BHARAT AHUJA vs M/S. METRO HEART INSTITUTE & ORS

Mr. Dev Nath Ahuja, aged about 72 years, (since deceased), (hereinafter referred as ''the patient''), was admitted to M/s Escorts Hospital, Faridabad, on 3.1.2002 and discharged on 4.1.2002, with the diagnosis of acute anterior wall myocardial Infarction (MI). Then, again he was admitted on the same day, in M/s Escort Hospital and Research Centre Limited (EHIRC), New Delhi. His coronary angiography was performed there, on 8.1.2002. It was reported that as patient was suffering from triple vessel disease with moderate LV Dysfunction, Coronary Artery Bypass Surgery [CABG] was advised. It was fixed for 30.1.2002, which was to be performed under the care of Dr. Naresh Trehan and Dr. S. Bhandari, EHIRC at New Delhi, [ext.C-1/16 to C-1/27]. Patient was discharged on 14.1.2002, on request. Again, on 16.1.2002, the patient suffered discomfort; he was taken to EHIRC at Faridabad, admitted in Cardiology CCU. He was discharged on 18.1.2002 and referred to EHIRC at New Delhi for CABG. In the meantime, Dr. S. S. Bansal, working with Escorts Hospital, Faridabad, advised and persuaded the complainant to take his father to Metro Heart Institute, OP 1 for the satisfactory treatment. On the basis of advice and persuasion of Dr. S. S. Bansal, the complainant admitted his father at OP 1, on 18.1.2002. On the next day, i.e. on 19.1.2002, the OPs 2 to 4 performed multi vessel Percutaneous Transluminal Balloon Angioplasty (hereinafter referred as ''PTCA'') with primary stenting of LAD and LCX. Only two stents were installed. The patient was discharged, on 25.1.2002. Prior to operation, the OPs 2 to 4 have not conducted any tests, but relied on the test reports of Escorts Hospital, which were previously conducted. As, there was no emergency for PTCA, the OPs could have waited for CABG, till 30.1.2002.Hence, it was alleged that, it was a malafide intention of OPs to grab a client to earn heavy amount. Thus, it was an unfair trade practice and greedy attitude of OPs. The OP intentionally avoided the scheduled CABG operation, which was recommended by Dr. Naresh Trehan, on 30.1.2002. Dr. Purushottam, OP 2, along with OP 4, have not properly assessed the coronary angiography report done at Escorts, on 8.1.2002.The patient was charged with a bill of Rs.1,65,000/-. After discharge, again on 6.2.2002, the patient suffered severe chest pain, chocking and congestion. Therefore, he was taken to Escort Hospital at Faridabad as it was near to the complainant''s house. The patient was discharged on 7.2.2002. The complainant enquired with the OP/doctor about the said episode. The OP called the patient to Metro Hospital and coronary angiography was performed again, upon which, OP''s suggested "nothing to worry". The patient was discharged on 9.2.2002. Again, the patient suffered chest pain with other symptoms on 14.3.2002, he was taken to Sunflag Hospital at Faridabad, which is the branch of OP-1. He was admitted in CCU and was discharged on 16.3.2002. Again, the patient suffered the same, on 23.3.2002, again, PCTA was performed. The patient subsequently died, on 26.3.2002. Therefore, alleging negligence on the part of OPs 1 to 4, the complainant Mr.Bharat Ahuja son of deceased filed a complaint before this Commission, under Section 21 (b) of the Consumer Protection Act, 1986, on 28.08.2002, and prayed for total compensation of Rs.25 lakhs. Defence:

The opposite party filed its written version and submitted that the patient was a chronic smoker with lung problem, had brain stroke (CVA) in 1995. He had previous heart attacks with recurrent left ventricular failure and cardiac arrhythmia. On 4.1.2002, he suffered MI and was admitted to Escorts at Delhi. The echo revealed, clot in left ventricle, he had another heart attack with LVF and cardiac arrhythmia, on 16.01.2002, for which, he was admitted to Escorts, Faridabad. He was discharged on 18.01.2002 with advice to go to Escort, New Delhi for CABG, but, however, a day earlier, his son/complainant visited the OP-Metro Hospital and discussed the alternatives of bypass surgery. Therefore, the OP considering the multiple health problems of the patient and due to inherent risk involved in the surgery, advised angioplasty as a better option. Thereafter only, the patient got admitted at OP-Hospital on 18.01.2002. After informed consent, OP 2 performed angioplasty on two major offending arteries. The patient improved and was discharged on 25.01.2002 in a stable condition. On 06.02.2002, he was re-admitted to Escorts, Faridabad, in acute LVF. He got discharged from there, on 07.02.2002 against medical advice (LAMA). On the same day, he was admitted to Metro Hospital, in view of the recurrent chest pain and breathlessness. Therefore, check coronary angiography was performed, which revealed patent stent, no abnormality. He was given proper medication and was discharged in a stable condition. Thereafter, the patient, again had episode of chest discomfort and breathlessness. Therefore, angioplasty of remaining non-dominant RCA was performed on 22.03.2002. He was doing well for three days. Thereafter, the condition suddenly deteriorated and the patient passed away, on 26.03.2002, due to LVF and cardiac arrhythmia i.e. cardiogenic shock. ARGUMENTS:

The counsel for the complainant vehemently argued that, the doctors at OP-1 had intentionally influenced the complainant. Therefore, the patient was taken to OP-hospital. CABG was advised by Escorts, but the OP intentionally performed angioplasty to grab money. The patient could have survived by the CABG surgery. The angioplasty was also not performed perfectly with due care and attention; OP misguided the patient and the complainant. The facilities at OP-hospital were not satisfactory. OP has unnecessarily put excessive charges for the angioplasty package. The counsel further mentioned that Dr. Bansal had been appointed by OP 1 as a Director, after leaving his job with Escorts, Faridabad. Therefore, the complainant suffered heavy financial expenses and mental agony. The counsel relied upon the authority of this Commission in Dr. (Mrs.) Indu Sharma Vs. Indraprastha Apollo Hospital & Ors., CC No.104 of 2002, decided on 22 April, 2015.

The rival arguments on behalf of the OP were advanced by Dr. M.C. Gupta. He vehemently argued that, the treating doctors were highly qualified and competent in cordiology. The diagnosis was correct. The method of treatment was, as per standard method, used by cardiologists. The complainant and patient decided themselves not to get CABG done, therefore, approached OP 1-hospital for necessary treatment. After evaluation only, the patient was advised for angioplasty. If the complainant had a grouse against Dr. Bansal, he ought to have made him a party in this case. The angioplasty was performed with internationally accepted norms. Moreover, the patient''s son-Mr. Bharat Ahuja, consulted the doctors at Metro Hospital, on 17.01.2002, while his father was admitted at Escorts Hospital, Faridabad. It was, after verifying the credentials of Metro Hospital that he decided to admit his father at Metro Hospital, on 18.01.2002, contrary to the advice given by the doctors of Escorts Hospital, Faridabad, as mentioned in the discharge summary. FINDINGS:

We have perused the medical record from OP/Hospital from Escorts Hospital, Faridabad and Escorts Hospital, New Delhi. It consists of all the prescriptions, various reports like ECG, Echo Cardiogram procedural aspects of angioplasty etc. The diagnosis made by the Escorts, New Delhi was triple vessel disease (TVD). The past history clearly revealed that patient suffered MI. On 3.1.2002, the patient was admitted with the complaint of chest pain, left side for 15 to 20 minutes and sweating. There was elevated value of Cretinin Kinase (CPK) 4708U/L, CK-MB 384 U/L and ECG revealed acute anterior wall MI. The coronary angiography done at EHIRC, New Delhi revealed right coronary artery (RCA) 70% Mid stenosis, Left Anterior Descending (LAD) 70% Mid stenosis, Left Circumflex had 80% Proximal stenosis, Ist Obtuse marginal shows 70% Mid stenosis 50% Distal stenosis, Posterior Descending Art. (LCX) shows 90% mid-stenosis. Therefore, the Cardiologist, Dr. S. Bhandari at EHIRC, New Delhi, recommended CABG. The patient was again admitted on 16.1.2002 with breathlessness and dyspnea, which was treated at Fortis Hospital, Faridabad and thereafter referred to New Delhi for CABG.

The medical record of OP-1 revealed that the patient took consultation from Dr. Purushottam Lall/Dr. S. M. Sachdeva on 17.1.2002. The PTCA was performed in LAD and LCX by Dr. Purushottam Lall and Dr. A. K. Pandey. The discharge summary dated 09.02.2002 of Metro Hospital, clearly revealed as follows: "Mr. D. N. Ahuja, 72 yrs old, male, non-hypertensive, nondiabetic, smoker was admitted with a history of anterior wall MI on 03.01.02 for which thrombolytic therapy was given at a local hospital. The patient developed acute LV F on 16/01/02. His ECG showed AF with fast ventricular rate which was reverted successfully with DC cardioversion. His coronary angiography was done on 19/01/02 which revealed triple vessel disease with moderate LV dysfunction. The angiography findings were discussed in detail with the patient and his family members and he was advised myocardial revascularization by CABG/multi-vessel PTCA. In view of his advanced age and other comorbidities, less invasive method of re-vascularisaiton by angioplasty was preferred. His PTV+CA with stenting to LAD and LCX was done on 19/01/02 with good angiographic results. Detailed angioplasty report is enclosed. His post TCA period was uneventful and he is being discharged in a stable condition."

We took reference from the medical text books on Cardiology to know about the advantages of CABG and PTCA. It is clear from the above discussion, that all the treating doctors were qualified and competent to treat the cardiac patient. The patient already suffered attacks of MI and the lab investigations and angiography clearly reveal triple TVD. The CABG was advised by Escorts, New Delhi, but the patient''s son approached the OP-1 and discussed the alternative mode of treatment, apart from CABG. Therefore, it was the decision of the patient and the complainant themselves to avoid CABG and preferred PTCA. The OPs evaluated the condition of the patient and as there was inherent risk for CABG surgery in this patient, therefore, angioplasty was suggested. The OP performed angioplasty, after informed consent. There was no need to perform angioplasty, in all three arteries, at the same sitting. Also, the patient had LVF and impaired renal functions.

The Bolam''s principle is squarely applicable here. The doctor can choose any mode of treatment, which is an accepted practice. In Achutrao Haribhau Khodwa and Ors. v State of Maharashtra and Ors (1996) 2 SCC 634, the Supreme Court observed that: "In the very nature of medical profession, skills differs from doctor to doctor and more than one alternative course of treatment are available, all admissible. Negligence cannot be attributed to a doctor so long as he is performing his duties to the best of his ability and with due care and caution. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession."

In the case Maynard v. West Midlands Regional Health Authority the words of Lord President (Clyde) in Hunter v. Hanley 1955 SLT 213 were referred to and quoted as under:- "In the realm of diagnosis and treatment there is ample scope for genuine difference of opinion and one man clearly is not negligent merely because his conclusion differs from that of other professional men...The true test for establishing negligence in diagnosis or treatment on the part of a doctor is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would be guilty of if acting with ordinary care...".

In " Martin F. D'' souza vs. Mohd. Ishfaq ", 2009 CTJ 352 (SC), the Hon''ble Supreme Court held as under:- " 41. A medical practitioner is not liable to be held negligent simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another."

" 49. When a patient dies of suffers some mishap, there is a tendency to blame the doctor for this. Things have gone wrong and, therefore, somebody must be punished for it. However, it is well known that even the best professionals what to say of the average professional, sometimes have failures. A lawyer cannot win every case in his professional career but surely he cannot be penalized for losing a case provided he appeared in it and made his submissions."

In the OP 171/1997 Smt. Narangiben Subodhchandra Shah & Ors. vs. Gujarat Research and Medical Institute , popularly known as Rajasthan Hospital (2012) III CPJ 509 (NC) has, inter alia, at Para 20, observed that: "After all doctors can only treat but cannot guarantee the success of a surgical operation which inevitably is fraught with risks."

Therefore, on the basis of above mentioned decisions and the discussion, we do not find any negligence on the part of OPs. Therefore, we dismiss this complaint. Parties to bear their own costs.