III (2014) CPJ 3 (SC)
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Complainant aged about 55 years at the relevant time, suffered acute chest pain and consulted a medical practitioner who found her symptoms to be of heart attack.. She consulted Respondent No. 2 (Dr.) an who examined the complainant clinically and conducted Echo test.
.
The Respondent No. 2 noticed that there was possibility of blockages and advised for admission. With consent of the complainant’s son, WHO IS A MEDICAL PRACTITIONER, conducted angiography
.
Angiogram showed LAD artery blockage to the extent of 95 per cent. It has been specifically alleged by the complainant that Respondent No.2 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.
.
She was shifted to Intensive Care Unit (ICU) and though she had severe pain throughout the night, yet nobody attended her. The complainant was discharged from the Research Centre (Respondent No.1) and thereafter she came to Delhi and consulted Dr. Trehan of the Escorts Heart Institute, Delhi and was admitted in the said Institute 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 RESPONDENT NO.2 AT TAGORE HEART CARES AND RESEARCH CENTRE, MAHAVIR NAGAR, JALANDHAR, PUNJAB AND THAT WAS IATROGENIC IN NATURE. Ultimately, she had undergone angioplasty and was discharged after ten days.
.
Allegations
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1) Medical negligence on the part of Respondent No.1 while conducting the angiography resulting into dissection of aorta.
.
2) 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.
.
3) Alleging the aforesaid, the complainant filed petition praying compensation of Rupees eleven lacs from Respondent No. 1 and 2.
.
Respondent No.1 and 2 contended , 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 and 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 next day, a Cardio-thoracic Surgeon was called for who 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. According to them, the complainant was stable and discharged for conservative management which 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 Respondent No. 2 while conducting the angiography
.
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 Respondent No.1 while conducting the angiography.
.
From the entries made in the discharge summary, there was any emergency to treat the aortic dissection, whereas 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
.
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 Respondent No.2 had undertaken any adventurous step. There is nothing on record which points out that Respondent No.2 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 RESPONDENT NO.2
.
IN THE RESULT, SUPREME COURT DISMISSED THE APPEAL
.
Complainant aged about 55 years at the relevant time, suffered acute chest pain and consulted a medical practitioner who found her symptoms to be of heart attack.. She consulted Respondent No. 2 (Dr.) an who examined the complainant clinically and conducted Echo test.
.
The Respondent No. 2 noticed that there was possibility of blockages and advised for admission. With consent of the complainant’s son, WHO IS A MEDICAL PRACTITIONER, conducted angiography
.
Angiogram showed LAD artery blockage to the extent of 95 per cent. It has been specifically alleged by the complainant that Respondent No.2 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.
.
She was shifted to Intensive Care Unit (ICU) and though she had severe pain throughout the night, yet nobody attended her. The complainant was discharged from the Research Centre (Respondent No.1) and thereafter she came to Delhi and consulted Dr. Trehan of the Escorts Heart Institute, Delhi and was admitted in the said Institute 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 RESPONDENT NO.2 AT TAGORE HEART CARES AND RESEARCH CENTRE, MAHAVIR NAGAR, JALANDHAR, PUNJAB AND THAT WAS IATROGENIC IN NATURE. Ultimately, she had undergone angioplasty and was discharged after ten days.
.
Allegations
.
1) Medical negligence on the part of Respondent No.1 while conducting the angiography resulting into dissection of aorta.
.
2) 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.
.
3) Alleging the aforesaid, the complainant filed petition praying compensation of Rupees eleven lacs from Respondent No. 1 and 2.
.
Respondent No.1 and 2 contended , 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 and 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 next day, a Cardio-thoracic Surgeon was called for who 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. According to them, the complainant was stable and discharged for conservative management which 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 Respondent No. 2 while conducting the angiography
.
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 Respondent No.1 while conducting the angiography.
.
From the entries made in the discharge summary, there was any emergency to treat the aortic dissection, whereas 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
.
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 Respondent No.2 had undertaken any adventurous step. There is nothing on record which points out that Respondent No.2 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 RESPONDENT NO.2
.
IN THE RESULT, SUPREME COURT DISMISSED THE APPEAL
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