CONSUMER RESEARCH INFORMATION And EDUCATION SOCIETY vs DURGABHAI DESHMUKH HOSPITA

THE complaint was filed by Sri P. Ramakrishna, Secretary of Consumer Research Information and Education Society (CRIES), on behalf of Sri K. Ravinder Reddy, S/o late K. Padma Reddy against M/s. Durgabhai Deshmukh Hospital and the consultant Cardiologist Dr. Dayasagar Rao, Durgabhai Deshmukh Hospital, Hyderabad stating that opposite parties were responsible for the unscrupulous exploitation of the patient K. Padma Reddy and his family and, leading to the death of K. Padma Reddy.

THE case in brief as per the complainant is as follows : Complainant''s father Sri K. Padma Reddy complained of breathlessness at his home in Thimmareddypally in November, 1989. After first aid he was rushed to Hyderabad and on the advise of Dr. Ramachandra Rao, who was the consultant at Durgabhai Deshmukh Hospital (the first opposite party), he was admitted on 8.11.1989 and was referred to Dr. Dayasagar Rao (the second opposite party) the consultant Cardiologist, for treatment. He was first taken into the Intensive Care Unit (ICU) as he complained of breathlessness. Upto 20th November, 1989 Sri Padma Reddy underwent a number of tests and was also given treatment, due to which his breathlessness receded and on that ground he was discharged. However, before discharge Sri Padma Reddy also developed stomach pain for which nothing was done. Later Padma Reddy visited the hospital as out-patient for the complaint of stomach pain and prescribed some more medicines but there was no relief. As his general health kept deteriorating, on the advice of the second opposite party, he was re admitted on January 15th, 1990 in the 1CU of the first opposite party surprisingly for stomach trouble despite the previous angiogram showing the heart condition normal. Again he underwent some more tests during the next eight days and it was reported that things were normal. While being discharged, he was advised to get endoscopy done at CDR Hospitals. He under went endoscopy and as per the reports it showed that everything was normal. But stomach pain continued and was getting worse day by day. Once again he was admitted on 27.2.1990 for the third time in the first opposite party hospital. Nevertheless hoping to get some relief and suspecting a wrong diagnosis and treatment, Padma Reddy on his own volition went to Apollo Diagnostic Center, Himayatnagar, Hyderabad to repeat the tests which were done on him earlier at the first opposite party hospital. To his utter shock the tests warned of renal failure, on 27th February, 1990. At this stage the first opposite party consulted Dr. Rambhupal, Nephrologist on February 28. In his presence all the clinical and pathological tests were repeated on March 1st and again they were found to be normal, though the patient was very weak and was suffering a lot. In fact Dr. Rambhupal threw the reports on the face of the staff and advised the patient to change the hospital. THE same tests were repeated on the advice of Dr. Rambhupal after getting him admitted at Amar Hospital, Hyderabad, on the same day, which confirmed renal failure due to a high count of serum creatinine calcium. It was then that Dr. Rambhupal concluded that the case had gone out of hand due to inadequate medical attention and treatment and the chances of survival were minimum. Under the treatment of Dr. Rambhupal, at Amar Hospital he remained till 9.3.1990. On March 9th he was shifted to Omsania Hospital and was discharged from there on 14th March. He was taken to his native place where he passed away on the same day. THE death certificate dated 29.5.1990 was issued by the Sarpanch. Thimmareddypalli. The complaint was lodged before this Commission on two accounts : (1) When the second opposite party found everything normal with the patient''s heart and discovered some ailment in the stomach as per his report dated 17.11.1989 he ought to have referred Padma Reddy to the concerned doctor. Instead, he continued to treat and subject the patient to a battery of tests like a guinea pig just for the sake of a few pennies.

(2) Though Padma Reddy was under the treatment of the second opposite party for almost four months his ailment was not diagnosed. correctly. On the other hand, tests done at Apollo Hospital, though the same as the ones done earlier at the first opposite party hospital, established a serious case of renal failure.

In view of the negligence, wrong diagnosis and treatment provided at the first opposite party hospital while under going treatment by opposite party No. 2 the claim was made as follows : Hospitalisation and medical expenses for four months . Rs. 50,000/- Boarding, lodging and travel expenses (for the bereaved family) Rs. 25,000/- Compensation for loss of life Rs. 1,75,000/- Rs. 2,50,000/-

The first opposite party filed its counter and refuted all the charges and allegations made by the complainant. According to it Padma Reddy came to the hospital in the month of November, 1991 with chest pain and abnormal ECC. He was then 65 years old with past history of ischemic heart disease, hypertension and family history of coronary artery disease. Sri Padma Reddy''s brother Dr. Indrasen a Reddy was stated to have suffered a heart attack previously. As Sri Padma Reddy complained of chest pain and as the ECG was abnormal, his condition required to be evaluated to establish the existence of a surgically curable /controllable, coronary artery disease and for this it was necessary to conduct the tests as advised by the consultant such as angiogram and screening of the heart which was done with the consent of the complainant on 17.11.1989. Again from the tests it was found that Sri Padma Reddy had cardiac disease of the coronary arteries which caused 30% to 40% obstruction and 100% occlusion of right common Iliac Artery. The second opposite party diagnosed the case of Padma Reddy as ''Anterolateral-Myo-Cardial Infarction'' a type of heart attack and put him on ISMO, Heparin and Depin. As Sri Padma Reddy was relieved of his chest pain after the treatment, he was discharged on 21.11.1989. He once again reiterated that all the tests conducted were essential and the treatment given to him was also right. The accusation that the diagnosis was wrong and the subsequent treatment led to the death of Sri Padma Reddy due to renal failure was unwarranted. The first opposite party was one of the best Cardiac Hospital in the city and they had been conducting open heart surgeries and Padma Reddy was correctly diagnosed and during this treatment he never complained of any stomach pain. Subsequently he visited as out-patient on 28.11.1989 and complained of pain in abdomen for the last three days and was seen by the duty doctor who asked him to stop using Dynaspirin. The duty doctor also advised Sri Padma Reddy to consult the Surgeon. Sri Padma Reddy returned again on 17.1.1990 with complaint of chest pain and breathlessness, though he did not complain of abdominal pain and therefore, was admitted in the hospital. He was diagnosed as having hypertension and left ventricular failure and was given appropriate treatment. Subsequently he was relieved of chest pain and breathlessness and he was discharged on 23.1.1990. The first opposite party further stated that the allegation that Sri Padma Reddy was admitted on 15.1.1990 was not correct. It also refuted that he visited the opposite parties quite a few times with the same complaint of stomach pain and medicines were also prescribed by the second opposite party but no relief was forthcoming. In February end he had returned from the village as he was having stomach pain and loose motions. He went to Dr. Sethu Babu at CDR Hospitals who conducted endoscopy and reported it as normal. Opposite parties never referred him to CDR Hospital. His allegation that the angiogram in November showed that his heart was normal was not correct. On the other hand the angiogram showed 30% to 40% ''long segment proximal block'', abdominal aerogram showed total block of right common ILIAC, internal and external ILIA vessels filling from left collaterals, thus accounting for the peripheral vascular disease of the right leg. He did not visit the hospital for follow-up after discharge on 23.1.1990. On 27.2.1990 he complained of abdominal pain and drowsiness and he was referred to a consultant visiting Surgeon on the day of admission and was seen by him on the very same day. The Surgeon wanted some investigations to be reviewed the following day. The bio-chemical test revealed abnormality indicative of renal problem and the matter was referred to Dr. Rambhupal on 28.2.1990. Since the laboratory values and the clinical picture were not matching, a laboratory error was suspected and a second blood sample was drawn at the hospital and was given to the attendant, son of the patient, Ravinder Reddy, to get the same analysed in another independent laboratory. The sample was sent to Apollo Diagnostic Centre at Hyderabad and the values showed high creatinine levels which was consistent with the clinical picture. The first opposite party also stated that the second opposite party was paid only Rs. 600/- per month as honorarium (conveyance allowance) for medical consultation thrice a week. He used to come at least thrice a week to the hospital and some times even 2 to 3 times a day and he was not paid anything for that. The allegation that the patients were overcharged and there was excessive billing was denied.

THE second opposite party, Dr. V. Dayasagar Rao, in his counter totally denied the charges made by the complainant. He had special objection to the first para quoted from Dr. Robert S. Mendelson. He reiterated the statements of the first opposite party. He argued that since he was an honorary consultant in the first opposite party hospital the case was outside the purview of the Consumer Forum. He further stated that Dr. S. Ramachandra Rao, retired Professor of Medicine, Osmania Medical College, a consulting Physician, referred K. Padma Reddy to him as a case of anterior wall myocardial infarction after admitting him in the ICU and that as such he had no role even in the admission. When first admitted Padma Reddy complained of chest pain for the last three days and the examination revealed that he had occlusive vascular disease of the right leg (blockage of blood vessel supplying blood to the leg). He also had anterior wall myocardial infarction as revealed by the abnormal ECG. He complained of breathlessness and had history of ischemic heart disease and hypertension. His brother Dr. Indrasena Reddy has also earlier suffered from heart attack. Since the ECG was found to be abnormal and in view of the age of Sri Padma Reddy and the symptoms like pain in the chest, breathlessness, poor blood supply to one of the leg and the family history, further investigation was carried out as the ECG was not a very reliable indicator of the extent of the disease. A coronary angiogram revealed the severity of the disease, so that further appropriate corrective measures could be taken. THE scanning of the heart (echo cardiogram) was done prior to angiogram to evaluate the possible risks during the procedure. If there was severe left ventricular dynafunction, the risk of angiogram would be very high, and consequently certain extra precautions would have to be taken. THE need for angiogram was explained to Padma Reddy and his brother Dr. Indrasena Reddy. A consent letter was also obtained and the test was performed on 17.11.1989. THE angiogram revealed the following : (a) disease of the left Anterior Descending Artery 30-40% block i.e. one of the major blood vessels supplying blood to the heart.

(b) disease of right iliac artery (i.e. the major blood vessel supplying blood to the leg) -100% of obstruction, and (c) mild hypokinesia of the apex (poor contraction of a portion of the heart).

THE diagnosis of the second opposite party was that Padma Reddy was suffering from "antero lateral myocardiac infarction". Padma Reddy was therefore given the necessary drugs i.e. ISMO, Heparin, Depin, Dynasprin and Mucaine Gel (an antacid). After treatment he was ambulant (walking) and asymptomatic. He was discharged on 21.11.1989. It must also be emphasised that there was no indication of renal disease either by clinical or bio-chemical parameters (blood test, urine examination).. THE fact that Padma Reddy was relieved from breathlessness and chest pain and that he was ambulatory would also confirm that the drugs given were appropriate and had the desired result. It was false to allege that the patient was discharged without relief. In view of the aforesaid facts, the allegation that the tests carried out were scandalously inaccurate, that there was wrong diagnosis and treatment which lead to his death, that angiogram and scanning were unnecessary, that tests performed immediately prior to death showed normal conditions, that the drugs prescribed had disastrous side effects and culminated in renal failure, that a renal problem was handled by a Cardiologist, were all baseless and made without any justification. No details were given as to the drugs alleged to have been administered, how they were not warranted and how they culminated in renal failure. THE records maintained did not indicate that Padma Reddy developed stomach pain prior to his discharge on 20.11.1989. THE second opposite party reiterated that on the basis of the symptoms, the result of the tests and the fact that Sri Padma Reddy was discharged following the absence of any complaint would only affirm that the diagnosis (heart attack and peripheral vascular disease) and treatment were proper. On 28.11.1989 when Sri Padma Reddy came to the first opposite party hospital with complaint of pain in the abdomen, he was seen in the out-patient department by Dr. V.K. Rama Rao, who asked him to stop Dynasprin and to consult a Surgeon for further evaluation. However the records did not show that Sri Padma Reddy followed the advise of the doctor. THE diagnostic report dated 27.2.1990 showed that he had urea 65 mg. per ltrs. and albumen in the urine : indicating renal failure. THE clinical examination revealed drowsiness and abnormal breathing because of which it was felt that there ought to be a higher level of renal insufficiency than what was indicated by the laboratory report. As such due to discrepancy between the clinical examinations and laboratory report, second sample was given to the complainant advising him to get tested from any laboratory of his choice and get a report. He got report on 28.2.1990 from Apollo Diagnostic Centre which confirmed the clinical suspicion of severe degree of renal failure. Dr. Rambhupal was called immediately. On the intervening night of 28.2.1990 and 1.3.1990 Padma Reddy went into left ventricular failure, for which he was attended. Dr. Rambhupal examined him on 1.3.1990 and advised peritorial dialysis and hence Padma Reddy was discharged on the same day and referred to Amar Hospital for further treatment under the care of Dr. Rambhupal. The second opposite party refuted the charge that Padma Reddy went to Apollo Diagnostic Centre on his own and alleged that he himself referred Padma Reddy to Apollo Diagnostic Centre and afterwards he was not aware as to what treatment Padma Reddy was given and why he was again shifted from Amar Hospital to Osmania Hospital and, then, discharged even from there and taken to his village. He refuted all the allegations made by the complainant like exploiting him and his family, trying to make fast buck by conducting unnecessary examinations, that the medicine given by the second opposite party led to renal failure, that he never treated Padma. Reddy for abdominal pain etc. Therefore, there was no question of giving any compensation to the tune of Rs. 1,75,000/-.

WHEN the case came up for hearing on 25.8.1990 it was mentioned by the first opposite party that the High Court had granted stay in WP. MP. No. 12139/90. However subsequently the case was taken up and written arguments were filed and it was reserved for judgment as per docket on 12.7.1993. The case was suo-moto reopened on 22.9.1997. Subsequently on 26.6.1998 when there was no response from the complainant (CRIES), notice was sent to the de- facto complainant Sri K. Ravinder Reddy, son of K. Padma Reddy which was also returned unserved, the case was posted for 13.8.1998. On 13.8.1998 it was reserved for judgment. Now the points to be considered are : (1) Was there wrong diagnosis by opposite party No. 2 on 17.11.1989 which led to the renal failure and subsequent death of Sri K. Padma Reddy ? (2) Were the tests not atall necessary and conducted only to extract more money, that is, unfair trade practice by the opposite parties ? (3) By not referring the case to nephrologist was there deficiency of service by the second opposite party? (4) Was the complainant made to buy harmful expensive medicines from unauthorised persons ? (5) Were the diagnostic reports given by Durgabhai Deshmukh Hospital not correct and cause of wrong diagnosis by the second opposite party ?

No witnesses were examined. However the second opposite party and the complainant filed their written arguments before the Commission. The medical reports, discharge certificates of Durgabhai Deshmukh Hospital, CDR Hospital reports and Amar Hospital reports were filed by the complainant. Strangely on behalf of the complainant some of the key witnesses like Dr. Rambhupal Reddy, nephrologist, Dr. Indrasena Reddy, brother of late K. Padma Reddy who accompanied Padma Reddy to Durgabhai Deshmukh Hospital and to whom the second opposite party had explained his line of treatment neither filed their affidavits nor were examined. On behalf of opposite parties 1 and 2 Incharge of Durgabhai Deshmukh Diagnostic Centre, Dr. S. Yella Reddy, Surgeon and Dr. Krishna Murthy, Surgeon who had seen Padma Reddy were neither examined nor their affidavits were filed. As regards the wrong diagnosis by the second opposite party as alleged by the complainant he has given detailed justification for his diagnosis and line of treatment, when Padma Reddy was first brought to him on 17.11.1989.

THE question is whether there was any conclusive proof that the second opposite party was aware of abdominal pain and other related symptoms in November. Padma Reddy was referred by Dr. S. Ramachander Rao after admitting him in the ICU for the complaint of breathlessness and chest pain i.e. heart complaint, therefore, he was treated accordingly. THE angiogram result and the test reports of the Durgabhai Deshmukh Diagnostic Centre also confirmed the heart related complaints and did not indicate very high creatinine level, therefore, he was discharged on getting relief. When Padma Reddy was seen in the out-patient department on 25.11.1989, abdominal pain was recorded for the last 3 days by Dr. Krishna Murthy and he was asked to discontinue Dynaspirin and to consult a Surgeon by the second opposite party. THE only point to be noted is that serum creatinine which was 1.0 mg% on 9.11.1989 was within normal value. When Padma Reddy was admitted the second time on January 17th, 1990 his serum creatinine value as per the report was 1.8 mg% which was slightly above the normal value of 0.8 -1.4 mg%. But as per the opinion of the second opposite party the slight rise could be due to heart conditions also and as such he did not pay much attention to it. It was only on 27.2.1990 when he was admitted for the third time serum creatinine was shown as 2.6 mg% which according to the second opposite party himself appeared to be less than the expected value as per the symptoms and therefore he sent the sample for another test to be done at Apollo Diagnostic Centre. THE report of the Apollo Diagnostic Centre showed very high creatinine level of 16.4 mg % as against 2.6 mg% shown by Durgabhai Deshmukh Diagnostic Centre which confirmed his opinion that Padma Reddy had to be treated by a nephrologist. As such the serum creatinine level of 1.8 mg% and 63 mg% of blood urea as per the report of 17.1.1990 might not prompt a cardiologist to refer the case to a nephrologist because such levels were possible in case of "left ventricular failure" which is usually temporary. As per the opinion of the second opposite party, such a condition needed only appropriate control of ''Hypertension and dietary control''.

WE find some contradiction in the original complaint and the affidavit given by the complainant. In the complaint the complainant accused the second opposite party for not referring Padma Reddy to a nephrologist in the month of November itself but in the affidavit he had shifted the stand and stated that in the month of January, he should have referred him to a nephrologist. Indicators of renal failure as we understand from the foregoing discussions, are high level of blood urea (above 45 mg%) serum creatinine (above 1.4 mg%) and albumen in urine (++). WE find that according to diagnostic report of another lab (Apollo Diagnostic Centre) the results were much higher but since the second opposite party was depending on the diagnositc centre of Durgabhai Deshmukh Hospital, he was led to conclude that Padma Reddy was suffering only from heart ailment. Therefore, basing on the reports of the Durgabai Deshmukh Diagnostic Centre his diagnosis and further treatment did not indicate any wilful negligence on the part of the second opposite party. 12.As per the charge of unfair trade practice by the second opposite party and Durgabhai Deshmukh Hospital (first opposite party) in conducting unnecessary tests for extracting money, we find no evidence of such a thing as has been clearly explained that angiogram was essential to confirm the ECG result and before angiogram, echo cardiogram was essential to know whether he could withstand it. Other tests like blood, urine, etc., are necessary even for confirming the case of renal failure. 13. The second opposite party was a consulting cardiologist and was not always present in the first opposite party hospital to observe the symptoms etc., and depended on the oral complaint of Padma Reddy, his relatives and reports of the Durgabhai Deshmukh Diagnostic Centre which were not very accurate and led him to the conclusion that consulting a nephrologist was not necessary in November or January. In February, 1990 however, he suspected deficiency in the report of the Durgabhai Deshmukh Diagnostic Centre and asked Padma Reddy to get the sample checked at Apollo Diagnostic Centre. Therefore, after he got a doubt, he immediately called for a nephrologist Dr. Rambhupal who came to Durgabhai Deshmukh Hospital and saw the complainant and on his advise Padma Reddy was shifted to Amar Hospital under his supervision, as such there was no proof of wilful negligence on this count. 14.As regards the purchase of medicines from unauthorised shop the second opposite party explained in detail that ''omnipaque'' was not available across the counter in the medical shops and it was available only from recognised dealers who had the licence to import it. Other . medicines must have been adequate for the heart ailment for which Padma Reddy was being treated. As such on this ground, the opposite parties could not be held responsible for unfair trade practice and making profit. 15.The charge that the diagnostic reports of the Durgabhai Deshmukh Hospital which led to the wrong diagnosis by the second opposite party appear to be true. The reports of Durgabhai Deshmukh Diagnostic Centre in the month of February when compared with the reports of Apollo Diagnostic Centre and subsequently with Amar Hospital showed drastically low values of serum creatinine, blood urea, which perhaps delayed the correct diagnosis by the second opposite party. In fact he himself got doubt about the report of the Durgabhai Deshmukh Diagnostic Centre and as such we find that some of the reports especially those of serum creatinine, blood urea and albumen in urine were perhaps not correct all the time, (though we have proof only for February). On this account, we find that there was deficiency in service on the part of Durgabhai Deshmukh Diagnostic Centre which was part of the first opposite party. 16. In consequence we hold that there is no conclusive proof of wilful negligence on the part of the second opposite party in diagnosis or treatment of Padma Reddy who was admitted for heart related complaints and was treated accordingly. There is also no evidence of overcharging by the opposite parties as only one receipt of Rs. 1,000/- has been produced which accounts for angiogram. Therefore, without any substantial evidence the second opposite party could not be held responsible for negligence in treatment and wrong diagnosis as he depended on the diagnostic reports of the first opposite party''s diagnostic services. 17. As regards the first opposite party there were no comparable diagnostic reports for November and January but the reports of February were much below compared to the reports of Apollo Diagnostic Centre and Amar Hospital. Hence it is conclusively established that the reports especially regarding serum creatinine levels were not correct. Had the reports been accurate and shown correct levels of serum creatinine second opposite party who was the consultant cardiologist would have referred Padma Reddy to a nephrologist in time for appropriate diagnosis and treatment for renal disease. There is no dispute that Sri K. Padma Reddy died of kidney failure. In the circumstances we are of the view that there is clear deficiency in service on the part of the 1st opposite party. Had the Diagnostic Centre of the 1st opposite party correctly conducted the serum creatinine level tests the renal failure could have been discovered earlier and Sri K. Padma Reddy could have been treated in time for renal failure and his life could have been prolonged. On the facts of the present case Sri K. Padma Reddy was in his mid sixties at the time of his death. He was suffering from ischemic heart disease and hypertension. On the facts of the present case we'' are of the view that a sum of Rs. 25,000/- would be a reasonable compensation for deficiency in service on the part of the 1st opposite party. In the result, the C.D. is dismissed as against the 2nd opposite party without costs. The 1st opposite party shall pay Rs. 25,000/- to the de facto complainant Sri K. Ravinder Reddy S/o late K. Padma Reddy within eight (8) weeks from today. The complaint is accordingly partly allowed as against the 1st opposite party with costs of Rs. 1,000/- The 1st opposite party shall also pay costs of Rs. 1,000/- within eight (8) weeks from today. Complaint partly allowed.