JUSTICE V.K. JAIN, PRESIDING MEMBER (ORAL)
1. Late Smt. Sonali Mandar Jadhav, wife of the complainant, was under treatment of a Gynecologist namely Dr. Geeta Balsarkar. Dr. Geeta Balsarkar was also an Associate Professor at Wadia Maternity Hospital. When she went to consult Dr. Geeta Balsarkar at Wadia Hospital, she was advised on 11.01.2011 to go to KEM Hospital for a Cardiac checkup. A perusal of the discharge summary issued by KEM Hospital would show that she had history of Chest Pain/Epigastria, Hypertension and nine months Amenorrhea at that time. She also had pain in upper abdomen and back when she was examined in KEM Hospital. Her Blood Pressure at that time was 106/60. An ECG was performed on her and she was given treatment primarily for Acidity and Gastric disorder, comprising injection Pan 4D, injection Diclo/Spazmoproxy, Syrup Mucaine and Tablet Shelcal. On the next date, she was discharged from the hospital and advised to continue the same treatment, besides taking Folic Acid tablets.
She was again taken to Wadia Maternity Hospital on 12.01.2011 at 11 pm where she was declared dead at 03:10 pm on 13.01.2011. The discharge summary issued by Wadia Maternity Hospital would show that she had sudden onset of chest discomfort on 11.01.2011 at 7 pm when she was referred to KEM Hospital. The said summary further shows that at about 2 pm on 13.01.2011, she collapsed all of a sudden and her pulse was feeble whereas her Blood Pressure was not recoverable. The post mortem report would show that at KEM Hospital, her ECG & Obstetrics USG were normal but she collapsed all of a sudden at 2 pm on 13.01.2011. She was declared dead at 03:05 pm after she had delivered a live baby.
2. Clause 20 of the post mortem report to the extent which appears to be relevant, reads as under:
vii Heart with weight
viii Large vessels
ix. Additional remarks
Pericardial cavity contains 300 ml blood and 290 gm of blood clots. Heart is mildly enlarged. Blood clots are also seen along Ascending Aorta, Arch and Pulmonary Artery. Two small Tears of 0.5 cm in length are present at Sino-tubular junction. Other 2 large tears are present 0.5 cm above the Sino-Tubular junction; transverse oriented which is above non-coronary cusp & (LT) Coronary Cusp. There is circumferential dissection of the entire length of Aorta. Two tears are also present on anterior aspect of left common carotid and left sub clavian artery. There is involvement of entire right brachia cephalic artery and 0.3 cm of Left sub clavian artery. There is mild enlargement of both atria and right ventricle. Left ventricle is moderately enlarged. Right coronary has dominant distribution. All coronaries are patent.
The probable cause of death in the opinion of doctor who conducted the post mortem was cardiac failure due to Cardiac Tamponade following Aortic Dissection (Natural).
3. The case of the complainant is that his wife died on account of negligence in her treatment by the doctors of KEM Hospital including OP No.1 Dr. Riya, a doctor in the Medicine Department and OP No.2 Dr. N.D. Karnik, Professor and Head in Department of Medicine. In nutshell, the contention of the complainant is that considering the fact that the Gynecologist at Wadia Maternity Hospital had suspected a Cardiac problem and therefore, referred the patient to KEM Hospital for cardiac check-up, she should have been subjected to extensive cardiac evaluation to rule out a coronary artery disease. This is also the contention of the complainant that she should not have been discharged by KEM Hospital on 12.01.2011 and should have been thoroughly investigated and treated for the cardiac disease from which she was suffering at that time. The complainant is therefore, before this Commission seeking compensation from the OPs.
4. The complaint has been opposed by all the OPs who have denied any negligence in the treatment of the wife of the complainant. According to the OPs, they had followed the universally accepted protocol in the treatment of the wife of the complainant. It is also alleged by them that the death was natural due to consequence of Aortic Dissection in the patient taken up for delivery for the use of Prostaglandins and there is possibility of Aortic Dissection being caused by the presence of Prostaglandins. It is further alleged that the treatment given to the deceased was the appropriate treatment to treat epigastric pain.
5. It is settled legal preposition that the onus to prove the alleged medical negligence is upon the person who alleges such a negligence. Therefore, the onus is upon the complainant to prove that the OPs had committed negligence in the treatment of his wife at KEM Hospital. The only negligence which he is alleging on the part of the doctors at KEM Hospital is that they stopped at her ECG instead of subjecting her to further cardiac investigations in the form of 2D ECO, MRI, CT Scan etc. However, no expert opinion has been submitted by the complainant to prove the alleged negligence in the treatment of his wife at KEM Hospital. It is not in dispute that ECG was performed when the wife of the complainant was brought to KEM Hospital. The ECG was found to be normal and there was no indication of any coronary artery disease in the ECG. Therefore, it would be difficult to say that the doctor at KEM Hospital should necessarily have subjected her to further cardiac evaluation in the form of 2D ECO, MRI, Angio CT Scan, Stress Thallium etc. Every patient coming to hospital with complaint of chest pain is first subjected to an ECG. Unless the doctor examining the patient suspects CAD in the clinical evaluation, he is not expected to subject the patient to further cardiac evaluation, when the ECG of the patient is normal. It would be unrealistic to expect the doctors in such a hospital to subject every patient coming with a complaint of chest pain to advanced cardiac investigations such as Eco Stress test, Thallium Test, Angiography or Coronary etc. No protocol requiring the doctor even if he happens to be a Cardiologist to conduct such tests on other person coming to the hospital with a complaint of chest pain, even when the ECG is normal has been brought to my notice. In any case, if there was an error of judgment on the part of the doctors in not subjecting the patient to offer Cardiac investigations, in the absence of protocol requiring them to do so, it would not amount to a negligence or deficiency in the services rendered to the patient. Therefore, it would be difficult to say that the accepted protocol for the treatment of such patients was not followed by the OPs.
6. When this matter was heard on 30.01.2017, the complainant was granted an opportunity to either produce a Cardiologist or to file his affidavit in support of his case alleging negligence on the part of the OPs in the treatment of his wife at KEM Hospital. Neither any affidavit has been filed nor is the complainant seeking to produce a Cardiologist as a witness. He states that no doctor has agreed either to come as a witness or to even give an opinion. In these circumstances, there is no escape from the finding that the complainant has failed to establish the alleged negligence on the part of the OPs in the treatment of his wife at KEM Hospital, Mumbai.
7. For the reasons stated hereinabove, the complaint is hereby dismissed with no order as to costs. It is however, made clear that the dismissal of the complaint will not come in the way of the complainant approaching a regulatory body such as the concerned Medical Council for the redressal of his grievance.