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--------------- Print Magazine --------------
  May 2016
  April 2016
CASE STUDY - by Anoop K. Kaushal
February 2012

Post Operative care

Hospitals to explain regimen followed

Gowri Gopal Hospital v. Sri P.Sudhakar and Sri P.Sudhakar v. Gowri Gopal Hospital

First Appeal No. 287 of 2006 and First Appeal No. 191 of 2008, pronounced on 30-11-2011 by the National Consumer Disputes Redressal Commission, New Delhi.

Facts : It was a case of alleged medical negligence in the treatment of a 14 years old boy. On 20-9-1997, deceased Ujwal was operated upon for appendicitis. The operation was successful and his general condition was good throughout the day. At about 10 PM, after an injection, his condition suddenly worsened. The boy had to be put on the ventilator, slipped into hypoxia and eventually died on 25-9-1997. It was alleged by the complainant (father of the hapless boy) that the sudden downturn in his condition was caused by an injection of Panancuronium Bromide which was mistakenly administered by the Staff Nurse at about 9.30 PM. The complainant based his allegation on a letter by Dr. H Radhakrishnan on 22-9-1997 ( i.e . 3 days before the boy died) to Dr. Krishna Reddy. Admittedly, Dr. Radhakrishnan was a part of the medical team treating the boy. This letter was written to obtain a second opinion for the benefit of the complainant as well as the treating surgeons. Opposite Parties accused the complainant for faking the purchase bill to generate evidence to show that Fancuran (Panancuronium) injection was procured. As for the letter of Dr. Radhakrishna, they say that it was based not on personal knowledge but on the information given to him by the husband of Dr. Geethalakshmi. They also refer to the case sheet of the patient, according to which at 10 PM, Divon injection was given. It had also been given before at 10 AM when there was no reaction. The Staff Nurse denied giving Fancuran injection to the deceased.

Impugned Order: The State Commission rejected the claim of the OPs that the complainant had fabricated evidence regarding the purchase bill of Fancuran. Further, on the basis of evidence on record, it concluded that this injection was given by the Nurse, who had mistaken it for an analgesic. The Commission therefore, held the hospital jointly and severally liable to pay a compensation of ` 4 lakhs to the complainant.

Grounds in Appeal : It was submitted that around 10 PM, for some inexplicable reason, the patient developed shaking of hands and legs and went into hypoxia, 'administration of Metrogyl and Divon is extremely routine and that it is extremely rare that it could lead to fall in blood pressure, pulse or respiratory problems.'

Observations : This raises a question as to what else could have caused the sudden and violent regression in the condition of the deceased. Strangely enough, the appeal memorandum itself states that the letter of 22-9-1997, which specifically mentioned Fancuran Bromide injection, was written "Believing the representation of the said Dr. Geethalakshmi and also keeping in mind the close family relations between appellant No. 2 and the complainant, under their influence, issued a letter dated 22-9-1997 wherein it was, inter alia , stated that the patient's condition had developed due to an injection of "Fancuran Bromide 2 ml"."

But the appeal memorandum explains it as a letter obtained by the complainant and Dr. Geethalakshmi by making a false representation. It even suggests that Dr. Geethalakshmi herself may have given this injection by mistake, simultaneously maintaining that no such injection was prescribed or given. The main ground for challenge to the impugned order is that the State Commission has held the OPs responsible ignoring their plea that the bill for Fancuran was not genuine and the letter of 22-9-1997 was obtained by misrepresentation. No basis is given by the appellant for such claims.

Counsel for the appellants relied heavily on the fact that there is no mention of Fancuran injection in the record of treatment, however, had no answer to the question, if Fancuran was not injected and only Divon and Metrogyl were given (which as per the OPs, are not known to cause such reaction) what else could have caused the sudden deterioration in the condition of the patient on the night of the operation, 20-9-1997. The hospital and the treating doctors should have given a professionally acceptable answer to this question instead of relying on bland denials that Fancuran was not administered.

Held: We find no substance in the Appeal No. 287 of 2006 filed by the OPs. It is consequently dismissed. We also do not find any ground for enhancement of the amount of compensation. The quantum awarded by the State Commission is commensurate with the nature of medical negligence in this case. Therefore, the Appeal No. 191 of 2008 filed by the complainant is also dismissed. The impugned order is confirmed. Parties to bear their own costs.

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