Facts in short :
1. The Complainants' mother, Mrs. Veena Pramod Srivastava, (since ‘deceased’, hereinafter referred to as the ‘patient’) was suffering from anxiety and diabetes. On 03.06.2015, she complained uneasiness, and restlessness. Initially, treatment form local doctor was taken who suggested consulting a cardiologist. Thereafter, she was taken to Inamdar Hospital wherein no experienced cardiologist was available. Therefore, she took discharge and on 05.06.2015, taken to Dr. Rahul Patil, a cardiologist (OP-1) at Ruby Hall Clinic (OP-2). After examination, OP-1 advised the patient to undergo angiography and angioplasty to remove the blockage.
2. It was alleged that the Cardiologist openly demanded his personal fee of Rs. 40,000 in cash payment, though there cashless Mediclaim insurance policy of Rs.6 lakh coverage. As the Complainants, having no other option, paid the said amount in cash to Doctor and after the Angiography he informed the Complainants that there was one blockage and advised angioplasty. The angioplasty surgery was performed successfully, and the patient was discharged from the hospital on 12.06.2015.
3. It was alleged that during the procedure, he mentioned about another block and its angioplasty would cost Rs.1,50,000/- apart from the other expenses. The total expenses would go around Rs. 5 to 6 lac excluding the additional cash payment. It was further alleged that, post-operatively, the Electronic Blood Pressure Machine was giving wrong readings, yet the Patient was administered medicine/drugs based on those wrong readings.
4 On 18.06.2015 at around 2 a.m. the Complainants' mother experienced respiratory problems. Therefore, immediately contacted OP-1 and took her to OP-2 Hospital at around 6 a.m. However, despite several requests, the OP-1 never arrived at that time. Therefore, Complainants managed to get another cardiologist, Dr. Shah, at the OP-2 hospital, but unfortunately, it was too late. As a result, the patient was declared dead due to cardiac arrest at 8 a.m.
5 Being aggrieved, the Complainants, filed this Consumer Complaint before this Commission and prayed sum of Rs.5,13,584 along with interest @10% p.a. towards medical expenses Rs,5,00,00,000/- as a compensation and Rs.1,00,000/- towards cost of litigation.
Defence: -
1. The Opponent The OPs- 1 & 2 filed their combined Written Versions, denying allegations of medical negligence. The preliminary objection was that the Complaint is defective because of misjoinder and non-joinder of necessary parties.
2. it was contended that the complainant intentionally concealed important facts, including the patient's past medical history and visits to other hospitals except visit to Inamdar Hospital. Also did not reveal details of treatments three days prior.
3. The complainants lodged a police complaint in Koregaon Park police station with alleged charge under section 300 of IPC. The matter was referred to an expert Committee at Sassoon General Hospital and B.J. Medical College. The expert Committee ruled out any negligence or deficiency of the OPs.
Arguments:
Surprisingly, None appeared for the Complainant. The Cardiologist argued in person and explained the details of treatment of the patient.
Held :
1. The Hon'ble commission perused the entire record and the dates were proven to be material and important.
2. It was revealed from the record that on 05.06.2015, at 01.15 pm the patient was brought to the Hospital and not in the morning as alleged. Initially, she was taken to Inamdar Hospital on 04.06.2015.
3. It was also proved that the Complainants made false statement that no Cardiologist was present at Inamdar Hospital as the discharge certificate of Inamdar Hospital, revealed diagnosed as ‘evolved inferior wall myocardial infarction, discharged against medical advice’.
4. It is pertinent to note that the patient stayed there for short period- admitted 9.22p.m. on 04.06.2015 at and discharged at 10.55 p.m. after about 1½ hour. She was advised by Dr. Krishna Dhoot and Dr. Sachin Lakade for urgent coronary angiography and intervention SOS, but relatives were not willing for coronary angiography and treatment.
5. Due to the Complainants delay, the Golden hour of management of MI of 12 hours was lost. On the next day at 01.15 p.m. the patient was taken to Ruby Hall for emergency ICU facility .
6. It is pertinent to note that prior to admission to Ruby Hall, the patient was first taken to another cardiologist Dr. Priya Palimkar's Clinic at Vishrantwadi, about 16 km from Undri. On the way itself there are 3 multispecialty hospitals including Ruby Hall Clinic, Jehangir Hospital and NM Wadia Institute of Cardiology where patient should have taken without any loss of time.
7. After watching ECG Dr. Priya Palimkar advised patient to get admitted to any specialty hospital. But instead, again she was taken to the clinic of family physician Dr. Alpana Sood, which was about 1.5 Km from Dr. Palimkar's clinic. Dr. Alpana Sood then phoned up Dr. Rahul Patil and informed that the patient’s critical condition to be taken to Ruby Hall Clinic and ultimately patient arrived at 01.15 PM on 05.06.2016. The complainants deliberately suppressed those events.
8. The patient was examined by Dr. Rahul Patil in the casualty , it revealed she was suffering from a very serious condition Cardiogenic shock & Heart attack (acute inferior wall myocardial infarction). The BP was 90/70. The risk was as high as 70 - 80%. The relatives were informed about the critical condition and in no time the patient was directly shifted from casualty to cardiac Cath lab for Rescue Angiography and a Primary Angioplasty.
9. After obtaining high risk consent the Cardiologist performed Rescue Angiography and a Primary Angioplasty within 02 hours of hospitalization. Both these procedures gave expected excellent results. She was kept in CCU for five days under close monitoring. On 08/06/2015, she developed a run of Ventricular Tachycardia(VT) at 1.33 am, it was managed with Inj Cordarone, then followed by Tab Cordarone. The patient was off all supports and was made to sit on the chair and mobilized in CCU. On the seventh day she was discharged on 12.06.2015.
10. On 18.06.2015 at 2 a.m., patient suffered breathlessness. The Doctor was contacted at 05.45 a.m. who informed the father of the complainant, to take the patient to Ruby Hall Clinic, at Wanowrie, since it is about 10 mins away from the residence of the patient, but they waited from 2.00 am and brought to Ruby Hall at 06.50 am. The crucial hours of medical help were already lost.
11. The patient was however immediately examined in casualty. She was unresponsive and unconscious. The Cardio Pulmonary Resuscitation (CPR) was immediately started, the patient was intubated and CPR was continued till 8 a.m. but she could not be revived and declared dead.
12. The Doctor advised for the post mortem examination, but the patient’s relatives started heated arguments on the issue. Therefore, considering the patients past history of acute heart attack and cardiogenic shock, with one episode of arrhythmia, the death certificate mentioning cause of death was issued. The written consent of the relatives was taken for denial of post-mortem.
13. The Commission held that the Primary Angioplasty is different as compared to routine angioplasty. Primary Angioplasty is done as a life-saving Angioplasty in a patient in an on-going heart attack.
14. These are extremely difficult situations involve special skills and for which the Doctor for his expertise fee of Rs. 40,000/- was charged. Moreover, receipt was issued.
15. The Commission observed that nothing was wrong or illegal about charging his professional fees, since same will not be reimbursed by the mediclaim. The allegations of Complainant are vague and he was just harping on Rs 40,000/- as collected in Cash.
16. It is evident from record that the patient was admitted in Ruby Hall Clinic as a private patient under the said Doctor and not a hospital case. The pleadings of complainant appear to be twisted facts.
Expert Committee of B.J. Medical College ruled out any Negligence.
17. The expert committee report form Sassoon General Hospital & B.J. Medical College, Pune clearly stated that No Negligence or deficiency is observed in the treatment given to the patient by the doctor.
18. The Commission relied on the expert opinion of Cardiologist – Dr. Shirish (MS) Hiremath, the Director of Cardiology at Ruby Hall Clinic revealed that the patient was managed for the heart attacks per guidelines of American College of Cardiology and American Heart Association (ACC / AHA). As per the data of Cathlab and CD Dr. Rahul Patil was able to manage the heart attack and Door to Balloon time less than 90 minutes. Very few Cardiologists across the globe are able to manage such time. The expert opined that there was no negligence of Dr. Rahul Patil.
19. The commission also took into consideration the credentials of the Opponent Cardiologist and observed that he was not a Junior Cardiologist, and he had successfully conducted more than 12,000 angiographies and 5000 angioplasties during past 9 years of his professional career. He was awarded "Best Cardiologist" of Pune the Chief Minister of Maharashtra.
20. lastly it was held that the fault lies with the complainants, who delayed in bringing the patient to the hospital, wasted almost valuable five hours, since 2 am. Thus complainants cannot shift their blame on the hospital.
21. It also relied upon the celebrated judgments of Hon’ble Supreme Court, firstly Kusum Sharma & Ors. V. Batra Hospital and Medical Research Centre & Ors[ AIR 2010 SC 1050], wherein The Supreme Court specifically held that:
“As long as the doctors have performed their duties and exercised an ordinary degree of professional skill and competence, they cannot be held guilty of medical negligence.”
In the same judgement the Hon’ble Supreme Court laid down certain principles (i to xi) while holding the doctor negligent.
It was held that the patient had already suffered MI, but unfortunately the complainants themselves have delayed for the treatment of MI. Thus no negligence is attributable to the OPs.
22. The commission yet again reiterated that “No Cure is No Negligence”. There is marked tendency to hold the doctor liable for any mishap and to punish him and relied upon the observations of Hon'ble Supreme Court in the well known case of Jacob Mathew v. State of Punjab[ (2005) 6 SCC 1] case,and held that in the instant case, it is clear that the OP-1 and his team performed their duties with utmost diligence and skill and competence in the interest of the Patient and no case of medical negligence is made out.
The Case yet again impliedly proves that adhering to standard code of conduct and proper documentation always help medicos in such cases. The CPA being the social legislation does not ask the complainants to pay the stamp duty in proportion to the amount of money claimed, unlike in Civil Suits.
It is also to be noted here that the Doctor who treated the patient properly was well versed with all the facts and that must have helped him in arguing the matter personally with the help of the Lawyer of the Opponent.
Thanks and Regards
Adv. ROHiT ERANDE
Pune ©
Comments
Post a Comment