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--------------- Print Magazine --------------
  May 2016
  April 2016
CASE STUDY - by Anoop K. Kaushal

Ethical Regulations For Indoor Patients

Mahesh Prasad Aggarwal v. Kamayani Patients Care India Ltd.

Original Petition No. 39 of 2003, pronounced on 3 rd January, 2013 by the National Consumer Disputes Redressal Commission, New Delhi.

Facts: Rajeev Aggarwal aged 41 years met with an accident while he was proceeding towards Agra as his vehicle overturned and he sustained multiple serious injuries and became unconscious. He was immediately taken to opposite party-hospital at Secundra, Agra where he was admitted and ` 1200 were charged for C.T. Scan of head, ` 300 for X-ray chest and wrist, ` 600 as OT charges, ' 500 as emergency charges and ' 500 as Doctors' examination fee. Rajeev Aggarwal was plastered in left hand and he was discharged and was informed that he was alright. It was alleged that he was not given documents of discharge, was complaining of serious headache and pain at back but no treatment regarding aforesaid pain was given, while he was in opposite party-hospital. When he was taken to the house his legs and hands were not moving properly; besides he was suffering from severe pain in head and back. Elderly persons of his family advised to shift him to a good hospital in Delhi and for this purpose an ambulance was hired on 15-10-2001 and they proceeded for Delhi but he collapsed after he travelled about 20 kms on account of the injuries sustained by him in the accident. It was further alleged that complainants contacted opposite party-hospital to supply entire medical record but opposite party-hospital refused. From the post-mortem report it was revealed that the deceased had fracture of left partial bone and there was evidence of haematoma of left side of the brain and even the membranes were found congested. 100 ml. free clotted blood was also found in the brain but the opposite party-hospital neither operated nor advised operation and on account of negligence of opposite party-doctors, Rajeev Aggarwal succumbed to death.

Defence: Opposite party-hospital filed written statement and submitted that deceased was given first-aid treatment as outdoor patient at the hospital of opposite party. It was admitted that C.T. scan of the head and X-ray of the chest was advised by the opposite party-hospital and ' 300 were charged, ` 600 were charged for operation theatre and ` 500 were charged as fee of doctor; that first-aid treatment by putting bandages on the wounds of the deceased was given. Duty doctor of the opposite party-hospital very vehemently advised the deceased to be admitted in the hospital but this advice was not followed and he was not admitted in the hospital. When the patient was brought to the opposite party-hospital, he was accompanied by his friends and after sometime his father and brother Dr. Rohit Aggarwal came there and they were of the firm view that they did not want to admit Rajeev Aggarwal in opposite party-hospital or take further treatment from the opposite party-hospital. Dr. Rohit Aggarwal represented himself to be a doctor having his own nursing home at his house where he wanted to treat the deceased. So, the deceased was not admitted in opposite party-hospital, hence, question of discharge did not arise. The deceased was not in a condition to be taken to Delhi rather should have been admitted in opposite party-hospital for proper care and treatment. The deceased was brought to the opposite party-hospital in the afternoon of 14-10-2001 and was taken away within an hour by his brother Dr. Rohit Aggarwal, his father and other relatives. As the deceased was not given proper care and treatment by his own relatives, the deceased, Rajeev Aggarwal expired. The complainant had alleged that the opposite party-hospital discharged the deceased, Rajeev Aggarwal negligently, though, deceased was not in a position to move, hence, complainants may be awarded compensation while the opposite party submitted that deceased was never admitted as indoor patient in opposite party-hospital, but was given first-aid and in spite of the advice of opposite party- Duty Doctor, relatives of deceased took away the deceased from opposite party-hospital.

Issue of Indoor Treatment: The complainants vehemently argued that opposite party- Duty Doctor committed negligence in discharging the patient from the hospital and placed reliance on Notification dated 11-3-2000 issued by the Medical Council of India vide clause 1.3 of Chapter I (Code of Medical Ethics) according to which every physician is required to maintain medical record pertaining to his indoor patient for a period of 3 years. It was observed that the important question in this case is whether the deceased, Rajeev Aggarwal was an indoor patient in the opposite party-hospital. Opposite party-hospital had proved Annexure 'E' vide affidavit of Dr. Gupta which reveals that on 14-10-2001, four patients were admitted in the opposite party-hospital and deceased was not admitted in the opposite party-hospital as indoor patient. Held, in these circumstances, Notification dated 11-3-2000 issued by the Medical Council of India was not applicable to the present case and opposite party-hospital was not required to maintain the medical record of deceased Rajeev Aggarwal, as deceased was treated as outdoor patient and after C.T. Scan, X-ray and giving first-aid, the deceased Rajeev Aggarwal was taken away from opposite party-hospital by his family members and relatives.

Evidence on Merits : Complainant Mahesh Prasad Aggarwal and Dr. Rohit Aggarwal, brother of deceased stated in their affidavit that deceased was not fit and on reaching home he was very uncomfortable and his condition was deteriorating, his sufferings were manifold and the pain was unbearable and in such circumstances it was decided to shift him to a good hospital in Delhi and accordingly the ambulance was hired on 15-10-2001. It was observed that this evidence reflected that after taking deceased Rajeev Aggarwal from opposite party-hospital he was brought to his residence which was not believable because when his legs and hands were not moving properly and he was suffering from severe pain in back and head, no person would take his kith and kin to his home instead of shifting him to some hospital particularly when deceased's brother Dr. Rohit Aggarwal was running Usha Memorial Health Centre in the same city having 24 hrs. facility for fracture and accident cases as reflected in photograph of Annexure 'A', 'B' & 'C' which were proved by opposite party's evidence. In normal course either Rajeev Aggarwal would have been brought to Dr. Rohit Aggarwal's hospital or admitted to some other hospital instead of bringing him home as the condition of Rajeev Aggarwal was deteriorating. Complainant's witness nowhere explained that after taking Rajeev Aggarwal to opposite party-hospital where was he kept for another 24 hours or more before proceeding for Delhi. It was obligatory on their part to lead evidence and prove that in the last 24 hours. proper care of the deceased Rajeev Aggarwal was taken which they failed to do, rather they have suppressed material facts about his treatment in the last 24 hours. Complainant's witness simply said that after plaster, opposite party informed that Rajeev Aggarwal was alright and fit and could be taken home and he was discharged. It was observed that this statement was not supported by any other independent witness, though, as per complaint and written statement, Rajeev Aggarwal was brought to opposite party-hospital just after the accident by other persons and these two witnesses reached opposite party-hospital after sometime. It was also observed that both witnesses being interested in the complaint could not be believed unless supported by other independent witnesses, particularly, when opposite party in the written statement specifically stated that Duty Doctor of opposite party-hospital advised the deceased to be admitted in the hospital but his advice was not followed and Rajeev Aggarwal was not admitted in the hospital and the same fact was proved by the affidavit of opposite party witness.

Held: It cannot be believed that in spite of insistence by the deceased's father and brother, the deceased was not admitted in the opposite party-hospital and was discharged but this inference can be drawn that advise of opposite party-hospital was discarded as deceased's brother Dr. Rohit Aggarwal was having his own hospital in the same city. He and his father insisted opposite party-hospital not to admit Rajeev Aggarwal in the hospital and took him away for treatment either in Dr. Rohit Aggarwal's hospital or in some other hospital where Rajeev Aggarwal's condition deteriorated and he ultimately died on the next day. Pleadings and evidence clearly proves that when Rajeev Aggarwal was brought to opposite party-hospital, C.T. scan, X-ray, etc. were done immediately and his hand was plastered and in such circumstances, it can be presumed that opposite party-hospital took care of the deceased, Rajeev Aggarwal. Complainant has failed to show any negligence or deficiency in taking C.T. scan, X-ray or plastering his hand. In the light of the above discussion, it becomes clear that opposite party-hospital was neither negligent nor deficient in providing services to the deceased, Rajeev Aggarwal and complaint is liable to be dismissed.

(Print Version)
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