LinkBack URL
About LinkBacks
Neuro Clinic 1. Mr. T.S.K.Ramani
2. Thiru. S.Kuppusamy,
Retd. Central Excise Superintendent
D.No.18, Sowripalayam Pririvu,
Ramanathapuram,Coimbatore -641045. --- Complainants
Vs.
1. Dr.C.Christopher Mariadass M.D.
(General Medicine, D.M. (Neuro),
M/s. St.Luke Hospital,
18-G, Ashok Layout,
Civil Aerodrome Road, Coimbatore – 641014.
2. Neuro Clinic,
D.No.999, Trichy Road,Olymbus,
Ramanathapuram, Coimbatore -641045. --- Opposite Parties.
ORDER
Complaint under Section 12 of the Consumer Protection Act, 1986 seeking direction against the Opposite parties to pay to the complainants a sum of Rs.4,90,000/- as compensation for death of Tmt.Nagararathinam, to pay Rs.25,000/- as cost of the proceedings.
The case of the complaint are as follows:
1. The Opposite party is running a hospital under the name and style of “SAINT LUKES HOSPITAL” and he is also running a Neuro Clinic in the above address. The opposite party is a leading Neurologist and he has retired as a professor of Neurology at Coimbatore Medical College Hospital. The First complainant is the Son of the 2nd complainant and the deceased Smt.Nagarathinam. The 2nd complainant and the deceased smt. Nagarathinam are Husband and Wife. On 2nd Feburary 2007 at about 11.30A.M deceased Smt.Nagarathinam, while she was alive, consulted the opposite party in the Clinic at about 11.00A.M along with the 1st complainant for her pain at the nap of neck. The opposite party examined late Smt.Nagarathinam and prescribed some of the medicines under the prescription dated 2nd February 2007.
2. Subsequently after intaking of the pills late Tmt. Nagarathinam suffered severe pain at the nap of her neck which was intolerable to her and she became suffering from sleeplessness night on the day of 2nd February 2007. She was admitted in-patient at St.Luke’s Hospital of him immediately. Then the opposite party examined the deceased Tmt. Nagarathinam and she was undergone for some medical tests as suggested by the opposite party and on thorough verification of the reports the opposite party prescribed number of tablets and injunctions under the prescription dated 3.02.07. Subsequently on 4.02.07 and 5.02.07, the opposite party prescribed some medicines and which were also followed by the patient late Tmt. Nagarathinam. Further the opposite party gave the “infrared light” treatment to the deceased Tmt. Nagarathinam.
3. But, despite by all the treatments, the deceased Tmt. Nagarathinam not at all recovered from pain and became very weak and seems to be drowsy and subsequently on 5.02.07 she was gradually disoriented from her memory and her condition was continuously checked by the opposite party and the staff of him in the hospital. This was explained to the opposite party on 6.02.07 at 6.00 A.M. during his visit. Then the opposite party suggested some required tests at N.M.Hospital, Coimbatore. But the complainant not agreeable for the same and discharged the patient Tmt. Nagarathinam in order to admit her at the Ramakrishna Hospital, Coimbatore. Then the opposite party immediately gave a letter dated 6.02.07 to Dr.K.R.Shetty, Ramakrishna Hospital, Coimbatore, without furnishing the case history and discharge summery of the patient Tmt. Nagarathinam at Ramakrishna Hospital at about 10.30 A.M as in-patient under the In-patient No. 064757 and immediately the patient was taken to I.C.U. and the hospital Doctors concerned gave immediate attention and diagnosied as that the patient was suffering from Carbuncle at nap of neck and due to the same septicemia was caused.
4. Thereafter the doctors concerned at Ramakrishna Hospital fixed the operation for opening and draining the place of the Carbuncle on the very next day on 7.02.07 at about 11A.M. But despite the treatment given at Ramakrishna Hospital and due to late admission and late diagnosis the patient Tmt. Nagarathinam suddenly went for respiratory depression and she died on 7.02.07 at about 1.25A.M. and the cause of death was due to Cardio respiratory arrest secondary to septicemia and T2DM. The death cause to Mrs. Nagarathinam was absolutely due to the opposite party’s medical negligence and he knowingly admitted her in his so called hospital which is in lack of all basic requirements to give treatment to the patients during the emergency condition. The said hospital of the opposite party is nothing but a dwelling house which is against the rules and regulations of All India Medical Council.
5. The first complainant, being the only son, lost his beloved mother’s love and affection which cannot be compensated in any manner. Whereas the 2nd complainant who is the age old husband of the dec eased Nagarathinam, he has lost his wife because of the negligence act of medical negligence on the party of the opposite party. Hence the complainants are entitled for compensation as claimed herein and whereas the opposite party is held liable to pay compensation for his act of negligence. Hence he is liable to pay a sum of Rs.4,90,000/- as compensation for the complainants loss of love and affection and medical expenses incurred to both the complainants.
The case of the opposite party are as follows:
6. The complaint by the above complainants is not at all maintainable either in Law or on facts. Without impleading the Ramakrishna Hospital as party to the above proceedings, where the deceased Nagarathinam took subsequent treatment, the above complaint is liable to be dismissed in limini for non joinder the proper and necessary party. The deceased Mrs. Nagarathinam was a known case of non insulin dependant diabetes Mellitus and had uncontrollable blood sugar when she was admitted in the oppose party’s Hospital on 2.02.07. She was admitted with severe pain in the nape of the neck radiating to the right arm and was diagnosed as a case of cervical spondylosis with bronchial neuralgia right side, a common cause for the pain in the neck due to old age. Therefore she was treated with insulin and oral anti diabetic and pain killer drugs. She did not have fever or fluctuant swelling or abscess at the nap of the neck.
7. Since the pain in the neck and the blood sugar level did not come down, gradually insulin and pain killer drugs were increased. As the deceased Mrs. Nagarathinam’s blood sugar and the said pain did not come down to normal even in spite of the medication administered, she was advised to be shifted to another hospital for further investigation like M.R.I. scan to assess the severity of the compression of nerve roots and spondylosis. The deceased attender wanted to consult with Dr. Shetty at Ramakrishna Hospital. As per the request of the deceased’s attender, the opposite party gave a reference letter to Dr.Shetty and arranged for an ambulance to shift the deceased to the Ramakrishna Hospital. The deceased neither had any temperature nor any abnormal eruption (swelling or abscess) in the nap of the neck till the said date of discharge from this opposite party’s hospital.
8. It is false to state that the opposite party did not furnish the case history and discharge summary. The complainants never made a request for the same. On perusal of the medical records provided by Ramakrishna Hospital, the functioning of the kidney of the deceased was normal. She neither had any electrolyte imbalance nor hypotension to suggest any peripheral circulatory failure. The C.T. brain was normal and did not reveal cerebral infarct or abscess or meningitis. The ultra sound scan abdomen was also normal. The normal course of septicemia will be of prolonged illness causing renal failure or fall of blood pressure with peripheral circulatory failure or electrolyte imbalance or cerebral abscess or meningitis or cerebral infarct. The patient did not have any one of the above complications to suggest septaecaemia.
9. If at all the Ramakrishna Hospital would have diagnosed the deceased had septaecaemia due to carbuncle, than they should had immediately done Incision and drainage irrespective of the condition of the patient, whereas the said procedure was postponed to the next day. The diagnosis of cardio respiratory arrest secondary to septaecaemia/T2 D.M. at Ramakrishna Hospital, in this case is only a provisional diagnosis and not a final one. The opposite party has not committed any act of negligence and did not confine the deceased in his hospital. In fact he has given the best treatment to the deceased with bonafide intentions. This opposite party has received only a sum of Rs.3000/- for the treatment given to the deceased, which includes bed charges, nursing charges, blood investigation and ancillary charges.
10. The complainant and opposite party No.1 have filed Proof Affidavits along with Exhibits A1 to A11 marked on the side of the complainant and documents B1 to B7 marked on the side of the opposite parties. The question and answers of Dr.Shetty is marked as Ex.C1. Both the parties have also filed written arguments.
The point for consideration is
1. Whether the opposite parties have committed deficiency in service? If so to what relief the complainants are entitled to?
ISSUE 1:
11. The case of the complainant is that the opposite party failed to diagnose the presence of “carbuncle” at the nap of neck which caused infection and resulting in “septicemia” condition. Due to the act of negligence by the opposite party and due to lack of involvement in his professional duty, he wrongly confined the patient Tmt.Nagarathinam at the hospital from 2.2.2007 to 5.2.2007 and gave medicine and treatment without diagnosing the patient ill-health and the death caused to Mrs.Nagarathinam was due to the opposite party’s medical negligence.
12. The case of the opposite party is that the disease neither had any temperature nor any abnormal swelling or abscess in the nap of neck till the date of discharge from the hospital. The normal course of septicemia will be of prolonged illness causing renal failure or fall of blood pressure with peripheral circulatory failure or electrolyte imbalance or cerebral abscess or meningitis or cerebral infarct. But the patient did not have any of the above complications to suggest septicemia. The opposite party has not committed to any act of negligence and did not confine the disease in his hospital.
The main allegations against the opposite party is
1. The opposite party failed to diagnose the presence of carbuncle at the nap of neck as early as 2.2.2007 .
2. The opposite party failed to suggest for all required tests
3. at the time of discharge on 6.2.207 to Ramakrishna hospital the opposite party has not furnished the case history and discharge summary.
13. It is settled law that in medical negligence cases (2009 CTJ 352(SC) Martin F.D.souza Vs.Mohd.Ishfaq) expert evidence is absolutely necessary. In the present case as per order dated 15.8.2008 in CMP 147/08 a questionnaire was filed by the complainant and the same was forwarded to Dr.K.Shetty of Ramakrishna Hospital and the doctor has given his answers. The question and answer are given below:
1. Can we take tachypnea as symptom for septisimea?
Tachypnea (increased respiratory rate) is a symptom observed in SEPTICEMIA and also in very many other medical conditions like respiratory illness, cardiovascular illness, psychiatric condtions, high fever etc. It may also be met with in the normal physiological conditions like running fast, after strenuous work etc. In Septicimia, multiple organ failure occurs and as a complication, when the lungs are involved, patient may develop tachypnea. It could not be concluded (pathiogram?) one exclusively for septicemia
2. The presence of carbuncle at the nap of neck was found with the naked eye.
Yes. Carbuncle is nothing but skin infection caused by staphylococcus infection where two or more furuncles coalesce to form carbuncle which takes 7-10 days to form fully developed carbuncle. Hence it can be seen by naked eye, provided if it is well formed, and evidently obvious for naked eye examination.
3. After confirming the presence of carbuncle why incision and drainage was postponed to next day?
When the patient was first seen by me, I made a professional diagnosis of carbuncle in the nape of the neck. Before my diagnosis could be confirmed with relevant investigations like blood culture, x-ray of the local part and finally incision and drainage so that if pus is let out, that material could also be sent for culture and sensitivity, the patient expired at 11.00 am due to sudden cardiac and respiratory arrest which in this case may be due to massive myocardial infarction, since she was an elderly of long standing hypertension and uncontrolled diabetes mellitus.
4. Explain the relationship between the septicemia and raising of blood sugar?
Septicemia is a condition where in the blood stream is infested with the pathogenic organisms. Increased blood sugar due to diabetes is called hyperglycemia. Both are different entities. Not all case of septicemia must be hyperglycemic and not all case of hyperglycemia must necessarily have septicemia, though septicemia is common in diabetes.
14. On the side of the complainant the following documents were marked. Ex.A1 to A4 are the prescriptions, Ex.A5 is the letter dt.6.2.08 by the opposite party to Dr.K.Shetty Ramakrishna Hospital, Ex.A7 is the case history of diseased Nagarathinam by Ramakrishna Hospital and Ex.A9 is the legal notice , Ex.A10 is the reply given by opposite party, Ex.A11 is the death certificate of Nagarathinam.
15. On the side of the opposite party Ex.B1 to B7 were marked. Ex.B1 is the reply notice, Ex.B3 is the temperature chart, case sheet, drug sheet and urine sugar chart.
16. The deceased came to opposite party’s hospital on 2.2.07 and he was treated as outpatient for diabetic and pain in the nap of neck is not disputed. The very fact that the patient was not admitted as in-patient on 2.2.07 indicates that the condition of the patient on that date does not warrant hospitalization.
As per both side documents the deceased Mrs.Nagarathinam was a known case of diabetic. Since she was having severe pain in the neck she was diagnosed as a case of cervical spondylosis. As per documents she did not have fever or fluctuant swelling or abscess at the nape of the neck at the time of admission. Subsequently the patient’s blood sugar and pain did not come down and she was advised to have further investigation to some other hospital but since the deceased attendar’s wanted to consult with Dr.K.R.Shetty at Ramakrishna hospital, she was shifted to Ramakrishna hospital with a reference letter Ex.A5. This was also admitted by the complainant in the complaint para-4.
17. As per complainant’s written arguments (Medicine Net dot com).There are 4 conditions to confirm the septicemia is as follows:
1. elevated heart rate
2. body temperature either high or low
3. increasedrespiratoryrate(Tachypnoea)
4. abnormal WBC counts
As per opposite party the normal course of septaecaemia will be prolonged illness causing renal failure, fall of blood pressure with peripheral circulatory failure, or electrolyte imbalance or cerebral abscess or meningitis or cerebral infarct.
18. But the deceased Nagarathinam did not have any one of the complications to suggest septaecaemia. The deceased neither had any temperature nor any abnormal eruption (Swelling or abscess) in the nape of neck till the time of discharge.
Moreover Dr.Shetty who has given expert opinion has stated as follows:
a) …... tachypnia is not the only symptom for septicemia and very many other medical conditions like respiratory illness, cardio vascular illness, psychiatric condition, high fever etc. may also be the reasons.
b) ……. the presence of carbuncle at the nape of neck could be seen with a naked eye provided if it is well formed and evidently obvious for naked eye examination.
c) ……… the patient expired at 11 am due to sudden cardiac and respiratory arrest which in this case may be due to massive myocardial infarction, since she was an elderly of long standing hypertension and uncontrolled diabetes mellitus.
d) ……… Septicemia is a condition where in the blood stream is infested with the pathogenic organisms. Increased blood sugar due to diabetes is called hyperglycemia. Both are different entities. Not all case of septicemia must be hyperglycemic and not all case of hyperglycemia must necessarily have septicemia, though septicemia is common in diabetes.
19. On perusal of the documents, medical records and Dr.Shetty’s Opinion we are of the view that the diseased had neither any temperature nor any abnormal eruption in the nape of the neck at opposite parties hospital, the deceased did not have any of the complications to suggest septicemia. Since the deceased attendars refused to take the advice of the opposite party and wanted to consult with Dr.K.R.Shetty, accordingly the patient was shifted to Ramakrishna Hospital hence the question of suggesting other required tests does not arise. Hence the main allegations No.1 and 2 not proved. Hence the opposite parties have not committed to any act of negligence and did not confine the deceased in his hospital.
20. The sudden cardiac respiratory arrest in this case may be due to old age with hypertension with uncontrolled diabetic mellitus and as such would have caused sudden myocardial infarction with cardiac arrest and not due to septicemia.
21. As per rule every hospital must give the discharge summary the next day of discharge. The case of the opposite party is neither the complainant nor her attendar turned up after her discharge and they never made a request for the same. Moreover at the time of discharge from the opposite party hospital a detailed history is given by the opposite party to Dr.Shetty giving all details about the past treatment. Based on this at Ramakrishna hospital also they have given further treatment which was also admitted by the complainant.
22. Hence the opposite parties have not committed any act of negligence and expert opinion is not in favour of the complainant but in favour of the opposite parties. Hence we are of the view that the opposite parties have not committed medical negligence and deficiency in service.
In the result, this complaint is dismissed. No costs.
Submit Complaint..
