JAGDISH CHANDER vs FORTIS HEART INSTITUTE

-BRIEFLY stated the facts are that complainant was employed as Health Inspector in the Punjab Health Department at Hoshiarpur. On 4. 7. 2002, he approached Opposite party No. 1 (Fortis Heart Institute) for general checkup and after examination, he was told that he needed coronary angiography test. Accordingly his coronary angiography test was conducted and the report Annexure C-1 as follows: "cad. Triple Vessel Disease. Normal left ventricular systolic function. "

UPON examination of the report, OP No. 2 Dr. G. S. Kalra and OP No. 3 Dr. Venkatesh S. advised the complainant to go for CAD and was discharged on 5. 7. 2002 and was put on some medicines. He was also advised to come prepared for surgery on 10. 7. 2002. Consequently he went to the Fortis Institute on 10. 7. 2002 and got himself admitted and paid Rs. 1,45,000 as package. It was next averred that since complainant was a diabetic and after due clearance from endocrinology department of hospital on 11. 7. 2002 vide Annexure R-3 and after getting clearance from psychiatrist (Annexure R-6), by-pass surgery was performed on the complainant on 15. 7. 2002 and was discharged on 31. 7. 2002 and was put on medicines. The operation was performed by Dr. H. S. Bedi and Dr. G. S. Kalra. However, according to OPs, he was discharged on 23. 7. 2002 and was asked to come for followup after 7 days on 30. 7. 2002.

It was further averred that instead of improvement in the health of complainant after by-pass surgery, it had deteriorated, therefore, he visited OP No. 1 and was examined by Dr. G. S. Kalra who asked him to repeat all tests which were conducted before by-pass surgery and accordingly he got those tests done and after going through tests, Dr. G. S. Kalra advised him to go for Treadmill test again and, thus, TMT was conducted and the report of TMT was strongly positive for inducible ischemia. The copy of report of TMT is Annexure C-3.

IT was further averred that after TMT report, angiography was repeated and the complainant was told by the doctors of OP No. 1 that everything would again be repeated but since complainant had lost faith in OPs and as such refused to further undergo by-pass surgery. Therefore, he visited Dr. Raman Chawla, cardiologist of Oxford Hospital, Ludhiana for treatment on 10. 11. 2003, who examined him and prescribed certain medicines vide Annexure C-4 and then again went to Dr. Raman Chawla after 15 days but there was no improvement and on the other hand, his condition deteriorated and thus, his life became hell. It was next averred that it was evident from the TMT report which was strongly positive that by-pass surgery conducted upon him by OPs was a total failure and it was due to their gross negligence.

ALLEGING deficiency in service, he claimed Rs. 25. 00 lakh as compensation. Consequently, complaint was filed on 14. 7. 2004 in Punjab State Consumer Commission which was subsequently transferred to this commission at the arguments stage. Opposite parties contested the complaint. OP No. 3 Dr. Venkatesh S. was not served and his service was abandoned vide order dated 21. 12. 2004 as complainant could not furnish his correct address. However, OP Nos. 1, 2 and 4 contested the complaint and filed written reply. They stated that the patient was admitted to Fortis Hospital on 4. 7. 2002 vide Annexure R-1 and his history showed that he was 56 years old when he visited for the first time. He had a heart attack in 1997 and was having unstable angina (heart pain) since, 1997. He had also bouts of four suffocation attacks in and before 2002. He was having diabetes since,1999 (Mellitus Type II) and was on insulin. He was also suffering from depression and was on psychosomatic drugs and therapy. Thus, he was not hale and hearty as projected in the complaint. Instead, he was a high risk patient for cardiac surgery, therefore, a high risk informed consent form Annexure R-4 was got signed from him. They next stated that since he was diabetic patient, so, after due clearance from endocrinology department of the hospital on 11. 7. 2002 and further after getting clearance from psychiatrist, by-pass surgery was performed on 15. 7. 2002 and discharged after 14 days and the total expenditure for the procedure was for Rs. 1,42,864. The operation was performed by Dr. H. S. Bedi and Dr. G. S. Kalra. After discharge vide discharge summary Annexure R-7, he was told to come up for follow up with Dr. H. S. Bedi in his OPD after seven days on 30. 7. 2002. It was mentioned in the discharge summary Annexure R-7 that an OP coronary artery bypass grafting was performed. He was discharged in a stable condition. He did not come for follow up with Dr. H. S. Bedi on 30. 7. 2002 and instead visited endocrinologist only on 3. 8. 2002 vide Annexure R-9. They next stated that it was only after 4 months of the operation that the patient returned to the cardiologist at Fortis Hospital for checkup and considering his condition, he was advised treadmill test (TMT) vide Annexure C-3 and vide Annexure R-6 it was reported that he was having positive inducible ischemia but sometimes results of TMT were false and as such he was recommended for repeat of angiography which he refused to get performed. They denied that the health of complainant deteriorated after by-pass operation at Fortis Hospital. The treatment which was given to him at the hospital was of standard protocol which was followed by specialists world over and there was no deficiency on their part , therefore, they prayed that the complaint should be dismissed. Parties adduced their evidence by way of affidavits and documents.

WE have heard Counsel for complainant Sh. Onkar Singh, Sh. Pavit Mattewal, Counsel for opposite party Nos. 1, 2 and 4 and carefully gone through the file.

IT is an admitted fact that complainant visited OP No. 1 on 4. 7. 2002 for checkup of his health and he was admitted as indoor patient for examination in the hospital. On that date, he went through numerous tests and the doctor of OP No. 1 told that he needed coronary angiography test which was done as per advice of the doctor. The copy of the angiography test which was conducted on 4. 7. 2002 Annexure R-2 (Annexure C-1) showed that complainant had triple vessel disease. He was discharged on 5. 7. 2002 with the advice to get by-pass surgery and not CAD as wrongly stated in the complaint. It is further stated in the complaint that he was hale and hearty. However, medical history as stated in Annexure R-1 shows that he had heart attack in 1997 and was aged about 56 years and further was having unstable angina i. e. pain since, 1999. He had also bouts of four suffocation attacks in and before 2002. He was also having diabetes since, 1999 (Mellitus Type II) and was on insulin. He was further suffering from depression and was on psychosomatic drugs and therapy. Therefore, it cannot be said that he was hale and hearty and on the other hand, he was a high risk patient for cardiac surgery. Consequently, high risk informed consent form Annexure R-4 was got signed from him before performing surgery. Bypass surgery was performed upon him on 15. 7. 2002 after obtaining clearance from the endocrinology department of the hospital on 11. 7. 2002 vide Annexure R-3 and clearing from the psychiatrist vide Annexure R-6. He was ultimately discharged on 23. 7. 2002 as is clear from discharge summary Annexure R-7. He was advised certain medicines and was also asked to follow up with Dr. H. S. Bedi in his OPD after seven days, after prior appointment. The case of OP is that he never came for followup action on 30. 7. 2002 or earlier but attended the endocrinology department on 3. 8. 2002 as is clear from out-patient receipt Annexure R-9.

Discharge summary Annexure R-7 revealed that an OP coronary artery by-pass grafting was performed, which reads as under: "median sternogomy-Saphenous vein and LIMA and left radial artery left harvested. Patient was heparinized. The LAD area was stabilized by say sutures, the mid-LAD opened, a 1. 5 mm shunt inserted and the LIMA anastomosed with 8-0 prolene. The distal LAD and RCA were similarly grafted with SVG and RA resp. the proximals of these had previous been constructed on the ascending aorta. Hemostasis achieved-After placing pacing wires, 2 mediastinal drainage tubes, and left pleural tube, wound closed in layers. Antiseptic dressing done and patient shifted to ICU on stable hemodynamics. "

THEREFORE, it is clear that the patient was admitted for CABG on 10. 7. 2002 and was operated upon on 15. 7. 2002 and was discharged on 23. 7. 2002 and not on 31. 7. 2002, as stated by the complainant in the complaint. The case of the complainant is that his condition worsened after operation but he approached the doctor at Fortis Hospital after four months of the operation and after seeing his condition, he was advised to go through TMT and report Annexure C-3 showed that TMT was strongly positive. Therefore, TMT showed inducible ischemia. Sometimes, report of TMT is false, therefore, in order to rule out this possibility, the doctor had advised for repeat of angiography test to which complainant did not agree. Complainant had wrongly stated in the complaint that repeated angiography was performed upon him by the Fortis Hospital. Since, diabetes is a well known risk factor for coronary artery disease, so, most of studies suggest that diabetic patients on insulin should be considered high risk candidates for CABG and required intense perioperative and long term management. For this reason, 5% mortality is associated in the case of high risk persons.

THERE is no material evidence on file that the complainant after operation had been reduced to permanent handicap. No expert evidence has been examined to prove that the operation was performed upon complainant negligently. No specific mention has been made in the complaint as to what doctors ought to had done in the circumstances which the OPs had not done. Mere failure of operation cannot be held to be negligence on the part of OPs. It has been stated in medical literature Annexures R-11 and R-12 that diabetes is a well established risk factor for coronary artery disease and it is associated with an increased rate of early and late adverse events after myocardial revascularization by coronary artery by-pass grafting. It is further stated that the patients with insulin-dependent Type II diabetes who had coronary artery by-pass grafting have a significantly higher rate of major post-operative complications with an extremely unfavourable short and long term prognosis. Therefore, we hold that complainant has failed to prove that by-pass surgery performed by doctors of OP No. 1 was a failure due to their negligence and the blockage re-occurred, since, he was already having heart attack and was having diabetes and diabetes is a well established risk factor for coronary artery disease which led to major post-operative complications with an extremely unfavourable short and long term prognosis. Hence, it cannot be said that there was negligence on the part of OPs or they had not followed proper treatment protocol or that Dr. H. S. Bedi was not competent to perform the operation. In view of what has been stated above, complaint fails and stands dismissed. However, parties are left to bear their own costs.

COPIES of this order be communicated to the parties, free of charge. Complaint dismissed.