JASWANT KAUR Vs. R K AGGARWAL

JUDGEMENT

(1.) Complainant, widow of S. Uttam Singh, who died on 3.11.1997, had filed this complaint against the opposite parties on the ground of medical negligence, lack of proper treatment, post-operative care, professional mis-conduct in administering the treatment to the deceased and blatant derogation of duties on the part of the opposite parties.

(2.) As per case set up in the complaint, S. Uttam Singh was a qualified Engineer and Senior Consultant in Construction Company. He was admitted in the B. R. S. Heart Institute and Research Centre (hereinafter referred to as the Institute) with some cardiac problem on 27.10.1997, in response to the package deal for a payment of Rs.2,10,000 inclusive of Angiography/angioplasty and fixing of stint or any other treatment required for cardiac problem for which husband of the complainant was suffering. The package also included room rent and charges for post-operative care. On 28.10.1997 the patient was taken to operation theatre for angiography and after the operation was over, Dr. Mehra-opposite party No.2 asked the complainant to deposit Rs.1,55,000 for angioplasty and fixing of stint. The complainant deposited Rs.1,05,000 immediately and sought time for deposit of the balance amount of Rs.50,000 within next 24 hours but the Doctors of the opposite party No.3 refused to carry out treatment immediately and the patient was brought back from the operation theatre. The opposite party No.2 further informed the complainant that till the full amount was deposited, treatment would not commence. Accordingly on the morning of 29.10.1997 a cheque for Rs.50,000 was handed over to Dr. Mehra and thereafter treatment was started. During the night, the complainant was informed that some complications have developed in fixing the stint and for that reason the patient was to be taken for open heart surgery and a further demand of Rs.1,15,000 for carrying out open heart surgery was made from the complainant. On 30.10.1997 at about 11.00 hours the complainant was informed by the hospital authorities that her husband was normal and was to be discharged immediately, despite the fact that he was still in the Intensive Care Unit and needed post-operative care after the major surgery performed by Dr. R. K. Aggarwal - opposite party No.1, who had also fixed a stint on the patient. Accordingly, he was forcibly discharged by the opposite parties. It is the case of the complainant that later on she gathered that the discharge of the patient was done because of the Diwali Festival as the Doctors and the staff of the Hospital wanted to have a holiday in connection with Diwali celebration. On 31.10.1997 Dr. Jindal, Chairman of the Institute - opposite party No.3 was informed by the members of the complainant's family that the patient has not passed any urine after the discharge from the hospital. Under the advice of Dr. Jindal, the patient was given Lasics tablet but still he did not pass any urine and for that reason he was again brought to the Hospital on 1.11.1997. After examining the patient but without giving any treatment to him, the patient was referred to P. G. I. , where after admission in the P. G. I. , the patient expired on 3.11.1997 due to massive bleeding and cardiac arrest. It is further alleged that even after the normal angioplasty, the Hospital required to provide atleast 24 hours post-operative care, while in the present case, after heart surgery, the patient was discharged within 12 hours of the operation without taking care that his condition had not stabilized. On these premises, Rs.12 lacs were claimed as damages along with interest @ 12% per annum, besides Rs.7,000 as costs of litigation against the opposite parties.

(3.) The complaint was contested by the opposite party Nos.1 and 2, who filed their separate written statements. It was pleaded by opposite party No.1 that the patient, who was aged 75 years was admitted in the Hospital on 27.10.1997. He had a history of heart attack, which he had suffered in the year 1974 and was also suffering from Diabetes for the last 12 years for which he was taking drugs. He had chest pain and sweating 8 days earlier on 19.10.1997 which was relieved after some injection. On 21.10.1997, he again had chest pain and sweating and was admitted in a Hospital. There he again had chest pain next day when blood test, ECG and ECHO done revealed that he had suffered a heart attack. He continued to have repeated episodes of chest pain and was admitted in the hospital of opposite party No.3 on 27.10.1997 where after examining the patient, diagnosis of old heart attack, fresh heart attack, post-heart attack, angina and diabetes was made. Therefore, a Coronary Agniography was planned. On the next day on 28.10.1998 it was revealed that two arteries of his heart were 99% blocked for which Angioplasty treatment was needed. The patient and the complainant were explained about the need for Angioplasty, its complications and chances of success. Thereafter Angioplasty was performed on 29.10.1999 without Anaesthesia and without incision or stitching. It was decided to use the special drug (Non-Ionic Dye) for the procedure rather than the regular drug (Ionic Dye), as the chances of drug related complications including kidney damage are less likely with the Non Ionic Dye in an old diabetic patient than the Ionic Dye. One artery was completely opened and a stint was fixed in it. The other artery could not be opened. The patient remained absolutely stable throughout the procedure. The procedure was completed at 6.00 p. m. and the patient was brought to the Intensive Cardiac Care Unit at 6.15 p. m. The patient was quite stable and the ECG done after the Angioplasty did not show any new change. He remained stable throughout the evening and during the night. Next day also he remained stable and also had his breakfast and lunch and he was discharged in the evening at 9.00 p. m. on 30.10.1997 after 26 hours of Angioplasty and not after 12 hours as alleged in the complaint. The further stand of opposite party No.1 is that the duration of time for which a patient is kept in the hospital after the Angioplasty varies and Angioplasties are being done even on out-patient procedures. As early as in 1989, and later also, a large number of experts have been sending patients after an uncomplicated Angioplasty without admission, in less than one day's stay in the hospital without any adverse effects as per "a pilot study of coronary angioplasty in out-patients" and "early Hospital Discharge After Percutaneous Transluminal Coronary Angioplasty". The patient - Uttam Singh had an uncomplicated Angioplasty and stint, the patients are being discharged after only upto one day's hospital stay without any adverse effects, if no blood thinning injections are given after the procedure, as was the case with Mr. Uttam Singh. According to J. Am Coll Cardiol, 1996 Jan; 27 (1) : 22-9 and AM J Cardiol 1996 Aug.1; 78 (3) : 334-6. another group of international experts on Angioplasty, have conclusively shown that if there are no complications during or within first four hours after the Angioplasty, the patient can be safely discharged even as early as 4 hours after Angioplasty. It was further stated that it has been firmly and conclusively shown that non-clinical or Angiographic variables are associated with length of stay of more than one day after the Angioplasty, and only complications during the angioplasty were associated with increased length of stay, as recorded in "length of Hospital Stay and Complications After Percutaneous Transluminal Coronary Angioplasty, Clinical and Procedural Predictors. " The patient was readmitted on 1.11.1997 at 12.40 p. m. with the history that he had not passed any urine since he was discharged from the Hospital about 40 hours earlier and he had hardly taken anything. Further according to him, "he suspected kidney damage, caused due to the dye used and also because he had very little intake. Kidney damage is a well known complication of dye used during the procedure, although it is less likely with the special dye (Nonp Ionic ). His pulse and BP were normal and he passed 50 ML of urine in the Hospital. He was catheterized and given adequate and proper treatment for his kidney failure. Various blood tests and ECG were also done. In the evening at 5.00 p. m. blood tests were again done and since by that time kidney failure had not improved much, he was referred to PGI for further management of kidney damage. He further averred that at the time of treatment of the patient, he was Senior Consultant of opposite party No.3. He stated to have done M. D. from Institute of Medical Sciences, Banaras Hindu University in the year 1981 and he did his DM (Cardiology) from P. G. I. in the year 1985. He had been working earlier in CMC, Ludhiana as a Professor of Cardiology and had left the service of that Centre in the year 1986 and thereafter he worked in private sector at Jalandhar before joining opposite party No.3. He maintained that he had given correct treatment with due diligence to the patient in accordance with well established norms. The patient was provided all the best facilities and medical assistance by the opposite parties. He has also raised other pleas of non-maintainability of the complaint and want of jurisdiction of the State Commission to try the complaint as detailed evidence is required to be led by the parties and cannot be tried in a summary manner.