T.RAMA RAO vs VIJAYA HOSPITAL

THE case of the complainant T. Rama Rao is that his wife late Dr. Vijaya Lakshmi was a Medical Officer at the Primary Health Centre, Vanapalli. She had undergone an operation for Mitral Stenosis in the Institute of Cardio Vascular Diseases sponsored by Madras Medical Mission (Opposite Party No. 2) with Dr. K.M. Cherian as the Chief Surgeon. THE operation was successful and the complainant''s wife meticulously followed the medical advice and she was declared to be doing well. While so on 13.7.91 she lost control of her left side limbs and she was immediately admitted in the 1st Opposite Party Hospital on 14.7.91. She was allotted room No. 103 and the 2nd Opposite Party Madras Medical Mission was nominated as the consultant by the 1st Opposite Party. THE complainant paid the necessary charges to the 1st Opposite Party. Next day, i.e., on 15.7.91, the patient was referred to Dr. Deepak, Neuron Physician and he conducted C.T. Scanning test. After the test. Dr. K.M. Cherian of the 2nd Opposite Party declared that it was a medi cal case and not a surgical one, and that the patient would be alright within a week under the treatment of the Neuron Physician. But either Dr. K.M. Cherian nor anybody else of the 2nd Opposite Party arranged for the services of a Neuron Physician till 24.7.91. When the condition of the complainant''s wife became very serious Dr. Deepak attended on her only on 24.7.91 but could not do anything, and the complainant''s wife died on 26.7.91 at 6 a.m. Thus the doctor patient died for want of proper medical treatment from 16.7.91 to 23.7.91. THE death could have been averted had the patient been placed under the treatment of a Neuron Physician. Thus the Opposite Parties were guilty of gross negligence in their duties in failing to arrange for proper treatment under a Neuron Physician. At least on 15.7.91 the 1st Opposite Party should have nominated a Neuron Physician as consultant and the 2nd Opposite Party ought to have referred back the patient to the 1st Opposite Party for nominating by it a Neuron Physician. Thus the Opposite Parties 1 and 2 jointly and severally are liable for the negligence. When the complainant''s father in law and the Consumer Action Group, Madras demanded from the Opposite Parties for copies of the case sheets pertaining to the complainant''s deceased wife, the Opposite Par ties declined. THE further case of the complainant is that the deceased Dr. Vijayalakshmi was draw ing a salary of Rs. 3,600/ p.m. + other benefits and perks before her death and she was aged only 38 years; when she died she had yet to serve 20 years more. THErefore, the loss of income to the complainant in the death of his wife would be about Rs. 10,00,000/ . On these grounds, the complaint has been filed for directing the Opposite Parties to pay the said sum of Rs. 10 lakhs to the complainant.

THE 1st Opposite party Vijaya Hospital in its written version contends that Dr. Vijayalakshmi was under the entire treatment provided by the 2nd Opposite Party which is an independent body consisting of its own special ists, assistants, etc., and the 1st Opposite Party was not responsible for the treatment. THE 1st Opposite Party only provides nursing services including all medical facilities in the hospital and it does not treat the patient. THE 2nd Opposite Party is not an employee of the 1st Opposite Party. THE complainant''s wife Dr. Vijayalakshmi died as early as 26.7.91 and this complaint has been filed belatedly and hence the complaint is the result of an after thought. A band of well qualified specialists and consultants is provided with consultation rooms for attending on the patients. THE patients are taken care of and attended to by the specialists, consultants who are not employees of this Opposite Party and they are paying charges to this Opposite Party for providing them with the consultation rooms and other facilities. This Opposite Party pro vides nursing facilities including all medical facilities such as laboratory services to those consultants. THE consultants pay for the consult ing rooms used by them in the hospital. As regards the treatment given to the patients, the consultants are alone responsible. THE patients and the attendants are fully made aware of this position. THE 2nd Opposite Party is an autonomous body which operates independently and there is not remotest master servant relationship or principal agent relationship between this Opposite Party and the 2nd Opposite Party. THE deceased Dr. Vijayalakshmi had been treated earlier by Dr. K.M. Cherian at the Railway Hospital in the year 1976 77 and by the 2nd Opposite Party on 10.8.87. When the patient Dr. Vijayalakshmi was brought to the main reception of this Opposite Party at 10 p.m. on 14.7.91 the Receptionist on duty might have found from the records available with the patient that the patient had been treated earlier by the 2nd Opposite Party and, therefore, had referred her to the 2nd Opposite Party. Thus the complaint against this Opposite Party is liable to be dismissed. The case of the 2nd Opposite Party in its written version is that the patient had her faculties fully alive till her death and she did not complain of any deficiency in service. This complaint has been filed belatedly after two years and, therefore, the 2nd Opposite party is handicapped to defend itself because it will be difficult to make available all the relevant papers. Dr. Vijayalakshmi had Mitral valve replacement done by Dr. K.M. Cherian on 10.8.87. She had a closed heart operation for her blocked valves by Dr. K.M. Cherian in 1976 77 when he was a Cardiac Surgeon for the Indian Railways in the Southern Railway Hospital, Perambur. The Mitral valve replacement was then a high risk surgery as most other open heart surgeries. Dr. Vijayalakshmi did well and was discharged with a particular advice to come for the first check up three months after discharge to regulate her anti coagulation. She had prosthetic valve replacement which necessitated absolute control over the blood clotting parameters. As in line with the hospital''s usual practice, a booklet containing all information about the post operative care was given to her in spite of the fact that she herself was a medical professional. She came for the first check up after three years on 12.4.90 and it is not known whether she had conducted her medical test regularly. When she came for the check up on 12.4.90 Dr. Vijayalakshmi specifically told Dr. K.M. Cherian about her unhappy married life. Dr. Vijayalakshmi was admitted on 14.7.91 with a history of sudden stroke which developed 24 hours before her admission. At that time, when Dr. K.M. Cherian enquired about the anti coagu lation status she specifically told him that she had stopped taking medicines. A C.T. Scan was taken. Dr. Deepak Arjundas-Consultant Neuron Physician was called in on 15.7.91 who pre scribed her some treatment and the treatment was given as per his instructions only and the patient got all the treatment prescribed by him and he had seen the patient on many occasions. She developed breathing difficulty and lowurnary output on 25.7.91 for which Dr. George Abraham, Consultant Nephrologist was consulted and necessary treatment was instituted. She was shifted to the Intensive Care Unit at 11 a.m. In spite of all endeavours and best treatment she was progressively becoming worse, and on 25.7.91 she became comatose. Obviously the brain lesion was progressing and she died of major embolic episode due to improper anti coagulation or rather absence of anti coagula tion. It is further contended by this Opposite Party that it is not unusual for patients who have undergone surgery, not following after discharge the post operative guidelines meticulously or take necessary care required of by them either owing to complacency or other extraneous reasons and in some cardiac surgery cases, even if patients take meticulous care after operation, complications do set in after some months or years leading to disastrous consequences for which there can be no explanation nor can any one be blamed. As such there was no deficiency in service on the part of this Opposite Party. Hence the complaint cannot be maintained.

The points that arise for consideration are: (1) Whether there was deficiency in service on the part of the Opposite Par ties as alleged; and (2) If so, what compensation the complainant is entitled ?

AS regards the relationship between the 1st Opposite Party Vijaya Hospital and the 2nd Opposite Party Madras Medical Mission, it is not in dispute that in the 1st Opposite Party hospital the 2nd Opposite Party is situated in a portion of it. According to the 1st Opposite Party, the 2nd Opposite Party is the consultant of the 1st Opposite Party and as regards the treatment of the patients, the 2nd Opposite Party alone is responsible and not the 1st Opposite Party. This is not disputed by the 2nd Opposite Party. According to the 2nd Opposite Party, it is a separate unit by itself though it is housed in a portion of the 1st Opposite Party hospital and once the patient is referred to the 2nd Opposite Party, the treatment is by the 2nd Opposite Party only and the 1st Opposite Party has no responsibility. The patient Dr. Vijayalakshmi was admitted by the 1st Opposite Party in its hospital and they issued Ex. A2 Admission Card. This is dated 14.7.91. In this Ex. A2 it is clearly mentioned that the consultant will be responsible for the treatment. It is also not in dispute that the 2nd Opposite Party pays rent for the portion of the hospital occupied by it and for the infrastructure provided by the 1st Opposite Party hospital which are necessary for the treatment. Therefore, clearly there is no employer employee relation ship between the 1st Opposite Party and the 2nd Opposite Party and hence no question of vicarious liability of the 1st Opposite Party for any deficiency in service in the treatment by the 2nd Opposite Party arises. It is however argued that considering the illness of the patient, the 1st Opposite Party should have referred the patient to a Neuron Physician consultant and not the 2nd Opposite Party Cardiac Surgeon consultant as the 1st Opposite Party did. Here it must be remembered that the patient had been already treated by Dr. K.M. Cherian, Chief Surgeon of the 2nd Opposite Party in the year 1987 for Mitral valve replacement. Even earlier she had a closed heart operation for a blocked valve per formed by Dr. K.M. Cherian in the year 1976 77 when he was the Cardiac Surgeon for Indian Railways, Perambur. It is common case that for the Mitral valve operation the patient was consulting Dr. K.M. Cherian at least for some time. While this being the case, the patient had been taken to the 1st Opposite Party at 10 p.m. on 14.7.91. According to the 1st Opposite Party, the Receptionist of the hospital, after finding from the records available with the patient that the patient had been treated earlier by Dr. K.M. Cherian, the 2nd Opposite Party, must have referred the patient to the 2nd Opposite Party. On this aspect of the matter, there is no dispute. Therefore, the 1st Opposite Party cannot be found fault with for having referred the patient to the 2nd Opposite Party. The main case of the complainant is stated in paragraph 3 of the complaint. It would be convenient to extract the relevant portion of that paragraph itself: "3. On 15.7.91 Complainant''s patient wife was referred to Dr. Deepak, Neuron Physician who conducted C.T. Scanning test. After the test Dr. K.M. Cherian (M.M.M. Opposite Party No. 2) declared that it was a medical case and not a surgical one and the patient would be all right within a week under the treatment of the Neuron Physician who would treat the patient in the Cardio vascular unit. But neither Dr. K.M. Cherian nor any one on behalf of the Opposite Party No. 2 or 1 could arrange for the services of a Neuron Physician till 24.7.1991 when the condition of complainant''s wife became very serious. Dr. Deepak attended only on 24.7.91 but could not do anything and complainant''s patient wife died on 26.7.1991 at 6.00 a.m. Thus a doctor patient died like a destitute without propermedi cal treatment from 16.7.91 to 23.7.91 in Asia''s best hospital as proudly claimed to be the Opposite Party No. 2. Complainant''s wife''s death could have been averted had she been placed under constant treatment of a Neuron Physician....."

So, according to the complainant, after the C.T. Scanning test by the Neuron Physician Dr. Deepak to whom the patient was referred and Dr. K.M. Cherian said that it was a medical case and not a surgical one, in spite of it no arrangement was made for Dr. Deepak to attend on the patient till 24.7.91 and this constitutes deficiency in service on the part of the 2nd Opposite Party. But the 2nd Opposite Party in his written version would deny that Dr. K.M. Cherian said that the patient Dr. Vijayalakshmi would be all right in a week under the treatment of the Neuron Physician. The 2nd Opposite Party would further deny that no arrangement was made for the services of a Neuron Physician till 24.7.91. It is an admitted fact that on 15.7.91 itself the patient was referred to the Neuron Physician Dr. Deepak Arjundas and he conducted C.T. Scan test. It is clearly stated so, as we have seen above, in paragraph 3 of the complaint. However, the case of the complain ant, as seen from the same paragraph 3 of the complaint, is that a Neuron Physician''s services were not requisitioned between 15.7.91 and 24.7.91. As regards this clear case of the complainant, there is no specific denial in the written version of the 2nd Opposite Party. It is only stated that the patient got all the treatments prescribed by Dr. Deepak Arjundas. In this re gard, it is submitted on behalf of the 2nd Opposite Party that Exs. B19, 20 & 21 - Nursing Record Registers-would show that Dr. Deepak Arjundas has seen the patient on 18.7.91,20.7.91 and 23.7.91. The relevant entries are said to have been made by 3 4 nurses but none of those nurses has been examined, but, instead, one Mrs. Jeevan Raj who claims to be the Nursing Coordinator in charge of the Nursing Department in the 2nd Opposite Party has been examined as RW 2 to speak to the said registers and entries. No reason has been given as to why the concerned nurses who made the entries themselves have not been examined. The said entries have not been referred to in the written version by the 2nd Opposite Party, and as already mentioned no specific denial in the written version is made that no Neuron Physician attended on the patient between 15.7.91 and 24.7.91. Even Dr. K.M. Cherian who has been examined as RW 3 has not stated that Dr. Deepak Arjundas has attended on the patient on the said dates. Here it may be mentioned that Dr. Deepak Arjundas himself was examined as RW 4 but he was only examined in Chief and when the matter was taken up for cross examination, on behalf of the 2nd Opposite Party it was submitted that further evidence of this witness may be dispensed with and mat the 2nd Opposite Party will not rely on the evidence given by him in chief examination. Upon this submission, on behalf of the complain ant it was agreed that if the 2nd Opposite Party would not rely on the chief examination of this witness (Dr. Deepak Arjundas RW 4), his cross examination is not necessary. In these circum stances, Dr. Deepak Arjundas was not cross-examined. In this position, it is as good as he has not been examined as a witness so far as the 2nd Opposite Party is concerned. In this situation, we are clearly of the view that no credence can be given to the relevant entries in the said Exs. B 19, 20& 21 as true ones. It, therefore, follows that it would appear to be the fact that Dr. Deepak Arjundas has not attended on the patient between 15.7.91 and 24.7.91. But a question re mains that even so can it be said that there was deficiency in service on the part of the 2nd Opposite Party As aforementioned, the very case of the complainant himself in the complaint is that on 15.7.91 the patient was referred to Dr. Deepak Arjundas who conducted a C.T. Scanning Test. Here it would be relevant to note that the complainant PW 1 in his evidence would even deny that on 15.7.91 his wife was referred to Dr. Deepak Arjundas and that Dr. Deepak Arjundas conducted the scanning test. This only shows that the complainant is capable of changing his version and has no regard for truth. It is, therefore, a fact that the patient was referred to Dr. Deepak Arjundas, Neuron Physician on 15.7.91 and it was he who did the C.T. Scanning test. According to the 2nd Opposite Party, treatment was given to the patient as per the instructions of Dr. Deepak Arjundas. This cannot be said to be untrue considering the fact that the patient had been referred to Dr. Deepak Arjundas and it was he who had done the Scanning test. Dr. K.M. Cherian (RW 3) also has stated in his evidence that Dr. Deepak Arjundas examined the patient and C.T. Scan was done and treatment was given according to his advice. Dr. K.M. Cherian''s fur ther evidence is that it is not necessary for Dr. Deepak Arjundas to see the patient everyday because there were in house Doctors and they had a system whereby the in house Doctors were constantly in touch with the consultants. As against this evidence in the chief examination, no question has been put in the cross-examination. Dr. K.M. Cherian has further testified that, "a Cardiac Surgeon is quite competent to deal with the case of Dr. Vijayalakshmi who suffered a stroke due to clot formed from the heart valves gone to the brain damaged half of the brain." He has also deposed that any MBBS Doctor is also qualified to treat any patient with any disease including a stroke. Regarding this also nothing has been elicited or suggested in the cross examination to the effect that it is not correct. We find no reason to reject the above said testimony of Dr. K.M. Cherian as unacceptable. This being the position, even if it is true that Dr. Deepak Arjundas, Neuron Physician has not visited the patient between 15.7.91 and 24.7.91, from that alone it can be said that the 2nd Opposite Party failed to give proper treatment to the patient and, therefore, the 2nd Opposite Party was deficient in service. It may be relevant to recall here that the only deficiency in service alleged in the complaint, according to the complainant, is that a Neuron Physician has not at tended on the patient between 15.7.91 and 24.7.91, and no other deficiency in service has been alleged.

IT is not in dispute that the patient had, earlier in 1987, a Mitral valve replacement and according to the 2nd Opposite Party when she was discharged then she was told to come for check up in three months'' time for regulating the anti coagulation but she came back only after three years. Of course according to the complain ant she correctly followed the advice given. However it may be, it is the evidence of Dr. K.M. Cherian (RW 3) that the patient died because of the increase in brain damage due to clot in the heart valve and the clot had occurred because of the fact that she never took anti coagulation medicines. Considering the entire facts and cir cumstances of the case, it is not possible to hold that there was deficiency in service in the treatment given to the patient by the 2nd Opposite Party. Then it is submitted on behalf of the complainant that in spite of several requests and demands made by the complainant directly by himself and through the Consumer Action Group, the 2nd Opposite Party failed to give the case sheets and other relevant records of treatment on the patient. In this regard, some correspondence have been filed. The 2nd Opposite Party seems to have sent to the Consumer Action Group some documents known as "Nurses'' Report". But no case sheet has been sent. Regarding this the 2nd Opposite Party has filed Ex. B.18 which is said to be an Office Note of the 2nd Opposite Party according to which the patient''s father Mr. Parthasarathy who was an ex employee of Indian Railways, went to the 2nd Opposite Party represented to a staff member there that he knew Dr. K.M. Cherian and that he wanted the case sheets for discussion with Dr. Cherian, and promising to return the documents, took them with him, but he never returned, and, therefore, the case sheets are not with the 2nd Opposite Party. This version given in Ex. B 18 may be true or may not be true, but, for the only reason that the case sheets were not given to the complainant by the 2nd Opposite Party it cannot be said that there was deficiency in service. There is no law that states that the case sheets should be furnished to the persons like the complainant on requirement, nor there is any undertaking by the Opposite Parties under an agreement or otherwise to so furnish. Of course, it may be argued that the contents of the case sheets would prove the deficiency in service but in the circumstances discussed above, especially the plea in the complainant, it cannot be said that for want of case sheets the complainant could not prove deficiency in service on the part of the Opposite Parties. In the result, no deficiency in service has been proved against the Opposite Parties, and as such the complaint is liable to be dismissed. In view of the above findings, no question of payment of any compensation arises.

IN the result, the complaint is dismissed. However there will be no order as to costs. Complaint dismissed.