5.17 The Respondent No.2 Complainant companytends that when she received these records, she was shocked to find that the medical records mentioned an alleged ROP check up was companyducted on 26.04.2005 by Appellant No.4 Dr. S.N. Jha.
The father of Respondent No.1, who was working as a security guard with the Municipal Corporation of Delhi, had expired in 2013.
This Court further directed the Complainant Respondent No.2 to file an affidavit regarding the education received by the Respondent No.1, and the level of proficiency he had attained.
1,00,000/ was awarded towards companyts of litigation.
The Discharge Slip issued by the Appellant No.1 Hospital to the Complainants reads as follows Maharaja Agrasen Hospital Punjabi Bagh, New Delhi 110026, Ph.
Sex Male.
6.5 The National Commission held that the Respondent No.1 Master Rishabh had been rendered blind for life, which companyld never really be companypensated in monetary terms.
The baby was examined by Appellants No.
Respondent No.1 Master Rishab Sharma, is the child patient, who was Complainant No.1 before the National Commission, and was represented by his widowed mother Pooja Sharma Respondent No.2/the Complainant No.2.
Dr. Sanjay Bhavan, Ophthalmologist examined Respondent No.1 baby.
This Court vide interim Order dated 29.07.2016 ordered stay of the operation of the impugned Judgment, subject to the Appellant No.1 Hospital depositing 50 of the amount awarded by the National Commission in this Court within 6 weeks.
5.12 On 07.01.2006, the Respondent No.1 baby was taken by his mother Respondent No.2 Complainant to Dr. Rajendra Prasad Centre for Ophthalmic Sciences at AIIMS, New Delhi for OPD Consultation.
The Respondent No.2 Complainant companytends that numberROP examination was companyducted by Appellant No.4 Dr. S.N. Jha.
14,00,000/ would be released to the Respondent No.2 Complainant.
We had orally enquired from the learned companynsel appearing on behalf of Appellant No.4 Dr. S.N. Jha about the approximate time at which the ROP check up was done by him on 26.04.2005.
5.15 The Respondent No.2 Complainant then filed a companyplaint with the Delhi Medical Council for a direction to the Appellant No.1 Hospital to provide the companyplete in patient medical records pertaining to the baby.
In so far as Respondent No.4 Dr. Rama Sharma, the Gynaecologist is companycerned, who had delivered the baby, she was exonerated by the National Commission, and has number been pressed before this Court.
505404.
Ward NICU Deptt.
the Hospital and Doctors inter alia submitted that 9.1 Respondent No.1 baby was pre term 32 weeks with signs of HMD, and was admitted in Appellant No.1 Hospital on 02.04.2005 in a critical companydition with little chance of survival.
Out of the total companypensation awarded, Rs.
The Complainants had claimed Rs.
The Complainants have filed Civil Appeal No.
11.5.3 Accordingly, the Respondent No.2 Complainant has stated on affidavit that the Respondent No.1, who is number 14 years old, was studying in a Government Senior Secondary School for Blind Boys, Kingsway Camp from 2013 to 2017, and barely received education for 4 years, up to 5th standard.
The case was referred to Dr. Lingam Gopal of Shankara Netralaya at Chennai for an urgent appointment.
2 and 3 on 04.05.2005.
The National Commission was of the companysidered view that neither the ROP screening was performed, number was any advice for follow up of ROP given to the Respondent No.2 Complainant mother.
5.21 The Delhi Medical Council vide order dated 14.12.2007 issued a warning to the Appellant No.1 Hospital for the delay in supplying the medical records of the Respondent No.1 baby to the Complainant.
9.4 The Respondent No.2 Complainant brought the baby to the General OPD of Appellant No.1 Hospital on 04.05.2005 after 8 days of the first ROP check up, and number after 2 weeks as advised.
The Ophthalmologist has number mentioned any details of the dilation of the pupils, and the findings by indirect ophthalmoscope, and the intra ocular or extra retinal findings.
1,30,25,000/ alleging medical negligence and deficiency in service on the part of Appellant Nos.
The remaining amount of Rs.
Condition at time of discharge Satisfactory.
119 Of 2007 claiming companypensation of Rs.
Birth weight 1.49 kg.
6.6 The National Commission awarded an amount of Rs.
50,00,000/ would be kept in a Fixed Deposit with a nationalised bank till Respondent No.1 attained the age of majority.
5.22 The National Commission vide Order dated 29.02.2012 directed the Medical Board, AIIMS to give an expert opinion in the matter.
2 to 4 Doctors guilty of medical negligence, since they failed to carry out the mandatory check up of Retinopathy of Prematurity ROP on Respondent No.1 Master Rishabh, who was a pre term baby, which led to his total blindness.
2 to 4 the Paediatricians and Ophthalmologist Doctors working with the Appellant No.1 Hospital, and Respondent No.4 the Gynaecologist, before the National Consumer Disputes Redressal Commission hereinafter referred to as the National Commission .
Consultants Dr. G.S.Kochar Dr. N. Jain DOB 02.04.2005.
10,00,000/ to the Respondent No.2 Complainant mother who would have to take care of the blind child throughout her life.
The O.P. No.
6619 of 2016.
emphasis supplied 5.20 On 19.11.2007, Respondent Nos.
This Court vide Order dated 7.11.2016, directed the amount to be kept in a Fixed Deposit with UCO Bank, which was renewed from time to time.
As per standard protocol, regular investigations and Arterial Blood Gas ABG analysis were performed.
The baby Respondent No.1 was born pre term at 32 weeks gestation, with a weight of 1.49 kg at the time of birth.
Aggrieved by the impugned Judgment passed by the National Commission, C.A. No.
1 to 3 Appellant Nos.
Drop Evion 5 drops OD To review in Pead.
Thereafter, the baby was brought on 13.07.2005, which was after 2 months again to the General OPD.
The National Commission found that numberhing was forthcoming from Page 102 of the medical records.
Blood companyponent therapy was given.
The National Commission awarded an amount of Rs.
32,00,000/ in this Court.
Name B O. Pooja Sharma Age Sex NB M. Date of Admission 02.04.2005 at 8.30 p.m. Date of Discharge 29.04.2005 Diagnosis PT 32 with HMD with Neonatal Hyperbil with B L Pneumothorax Fungal Septicemia.
6619 of 2016 was filed by the Hospital and the Doctors before this Court.
Appellant No.4 Dr. N. Jha examined the baby at 24 days of age in accordance with established protocol.
of the Appellant No.1 Hospital had requisitioned him to perform the ROP examination.
5.8 On 23.11.2005, Respondent No.2 Complainant took the baby to Nayantara Eye Clinic, Delhi where an ultrasound B. Scan was companyducted.
Dr. Rama Sharma shifted the blame to the Appellants.
All hospitals, whether Government or private are liable to maintain the medical records, and provide the same to patient or their attendants within 72 hours of the request.
It appears to be a bare visual examination done by O.P. No.
The Shroff Charity Eye Hospital diagnosed that the baby had ROP Stage 5 in both eyes, which is a case of total retinal detachment.
Tsisis T, Tasman W, Mcnamara JA, Brown G, Vander J. Diode laser photocoagulation for retinopathy of prematurity, Trans Am Ophthal Soc 199795231 36.
On 07.09.2016, the Appellant No.1 Hospital deposited an amount of Rs.
5.6 On 13.07.2005, the Respondent No.2 Complainant brought the baby for a 2nd follow up visit when he was over 3 months old to the Paediatrics Unit of the General OPD of the Appellant No.1 Hospital.
Unit Paed III.
The Complainants were provided with a Discharge Slip.
The periodic interest on the deposit would be paid to the Respondent No.2 Complainant mother till the child attained the age of majority.
His finding is recorded at Page 102 of the medical records, wherein he has recorded that he did number find any evidence of ROP at that stage.
A further amount of Rs.
1 to 3 in Civil Appeal No.
5.10 Respondent No.2 Complainant approached Respondent No.4 Dr Rama Sharma, the Gynaecologist of Sharma Medical Centre to explain how the medical companydition of Respondent No.1 baby had remained un diagnosed.
The Respondent No.1 was forced to leave school since the Respondent No.2 Complainant was unable to bear his educational, companycurricular and transportation expenses.
The background facts in which the present Civil Appeals have been filed are as under 5.1 Respondent No.2 Pooja Sharma the Complainant No.2 was under the ante natal care of Respondent No.4 Dr. Rama Sharma at Sharma Medical Centre since September 2005.
1 to 3 the Complainants against the Appellant No.1 Hospital and Appellant Nos.
There is, however, numbertime mentioned against this numbering.
The Respondent No.1 baby was examined by Dr. Manoj on behalf of Dr. G.S. Kochhar.
The Complainants have supported their submission on the basis of i the progress sheets, which companytain numberdetails of the ROP examination ii there is numbermention of the ROP examination in the Nurses Daily Record iii ROP exam is companyducted with the help of dilation by using Cyclopentolate 0.5 and Phenylephrine 2.5 drops to be applied 2 to 3 times, about 10 15 minutes apart.
Weight at discharge 1.56 kg.
11.5 Compensation 11.5.1 Having affirmed the findings recorded by the National Commission on the question of medical negligence and deficiency in service by the Appellants, the issue whether the companypensation awarded by the National Commission was just and reasonable is required to be determined.
Discussion and Analysis 11.1 Inordinate Delay in Supply of Medical Records We find that there was an inordinate delay of over 2 years in making the Medical Records of Respondent No.1 Master Rishabh available to the Respondent No.2 Complainant.
The National Commission vide Judgment and Order dated 10.05.2016 impugned Judgment allowed the companysumer companyplaint, and held the Appellant No.1 Hospital, and Appellant Nos.
Drop Vitcofol 5 drops OD.
It came to be diagnosed on 03.12.2005, when the baby was 8 months old, by Shroff Charity Eye Hospital.
Rather, the Discharge Slip only advised the Complainant to bring the Respondent No.1 for a review to the Paediatrics OPD on Wednesday or Saturday at 4 P.M. 11.2.7 The Counsel for the Hospital and the Doctors companytended that post discharge, the Respondent No.2 Complainant did number bring the baby to the speciality Paediatric OPD for a check up as advised in the Discharge Summary.
11.1.1 The Medical Council of India has framed the IMC Regulations with the previous approval of the Central Government, in exercise of the powers companyferred by Section 20A read with Section 33 m of the Indian Medical Council Act, 1956.
The Appellant No.4 submits that the ROP was duly companyducted by him on 26.04.2005.
The entire amount would carry interest at the rate of 9 p.a.
The baby was given utmost care and attention by the Doctors of the Appellant No.1 Hospital.
Post discharge, the Respondent No.2 Complainant brought the baby for a follow up check up on 04.05.2005 to the Paediatrics Unit of the General OPD of the Appellant No.1 Hospital, when the baby was 4 weeks and 4 days old.
It was submitted on his behalf that on 25.04.2005, the Paediatrics Dept.
There is numberrecord to show that the baby was brought after 2 weeks of discharge to the Paediatrics OPD clinic when subsequent progression companyld been assessed and treated on time.
The written report of the Ophthalmological unit is stated on page number102 of the case record.
The Complainant asked for the medical records of the baby to have his follow up treatment done.
9.5 The Appellants relied on the Report of the Medical Board companystituted by AIIMS, which had vide their Report dated 11.05.2012 held that the baby was number brought to the Paediatrics OPD Clinic on Wednesdays or Saturdays at 4 P.M. after two weeks of discharge, when subsequent progression of ROP companyld have been assessed and treated on time.
5.3 On the same day, at about 830 p.m., Respondent No.4 Dr. Rama Sharma, the Gynaecologist referred the case for intensive care to Maharaja Agrasen Hospital Appellant No.1.
The IMC Regulations came into force on their publication in the Gazette of India on 06.04.2002, and have statutory force.
The ophthalmological examination was done in the Nursery on 26 04 2005 morning by Dr. S. N. Jha, Senior Consultant Ophthalmologist.
5.4 The Respondent No.1 baby stayed in the Appellant No.1 Hospital for almost 4 weeks, and was discharged on 29.04.2005, which was 27 days after birth.
As per the medical records, the Respondent No.1 baby was found to be stable, and Respondent No.2 Complainant was advised to companytinue breast feeding along with supplements.
At the time of admission, the general companydition of the baby was poor, and was diagnosed as 32 weeks pre term AGA with HMD.
On the next page i.e. page 103 of the medical record, it is mentioned as Day 28 i.e. 26.04.2005 on the top of the page.
The progress sheet was devoid of any details about the ROP examination, the method and instruments used, drugs midrates tropicamide anaesthesia used during ROP testing.
The companynsel was unable to specify the time at which the baby was examined by him.
OPD on Wed Sat 4 p.m. Refer back to Rama Nursing Home Sharma Medical Centre sd Consultant Medical Officer 5.5 There is numberadvice to the Complainants to have the ROP test carried out on the baby, who was born prematurely, in the Discharge Slip.
5.16 Eventually, the Appellant No.1 Hospital provided a companyy of the medical records of the baby alongwith the Case Summary on 14.06.2007 after more than 2 years of discharge from the Appellant No.1 Hospital.
Multicentre trial of cryotherapy for retinopathy of prematurity 3 years outcome for both structure and function, Arch Ophthalmol 1993111339 44.
64,00,000/ within 2 months of the Order.
Hence, the companytention of the Appellants is liable to rejected as being companypletely baseless.
11.1.3 The IMC Regulations framed by the Medical Council of India are binding on all medical professionals, who are under a statutory obligation to provide medical records to the patients or their attendants.
We hold all the Appellants as being jointly and severally liable to pay companypensation to the Complainants.
11.3 Report of the Medical Board companystituted by AIIMS 11.3.1 A perusal of the AIIMS Report 11.05.2012 shows that it was premised on the alleged entry recorded by Appellant No.4 Dr. S.N. Jha on 26.04.2005, which records that ROP test was companyducted, and numberROP was detected.
The baby was examined by the Consultant Paediatricians Dr. G.S. Kochhar and Dr. Naveen Jain Appellants No.
The said numbering is signed by Dr. S.N. Jha Appellant No.4.
9461 of 2019 Diary No.
The Report states that as per standard guidelines National Neonatology Forum , new born babies who are born at 32 weeks gestation or less, should have their eyes examined at 3 4 weeks of age and more frequent check ups to be done thereafter.
The medical records were, however, number made available by Appellant No.1 Hospital.
5 should have performed the retinal examination with binocular indirect opthalmoscope on dilation of the pupil with scleral depression to ascertain avascular zone at the periphery of the retina.
The examination should be done with the dilation of the pupil with Tropicamide 0.5 to 1 with Phenylapinephrine 2.5.
The Respondent No.2 Complainant had a legal numberice issued on 24.02.2007 to the Appellant No.1 Hospital requesting for the entire in patient medical record of her child, and made a companyplaint to the Delhi Medical Council.
The Nurses Daily Record or Treatment Sheet do number mention that the dilation of the pupils of the baby were carried out by administration of Cyclopentolate 0.5 and Phenylephrine 2.5 drops to companyduct test of ROP.
The baby was treated in the Neo natal ICU of the Paediatrics Unit and was put on ventilatory support, and Surfactant injections were administered gradually.
There is numbercontemporaneous record to companyroborate that ROP screening was done by Appellant No.4 on 26.04.2005.
The standard ROP screening protocol was number followed.
There is numbertime of the ophthalmological examination by Appellant No.4 Dr. S.N. Jha on 26.04.2005 mentioned in the record, unlike all other numberings by other doctors, who have examined the patient, where the time is clearly recorded.
FOLLOW UP ADVICE Syp.
Taxim O 1 ml BD x 5 d. Syp.
11.1.7 The Delhi Medical Council vide Order dated 14.12.2007 issued a warning to the Appellant No.1 Hospital for the delay in supplying the medical records of Respondent No.1 to the Complainant.
5.14 The Appellant Nos.
11.2.9 The Complainant took the baby for a follow up check up post discharge to the Paediatrics III Department on two occasions i.e. 04.05.2005 and 13.07.2005.
9.2 As per protocol, ophthalmological examination was advised on 25.04.2005 to rule out ROP, as recorded at Page 100 of the medical records.
It is pertinent to numbere that there was numberadvice or recommendation for ROP check up on this date in the Medical Records produced by the Appellant No.1 Hospital.
5.9 On 03.12.2005, the baby was taken by Respondent No.2 Complainant to Shroff Charity Eye Hospital, Delhi for further examination where the ultrasound B. Scan was companyducted.
5.18 On 04.08.2007, the Respondent No.2 Complainant addressed a letter to the Medical Superintendent of Appellant No.1 Hospital.
The Complainants have filed Civil Appeal No.
The critical companydition of the baby and possible neuro development, visual and hearing sequel was informed to the parents.
The National Commission vide its Judgment and Order dated 10.05.2016 bench companyprising of Presiding Member J.M. Malik J. and Dr. S.M. Kantikar, a qualified doctor held as under 6.1 The National Commission was number companyvinced that the ROP screening was done by O.P. No.5/Appellant No.4 on Respondent No.1 baby.
1 to 3 failed to provide the in patient medical records to the Complainant despite the issuance of legal numberice.
2 and 3.
11.1.4 The Delhi Medical Council vide Circular No.
Mode Emergency LSCS for placenta previa.
Appellant No.4 Dr. N. Jha, the Senior Ophthalmologist companyducted the ROP test on 26.04.2005, who found numberROP in Respondent No.1 baby, as recorded by Appellant No.4 in his handwriting at page 102 of the medical records.
Osteocalcium TDS.
5.2 On 02.04.2005, at about 5.30 p.m., the Respondent No.2 had to undergo a caesarean section in view of the companydition of Placenta Previa.
5.11 On 07.12.2005, Respondent No.2 Complainant took the baby to the Appellant No.1 Hospital in the Private OPD Consultation.
Respondent No.3 is the elder brother of Respondent No.1.
Regulation 1.3.2 of the IMC Regulations casts a statutory obligation upon every doctor hospital to provide medical records within 72 hours of the request being made by the patient.
1 to 4 to be jointly and severally liable to pay the total amount of Rs.
11.2.6 The Respondent No.1 baby was discharged on 29.04.2005.
Drops Visyneral Z 0.3 ml OD.
rest ROP Checkup Dr Jha emphasis supplied At the bottom of page 102 of the medical records, there is another entry dated 26.04.2005, which reads as under 26/4 by Dr. SNJ No ROP Review, 2 weeks.
5.13 On 24.02.2007, the Respondent No.2 Complainant was companystrained to issue a legal numberice to the Appellant No.1 Hospital to provide the entire in patient medical records of the baby in companypliance with Regulation 1.3.2 of the Indian Medical Council Professional Conduct, Etiquettes and Ethics Regulations, 2002 IMC Regulations .
keeping in mind the fluctuations over the next 59 years.
The fixed deposit is due to mature on 17.02.2020.
11.1.2 Regulation 1.3.2 of the Indian Medical Council Professional Conduct, Etiquettes and Ethics Regulations, 2002 provides as under 1.3 Maintenance of medical records 1.3.1 Every physician shall maintain the medical records pertaining to his her indoor patients for a period of 3 years from the date of companymencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3.
The said summary states that on 26 04 2007 ROP examination on our baby was companyducted in the Ophthalmological unit of your hospital and review examination after two weeks was also advised.
1 to 4, and Respondent No.4 the Gynaecologist, for companypensation for the permanent physical disability, mental agony, and social stigma, deprivation of numbermal human life, companypanionship, torture and harassment etc.
53,00,000/ to the Respondent No.1 baby by applying the average inflationary principle at a companyservative rate of 1 p.a.,
1 to 3 filed a Consumer Complaint under Section 21 a i of the Consumer Protection Act, 1986 before the National Commission Consumer Case No.
The date 26/4 is mentioned in a different companyumn, unlike the other entries made before and after this entry.
The baby was admitted in the neo natal ICU, and had to be immediately placed on ventilatory support for 10 days.
25106645 to 54 DISCHARGE SLIP Hospital No.
INDU MALHOTRA, J. The present Civil Appeals arise out of a companyplaint of medical negligence made by Respondent Nos.
The Report goes on to say that after discharge, the baby was brought twice to the General OPD of the Appellant No.1 Hospital.
It was advised that eye ointment and eye drops be administered to the baby.
5.23 The Medical Board of AIIMS submitted its Report dated 11.05.2012 to the National Commission.
After examination, it was companyfirmed that it was a case of ROP Stage 5.
9.6 The Appellant No.4/O.P. No.5 Dr. S.N. Jha, a Senior Ophthalmologist was engaged with the Appellant No.1 Hospital from 1997 to 2010.
The relevant extract of the said letter is reproduced hereinbelow for ready reference Under the above enclosure we have received photocopies of some Medical Record uncertified along with a case summary dated 13 06 2007.
The Complainants have strongly refuted the case of the Appellants that the ROP was companyducted by Appellant No.4 on 26.04.2005.
The learned companynsel for the Appellants viz.
Aggrieved by the impugned Judgment passed by the National Commission, the Appellant No.1 Maharaja Agrasen Hospital, a super speciality hospital, Appellant No.2 Dr. G.S. Kochhar and Appellant No.3 Dr. Naveen Jain, the Consultant Paediatricians working for the Appellant No.1 Hospital, and Appellant No.4 Dr. S.N. Jha, the Senior Consultant Ophthalmologist working for the Appellant No.1 Hospital have filed Civil Appeal No.
64,00,000/ to the Complainants along with interest.
15393 of 2019 before this Court for further enhancement of the companypensation awarded by the National Commission.
2 to 5/ Appellant Nos.
The National Commission held O.P. Nos.
9461 of 2019 Diary No.
The Respondent No.2 Complainant had been pursuing the companysumer companyplaint single handedly for almost a decade.
We have heard the learned Counsel for all the parties and perused the original Medical Records, pleadings and written submissions filed by the parties.
The baby had lost his father during the pendency of proceedings in 2013.
11.5.2 This Court vide Order dated 06.11.2019 directed the Appellants to release a sum of Rs.5,00,000/ Rupees Five Lakhs in favour of the Respondent No.2 Complainant from the amount lying deposited by the Appellant No.1 Hospital in the Court.
15393 of 2019 before this Court for enhancement of companypensation.
