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Tuesday, July 29, 2014

Medical Negligence - Angiography - aorta dissection - sever pain - right leg runs down- no pulse sensation - resulted in another Hospital an anigography and angio palsty - drives the complainant for mental and physical agony and financial loss - state consumer forum allowed the petiton - on appeal National consumer forum dismissed the complainant - Apex court held that There is sufficient material to come to the conclusion that the complainant was found stable after third day of angiography and till the date of discharge on September 8, 1999. The only allegation of the complainant is of abdominal pain during the process of angiography. There is no dispute that she was aged about 55 years and suffering from hypertension when the angiography procedure was conducted on her. It is probable that due to such associated causes the passage of the catheter through aortic space was not smooth. There is no material to infer that Dr. Chawla had undertaken any adventurous step. There is nothing on record which points out that Dr.Chawla used any brutal force to push the catheter. In our opinion, mere completion of the angiography does not rule out aorta dissection during the procedure. We find that the complainant did not had a serious aorta dissection but was having sub-acute aorta dissection and this is the reason that the complainant was subjected to clinical management and, in fact, her condition became stable without any surgical interference. It is nobody’s case that Dr. Chawla is not a competent coronary expert or he lacked adequate knowledge in the field of coronary surgery. He is duly qualified and has good academic credentials. We have not found his conduct to be below the normal standard of a reasonably competent practitioner in his field. We are in agreement with the reasoning and the conclusion arrived at by the National Commission that the complainant has not been able to prove medical negligence on the part of Dr. Chawla. In the result, we do not find any merit in the appeal and it is dismissed without any order as to costs.= CIVIL APPEAL NO. 6284 OF 2014 (@SPECIAL LEAVE PETITION (CIVIL.) NO. 18367 OF 2012) MRS. KANTA … APPELLANT VERSUS TAGORE HEART CARE & RESEARCH CENTRE PVT. LTD.& ANR. …RESPONDENTS = 2014 – July. Part – http://judis.nic.in/supremecourt/filename=41759

 Medical Negligence - Angiography - aorta dissection - sever pain - right leg runs down - no pulse sensation - resulted in another Hospital an anigography and angio palsty - drives the complainant for mental and physical agony and financial loss - state consumer forum allowed the petiton - on appeal National consumer forum dismissed the complainant - Apex court held that There   is sufficient material to come to  the  conclusion  that  the  complainant  was
found stable after third day of angiography and till the date  of  discharge on September 8,  1999. The  only  allegation  of  the  complainant  is  of abdominal pain during the process of angiography.  There is no dispute  that she was aged about  55  years  and  suffering  from  hypertension  when  the angiography procedure was conducted on her.   It  is  probable  that  due  to such associated causes the passage of the catheter through aortic space  was not smooth.  
There is no material to infer that Dr.  Chawla  had  undertaken any adventurous step.  
There is nothing on record which points out that  Dr.Chawla used any brutal force to push the catheter.   In  our  opinion,  mere completion of the angiography does not rule out aorta dissection during  the procedure.   We find that  the  complainant  did  not  had  a  serious  aorta dissection but was having sub-acute aorta dissection and this is the  reason that the complainant was subjected to clinical management and, in fact,  her condition became stable without any surgical interference.   It  is  nobody’s case that Dr. Chawla is  not  a  competent  coronary  expert  or  he  lacked adequate knowledge in the field of coronary surgery.   He is  duly  qualified and has good academic credentials.   We have not  found  his  conduct  to  be below the normal standard of a  reasonably  competent  practitioner  in  his field.   We are in agreement with the reasoning and  the  conclusion  arrived at by the National Commission that the complainant  has  not  been  able  to prove medical negligence on the part of Dr. Chawla. In the result, we do not find any  merit  in  the  appeal  and  it  is dismissed without any order as to costs.=

whether it  was
the direct result of any negligent or  rash  act  committed  by  Dr.  Chawla
while conducting the angiography.  

Dr. Chawla examined  the  complainant  clinically
on September 1, 1999 and conducted  Echo  test.   Dr.  Chawla  noticed  that
there was possibility of blockages  which  needed  appropriate  confirmation
and medical treatment and  accordingly  he  advised  for  admission  of  the
complainant in the Research Centre for conducting angiography. =

Dr. Chawla  with  the  consent  of  the  complainant’s  son,  a
medical practitioner, decided to conduct angiography on September 2, 1999.=
The  complainant  has  alleged
that during the angiography procedure, she felt severe pain in  the  abdomen
and brought the said fact to the notice of Dr. Chawla  but  he  ignored  the
same and continued with the procedure.  =
 On
September 3, 1999,  according  to  the  complainant,  Dr.  Chawla  alongwith
another consultant namely Dr. Suri examined  her  who  found  pulse  of  her
right leg practically absent and as such he  reprimanded  Dr.  Chawla=
Dr. Trehan of the Escorts Heart Institute, Delhi  and
was  admitted  in  the  said  Institute  on  September  13,  1999.   Another
angiography was conducted at the  Escorts  Heart  Institute  through  radial
artery of the right arm and on that basis,  according  to  the  complainant,
Dr.  Trehan  opined  that  aorta  dissection  has  taken  place  during  the
angiography procedure done by Dr. Chawla at Tagore Heart Care  and  Research
Centre, Mahavir Nagar, Jalandhar, Punjab and that was iatrogenic in  nature.
 Ultimately, she had undergone angioplasty  on  October  18,  1999  and  was
discharged after ten days.=
The complainant alleged medical negligence on the part of  Dr.  Chawla
and the Research Centre while conducting the  angiography  on  September  2,
1999 resulting into dissection of aorta.  
She has alleged that  she  had  to
obtain further treatment and due to the sheer negligent act  of  Dr.  Chawla
incurred heavy expenditure in  undergoing  angioplasty  and  angiography  at
Escorts Heart Institute.  
Alleging  the  aforesaid,  the  complainant  filed
petition before State Commission, interalia, praying compensation of  Rupees
Eleven lacs  from  Dr.  Chawla-Respondent  No.2  and  the  Research  Centre-
Respondent No.1.=
State  Commission  held in this regard:

      “….It is true that hypertension is  one  of  the  factors  of  causing
aorta dissection but in the present case, the aortic  dissection  had  taken
place when respondent no.2 was passing the  catheter  through  iliac  artery
travelling  through  aorta  blood  vessel  reaching  inside   the   arteries
adjoining the heart.
The  dissection  of  aorta  had  taken  place  because
respondent no.2 was negligent.
 In fact, it is case  of  res  ipsa  loquitur
i.e. the facts speak themselves and point out that it has  taken  place  due
to negligence of respondent no. 2.If he taken due  care  and  caution,  then
this dissection of aorta would not have taken place because  it  is  a  very
rare phenomenon.
Hence, we hold that the respondent had not taken due  care
and caution and had acted negligently in passing the catheter through  iliac
artery by performing angiography and this led to severe pain in her  abdomen
and she even complained but unmindful  with  the  pain  of  complainant,  he
continued with the process and completed  the  same.  
This  again  suggests
that he was insensitive to the pain and agony of the complainant.”
 In this regard, the National Commission has observed as follows:
      “18.  We are of  the  opinion  that  the  State  Commission  committed
an error while reaching a finding that the doctrine of Res ipsa loquitur  is
applicable to the fact situation of the present case.  In fact,  we  do  not
find any basis to support  such  finding,  particularly,  when  the  medical
record shows  that  complainant  –  Smt.  Kanta  was  stable  when  she  was
discharged on 8.9.1999 from the hospital and could later on travel to  Delhi
for the purpose of coronary surgery.  We think it proper to hold that  there
was  no  negligence  committed  by  the  appellants  while  conducting   the
angiography procedure.”

 In this regard, the National Commission has observed as follows:

      “18.  We are of  the  opinion  that  the  State  Commission  committed
an error while reaching a finding that the doctrine of Res ipsa loquitur  is
applicable to the fact situation of the present case.
In fact,  we  do  not
find any basis to support  such  finding,  particularly,  when  the  medical
record shows  that  complainant  –  Smt.  Kanta  was  stable  when  she  was
discharged on 8.9.1999 from the hospital and could later on travel to  Delhi
for the purpose of coronary surgery.
We think it proper to hold that  there
was  no  negligence  committed  by  the  appellants  while  conducting   the
angiography procedure.”=

Apex court held that

From the entries made  in  the  discharge
summary, we do not find that there was any emergency  to  treat  the  aortic
dissection.  
Aortic dissection came to  be  noticed  beyond  all  reasonable
doubt on September  3,  1999.  
She  was  not  operated  upon.   
It  may  be
mentioned here that in case  of  acute  aortic  dissection,  emergency  open
heart  surgery  is  required.   
However,  in  case   of   sub-acute   aortic
dissection,  treatment  with  medication  may  be  sufficient.  
There   is
sufficient material to come to  the  conclusion  that  the  complainant  was
found stable after third day of angiography and till the date  of  discharge
on September 8,  1999.  
The  only  allegation  of  the  complainant  is  of
abdominal pain during the process of angiography.  
There is no dispute  that
she was aged about  55  years  and  suffering  from  hypertension  when  the
angiography procedure was conducted on her.  
It  is  probable  that  due  to
such associated causes the passage of the catheter through aortic space  was
not smooth.  
There is no material to infer that Dr.  Chawla  had  undertaken
any adventurous step.  
There is nothing on record which points out that  Dr.Chawla used any brutal force to push the catheter.   
In  our  opinion,  mere
completion of the angiography does not rule out aorta dissection during  the
procedure.  
We find that  the  complainant  did  not  had  a  serious  aorta
dissection but was having sub-acute aorta dissection and this is the  reason
that the complainant was subjected to clinical management and, in fact,  her
condition became stable without any surgical interference.  
It  is  nobody’s
case that Dr. Chawla is  not  a  competent  coronary  expert  or  he  lacked
adequate knowledge in the field of coronary surgery.  
He is  duly  qualified
and has good academic credentials.  
We have not  found  his  conduct  to  be
below the normal standard of a  reasonably  competent  practitioner  in  his
field.  
We are in agreement with the reasoning and  the  conclusion  arrived
at by the National Commission that the complainant  has  not  been  able  to
prove medical negligence on the part of Dr. Chawla.

      In the result, we do not find any  merit  in  the  appeal  and  it  is
dismissed without any order as to costs.

2014 – July. Part – http://judis.nic.in/supremecourt/filename=41759


                                             NON-REPORTABLE

                        IN THE SUPREME COURT OF INDIA
                        CIVIL APPELLATE JURISDICTION

                       CIVIL APPEAL NO. 6284  OF 2014
            (@SPECIAL LEAVE PETITION (CIVIL.) NO. 18367 OF 2012)

MRS. KANTA                                   … APPELLANT

                                   VERSUS


TAGORE HEART CARE & RESEARCH
CENTRE PVT. LTD.& ANR.                 …RESPONDENTS



                               J U D G M E N T



CHANDRAMAULI KR. PRASAD, J.
      The complainant-appellant, aggrieved by the order dated May  27,  2011
passed by the National Consumer Disputes Redressal  Commission  (hereinafter
referred to as ‘the National Commission’), setting  aside  the  Order  dated
July 14, 2006 of the Punjab State  Consumer  Disputes  Redressal  Commission
(hereinafter  referred  to  as  ‘the   State   Commission’)   granting   her
compensation  of  Rupees  five  lacs,  has   preferred  this  Special  Leave
Petition.

      Leave granted.

      Bereft of unnecessary  details,  facts  giving  rise  to  the  present
appeal are that the complainant-appellant Mrs. Kanta, aged  about  55  years
at the relevant time, suffered acute chest pain in the last week of  August,
1999.  She consulted a  medical  practitioner  at  Amritsar  who  found  her
symptoms to be of heart attack.  Accordingly,  she  was  advised  to  obtain
opinion and treatment of a cardiologist and cardio  vascular  surgeon.   She
was taken to Jalandhar by her family members where they consulted Dr.  Raman
Chawla (Respondent No.2 herein), attached to Tagore Heart Care and  Research
Centre  Pvt.  Ltd.,  hereinafter  referred  to  as  ‘the  Research  Centre’,
(Respondent No.1 herein).  Dr. Chawla examined  the  complainant  clinically
on September 1, 1999 and conducted  Echo  test.   Dr.  Chawla  noticed  that
there was possibility of blockages  which  needed  appropriate  confirmation
and medical treatment and  accordingly  he  advised  for  admission  of  the
complainant in the Research Centre for conducting angiography.  It was  made
known by the complainant that she is allergic to almost all the  antibiotics
except few.  Dr. Chawla  with  the  consent  of  the  complainant’s  son,  a
medical practitioner, decided to conduct angiography on September 2, 1999.

      It is the allegation of the complainant that the  angiography  was  to
be performed in the morning of September 2, 1999 but it was not done at  the
scheduled time but was performed in the afternoon. The complainant  was  not
allowed to take any food the previous night.  The  complainant  has  alleged
that during the angiography procedure, she felt severe pain in  the  abdomen
and brought the said fact to the notice of Dr. Chawla  but  he  ignored  the
same and continued with the procedure.  After the procedure  was  completed,
according to  the  complainant,  she  was  shifted  to  the  recovery  room.
Angiogram showed LAD artery blockage to the extent of 95 per cent.   It  has
been specifically alleged by the complainant that Dr.  Chawla  took  consent
of her son for performance  of  PTCA  or  angioplasty  for  removal  of  the
blockage, yet it was given up in the midway after  about  15-20  minutes  on
the  pretext  that  she  was  allergic  to  many  drugs.  According  to  the
complainant, she was shifted to Intensive Care Unit  (ICU)  and  though  she
had  severe  pain  throughout  the  night,  yet  nobody  attended  her.   On
September 3, 1999,  according  to  the  complainant,  Dr.  Chawla  alongwith
another consultant namely Dr. Suri examined  her  who  found  pulse  of  her
right leg practically absent and as such he  reprimanded  Dr.  Chawla.   The
complainant was discharged from the Research Centre and thereafter she  came
to Delhi and consulted Dr. Trehan of the Escorts Heart Institute, Delhi  and
was  admitted  in  the  said  Institute  on  September  13,  1999.   Another
angiography was conducted at the  Escorts  Heart  Institute  through  radial
artery of the right arm and on that basis,  according  to  the  complainant,
Dr.  Trehan  opined  that  aorta  dissection  has  taken  place  during  the
angiography procedure done by Dr. Chawla at Tagore Heart Care  and  Research
Centre, Mahavir Nagar, Jalandhar, Punjab and that was iatrogenic in  nature.
 Ultimately, she had undergone angioplasty  on  October  18,  1999  and  was
discharged after ten days.

      The complainant alleged medical negligence on the part of  Dr.  Chawla
and the Research Centre while conducting the  angiography  on  September  2,
1999 resulting into dissection of aorta.  She has alleged that  she  had  to
obtain further treatment and due to the sheer negligent act  of  Dr.  Chawla
incurred heavy expenditure in  undergoing  angioplasty  and  angiography  at
Escorts Heart Institute.  Alleging  the  aforesaid,  the  complainant  filed
petition before State Commission, interalia, praying compensation of  Rupees
Eleven lacs  from  Dr.  Chawla-Respondent  No.2  and  the  Research  Centre-
Respondent No.1.

      After issuance of notice, Dr. Chawla-Respondent No.2 and the  Research
Centre-Respondent No.1 entered their appearance and denied allegations  made
by  the  complainant  that  former  was  negligent  while   conducting   the
angiography on the complainant on September 2,  1999.   According  to  them,
the complainant  was  a  patient  of  hypertension  and  had  a  history  of
ischaemia as also allergic to most of the antibiotics and as such there  was
risk involved in conducting the angiography on the complainant on  September
2, 1999.  Dr. Chawla and the Research Centre further averred  that  coronary
angiography was done successfully and the complainant was shifted to ICU  in
a stable condition.  According to them, after about  a  couple  of  days  of
stabilization, the coronary angioplasty was planned.  However, on  September
3, 1999 in the morning, the  complainant  got  acute  pain  in  abdomen  and
thereafter Dr. Suri, a Cardio-thoracic  Surgeon  was  called  for  examining
her.  He suspected aorta dissection and as such CT scan of the  abdomen  and
thereafter MRI was done immediately and on  that  basis  the  dissection  of
aorta was confirmed and further treatment in consultation with Dr. Suri  was
planned. According to them, the complainant was  stable  and  discharged  on
September 8, 1999.  They have further averred that  conservative  management
was planned for 4 to 6 weeks to  ensure  healing  of  the  aorta  dissection
prior to conducting of contemplated angioplasty.   According  to  them,  the
complainant did not turn up after the discharge. She took further  treatment
at the Escorts Heart Institute, Delhi and in fact developed allergy  due  to
side effects of the drug  called  ‘Ticlopidin’  prescribed  at  the  Escorts
Heart Institute after the angioplasty procedure.  According  to  them,  they
were  not  at  all  responsible  for  deterioration  of  her  condition  nor
deficiency in their medical service.  They have also denied  the  allegation
of negligence made against Dr. Chawla  (Respondent  No.2)  while  conducting
the angiography on September 2, 1999.

      The State Commission directed both the parties to file affidavits  and
place such other materials which were relevant for  decision  of  the  issue
before it.  On the basis of  the  materials  placed  on  record,  the  State
Commission came to the conclusion that  aortic  dissection  occurred  during
the angiography conducted by Dr. Chawla when he forced the catheter  through
artery in a negligent manner.  For coming to the aforesaid  conclusion,  the
State Commission heavily relied on the assertion  of  the  complainant  that
she felt severe pain in the abdomen during angiography. In this  connection,
it is apt to reproduce the observations made  by  the  State  Commission  in
this regard:
      “….It is true that hypertension is  one  of  the  factors  of  causing
aorta dissection but in the present case, the aortic  dissection  had  taken
place when respondent no.2 was passing the  catheter  through  iliac  artery
travelling  through  aorta  blood  vessel  reaching  inside   the   arteries
adjoining the heart.  The  dissection  of  aorta  had  taken  place  because
respondent no.2 was negligent.  In fact, it is case  of  res  ipsa  loquitur
i.e. the facts speak themselves and point out that it has  taken  place  due
to negligence of respondent no. 2.If he taken due  care  and  caution,  then
this dissection of aorta would not have taken place because  it  is  a  very
rare phenomenon.  Hence, we hold that the respondent had not taken due  care
and caution and had acted negligently in passing the catheter through  iliac
artery by performing angiography and this led to severe pain in her  abdomen
and she even complained but unmindful  with  the  pain  of  complainant,  he
continued with the process and completed  the  same.   This  again  suggests
that he was insensitive to the pain and agony of the complainant.”


      On appeal  by  Dr.  Chawla  and  the  Research  Centre,  the  National
Commission set aside  the  finding  of  the  State  Commission  that  aortic
dissection had taken  place  during  angiography  done  negligently  by  Dr.
Chawla.  In this regard, the National Commission has observed as follows:
      “18.  We are of  the  opinion  that  the  State  Commission  committed
an error while reaching a finding that the doctrine of Res ipsa loquitur  is
applicable to the fact situation of the present case.  In fact,  we  do  not
find any basis to support  such  finding,  particularly,  when  the  medical
record shows  that  complainant  –  Smt.  Kanta  was  stable  when  she  was
discharged on 8.9.1999 from the hospital and could later on travel to  Delhi
for the purpose of coronary surgery.  We think it proper to hold that  there
was  no  negligence  committed  by  the  appellants  while  conducting   the
angiography procedure.”

      Undisputedly, the complainant had suffered aorta dissection.   The  CT
scan and MRI conducted on September 3,  1999  confirmed  it.   However,  the
controversy is  when  did  it  occur?   According  to  the  complainant,  it
happened while angiography was being done by  Dr.  Chawla  on  September  2,
1999 whereas according to Dr. Chawla and the Research Centre,  she  suffered
the same not during angiography but the day following that because  of  high
blood pressure.  It is further beyond controversy that Dr. Chawla  completed
the angiography on September 2, 1999 which showed  LAD  artery  blockage  to
the extent of 95 per cent.  It is the  plea  of  the  respondents  that  had
complainant suffered aortic dissection during the angiography, it could  not
have been completed.
      We have heard Mr. Mahabir Singh, Senior Counsel for the  appellant  as
also Mr. Amarendra Sharan, Senior Counsel for the respondent.   Undoubtedly,
the complainant had aorta dissection.  The question is as to whether it  was
the direct result of any negligent or  rash  act  committed  by  Dr.  Chawla
while conducting the angiography.  From the entries made  in  the  discharge
summary, we do not find that there was any emergency  to  treat  the  aortic
dissection.  Aortic dissection came to  be  noticed  beyond  all  reasonable
doubt on September  3,  1999.   She  was  not  operated  upon.   It  may  be
mentioned here that in case  of  acute  aortic  dissection,  emergency  open
heart  surgery  is  required.   However,  in  case   of   sub-acute   aortic
dissection,  treatment  with  medication  may  be  sufficient.    There   is
sufficient material to come to  the  conclusion  that  the  complainant  was
found stable after third day of angiography and till the date  of  discharge
on September 8,  1999.   The  only  allegation  of  the  complainant  is  of
abdominal pain during the process of angiography.  There is no dispute  that
she was aged about  55  years  and  suffering  from  hypertension  when  the
angiography procedure was conducted on her.  It  is  probable  that  due  to
such associated causes the passage of the catheter through aortic space  was
not smooth.  There is no material to infer that Dr.  Chawla  had  undertaken
any adventurous step.  There is nothing on record which points out that  Dr.
Chawla used any brutal force to push the catheter.   In  our  opinion,  mere
completion of the angiography does not rule out aorta dissection during  the
procedure.  We find that  the  complainant  did  not  had  a  serious  aorta
dissection but was having sub-acute aorta dissection and this is the  reason
that the complainant was subjected to clinical management and, in fact,  her
condition became stable without any surgical interference.  It  is  nobody’s
case that Dr. Chawla is  not  a  competent  coronary  expert  or  he  lacked
adequate knowledge in the field of coronary surgery.  He is  duly  qualified
and has good academic credentials.  We have not  found  his  conduct  to  be
below the normal standard of a  reasonably  competent  practitioner  in  his
field.  We are in agreement with the reasoning and  the  conclusion  arrived
at by the National Commission that the complainant  has  not  been  able  to
prove medical negligence on the part of Dr. Chawla.

      In the result, we do not find any  merit  in  the  appeal  and  it  is
dismissed without any order as to costs.
                                …....………..……………………………….J.
    (CHANDRAMAULI KR. PRASAD)



                                                    ………………….………………………………….J.
  (PINAKI CHANDRA GHOSE)
NEW DELHI,
JULY 10, 2014.
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