{"id":237941,"date":"2005-05-13T00:00:00","date_gmt":"2005-05-12T18:30:00","guid":{"rendered":"https:\/\/www.legalindia.com\/judgments\/mrs-sheela-hirba-naik-gaunekar-vs-apollo-hospitals-ltd-chennai-on-13-may-2005"},"modified":"2015-06-28T09:14:02","modified_gmt":"2015-06-28T03:44:02","slug":"mrs-sheela-hirba-naik-gaunekar-vs-apollo-hospitals-ltd-chennai-on-13-may-2005","status":"publish","type":"post","link":"https:\/\/www.legalindia.com\/judgments\/mrs-sheela-hirba-naik-gaunekar-vs-apollo-hospitals-ltd-chennai-on-13-may-2005","title":{"rendered":"Mrs. Sheela Hirba Naik Gaunekar vs Apollo Hospitals Ltd., Chennai & … on 13 May, 2005"},"content":{"rendered":"
National Consumer Disputes Redressal<\/div>\n
Mrs. Sheela Hirba Naik Gaunekar vs Apollo Hospitals Ltd., Chennai & … on 13 May, 2005<\/div>\n
  \n \n \n \n \n \n NATIONAL  CONSUMER  DISPUTES  REDRESSAL  \n  \n \n \n \n \n \n \n \n\n\n\n\n\n\n\n \n\n\n\n \n\nNATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION  \n\n \n\n  NEW DELHI \n\n \n\n \u00a0\n\n ORIGINAL PETITION NO.\n103 OF 1997 \n\n \n\n  \u00a0\n\n \n\n  \u00a0\n\n \n\nMrs. Sheela Hirba Naik Gaunekar  Complainant \n\n Versus \n\n \n\n \u00a0\n\n \n\nApollo Hospitals Ltd.,\nChennai & Anr.  Opposite Parties \n\n \n\n \u00a0\n\n \n\n BEFORE : \n\n \n\n \u00a0\n\n \n\n HONBLE\nMR. JUSTICE M.B. SHAH, PRESIDENT \n\n \n\n MRS.\nRAJYALAKSHMI RAO, MEMBER \n\n \n\n \u00a0\n\n \n\nFor the Complainant : Mr. Dhruv\nMehta, Mr. Mohit Choudhary  \n\n \n\n& Mr. Harshvardhan Jha, Advocates \n\n \n\n \u00a0\n\n \n\nFor the Opp. Party No.1: Mr. S. Ganesh,\nSr. Advocate & Ms. A.S.  \n\n \n\nChandrashekar & Ms. Surekha\nRaman, Advocates with him. \n\n \n\n \u00a0\n\n \n\nFor the Opp. Party No.2 : Mr. Joseph Vellapally, Sr. Advocate and  \n\n \n\nMr. Mani Shankar & Mr. Som Mathew, Advocates with him. \n\n \n\n \u00a0\n\n \n\n 13.05.2005 \n\n O R D E R \n<\/pre>\n
 \u00a0<\/p>\n
  MRS. RAJYALAKSHMI RAO, MEMBER <\/p>\n
  \u00a0<\/p>\n
 \u00a0<\/p>\n
 Wife
\nof the deceased, Mrs. Sheela Hirba Morto Naik Gaunekar, has filed this
\ncomplaint alleging deficiency in service rendered by the doctors of the   Apollo  Hospital, Chennai, who carried out the Angioplasty
\noperation, which resulted in death of Mr. Gaunekar on 18.5.1996 in the hospital. It is her say that on 9.4.1996, the deceased
\nwas to celebrate his 60th Birthday.\n<\/p>\n
However, he was admitted in   Goa  Medical  College, Bambolin, on
\n1.4.1996 and was kept under observation for 8 days and was discharged on
\n9.4.1996. During the observation, the
\ndoctors advised the deceased to have Angiography at some future date to dispel
\ndoubts of possible blockage of blood vessels.\n<\/p>\n
He thereafter took appointment from Dr.Mathew
\nand went to Apollo Hospitals,   Madras on 9.5.1996. Angiogram was taken on 10.5.1996 and the
\ndeceased was advised to have Angioplasty by putting stents. Angioplasty was decided to be done on
\n14.5.1996 at  9.00 AM.\n<\/p>\n
 On
\n14.5.1996, the deceased was given light breakfast and tea at  6.30 AM and was taken to Cathlab
\nat  9.00 AM
\nfor Angioplasty. Instead of carrying out
\nAngioplasty, Dr.Vivek Bose came at  12.00 Oclock and assured that Mr.Gaunekar
\nwill be taken to Cathlab very soon. However, he was taken only at  4.00 PM in the evening. The complainant was informed at about  6.30 PM by Dr.Vivek
\nBose that the whole procedure was over and there was no problem in inserting
\nthe stents. Thereafter, Mr.Gaunekar
\nwas taken to ICCU.\n<\/p>\n
 It
\nis the say of the complainant that after going to the ICCU, she noticed that
\nthe air-conditioner in ICCU was not working and Mr.Gaunekar
\nwas restless and perspiring. She,
\ntherefore, complained to the doctors. It
\nis her say that in   Madras, at the relevant time, temperature was 43oC. She had even complained to the Managing
\nDirectors office for this. Thereafter, Dr.Mathew came and informed her that there was nothing to
\nworry as the whole Angioplasty process went on very well and there were no
\nblocks or deposits in the arteries.\n<\/p>\n
Therefore, the process took only 20 minutes instead of 30 minutes.\n<\/p>\n
 It
\nis the say of the complainant that she requested Dr.Vivek
\nBose that as the air-conditioners were not working in the ICCU, Mr.Gaunekar be shifted to the room on 15th
\nevening, as promised earlier. However, Dr.Vivek informed that Mr.Gaunekar
\nneeded to be monitored further for one day more.\n<\/p>\n
 Mr.Gaunekar was brought to the room on 16th
\nmorning. He was having general weakness
\nand the nausea continued. Thereafter,
\ndoctors came and saw him and prescribed some medicines. He had hiccoughs throughout the day. On 17th morning also he was having
\nnausea and was given anti-vomitting drug. On that day, in the evening, Dr.Mathews and his team saw the deceased and they informed
\nthat he was quite normal and that he would be discharged on the next day
\nmorning. She, therefore, paid off the
\nhospital bills as they were supposed to leave the hospital on 18.5.1996 at  9.30 AM.
\nShe was informed that general weakness of Mr.Gaunekar
\nwould be overcome after he gets his normal food, once he goes home. He was advised to restrict oil, sugar and
\nsalt intake.\n<\/p>\n
Thereafter, it is her say that
\nthe deceased went to sleep on 17.5.96 at about  10 PM and got up at  11.30 PM to go to toilet. She accompanied him to the bathroom but
\nbefore passing urine he collapsed and she could not control him. She called the nurses and the doctors who
\npicked him up. Thereafter, the deceased
\nwas made to walk to his bed. It is her
\ncontention that at the relevant time he turned pale,
\nhis lips were also pale and rolled his eyes.\n<\/p>\n
This was noted by the nurses and the RMO but ECG was not taken. On her insistence, Dr.Vivek
\nBose came. It is her say that at that
\njuncture it was necessary to shift Mr.Gaunekar to
\nICCU and to monitor the working of his heart and to carry out the examination
\nof the head and brain which the doctors had neglected to do.\n<\/p>\n
 In
\nthe complaint it is her further say that Mr.Gaunekar
\nwas restless and in spite of the air-conditioner he felt warm. Thereafter, at about  1.30 AM he was given sedative treatment and thereby
\nthe deceased was snoring loudly but was not normal. At that stage also Dr.Vivek
\nassured her that everything was normal and the deceased would be alright.\n<\/p>\n
 At
\nabout  5.30 AM on
\n18.5.96, the deceased got up all dazed and asked for the doctor and Dr.Vivek attended on him for 5 minutes. At this juncture also Dr.Mathew
\ndid not come. Dr.Vivek
\nasked her to cancel the tickets and informed her that the deceased would be
\ntaken to ICCU. On the way to ICCU, Mr.Gaunekar had a Cardiac Arrest. Dr.Vivek informed
\nher that they were trying their best to revive him. Dr.Mathew was
\ncalled and he came from the airport to the ICCU. Mr.Gaunekar
\nremained unconscious. He had all sorts
\nof life saving gadgets around him but was declared dead at  9.45 AM.\n<\/p>\n
 In
\nthe complaint, a number of deficiencies are mentioned. However, at the time of
\nhearing of this complaint, learned counsel for the complainant had submitted
\nthe deficiencies mentioned by the witness Dr.Desai, a
\nThorasic Surgeon from  Goa who gave his opinion on 26.6.2002 and on
\n18.1.2003 on the basis of the medical record made available to him.\n<\/p>\n
These have been grouped by the Complainant
\nas follows :\n<\/p>\n
a.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\n<\/p>\n
Non-functioning
\nof air-conditioner in ICCU leading to restlessness of the patient and the other
\ncomplications such as temperature in   Madras at the relevant time was 43 degree C.\n<\/p>\n
b.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\n<\/p>\n
Delay
\nin carrying out angioplasty on 14.5.1996 and prolonged starvation of the patient\n<\/p>\n
– its consequences.\n<\/p>\n
c.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\n<\/p>\n
Reference
\nto the sheath removal and application of digital pressure on puncture
\nside. Not attending to the haematoma at the groin.\n<\/p>\n
d.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\n<\/p>\n
Fall
\nin the bathroom at 11.30 p.m.on 17.5.1996 and not taking
\nadequate measures at  11.30 p.m. and again at  2.30 a.m. on 18.5.1996 when discharge of the
\npatient was cancelled.\n<\/p>\n
e.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\n<\/p>\n
Patient
\ncollapsing in the lift at  5.30 a.m. on 18.5.1996 while being taken to the
\nICCU. And,  <\/p>\n
f.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\n<\/p>\n
Vagueness
\nin the Death Certificate and Discharge Summary.\n<\/p>\n
Before we proceed to state the
\nversion of the opposite parties, it is necessary to state certain established
\nfacts. Dr. Mathew, Consultant and
\nHonorary Director, Interventional Cardiology who performed the surgery on the
\npatient at the   Apollo  Hospital is not an employee of the   Apollo  Hospital.
\nHe only uses the facilities of the   Apollo  Hospital and charges his patients directly. Dr. Vivek Bose, the
\nAssociate Cardiologist is on the payrolls of the   Apollo  Hospital. At
\nthe relevant time, he was working in the Interventional Cardiology Department
\nat the   Apollo
\n  Hospital with Dr. Mathew, looking after Dr.
\nMathews patients during their stay in the hospital, prior to
\nsurgery\/procedures, post surgery\/ procedures and also used to help Dr. Mathew
\nduring the surgery\/procedure.\n<\/p>\n
 Dr.\n<\/p>\n
Vivek Bose is an M.D. (Medicine) and D.M.\n<\/p>\n
(Cardiology) and was a gold medalist.\n<\/p>\n
For looking after Dr. Mathews patients he was also paid some amount by
\nDr. Mathew. Though the Complainant
\nraised complaints of delay in performing the angioplasty, and of not attending
\nto the patient after  3.00 p.m. on  17th May, 1996 against Dr. Mathew, the main thrust of
\nthe arguments of the Complainant is against Dr. Vivek
\nBose and the hospital staff for negligence of the post-operative care. However, Dr. Vivek
\nBose has not been made a party to the proceedings but was only examined as a
\nwitness.\n<\/p>\n
 After
\nhearing the arguments of both the parties and after a careful consideration of
\nthe evidence on record, our findings on each of the set of the complaints is as
\nfollows :\n<\/p>\n
a.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\n<\/p>\n
The
\nallegation is that the air-conditioner in the ICCU was not working on 14th
\nMay and that this had led to dehydration of the patient and loss of electrolyte
\nand potassium causing arrhythmia. The
\ncase of both Respondents No. 1 & 2 is that the
\nair-conditioner was in fact working throughout the daytime on the 14th
\nand that there was some problem with the air-conditioner in the evening. However, it is also a fact that all the beds
\nin the ICCU were fully occupied and all the patients were feeling comfortable
\nand no one complained of lack of air-conditioning. But Mr. Gaunekar was complaining of the
\nunsatisfactory working of the air-conditioner.
\nThe hospital and Dr. Bose arranged two pedestal fans in addition to the
\nair-conditioner to make Mr. Gaunekar more comfortable. We find that there is no clinical or medical
\nevidence regarding the allegation of dehydration or loss of electrolyte and
\npotassium etc., and that the allegations are without any basis and imaginary.\n<\/p>\n
b.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\n<\/p>\n
The
\nsecond complaint is that on the 14th, there was considerable delay
\nin taking Mr. Gaunekar for the Angioplasty procedure and that being a diabetic patient
\nhe might have developed hypo-glycemia because of the
\ndelay. Once again we find that no
\nmedical evidence was led to show that Mr. Gaunekar developed or shown at any
\nstage, any signs of hypo or hyper-glycemia and ketoacidosis and that these allegations once again are without
\nany basis. Dr. Mathew was fully aware
\nand conscious of the fact that Mr. Gaunekar is a chronic diabetic patient and
\nalso is hypertensive. The patient was
\nasked to take light breakfast at around  6.30 a.m. on 14.5.1996 and to be  on the call
\nfor Angioplasty. There is enough
\nevidence on record to show that no specific time was fixed for the Angioplasty
\nand in fact all records show that the patient was to be  on call for Angioplasty
\non 14.5.1996. The Nurses Chart dated
\n13.5.1996 clearly states posted for PTCA tomorrow on call. Dr. Mathew stated in his affidavit that he
\nexpected to take the patient for the operation around  noon but as the earlier Angioplasty took more
\ntime than expected the procedure for Mr. Gaunekar was delayed. On his instructions Dr. Vivek
\nBose informed the patient of the delay and advised him to have fruit juice or
\nlight lunch which the deceased did. The
\nComplainant herself admits that Dr. Bose met the patient at  12 noon. Investigations
\nto detect the blood sugar level for hypo or hyper-glycemia
\nwere conducted at  12 noon and found to be within acceptable limits. He was shifted to Cath
\nlab at  2.20 p.m. and the angioplasty was performed. The procedure was completed successfully and
\nthe patient was received back in the ICCU at  4.50 p.m.
\nThe clinching argument advanced by Dr. Mathew is that fasting for upto 10-12 hours prior to surgery\/procedure does not lead
\nto the occurrence of diabetic Ketoacidosis (Hypoglycemia)
\nor electrolyte imbalance even in the diabetic patient, and in this, Dr. Mathew is
\nsupported by the expert opinion of Dr. Kerkar. Otherwise, all diabetic patients could
\ndevelop hypoglycemia every morning when they wake up. We, therefore, see no
\nforce in the allegation of delay in conducting Angioplasty.\n<\/p>\n
c.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\n<\/p>\n
The Angioplasty
\nprocedure was conducted through a puncture in the groin. To avoid bleeding from this puncture an arterial
\nsheath was applied at the groin. Dr. Vivek Bose who removed the arterial sheath took longer time
\nthan usual to get proper homeostasis so the patient was not allowed to move
\ntill the puncture site is fully healed.\n<\/p>\n
Because of the patients history of hypertension Dr. Mathew and Dr. Bose
\ntook the decision to keep him in the ICCU for an extra 12 hours in his own
\ninterest. The allegation that Mr.
\nGaunekar suffered an extra 12 hours in the ICCU without air-conditioning has no
\nvalid basis.\n<\/p>\n
Another complaint is that it
\ntook Dr. Bose three hours to obtain full Homeostasis and that there was oozing of
\nblood from the puncture site and that the Doctors should have considered
\nsurgical stitches or blood transfusion and they did not even obtain the opinion
\nof a Cardiovascular Surgeon. Dr. Bose
\nmentioned that he had followed the standard procedure and that six hours after
\nthe Angioplasty, he removed the arterial sheath himself and gave digital
\ncompression (i.e. with hand) till proper homeostasis was obtained. He stated that he waited for three hours to
\nobtain full homeostasis and tightly bandaged the groin. When proper homeostasis obtained, a small hematoma was noticed which was within acceptable
\nlimits. There was no bleeding and
\ndigital pressure compression to stop bleeding after sheath removal is a
\nstandard procedure all over the world.\n<\/p>\n
The small hematoma observed is again a normal
\nphenomenon after sheath removal and was within the acceptable limits. Since there was no bleeding, there is no need
\nto have surgical stitches or blood transfusion.
\nThe bleeding and clotting time were also measured and found to be normal
\nand there was no need to consult a Cardio-Vascular Surgeon. In addition, Dr. Mathew has stated that he,
\nhis team and the nurses inspected the groin puncture site on the 15th,
\n16th and 17th May and found that everything was within
\nnormal limits. Therefore, there is no
\nevidence to show any deficiency in service regarding sheath removal and groin
\ncare. We find that none of these
\naverments of the opposite parties were challenged with any appropriate medical
\nevidence to the contrary. The allegation
\nis therefore without any medical evidence or proof.\n<\/p>\n
d.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\n<\/p>\n
The
\nmain emphasis of the Complainant has been on point D. It is alleged that at  3.00 p.m. on 17.5.1996, Dr. Mathew, the Cardiac
\nSurgeon attending on the patient, saw the patient and advised that he should be
\ndischarged. The Complainant cleared the
\nhospital bills and made arrangements to leave the hospital at 9.30 on the next
\nmorning i.e. on the 18th. Accordingly,
\ntickets for going back to their home town  Goa were also arranged. However, it is alleged that the patient slept
\nat  10.00 p.m.
\non 17th night but got up at  11.30 p.m. for urination. The Complainant accompanied the patient to
\nthe bathroom and it is alleged that the patient fell down in the bathroom. The attending nurse, who was summoned, helped
\nhim to get up and after passing urine he was made to walk to his bed. The Resident Doctor, Dr. Bhaskar
\nRao examined the patient. The artery which was punctured was bleeding
\nand there was hematoma at the wound. It is alleged that the Doctor concentrated on
\nthe wound and did not pay attention to the patients general condition or tried
\nto find out why he collapsed.\n<\/p>\n
Thereafter, the patient was
\nrestless and hence Dr. Vivek Bose was summoned at
\nabout 2.30 in the early morning hours of 18.5.1996. Dr. Vivek Bose then
\ndecided at  2.45 a.m. that the orders for the patients discharge should
\nbe cancelled and further instructed that the patient should be given sedation. Thereafter at 5.30 in the morning when he was
\nbeing taken to the ICCU, he developed cardiac arrest in the lift and in spite
\nof various efforts made to revive him he died at about  9.15 a.m.
\nDr. Desai who had been examined as witness of the Complainant had stated
\nthat six hours between  11.30 p.m. on 17th to 5.30 next morning
\non 18th was a very crucial period and that the patient should have
\nbeen shifted to ICCU immediately at  11.30 p.m. when he complained of giddiness. The
\nOperating Surgeon, Dr. Mathew should have been informed of the patients
\ncondition which was not done. Dr. Mathew
\nwas to address a Medical Conference at Pune on the
\nnext day, i.e., 18.5.1996 and when he was at the airport, he was informed only
\nat  6.00 a.m.
\non 18th about the patients condition and he rushed back to the
\npatient. The argument is that between  3.00 p.m. on 17th when Dr. Mathew
\nordered the discharge and  6.30 a.m. on the next morning on   18th Dr. Mathew was not kept informed of the
\npatients condition. It is also argued
\nthat after  11.30 p.m. on 17th , opinion
\nof the Cardio- Vascular Surgeon should have been obtained about the Hematoma in the groin and an ultrasound examination should
\nhave been done to see if there is any blood collection in the deeper
\ntissues. Similarly, a C.T. scan should
\nhave been done at that stage and the opinion of Neurosurgeon should have been
\nobtained to know the reasons for the giddiness and fall of the patient in the
\nbathroom. He should have been
\nimmediately shifted to the ICCU and various tests like Haemoglobin,
\nECG, Blood Sugar, Blood Urea, Cerium Critemin, Serium Electrolyze, Acid base estimation should have been
\ndone at that stage. The failure to do all
\nthe above, it is argued, amounts to negligence.\n<\/p>\n
The thrust of the complaint is
\nthat Dr. Vivek Bose joined   Apollo  Hospital only in January 1996, and that he was not
\nvery experienced and that he was negligent in not informing Dr. Mathew between  11.30 p.m. on 17th and  5.30 a.m. on 18th. It is argued on behalf of the Respondents
\nthat Dr. Bose is a well qualified and experienced Doctor having obtained MD
\n(Medicine) and DM (Cardiology) and that in addition to the Resident Doctors,
\nDr. Bose himself attended to the patient very promptly at various points of
\ntime in the night of 17th at 2.30 a.m. and 5.30 a.m.(on 18th).
\nIt is argued that the patient did not fall down in the bathroom at  11.30 p.m.
\nHowever, on behalf of the Complainants, it is argued that the words
\nfell down have been scored off from the medical records. Dr. Bose averred that as far as his knowledge
\ngoes the patient did not fall down and he was informed by Dr. Bhaskar Rao that the patient felt
\ngiddy. But there was no rebuttal of the version of the Complainant that the
\nwords fell down have been struck off from the record. We therefore believe in the version of the
\nComplainant. Dr. Bose as well as Dr.
\nMathew have argued that the cause for the giddiness
\nwas the pain in the groin and subsequent vasovagal
\nsyndrome from which the patient recovered immediately and that all his clinical
\nparameters were normal even at  5.30 a.m. when the patient suffered cardiac arrest
\nin the lift while being transferred to the ICCU. We find that although Dr. Bose averred that
\nhe was fully competent to handle independently the post-operative care of the patient
\nand that he did not feel the need to inform seniors, we find his experience is
\nactually limited to few months in this field.\n<\/p>\n
We would revert to this in more detail in a latter paragraph but we
\nwould like to state that no evidence is available to show that the events
\nduring the night of 17th\/18th May have led to the death
\nof the patient.\n<\/p>\n
e.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\n<\/p>\n
Dr.\n<\/p>\n
Bose in his deposition stated that at about  5.20 a.m., the attending nurse informed him that
\nthe patient was restless. That at  5.30 a.m., Dr. Bose again saw the patient and found
\nhim to be restless though his vital signs were normal. He decided to shift the patient to the ICCU
\nfor monitoring as an abundant caution, though the Complainant objected to
\nshifting the patient to the ICCU as the air-conditioning there was not allegedly
\nsatisfactory. Unfortunately the patient
\nhad a pulmonary cardiac arrest in the lift while on the way to the ICCU. He was revived with cardio pulmonary
\nresuscitation measures. He was incubated
\nand put on 100% oxygen and ventilated in the ICCU. At the time of receiving in the ICCU, Registrar
\nfound that the patient had signs of irreversible brain damage like not
\nresponding to painful stimuli and with pupils dilated and not reacting and was unconscious. By this time Dr. Mathew rushed back to the
\npatient and administered to life saving measures. After cardio pulmonary resuscitation the
\nDoctors were able to get the cardiac rhythm back and with heavy doses of drugs
\nwere able to prop up blood pressure for sometime. However, in spite of their best efforts, the
\npatient remained unstable and ultimately declared dead at  9.45 a.m.
\nDr. Mathew stated that even after the unfortunate death of the patient,
\nthe Complainant was fully appreciative of the herculean
\nefforts made by Dr. Mathew and his team to save the patient. In fact, the Complainant paid the fees of Dr.
\nMathew five days after the death, though Dr. Mathew himself was reluctant to
\naccept the payment. He therefore argues
\nthat the Complainant was fully satisfied with the treatment in the hospital,
\nand never complained about any part of the treatment in the hospital, except
\nfor the complaint about the unsatisfactory working of the air-conditioner in
\nthe ICCU. It is argued that the
\ncomplaint filed one year after the operation, was an afterthought. It is further argued that the death of the
\npatient after three days of the operation was only because of cardiac arrest
\nwhich could not be predicted.\n<\/p>\n
We agree with the arguments of
\nthe opponents and hold that there was no negligence in treatment of the patient
\nafter  5.20 p.m.
\non 18th.\n<\/p>\n
f.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\n<\/p>\n
Regarding
\nthe vagueness of the death certificate, it is argued by the Complainant that
\nthe cause of death is given as CerebroVascular\/Accident\/Diabetes\/Mellitus\/Hypertension\/Coronary
\nArtery disease\/Rest PTCA status. It is
\nargued that diabetes, hypertension and coronary
\nartery disease are diseases that can afflict a patient and cannot be the exact
\ncauses of the death. Similarly the
\nmention of Rest PTCA (Percutaneous Transluminal Coronary Angioplasty, meaning that the patient
\nhas undergone an Angioplasty) cannot be the cause of death and it is therefore
\nalleged that death certificate is deficient.\n<\/p>\n
Opposite party No.1 has argued
\nthat it is the standard practice of the   Apollo  Hospital to list all diseases in the death
\ncertificate. It is further averred that
\nin addition to the death certificate, a death summary was prepared by Dr. Bose
\nwhich clearly showed that death was due to Cardiac arrest leading to
\nirreversible brain damage and hence described as due to Cerebral-Vascular
\nAccident. It is further argued that the
\nbrother of the Complainant is a senior police officer and he was present when
\nthe death took place and neither he nor the Complainant asked for a post-mortem. We do not think that the Doctors at the   Apollo  Hospital made an effort to mislead or misrepresent
\nthe cause of death.\n<\/p>\n
We therefore hold the
\nComplainant has not made out a case against the opposite parties in this regard.\n<\/p>\n
We would now examine the
\nquality of the post-operative service especially in the light of the incidents
\non the night of 17th\/ 18th May 1996. In the
\ntreatment of a patient coming in for a surgical procedure, the post-operative
\ncare is as important as the care that has to be attached to the surgical
\nprocedure itself. While we have stated
\nthat the surgery seems to have proceeded well, we find that adequate attention
\nhas not been given to the post-operative care.\n<\/p>\n
36 hours after the surgery, the patient was brought from the ICCU to his
\nroom on the 16th morning. It
\nis admitted that sometime before  2.00 p.m. on the 16th, the patient had
\nvomiting. It is also admitted that at  2.00 p.m. the blood pressure was 190\/90 and the
\npulse was 96. It is again admitted that
\nthe patient developed severe rigor at  7.45 a.m. on the 17th. The record again show that at 11.30 p.m. on
\nthe night of 17.5.1996, the patient fell down in the bathroom when he went for
\nurination, though the words fell down have been struck off from the hospital
\nrecord. All these indicate that the
\npatient has not really stabilized after the operation. However, at  11.30 p.m., it was only a junior Resident, Dr. Bhaskar Rao who attended on the
\npatient and gave a clinical diagnosis that the patient developed Vaso Vagal Symcope
\nsecondary to groin pain. No pathological
\ntests were however carried out between  11.30 p.m. on the 17th and 2.30 a.m. on
\nthe18th when Dr. Vivek Bose saw the
\npatient. During this period the only
\nmedicines given were analgesics for reducing pain and for inducing sleep.\n<\/p>\n
When Dr. Bose saw the patient
\nat  2.30 a.m.
\non the 18th, the only thing he did was again a clinical examination
\non the basis of which he says he confirmed the diagnosis of Vaso
\nVagal Symcope. At  2.45 a.m. Dr. Bose says that he ordered that the
\ndischarge of the patient slated for  9.30 a.m. on the 18th should be
\ncancelled. Obviously, Dr. Bose felt
\nconcerned about the patients condition.\n<\/p>\n
Otherwise he would not have ordered cancellation of discharge of the
\npatient on his own authority by modifying the discharge order of his boss (Dr.
\nMathew) and even though it meant cancellation of air travel reservation made
\nearlier with some difficulty. But he did
\nnot deem it necessary to shift the patient to ICCU at that stage. He did order tests for blood parameters and
\nan ECG. But none of these were in fact
\ncarried out till  5.20 a.m. on the ground that the patient was fast asleep. However, Dr. Bose himself admitted that when
\nhe saw the patient at  2.30 a.m. the patient was awake and talked to him. Even during the period  11.30 p.m. on 17th and  2.30 a.m. on 18th there was ample time
\nwhen an ECG could have been taken without disturbing the sleep of the patient,
\nbut none of the Doctors thought of an ECG at that time. Dr. Bose also admitted that he did not order
\na C.T. scan and ultrasonography, but justifies on the
\nground that there was no corresponding clinical examination.\n<\/p>\n
But as pointed out above, the
\npatient was neither stable nor normal.\n<\/p>\n
At  5.20 a.m. Dr. Bose was summoned by the nurses as the patient
\nwas complaining of restlessness. It is
\nat that stage Dr. Bose decided to shift him to the ICCU. However, before he could be reached to the
\nICCU, the patient had a cardiac arrest in the lift. We do therefore hold that there has been
\ncertain amount of negligence and apparent deficiency in service in the post-operative
\ncare of the patient during the night of 17th\/18th 1996.
\nOne does not expect or countenance such type of deficiency from a super
\nspecialty hospital like the Apollo.\n<\/p>\n
The next question that
\nrequires consideration is whether this deficiency in the post-operative care
\nhas caused death of the patient or to what extent it contributed to the
\ndeath. For either of these purposes
\nthere is no evidence on record. The
\napparent cause of death is the cardiac arrest suffered by the patient. A cardiac arrest can happen suddenly and in
\nan unforeseen manner. It is therefore
\nnot possible to give a finding as to whether the above narrated negligence in
\npost-operative care has to what extent contributed to the death of the
\npatient. A postmortem examination could
\nperhaps have shown the factor leading to the death of the patient. However, as brought out earlier, no
\npost-mortem was insisted upon by the Complainant or the relatives of the
\ndeceased. In fact, brother-in-law of the
\ndeceased who was a high ranking police officer was present at that time and
\neven he did not ask for the post-mortem examination.\n<\/p>\n
Considering the fact that the
\ndeceased was diabetic, alcoholic and having hypertension, it would be difficult
\nto arrive at the conclusion that the aforesaid deficiency in service by the
\nhospital alone has resulted in the death of the patient. However, the fact remains that there has been
\nsome negligence in the post-operative care and the hospital staff should have
\nshown more alertness and urgency in looking after the patient during the
\ncrucial time on 17th\/18th when patient was complaining on
\nvarious counts such as giddiness and restlessness. Although worried Complainant brought all
\nthese factors to their notice and O.Ps.s have
\nthemselves had concern to stop the discharge of the patient for the next day,
\nthen why did they take post-operative treatment of the patient lightly? Mere couple of rounds of Doctors doing
\nclinical examination without doing crucial tests such as ECG does not show
\nvigilance and alertness from the opposite party which is known to be one of the
\npremier Institutions.\n<\/p>\n
From the aforesaid discussion
\nit can be held that even though Angioplasty was successfully carried out on
\n14.5.96 there was deficiency in service in post-operative
\ntreatment particularly on 17th \/18th. Apart from operation, post-operative
\ntreatment is equally important in such surgeries because complications may
\narise at any point of time. For treating
\nsuch complications alertness on the part of the resident doctors\/nursing staff
\nis must. If that is not done, it would
\nbe a deficiency in service by the hospital.\n<\/p>\n
In the present case the patient had giddiness; had fallen in the
\nbathroom; was restless and had nausea.\n<\/p>\n
These indications ought to have made the doctors and the staff alert at
\nleast for examination by ECG. That was
\nnot done on a pretext that the deceased was fast asleep.\n<\/p>\n
Therefore, for the deficiencies brought out
\nabove, we allow the complaint in part and direct opposite party No.1,   Apollo  Hospital to pay a nominal amount of Rs.2 lakhs as compensation to the Complainant with interest at
\n6% p.a. from the date of complaint till payment and Rs.10,000\/-
\ncosts within four weeks of the receipt of this order.\n<\/p>\n
.J <\/p>\n
(M.B. SHAH)  <\/p>\n
PRESIDENT <\/p>\n
 \u00a0<\/p>\n
..\n<\/p>\n
(RAJYALAKSHMI RAO) <\/p>\n
MEMBER  <\/p>\n
 P <\/p>\n","protected":false},"excerpt":{"rendered":"
National Consumer Disputes Redressal Mrs. Sheela Hirba Naik Gaunekar vs Apollo Hospitals Ltd., Chennai & … on 13 May, 2005 NATIONAL CONSUMER DISPUTES REDRESSAL NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI \u00a0 ORIGINAL PETITION NO. 103 OF 1997 \u00a0 \u00a0 Mrs. Sheela Hirba Naik Gaunekar Complainant Versus \u00a0 Apollo Hospitals Ltd., Chennai & Anr. Opposite […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-237941","post","type-post","status-publish","format-standard","hentry","category-judgements"],"yoast_head":"\nMrs. Sheela Hirba Naik Gaunekar vs Apollo Hospitals Ltd., Chennai & ... on 13 May, 2005 - Free Judgements of Supreme Court & High Court | Legal India<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.legalindia.com\/judgments\/mrs-sheela-hirba-naik-gaunekar-vs-apollo-hospitals-ltd-chennai-on-13-may-2005\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Mrs. Sheela Hirba Naik Gaunekar vs Apollo Hospitals Ltd., Chennai & ... on 13 May, 2005 - 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