was also of the view that it was a serious case and a new mode of treatment, namely, plasma pherasis, should be tried. This facility, according to the respondent No. 5 was stated to be available at G.B. Pant Hospital and the Safdarjung Hospital. HE is alleged to have pointed out that he knew the Doctor-in-Charge of the Neurology Department at the G.B. Pant Hospital, as he had earlier worked in that very hospital and he gave them a letter addressed to Dr. M.M. Mehadiratta, which reads as under : "Mr. Vijay Kumar aged 24 years has been admitted in Mool Chand Hospital today, with almost complete paralysis of lower limbs and partial paralysis of upper limbs (since last night). Clinically he is a case of? Acute Ineffective Polyneurities, ?? Hypopotassemic paralysis, .??? Acute Myaesthenia Gravis. I shall feel obliged if you may consider him from the point of view of PLASMAPHERASIS. We can transfer the patient under your care if you plan for plasmapherasis. HE is conscious but restless. HE has got mild repiratory difficulty."

It is not in dispute that after giving his diagnosis and suggestions the line of treatment and giving aforesaid letter, this Consultant, respondent No. 5, left the hospital, respondent No. 1, and the matter was in the care of respondent No. 4, the Doctor-in-charge, and the staff of his unit and also that the said treatment of plasma-pherasis was not available in the respondent No. 1. According to the version of respondent No. 5 it was respondent No. 4 who took respondent No. 5 to the relations of the deceased who were present at the hospital whom the respondent No. 5 informed of the latest treatment, i.e. plasma- pherasis which was in use those days at some hospitals for treatment of such cases and it was at the suggestion of Dr. H.K. Chopra that respondent No. 5 gave a letter (quoted above) addressed to Dr. Mehadiratta. Dr. Mehadiratta could not take the patient in as there was no bed available at the given time and pointed out that the patient could be brought on Monday when he could arrange a bed and he recorded this on that very letter addressed by respondent No. 5 to respondent No. 6. By the time the complainant No. 1 returned to respondent No. 1, he found that his son, Vijay Kumar, had already died. The petitioner No. 2 stated that the patient died on 11.30 a.m. although the death summary stated 12.10 (noon) as the time of death. There are two death summaries prepared at respondent No. 1, one is signed by Dr. H.K. Chopra, Senior Consultant in Cardiology and Medicine. It is counter-signed by K.L. Chopra who is the head of the department and it is signed by one Dr. Nandini Gupta, Senior Resident. There is another death summary filed on record reading almost the same thing which is in type-written and that one is signed apart from H.K. Chopra, by K.L. Chopra and by Dr. M.S. Gulati as well. Contents of both are set out hereunder : "SHRI MOOLCHAND KHARAITIRAM HOSPITAL AND AYURVEDIC RESEARCH INSTITUTE, LAJPATNAGAR III NEW DELHI - 24 DEATH SUMMARY OF MR. VIJAY , KUMAR Mr. Vijay Kumar, 24 years of resident of 4/9, Jalvihar, Lajpat; Nagar, was admitted in ICCU on 27th June at 8.30 a.m. with the complaint of rapidly progressing weakness of body staring at lower limbs and upper limbs. Patient was restless and had total loss of movements and power of lower limbs and almost complete loss of power of upper limbs. The patient was straightaway referred to Senior Consultant in Neurology Dr. M.S. Gulati. Soon after he was seen by him. The treatment was started immediately after admission with I.V. Dextose, Steroids and antibiotic cover. The treatment was based on clinical diagnosis of Acute Polyradiculoneuropathy of acute onset (? Viral). The diagnosis was confirmed by senior neurophysicians who advised to continue the treatment. At 11.30 a.m. patient became restless and his respiration became laboured because of involvement of respiratory muscles. Patient was intubated and assisted respiration was given. Subsequently patient had cardiac arrest for which cardiopulmonary resuscitation and other resuscitation measures were undertaken. In spite of intensive treatment the patient died at 1210 hrs. on 27th June, 1992. The death occurred within four hours of admission because of acute culminant adrenaline paralysis of the muscle of the body including respiratory muscles. The cause of death was acute Polyrasdiculoneuropathy (leading to cardiac respiratory arrest). The prognosis of the case were explained to the relatives of the patient by me and Dr. M.S. Gulati. Sd/- xxxx Sd/- xxxx Dr. H.K. Chopra Dr. M.S. Gulati Associate Consultant in Senior Consultant Cardiology and Medicine Neurology in Mool Chand Moolchand KR Hospital KR Hospital Countersigned by Sd/-xxxx Dr. (Col. K.L. Chopra) Co-Ordinator Cardiology and Medicine. Sd/-xxxx Dr. (Major Gen). J.P. Bhalla Medical Superintendent M.C. K.R. Hospital."

There is another death summary on record which is in handwriting reading as under : Mr. Vijay Kumar, 24 years male, a ,resident of 4/9, lalvihar, Lajpat Nagar, was admitted in ICCU on 27th June at 8.30 a.m. with the complaint of rapidly progressing weakness of body staring at 3 a.m. today. The patient was restless and had total loss of movements and power of lower limbs with decreased power of upper limbs. The patient was referred to Neurophysician and to Anesthetist His vidal volume was within normal limits at admission. At 11.30 a.m. patient became tachypneic and his resuscitation became laboured at 11.40 a.m. The patient was intubated and respiration with Ambu bag started. Subsequently, the patient developed. Subsequently rescst. CPR started. Injc. Adrenative injuc 1/v and intra-cardiac. Injec. sodabicarb and inj Efcorlin given. The patient''s pupils were widely fixed and dilated and there were no dol''ls eyes movement. Cereneal reflexes was negative. In spite of all resuscitative measures patient could not be revived and was declared dead at 12.10 p.m. on 27.6.1992. The cause of death was fulminating Gullias Barse Syndromic c. cardiorespiratory arrest. Sd/-xxxx (Dr. Nandini Gupta) J.R. Sd/- xxxx (Dr. H.K. Chopra) Associate Consultant in Cardiology and Medicine. Sd/-xxxx (Col. K.L. Chopra)"

This is not in dispute that the deceased was suffering from acute polyradiculoneuropathy and within hours, i.e. from the time he got up to the time of admission in the respondent No. 1, the disease had progressed quite a lot and he was already paralysed in the lower limbs and that paralysis was travelling upwards and was interfering with the other functions of the body including breathing and functions of the other limbs. According to the complainant''s version, Dr. Gulati, respondent No. 5, saw the deceased only once. This position is admitted by respondent No. 5 and his stand is that he was called by the consultant under whom the patient had been admitted for his expert opinion. He, after examining the patient, gave his diagnosis and the three possibilities which were recorded in his diagnosis were also mentioned in his letter to Dr. Mehadiratta, respondent No. 6, which were to be confirmed after the various tests suggested by Dr. Gulati, respondent No. 5. From the treatment chart it appears that the treatment which was prescribed by the specialists was followed although the complainant alleged that it was not followed meticulously because she alleges that at one time the oxygen tube had come out and it was only when she drew the attention of the Nurse, that it was put back. A short while later, the patient was intubated shortly after 11.30. At that time, the Nurse summoned the Doctor who resorted to artificial respiration as the patient was unable to breathe. According to the mother of the deceased, the patient had died around 11.30 a.m., but according to the hospital records, death took place at 12.10 noon. The patient was given apart from oxygen and other aids to breathe, certain emergency medicines, such as cortizone... and also ampicilene. All through while the patient was in, respondent No. 1, he remained In ICCU ever since he was shifted from ICU to ICCU. That unit is stated to have the necessary equipment to intubate the patients and also the regular supply of oxygen.

OBJECTIONS have been raised by some of the respondents, such as respondent No. 6, who states that there could be no case of medical negligence against him as he did not even see the patient nor he treated him at any times. Similarly, respondent Nos. 7, 8 and 9 have taken the preliminary objections. We find that these objections are not without substance. The patient was never taken to respondent No. 7, as such there could be no question of hiring its services and consequently there could be no question of deficiency of service there. Insufficiency of beds in that hospital is something which was beyond the control of either respondent Nos. 6 or 7 or even 8 and 9. Further, the respondent No. 6 did not at any time examine or treat the patient. As such, there was no hiring of services of respondent No. 6 also. Grievance against respondent Nos. 8 and 9 is not in the nature of a consumer dispute but is mainly in the nature of a public interest litigation which is beyond the jurisdiction of this Commission. For these reasons and in view of the admitted position that Respondent No. 6 never rendered any service nor did he examine the patient, nor was there any hiring of services of respondent No. 7, we find that no case is made out against these respondents. Accordingly, the complaint against respondent Nos. 6,7,8 and 9 is dismissed. Coming to the role of other Respondents, let us first examine the legal position relating to cases of medical negligence. As to what is the standard of care and the duty that a medical practitioner owes to its patient, it will be appropriate to know some of the decisions of the Hon''ble Supreme Court.

IN Halsbury''s Laws of England, Ed. 3 - Vol. 26, pp. 17-18, the question of negligence and duties owed to the patient has been dealt with on the basis of various precedents extracts wherefrom are reproduced hereunder : "22. Negligence: Duties owed to patient. A person who holds himself out as ready to give medical (a) advice or treatment impliedly undertaken that he is proposed of skill and knowledge for the purpose. Such a person, whether he is a registered medical practitioner or not, who is consulted by a patient, owes him certain duties, namely, a duty of care in deciding whether to undertake the case; a duty of care in deciding what treatment to give and a duty of care in his administration of that treatment (b) A breach of any of these duties will support an action for negligence by the patient (c).

Degree of skill and care required. The practitioner must bring to his task a reasonable degree of skill and knowledge, and must exercise a reasonable degree of care. Neither the very highest, nor a very low degree of care and competence judged in the light of the particular circumstances of each case, is what the law requires (d); a person is not liable in negligence because someone else of greater skill and knowledge would have prescribed different treatment or operated in a different way (e); nor is he guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art, although a body of adverse opinion also existed among medical men (f). IN Bolan v. Friern Hospital Management Committee, (1957) I WLR 582, Lord Justice McNair, while briefing the jury had directed: (1) a doctor is not negligent, if he is acting in accordance with a practice accepted as proper by a reasonable body of medical men skilled in that particular act, merely because there is a body of such opinion that takes a contrary view. Where there are two different schools of medical practice, both having recognition among practitioners, it is not negligent for a practitioner to follow one in preferences the other. American Law; see 70 Corpus Juris Secumdum (1951) 952, 953, pr. 44, Moreover, it seems that by American Law a failure to warn the patient of dangers of treatment is not, by itself, negligence libid 971. prs. 48m). IN an earlier decision of this Bench in the case of Smt. Kusum Sharma & Ors. v. Batra Hospital and Medical Research Centre & Ors., an extract was quoted from Taylor''s Principles and Practice of Medical Jurisprudence - XIII Ed. which we consider it appropriate to reproduce here also: ''I myself would prefer to put it in this way; A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by responsible body of medical men skilled in that particular art Medical science has conferred great benefits on mankind, but these benefits are attended by considerable risks. Every surgical operation is attended by risks. We cannot take the benefits without taking risks. Every advance in technique is also attended by risks.'' Again in Roe and Woolley v. The Ministry of Health, Lord Justice had stated thus: It is easy to be wise after the event and to condemn as negligence that which was only a misadventure. We ought always to be on our guard against it, especially in cases against hospitals and doctors. Medical science has conferred great benefits on mankind but these benefits are attended by unavoidable risks. Every surgical operation is attended by risks. We cannot take the benefits without taking the risks. Every advance in technique is also attended by risks. Doctors, like the rest of us, have to learn by experience; and experience often teaches in a hard way. IN that case it was observed that, ''we must not look at a 1947 accident with 1954 spectacles (emphasis supplied). But, we should be doing a disservice to the community at large if we were to impose liability on hospitals and doctors for everything that happens to go wrong. Doctors would be led to think more of their own safety than of the good of their patients. INitiative would be stifled and confidence shaken. A proper sense of proportion requires us to have regard to the conditions in which hospitals and doctors have to work. We B- must insist on due care for the patient at every point, but we must not condemn as negligence that which is only a misadventure."

In Poonam Verma v. Ashwin Patel & Ors., II (1996) CPJ 1 (SC)=AIR 1996 SC 2111, while considering the question of medical negligence in the context of treatment of a patient, the Hon''ble Supreme Court has observed : "Negligence has many manifestations - it may be active negligence, collateral negligence, comparative negligence, concurrent negligence, continued negligence, criminal negligence, gross negligence, hazardous negligence, active negligence, active negligence and passive negligence, wilful or reckless negligence or negligence per se which is defined in Black''s Law Dictionary as under : Negligence per se : Conduct, whether of action or omission, which may be declared and treated as negligence without any argument or proof as to the particular surrounding circumstances, either because it is in violation of a statute or valid municipal ordinance, or because it is so palpably opposed to the dictates of common prudence that it can be said without hesitation or doubt that no careful person would have been guilty of it. As a general rule, the violation of a public duty, enjoined by law for the protection of person or property, so constitutes."

In Laxman v. Trimbak Bapu Godbole & Anr., AIR 1969 SC 128, it was laid down as under: "The duties which a doctor owes to his patient are clear. A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding what treatment to give or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires; (of Halsbury'' s Laws of England, 3rd Ed. Vol. 26. p. 17). A medical practitioner has various duties towards his patient and he must act with a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. This is the least which a patient expects from a doctor. The skill of medical practitioners differs from doctor to doctor. The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be 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 a patient, but as long as a 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, diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence. But in cases where the doctors act carelessly and in a manner which is not expected of a medical practitioner, then in such a case an action in torts would be maintainable."

In the light of the statement of law set out hereinabove, the question as to whether there has been negligence on the part of any of the respondents in treating the deceased has to be viewed.

THE matter can be dealt with in three parts. One is the case against respondent No. 1, secondly the case is against respondent Nos. 2 to 4, and thirdly, the case against respondent No. 5.

THE case of respondent No. 5 appears to be distinct and separate from that of respondents Nos. 1 to 4 and other respondents inasmuch as, he was called in by Dr. H.K. Chopra, respondent No. 4 to examine the deceased and to give his expert findings/opinion and suggestions for treatment, which he did. Apart from that, he was never contacted again nor summoned by the Doctor under whom the patient had been admitted i.e. respondent No. 4. No fault has been found by either the complainant or anyone else in what was recorded or prescribed by respondent No. 5. THE only thing pointed out was that the AIIMS also had plasma pheresis facility and Dr. Gulati, respondent No. 5, should have recommended that place. We fail to understand how this amounts to negligence. THE AIIMS and the Safdarjung Hospitals are equidistant from respondent No. 1 and respondent No. 5 did inform about the facilities being available at Safdarjung Hospital. No motives have been attributed to respondent No. 5 in giving the letter to respondent No. 6, which was apparently done at the request of relations of the deceased and respondent No. 4 as respondent No. 6 is stated to have been known to respondent No. 5. The respondent No. 5 has set out in his version the procedure of consulting Senior Consultants at the hospital, respondent No. 1, and has stated that since the patient had been admitted under respondent No. 4 and he was called by the said respondent No. 4 to examine the patient and to give his expert opinion/ diagnosis and suggestions for the line of treatment to be followed and do nothing more. This he had done. It is further stated, which fact is not disputed, that one Consultant does not normally interfere with the treatment being administered by the Consultant under whom the patient is admitted in the hospital, unless he is required to do so by that Consultant. It is also clear from the facts of the present case that the disease was progressing rapidly and respondent No. 5 was not called again. The respondent No. 5 in support of his line of treatment had cited some medical authorities. The diagnosis recorded by respondent No. 5, on clinical examination of the patient, appears to be the prima facie view to be confirmed after further tests. The said Doctor had suggested further tests to be carried out and treatment to be administered. The prima facie diagnosis on examination of the patient recorded by the respondent No. 5 was: (i) Acute Infective Polyneuritis; or (ii) Hypo potassiumic Paralysis; or (iii) ?? Myaesthenia Gravis. His suggestions were, (i) fundus examination; (ii) C.S.F. examination, (ii) injection methyl prednisilon 500 mgs. Intravenous in drip, (iv) Ryletube; (v) Nil orally except Aludrox Gel 3 tea-spoonful six hourly, etc.

In fact, the version of respondent No. 5 that the said respondent, at the request of Dr. Chopra, respondent No. 4, and the relations of the deceased, went out of his way and gave a letter of introduction to the Doctor-in-Charge (respondent No. 6) at the G.B. Pant Hospital respondent No. 7 which is also a Government Hospital appears to be correct.

THE one of the tests of medical negligent is that something which is required under medical practice to be done was not done or what was done was contra indicated. At the same time it is also a settled principle that a specialist required to know the latest techniques for management of the patient and if he is ignorant about it, then he could be considered to be negligent in following his profession. It is nobody''s case that there was some treatment which in those days was available for management of such cases which was either not suggested by the respondent No. 5 or on which the respondent No. 4 differed with him. However, the facility of plasma pherisis being not available in that hospital, nobody could do anything about its not being made available to the patient. An effort was certainly made by the respondents particularly, respondent No. 5, at the request of respondent No. 4, to go out of his way to recommend the case of the deceased to the G.B. Pant Hospital, respondent No. 7, through the respondent No. 6, who was in charge of the Neurology Department there and was known to respondent No. 5. The only grievance of the complainant appears to be that they should have been referred to the AIIMS. It may be noted that the AIIMS or the Safdarjung Hospital are opposite to each other and both will take the same time and that it was pointed out to the relatives of the patient that the Safdarjung Hospital had this facility. The AIIMS is again a referral institute and patient had to be referred to it. That would have resulted in considerable loss of time. In Safdarjung Hospital, without knowing any Doctor, they would first take the patient in the casualty/ emergency, then refer it to the Specialists. It could have resulted in loss of precious time. It was on this account that apparently Dr. Chopra, respondent No. 4, and the relations of the deceased requested for a letter of introduction from respondent No. 5 which he gave. This is no case of medical negligence. In fact, the gesture of respondent No. 5 in cooperating to this extent with the patients'' relatives without any allegation of motive or personal gain has to be appreciated. It is for these reasons that we are unable to find any substance in the allegations against the respondent No. 5 and the complainants have failed to make out any case of medical negligence against this respondent. Therefore, the complaint against respondent No. 5 is dismissed.

IT is most unfortunate that the condition of the patient went on deteriorating very fast. At one point of time, i.e. before 11.30 a.m. the oxygen tube came out. That was noticed by the mother of the patient. She reported that matter to the nurse on duty who immediately called the doctors concerned on duty at that time and they tried to revive the patient. They tried to give the necessary emergency treatment. However, the condition of the patient did not improve and he succumbed to the ailment. In cases where the patients are restless it may happen at times that the tube/ s is/ are pulled out. In this case also such a thing appears to have happened and on it being pointed out to the nurse she took the remedial measures of putting back the tube and also summoned the doctors for giving further treatment. In ICCU it is not expected that the relatives of the patient have to point out pulling out of the oxygen tube. Such a thing should be noticed by the staff on duty immediately. Unfortunately, the aforesaid lapse on the part of staff on duty turned out to be too expired. IT is not the case of the complainant that there was no nurse present in the ICCU or that the doctor did not turn up when summoned by the nurse or that the necessary resuscitation measures were not taken. IT is not acceptable that the staff on duty in ICCU should not notice the withdrawal of oxygen tube until this is brought to their notice by the mother of the deceased. IT is also not clear as to what prevented the patient being not intubated prior to 11.30 a.m. IT appears to be one of the cases where the progress of the disease was so fast that not much could be done to the patient and on account of non-availability of the facility of the treatment of plasma pherisis, that latest treatment could not become available to the patient in time. Coming to Dr. H.K. Chopra, respondent No. 4 who was the Doctor-in-Charge of this case, under whom the patient was admitted, had transferred the patient immediately to ICCU where constant monitoring facilities were available and the patient was put on oxygen to relieve the breathing distress and when this respondent found that there was need to consult a neurologist also, he after checking with the resident Neurologist sent for Dr. Gulati, respondent No. 5 for his opinion. Dr. Gulati, respondent No. 5, also diagnosed that it was a serious case and that it needed further investigations and a specialised treatment, namely, plasma pherisis, which facility was not available in the respondent No. 1 Hospital and he suggested to respondent No. 4 that this patient should be put on plasma pherisis wherever that facility is, The respondent No. 4 took him to the relations of the deceased who wanted the help of respondent No. 5 in getting an introduction to the hospital where this facility was available following which he gave a letter of introduction to Dr. Mehadiratta, respondent No. 6, who was the Neurologist at the G.B. Pant Hospital which was one of the hospitals having this facility. According to the practice of the hospital, respondent No. 5 could not do anything further without being required to do so by respondent No. 4 who was the Doctor-in-Charge under whom the patient had been admitted. The respondent No. 4, in fact, followed the suggestions of respondent No. 5. Respondent No. 4 had left detailed instructions with the nurse on duty on the treatment to be followed. No authority has been brought to our notice wherein the treatment suggested was contra- indicated nor is there any evidence or even allegation to that effect. Looking to the facts of this case, we find that respondent No. 4 had given detailed instructions to the staff-in-charge of ICCU. One of the important suggestions of respondent No. 5 was that the patient be intubated. This suggestion was given between 9 and 9.30 a.m. and one would have expected action in this behalf immediately. No doubt, the patient had been put on oxygen and was otherwise being monitored in ICCU, yet there were two very serious lapses, one of the nurses not noticing that the oxygen tube had come out and the other of delay of about two hours in intubating the patient. There was also a further lapse on the part of the nurse not being vigilant to ensure that the oxygen tube remained in place and if at all it is pulled out by the patient it was restored immediately. In cases of such grave and serious nature extra care and vigilance is required and lack of it can have serious consequences as it did in the present case. As a rule, only serious patients are in ICCU and the staff is expected to be extra cautious. That level of caution should have been more, particularly, when staff was attributed with the knowledge that the patient was restless and his condition was deteriorating very fast. No one is sure as to whether the patient would have pulled through that crisis or even if he had survived, the damage already done by the said disease which had progressed to affect the entire body within a few hours, and was still progressing could be checked or reversed. But, the lack of extra vigilance, at least contributed to the acceleration of the end. There is no evidence to show that intubation would have saved the patient. But, such action may have helped in the treatment. This is most unfortunate that the disease progressed so fast that before the patient could be removed to any centre where the latest treatment of Plasmapherasis was available the end came. No one can with certainty say if intubation in time would have saved the patient or at least prolonged his life until he could be taken to any other hospital where Plasmapherasis facility was available. Nonetheless, such delays and lapse in not noticing the coming out of oxygen tube which was in a way life support system are serious matters for which the hospital administration cannot escape liability. Even if it is argued that there was no callousness on the part of the respondent No. 4 who was the Doctor- in-Charge and who accepted the suggestions and recommendations of respondent No. 5 and gave instructions to give effect thereto, it is difficult to overlook the lapses on the part of the staff in the ICCU unit. For that reason we feel that the hospital would be liable to compensate the petitioners. Taking a overall view of the matter, we feel that ends of justice will be served if a sum of Rs. 2.00 lakhs is awarded in favour of the complainants and against the respondent No. 1. The respondent No. 2 in his capacity as the Medical Superintendent will have the responsibility of ensuring prompt payment to the complainants.

IN the light of the above discussion, we cannot fasten any personal liability on either respondent No. 3 and respondent No. 4. Respondent No. 2 is only vicariously liable being the Medical Superintendent of the respondent No. 1. But, the amount of compensation shall be realised from respondent No. 1. IN case the amount is not paid within four weeks of this order the 1st respondent will become liable to pay interest at the rate of 12% p.a. on the said amount from the date of this order till the date of payment. The original complaint is disposed of in the above terms. Complaint disposed of.