O R D E R

Sri. George Baby (President):

          This complaint is filed under section 12 of the Consumer Protection Act 1986 by the complainant alleging deficiency in service from the part of the opposite parties.

          2. The case of the complainant in brief as follows:- The complainant is a doctor by profession she was under the treatment of the 1^st opposite party.  The 2^nd opposite party is the hospital wherein the 1^st opposite party worked.  The complainant was admitted in the 2^nd opposite party’s hospital on 23/12/2014 for delivery.  The complainant has no complications in her pregnancy.  The expected date of delivery was on 24/12/2014 and on that day she had not experienced labour pain and hence the 1^st opposite party advised that the delivery could not be delayed further.  At 7am the complainant was administered IV Pitocin drip.   The per-vaginal examination was conducted on the complainant from 7 am to 1.30 pm by the head nurse. At 2pm the 1^st opposite party conducted the P.V examination and performed artificial rupture membrance.  The heart beat was reduced following ARM and an emergency caesarean was conducted under general anaesthesia.  The 1^st opposite party not informed that there was bleeding either at the time of surgery or post-surgery.  After the surgery the complainant was shifted to ICU.  The complainant experienced dehydration and was informed to the authorities when she regained consciousness.  There was no urine output and the nurses stated that the complainant be administered IV fluids.  But that has not been done because of the reason that the doctor has not given prescription with that effect.  The complainant informed the 1^st opposite party that she is experiencing weakness and has not been given I.V fluids.  Subsequently IV fluids were provided.  The complainant was also administrated medicine named Amikacin, Dolonex Injection, Paracetamol infusion and Acelofenac tablets which were potentially dangerous to the kidney.  On 25/12/2014 the nursing sisters informed that the complainant’s HB had been 7 and she needed blood transfusion.  After the surgery the 1^st opposite party left to her home.  On 25/12/2014 the complainant was shifted to the room.  In the evening the complainant underwent whole blood transfusion.  There was an attempt to remove catheter and then the complainant requested not to remove catheter on the reason that her urine output was low.  But the catheter was removed as per the advice of the 1^st opposite party that too without the consent of complainant.  The complainant’s face and body became bloated and hence she demanded to test her urea and creatinine in levels in the blood.  The 1^st opposite party had not in hospital on that occasion and hence nobody had given instruction for the test.  Then the complainant contacted DDRC Kozehcherry and arranged blood test.  From the result it found that the complainant’s urea and creatinine level elevated and the HB levels had dropped.  The complainant’s health situation deteriorated and then the complainant’s husband demanded immediate discharge and the complainant was shifted to Amrita Hospital Kochi.  Her health condition was critical and admitted to ICU.  The complainant’s health was gradually improved.  The complainant was informed that due to the improper care and poor medical management the complainant had faced such situation and the same was almost fatal or which would have necessitated lifelong dialysis.  The complainant’s creatinine level evaluated due to lack of monitoring of the hospital wherein she treated.  The proper lab test and other investigation were not conducted in time.  The careless administration of medicines caused damage to the organs of the complainant.  The complainant spent huge amounts in availing subsequent treatment.  The complainant had undergone severe mental agony due to the inefficient treatment of the opposite parties one and two.  Hence the complainant pray to realiseRs. 5,00,000/- (Rupees Five Lakh only) from the opposite parties towards the loss and additional expenses incurred along with other relief of compensation and cost.

          3. This Forum entertained the complaint and issued notice to the opposite parties.  All the opposite parties were appeared through their counsel and filed written version.

          4. The contentions of the 1^st opposite party is as follows:-  The complaint is not maintainable either in law or on facts.  The averments in the compliant are cooked up stories for the undue financial advantage of the complainant.  The complainant had her antenatal check-ups from outside till 30^th week of gestation.  The complainant had consulted the 1^st opposite party at later stage of her pregnancy on 23/10/2014.  The date expected for the delivery was on 24/12/2014 and the complainant came to the hospital on 23/12/2014.  Vaginal examination findings were unfavourable for vaginal delivery in view of estimated weight of baby having more than 3.25kg.  The complainant and her husband, who is also a doctor, were fully aware of these matters.  At 9am on 24/12/2014 the 1^st opposite party examined the complainant and discussed her condition with her husband.  The 1^st opposite party had closely monitored the complainant.  The head nurse did per vaginal examination to assess the situation and informed the 1^st opposite party that cervix was only finger loose foetal heart rate as normal.  At 1.45pm the progress of labour was re-assessed with per vaginal examination which showed cervix 3cm delated and hence the 1^st opposite party conducted ARM for accelerating labour. Around 2.15pm foetal heart variation was noticed and the complainant’s condition was re-assessed with per vaginal examination which showed same finding. Foetal heart rate showed persistently low rate and not picking up in between contractions.  Thus an emergency caesarean was necessitated and the matter is informed to the complainant.  After obtaining necessary permission form the concerned the surgery was conducted and completed the same at 3.5pm.  The complainant had stable vital signs throughout the post-operative period.  Adequated IV Fluids were given to the complainant.  All necessary treatments were properly provided to the complainant.  Foley’s catheter was kept in caesarean section and there was catheter leak and the same was notice by duty nurse at 8pm and 1^st opposite party herself personally changed urinary catheter and confirmed clear urine drainage through catheter.  The complainant was given antibiotics and anti-inflammatory drugs were administered as per the routine practice and the condition of the complainant was periodically assessed by the 1^st opposite party.  On 26/12/2014 it found that the complainant was normal and active with normal pulse and BP.  Her uterus was well contracted and her bleeding was within normal limits.  The complainant herself reported that her urine output was adequate and she did not complain of bleeding in post-operative period.  On investigation it found that her HB was low even after transfusion of 1 pint blood and the matter was discussed with Dr. Joseph George who is also a Gynaecologist and complainant’s blood for RFT, LFT, Platelet count, TC, DC and blood urea etc.  After getting RFT report and finding it to be abnormal the 1^st opposite party immediately stopped all medications.  There after an ultrasound scanning was performed after consultation with above said Dr. Joseph George for ascertaining any collection in uterus or abdominal cavity.  The 1^st opposite party later it was found that the complainant’s husband sent her blood for investigation to DDRC without informing the 1^st opposite party.  The 1^st opposite party had told to the complainant’s husband about the deranged RFT report.  At this time the complainant had told about the reports of investigation of DDRC.  The first opposite party had already done necessary investigations and diagnosed cause of low HB as due to abnormal renal function.  The complainant was advised for reference to higher centre having nephrology unit.  The 1^st opposite party had treated the complainant with due dedication and sincerity.  All proved medical treatment was provided to the complainant.  As the baby was running risk of foetal heart beat was below 90/mt and the delay in extracting baby would have resulted in still birth due to possible asphyxia.  General anaesthesia is the reasonable option and hence the same was administrated to the complainant.  The allegation of dehydration was denied by the 1^st opposite party.  The careless administration of medicines dangerous to the kidneys had affected organ damage is false and denied. The complainant had not caused any mental agony due to the act of the 1^stopposite party.  The complaint is on experimental basis. The 1^st opposite party prayed for the dismissal of the compliant with cost. 

          5.  The 2^nd opposite party filed version and the main contentions of the 2^nd opposite party as follows:- At the outset it can see that the 2^nd opposite party had taken the contentions which is almost similar to the contentions of the 1^st opposite party.  The 2^nd opposite party stated that the maximum care and approved mode of medication was provided to the complainant in the 2^nd opposite party’s hospital under the supervision of the 1^st opposite party.  All the allegations raised by the complainant was strongly denied by the 2^nd opposite party.  The 2^nd opposite party further contended that the 2^nd opposite party’s hospital is insured with the National Insurance Company Limited vide Policy No. 571402/46/14/870000006 and the same is valid from 26/04/2014 to 25/04/2015 and the said Insurance company is liable to indemnify the complainant if the Forum found that any amount to be paid to the complainant.  The 2^nd opposite party stated that there is no merit in the complaint and hence the 2^nd opposite party also prayed to the dismissal of the complaint with their cost.

          6.  On the basis of the contention of the 2^nd opposite party, the complainant had impleaded the National Insurance Company Limited, Pathanamthitta Branch as the additional 3^rd opposite party. The additional 3^rd opposite party had filed their version in due course and their main contentions are as follows:- The complainant has no cause of action against the additional 3^rd opposite party as the complainant had not availed any service from the said opposite party.  The complainant is not a consumer of the additional 3^rd opposite party.  The allegation of professional negligence of the 1^st opposite party was denied by the additional 3^rd opposite party.  The issuance of the policy towards the 2^nd opposite party and its validity was admitted by the additional 3^rd opposite party.  The basis sum insured in the said policy was Rs. 1,00,000/- with Rs. 2,50,000/- as claim in respect of one person.  The insured and the insurer are bound by the terms and conditions of the policy.  According to the terms of the policy the insured hospital is bound to give notice of the claim as soon as practicable which has not been complied by the 2^nd opposite party in this case.  The 2^nd opposite party had not inform the insurance company about the complaint directly even after filing of this complaint.  Hence the additional 3^rd opposite party pray to dismiss the complaint with their cost.

          7.  We peruse the complaint, versions and records before us and we framed the following issues for consideration.

          (1). Whether the opposite parties committed any deficiency in

service against the complainant?

          (2). Whether the complainant is entitled to get compensation

from the opposite parties?

          (3). Regarding the relief and cost?

8. In order to prove the case of the complainant PW1 to PW4 were examined from the part of the complainant.  PW1 is the complainant herself and Exhibit A1 to A8 were marked through PW1.  Ext. A1 is the copy of the discharge summary issued from Amritha Institute. Ext. A2 is the copy of lab report from DDRC dated: 27/12/2014. Ext. A3 is the copy of lab report from DDRC dated: 26/12/2014.  Ext. A4 is the copy of OP ticket from Poyyanil Hospital, Kozhencherry.  Ext. A5 is the copy of copy of lab report from Poyyanil Hospital, Kozhencherry.  Ext. A6 is the copy of patient record from Poyyanil Hospital, Kozencherry.  Ext. A7 is the copy of medical bill. Ext. A8 is the copy of DMO Report.  From the side of the opposite parties 1 & 2, 4 witnesses were examined respectively as DW1 to DW4.  The 1^st opposite party was examined as DW1.  Ext. B1 to B3 were marked from the side of the opposite parties. Ext. B1 is the copy of expert panel committee. Ext. B2 is the copy of enquiry report issued by DMO, Pathanamthitta. Ext. B3 is the copy of policy details issued by 3^rd opposite party. After the completion of the evidence we heard the complainant and the opposite parties in detail.

          9.  Point No. 1 & 2:- For the sake of convenience we would consider point No. 1 & 2 together.  The complainant’s case is that she was admitted in the 2^nd opposite parties hospital on 23/12/2014 for delivery.  The expected date of delivery was 24/12/2014.  There was no labour pain and hence the ARM was performed and an emergency caesarean was conducted by the 1^st opposite party.  The surgery was done under the general anesthesia.  After the surgery PW1 was experienced dehydration and the matter was informed to the medical staff and requested IV fluids. PW1herself is a doctor by profession.  PW1 deposed that she was administered with Amikacin, Dolonex and Paracetamol at 2^nd opposite party’s hospital and all of them were harmful to kidneys.  According to PW1 she underwent blood transfusion on 25/12/2014 and after that she experienced low urine output and this also was intimated to the hospital authorities but they have not taken any steps to monitor that aspect properly and because that PW1and her husband, who is also a doctor, were forced to conduct RFT through the laboratory named DDRC and from that result it found that PW1’s renal function was abnormal and also found from the result of the DDRC that the PW1’s HB and BP was low.  At the same time her creatinine and urea contents were high and same is very harmful and the husband of the PW1 requested for her discharge.  After the discharge PW1 was admitted to Amrita Hospital at Ernakulam.  Exhibit A1 is the discharge summary of PW1 from Amrita Institute of Medical Sciences and Research Centre.  Course in the hospital i.e., at Amrita Hospital it is revealed through Exhibit A1 that during the course of the hospital stay there was steady improvement in the urine output and renal function. There was no further drop in the hemoglobin levels.  As she developed fever spikes, blood and urine cultures were sent and she was continued on Meropenem.  Her fever subsided and RFT became normal.  The urine culture grew Acinetobacter, she was started on Levofloxacin based on culture sensitivity.  She is being discharged in a stable condition with an advice to follow up on OPD basis.  The specific contention of PW1 and PW3 was that nobody has conducted a proper monitoring PW1 on 25/12/2014 and the 1^st opposite party went on leave.  The PW1’s urine output was decreased and her face became bloated and the 1^st opposite party had declined the RFT.  In this context it is pertinent to not the deposition of PW4.  The PW4 deposed that the identification of low urine output is a symptom of some injury to kidney. It is noted that at the time of admission at Amritha Hospital the PW1’s creatinine level was 4.7.  Normal reading is to be 0.6 to 1.2 PW4 further deposed that if the doctor could administer proper medicine and care the particular situation could have been avoided and can be prevented renal injuries.  The specific contention of the PW1 is that RFT was not done by the 1^st opposite party even though she has developed tiredness and low urine output.  In the cross-examination of DW1 she has stated that it was not a regular practice to do RFT and LFT daily.  This is sufficient enough to convince us that the 1^st opposite party has not carried out the RFT when it needed to PW1.  It is seen from the evidence that the medicine named lasix was administered to PW1and it is for normal urine flow.  DW1 admitted that at the time of discharge of PW1 her RFT reading was abnormal but DW1 has not specifically given any convincing circumstances how it happened and that such circumstance was beyond her control. At one point of time DW1 stated that the entry made in Exhibit A6 may be a wrong entry by the staff.  Another important contention raised by the PW1 is that the blood transfusion was as per the advice of Dr. Joseph George that too even without examining PW1.  This aspect has not been rebutted by the opposite parties on production of any cogent and convincing evidences.  The DW2 in cross-examination admitted that Amikacin, Aceclofenac and Paracetamol are harmful to the kidney.  The 1^st opposite party has not a case that she has not administered the above mentioned drugs to the PW1 during the course or her treatment in 2^nd opposite party’s hospital.  The DW2 also admitted that the creatinine level of PW1 at the time of discharge was abnormal and further deposed that such situation can be avoided if proper RFT was conducted.  The DW3 also deposed in the same tune and he almost accepted the finding which mentioned in Exhibits A1.  The DW3 admitted Acute Kidney Injury (AKI) of PW1 on the basis of Exhibits A1.  While we go through the evidence of opposite parties 1 & 2, both of them had stick on the point that they were provided accepted method of treatment to PW1.  But the said opposite parties were failed to substantiate that contention.  Even though PW1 has taken the contention that she needed lifelong medicine for her AKI and there may be difficulty to the conception of 2^nd child.  But actually PW1 has not adduced any evidence in this regard.  The deposition and evidences of PW1 and DW1 is sufficient enough to come a safe conclusion that DW1 has committed deficiency in service in the treatment of PW1 and Point No. 1 and 2 found in favour of complainant and the complainant is entitled to realise her treatment expenses incurred in 2^nd opposite party’s hospital.  As the 2^nd opposite party has valid insurance coverage with the 3^rd opposite party for indemnifying their loss and hencethe 3^rd opposite party is liable to pay the ordered amount.

          10. Point No. 3:- On the basis of the foregoing discussions the complainant is entitled to get the reliefs, compensation and cost from the opposite parties and we found Point No.3 in favour of the complainant. 

          11. In the result we pass the following order:

1. The additional 3^rd opposite party is directed to pay an amount of

Rs. 49,657/- (Rupees Forty Nine Thousand Six Hundred and Fifty

Seven only) the treatment expenses incurred tothe complainant

with 10% interest from the date of order to the complainant.

2. The additional 3^rd opposite party is directed to pay an amount of

Rs. 1,00,000/- (Rupees One Lakhs only) as compensation and

along with cost of Rs. 10,000/- (Rupees Ten Thousand only) to

the complainant with 10% interest from the date of receipt of this

order.

     Dictated to the Confidential Assistant, transcribed and typed by her, corrected by me and pronounced in the Open Forum on this the 28^thday of February, 2020.

                                                                                                  (Sd/-)

                                                                                            Sri. George Baby,

                                                                                          (President)

Smt. N. ShajithaBeevi (Member-I)   :  (Sd/-)

Sri.NishadThankappan (Member-II): (Sd/-)

Appendix:

Witness examined on the side of the complainant:

PW1:Dr. Preetha R Pillai.

PW2:Dr. GraccyIthack

PW3:Jithesh K

PW4:Dr. Sangeeth Kumar

Exhibits marked on the side of the complainant:

A1: copy of the discharge summary issued from Amritha Institute.

A2: copy of the lab report from DDRC dated: 27/12/2014

A3: copy of the lab report from DDRC dated: 26/12/2014

A4: copy of OP ticket from Poyyanil Hospital, Kozhencherry.

A5: copy of the lab report from Poyyanil Hospital, Kozhencherry

dated: 23/12/2014.

A6: copy of the patient record from Poyyanil Hospital, Kozencherry.

A7: copy of the medical bill

A8: copy of the DMO Report

Witness examined on the side of the opposite parties:

DW1: Dr. Prameela Philip

DW2: Dr. C.P. Vijayan

DW3: Dr. Rajesh Joseph

DW4: Dr. Sheeja A.L

Exhibits marked on the side of the opposite parties:

B1: copy of expert panel committee

B2: copy of enquiry report issued by DMO, Pathanamthitta

B3: copy of policy details issued by 3^rd opposite party.

Copy to:-

          (1) Dr. Preetha R Pillai,

                   Sreerangam, Poomala P.O,Chengannur, Alappuzha.

                  (2) Dr. Prameela Philip,

          Gynecologist, Poyanil Hospital, Kozhencherry, Pathanamthitta.

        (3) The Managing Director,

Poyanil Hospital, Kozencherry P.O,Pathanamthitta.

        (4) The Branch Manager,

National Insurance Company Ltd.,Pathanamthitta.

        (5) The Stock File.