Pronounced on: 06th April, 2023
The Judgment Starts with following words :
Patients' expectations are defined as a set of beliefs an individual holds in regard to the treatment and its outcomes with an anticipation that a given event is likely to happen as a consequence of an intervention. Those in health care continue to increase and need to be managed adequately in order to improve outcomes and decrease liability. The days of absolute trust and blind obedience to doctors are over.
Facts in short :
1. The Complainant G. K. Raghuvanshi (for short ‘the Patient’) since June 2007 was suffering from multiple health problems like diabetes, cardiac and kidney. Till December 2012 end on several occasions he was hospitalized and underwent few procedures like angioplasty, CABG ,hemodialysis. On 25.07.2011 he underwent renal transplant in SGPGIMS, the kidney was donated by his wife and he was put on immunosuppressive drugs.
2. He alleged that there was urinary leakage for three months after renal transplant. On 31.10.2011 he got himself discharged from the OP hospital and got admitted in Fortis Hospital where he underwent ‘Graft kidney with closure of celestial fistula and removal of PCN tube under GA’ and the urinary leak was stopped, he was discharged on 09.11.2011.
3. The patient suffered ‘gangrene’ of toes in Rt. Foot and on 26.12.2012 consulted Dr. Amit Gupta, Professor of Nephrology at SGPGIMS. He further referred the patient to Department of ‘Endocrine Surgery’ OPD for advice. Again he was referred back to the ‘Nephrology’ Department with advice to clean daily the gangrenous wounds of the Rt. foot and use Betadine ointment. It was alleged that, at the initial stage of gangrene both the departments did not take proper care and further Doctors at ‘CVTS’ at also took it casually and prescribed medicines only. Also he took hyperbaric oxygen session at Fortis but gangrene was not healed due to alleged delay in treatment of SGPGI & Consequently, amputation of toes was done and discharged on 30.03.2013.
3. The allegation of the Complainant was that not providing Endovascular Intervention Therapy, his Right 3rd and 4th toe was amputated on 31.05.2013. On 04.12.2013 the Complainant requested Chief Secretary who was Chairman of OP to make available ‘Balloon Dilation Therapy’. Thereafter he was admitted on 16.12.2013 for ‘Endovascular Intervention Therapy’ but doctors were unable to save his left great toe. He further alleged that his wife donated kidney for him , became a patient of Chronic Kidney Disease (CKD) and type-2 DM. Due to unbearable hardship, she got her treatment at Shekhar Hospital, Lucknow.
4. Being aggrieved due to alleged medical negligence and deficiency in service from the SGPGIMA , the Complainant filed Consumer Complaint No. 07/2015 before State Consumer Dispute Redressal Commission, U.P. (for short, the ‘State Commission’) to claim compensation of Rs. 99,98,800/-.
5. The Opposite Party did not file written statement, therefore proceeded against ex-parte.
6. The State Commission decided the Complaint after obtaining an expert report from King George Medical University (KGMU), Lucknow and partly allowed the complaint by holding the Appellant as negligent in treating the patient in time for amputation of toes.. The OP was directed to pay Rs. 24,50,000/- and Rs. 10,000/- as cost of litigation to the Complainant. Being aggrieved the SGPGIMS - Appellant-OP filed the instant Appeal.
8. Heard the learned Counsel on both the sides. Perused the material on record and we gave our thoughtful consideration to the arguments.
Held :
1. The main grouse of the Complainant was that, he noticed eruptions on his both legs which was suggestive of early stage of gangrene. He attended the OPD of CVTS (Cardiovascular and Thoracic Surgery) dept. on 26.12.2012 but the doctors did not provide the ‘balloon dilation therapy’. It would be beneficial to get adequate blood supply to both the feet and gangrene could be avoided. Instead of that, he was immediately referred to the Department of Endocrine for daily cleaning the gangrene wound and to maintain hygiene by use of Betadine ointment. He was also advised Doppler test and a review after 15 days. The Complainant visited the OPD of CVTS at SGPGI only on 20.02.2013.
2. The other allegations was that the doctors did not do ‘endo-vascular intervention’ or ‘balloon dilation therapy’ though the facility was available at SGPGI. The amputation could have avoided. However, only after his representation made to the Chief Secretary on 04.12.2013, ‘endo-vascular intervention’ was done for him on 16.12.2013.
3. The Court On careful perusal of record observed that admittedly the patient was known diabetic since 7 years and on Insulin therapy for 4 years. He was hypertensive also. The chronology of treatment, clearly shows that since June, 2007 to December, 2013, the Complainant had underwent several surgical procedures like coronary angiography, angioplasty, coronary artery bypass grafting (CABG) and haemodialysis. He underwent Renal transplant on 25.07.2011, from a kidney donated by his wife. The renal transplant was done after detailed family counselling for high risks. The written and video graphic informed consent was taken from the donor and recipient. He was discharged on 30.10.2011. At the time of discharge, his blood urea was 36.7 mg% and serum creatinine 1.05 mg% (normal). Subsequently the patient was managed by Department of Urology, however he developed diabetic nephropathy. It is known that about 50% of the diabetic patients would develop gangrene with associated peripheral vascular disease.
4. The expert medical board appointed by the state commission held that there was no negligence in the treatment of G.K.Raghuvanshi (Patient). The NCDRC did not agree with the following observations of the State Commission that
“Had the institute of OP acted carefully and properly in providing treatment to Complainant at initial stage on 26.12.2012 amputation might have been avoided”
5. it was held that as the patient was on immunosuppressive agents for his new transplanted kidney, the department of Nephrology has no role in the treatment of gangrene. Thus, any specific treatment for the diabetic foot lesions was not advised by the department of Nephrology as it has neither the knowledge nor the expertise to deal with such problem, thus he was referred to the concerned endocrine surgery department. The patient was kept under follow up with Nephrology for transplanted kidney.
6. It is pertinent to note that the patient was admitted in Urology ward on 16.12.2013 for balloon dilatation of left lower limb vessels. He underwent the procedure on 21.12.2013 by the department of radiology. After the procedure his Sr. Creatinin was normal-1.03mg% and he was discharged 26.12.2013. Therefore, we do not find any negligence of the department of Nephrology. The doctors have treated the patient with due diligence whenever he attended OPD or whenever he was admitted under any specialty at SGPGIMS.
7. It was further observed that the management of diabetic foot due to arterial blockage is usually because of multilevel diffuse peripheral vascular disease. If the disease is amenable to bypass / angioplasty, then it is done to prevent major amputation. Many patients with diabetic foot have long standing vascular problem which is not amenable to bypass or angioplasty as was the case in this patient.
8. Admittedly the patient was suffering from multi organ complications of long standing diabetes.
9. In our country in hospitals like SGPGIMS minor administrative lapses do occur during arranging to call for the doctors on duty in their respective wards, who might be attending other patients. In our view, the instant patient was taking consultation and treatment since 2007 for various health problems. Every time he was attended without any lapses. The DIbetic Foot was not due to any wrong treatment or any negligence from the doctors at SGPGIMS. He was attended by the residents on duty as qualified physician. The patient was suffering from multiple ailments. The gangrene developed in the toes was not due to any negligence or failure of duty of care from the SGPGI. It was due to the long standing diabetes and the atherosclerotic changes in the blood vessels. In our view the patient care was as multi-disciplinary approach at SGPGIMS as per the standard protocol. It was an accepted standard of practice. It can’t be the deficiency in services.
10. No doubt, every patient expects complete cure, but in certain cases complete cure depends upon several inherent factors. Moreover, no cure is not negligence. The Hon’ble Supreme Court in catena of judgments held that in every case where the treatment is not successful or the patient dies during surgery, it cannot be automatically assumed that the medical professional was negligent.
11. In the recent judgment in the case Chanda Rani Akhouri vs M.S.Methusethupathi Mithupathi [2022 LiveLaw (SC) 391, the Hon’ble bench of Supreme Court said that it clearly emerges from the exposition of law that a medical practitioner is not to be held liable simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another. In the practice of medicine, there could be varying approaches to treatment. There could be a genuine difference of opinion. However, while adopting a course of treatment, the duty cast upon the medical professional. The bench said that the treating doctors, all were academically sound and experts in the field of nephrology, kidney transplantation and surgery. In another judgment in Bombay Hospital & Medical Research Centre vs. Asha Jaiswal & Ors. 2021 SCC OnLine SC 1149 , Hon’ble Supreme Court held that the allegations need to be proved with cogent evidence.
12. We can’t brush aside that the SGPGIMS is one of the reputed post graduate institutes having best medical experts in their relevant field and giving their services. Thus, no doctor will gain any thing by doing something wrong. The doctors will not be able to serve the patients with their dedication if the halter is on their neck.
13. At the end, it was observed that the instant case was filed based on just surmises and presumptions with lack of medical acumen. The State Commission erred in holding the OP was liable for the gangrene and amputation of toes due to medical negligence.
India which is regarded as capital of diabetics, this case is of utmost importance as it has given solace to Doctors at the same time has cautioned Doctors too.
Thanks and Regards
Adv. ROHiT ERANDE ©
Pune.
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