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Medical Negligence – Angiography – aorta dissection – sever pain – right leg runs down- no pulse sensation – resulted in another Hospital an anigography and angio palsty – drives the complainant for mental and physical agony and financial loss – state consumer forum allowed the petiton – on appeal National consumer forum dismissed the complainant – Apex court held that There is sufficient material to come to the conclusion that the complainant was found stable after third day of angiography and till the date of discharge on September 8, 1999. The only allegation of the complainant is of abdominal pain during the process of angiography. There is no dispute that she was aged about 55 years and suffering from hypertension when the angiography procedure was conducted on her. It is probable that due to such associated causes the passage of the catheter through aortic space was not smooth. There is no material to infer that Dr. Chawla had undertaken any adventurous step. There is nothing on record which points out that Dr.Chawla used any brutal force to push the catheter. In our opinion, mere completion of the angiography does not rule out aorta dissection during the procedure. We find that the complainant did not had a serious aorta dissection but was having sub-acute aorta dissection and this is the reason that the complainant was subjected to clinical management and, in fact, her condition became stable without any surgical interference. It is nobody’s case that Dr. Chawla is not a competent coronary expert or he lacked adequate knowledge in the field of coronary surgery. He is duly qualified and has good academic credentials. We have not found his conduct to be below the normal standard of a reasonably competent practitioner in his field. We are in agreement with the reasoning and the conclusion arrived at by the National Commission that the complainant has not been able to prove medical negligence on the part of Dr. Chawla. In the result, we do not find any merit in the appeal and it is dismissed without any order as to costs.= CIVIL APPEAL NO. 6284 OF 2014 (@SPECIAL LEAVE PETITION (CIVIL.) NO. 18367 OF 2012) MRS. KANTA … APPELLANT VERSUS TAGORE HEART CARE & RESEARCH CENTRE PVT. LTD.& ANR. …RESPONDENTS = 2014 – July. Part – http://judis.nic.in/supremecourt/filename=41759

Medical Negligence – Angiography – aorta dissection – sever pain – right leg runs down – no pulse sensation – resulted in another Hospital an anigography and angio palsty – drives the complainant for mental and physical agony and financial loss – state consumer forum allowed the petiton – on appeal National consumer forum dismissed the complainant – Apex court held that There   is sufficient material to come to  the  conclusion  that  the  complainant  was

found stable after third day of angiography and till the date  of  discharge on September 8,  1999. The  only  allegation  of  the  complainant  is  of abdominal pain during the process of angiography.  There is no dispute  that she was aged about  55  years  and  suffering  from  hypertension  when  the angiography procedure was conducted on her.   It  is  probable  that  due  to such associated causes the passage of the catheter through aortic space  was not smooth.  

There is no material to infer that Dr.  Chawla  had  undertaken any adventurous step.  

There is nothing on record which points out that  Dr.Chawla used any brutal force to push the catheter.   In  our  opinion,  mere completion of the angiography does not rule out aorta dissection during  the procedure.   We find that  the  complainant  did  not  had  a  serious  aorta dissection but was having sub-acute aorta dissection and this is the  reason that the complainant was subjected to clinical management and, in fact,  her condition became stable without any surgical interference.   It  is  nobody’s case that Dr. Chawla is  not  a  competent  coronary  expert  or  he  lacked adequate knowledge in the field of coronary surgery.   He is  duly  qualified and has good academic credentials.   We have not  found  his  conduct  to  be below the normal standard of a  reasonably  competent  practitioner  in  his field.   We are in agreement with the reasoning and  the  conclusion  arrived at by the National Commission that the complainant  has  not  been  able  to prove medical negligence on the part of Dr. Chawla. In the result, we do not find any  merit  in  the  appeal  and  it  is dismissed without any order as to costs.=

whether it  was

the direct result of any negligent or  rash  act  committed  by  Dr.  Chawla

while conducting the angiography.  

Dr. Chawla examined  the  complainant  clinically

on September 1, 1999 and conducted  Echo  test.   Dr.  Chawla  noticed  that

there was possibility of blockages  which  needed  appropriate  confirmation

and medical treatment and  accordingly  he  advised  for  admission  of  the

complainant in the Research Centre for conducting angiography. =

Dr. Chawla  with  the  consent  of  the  complainant’s  son,  a

medical practitioner, decided to conduct angiography on September 2, 1999.=

The  complainant  has  alleged

that during the angiography procedure, she felt severe pain in  the  abdomen

and brought the said fact to the notice of Dr. Chawla  but  he  ignored  the

same and continued with the procedure.  =

On

September 3, 1999,  according  to  the  complainant,  Dr.  Chawla  alongwith

another consultant namely Dr. Suri examined  her  who  found  pulse  of  her

right leg practically absent and as such he  reprimanded  Dr.  Chawla=

Dr. Trehan of the Escorts Heart Institute, Delhi  and

was  admitted  in  the  said  Institute  on  September  13,  1999.   Another

angiography was conducted at the  Escorts  Heart  Institute  through  radial

artery of the right arm and on that basis,  according  to  the  complainant,

Dr.  Trehan  opined  that  aorta  dissection  has  taken  place  during  the

angiography procedure done by Dr. Chawla at Tagore Heart Care  and  Research

Centre, Mahavir Nagar, Jalandhar, Punjab and that was iatrogenic in  nature.

Ultimately, she had undergone angioplasty  on  October  18,  1999  and  was

discharged after ten days.=

The complainant alleged medical negligence on the part of  Dr.  Chawla

and the Research Centre while conducting the  angiography  on  September  2,

1999 resulting into dissection of aorta.  

She has alleged that  she  had  to

obtain further treatment and due to the sheer negligent act  of  Dr.  Chawla

incurred heavy expenditure in  undergoing  angioplasty  and  angiography  at

Escorts Heart Institute.  

Alleging  the  aforesaid,  the  complainant  filed

petition before State Commission, interalia, praying compensation of  Rupees

Eleven lacs  from  Dr.  Chawla-Respondent  No.2  and  the  Research  Centre-

Respondent No.1.=

State  Commission  held in this regard:

“….It is true that hypertension is  one  of  the  factors  of  causing

aorta dissection but in the present case, the aortic  dissection  had  taken

place when respondent no.2 was passing the  catheter  through  iliac  artery

travelling  through  aorta  blood  vessel  reaching  inside   the   arteries

adjoining the heart.

The  dissection  of  aorta  had  taken  place  because

respondent no.2 was negligent.

In fact, it is case  of  res  ipsa  loquitur

i.e. the facts speak themselves and point out that it has  taken  place  due

to negligence of respondent no. 2.If he taken due  care  and  caution,  then

this dissection of aorta would not have taken place because  it  is  a  very

rare phenomenon.

Hence, we hold that the respondent had not taken due  care

and caution and had acted negligently in passing the catheter through  iliac

artery by performing angiography and this led to severe pain in her  abdomen

and she even complained but unmindful  with  the  pain  of  complainant,  he

continued with the process and completed  the  same.

This  again  suggests

that he was insensitive to the pain and agony of the complainant.”

 In this regard, the National Commission has observed as follows:

“18.  We are of  the  opinion  that  the  State  Commission  committed

an error while reaching a finding that the doctrine of Res ipsa loquitur  is

applicable to the fact situation of the present case.  In fact,  we  do  not

find any basis to support  such  finding,  particularly,  when  the  medical

record shows  that  complainant  –  Smt.  Kanta  was  stable  when  she  was

discharged on 8.9.1999 from the hospital and could later on travel to  Delhi

for the purpose of coronary surgery.  We think it proper to hold that  there

was  no  negligence  committed  by  the  appellants  while  conducting   the

angiography procedure.”

 In this regard, the National Commission has observed as follows:

“18.  We are of  the  opinion  that  the  State  Commission  committed

an error while reaching a finding that the doctrine of Res ipsa loquitur  is

applicable to the fact situation of the present case.

In fact,  we  do  not

find any basis to support  such  finding,  particularly,  when  the  medical

record shows  that  complainant  –  Smt.  Kanta  was  stable  when  she  was

discharged on 8.9.1999 from the hospital and could later on travel to  Delhi

for the purpose of coronary surgery.

We think it proper to hold that  there

was  no  negligence  committed  by  the  appellants  while  conducting   the

angiography procedure.”=

Apex court held that

From the entries made  in  the  discharge

summary, we do not find that there was any emergency  to  treat  the  aortic

dissection.  

Aortic dissection came to  be  noticed  beyond  all  reasonable

doubt on September  3,  1999.

She  was  not  operated  upon.   

It  may  be

mentioned here that in case  of  acute  aortic  dissection,  emergency  open

heart  surgery  is  required.   

However,  in  case   of   sub-acute   aortic

dissection,  treatment  with  medication  may  be  sufficient.

There   is

sufficient material to come to  the  conclusion  that  the  complainant  was

found stable after third day of angiography and till the date  of  discharge

on September 8,  1999.  

The  only  allegation  of  the  complainant  is  of

abdominal pain during the process of angiography.  

There is no dispute  that

she was aged about  55  years  and  suffering  from  hypertension  when  the

angiography procedure was conducted on her.  

It  is  probable  that  due  to

such associated causes the passage of the catheter through aortic space  was

not smooth.  

There is no material to infer that Dr.  Chawla  had  undertaken

any adventurous step.  

There is nothing on record which points out that  Dr.Chawla used any brutal force to push the catheter.   

In  our  opinion,  mere

completion of the angiography does not rule out aorta dissection during  the

procedure.  

We find that  the  complainant  did  not  had  a  serious  aorta

dissection but was having sub-acute aorta dissection and this is the  reason

that the complainant was subjected to clinical management and, in fact,  her

condition became stable without any surgical interference.  

It  is  nobody’s

case that Dr. Chawla is  not  a  competent  coronary  expert  or  he  lacked

adequate knowledge in the field of coronary surgery.  

He is  duly  qualified

and has good academic credentials.  

We have not  found  his  conduct  to  be

below the normal standard of a  reasonably  competent  practitioner  in  his

field.  

We are in agreement with the reasoning and  the  conclusion  arrived

at by the National Commission that the complainant  has  not  been  able  to

prove medical negligence on the part of Dr. Chawla.

      In the result, we do not find any  merit  in  the  appeal  and  it  is

dismissed without any order as to costs.

2014 – July. Part – http://judis.nic.in/supremecourt/filename=41759

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