JASWANT KAUR vs R.K.AGGARWAL

COMPLAINANT, widow of S. Uttam Singh, who died on 3.11.1997, had filed this complaint against the opposite parties on the ground of medical negligence, lack of proper treatment, post-operative care, professional mis-conduct in administering the treatment to the deceased and blatant derogation of duties on the part of the opposite parties.

AS per case set up in the complaint, S. Uttam Singh was a qualified Engineer and Senior Consultant in Construction Company. He was admitted in the B.R.S. Heart Institute and Research Centre (hereinafter referred to as the Institute) with some cardiac problem on 27.10.1997, in response to the package deal for a payment of Rs. 2,10,000 inclusive of Angiography/Angioplasty and fixing of stint or any other treatment required for cardiac problem for which husband of the complainant was suffering. The package also included room rent and charges for post-operative care. On 28.10.1997 the patient was taken to operation theatre for angiography and after the operation was over, Dr. Mehra-opposite party No. 2 asked the complainant to deposit Rs. 1,55,000 for angioplasty and fixing of stint. The complainant deposited Rs. 1,05,000 immediately and sought time for deposit of the balance amount of Rs. 50,000 within next 24 hours but the Doctors of the opposite party No. 3 refused to carry out treatment immediately and the patient was brought back from the operation theatre. The opposite party No. 2 further informed the complainant that till the full amount was deposited, treatment would not commence. Accordingly on the morning of 29.10.1997 a cheque for Rs. 50,000 was handed over to Dr. Mehra and thereafter treatment was started. During the night, the complainant was informed that some complications have developed in fixing the stint and for that reason the patient was to be taken for open heart surgery and a further demand of Rs. 1,15,000 for carrying out open heart surgery was made from the complainant. On 30.10.1997 at about 11.00 hours the complainant was informed by the hospital authorities that her husband was normal and was to be discharged immediately, despite the fact that he was still in the Intensive Care Unit and needed post-operative care after the major surgery performed by Dr. R.K. Aggarwal - opposite party No. 1, who had also fixed a stint on the patient. Accordingly, he was forcibly discharged by the opposite parties. It is the case of the complainant that later on she gathered that the discharge of the patient was done because of the Diwali Festival as the Doctors and the staff of the Hospital wanted to have a holiday in connection with Diwali celebration. On 31.10.1997 Dr. Jindal, Chairman of the Institute - opposite party No. 3 was informed by the members of the complainant''s family that the patient has not passed any urine after the discharge from the hospital. Under the advice of Dr. Jindal, the patient was given Lasics tablet but still he did not pass any urine and for that reason he was again brought to the Hospital on 1.11.1997. After examining the patient but without giving any treatment to him, the patient was referred to P.G.I., where after admission in the P.G.I., the patient expired on 3.11.1997 due to massive bleeding and cardiac arrest. It is further alleged that even after the normal angioplasty, the Hospital required to provide atleast 24 hours post-operative care, while in the present case, after heart surgery, the patient was discharged within 12 hours of the operation without taking care that his condition had not stabilized. On these premises, Rs. 12 lacs were claimed as damages along with interest @ 12% per annum, besides Rs. 7,000 as costs of litigation against the opposite parties. The complaint was contested by the opposite party Nos. 1 and 2, who filed their separate written statements. It was pleaded by opposite party No. 1 that the patient, who was aged 75 years was admitted in the Hospital on 27.10.1997. He had a history of heart attack, which he had suffered in the year 1974 and was also suffering from Diabetes for the last 12 years for which he was taking drugs. He had chest pain and sweating 8 days earlier on 19.10.1997 which was relieved after some injection. On 21.10.1997, he again had chest pain and sweating and was admitted in a Hospital. There he again had chest pain next day when blood test, ECG and ECHO done revealed that he had suffered a heart attack. He continued to have repeated episodes of chest pain and was admitted in the hospital of opposite party No. 3 on 27.10.1997 where after examining the patient, diagnosis of old heart attack, fresh heart attack, post-heart attack, angina and diabetes was made. Therefore, a Coronary Agniography was planned. On the next day on 28.10.1998 it was revealed that two arteries of his heart were 99% blocked for which Angioplasty treatment was needed. The patient and the complainant were explained about the need for Angioplasty, its complications and chances of success. Thereafter Angioplasty was performed on 29.10.1999 without Anaesthesia and without incision or stitching. It was decided to use the special drug (Non-Ionic Dye) for the procedure rather than the regular drug (Ionic Dye), as the chances of drug related complications including kidney damage are less likely with the Non Ionic Dye in an old diabetic patient than the Ionic Dye. One artery was completely opened and a stint was fixed in it. The other artery could not be opened. The patient remained absolutely stable throughout the procedure. The procedure was completed at 6.00 p.m. and the patient was brought to the Intensive Cardiac Care Unit at 6.15 p.m. The patient was quite stable and the ECG done after the Angioplasty did not show any new change. He remained stable throughout the evening and during the night. Next day also he remained stable and also had his breakfast and lunch and he was discharged in the evening at 9.00 p.m. on 30.10.1997 after 26 hours of Angioplasty and not after 12 hours as alleged in the complaint. The further stand of opposite party No. 1 is that the duration of time for which a patient is kept in the hospital after the Angioplasty varies and Angioplasties are being done even on out-patient procedures. As early as in 1989, and later also, a large number of experts have been sending patients after an uncomplicated Angioplasty without admission, in less than one day''s stay in the hospital without any adverse effects as per "A pilot study of coronary angioplasty in out-patients" and "Early Hospital Discharge After Percutaneous Transluminal Coronary Angioplasty". The patient - Uttam Singh had an uncomplicated Angioplasty and stint, the patients are being discharged after only upto one day''s hospital stay without any adverse effects, if no blood thinning injections are given after the procedure, as was the case with Mr. Uttam Singh. According to J. Am Coll Cardiol, 1996 Jan; 27(1) : 22-9 and AM J Cardiol 1996 Aug. 1; 78 (3) : 334-6. another group of international experts on Angioplasty, have conclusively shown that if there are no complications during or within first four hours after the Angioplasty, the patient can be safely discharged even as early as 4 hours after Angioplasty. It was further stated that it has been firmly and conclusively shown that non-clinical or Angiographic variables are associated with length of stay of more than one day after the Angioplasty, and only complications during the angioplasty were associated with increased length of stay, as recorded in "Length of Hospital Stay and Complications After Percutaneous Transluminal Coronary Angioplasty, Clinical and Procedural Predictors." The patient was readmitted on 1.11.1997 at 12.40 p.m. with the history that he had not passed any urine since he was discharged from the Hospital about 40 hours earlier and he had hardly taken anything. Further according to him, "he suspected kidney damage, caused due to the dye used and also because he had very little intake. Kidney damage is a well known complication of dye used during the procedure, although it is less likely with the special dye (Nonp Ionic). His pulse and BP were normal and he passed 50 ML of urine in the Hospital. He was catheterized and given adequate and proper treatment for his kidney failure. Various blood tests and ECG were also done. In the evening at 5.00 p.m. blood tests were again done and since by that time kidney failure had not improved much, he was referred to PGI for further management of kidney damage. He further averred that at the time of treatment of the patient, he was Senior Consultant of opposite party No. 3. He stated to have done M.D. from Institute of Medical Sciences, Banaras Hindu University in the year 1981 and he did his DM (Cardiology) from P.G.I. in the year 1985. He had been working earlier in CMC, Ludhiana as a Professor of Cardiology and had left the service of that Centre in the year 1986 and thereafter he worked in private sector at Jalandhar before joining opposite party No. 3. He maintained that he had given correct treatment with due diligence to the patient in accordance with well established norms. The patient was provided all the best facilities and medical assistance by the opposite parties. He has also raised other pleas of non-maintainability of the complaint and want of jurisdiction of the State Commission to try the complaint as detailed evidence is required to be led by the parties and cannot be tried in a summary manner.

The opposite party No. 3 in his written statement refuted the stand of the complainant. It was pleaded by him that opposite party No. 3 is a fully equipped Hospital and has arrangements for heart by-pass surgery and other complicated cardiac surgeries. According to him, a large number of surgeries have been performed in the Institute. This Institute has fully qualified and professional team of surgeons, doctors and para-medical staff and has the latest equipment and infrastructure. While admitting that the patient was admitted in the Institute on 27.10.1997 he was accorded treatment, details of which had been given by the opposite party No. 1 in the written statement filed and for that reasons need not be repeated. Thus, it was pleaded that as the patient was treated to the best of ability and knowledge of the attending doctors, there was no medical negligence or deficiency in service on the part of the opposite parties and the complaint merited dismissal.

TO support the stand taken in the complaint, apart from the affidavit dated 29.9.1999 of the complainant- Smt. Jaswant Kaur, reliance has also been placed on statement of CW-1 Dr. Venkatesh, Senior Resident, PGI, Chandigarh, who produced the summoned record. At the same time, he maintained that he never gave treatment to Uttam Singh. From the side of the contesting opposite parties, reliance has been placed on the affidavit dated 23.5.2000 of Dr. R.K. Aggarwal- opposite party No. 1 and affidavit dated 31.5.2000 of Anoop Kumar, Secretary, B.R.S. Institute-opposite party No. 3. The main thrust of the arguments of the learned Counsel representing the complainant is that death of Uttam Singh is directly attributable to the medical negligence and improper post-operative care on the part of the opposite parties which is clearly brought out from the enumerated circumstances stated in the complaint. He, in particular, laid emphasis on the forcible discharge of the patient within 12 hours of his having undergone angioplasty. Further, according to him, principle of res ipsa loquitur, which is applicable in the present case, speaks of the magnitude of the medical negligence of the opposite parties in treating the deceased during the period he remained in the Institute and it is the duty of this Commission to take notice of conspiracy of silence as the contesting opposite parties have not chosen to support their stand taken in their written reply by appearing in the witness box during the trial of the complaint. In support of the stand taken, reliance was placed on the case Bhajan Lal Gupta and Anr. v. Mool Chand Kharati Ram Hospital & Ors., I (2001) CPJ 31 (NC)=2001 Judicial Reports Consumer 450, wherein it was laid down that in case where the doctors had acted carelessly and in a manner which is not expected of a medical practitioner, in such a case, action in torts would be maintainable. It was also laid down that a specialist is required to know the latest techniques for management of the patient and if he is ignorant about it, then he could be considered to be negligent in following his profession and for the lapse on the part of the staff, hospital would be liable to compensate the complainant. Again, reference was made to the case Dr. Janak Kantimathi Nathan & Ors. v. Murlidhar Eknath Masane and Ors., 2003 (1) Judicial Reports Consumer 124, wherein the facts were that a boy of 13 years of age, who had attended his school regularly upto 3.1.1992, was admitted in the Hospital on 6.1.1992 for treatment of epilepsy but he died within 48 hours of his admission, of septicemia and in this case, principle of res ipsa loquitor was applied.

OPPOSING the submission made, it has been strenuously urged by the Counsel representing the opposite party Nos. 1 and 3 respectively that in medical negligence cases it is for the complainant to establish his claim against the medical man and not for the medical man that he has acted with sufficient care and skill. They further contended that in this case, as allegations made in the complaint have not been supported by any expert evidence, the complaint deserves to be dismissed on this ground alone. Additionally, it was submitted that affidavit produced on record from the side of the opposite parties have clearly established that angioplasty was performed on the patient in accordance with the wholly accepted procedure, norms and standards with all degree of care and medical skill. It was also pointed out by them that no heart surgery as alleged by the complainant was done on the patient and the patient was not discharged forcibly, as stated by the complainant, but was discharged after 26 hours of the angioplasty in accordance with the norms of the medical jurisprudence and at the time of discharge the patient was quite normal. They justified that the patient was rightly referred to P.G.I. after kindney damage was suspected due to the Dye used and because of the little intake by the patient and before sending to P.G.I. he was catheterized and given adequate and proper treatment for kidney failure. It was also contended by them that the complainant has even failed to establish the exact cause of death of the patient and in view of the above stated circumstances brought on record the complaint be dismisssed. In support of the stand taken, reference has been made to relevant decisions on the issue of medical negligence. In case K.S. Bhatia v. Jeevan Hospital and Ors., IV (2003) CPJ 9 (NC) allegations made in the complaint were unsupported by evidence and for that reason the complaint was dismissed. In another case Babandeep Kaur v. Dr. (Brig.) S.C. Anand & Anr., III (2004) CPJ 577, it was laid down that in case of alleged medical negligence, specific acts of negligence have to be alleged and then proved as to how that amounts to negligence and this has to be supported by expert evidence of medical literature on the subject. In case Surinder Kumar (Laddi) & Anr. v. Dr. Santosh Menon & Ors., III (2000) CPJ 517, it was observed that onus to prove negligent act on the part of the doctor is very heavy on the complainant as held by the Hon''ble National Commission in case Sethuraman Subramaniam Iyer v. Triveni Nursing Home and Anr., I (1998) CPJ 10 (NC) that "in the absence of such evidence regarding the cause of the death and absence of any expert medical evidence, the complainants have failed to prove negligence on the part of the opposite parties". In case Smt. Kusum Sharma & Ors. v. Batra Hospital and Medical Research Centre & Others, III (2000) CPJ 18 (NC)=2002 (2) C.P.C. 669 it has been stated that it is a settled law that if a doctor has acted in accordance with a practice accepted as proper by responsible medical body skilled in that particular art thereby he cannot be held guilty of medical negligence. Moreover, every surgical operation is attended by risks and no benefit can be taken without taking risks. In that very judgment, it was also observed that error of judgment would not be the criteria of negligence and where there was two different schools of medical practice, both having recognition among practitioners, it is not negligence for a practitioner to follow them in preference to another. In Poonam Verma v. Ashwin Pateland Ors., II (1996) CPJ 1 (SC)=1996 (2) CPC 7, the Hon''ble Apex Court held that negligence as a tort is the breach of a duty caused by omission to do something which a reasonable man would do, or doing something which a prudent and reasonable man would not do. Therefore, the whole concept is performing or non-performing of an act which a prudent and reasonable man would perform or not perform. It again depends, in the case of profession, upon the skill which is expected from such persons. In Dr. Harkanwaljit Singh Saini v. Gurbax Singh & Anr., I (2003) CPJ 153 (NC), it was stated that professional negligence creates particular problems and, in practice it has to be higher standard of proof than for ordinary civil cases of negligence. The complainant has to rely on an inference of negligence where the circumstances are such that the injury of which he complains does not normally happen in the absence of negligence. This is based on the principle of res ipsa loquitur (the thing speaks of itself). This requires defendant to provide some reasonable explanation to all the incidents which could have occurred without negligence by him. It was further laid down in the above reported case that "the Commission cannot constitute itself into an expert body and contradict the statement of the doctor unless there is something contrary on the record by way of expert opinion or there is any medical treatise on which reliance could be based". At this stage, notice has to be taken of the other judgments in which emphasis has been laid as to the duty of the doctor towards the patient. In case Dr. Laxman Balkrishna Joshi v. Dr. Trimbak Bapu Godbole and Anr., AIR 1969 SC 128, the Hon''ble the Apex Court held as under: "The duties which a doctor owes to his patient are clear. A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding the treatment to be given or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires. The doctor no doubt has a discretion in choosing treatment which he proposes to give to the patient and such discretion is relatively ampler in case of emergency."

In Achut Rai Haribhau Khodwa v. State of Maharashtra & Ors., I (1996) CLT 532 (SC), the Hon''ble Supreme Court held as follows: "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 practitioner differs from doctor to doctor. The very nature of the profession 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 and 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. But in cases where the doctors act carelessly and in a manner which is not expected of a medical practitioner, then in such a case an action in torts would be maintainable."

In the latest pronouncement of the Apex Court in case Jacob Mathew v. State of Punjab and Anr., III (2005) CPJ 9 (SC)=VI (2005) SLT 1=III (2005) CCR 9 (SC)=122 (2005) DLT 83 (SC)=2005 CTJ (SC) (CP) 1091 in para 18 under the heading "Negligence by professionals" relating to physician it has been observed as under: "A physician would not assure the patient of full recovery in every case. A surgeon cannot and does not guarantee that the result of surgery would invariably be beneficial, much less to the extent of 100% for the person operated on. The only assurance which such a professional can give or can be understood to have given by implication is that he is possessed of the requisite skill in that branch of profession which he is practising and while undertaking the performance of the task entrusted to him he would be exercising his skill with reasonable competence. This is all what the person approaching the professional can expect. Judged by this standard, a professional may be held liable for negligence on one of two findings, either he was not possessed of the requisite skill which he professed to have possessed, or, he did not execise, with reasonable competence in the given case, the skill which he did possess. The standard to be applied for judging, whether the person charged has been negligent or not, would be that of an ordinary competent person exercising ordinary skill in that profession. It is not necessary for every professional to possess the highest level of expertise in that branch which he practises."

ADVERTING to the facts of the present case, hospitalization of the deceased during the period 27.10.1997 to 3.11.1997 can be sub-divided in three stages. The first stage relates to the period when he was admitted in the Institution on 27.10.1997 to 30.10.1997 when he was discharged, the second stage is in respect of the period when the patient was re-admitted on 1.11.1997 at 12.40 p.m, in the Institution and on the same day, he was referred to P.G.I. and the third stage refers to the period when he was admitted in P.G.I. on 1.11.1997 where he passed away on 3.11.1997.

IT would be pertinent to mention at this stage that the complainant has nowhere alleged in the complaint that during the period Uttam Singh remained admitted in P.G.I. from 1.11.1997 till he expired on 3.11.1997, there was any negligence on the part of the doctors, who treated him during this period, nor claimed any compensation against them. The complainant herself has examined CW-1, Dr. Venkatesh, Senior Resident, PGI, Chandigarh, who brought the summoned record and produced the death notification form in his statement. IT has been recorded in this form that cause of death is massive bleeding and cardiac arrest. The complainant has not produced on record any evidence or to examine the treating doctor of the P.G.I. to establish the cause which led to the massive bleeding and his cardiac arrest. Uttam Singh was 75 years on the date of death. Reverting back to the circumstances under which Uttam Singh was admitted in the Institute of opposite party No. 3, there is a definite assertion made by Dr. R.K. Aggarwal in his affidavit that husband of the complainant, who was 75 years old was suffering from heart ailment for the last 24 years and was diabetic for the last 12 years and had a history of two heart attacks and on that basis he has stated that with this background he could not have become a senior consultant in the construction company and engaged in a hectic business. In the affidavit filed by the complainant-Jaswant Kaur, she has not named the construction company where he was stated to be employed as senior consultant. No other affidavit of any close relative or of the construction company has been produced on record to establish the averments made in the complaint filed. Even stand of Dr. R.K. Aggarwal-opposite party No. 1 with regard to the earlier ailment of Uttam Singh has not been challenged by any other evidence produced during the trial of the complaint. Therefore, because of the previous history of heart attack, Uttam Singh was admitted in the Institute on 27.10.1997. Dr. R.K. Aggarwal has maintained in his affidavit that no open heart surgery was ever suggested by him and rather after angiography it was found that two arteries of Uttam Singh were blocked to the extent of 99%. He has taken care to inform of this finding to the patient as well as the expenses required to be incurred for angioplasty and fixing a stint as well as need for second stint, besides charges for extra balloon and use of special drug (Non Ionic Dye) for the angioplasty. He has specifically denied that the patient was asked to deposit Rs. 1,55,000 for carrying out open heart surgery and, in fact, according to him, no such surgery was performed. Therefore, the allegations made in the complaint in this regard cannot be accepted in the face of the above explanation furnished by Dr. R.K. Aggarwal.

Coming to the treatment part, Dr. R.K. Aggarwal has stated in his affidavit that after he had made a diagnosis of old heart attack, fresh heart attack, post-heart attack, angina and diabetes, he had planned a Coronary Angiography, which was done by him on 28.10.1998. He had also explained about the possible complications and chances of success to the patient as well as his family members and it is not even the case set up by the complainant in the complaint that Dr. R.K. Aggarwal had not explained to them about the possible complications of the angioplasty and chances of success. The decision of Dr. R.K. Aggarwal to use special drug. Non-Ionic Dye for the procedure of angioplasty has also not been challenged in the complaint filed. He has clearly explained that he had taken decision to use special drug (Non-Ionic Dye) for the procedure rather than the regular drug (Ionic Dye), as chances of drug related complications including kidney damage are less likely with the Non-Ionic Dye in an old diabetic patient than the Ionic Dye. At the time of angioplasty, he opened an artery and a stint was fixed in it. The other artery could not be opened. He has also stated that the patient remained absolutely stable throughout the procedure and the same was completed at 6.00 p.m. on 29.10.1997 and thereafter he was brought at the Intensive Cardiac Care Unit at 6.15 p.m. His ECG was also taken after the angioplasty which did not reveal any new change. Stable condition of the patient continued throughout the evening and during the night as well as on the next day. The patient had taken his breakfast and lunch and remained in the Hospital till evening and he was discharged on 30.10.1997 at 9.00 p.m. in a stable condition. The professional skill of Dr. R.K. Aggarwal has not been challenged except general allegations have been made in para 12 of the complaint that "the opposite parties acted with total misperfection and mishandled a normal case with their culpable incompetency and blatant dereliction of duty". The complainant has not explained this part of the allegations as to how at the time of performance of angioplasty any mishandling took place or dereliction of duty was committed by Dr. R.K. Aggarwal and in fact no evidence whatsoever has been led on record from the side of the complainant to prove any negligence in performing the angioplasty on the part of Dr. R.K. Aggarwal. The affidavit of Anoop Kumar, Secretary of opposite party No. 3 has fully supported the stand taken by Dr. R.K. Aggarwal, referred to above. Dr. R.K. Aggarwal in his affidavit has also stated that he was a Senior Consultant at the time of angioplasty was done. He has claimed that he had done M.D. from Banaras Hindu University in the year 1981 and did his DM (Cardiology) from P.G.I. in the year 1985. He had also been working with CMC Hospital, Ludhiana, which he left in 1986 as a Professor of Cardiology. Thereafter he worked in a private clinic at Jalandhar before joining opposite party No. 3. His professional experience, skill and perfection in the subject of Cardiology could not be questioned by producing any material on record from the side of the complainant to prove her part of the averments made in the complaint. The genesis of the main grievance made from the side of the complainant during the course of arguments is, post-operative care extended to the patient as it was alleged in the complaint that he was forcibly discharged on account of Diwali festival as doctors and the staff of the Institute wanted to have a holiday for Diwali celebrations. The stand of the complainant is that as the patient was in Intensive Cardiac Care Unit, there was a need for his post-operative care after major surgery was performed on him. This stand of the complainant has been denied by both the contesting opposite parties in the affidavits filed that they have forcibly discharged the patient due to Diwali festival, rather, it has been maintained by Dr. R.K. Aggarwal in his affidavit that the patient was discharged after 26 hours of the angioplasty. During the course of arguments, reference was made to an article under the caption "A Pilot Study of Coronary Angioplasty in Outpatients" authored by Gerrit J. Laarman & Ors., (Annexure O.P. 4), wherein it was stated "that coronary angioplasty with miniature equipment passed through the brachial artery was a safe procedure with a high initial success rate. The results of this pilot trial suggest that with careful selection of patients before and after angioplasty PTCA can be performed safely in outpatients". Another article under the caption "Early Hospital Discharge After Percutaneous Transluminal Coronary Angioplasty" written by David R. Cragg, M.D. & Ors., (Annexure O.P. 5) also records that "20 patients were admitted to an in-patient unit for extended observation. Excluding 4 patients with myocardial infarction, 75% (12 of 16) were discharged the next day". In this article a table has been drawn for the study of 100 patients, out of which, it shows that 86 patients of a short stay unit, 14 in-patient unit, 80 were sent home after 23 hours, out of 20 in-patients, 12 were sent home after 48 hours and 8 were kept for extended observation. In another extract of a Journal, J Am Coll Cardiol, 1996 Jan; 27 (1); 22-9 (Annexure O.P. 6), it is recorded that "The first 52 patients (group A) underwent coronary angiography 24 hours after stenting, and hospital stay was extended until an internation normalized ratio of 2 to 3.5 was achieved. The remaining 58 patients (group B) were discharged 24 hours after stenting." In another Journal, Am J. Cardiol, 1996 Aug 1; 78 (3); 334-6 (Annexure O.P. 7), it is mentioned that "the patients managed with antiplate let therapy alone had significantly reduced total hospitalization costs and a significantly reduced average hospital stay than patients managed with anti-coagulation". Again in the Journal Am J. Cardiol 1997 Dec 15; 80 (12); 1591-4 (Annexure O.P. 8), it is stated that "In a prospective evaluation of the safety of short-term observation after elective percutaneous transluminal coronary angioplasty (PTCA) in 1900 consecutive patients, 1 of 1680 patients triaged to discharge after 4 hours of observation reached the primary end point of acute recurrent ischemia, 7 patients underwent repeat PTCA during 4 hours of observation, and 66 of 187 patients selected for prolonged observation had a complicated course. It is concluded that short-term observation after elective coronary angioplasty is safe, with a negligible risk of vessel closure after this period; triage for prolonged observation can be based appropriately on the immediate procedural result". Again reference was made to the discussion of Mark W. Wolfe, MD & Ors., contained under the heading "Length of Hospital Stay and Complications After Percutaneous Transluminal Coronary Angtoplasty, Clinical and Procedural Predictors" (Annexure OP-9), wherein it was mentioned that "No clinical or angiographic variable was associated with increased length of stay of 1.0 day, whereas each major or minor PTCA complication was associated with increases in length of stay ranging from 2.9+ 0.9 days for abrupt closure to 9.6 + 1.1. days for emergency bypass surgery."

NO expert evidence has been produced from the side of the complainant to esatblish that discharge of Uttam Singh after 26 hours of the angioplasty was against the accepted medical norms, above stated study made by the medical experts involved, clearly spelled out that a patient can be discharged even after 4 hours of the angioplasty. It has come on record that at the time of discharge Uttam Singh was stable and his pulse and blood pressure was normal. Therefore, evidence on record does not support the stand taken from the side of the complainant in this regard. Coming to the period after discharge of Uttam Singh from the Institute it is explained by Dr. R.K. Aggarwal in his affidavit that after the patient had developed kidney problem, he was brought back on 1.11.1997 at 12.40 p.m. His explanation in this regard is that possibly this problem took place due to Dye used in the angioplasty and poor intake. According to him, tests were conducted by him and the result showed " Seerum K-3.9 meq/L, Urea-96 mg%, Creatinine-3.4 mg%. Hb-10 gms%, and Blood Sugar-81mg%". The above result is indicative of the fact that the kidney of the patient was not working properly. He was accordingly treated with the drugs including injections of Lasix and antibiotics. He was catheterized and given adequate and proper treatment but his condition did not improve. He was referred to P.G.I. for further management of the kidney damage. Nothing has been brought on record from the side of the complainant to contradict the stand of Dr. R.K. Aggarwal that the kidney damage cannot be attributable to the Dye used in angioplasty and due to very little intake. Again, there is no material on record that the treatment given by Dr. R.K. Aggarwal when he was again taken to the Institute was not recognized and accepted procedure of treatment. Therefore, for the kidney failure under the circumstances of the case, no attributable negligence can be made to Dr. R.K. Aggarwal and other opposite parties. It is also the stand of Dr. R.K. Aggarwal that as per allegations made in the complaint, the patient has stated to have died on 3.11.1997 at P.G.I. but the accurate cause of death cannot be determined because the death notification form only records that Uttam Singh died due to massive bleedings and cardiac arrest but no autopsy was done in this case and for that reason it cannot be said that massive bleeding was the result of above complications of angioplasty. Under the circumstances of the case, the stand taken from the side of opposite party No. 1-Dr. R.K. Aggarwal has to be accepted. For the aforesaid reasons, the complainant has failed to substantiate the allegations made in the complaint and the complaint is accordingly dismissed. Complaint dismissed.