PGI Chandigarh saved from paying Rs.95 lakhs compensation claim, but directed to pay Rs.1 lakh + Rs.10,000 for a defective Ventilator and mentioning of wrong date, as Deficiency in service, Adv. ROHiT ERANDE ©

PGI Chandigarh saved from paying Rs.95 lakhs compensation claim, but directed to pay Rs.1 lakh + Rs.10,000 for a defective Ventilator and mentioning of wrong date, as  Deficiency in service, 

 Adv. ROHiT ERANDE ©

Case Details : 

FIRST APPEAL NO. 9 OF 2013

 (Against the Order dated 01/10/2012 in Complaint No. 26/2011 of the State Commission Chandigarh)

NAMRATA KATARIA & 2 ORS V/s. POST GRADUATE INSTITUTE OF MEDICAL EDUCATION & RESEARCH (PGIMER), Chandigarh

BEFORE:  

  HON'BLE MR. JUSTICE R.K. AGRAWAL,PRESIDENT

  HON'BLE DR. S.M. KANTIKAR,MEMBER

  HON'BLE MR. BINOY KUMAR,MEMBER

ORDER Dated : 04 Jul 2022

Judgment Link : http://cms.nic.in/ncdrcusersWeb/GetJudgement.do?method=GetJudgement&caseidin=0%2F0%2FFA%2F9%2F2013&dtofhearing=2022-07-04

 Why the matter reached the National commission ?

      The present cross Appeals have been filed against judgment/order dated 01.10.2012 passed by the Chandigarh State Consumer Disputes Redressal Commission (hereinafter referred to as the ‘State Commission’) in Complaint Case No. 26 of 2011, wherein the claim of Rs.95 lakhs was rejected, but the PGI was directed to pay Rs.1 Lakh + Rs.10,000 costs, for Defective Ventilator and wrong  entries record keeping. 

Facts of the case in short :

1.      On 04.06.2008, Mr. Naresh Kataria (since deceased - patient) met with an accident and was firstly taken to Govt. Hospital, and later on he was shifted to emergency ward of the Opposite Party - PGI, Chandigarh at about 12.30 noon. At the time of admission, he was complaining of acute abdominal pain and breathing problem. In the evening, Ultra-Sonography (USG) of abdomen was conducted which showed extensive surgical emphysema i.e. air under the skin over right side of abdomen and epigastrium. 

2. It was alleged that the attending doctors in emergency ward did not pay attention and went on telling that nothing to be worried.  On the next morning (05.06.2008), the patient’s abdomen was distended and he started laboured respiration, an emergency call was sent to Specialist Prof. G. Singh, to examine him, but he came late at 4.00 p.m. and examined the patient. He advised for immediate operation and put the patient on ventilator, but the ventilator was defective. Therefore, the patient could not be ventilated and alternatively, manual ventilation with a AMBU Bag was given, but the condition of patient deteriorated and patient became unconscious. After 10 days, the patient expired on 16.06.2008 at 2.20 a.m. Being aggrieved by the negligent treatment at each step of treatment and deficiency in service, the Complainants filed the complaint before the Commission seeking Rs. 95,00,000/- as compensation .

Defense :

3.       The Opposite Party filed the written statement along with relevant documents and medical literature and denied any negligence during the treatment. It was submitted that the lack of ventilator was temporary and after the operation, the patient stayed in the ICU for 10 days (06.06.2008 to 16.06.2008) on ventilator and also availed services of the PGI as available for critically ill patients. It was further submitted that AMBU bag is manual resuscitator, a hand held devise, commonly used for patients with inadequate breathing, it provides positive pressure ventilation. It was commonly used in emergency rooms as part of standard equipment in, critical care settings in the hospitals.

4.       The State Commission,  did not find medical negligence of PGI during  treatment, but it held the PGI liable for certain administrative lapses and deficiency in service for not providing ventilator The Complaint was partly allowed and it was directed to the PGI to pay compensation of Rs. 1,00,000/- along with costs of Rs. 10,000/-.

Held : 

1. The National Commission heard the parties and after going through the documents observed that considering the condition of the patient and after carrying out the necessary investigations,         the patient was referred to general surgery for urgent need of laparotomy.  The Professor, Dr. G. Singh, examined the patient at 4 p.m. and diagnosed air under diaphragm and right lung contusion and emergency operation was conducted on the same day.

2.      It was observed that,  the Complainant’s main grouse was that there was delay in performing surgery. As per the medical record of PGI, on the day of incident, Dr. G. Singh, the Senior most Doctor, was operating another critical patient and  it was not possible for him to remain present in the emergency for 24 hours. The patient was properly attended by his senior residents and investigations were performed. 

3.     It was held that from the medical literature it appears that, due to blunt abdominal trauma, the colonic injury was a very rare phenomenon and such injuries frequently remained undetected, but diagnosed at delayed stage and the patient would present with severe abdominal tenderness. Despite instructions of specialist doctor, the patient could not be ventilated and therefore manual ventilation by pump was given. The condition of patient deteriorated further and he became unconscious. After the laparotomy (surgery) the patient stayed in ICU for 10 days with all facilities available.

4. The commission also observed about the busy functioning of PGI like reputed hospitals which    provide quality of care. It was held that it was a fair admission of PGI about non availability of ventilator because it was defective. However, no steps were taken to repair such defective ventilators certainly amounts to deficiency and failure of duty care towards the emergency patients. The hospital authority was responsible for regular maintenance and servicing of the life-saving equipment. 

It was further held  on the allegation of wrong date mentioned in the death summary, PM report and the death certificate as 15th or 16th April, 2011, that , erroneous entries in the crucial documents create lot of doubts  no doubt the Complainants struggled more and got the mistake rectified by the Opposite Party on 23.07.2008. Thus, in the instant case, the lapses and casual approach of the PGI authorities are visible. 

5. It was lastly held that the government institutes like AIIMS, Safdarjung and PGI etc. are flooded with huge patient workload. The expected duty of care and responsibility towards the critical patients were more, but practically it is more difficult to cope up with situation. In the instant case it was temporary failure of ventilator, but timely alternative arrangements were made and mechanical manual pump was provided. In the emergency ward round O’ clock Junior /Senior Residents are available to look after the patients and time to time update the condition to the senior consultant. From the record is evident that he patient was reviewed and investigated from time to time, he was also examined by the cardiothoracic surgeons on 05.06.2008. Thus, negligence in the treatment was not evident. It should be borne in mind that it is not possible to provide ventilator to each patient in any Govt. or Private hospitals/medical institutes. There is always a shortage especially in research institutes like PGI, AIIMS etc.

6.  The commission held no ground has been made to enhance the award as there was no Medical Negligence, but there was a deficiency in service in not repairing the ventilators in time and mentioning of wrong date and thus Rs.1 lakhs awarded are not to be interfered with and the commission observed that "We expect systemic improvement in the patient’s care and more accountability of erring staff at PGI."

This Case is an eye-opener for all the Hospitals and Doctors, of any size. It again emphasizes the basis principle of defense that "POOR RECORD IS POOR DEFENSE EAND NO RECORD IS NO DEFENSE". Such lapses may amount to "Penny wise-pound foolish" Further, the life saving instruments like Ventilator are very crucial and thus its timely repair is a task to be taken on priority. Fortunately for Doctors, the claim of Rs.95 lakhs was rejected and it was held that there was no Negligence. Albeit, loss of  dear and near ones can never compensated in terms of money. It's always irreversible loss. 

Thanks and Regards

Adv. ROHiT ERANDE ©

PUNE.