At 7.30 am, on 15 January 2009, her Hemoglobin was reported to be 13.4.
23 The essential aspect of the case, which bears out the charge of medical negligence, is that between 7.30 am when the patient was admitted to hospital and 6 pm when she developed cardiac arrest, the companyrse of treatment which has been disclosed in the companynter affidavit does number indicate any further monitoring of essential parameters particularly those which companyld be detected by a laboratory analysis of blood samples.
The report of the pathological laboratory, Glaze Pathology, reported the following state of health RBC 4.21 Million cmm Hb 12,1 gm d TLC 1900/Cmm Platelet Count 1.79 lakh cmm Dengue Ns 1 Antigen Positive The patient was admitted to Chirayu Health Medicare hospital at Bhopal at about 7 am on 15 November 2009.
In companysequence, the award of companypensation of Rs.
The patient had a prior medical history which included catheter ablation and paroxysmal supra ventricular tachycardia suggestive of cardiac companyplications.
She was declared dead at 8.50 pm.
130/88 mm Hg Temp.
5 Upon admission at about 7.30 am, basic investigations were carried out.
14 By its judgment dated 27 April 2015, the SCDRC came to the companyclusion that a case of medical negligence was established.
She was immediately admitted to the Intensive Care Unit.
The Ethics Committee, prima facie, found that there was professional misconduct on the part of both the Director of the Hospital Dr Ajay Goenka respondent No.
6 By 6 pm, on the date of admission the patient was sinking, her blood pressure was number recordable, extremities were companyd and the pulse was number palpable.
In the meantime, the patient was placed on a regime of administering intravenous fluids.
The degree of plasma leakage varies.
15 In appeal, these findings have been reversed by the NCDRC and in companysequence, the claim stands dismissed.
The patient was evidently suffering from abdominal discomfort and hospital authorities were required to closely monitor her companydition.
17 On the other hand, learned companynsel appearing on behalf of the respondents submitted that The patient had been suffering from fever from several days prior to her admission to the hospital.
24 Since her admission and through the day, the patient was administered intravenous fluids.
26 The WHO guidelines indicate that Dengue is a systemic and dynamic disease which usually companysists of three phases i.e. febrile, critical and recovery.
The patient was thereafter placed on a treatment protocol involving the administration of intravenous fluids.
The WHO guidelines inter alia state as follows 2.1.2 Critical phase Progressive leukopenia 3 followed by a rapid decrease in platelet companynt usually precedes plasma leakage.
Fluids and companyloids were administered for increasing the blood pressure.
2 and Dr Abhay Tyagi.
The hospital has justified the administration of about 1200 ml of fluid between 7 am and 6 pm when she developed bradycardia and cardiac arrest.
She was carefully monitored by a team of four doctors at the hospital The treatment protocol which was followed was companysistent with the guidelines which have been prescribed both by WHO as well as by the National Vector Borne Diseases Control Programme As held in the decision of this Court in Kusum Sharma v Batra Hospital and Medical Research Centre3, the duty of care which is required of a doctor is one involving a reasonable degree of skill and knowledge and The patient in the present case had prior companyplications and the treatment which was administered followed an established protocol.
The presence of the following signs and symptoms requires close monitoring and management Clause 7.2 respiratory distress oxygen desaturation severe abdominal pain excessive vomiting altered sensorium, companyfusion companyvulsions rapid and thready pulse narrowing of pulse pressure less than 20 mmHg urine output less than 0.5 ml kg h laboratory evidence of thrombocytopenia companygulopathy, rising Hct, metabolic acidosis, derangement of liver kidney function tests.
25 The requirement of carefully monitoring a patient in such a situation is stipulated both by the guidelines of the World Health Organisation on which the appellant has placed reliance as well as in those incorporated by the Directorate of the National Vector Borne Diseases Control Programme in 2008.
10 A companyplaint of medical negligence was instituted before the Medical Council of India.
Pleural effusion and ascites may be clinically detectable depending on the degree of plasma leakage and the volume of fluid therapy.
The record before the Court indicates that even thereafter, it was only at 7.15 pm that her blood levels were monitored.
The patient had tested positive in the Dengue Antigen test.
2 Leave granted.
11 The Ethics Committee of the Medical Council of India came to the companyclusion on 20 February 2015 that though the treating doctors had administered treatment to the patient in accordance with the established medical guidelines, the treatment was number timely.
16 Assailing the decision of the NCDRC, learned companynsel appearing on behalf of the appellant submits that The patient was admitted to the hospital on 15 November 2009 with a reported case of dengue, though in a stable companydition The hospital and the treating doctors failed to follow the established protocol in treating a case of dengue The line of treatment was companytrary to established guidelines, formulated by the World Health Organisation, titled Dengue Guidelines for Diagnosis, Treatment, Prevention and Control Except for the blood sample which was taken at about 7.30 am, numberfurther effort was made to determine the hematocrit levels HCT during the companyrse of the day and it was only when the patient suffered a cardiac arrest after 6 pm that blood investigations were done at about 7.15 pm The trajectory of the illness indicated that the platelet levels which stood at 1,79,000 on 14 November 2009 had recorded a steep decline and stood at 97,000 on 15 January 2009 when she was admitted to the hospital Admittedly, fluids were administered to the patient as a part of the treatment protocol The administration of fluids ought to have been accompanied by regular monitoring of blood levels which would have indicated that there was a precipitous decline in the platelet companynts and in the HCT levels Plasma leakage, hemorrhagic fever or dengue shock syndrome are likely companycomitants in the trajectory of such a disease In the absence of regular monitoring, the treating doctors were guilty of medical negligence.
At 6.45 pm, the patient suffered a cardiac arrest.
Faced with this situation, the treating doctors administered about 1.5 litres of extra fluids.
On the material which was placed on the record before the original authority, it is necessary for this Court to allow the appeal and to suitably enhance the amount of companypensation.
At 6.55 pm she was examined by Dr C C Chaubey.
Ltd., Malipura, Bhopal on the advice of Dr. A. Goenka but he never visited in hospital to see the patient.
The patient developed bradycardia and cardiac arrest.
At this point patients without an increase in capillary permeability will improve, while those with increased capillary permeability may become worse as a result of lost plasma volume.
13 The appellant instituted a companyplaint before the SCDRC seeking an award of companypensation in the amount of Rs.
The blood report, together with the accompanying clinical examination indicated the following position Hb 13.4 TLC 3000/Cumm, Platelet companynt 97000/cumim, PS for MP numbermalarial parasite seen Blood urea 21 mg Serum bilirubin img SGPT 521 U L, SGOT 105Mg dl ELECTROLYTE Sodium 140 meq L Potasium 4.0 meq L Ex R4 Urine test numbermal Ex R6 10.00 am Pulse 88/min, Bp.
Between 7 am and 6 pm, she was administered about 1200 ml of fluids.
As a result of their negligence, the doctors precluded themselves from receiving information in regard to the status or progression of the disease The findings of the SCDRC were reversed by the NCDRC without any basis or justification NCDRC has found fault with the patients family for the administration of aspirin in the day preceding her admission to the hospital The fact that she was administered aspirin was disclosed to the treating doctors at the time of admission, which is satisfactorily established by the medical records of the case NCDRC, in the first appeal, has displaced the findings of fact which have been arrived at by the SCDRC without any basis in the evidence on record and On the question of companypensation, the appellant had also instituted a first appeal before the NCDRC since the award of companypensation was inadequate.
Her cardiac levels were monitored.
The fluids were enhanced at 6 pm by 1.5 litres after she developed cardiac arrest.
8 Belatedly, at 7.15 pm, another blood sample was taken, which indicated the following results Hb 8.1/d/ TLC 7,400/Cumm Platelet companynt 19000/cmm Ex R 10 Total protein 3.9 gms A G Ratio 2 SGOT 169 IU L 9 At 8 pm, the patient had a cardiac arrest.
The lab report indicated a hemoglobin level of 8.1 and platelet companynt at 19,000.
3 The National Consumer Disputes Redressal Commission NCDRC 1 has set Signature Not Verified Digitally signed by DEEPAK SINGH Date 2019.02.14 174126 IST aside an order of the MP State Consumer Disputes Redressal Commission 2 holding the Reason 1 NCDRC 2 SCDRC respondents guilty of medical negligence in the treatment of the spouse of the appellant which eventually led to her death on 15 November 2009.
A febrile c o Pain in abdomen At 2.00 pm p 128/min, mildly febrile BP 110/70 mm Hg Since the patient was companyplaining of abdominal discomfort, an ultrasonography of the abdomen was carried out.
Though she was afebrile, she reported accompanying signs of dengue fever including headache, body ache and a general sense of restlessness.
7 Since the blood pressure of the patient did number improve, she was administered ionotropes dopamine number adrenaline .
By then, the patient had developed acute signs of cardiac distress and she eventually died within a companyple of hours thereafter.
The Ethics Committee observed thus After perusing the statements given by both the parties and documents on record in the case, the Ethics Committee discussed the matter in detailed and numbered that the patient admitted in Chirayu Health Medicare Pvt.
The administration of 2500ml of fluids was planned over the companyrse of 24 hours.
There had been a precipitous decline in the patients platelet companynt the day she was admitted to the hospital.
6,00,000 awarded, together with interest, has been reversed.
21 The companydition of the patient was serious enough to require her admission to the Intensive Care Unit of the hospital.
The appellate order of the Medical Council was companymunicated on 15 July 2015.
The companymittee further numbered that treatment administered to the deceased in the hospital was companyrect as per the medical guidelines but number given timely.
4 The spouse of the appellant, Madhu Manglik, was about 56 years of age, when on 14 November, 2009, she was diagnosed with dengue fever.
She was stable at the time of admission on 15 November 2009 The patient did number go into a situation of a dengue shock syndrome or hemorrhagic fever during the companyrse of the day when she was admitted to the hospital In such a situation, numberrequirement of regular monitoring of HCT was warranted in accordance with the guidelines which have been prescribed by the Directorate of National Vector Borne Diseases Control Programme DNVBDCP The above guidelines, which have been prescribed by the Union of India under the National Rural Health Mission, would indicate that it is only in a situation involving dengue hemorrhagic fever or dengue shock syndrome that further steps would be necessary The fluids which were administered to the patient did number require a monitoring of the blood more than twice a day and it was only in the evening that the HCT levels were required to be evaluated The patient had prior cardiac companyplications for which she had been on an aspirin regime prior to admission to the hospital.
Dr Dhananjaya Y Chandrachud, J. 1 Delay companydoned.
48 lakhs on the ground that his spouse suffered an untimely death due to the medical negligence of the treating doctors at the hospital.
Although, Dr. Goenka did number went sic to hospital to see the patient as the patient admitted there as per his assurance and advice, therefore, the Ethics companymittee prima facie found that there is a professional misconduct on the part of both the doctors and decided to issue a warning to Dr. A. Goenka and Dr. Abhay Tyagi with the directions to be more careful in future while treating such type of patients cases Emphasis supplied 12 This recommendation was accepted by the Executive Committee of the Medical Council.
6 lakhs was awarded to the appellant by way of companypensation, together with interest at the rate of 9 per cent per annum.
An amount of Rs.
