IMPORTANT POINT
Referring patient to higher centre is not a medical negligence.

Dr. S.M. Kantikar, Member—On 14.05.2015, at about 5 AM, Mr. Anil Taneja, 57 yreas of age (since deceased herein referred as a “Patient”) approached Metro Hospital & Heart Institute, Haridwar (OP-1) for chest pain as an emergency. Dr. Abhilash Kumar Gupta,(OP-2) a cardiologist examined him and diagnosed as a case of Inferior Wall Myocardial Infarction (IWMI). The patient was kept under observation in CCU, prescribed few medicines including Injection Mirel 18 mg worth Rs. 29,500/-. But, shockingly OP-2 refused to treat him with routine stenting, because he was to leave for holiday. The attendants of patient begged mercy to OP-2 to save the life of the patient but, no avail. Due to the negligent attitute, valuable golden time was wasted. Therefore, patient had to run to another hospital in Dehradun from Haridwar covering a distance of 52 kms. Ambulance was not available immediately; it has to come from Dehradun. Due to heavy traffic, it took four hours; patient with attendants reached Himalayan Hospital, Dehradun at around 01:00 p.m. Thus, it was clear failure of OP- 1 and OP-2 to perform their professional duty and ethical obligation to attend the patient in the emergency. The patient died at 03:20 A.M. Therefore, it was alleged that had the patient been treated properly by OPs at 05:00 a.m. on 14.06.2015 itself, he would have been alive today. Therefore, complainant Smt. Suman Taneja filed this complaint under section 21 (a) (i) of the Consumer Protection Act, 1986 on 21.12.2015. The complainant prayed for approximate total compensation of Rs. 2.5 crores. The complainant placed reliance upon few medical literatures.

2. We have heard the learned counsel for complainants at the admission stage. The counsel submitted that, the conduct of OP-2 inter alia, is violation of Rule 2.4 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 that provides:

“A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not wilfully commit on act of negligence that may deprive his patient or patients from necessary medical care.”

3. The counsel further argued that, OP-2 violated the Hippocratic Oath. For the emergency treatment, the act of OPs is against the Apex Court’s verdict in Parmanand Katara Vs. Union of India, 1989 (4) SCC 286, held, “law courts will not summon a medical professional to give evidence, unless the evidence is necessary.” The counsel further contended that, this instant case is covered by principles of res ipsa loquitur. The OP-2 being a specialist in cardiology working under the expert like Dr.Puroshattam Lal ( OP 4) failed to perform stenting immediately, which any other prudent cardiologist would do.

4. We have perused the medical record, investigations done at OP-1 and at Himalayan Hospital. At OP-1 Metro Hospital, the patient, a known diabetic was admitted in the emergency with chest pain, sweating. It was diagnosed, as CAD / Ac IWMI + RVMI with Shock . The hand written “ Case Summary” is reproduced as below;

“Patient was thrombolysed with reteplase. He was explained about the risks. The Primary PCT was not done due to non-availability of cardiologist. Therefore with explained consent, the patient was referred to higher centre for further management. The risks and prognosis explained to the attendants.”

5. The clinical notes and lab report at 05:36 a.m. revealed high Blood Urea 141 mg and Creatinine 1.80 mg. The ECG revealed Atrial Fibrillation, Inferior Myocardial Infarction. The doctors there planned for angioplasty on the next day. On shifting/admission to Himalayan hospital, Dehradun, the doctors diagnosed it as:

“i) CAD-IWMI

ii) Cardiogenic Shock

iii) Type 2 Diabetes Mell