YASHUMATI DEVI Vs. CHRISTIAN MEDICAL COLLEGE

JUDGEMENT

(1.) On 10/6/2009 Mr. Raj Ballav Ram, aged about 58 years (since deceased, for short the 'patient') visited the Out-patient Department (OPD) at Christian Medical College, Vellore (for short "CMC / Hospital"- the OP). He was known diabetic and hypertensive. Since year 2006, he was suffering off and on pain in his left arm on exertion, walking and/or climbing the stairs. His Treadmill Test (TMT) done elsewhere was positive and he informed the some to the doctors at CMC. The patient got admitted in CMC as a private patient. On next day, after examination, it was diagnosed as a case of Coronary Artery Disease (CAD) [effort angina NYHA class 2].

(2.) On the 13/6/2009, Dr. Oomen K. George, the treating doctor advised patient to undergo 'Coronary Angiogram' (CAG) test and if needed, Angioplasty be done at the same setting which will be economical. On the same day, the complainants deposited Rs.1,50,000.00 in the hospital. On 14/6/2009, Dr. Oomen K George while conducting the CAG expressed that it would be better for patient to undergo Coronary Arterial By-pass Graft (CABG) surgery instead of angioplasty to avoid multiple stenting. Due to long waiting list, the patient's CABG was not possible within 15 days and therefore no specific date was fixed for CABG. On 16/6/2009, Dr. Sujit discontinued medicines Ecospirin and Clopidogrel, and started Heparin 5000 units 6 hourly. It was alleged that Heparin was started without any laboratory investigations or monitoring protocol. The Complainant no. 2, noted some bleeding at the site of insertion of the intravenous needle, it was informed to the nurse, but despite repeated requests the doctors ignored it. On 17/6/2009 in the morning at 08.30 am the 3rd dose of Heparin injection was given and after about an hour patient showed signs of sudden numbness of his left arm and trouble in walking and/or wearing slippers. Coincidentally there were four doctors including Dr. George Joseph the Head of the Department - Cardiology-I unit saw the patient and confirmed that the patient seems to have suffered a mini stroke and immediate CT Scan to be done, however but Dr. George Joseph did not do stroke evaluation. It was further alleged that around 11.00 AM the patient was transferred to the Thoracic surgery unit in Semi-ICU i.e. 3 hours after the onset of stroke. At around 11:15 AM the neurologist came for primary evaluation of the patient and suggested 'CT Brain-Plain study', but the CT scan was delayed till 12.30 PM. The staff told the 2nd complainant to remit and get a receipt of Rs.1850.00 for the CT Scan, though they have already deposited Rs.150000.00 as an advance. The doctor in thoracic surgery told the complainant that now it became neurology problem and thence the neurology dept. will look after the patient. Due to such condition of patient the CABG was deferred. The Neurosurgeon after seeing brain CT Scan report informed the complainants that as the patient already progressed into coma, nothing more could be done. Finally, doctors suggested the family that they should accept the inevitable event and instead of wasting money allow them to withdraw ventilator support. Thereafter, the 2nd complainant met and discussed about the condition of the patient with few doctors in CMC namely Dr. Roy Thanka Chen, Dr. John Korula, Dr. Binila Chacko. They expressed the delay caused for stroke management was fatal and it was due to lapses in the hospital. It was alleged that on 17/6/2009 the patient suffered stroke in the morning at 08:30 AM, since then the doctors at CMC virtually did nothing till 10.30 PM and after long struggle the patient died on 20/6/2009 at 6.30am. Being aggrieved the patient's wife Yashumati Devi and son Dhananjay Kumar filed the Consumer Complaint against the CMC for the alleged medical negligence and callousness of the doctors at CMC caused death of the health man/patient for seeking compensation of Rs.2,01,44,000.00.

(3.) The OP raised preliminary objections that the Complainants filed a false complaint and suppressed the true and correct facts. It involves complicated questions of facts and needs elaborate evidence of experts, therefore, it cannot be adjudicated in the summary proceedings under the Consumer Protection Act, 1986 (The Act 1986). Such Complaint shall be tried before Civil Court. The OP further submitted that the deceased was admitted in CMC on 14/6/2009 and not on 09/10/6/2009. The patient came to CMC complaining of chest pain since two years on exertion and it was increasing since last two months. He was known diabetic for the last 11 years and recently detected as a hypertensive. The Angiography revealed a very serious condition of the heart (TVD) and patient was prone to a fatal heart attack. The patient was given urgent medical attention at the CMC. The OP submitted that the patient was informed about the two kinds of treatment available for coronary arteries blockages namely i) Angioplasty- if blockage is not severe and ii) By-pass Surgery (CABG) - if the blockage is severe. The patient agreed for CABG. On16/6/2009, the patient was transferred from Cardiology Unit III to the Cardiothoracic Surgery Unit-II for elective CABG. The patient, for his cardiac problems, was already taking blood thinners Ecosprin and Clopidogrel which had a risk of causing a bleeding, or leak into, inter-alia, the brain, stomach or urine. On the instructions of Dr. Sujith Velayudhan Indira, from 16/6/2009 evening the blood thinners Ecosprin and Clopidogrel were withdrawn and the Heparin injection 5000 units every six hourly started to prevent clotting of blood. The dose of Heparin was calculated on the basis of body weight of the patient (65 kg) and it was the normal dose. As per the common practice the consent is not required for administration of Heparin. In and around Vellore, the doctors prescribe Heparin without obtaining any specific consent from patient. In CMC for all cases the treating doctor decides for Heparin administration, the quantum and frequency determined on the basis of the health condition of the patient, age, and weight, etc. On 17/6/2009 in the morning, the patient felt a tingling sensation in the left side of the body and developed weakness of the left upper and lower limbs. Therefore the patient was immediately transferred to KN ward semi ICU and Neuro consultation was taken from specialists. The patient underwent a CT Scan at about 12:30 p.m., which revealed patient developed stroke due to blood inside the brain (Intra parenchymal bleeding). It might be possible due to blood thinners which patient was taking for long time. On 18/6/2009, at about 1.00 a.m. for difficulty in breathing, patient was kept on ventilator support. The GCS (Glasgow Coma Scale/Score) of the patient was dropped further from 19/6/2009. All the brain stem reflexes were lost, thus repeat CT Scan of the brain was difficult to perform. The neuro and cardiothoracic surgeons reviewed the patient, the prognosis was poor and same was explained to the relatives of the patient. However, despite all the efforts the patient passed away on 20/6/2009 at 6.30 AM, before the CABG could be done. There was no negligence or deficiency in service during the treatment of the patient at CMC, Vellore.