C Pratap Reddy vs C Jaypal Reddy

THESE revision petitions arise out of single order of State Commission; hence, decided by common order.

R .P. No. 4135 of 2012 C. Pratap Reddy and Anr. Vs. C. Jaypal Reddy and Ors. has been filed by OP and R.P. No. 693 of 2013 C. Jaya Pal Reddy Vs. C. Pratap Reddy and Ors. has been filed by complainant against order dated 23.5.2012 passed by the A.P. State Consumer Disputes Redressal Commission, Hyderabad (in short, ''the State Commission'') in Appeal No. 1214 of 2009 by which, while allowing appeal order of District Forum dismissing complaint was set aside and compensation of Rs.1,00,000/ - was awarded.

BRIEF facts of the case are that complainant''s father Y.A. Chenna Reddy met with road accident on 7.1.2003 and was admitted in the OP No. 1 Hospital for treatment of fracture of the left femur and colles fracture of the left wrist which also caused acute chronic renal failure. Since the time of the accident he was advised to go on haemodialysis. The patient had undergone peritoneal dialysis in Apollo Hospital. On 10.5.2004 the deceased Chenna Reddy had fallen resulting in head injury. After subjecting him to CT scan it was informed that the deceased was suffering with intra -cerebral bleed with small bleed subarkhnold and subdural space. He was shifted to ICU and was discharged on 22.5.2004 and again he was admitted in the hospital on 28.5.2004. While at ICU he developed bedsore due to negligence of nursing staff of ICU. On 2.6.2004 at 6.00 a.m. the patient was checked by both the duty nurse and also by the duty doctor Dr. Sharmila and informed that the patient was normal. Dr. Sharmila had called Dr. Kailash to check the patient who also declared the patient to be normal and declared that the patient does not require oxygen. In the intervening period of stopping the Oxygen and waiting for the saturation machine, the patient could not receive oxygen as the oxygen mask was not removed and the patient collapsed. When Dr. Sharmila entered the room with the saturation machine, the patient collapsed and Dr. Prabhakar Sastry had declared "Code Blue". Immediately a ventilator was given and the patient was shifted to ICU unit around 8 a.m. At about8.45 a.m. Dr. Sharmila had come on to the ICU and informed the appellant that the patient was normal on the ventilator. By collusion, the hospital doctors and other staff of IVCU prepared progress sheet no. 11 and 12 and the death summary. The case sheet was fabricated. Alleging deficiency on the part of O Ps, complainant filed complaint before District Forum. The OP No. 1 and 2 filed counter which was adopted by opposite party No. 4, contending that the father of the appellant was terminally ill with renal failure and his general condition was poor and he was admitted at the Apollo Hospitals in January 2003 and July 2003 for fracture of neck of left femur, colles left radius, acute chronic renal failure, diabetes type 2 and hypertension. He was again admitted on 10.5.2004 with a complaint of altered sensorium following a fall. Evaluation of the patient reveals inter cerebral bleed. He was discharged on 22.5.2004 when his condition improved. He was again brought to the hospital with the complaint of sudden breathlessness on 28.5.2004. On evaluation it was found that he was suffering from dysponea, arterial blood gas analysis suggestive of Type -1 respiratory failure. The patient developed lower respiratory tract infection and was not responsive to pain. On 2.6.2004 he was found to have labored breathing associated with sweating. It was inferred that he had cardiac arrest and was immediately resuscitated and put on ventilator. However, pulse rate and BP could not be recorded and patient desaturated steadily. He had a further cardiac arrest at 10.20 a.m. on 2.6.2004 and could not be revived. He was declared dead at 1.30 p.m. on the same day. OP No. 1 and 2 submitted that there was no need to remove the mask for conducting the saturation test and the same was conducted through a finger probe. The committee constituted by the hospital concluded that the third OP treated the patient in accordance with the medical standards and prayed for dismissal of complaint.

OP No. 3 did not appear before District Forum and she was proceeded ex -parte.

OP No. 4 was impleaded later on.

LEARNED District Forum after hearing all the parties dismissed complaint. Complainant filed appeal before learned State Commission and State Commission vide impugned order allowed appeal and directed OP No. 1 to 4 to pay Rs.1,00,000/ - along with Rs.5,000/ - as costs against which both parties have filed revision petitions along with application for condonation of delay.

OP No. 3 did not appear inspite of service through publication in R.P. No. 693 of 2012 and she was proceeded ex -parte. In R.P. No. 4135 of 2012, OP No. 3 was deleted.

HEARD complainant in person and learned Counsel for OP No. 1, 2 and 4 and perused record.

OP filed revision petition after delay of 45 days and complainant filed revision petition after delay of 158 days. I deem it appropriate to condone the delay in filing both the revision petitions for the reasons mentioned in the application and delay stands condoned.

COMPLAINANT submitted that inspite of proof of negligence on the part of OP in not providing oxygen and ventilator facility just before death of his father, learned State Commission committed error in granting compensation of only Rs.1,00,000/ -, hence, revision petition be allowed and compensation be enhanced. On the other hand, learned Counsel for the respondent submitted that inspite of proof that there was no negligence on the part of OP during treatment and just before Death learned State Commission has committed error in awarding compensation, hence, revision petition be allowed and impugned order be set aside.

PERUSAL of record reveals that complainant''s father was treated in OP Hospital from 7.1.2003 to 21.1.2003. 14.7.2003 to 18.7.2003, 10.5.2004 to 22.5.2004 and 28.5.2004 till his death on 2.6.2004. Complainant has alleged negligence on the party of OP on the basis that OP No. 3 was not qualified doctor to treat the patient. When complainant was asked whether OP No. 3 was MBBS or not, complainant submitted that OP No. 3 may be MBBS, but she was not Nephrologist and in such circumstances, she was not competent to treat the patient. Admittedly, OP No. 3 was qualified doctor to treat complainant''s father and complainant could not show that only Nephrologist was competent to treat patient.

COMPLAINANT further submitted that his father was just to be discharged, but suddenly he felt breathlessness and he was not provided oxygen and ventilator facility immediately. Complainant has not placed any expert opinion that there was any deficiency on the part of OP in treating complainant''s father. On the other hand, OP has placed proceedings of meeting dated 3.6.2004 in which 5 doctors observed that there was no lapse on the part of Dr. Sharmila, i.e., OP NO. 3. Later on, other 4 Doctors examined medical report of complainant''s father and observed as under: "MEDICAL REPORT OF SRI Y.A. CHENNA REDDY, 67 YEARS MALE The Head of Department of Nephrology, Neurology, Anesthesiology and Medical Superintendent have studied the medical record of Sri Y.A. Chenna Reddy, aged 67 years. The team examined the documents provided i.e. history, physical examination and investigations treatment summary. He was on follow up at Apollo Hospitals with diagnosis of Diabetes Mellitus, Hypertension, chronic renal failure resulting in end stage renal disease. He was treated initially with hemodialysis and later with continuous peritoneal dialysis since 2003. This patient was admitted on 28.5.2004 and expired on 2.6.2004 at 1.30 PM. He was admitted with sudden onset of breathlessness and non -productive cough. He was investigated and treated on the lines of lower respiratory tract infection with antibiotics, broncho -dilators and other supportive medication. Cardiologist, Nephrologist, Neurologist and the physician have examined him during his hospital stay. Two weeks prior to this admission he was admitted in the same hospital with history of fall and altered sensorium and was found to have intra cerebral bleed with extension into subarachnoid and subdural spaces. At that time he was managed conservatively and discharged. During this admission, he developed Type I Respiratory failure and lower respiratory tract infection and gradually became unresponsive and was treated in the intensive care unit with supportive care. The patient expired on 2.6.2004. CONCLUSION On review the management of the patient and patient of management is found satisfactory." Discharge summary given by two doctors including Nephrologist which runs as under: ESRD on CAPD for the last 6 months was admitted on account of breathlessness of sudden onset from the morning of the date of admission. About 2 weeks prior to the present admission the patient was admitted in this hospital on account of altered sensorium of sudden onset following a fall. Evaluation was revealed intracerebral bleed, since that time the patient had altered sensorium with global aphasia and reduced response to painful stimuli. During the initial evaluation of the present admission, patient was having dyspnea with ABG suggestive of Type I respiratory failure. During the course of his admission, the patient developed a lower respiratory tract infection and in course of time, the patient was found to have become unresponsive to pain. Patient showed very little response to therapy. Patient was initially admitted in the ICU and given all supportive care. On the morning of 02.06.2004, patient was found to have labored breathing associated with sweating. He had a cardiac arrest within a few minutes was resuscitated and put on ventilator. In spite of maximum inotropic support pulse rate and BP could not be recorded and patient desaturated steadily. At 1.20 PM on 02.06.2004, patient had cardiac arrest with asystole from which he could be revived. Patient was declared dead at 1.30 PM on 02.06.2004. Relatives were periodically counseled regarding his illness and the poor outcome". The above report reveals that death occurred due to cardiac arrest with asystole. Death certificate also reveals that cause of death was - "CAUSE OF DEATH: Terminal illness with D.M. HTTN CRF and Intracraneal bleed cardio respiratory arrest. He/She was not suffering from any communicable disease and is not infectious others".

IN the light of aforesaid opinion of experts, discharge summary and death certificate, it cannot be held that there was any deficiency on the part of Ops in treating complainant''s father. Learned State Commission in paragraph 30 of the judgment observed "The third respondent stopping supply of oxygen for a minute or two led to the patient suffering from breathlessness which however could not be an exclusive factor contributing to the death of the patient " which makes it clear that non -supply of oxygen and ventilator facility at the last moment was not the only cause contributing to death of complainant''s father. Merely because complainant''s father who was 67 years old suffering from Terminal illness with D.M. HTTN CRF and Intracraneal bleed collapsed suddenly on account of cardiac arrest, at the time of discharge (either he was fit for discharge or likely uncurable) no medical negligence can be attributed on the part of OPs.

IN the light of above discussion, no medical negligence can be attributed on the part of OPs and learned District Forum rightly dismissed complaint, but learned State Commission committed error in allowing appeal partly and awarding compensation. In such circumstances, Revision Petition No. 4135 of 2012 is to be allowed and Revision Petition No. 693 of 2013 is to be dismissed.

CONSEQUENTLY , Revision Petition No. 4135 of 2012 filed by OP is allowed and impugned order dated 23.5.2012 passed by learned State Commission in Appeal No. 1214 of 2009 - C. Pratap Reddy and Anr. Vs. C. Jaypal Reddy and Ors. is set aside and order dated 11.04.2008 passed in CC No. 614 of 2006 C. Jayapal Reddy Vs. C. Pratapreddy and Ors. dismissing complaint is affirmed. As complaint has been dismissed, R.P. No. 693 of 2013 filed by complainant stands dismissed with no order as to costs.