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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION=medical negligence = Coming finally to the assessment of the expert committee of AIIMS, we find that on the fall of the patient in the bathroom, it says— “It has been established from the record that the patient had a fall on the day 15 of the treatment, but the details of the fall, injury sustained if any, clinical condition post fall and/or CT scan are not available. There is a mention of altered sensoriumon day 16 which may be a part of Intra Cranial event (which may be a neurological manifestation) or Neutropenic shock because of infection.” 9. We have already noted the observation of the expert committee that in the absence of record of the clinical condition of the patient from 15th afternoon to 16th morning, they were not in a position to comment whether there was medical negligence or not. These observations of the expert committee of AIIMS and the records of treatment clearly show that on 15.12.2000, after deciding not to discharge the patient, respondent/NIMS has committed two serious lapses— a. While the condition of the patient warranted assessment of the effect of fall in the bathroom (whether by CT scan or any other investigation) it was not done. b. In fact there was no further investigation or treatment till the morning of the fateful day 16.12.2000. This is established by absence of record of treatment after 4 PM. Even the oral testimony of OP-3 examined above does not travel beyond 5 PM on 15.12.2000. The total gap from 5 PM on 15.12.2000 and 8 AM on 16.12.2000 has remained completely unexplained. 10. What compounds these two lapses is that the patient was running high temperature. In fact, it was serious enough for the OPs to postpone his discharge fixed for 15.12.2000. Secondly, as per their own evidence, the OPs knew that sudden deterioration in the condition of the patient was a strong possibility. Thirdly, OP-3 knew about high fever and had been telephonically informed about the fall. In our considered view, these lapses amount to deficiency of service, within the meaning of Section 2(1)(g) of the Consumer Protection Act 1986. 11. In view of the above, the appeal is partially allowed. The allegation of deficiency of service is upheld to the extent of the lapses discussed above. A lump sum compensation of Rupees three lakhs is therefore awarded, with interest at 7% from the date of the complaint. The same shall be paid to the complainants by the OPs, jointly and severally, within a period of three months. Failing this, the amount shall carry interest at 12% for the period of delay.

NATIONAL CONSUMER DISPUTES REDRESSAL

Medical

COMMISSION

NEW DELHI

 

FIRST APPEAL NO. 202  OF 2006

(Against the order dated 31/12/2005 in C.D. No.116 of 2001  of the State Commission, Andhra Pradesh)

 

  1. Smt. N. Shree Mani

W/o late Sri N. Vinayaka Rao

Aged about 42 years, Indian,

Occ: Accounts Officers in Telephones

  1. N. Purnima, daughter of late No. Vinayaka Rao,

Aged about 21 years, Student

  1. N. Lakshmi, daughter of late N. Vinayaka Rao,

Aged about 18 years, Student

  1. N.L. N. Shree Rama Murthy, Son of late N. Vinayaka Rao,

Aged about 11 yrs.

(Appellants 4 being minor rep.

by his mother and natural guardian Smt. N. Shree Mani)

All R/o Type-III/2, Ground Floor, New Telephone Quarters,

Behind New Telephone Exchange,

Halar Road, Valsad– 001.

GUJARAT                                                                                                                                                   ……….Appellants

 

Versus

 

  1. Nizam Institute of Medical Sciences, Through Director,

Punjagutta, Hyderabad- 082, A.P.

  1. Dr. D. Raghunandha Rao, M.D.D.M.,

Addl. Professor and Head Department of Medical

Oncology NIMS, Punjagutta, Hyderabad, A.P.

  1. Dr. Lakshmi Sreenivas,

Department of Medical Oncology,

NIMS, Hyderabad, A.P.                                                                                                                             ………Respondents

 

BEFORE

HON’BLE MR. JUSTICE V.R. KINGAONKAR,

                                    PRESIDING MEMBER

HON’BLE MR. VINAY KUMAR, MEMBER

 

For the Appellants         :   Mrs. N. Shrimani, In Person

For the Respondents     :  Mr. G. Ramakrishna Prasad, Advocate

PRONOUNCED ON:    01-11-2011   

 

ORDER

 

PER MR.VINAY KUMAR, MEMBER

                                 

1.      The matter in this appeal pertains to the death of one Vinayaka Rao, who was under treatment for acute leukemia in the Nizam Institute of Medical sciences, Hyderabad. His wife and three children filed a consumer complaint before the AP State Consumer Disputes Redressal Commission, Hyderabad, together with the two doctors who had treated him. The allegation was of lack of proper and timely treatment. The State Commission dismissed the complaint, holding that there was no medical negligence.

2.      The case of the complainant before the State Commission was that on 23.11.2000, her husband was diagnosed in Valsad, Gujrat to be suffering from acute leukemia. He was advised to consult NIMS (OP-1) or Tata Memorial Hospital at Bombay. He consulted the OPs at NIMS on 27.11.2000, who diagnosed the problem as Acute MyloidLeukemia. The same day he was admitted to NIMS for treatment. The allegations of the complainants are related to certain developments of the last few days of treatment. On 15.12.2000, the patient developed high fever. It rose to 104.9 degrees. OP-3 examined him at 3.30 PM and prescribed Cifran-Z tablets. When he fell down in the bathroom at about 5 PM, there was no duty doctor available. But, as per the complaint petition, OP-3 was reached on phone. He advised to give Laringo tablets. According to the complainant, when the patient fell down, a CT scan was required in the background of high fever. This shows lack of reasonable and timely care.

3.      The response of the OPs was that NIMS treats about 150 patients of myloid leukemia every year. Death occurs in about 20-25% cases. It is not uncommon for its patients to remain in excellent health and suddenly deteriorate while on chemotherapy. As for sudden high fever on 15.12.2000, the OPs state that the spike in fever was due toneutropaenic  fever. It is not a reflection of the platelet count or hemoglobin. There has been no deviation from any standard or approved medical practice in treating the patient.

4.      It is seen from the impugned order that the State Commission has also considered the relevant medical literature which shows that infection and hemorrhage are primary causes of death in patients with leukemia. Fever is sensitive but non-specific sign of infection in neutropenic patients.  Considering such material, evidence on record and the pleadings, the State Commission concluded that the case of medical negligence was not made out.

 5.     The complainants have challenged this decision of the State Commission in the appeal before us. The appeal has been filed with delay of 46 days, which has been adequately explained. The delay is therefore, condoned. In the course of the appeal proceedings, the appellant expressed her inability to obtain report from an independent medical expert. Therefore, this Commission has sent the records to the All India Institute of Medical Science (AIIMS), New Delhi and obtained their opinion on the treatment given to the deceased. It has been shared with the complainant and the counsel for the respondents and they have been heard.

6.      We may note at the outset that the complaint petition states categorically that, “There is no dispute regarding the treatment and administration of drugs up to 11.12.2000.” Therefore, consideration of the complainant gets automatically limited to the developments of the last four days, from 12.12.2000 to 16.12.2000, when the patient died at NIMS.

7.      Appellant/complainant-1, personally argued her case and informed that there is no record of treatment for 15.12.2000.  We find from the record that on this day the record of treatment showed the blood profile as 14.5/8000/2.6. The instruction recorded is “Stop all drugs.  Discharge.” The last entry at 4PM states “febrile agreed to stay in hospital.”  The next entry is of 16.12.2000. This explains why AIIMS have observed in their report that no record of clinical condition of the patient from the afternoon of 15th till the morning of 16th is available. Respondent counsel attempted to answer this gap by referring to para 8 in the affidavit evidence of OP-3/Dr Lakshmi Srinivas.  A perusal of the same, shows that it does not explain the developments after 5 PM on 15.12.2000.

  8.    Coming finally to the assessment of the expert committee of AIIMS, we find that on the fall of the patient in the bathroom, it says—

“It has been established from the record that the patient had a fall on the day 15 of the treatment, but the details of the fall, injury sustained if any, clinical condition post fall and/or CT scan are not available. There is a mention of  altered sensoriumon day 16 which may be a part of Intra Cranial event (which may be a neurological manifestation) or Neutropenic shock because of infection.”

 

9.      We have already noted the observation of the expert committee that in the absence of record of the clinical condition of the patient from 15th afternoon to 16th morning, they were not in a position to comment whether there was medical negligence or not.

          These observations of the expert committee of AIIMS and the records of treatment clearly show that on 15.12.2000, after deciding not to discharge the patient, respondent/NIMS has committed two serious lapses—

a.   While the condition of the patient warranted assessment of the effect of fall in the bathroom (whether by CT scan or any other investigation) it was not done.

b.   In fact there was no further investigation or treatment till the morning of the fateful day 16.12.2000. This is established by absence of record of treatment after 4 PM. Even the oral testimony of OP-3 examined above does not travel beyond 5 PM on 15.12.2000. The total gap from 5 PM on 15.12.2000 and 8 AM on 16.12.2000 has remained completely unexplained.

10.    What compounds these two lapses is that the patient was running high temperature. In fact, it was serious enough for the OPs to postpone his discharge fixed for 15.12.2000. Secondly, as per their own evidence, the OPs knew that sudden deterioration in the condition of the patient was a strong possibility. Thirdly, OP-3 knew about high fever and had been telephonically informed about the fall. In our considered view, these lapses amount to deficiency of service, within the meaning of Section 2(1)(g) of the Consumer Protection Act 1986.

11.    In view of the above, the appeal is partially allowed. The allegation of deficiency of service is upheld to the extent of the lapses discussed above. A lump sum compensation of Rupees three lakhs is therefore awarded, with interest at 7% from the date of the complaint. The same shall be paid to the complainants by the OPs, jointly and severally, within a period of three months. Failing this, the amount shall carry interest at 12% for the period of delay. No orders as to costs.

                                   …………..……… ………..

 (V.R. KINGAONKAR,J.)

PRESIDING MEMBER

 

…..…………….…….……

                                                        (VINAY KUMAR)

MEMBER

S./-

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