SADANAND RAWAL vs State of Uttar Pradesh

-THE present complaint is filed by Shri Sadanand Rawal, husband of the deceased. Smt. Uma Rawal against six opposite parties alleging medical negligence. Among the six impleaded parties, two parties i.e., O.P. No. 1, Ministry of Health and Family Welfare and O.P. No. 2, the Director General, Medical Education, Lucknow have been deleted during the course of proceedings. O.P. No. 3 Principal, GSVM Medical College, Kanpur, U.P. has not filed written version and hence is proceeded ex parte. For the consideration of the present case, the following parties are relevant which are O.P. No. 4, Dr. (Mrs.) Savita Luthra, O.P. No. 5, Dr. S.K. Luthra, both of Suraj Nursing Home and O.P. No. 6, Dr. Kiran Mehrotra, Head of the Department of Anesthesia, GSVM Medical College, Kanpur, U.P., who acted as the Anesthetist during the operation. Facts of the case are: Mrs. Uma Rawal consulted Dr. S.K. Luthra, O.P. No. 5 for some stomach complaint. Dr. S.K. Luthra informed the complainant and his wife that she had to be operated upon for removal of stones from the gall bladder. She was admitted on 24.10.1997 at about 9.00 a.m. in Suraj Nursing Home which is owned by O.P. Nos. 4 and 5. At the time of admission Mrs. Uma Rawal was having no adverse past medical history and all the test reports were normal including B.P., E.C.G., blood sugar, etc. She was informed that the gall bladder shall be removed by using the most modern technique by laser and the total time for operation shall only be 30 to 45 minutes. Mrs. Rawal was shifted to operation theatre at 10 a.m. on 24.10.1997 and it is alleged that operation lasted for five hours. At about 3 p.m. she was shifted to Regency Hospital Ltd. and the admission report of this hospital shows that she was having hypertension and could not be reversed from anesthesia. On 15.11.1997 she was shifted to PGI Hospital at Lucknow where she died. On 8.12.1997 in the death certificate it has been mentioned that her case was of hypoxic brain damage and that death was due to Cardio Respiratory Arrest at 11.30 a.m. It is alleged by the complainant that his wife went into coma during the operation at Suraj Nursing Home as a result of negligence of Dr. Kiran Mehrotra, O.P. No. 6 and that the hospital owners O.Ps. 4 and 5 and Dr. Luthra had performed the operation and Dr. Kiran Mehrotra jointly and severally liable for medical negligence.

THE case of the complainant is that his wife was given excessive dosage of atropine and other drugs by the Anesthetist leading to brain damage. As regards to the amount of compensation, it is argued that Mrs. Uma Rawal was a business woman and a tax payee since 1981. THE complainant states that he was put to heavy financial loss due to demise of his wife and he himself had two cardiac arrests. It is also stated that he had to ultimately give up the business which she was running. He claimed Rs. 55 lakh of compensation by the financial, emotional loss that he suffered due to negligence, inefficiency and carelessness of the Doctors. It is also stated that the deceased was only 55 years old at the time of her death and had a life span of more than 20 years. Being a successful entrepreneur in her own right who carried business on her own, it is argued that the compensation that has been claimed is justified. The case of the respondents 4, 5 and 6 is common and is that anesthesia and the drugs administered during operation are according to the standard medical practice and the dosage was not at all excessive and that the operation was successful; that the patient was reversed from anesthesia after the operation at 12.20 p.m. It is argued that 25 minutes later i.e., at about 12.45 p.m., the patient developed respiratory distress and that it has intensified by about 1.30 p.m. It is argued that this was due to pulmonary embolism which is a rare but at the same time a very major complication associated with surgery and that this pulmonary embolism resulted in pulmonary oedema. At about 2.20 p.m. she developed sudden hypotension and bradycardia. All these conditions were dealt with by administration of drugs according to the standard medical practice.

It is also argued that the complainant desired that the patient should be shifted to another hospital known as Regency Hospital and that at 3.05 p.m. on the same day, i.e., 24.10.1997, she was allowed to be shifted to the Regency Hospital. She continued under treatment at the Regency Hospital till 15.11.1997. Thereafter on 15.11.1997 she was shifted to Sanjay Gandhi P.G. Institute, Lucknow where she ultimately died on 8.12.1997. It is argued that the details of the treatment given at the Regency Hospital and at the Sanjay Gandhi P.G. Institute, Lucknow were not filed nor the two Institutions made parties to the complaint.

ON behalf of the opposite parties, it was also argued that a criminal complaint No. 452/97 was filed by the present complainant with the Metropolitan Magistrate, Kanpur against the O.P. Nos. 4, 5 and 6 under Section 304A read with Section 34, IPC for alleged medical negligence in this particular case. An investigation was made and the police filed a final report that no case against the accused was made out and that the Magistrate finally closed the case on 6.2.2003. It is also alleged that the Chief Medical Officer, Kanpur constituted a Medical Board comprising three eminent Doctors namely, Dr. Ravi Saxena, Associate Professor, Anesthesia, AIIMS, New Delhi, Dr. (sic.) College, Kanpur; and Dr. V.S. Tewari, Associate Professor in the same Medical College. The Board after examining the relevant hospital records submitted its report on 24.2.1998 concluding that no medical negligence has been proved in the treatment of Mrs. Uma Rawal. The opposite parties further argued that this Commission had sent the copy of the said medical report to Dr. Ravi Saxena who is now working as Professor Honorary Advisor Anesthesia to the Govt. of India with a request that the detailed reasons for arriving at the conclusion that there was no negligence should be furnished to the Commission. It is stated that Dr. Ravi Saxena accordingly sent his detailed report on 13.7.2004 wherein he has given six reasons as to why no deficiency in standard of care given to the patient can be found. It is argued on the basis of the above that since there is no evidence whatsoever to prove that there is medical negligence, the complaint should be dismissed.

THE critical factor for decision, therefore, is to determine whether any excessive dosage of anesthesia or other drugs was given to the patient resulting in complications as noted above. It is admitted Mrs. Uma Rawal, the wife of the complainant approached the O.P. No. 5 on 23.10.1997 with the complaint of pain in the abdomen off and on for the past two months and she approached the said doctor with certain investigation reports already carried out like ultrasound, chest x-ray, etc. THE Doctor diagnosed the case as Cholecystitis (inflamed gallbladder) and advised that the gallbladder should be removed (Cholecystectomy) by laproscopic surgery. THE surgery was fixed for the next morning i.e., on 24.10.1997. The complainant states that the patient was taken into the operation theatre at 10.00 a.m. The opposite parties aver that she was taken into the operation theatre at 11.15 a.m. and the anesthesia was given at 11.30 p.m. and the operation was finished in about 40 minutes time. The record further shows that it has been averred by O.P. Nos. 4, 5 and 6 through their affidavit that at 12.20 p.m. the patient was reversed from anesthesia by administration of 2.5 mg. Prostogamine and plus 2 amp of Glycopyrolate which are the standard drugs used for anesthesia reversal. Evidence from various medical authorities has been brought on record to show that these are the standard drugs used for such reversal. As regards the use of Atropine and its usage which have been strongly questioned by the complainant, it is the averment of the O.P. Nos. 4, 5 and 6 that in all only 3 amp each of 0.6 mg. Atropine was given as indicated below: (i) At 11.15 a.m. - 1 amp of Atropine was injected as anesthesia. (ii) At 2.20 p.m. - two more amp of 0.6 mg. each was injected to treat sudden hypotension and bradycardia. Extracts from various medical authorities have been brought on record to show that use of Atropine is indicated in the above circumstances and that the dosage was not at all excessive. (iii) At 2.20 p.m. - dopamine drip (2 amp) was given for controlling hypotension and bradycardia.

It is quite clear from the above that no case of wrong use of drugs and excessive uses of dosage has been proved against the opposite parties.

THE complainant has argued that the deceased Mrs. Uma Rawal was aged 55 and that her age was wrongly shown in the records of Suraj Nursing Home differently as 60 years and 62 years. Further, it is argued that her weight was not shown in the records and that the dosage of anesthesia is required to be calibrated according to the weight of the patient. It is true that the age of the patient is shown at different places in the records as 60 and 62 years. Assuming that the patient''s real age was 55, the Doctors have erred in recording a higher age. This recording of a higher age would if at all have led to administration of a lesser dosage of anesthesia and not a higher dosage. Similarly, even though the weight of the patient has not been recorded, it is mentioned in records as a matter of fact, twice in the same report as "Over-weight". In the written submissions of opposite parties 4 and 5, Mrs. Uma Rawal, the patient was described as "Grossly obese". It, therefore, appears that even though the exact weight of the patient is not recorded, the Anesthetists were quite well aware about the overweight of the patient.

IT is argued by the complainant that ECG of the patient was not recorded before she was taken in for Operation. The patient''s x-ray of chest was seen by O.P. No. 5 who also recorded the condition of the heart as "NAD-Nothing Abnormal Detected". This coupled with the fact that her pulse, B.P. respiration and blood chemistry were normal shows that the Doctors did not find it necessary to insist on an ECG. The complainant placed great reliance on the "Detailed case summary" given on 1.11.1997 by the Regency Hospital. Talking about her condition when she was brought for admission the report reads as follows: "She developed hypotension and could not be reversed from anesthesia and was brought to our Emergency Room about 5 hours after the surgery started in a state of Cardio Pulmonary Arrest. She was given CPR for about one hour then shifted to ICU. At the time of admission she was pulseless, BP-less and poor respiratory .......x-ray revealed gross Bilateral Pulmonary Oedema. She was provisonally diagnosed as a case of Pulmonary Oedema with ARF with Hypoxic Brain Damage."

Thereafter the report goes on describing how within 24 hours the patient showed slight improvement and how she further improved subsequently. The complainant relies on this to show that this condition of the patient was due to mismanagement by the Suraj Nursing Home. On the other hand the O.P. Nos. 4, 5 and 6 have argued that no reliance can be placed on this report which was given three days after the admission in the Regency Hospital. The complainant''s case is that the description given by the Regency Hospital amounts to say that the patient was brought dead to their hospital and it is argued that no hospital would accept a dead patient. The opposite parties also states that no credence can be given to the remarks that CPR (Cardio Pulmonary Resuscitation) was given for about one hour. In support of their case, the opposite parties relied on a Cat Scan report given by the same Regency Hospital on 4.11.1997 i.e., three days after the above said report. The Cat Scan report clearly reads as follows: (i) No evidence of intracerebral haematoma on infarct. (ii) No mass lesion or midline shift. (iii) Ventricles and sub-arachnoid spaces are clear and prominent senile cerebral atrophy. (iv) Cerebellum appears normal. (v) Maxillary and atnoide sinuses are partially pacified-inflam-mation.

OBVIOUSLY this report does not support what is stated in the report dated 1.11.1997. We agree with the opposite parties that this report which is an investigation report needs to be given higher credibility than the subjective report dated 1.11.1997. In the result we agree with the opposite party Nos. 4, 5 and 6 and that this is an unfortunate case of development of pulmonary embolism which is described as a rare but major hazard of any surgery and that every effort was made to control the same. No case of negligence against the opposite parties has been proved. The complaint, therefore, stands dismissed. Complaint dismissed.