JAGAT NARAYAN CHAUBE vs ACHAL SEPAHA

THIS complaint is filed under Section 17(1)(a)(i) of the Consumer Protection Act, 1986 (for short the Act) by the complainant Jagat Narayan Chaube and his two sons against the opposite party Dr. Achal Sepaha and Choithram Hospital for the alleged medical negligence in the treatment of late Smt. Vimal Chaube wife of complainant No.1 and mother of complainant Nos. 2 and 3.

FACTS of the case in brief are that Smt. Vimla Chaube was suffering from Diabetes Mellitus and Chronic Renal Failure. She was under treatment of Dr. D.K. Agrawal and Dr. V.K. Sharma at Bhopal. As her both kidneys were not functioning, therefore, she was kept on dialysis from time to time as per requirement. Dr. D.K. Agrawal is a qualified Nephrologist having degree of DM and DNB in Nephrology and was Lecturer in Gandhi Medical College, Bhopal. Doctors at Bhopal advised, for transplantation of kidney. Prior to kidney transplantation matching of donor''s kidney with receiving patient was necessary, therefore, tests like HLA typing and tissue matching are necessary. He came to know that facilities for these tests are available in M.P. at Choithram Hospital and Research Centre in Indore, therefore, the patient was taken to Indore. The complainant took his wife and the donor to carry out these two tests at Choithram Hospital and Research Centre, Indore. Dr. Achal Sepaha i.e., opposite party No. 1 who was Surgeon and Nephrologist Consultant at Choithram Hospital examined his wife and told that it is an offence to take kidney from a donor other than relative. Dr. Sepaha found the blood group of complainant''s son matches with the complainant''s wife, he told the complainant No. 1 that his son can donate kidney and transplantation can be done, but the complainant No. 1 did not agree to transplant the kidney of his son. It is alleged that opposite party No. 1 Dr. Sepaha told that his wife will be cured through regular treatment and there will be no necessity of transplantation of kidney. Therefore, the complainant admitted his wife in Choithram Hospital on 1.8.1996. The patient remained in the hospital but Doctors did not take proper care, as a result of which patient expired on 11.9.1996 in the hospital. The complainants have alleged deficiency and negligence which resulted in death of the patient on the following gounds : 1. That the opposite party No. 1 Dr. Achal Sepaha is not a qualified Doctor to treat the kidney patients. 2. The complainant''s wife was given blood on 2.8.1996 which was one month old. Again on 6.8.1996 two units of blood plasma was given. The blood group of the patient matched with the blood group of his son. Hospital Authorities took fresh blood of his son but the same was not utilized and one month old blood was transfused. 3. Blood Transfusion was not needed as Haemoglobin (HB) was 11 gm% on 31.7.1996 and 10.8 gm% on 2.8.1996.

On 5.8.1996, the opposite party No.1 Dr. Sepaha, advised for Haemodialysis while earlier he assured that dialysis will not be required. On 6.8.1996, when the dialysis was to be done in morning, tablet of Hipril was given whereas this tablet is not given on the day before dialysis, therefore, during dialysis on 6.8.1996 at around 12 O''clock complainant No. 1''s wife was drowsy and deteriorating and her pulse was lost.

ON 28.8.1996, the complainant No. 1 brought his wife to opposite party No. 2 hospital for HLA Typing and Tissue matching of another donor. She was admitted in the hospital where on 29.8.1996, dialysis was carried out. During this dialysis, patient suffered cardiac arrest which was revived with great difficulty. This was due to failure of opposite party to control blood pressure during dialysis. On 5.9.1996, certain tests were conducted. One of the test which was conducted was for Hepatitis B. On test, Hepatitis B was found positive. The opposite party No. 1 Dr. Achal Sepaha when he was consulted, told that unless Hepatitis B is controlled, transplantation cannot be done. It will take more than three months. The complainant alleges that this Hepatitis B developed due to blood transfusion, in the opposite party No. 2 hospital because she was given five bottles of blood in Choithram Hospital between 31.7.1996 to 6.9.1996.

IT is alleged that increase in leucocyte count was also due to negligence of the opposite party because on 2.8.1996 leucocyte count was 8,900 which reached to 33,000 on 9.8.1996. IT is alleged that due to unhygienic condition in the hospital and particularly in the dialysis room the infection developed. The opposite party Dr. Sepaha recommended another dialysis on 7.9.1996 while it was not required because the weight of the patient was only 46 kgs. which was much less than patient''s ideal weight of 49 kgs. It is alleged that during dialysis, blood pressure of the patient was not monitored, ultrafiltration was started along with dialysis. This ultrafiltration suddenly reduces the blood pressure which resulted another cardiac arrest and the patient was put on Oxygen and the patient was required to be shifted to ICCU. It is alleged that while shifting to ICCU Oxygen was removed which was a mistake on the part of the opposite party.

THE Junior Doctor recorded the blood pressure from the right hand where fistula was fixed. This was a negligent act which resulted the flow of blood through fistula and was dropping on the floor.

PATIENT Smt. Vimal Choube was a known case of hypotention, diabetes but the opposite party did not take care to control both these ailments. Glucose was given to the patient from time to time but nothing was done to neutralize the sugar.

The another point of carelessness has been alleged in the ECG report of the patient as the patient''s name in this report has been mentioned as Urmila Choudhary instead of Vimal Chauble.

THE record of the hospital has been manipulated. To corroborate his stand the complainant alleged that on 28.8.1996 Hipril was mentioned to be given at 10 a.m. but the record shows that it has been struck down and SOS has been written in the same sheet on 29.8.1996, the Hipril was perhaps given at 10 a.m. but this record has been tampered by rubbing the entry. This shows that there is manipulation in the record. Another example of tampering of record has been shown by the complainant is the Haemodialysis record. Haemodialysis record dated 7.9.1996 in which time of dialysis has been shown starting from 2.25 p.m. and ending at 7.25 p.m. while in the hospital record dated 7.9.1996, it is mentioned that haemodialysis was ordered to be stopped at 4.25 p.m. and the patient was to be shifted to ICCU for observation. 4. THE opposite parties in their defence version have denied the allegations made in the complaint. THEy have produced hospital record showing daily record of treatment given from time to time. THE treatment given in the hospital and the record has been proved by the opposite party by their affidavits. Special attention has been drawn to the affidavit given by Mr. Prateek Birthare who is nephew (sister''s son) of the complainant No. 1 and is working as technician in the Dialysis Unit of the Choithram Hospital. He has denied the allegations made in the complaint and has stated on oath that proper care and treatment was given to the patient. THE opposite parties have submitted that the patient was a known case of chronic renal failure whose both kidney were not functioning, therefore, the only way to save her was Dialysis from time to time and ultimately kidney transplantation. THEy have done dialysis and treatment with utmost care and responsibility. THE opposite parties produced photocopies of the hospital record because the original record has been ceased by the police in the complaint lodged against them by the complainant No. 1. 5. After appraisal of the complaint, written statement, affidavits, record of the hospital, medical literature filed by both the parties findings are as under: From the record it is an established fact that the complainant No. 1''s wife Smt. Vimla Chaube was an old case of Chronic Renal Failure and was under treatment of several Doctors prior coming to opposite party No. 2 Choithram Hospital. Prescription dated 27.12.1995 of Dr. D.K. Agrawal makes it clear that she was a case of Diabetes Mellitus and had complaint of swelling, ghabrahat, loss of appetite, less urine, pain in right leg. Another prscriptions dated 3.1.1996, 9.1.1996 and 10.1.1996 of Dr. A.K. Agrawal mentions Chronic Renal Failure. Other prescription dated 29.3.1996 of Dr. V.K. Sharma also mention Chronic Renal Failure. It makes clear that the patient before going to Choithram Hospital had complaint of Chronic Renal Failure and treatment for kidney was being administered. It is stated on oath by opposite party No. 1 that kidney was practically defunct resulting edema plus and collection of fluid in the body in May-96. THE patient was taken to Sanjay Gandhi P.G. Institute of Medical Reserach, Lucknow, where Prof. Dr. R.K. Sharma prescribed six tablets of lesix per day even when she was already on dialysis, this means that the patient was already in critical condition before reaching to Choithram Hospital i.e. on 31.7.1996. 6. So far as the point that the opposite party No. 1 Dr. Achal Sepaha was not competent to treat the cases of kidney is concerned, it is stated on oath by Dr. Achal Sepaha that he passed MBBS from Indore in 1974-75 and had done MD in the year 1978, then he worked in Jaslok Hospital, Mumbai as Senior Registrar in the Department of Nephrology from June, 1978 to July, 1979 and then had an advanced training in Nephrology for three months in the year 1981 at Manchester, United Kingdom and has done a course of kidney transplant in the year 1982 at Brooklyne Down State Medical Centre, U.S.A. This is sufficient to show that the opposite party No. 1 Dr. Achal Sepaha is a qualified Doctor in the field of Nephrology and was competent to take the case of the patient for administration of treatment. 7. So far as taking blood of the son of the complainant and not administering that blood is concerned, the opposite party has submitted that the allegation that one month old blood was given on 2.8.1996 and 6.8.1996 is not correct. In fact, tested plasma was given on 2.8.1996 and 6.8.1996. Fresh blood or Plasma cannot be given to any patient without performing necessary tests which takes at least 48 hours to rule out the presence of Australian Antigen (Hepatitis ''B'') Aids etc. THErefore, even the blood of complainant''s son was taken, it could not have been administered because it was not tested as per practice prevailing in the blood bank. THE opposite party has submitted that fresh blood was obtained and in its place tested blood was issued and after testing the blood taken on that date, it is replaced in the blood bank. This practice is adopted universally for smooth running of the blood bank, therefore, to say that fresh blood should have been administered is against medical norms. Moreover, it was not fresh blood that was administered but it was tested plasma which was given on 2.8.1996 and 6.8.1996, therefore, the opposite party Doctor cannot be blamed for not administering the blood taken from his son. 8. THE allegation that his son was prepared to donate the kidney is not correct as Mayank Kumar Chaube, the complainant No. 2, in his affidavit has stated that on 30.7.1996, he accompanied his mother and father with one Babulal resident of Satna who was just like a family member. This Babulal was prepared to donate the kidney. This means that the averment of opposite party No. 1 is correct, that no relative of the patient or complainant was ready to donate the kidney. On the other hand the complainant No. 1 asked to transplant the kidney of some one other than the relative, to which opposite party No. 1 refused. 9. THE above fact is further corroborated by the affidavit of Mr. Prateek Birthare, who is the nephew of the complainant, who has stated on oath that the complainant brought three persons for kidney donation but it was against the law, hence, Doctor refused to transplant the kidney, therefore, the complainants have made wild allegations against the opposite party No. 1. We, therefore, find that the averment of the complainant that his son was prepared to donate the kidney is not proved. 10. Regarding allegation that plasma was one month old, it is submitted by the opposite party that as per act pertaining to Blood Bank, plasma can be stored for one year. THE opposite party doctor has submitted that he administered blood plasma on 6.8.1996 and 8.8.1996 and the condition of the patient improved. THErefore, we find that one month''s old plasma transfused had no adverse affect. 11. So far as the blood ought not to have been given on 2.8.1996 and 6.8.1996 because Haemoglobin (Hb) was 11 and 10.8 gm% the opposite party No. 1 has stated that this allegation is based on the basis of report dated 15.10.1997 of Dr. D.S. Badkur that the blood transfusion was not necessary. To this, Dr. Achal Sepaha submitted that the report issued by Dr. Badkur is self contradictory because in the last para of his affidavit he has stated that he cannot give a definite opinion on the medicines used in the common way so it is the contention of the opposite party No. 1 that when he cannot give opinion about common treatment then how he is giving opinion about blood transfusion and dialysis which is a highly specialized mode of treatment. Dr. Badkur has no experience of treating patients as he is employed in Executive capacity in a non-clinical department. He basically deals in medico legal cases and carries out post-mortem, his area of expertise is in dealing with dead bodies. He has submitted that the imagination of the complainants that blood transfusion was not needed to the patient having satisfactory level of haemoglobin is only a wishful thinking of the complainants and not of medical experts. Blood transfusion is not dependent on one factor of haemoglobin. As has been stated by the opposite party No. 1 that after administration of blood plasma, the condition of the patient improved. It is stated by him that when he refused to accept the request of the complainant No. 1 to transplant the kidney of any other person, he got annoyed and got the patient discharged of his own and made false allegations. We, therefore, find that the decision of the opposite party to administer blood plasma was necessary because after administration of blood plasma condition of the patient improved. 12. THE opposite party No. 1 Dr. Achal Sepaha in his affidavit dated 22.11.1999 has submitted that the complainant has brought his wife in March-April, 1996 and consulted him. At that time, he advised to get his wife admitted in Choithram Hospital because she meeded dialysis. At that time, he did not listen to his advice and has stated that dialysis has been done in other hospitals. This shows that the opposite party has been suggesting dialysis and kidney transplantation prior to 1.8.1996 and 5.8.1996. He has further submitted that he never assured to the complainant that after treatment in Choithram Hospital by him, the patient will never require dialysis or kidney transplantation, hence, this is totally concocted and after thought. From the affidavit of Mr. Prateek Birthare and Dr. Achal Sepaha and previous presicriptions, it is clear that the complainant''s wife was having Chronic Renal Failure and therefore, dialysis was necessary. THErefore, it cannot be believed that any Doctor can state that the patient will not require dialysis or kidney transplantation. 13. So far as, the allegation that the Hipril Tablet was given on 5.8.1996 and 6.8.1996 before dialysis is concerned, perhaps, the complainant No. 1 has added this point in the complaint on the basis of report of Dr. Heeresh Chandra dated 6.5.1998 in which he has mentioned that Hipril Tablet was given on 4.8.1996 when BP was 130/70 but on 6.8.1996 this Hipril was not withdrawn before taking the patient for haemodialysis. Thus BP fall down to 70/50 and the patient became drowsy. To this Dr. Sepaha has submitted that on 5.8.1996, dialysis was not carried out. On 6.8.1996 dialysis was carried out and this tablet of Hipril was given at 10 a.m. He has submitted that the administration of any particular drug is not dependent on common practice but it depends upon number of factors in a particular case and in exigencies of situation of a particular patient. According to him the administration of this drug was proper in this situation. 14. From the Doctor''s Order Sheet of Choithram Hospital, we find that Haemodialysis could not be done on 5.8.1996 but this was done on 6.8.1996. According to Dialysis flow sheet of Choithram Hospital, Submitted by the complainant as Annexure-15 dialysis was started at 5 p.m. and ended at 10.30 p.m. which has been corroborated by the Nurses daily record. THE report of Dr. Badkur mentions that on 6.8.1996 BP was 130/70, it is alleged that it was on higher side and even going for dialysis Hipril Tablet was necessary to control the BP which was on higher side. Dr. Achal Sepaha has submitted that Tablet Hipril is an Angiotensin Converting Enzyme (ACE) Intibitor which is not used only as an Anti-hypertensive agent but also in left ventricular dysfunction. THE Hipril tablet is given to patients with impaired left ventricular function because of the institution of ACE in patients with ventricular dysfunction it prevents or delays the progression of heart failure and the incidence of sudden death. So far as the reference mentioned in the report of Dr. Badkur and Dr. Heeresh Chandra, that blood pressure has not been monitored, the opposite party has submitted that blood pressure was monitored, half-hourly and it has been mentioned in the separate register pertaining to Dialysis. From the above, we find that the decision of treating Doctor Sepaha for Haemodialysis on 6.8.1996 was correct.

THE complainant No. 1 has alleged that on 28.8.1996, he has again taken his wife to Choithram Hospital for HLA typing and Tissue Matching of another donor, his wife was again admitted in the hospital and dialysis was carried out on 29.8.1996. It is alleged by the complainant No. 1 that during dialysis, blood pressure was not controlled, therefore, his wife suffered cardiac arrest. THE report of Dr. Badkur has mentioned that the patient was admitted on 29.8.1996 but there was no mention about time and date of admission and the condition of the patient. To this, the opposite party Dr. Sepaha has stated that Dr. Badkur has not carefully seen the admission note, because the record reveals that patient was admitted in Choithram Hospital on 28.8.1996 at 10 p.m. with the diagnosis of Diabetes Mellitus, Chronic Renal Failure with fluid overload with fluid effusion. THE hospital record revealed that at the time of admission, she was having complaint of continuous vomiting, unable to sleep, breathlessness, loss of appetite, edema++. On this Haemodialysis was advised. THE treatment was given by intranasal oxygen, injection lasix and injection stemetil. THErefore, the report of Dr. Badkur that no time and diagnosis has been mentioned at the time of admission on 28.8.1996 or 29.8.1996 is not correct. From the record, it is clear that tablet Hipril was withhold. It is alleged by the complainant that though Doctor record mentions holding of tablet Hipril but medication record reveals that there is tampering in the record in which on 29.8.1996 same entry was made but later on it has been scratched down. Against Tablet Hipril it was mentioned that it is to be given at 10 a.m. once a day but this 10 a.m. has been cut and SOS has been added. During argument, the complainant No. 1 and his Counsel stressed this point that tablet Hipril was given by nurse in spite of the fact that Doctor has ordered to withhold this tablet and to this he alleged medical negligence on the part of opposite party No. 2 Hospital. We have gone through the record of Dialysis submitted by the complainant as Annexure. A-15. This chart shows that on 29.8.1996 predialysis BP was 120/90 and post-dialysis was 100/70. This chart also mentions that dialysis started at 10.30 p.m. on 29.8.1996 and ended at 3.30 a.m. on 30.8.1996. From the record itself submitted by the complainant we find that the patient was taken for dialysis at 10.30 p.m. on 29.8.1996. The allegation that Hipril was given to the patient at 10 a.m. in spite of Doctor''s instructions to hold it is not proved by the record itself because as per dialysis record, pre-dialysis PB of the patient was 120/90. If we accept the allegation Hipril at 10 a.m. the blood pressure of the patient should have come down which is not the case, because at 10.30 in the night, the BP was 120/90. Therefore, from the record submitted by the complainant itself, the allegation that Hipril Tablet was administered by the nursing staff against the advice of Doctors of Hospital is not proved. So far as the point that the Australian Antigen i.e., Hepatitis-B developed during transfusion of blood in Choithram Hospital is concerned, the opposite parties have stated that this is a false allegation and in the circumstances of the case, it cannot happen within four weeks of blood transfusion. He has submitted that Australian Antigen does not develop instantaneously. Research revealed that this virus takes minimum six weeks to six months to have a reaction. Perhaps, this allegation has been added by the complainants on the basis of report of Dr. Badkur and of Dr. Heeresh Chandra. The report of Dr. Heeresh Chandra mentions that incubation period for Hepatitis B is 20 to 150 days. Both these reports mention that Hepatitis B infection might have developed in the transfusion done in the Choithram Hospital. To this Dr. Achal Sepaha has drawn our attention to the fact that the complainant has taken his wife to several hospitals for dialysis before coming to Choithram Hospital on 31.7.1996. The first blood transfusion was done on 2.8.1996. The inculbation period for virus of Hepatitis B is minimum 60 to 150 days. The Blood examination report dated 5.9.1996 revealed that Hepatitis B Positive while report dated 31.7.1996 was showing Negtive that means from 31.7.1996 to 5.9.1996 when the patient was under treatment at Choithram Hospital, period is only of 36 days. The opposite party further submitted that incubation period is minimum 60 days, therefore, development of Hepatitis B is not after the blood transfusion at Choithram Hospital but might have occurred prior to 31.7.1996 when the patient was taken moving from one hospital to other for dialysis. To corroborate his submission he has drawn our attention to a medical book Sleisenger & Fordtran''s Gastrointestinal and Liver Disease by Mark Feldman & Ors., 7th Edition 2002, Volume 2 published by Saunders at page-1293, which we quote : "Acute infection- The incubation period from acute exposure to clinical symptoms ranges from 60 to 180 days. Clinical presentation varies from a symptomiatic infection to cholestiatic hepatitis with jaundice, and rarely liver failure. In acute infection, Hbs Ag and markers of active viral replication (HbeAg and HBV DNA by hybridization assays) become detectable approximately 6 weeks after inoculation, before the onset of clinical symptoms or biochemical abnormalities."

THE complainant has filed a copy of literature regarding blood transfusion and ill effect of blood transfusion in which he had tried to establish that Hepatitis B can develop due to transfusion of two units of blood, but in this very literature it is mentioned that incubation period is generally between 60 to 150 days. From the literature submitted by the opposite party, it is also clear that Hepatitis B develops in minimum 60 to 150 days. In the report of Dr. Badkur, there is no mention about incubation period but in the report given by Dr. Heeresh Chandra he has mentioned that incubation period for Hepatitis B was 20 to 150 days thus on the basis of this medical literature these reports do not seem to be correct. THErefore, we find that this Hepatitis B might have developed prior to one month before coming to the Choithram Hospital.

SO far as the case of increase in leukocytes is concerned, Dr. Badkur mentioned in his report that on 2.8.1996 leukocyte count was 3,900 (actually it was 8,900). On 9.8.1996 it rose to 33,000. This shows that there was some infection. Dr. Badkur has stated that he cannot definitely say that this leukocyte count developed due to negligence of opposite party Doctor or hospital. The opposite party No. 1 Dr. Achal Sepaha has submitted that the patient was admitted in the Choithram Hospital on 1.8.1996 at 9.25 p.m, a case of Diabetes Mellitus, Hypertension, Chronic Renal Failure with Pleural Effusion. He stated that he drained 1,200 ml. pleural fluid. This fluid was the cause of increase of leukocytes. He further submits that it was he who diagnosed pleural effusion prior to this date none of the Doctors detected this development, therefore he submitted that infection was already there in the chest and thus increase of leukocytes cannot be alleged due to negligence or alleged non-cleanliness in the Choithram Hospital. We have no reason to disbelieve this submission that on the very first day on 1.8.1996 when the patient was admitted in Choithram Hospital. The opposite party Doctor diagnosed along with other diseases presence of pleural effusion and, therefore, there was no negligence on the part of the opposite party. So far as this allegation that the dialysis on 7.9.1996 was not required is concerned, the opposite party Dr. Sepaha has submitted that the necessity of dialysis was much more to this patient because patient was at end stage of Renal Disease which needs dialysis thrice a week. He has submitted that Dr. Badkur in his report agreed to the requirement of dialysis on 5.9.1996 on the basis of Bio-Chemical reports but for 7.9.1996 he gave no definite opinion due to non-availablity of record. The opposite party Doctor has submitted that dialysis was more necessary because urine output was only 60 ml. from 5.9.1996 to 6.9.1996 which is mentioned in Intake and Output charts of the hosptial. He has further submitted that Dr. Badkur and Dr. Heeresh Chandra have not seen the dialysis record which makes clear that the record of vital sign from from time to time has been mentioned.

The complainants have alleged that the disalysis record and the Doctors order sheet has different timings, it shows that the record has been manipulated, to demonstrate that the complainants have filed copy of dialysis chart in which entry on 7.9.1996 reveal that the patitent''s weight was 46 kgs. and BP was 120/70. So far as the timing is concerned, the dialysis started at 2.25 p.m. and was off by 7.25 p.m. but remarks column makes it clear that the patient was shifted to ICCU but no timing has been given. It means that he has been sifted after 7.25 p.m. while Doctor''s notes mentions that at 4.20 p.m. Haemodialysis was stopped and direction for shifting of the patient to ICCU for observation was given. From the record we find that during dialysis BP was 110 systolic and pulse was palpable, hence the patient was gasping. So, the Doctors stopped dialysis at 4.15 p.m. and the patient was shifted to ICCU. Therefore, the timings which are mentioned by the Doctor are important and worth relying. The timing in dialysis sheet are recorded by nurses and it is a clerical noting which is of not imortance. Therefore, the allegation of manipulation of the record has no merit.

SO far as the point of ultrafiltration should not have been done is concerned, the opposite party submitted that in view of the critical condition of the patient, dialysis was necessary. It has nothing to do with the weight of the patient when the life of the patient was on stake. He has submitted that if he had not carried out dialysis, the patient could have lost her life instantaneously. He states that BP was recorded. Ultrafilrtration was necessary looking to the condition of the paitnet as there was fluid overload as well as passing of urine was practically nil, therefore, the ultrafiltration was necessary. The opposite party Doctor has submitted that all necessary precautions and parameters were recorded and it is totally false to say that while shifting the patient to ICCU Oxygen was withdrawn or no Doctor had attended the patient while shifting the patient to ICCU. We have no reason to disbelieve the submission of the Doctor which is clear from the Doctors and Nurses record. The opposite party has stated that their hospital has so for done 41,105 Dialysis and they are having well trained staff. The paramedical staff of the hospital know that the patient for dialysis has fistula, because from this fistula IV fluid is given through left hand, in the circumstances, BP was recorded from the right hand, hence, it is totally false that bursting to fistula or bleeding occurred. From the record of the hospital we find that the hospital has undertaken 41,105 dialysis and 260 kidney transplants. Hence, it cannot be said that the staff was negligent only in dealing with his case.

SO far as the allegation that the blood sugar was not monitored is concerned, this allegation is based on the report dated 6.5.1998 of Dr. Heeresh Chandra in which he has stated that the hospital record does not indicate that the blood glucose was regularly monitored. To this, the opposite party has submitted that from very beginning it was a known case of Diabetes Mellitus and treatment was being given keeping all these points into consideration. The precautions were taken to control the diabetes which are supported by the record. As has been stated by Dr. Sepaha in his affidavit in paras 17(b) and (c) Patient was re-admitted on 29.8.1986 and was discharged on 1.9.1996. Blood sugar was estimated once on 29.8.1996 and twice on 30.8.1996. Morning blood sugar on 30.8.1996 was 402 mgs% which was nicely controlled to 185 mg% by evening. Dr. Heeresh Chandra just to support his opinion incorrectly stated in his report that blood sugar was 185 mgs% in the morning and 402 mgs% in the evening. This fact can be verified from the Receipt No. 24/275 the serial number of which is earlier than the Receipt No. 140/275. Though blood sugar estimation was done thrice but Dr. Heeresh Chandra states that it has not been done. The patient was not re-admitted on 29.8.1996 but on 28.8.1996 in a poor condition. After admission due care and precautions were taken to control diabetes which is evident from the record as under : (a) Blood sugar on 10.9.1996 at 1.00 p.m. - 195 mg% Blood sugar on 10.9.1996 at 8.00 p.m. - 296 mg% Injection Crystalline Insulin given (b) On 11.9.1996 ordered to do blood sugar analysis six hourly. (c) BSR was high on 11.9.1996 at 1.45 p.m. injection insulin given. (d) 15 units of insulin added in each peritoneal dialysis bottle meaning 15 units if insulin was given every hour. (e) Injection cyrstalline insulin increased to 20 units in each pertioneal dialysis bottle meaning 20 units of Insulin was given every hours.

The allegation of non-attending the diabetes ailment is false. The same was controlled from the beginning with effective medicines like insulin, which is duly recorded in the records after investigating it in time bound programme. The opposite party No. 1 has submitted that the medicines given if did not respond by the patient then it is beyond doctor''s control. From the record it is evident that the treatment was done keeping in view the diabetic condition of the patient. Therefore, the opinion of Dr. Heeresh Chandra which is contrary to record cannot be accepted.

THE complainants have alleged that the hospital was negligent in sending the report of ECG which show the name of Urmila Choudhary instead of Vimal Chaube, the opposite party has submitted that the complainant No. 1 had himself gone to the admission counter and got recorded the name of patient Urmila which was corrected when it was brought to the notice of opposite party No. 2. We have perused the ECG report though the name is mentioned as Urmila Choudhary but the hospital admission No. is mentioned as 218899 which was the number given to the complainant''s wife. This shows that it is clerical mistake which had nothing to do with the medical negligence.

FROM perusal of record, it is well establised that the complainant No. 1''s wife was the patient of Diabetes Mellitus with Chronic Renal Failure with Pleural effusion and when she came to Choithram Hospital, her case was that kidney was totally non-functional. Record shows that only 60 ml. urine passed during 24 hours. In such a case, where at the end stage renal disease has developed, there was necessity of dialysis thrice in a week. The opposite party has submitted that in the circumstances dialysis was necessary but dialysis hasits own effect. Even in Massry & Glassock''s Textbok of Nephrology it is clear that the death may occur during dialysis in cardiovascualr events. We, therefore, find that the opposite party No. 1 Dr. Achal Sepaha has diagnosed, treated and had taken proper care when the patient was admitted in the hospital and for that the opposite parties cannot be held negligent in any way. Here it will not be out of context to mention that in the complaint, the complainant No. 1 has tried to place himself as an expert by stating that such and such medicines should not have been given, administered or dialysis should not have been attempted which is not supported by any expert on clinical side.

In case of Achutrao Haribhau Khodwa v. State of Maharashtra, I (1996) CLT 532 (SC)=(1996) 2 SCC 634, the Supreme Court has observed thus : "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 prefession 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 and diligence 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."

TO conclude we find that the opposite party Doctor and hospital has diagnosed and treated the patient on the basis of the medical norms with due diligence skill and reasonable care. Therefore, the opposite party cannot be held negligent in any way. In the result, complaint fails and is missed with no order as to costsdis. Complaint dismissed.