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2007(2) CPR 76 (NC)
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION,
NEW DELHI
M.B. Shah, President and Rajyalakshmi Rao, Member
H.S. Sharma—Complainant
versus
Indraprastha Apollo Hospital
and Anr.—Opp. Parties
Original Petition No. 36 of 1998
Decided on 1-2-2007
Counsel for the Parties:
For the Complainant:Mr. Rajan Sareen, Advocate.
For the Opp. Party No 1:Mr. Lalit Bhasin, Advocate with Ms. Anupama, Advocate.
For the Opp. Party No. 2: Mr. Yakesh Anand for Dr. Sethi (In person).
IMPORTANT POINT
Not attending the patient after operation properly or delay in giving appointment in case of complications, would certainly be deficiency in service.
Headnote:Consumer Protection Act, 1986—Section 21(a)(i) and 2(1)(g)—Complaint about deficiency in medical service—Diabetic patient having eye problem—Advised operation—Diabetes got controlled—Operation done—Successful—Due to carelessness in post-operative treatment, complications arose—Loss of eyesight—Complaint—Record, medical expert opinion establishing negligence in the treatment given by the OP—During the post-operative stage—Granted compensation of Rs 2 lacs in place of claim of over Rs. 1 crore—Complaint allowed accordingly.
Held: At the outset, we would state that over busy medical practitioners are expected to devote some time and see that post-operative treatment is also given properly and care is taken by the patient in accordance with the requirements of the disease or the operation. It is their duty. If this is not done, it is likely to create complications after operation which may on occasions be fatal or affect the health of the patient. Not doing so or not attending the patient after operation or delay in giving appointment, in case of complications, would certainly be deficiency in service.
Further, discharge summary must also contain treatment chart at the pre-operative and post-operative stages. It. must also contain details of what precautions are required to be taken by the patient. (Paras 1 & 2)
Held further: The questions that arose for our consideration in this case are:
(1) Whether there was any negligence or deficiency in service by the opposite parties at pre-operative stage?
(2) Whether there was any negligence or deficiency in service by the opposite parties during the operation?
(3) Whether there was any negligence in the treatment given by opposite parties during the post-operative stage?
We hold that there has been negligence on the part of the opposite parties only on last count. (Paras 33 and 34)
Held later: We reiterate that post operative treatment is also important in surgery of any kind. After operation also, surgeons are expected to devote some time for the operated patients and have regular check up, if required on holidays also, as that is part and parcel of their duty, being member of the noble profession dealing with the life and health of the patient.
In the result, we hold that even though the operation was successful, but at the same time, post-operative required care was not taken and for this deficiency in service Complainant is entitled to receive compensation. Considering the overall view, particularly, the fact that to some extent it is contributory negligence on the part of the patient who himself is an Advocate, we assess the compensation at Rs. 2,00,000. In the result, the complaint is allowed. Opposite parties No. 1 and 2 are directed to pay a sum of Rs.2,00,000 to the Complainant within a period of six weeks from today. There shall be no order as to costs. (Paras 46 and 47)
Result: Complaint allowed accordingly.
Based on the provided legal document, the key points are as follows:
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Duty of Post-Operative Care: Medical practitioners are expected to devote adequate time and attention to post-operative treatment, including regular follow-up and monitoring of vital parameters such as blood sugar and blood pressure. Failure to do so constitutes deficiency in service (!) (!) .
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Importance of Medical Records: Proper maintenance of medical records, including treatment charts, blood sugar levels, blood pressure, and other vital parameters, is mandatory. Lack of accurate and complete records can impact the assessment of negligence (!) (!) .
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Monitoring of Blood Sugar in Diabetic Patients: Diabetic patients undergoing surgery require continuous monitoring of blood glucose levels before, during, and after the procedure. Relying solely on patient statements about blood sugar control, without objective monitoring, is considered negligent (!) (!) .
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Timing of Post-Operative Follow-Up: Prompt response to post-operative complications, such as sudden vision deterioration, is critical. Delayed intervention can lead to worsened outcomes, including loss of vision or the need for evisceration (!) (!) (!) .
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Management of Post-Operative Infection: Early identification and treatment of infections, particularly fungal endophthalmitis, are essential. Failure to recognize the severity and nature of infection promptly can result in irreversible damage, including loss of the eye (!) (!) .
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Use of Steroids and Medications: Administering medications such as systemic steroids without proper assessment of infection type or patient condition, especially in diabetics, can exacerbate complications. Appropriate treatment protocols must be followed (!) (!) .
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Informed Consent and Explanation: Patients should be thoroughly informed about the nature of the surgery, potential risks, and post-operative care requirements. Proper documentation of this communication is necessary (!) (!) .
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Negligence in Surgical Environment and Procedures: Sterilization and infection control measures should be diligently followed. The absence of evidence of sterilization or lapses in aseptic procedures can be grounds for negligence (!) (!) .
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Contributory Negligence: Patient’s own negligence, such as poor control of underlying conditions like diabetes, can influence outcomes but does not absolve the healthcare provider of their duty to provide proper post-operative care (!) (!) .
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Legal Consequences and Compensation: Failure to provide adequate post-operative care, monitoring, and timely intervention constitutes deficiency in service, which can lead to awarding compensation. In this case, the compensation was assessed at Rs. 2,00,000 for deficiency in post-operative care (!) (!) (!) .
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Professional Responsibility: Surgeons and hospitals are responsible for ensuring that post-operative instructions are clear, comprehensive, and followed, including instructions on managing complications and maintaining health parameters (!) (!) .
In summary, the document emphasizes that post-operative care is a vital component of medical treatment, and neglect or deficiency in this stage can result in severe consequences for the patient, including permanent disability or loss of eyesight. Proper documentation, monitoring, timely response to complications, and adherence to medical protocols are essential to fulfill the duty of care and avoid liability.
Mrs. Rajyalakshmi Rao, Member—At the outset, we would state that over busy medical practitioners are expected to devote some time and see that post-operative treatment is also given properly and care is taken by the patient in accordance with the requirements of the disease or the operation. It is their duty. If this is not done, it is likely to create complications after operation which may on occasions be fatal or affect the health of the patient. Not doing so or not attending the patient after operation or delay in giving appointment, in case of complications, would certainly be deficiency in service.
2. Further, discharge summary must also contain treatment chart at the pre-operative and post-operative stages. It must also contain details of what precautions are required to be taken by the patient.
Facts:
3. This Original Complaint is filed by H. S. Sharma, Complainant against Indraprastha Apollo Hospital, opposite party No. 1 and Dr. Arun Sethi, Senior Consultant Opthalmology of Indraprastha Apollo Hospital, opposite party No. 2, alleging medical negligence and deficiency in service with regard to the surgery and treatment of his eye. For this, an amount of Rs. 1 crore towards compensation has been claimed for damages.
4. The Complainant has retired from Indian Revenue Service and is practising as an Advocate. He is a beneficiary of the C.G.H.S Scheme (Central Government Health Scheme in short CGHS). As per the scheme, he would be reimbursed by the Government certain amount and the remaining amount has to be borne by the Complainant, Pensioner.
5. On 30.5.1997, he was referred to Indraprastha Apollo Hospital, New Delhi for his eye treatment by C. M. O., CGHS Dispensary, Ghaziabad.
6. The Complainant reported to the Apollo Hospital on 31.5.1997 and opposite party No. 2 Dr. Sethi examined all the relevant papers of the earlier treatment taken under the CGHS. The Complainant was told by the opposite party No. 2 that the Complainant being diabetic, cataract surgery requires utmost care and expertise for which he was trained in. Opposite party No. 2 did several pre-operative tests like corneal swab, slit lamp examination and asked the Complainant to get his blood tested for HLC, TLC, DLC, ESR, ECG, conjectival culture and mainly blood sugar test. Opposite party No. 2 has also asked the Complainant to get a certificate from the Physician about control of blood sugar. All these tests were got done and thereafter submitted to opposite party No. 2 along with the certificate of blood sugar which was normal and controlled by the Physician. After checking these, he was admitted in the hospital on 19.6.1997. The operation was scheduled at 13.00 hours and accordingly the Complainant got admitted in the hospital in the early morning on the scheduled date. The operation was lasted for two hours, i.e. from 4.00 p.m. to 6.00 p.m. and the Complainant was discharged on the next day i.e. 20.6.1997.
7. However, the Complainant was not satisfied with the post-operative visual recovery. O.P. No. 2 assured that in due course it would improve and asked him to come back for review on 23/24.6.1997. Although the recovery was still not good, opposite party No. 2 told him to resume his normal activities and prescribed some eye drops. Complainant’s vision still did not improve and he contacted opposite party No. 2 on 4.7.1997 but opposite party No. 2 did nothing as remedial measure. The Complainant was admitted by opposite party No. 2 to seek an appointment with the Hospital, i.e. opposite party No. 1 for examination and treatment on 7.7.1997 at 9 a.m. On that day, opposite party No. 2 administered two injections in the eye, one in the morning and the other in the evening and also administered several oral tablets and medicines with the advice to report back to him on the following day. The Complainant reported to opposite party No.2 on the next morning, i.e. on 8.7.1997.
8. Opposite party No. 2 expressed his helplessness to give any effective rem
