TAKAM JAMES Vs. DR. NAVANIL BARUA

JUDGEMENT

(1.) The present Consumer Complaint has been filed under Sec. 21 of the Consumer Protection Act, 1986 (for short "the Act") against the Opposite Parties seeking to direct the OPs.:-

(2.) Brief facts of the case, as per the complainant, are that at about 6:00 PM on 8/7/2013, Takam James, the complainant, had met with an accident while riding his motorbike in Nirjuli, Arunachal Pradesh. He was rushed to General Hospital in Naharlagun for initial treatment and subsequently referred to GNRC Hospital in Guwahati, where he was admitted on 9/7/2013. Following his recovery, he was discharged on 27/8/2013, with a tracheostomy tube in place. Upon returning home, Takam began to experience severe discomfort, including extreme coughing and expulsion of food particles through the tracheostomy tube. Despite being advised to consult the Neurosurgery outpatient department (OPD) after six weeks, his condition deteriorated due to significant damage to his vocal organs. He was rushed to the nearby hospital in Naharlagun on 11/9/2013 where the attending physician referred him to CMC Vellore for advanced care. He arrived at Vellore on 19/9/2013, with private medical team. Upon arrival, the procedures commenced on 12/9/2013, at CMC Vellore revealing that the surgical intervention performed at GNRC Hospital had resulted in the severing of both the food pipe and the windpipe, leading to permanent damage to Takam's vocal organs. He, therefore, filed the present complaint.

(3.) The complainant contended that medical negligence, deficiencies in service, and unfair trade practices in his case are conspicuous from the significant lapses in the evaluation and treatment of the patient from 11/15/7.2013, and again from 17/21/7.2013, during which time he was not adequately attended to by specialized medical experts. Multiple instances of inappropriate treatment occurred at GNRC Hospital, and despite the patient's lack of significant improvement, the authorities chose to detain him in the facility from 24/7/2013 to 27/8/2013, leading to an unnecessary escalation of medical expenses. Upon discharge, his CGS was recorded at E4V5M6, indicating a severity score of 15, alongside bilateral pupils graded 2+, yet the condition of his voice box was not clearly addressed. He lost his voice, potentially permanently, prior to his discharge from GNRC Hospital itself. The complainant further contended that he was kept in the super specialty hospital for an excessive duration of one and a half months without receiving any ENT measures to restore his voice, further exacerbating the financial burden. This delay contributed to irreversible damage to his vocal cords. The discharge summary from CMC Vellore, where he was admitted on 8/10/2013 indicated that the re-tracheostomy was a likely cause of the vocal cord damage. He contended that on 11/7/2013, the endotracheal tube was accidentally extubated and successfully reinserted. A CT scan conducted on 12/7/2013 confirmed that the area surrounding the vocal box was normal. Given this context, Dr. N. Barua, neurosurgeon, should have recognized that a tracheostomy could have been a more appropriate alternative to maintain intubation for over ten days. Consequently, the patient suffered a permanent loss of voice due to the consultant's lack of knowledge and a careless approach to treatment. The complainant contended that, as outlined by Medical Council of India (MCI) guidelines, it is the primary duty of a consultant to ensure that the healthcare professionals to whom they refer patients are competent. He raised questions regarding professional skills of doctors at GNRC performing a critical and potentially life-threatening procedure such as a tracheostomy. He alleged that, historically, this procedure was completed by both general and ENT surgeons, however, with increasing specialization it is now primarily confined to ENT specialists. He contended that as per GNRC discharge summary dtd. 27/8/2013, the diagnosis included diffuse axonal injury and mandible fracture. However, there was no acknowledgment of post-tracheostomy airway (subglottic) stenosis, a serious condition requiring specialized treatment. The document inaccurately stated that his post-operative recovery was uneventful and failed to mention the airway stenosis, despite its identification by attending physicians on 20/8/2013, through a confirmed CT scan. The summary further advised rest for six weeks and a re-evaluation in Neurosurgery OPD, with no mention of further consultation with an ENT specialist. Upon returning home to Arunachal Pradesh, he exhibited distress characterized by coughing and the emergence of food particles from the tracheostomy tube. As per the complainant, such symptoms are indicative of a tracheoesophageal fistula, a life-threatening condition that may arise from significant trauma or as a complication of tracheal surgery. The emergence of this condition post-procedure suggests it had developed as a direct result of the last tracheostomy performed by Dr. Agarwal, which was not due to the initial trauma from the accident. The non-availability of Dr. N. Barua needs to be construed as a deficiency in service and an instance of medical negligence. According to the doctor's note dtd. 11/7/2013, it was recorded that at 1:45 PM, the patient experienced an accidental extubation while under active mechanical ventilation. However, the note does not provide any explanation as to how such a critical incident occurred. Accidental extubation in a mechanically ventilated patient is a serious event that typically results from inadequate monitoring or improper care. Had the patient been adequately attended to by the clinical team, such an incident could likely have been prevented. Thus, the complainant, suffering from a severe brain injury, was subjected to repeated instances of inadequate and improper treatment at GNRC which amounts to a serious deficiency in service. The documentation reveals significant concerns regarding the medical care at GNRC. From 11/7/2013 to 16/7/2013, no neurosurgical specialist evaluated the patient despite the facility's neurological focus, constituting a serious service deficiency in treating a severe head injury case. The hospital failed to provide appropriate ENT care for the patient's voice box and neglected to refer them to a facility capable of providing such specialized care, instead discharging them with minimal advice and a six-week follow-up recommendation. This represents both service deficiency and unfair practice. The absence of ENT surgeon during the retrachestomy directly resulted in surgical damage to his voice box. Although tracheostomy was planned for 21/7/2013, it was not performed until 23/7/2013, which is a critical delay. Medical standards indicate that prolonged intubation beyond 10 days risks windpipe damage and narrowing, necessitating tracheostomy rather than continued oral intubation. The failure to perform this procedure by 19/7/2013 (after ten days of intubation) constitutes another serious service deficiency. Additionally, standard operation and aesthetic record forms were not utilized for the tracheostomy, and documentation fails to identify the surgeon who performed the initial procedure a fundamental professional responsibility. These facts collectively demonstrate substantial deficiency in care provision and documentation. Examination of medical records reveals numerous issues regarding patient care practices at the facility. This procedure should have been conducted under expert supervision in the relevant specialty, but the identity of the supervising specialist remains undisclosed to the patient's family, constituting both medical negligence and unfair trade practice. He contended that the documentation deficiencies are particularly concerning wherein the record fails to identify who examined the patient on 10/7/2014, and assessed their Glasgow Coma Scale (GCS) as E2M5VT. Dr. Barua, as the neurosurgeon should have personally evaluated a severe head injury patient under his care. The questions arise regarding his rapid improvement from severe to moderate head injury by 12/7/2014, when the GCS was documented as E3M6VT, raising concerns about the accuracy of these assessments. Critical gaps exist in the evaluation timeline, with documentation suggesting the patient may not have been evaluated on 13/7/2013, despite daily assessment being crucial for severe trauma cases. Evaluations documented between 11-16/7/2013, appear on a single sheet, with only a casual notation of "better" on July 15 without specific clinical parameters or GCS scores. The documentation regarding the tracheostomy is particularly problematic. On July 21, 2013, records indicate a planned tracheostomy without clearly identifying who made this decision. The procedure was performed on 24/7/2013, but without documenting whether an ENT surgeon or neurosurgeon performed this high-risk invasive procedure. OPs failed to legibly document their names, qualifications, and registration numbers requirements that, when neglected, constitute negligence and unfair practice, particularly when patient harm results from procedural errors. On 22/7/2013, the ITU progress note documented at 10:10 AM indicated "Tracheostomy to be done," signed by an illegible physician signature and by Dr. Barua without a date. A consent form issued that same day in Dr. Barua's name requested an unnamed doctor to perform the tracheostomy. While the form was signed by the patient's guardian and a witness, it failed to specify which physician explained the procedure to the patient violating the ethical obligation of surgeons to personally discuss procedures, risks, and benefits with patients or families before non-emergency operations. This demonstrated that proper informed consent protocols were not followed, representing another significant breach of medical standards. Alleging medical negligence, unfair trade practice and deficiency in service, on part of OPs, he prayed for compensation.