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.
- 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.”
- 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.
- 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.”
- 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:
ii) Cardiogenic Shock
iii) Type 2 Diabetes Mellitus
iv) SevereLvDysfunctin CHB/VT/VF
v) Chest pain since 1 day”
- The counsel placed several medical articles in cardiology like “Golden Hour for Heart Attack patients”, “The golden hour and the difference between life and death”, Myocardial infarction Treatment & management”. He brought our attention to the following literature:
“What is the immediate treatment one can expect in a hospital?
Once the patient reaches the hospital, the primary goal of treatment would be to dissolve the obstructing clot, and restore blood supply to the affected part of the heart.
This is done, most commonly, by clot busting drugs. But of late, the preferred modality is mechanical dissolution of the clot by a procedure called s primary angioplasty.
The only prerequisite for angioplasty is that it can be done only in hospitals where a cardiac catheterization laboratory and doctors well versed with this procedure are available.”
- We do not find any force in these arguments. Patient suffered IWMI, it was a cardiac emergency and he was in a critical stage. After diagnosis, the OP-2 rightly treated the patient by thrombolysing agents. Due to non-availability of cardiologist, he has referred the patient to the higher centre. Referring the patient to the higher centre is not a medical negligence.
- No doubt, the OP hospital is a Heart Institute, but has few cardiologists. The hand written Case summary clearly reveals, that it was a case of CAD/acute IWMI + RVMI with shock. The patient was thrombolysed with reteplase with explained reasons. The primary (Percutaneous Coronary Intervention) PCI was not done due to non-availability of cardiologist, with explained consent and patient was referred to higher centre. It should be borne in mind that, every cardiologist is not capable or experienced to the extent to perform PCI. Therefore, we do not find the OPs breached in their duty of care or there was deficiency on the part of OP2 who referred the patient to higher centre due to non-availability of cardiologist. As per medical record, the patient was given proper care during the emergency. The lab investigations also revealed high blood urea (141 mg) and creatinin 1.8 mg, thus there was renal impairment also. Ideally, PCI would be conducted within 6 to 48 hours after thrombolisation and after normal renal function test. Therefore, we are of considered view that, the decision taken by OP2 to refer patient to higher centre was proper.
- We rely upon the landmark judgment from the bench comprising Hon’ble Justices Dalveer Bhandari and H S Bedi of Hon’ble Supreme Court in the case Kusum Sharma & Others Vs. Batra Hospital & Medical Research Centre & Others (2010) 3 SCC 480; dismissing a complaint held that,
“Consumer Protection Act (CPA) should not be a "halter round the neck" of doctors to make them fearful and apprehensive of taking professional decisions at crucial moments to explore possibility of reviving patients hanging between life and death." Also said that “Doctors in complicated cases have to take chance even if the rate of survival is low. A doctor faced with an emergency ordinarily tries his best to redeem the patient out of his suffering. He does not gain anything by acting with negligence or by omitting to do an act,” It further observed as, "It is a matter of common knowledge that after some unfortunate event, there is a marked tendency to look for a human factor to blame for an untoward event, a tendency which is closely linked with the desire to punish,”
10. Doctors should not be dragged to court unnecessarily on frivolous ground which prevents them from discharging their duty to a suffering person who needs their assistance utmost. On the basis of forgoing discussion, we are not satisfied that the damage had been caused by OP-2’s deficiency or negligence. Therefore, the instant complaint is dismissed at admission stage.