Case Study

Relevance of History of
previous prolonged illness

Decided by the Hon’ble NCDRC on Dated : 24 Mar 2021

FACTS: Mr. Raja Ram Mohan was working as an Instrumentation Engineer in Kuwait and was earning KD 1200 per month. On 12.06.2014, he came to his home town at Vishakhapatnam for 10 days to spend time with the family and he was supposed to return on 20.06.2014. His health was good. On 18.06.2014 at 9.45 p.m., he had vomiting and was taken to Care Hospital The patient walked from the main gate to the casualty of the hospital. The General Physician – examined the patient in the casualty and kept him there for three hours. The hospital authorities collected Rs. 5,000/- at the time of admission. In the casualty, the patient again vomited and for the first time complained about breathlessness. The patient and his wife requested for Oxygen mask but the Opposite Party No. 3 did not pay heed to the request. The Opposite Party No. 3 roughly told the Complainant and the attendants to stay away from casualty ward and also instructed the hospital staff to close the doors of casualty. Therefore, they were observing the patient through glass window from outside. The Opposite Party No. 3 gave one injection to the patient upon which the patient immediately developed convulsions and cramps and he became unconscious. The Complainant and relatives shouted and cried to save the life of the patient. It was alleged that at 10.20 p.m., one assisting doctor came outside the casualty and informed that due to 70% of blockage of arteries of heart, the patient became unconscious. It was further alleged that the Opposite Party No. 3 demanded medicines worth Rs. 40,000/- and the Complainant paid the same on the spot. The Complainant repeatedly requested the hospital staff to call the Cardiologist, Dr. G.S.R. Murthy (the Opposite Party No. 2), but no avail. At 12′ O clock midnight, the Opposite Party No. 2 attended the patient and patient was shifted to ICU, however, the patient expired at 1.06 a.m. on 19.06.2014. On inquiry, the Opposite Party No. 2 did not give proper explanation for cause of death of her husband and simply walked away. The Complainant alleged that the precious time was wasted in casualty for non-administration of initial injection, non-supply of the oxygen mask and not shifting the patient to the ICU. It was further alleged that despite requests for entire medical record, the hospital supplied only three documents. The Complainant also requested to provide CCTV Camera recording for 19.06.2014 but it was not provided. The Opposite Parties treated the patient casually. Being aggrieved, the Complainant filed the Complaint for alleged medical negligence and deficiency in service during treatment of the patient by the Opposite Parties. As her husband was drawing salary of KD1200 per month i.e. equivalent to Rs. 2,61,000/-, she prayed for compensation of Rs. 7 crores with 18% interest and Rs. 3 crores for mental agony from the Opposite Parties.

DEFENSE: The patient and his wife at the time of admission suppressed that the deceased was suffering from diabetes for the last 20 years, that the patient was brought to the Opposite Party No. 1 hospital on 18.06.2014 to the casualty at 9.45 p.m. with the complaints of severe back pain and vomiting. The doctors had been informed that he was DM Type-II for the last 20 years on insulin injections. The patient was given injection Zofar commonly used for nausea and vomiting and Pantocid injection for acidity. The ECG was taken at about 10 p.m. showed showing subtle changes. The pulse oximeter showed that the Oxygen (O2) saturation was normal. One cardiology resident Dr. Swarupa Rani, who was on duty, examined the ECG and immediately informed the Cardiologist – Dr. G.S.R. Murthy. As the patient’s relatives were creating unruly behaviour, therefore, they were asked to leave the casualty. As the patient developed severe breathlessness followed by respiratory arrest, Code Blue was announced and immediately, as per ACLS (algorithms for Advanced Cardiac Life Support) guidelines, CPR was started with Ambuventilation. The patient was given injections of Adrenaline and Inotropes. The Cardiologist came to the hospital and took control of the situation. After 20 minutes of CPR, the patient regained rhythm and the second ECG was taken at around 10.20 p.m., which showed the patient had suffered massive heart-attack. The relatives were informed. Immediately, the patient was intubated and connected to mechanical ventilator. The cardiac monitor showed ventricular fibrillation, therefore immediately defibrillated with 360 Joules shock. At the same time, the relatives of the patient were informed by the Opposite Party No. 2 for the need of dissolving blood clot to stabilise the patient. Thus, Tenecteplase 40 mg IV bolus was given which was worth Rs. 40,000/-. The patient immediately shifted to ICCU under the directions of the Opposite Party No. 2 and the injection Cordarone, the anti arrethmetic drug was given to the patient. Also injection Vasopresin was administered @ 4 ml per hour. Thus under the supervision of the Opposite Party No. 2, the entire cardiology and critical care team treated the patient from 9.45 pm. However, the patient could not be revived and died at 1:06 am on 19.06.2014.

OBSERVATIONS: We have perused the medical record of the Care Hospital and the other documents like copy of passport, copy of fitness certificate of Raja Ram Mohan, the air tickets and job offer letter. As per medical record, Raja Ram Mohan was about 47 years of age with weight 45 kg and known Diabetic (DM Type-2) since 20 years. He was alcoholic and tobacco chewer / snuffer. The senior Cardiologist examined the patient at 10.20 p.m. and injection Tenecteplese 40 mg IV Bolous was given which is used to prevent death from heart attack. It is an expensive medicine worth Rs. 40,000/-. The record revealed that the Cardiology resident doctor (Opposite Party No. 3) was present on duty and regularly briefing the relatives of the patient about the health status of the patient. We do not accept that the patient was not admitted in ICU till arrival of the Cardiologist or that Oxygen was not given and there was delay in the treatment of the patient.It is apparent from the counter affidavit filed by the Opposite Parties Nos. 1 & 2 that CCTV camera was installed in the casualty but it does not have recording and storing facility. It was only for viewing the live pictures. In this regard the certification made by the supplier ‘Arrow Communication’ carries more value (Annexure R-3) which is reproduced as below:

“this is certify that we have installed CCTV Camera’s in M/s. Visakha Hospitals and Diagnostics Ltd. (Care Hospital) located in Waltair Main Road, Ramnagar, Vishakapatnam. In the Hospital Casualty, ICCU and AMCU Areas cameras are for viewing purpose only. Only in some crucial area like security main gate and cellar are recorded. That records are only for 1 month. After one month automatically re-writed”.

It is pertinent to note that the ECG done at 10.15 p.m. revealed clear findings of myocardial infarction i.e. ST Elevation in V1 to V6 and aVL leads and ST depression in II, III and aVF. The 2D Echo reveals moderate LV dysfunction. Dr. G.S.R. Murthy diagnosed it as acute extensive anterolateral STEMI and very bad prognosis. The patient suffered cardiac arrest and the CPR was started as per ACLS guidelines. The record revealed that after thrombolysis, the patient suffered recurrent ventricular fibrillation. Therefore, injection Cordarone bolus was given and Adrenaline infusion was started; however, the patient could not survive.

HELD: 10. The medical record of the Care Hospital is a vital document to prove the medical negligence, if any. It is apparent from the record that the Annexure C5 – the medical report, issued on 04.11.2013 is a normal report. We note after nine months of that report the patient got admitted in serious condition in Care Hospital. There was past medical history of diabetes and the ECGs were confirmatory of acute MI (STEMI). Therefore, we cannot rule out the possibility that the patient developed cardiac problems during the nine months. We note that the doctors made all efforts to resuscitate the patient from the cardiac arrest but could not revive the patient. In our view, they performed their duty with reasonable standard of care. We do not find any deficiency either from the hospital or the treating doctors. In the instant case, the medical negligence is not conclusively established against the Opposite Parties. The Complaint fails. It is dismissed.

About the author

Anoop K. Kaushal

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