BABU SINGH SOLANKI Vs. MAX SUPER SPECIALITY HOSPITAL

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 his son Mr. Balwant Singh Solanki was diagnosed with Pulmonary Blastoma (a form of lung cancer) in year 2012. He went through chemotherapy for its treatment. He was operated in 2014, after which he was declared clear of the said problem. He was diagnosed with Spindle Cell Tumour in right hand in 2016 and was operated on 8/9/2016 and Tumour was removed successfully. He was advised for regular PET Scan for Ca-Lung (lung cancer) every six month to monitor his condition. He underwent radiotherapy from 17/10/2016 to 29/11/2016. OP-3, Dr PK Julka, advised chemo-profile minor from 6/12/2016. He started chemotherapy with OP-3 at OP-2, Max Cancer Care, Lajpat Nagar. He was then diagnosed with Stones in both the Kidneys on 16/3/2017 and OP-3 referred him to OP-4, Dr Samit Chaturvedi for urology opinion. On 16/3/2017 he was admitted in OP-1, Max Super Speciality Hospital where OP-4, OP-5 and OP-6 treated him. He was scheduled to operation for removal of kidney stone, but due to cardio problem his operation was put on hold. He was scheduled to be discharge on 18/3/2017 from OP-1. But, as he developed sudden complications and his discharged was held up. Despite repeated requests for immediate Cardio intervention, OP-6 did not visit him or check him in-person. His condition worsened further and expired on 19/3/2017. But, OP-4, OP-5 or OP-6 failed to visit or treated him in person from the time his discharge was withheld till he expired.

(3.) Upon notice, the complaint was resisted by the OPs by filing their Written Version. It was contended that the patient had a history of multiple medical conditions, including Pulmonary Blastoma of the left lung diagnosed in 2012 and recurrent synovial carcinoma - soft tissue tumour on his right wrist. He underwent chemotherapy, radiotherapy and a lobectomy, which is a surgical procedure to remove lobe in the lung for the former, while the latter was for excision surgery in 2016. The OPs emphasized that these treatments occurred at different hospitals and that the patient had long-standing symptoms, including wrist swelling, breathing difficulties, and chest pain. They contended that the Complainant deliberately suppressed these material facts. OPs further contended that the patient was diagnosed with recurrent synovial sarcoma of the right wrist and Stage IV post-chemotherapy pulmonary blastoma and was admitted to OP-2 hospital. Under OP-3's care, he underwent three cycles of palliative chemotherapy with Ifosfamide (IFOS) and Doxorubicin (DOX), followed by two cycles of DOX alone due to poor tolerance. A psychological evaluation revealed PTSD, and further assessment was advised on 10/3/2017, but the Patient failed to appear. On 16/3/2017, he visited OP-2 hospital with right flank pain, he was treated by OP-3 and referred to the Urology team at OP-1 hospital. A PET CT on 5/2/2017 had incidentally revealed bilateral renal calculi, which was confirmed by an ultrasound. Patient was admitted under OPs-4 and 5 and was started on antibiotics and symptomatically managed. Initially planned for bilateral retrograde intrarenal surgery (RIRS) with DJ stenting on 17/3/2017, the procedure was revised to DJ stenting alone due to an ongoing infection indicated by elevated TLC levels (Total Leukocyte Count) and puss cells in urine. The patient was evaluated by an anaesthesiologist and cardiologist and OP- 6, for pre-aesthetic clearance. A 2D ECHO revealed severe left ventricular dysfunction (LVEF 25-30%), indicating high cardiac risk due to suspected chemotherapy-induced cardiomyopathy i.e. a weakening of the heart muscles as a side effect of chemotherapy drugs. Given these findings, the surgery was deferred, and he was advised oral medication to improve heart functioning. The risks associated with any surgical intervention in such a condition were explained to the patient and his relatives. On the night of 17/3/2017, the patient developed breathlessness, nausea and vomiting, for which he was attended multiple times by the Urology team. He was managed symptomatically with oxygen therapy, medication and close observation. The possibility of requiring CCU care at any time was conveyed to the patient's relatives. On 18/3/2017, he was found to be symptomatically stable. In view of severe LV dysfunction, he was deemed unfit for surgery and was advised discharge with a follow-up review after a week for cardiac reassessment. Discharge formalities were accordingly initiated. However, while the discharge was in progress, he developed sudden restlessness at 2:21 PM and was promptly attended by the Urology team. Upon examination, he was found to have cold extremities, feeble pulse, un-recordable blood pressure, and an oxygen saturation of 97% with supplemental oxygen. The rapid response team was activated, and the discharge was withheld. The patient was immediately shifted to the Surgical Intensive Care Unit (SICU), and the Cardiology team was informed. In SICU, he exhibited deteriorating vitals, necessitating inotropic support and intubation. Subsequent blood investigations revealed markedly elevated TLC (49.4/cu.mm) and serum creatinine levels (2.5 mg/dL), indicating a worsening clinical status. Antibiotics were escalated, and the patient's critical condition was explained to his wife and other relatives. Despite all intensive medical efforts, his condition further deteriorated, with decreasing urine output and increasing lactic acidosis. Nephrology consultation was sought, and Sustained Low Efficiency Dialysis (SLED) was initiated due to persistently low blood pressure. On 19/3/2017, while on ventilator and inotropic support, the Patient's TLC remained elevated (48.1 x 109/L), serum creatinine increased to 3.1 mg/dL, and urine output remained poor, indicating multi-organ dysfunction. The medical team continued requisite interventions and informed the family of the ongoing treatment. Despite all measures, the patient's condition worsened on 19/3/2017, with his pulse dropping to 115 BPM and BP as 83/45 mmHg by 2:00 p.m., despite full inotropic support. He suffered a sudden cardiac arrest and, despite all resuscitative efforts, could not be revived. He was declared deceased at 4:43 PM, and the events were duly communicated to his relatives. It was contended that the complaint lacked any expert opinion or medical basis. Reliance was placed on Jacob Mathew (Dr.) v. State of Punjab and Anr, III (2005) CPJ 9(SC) and Indian Medical Association v. VP Shantha, AIR 1996 SC 550, to assert that an adverse medical outcome did not automatically imply negligence and that the burden lay upon him to establish any deficiency in medical treatment. It was denied that the Patient had been declared free from illness after his surgery in 2014. They maintained that the Patient was provided with the best possible medical care given his complex and high-risk condition, and that the complaint was wholly misconceived and devoid of merit.