Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment

Judgment:

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			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
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			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
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			'decidedon' => '2012-06-26',
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			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
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		'decidedon' => '2012-06-26',
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		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
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Honble Mr. P. N. Kashalkar, Presiding Judicial Member

This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
			'caseanalysis' => null,
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			'citingcases' => null,
			'counselplain' => null,
			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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		'id' => '1108073',
		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
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[2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
			'caseanalysis' => null,
			'casesref' => null,
			'citingcases' => null,
			'counselplain' => null,
			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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	'Judgement' => array(
		'id' => '1108073',
		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
)
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[3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
			'caseanalysis' => null,
			'casesref' => null,
			'citingcases' => null,
			'counselplain' => null,
			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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	'Judgement' => array(
		'id' => '1108073',
		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
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[4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.

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			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
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			'favorof' => null,
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			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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		'id' => '1108073',
		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
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[5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
			'caseanalysis' => null,
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			'counselplain' => null,
			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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	'Judgement' => array(
		'id' => '1108073',
		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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		'respondent' => 'Dr. S.M.Shah Holy Spirit Hospital and Another',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
)
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[6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
			'caseanalysis' => null,
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			'citingcases' => null,
			'counselplain' => null,
			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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		'id' => '1108073',
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		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
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		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
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		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
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[7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
			'caseanalysis' => null,
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			'citingcases' => null,
			'counselplain' => null,
			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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		'id' => '1108073',
		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
)
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[8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
			'caseanalysis' => null,
			'casesref' => null,
			'citingcases' => null,
			'counselplain' => null,
			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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	'Judgement' => array(
		'id' => '1108073',
		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
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[9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
			'caseanalysis' => null,
			'casesref' => null,
			'citingcases' => null,
			'counselplain' => null,
			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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		'id' => '1108073',
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		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
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		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
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		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
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[10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day i.e. on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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			'caseanalysis' => null,
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			'citingcases' => null,
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			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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		'id' => '1108073',
		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
)
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[11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
			'caseanalysis' => null,
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			'citingcases' => null,
			'counselplain' => null,
			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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	'Judgement' => array(
		'id' => '1108073',
		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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		'respondent' => 'Dr. S.M.Shah Holy Spirit Hospital and Another',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
)
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[12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
	'desc' => array(
		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
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			'counselplain' => null,
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			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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		'id' => '1108073',
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		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
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		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
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		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
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[13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
			'caseanalysis' => null,
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			'citingcases' => null,
			'counselplain' => null,
			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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		'id' => '1108073',
		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
)
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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
			'caseanalysis' => null,
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			'citingcases' => null,
			'counselplain' => null,
			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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	'Judgement' => array(
		'id' => '1108073',
		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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		'respondent' => 'Dr. S.M.Shah Holy Spirit Hospital and Another',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
)
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			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
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			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
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			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
		'casenote' => '',
		'caseanalysis' => null,
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
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The complaint stands dismissed.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
			'caseanalysis' => null,
			'casesref' => null,
			'citingcases' => null,
			'counselplain' => null,
			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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		'id' => '1108073',
		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
)
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No order as to costs.

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	'title_for_layout' => 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | ',
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		'Judgement' => array(
			'id' => '1108073',
			'acts' => null,
			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
			'authreffered' => null,
			'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
			'casenote' => '',
			'caseanalysis' => null,
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			'counselplain' => null,
			'counseldef' => null,
			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
			'deposition' => null,
			'favorof' => null,
			'findings' => null,
			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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$title_for_layout = 'Smt Pushpa Dinesh Tiwari Vs Dr S M Shah Holy Spirit Hospital and Another - Citation 1108073 - Court Judgment | '
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	'Judgement' => array(
		'id' => '1108073',
		'acts' => null,
		'appealno' => 'Complaint Case No. CC/99/99 ',
		'appellant' => 'Smt. Pushpa Dinesh Tiwari',
		'authreffered' => null,
		'casename' => 'Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
)
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			'id' => '1108073',
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			'appealno' => 'Complaint Case No. CC/99/99 ',
			'appellant' => 'Smt. Pushpa Dinesh Tiwari',
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			'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
			'court_type' => 'TRI',
			'decidedon' => '2012-06-26',
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			'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
			'judgement' => '<p style="text-align: justify;"><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p style="text-align: justify;"> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p style="text-align: justify;"> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p style="text-align: justify;"> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p style="text-align: justify;"> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p style="text-align: justify;"> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p style="text-align: justify;"> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p style="text-align: justify;"> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p style="text-align: justify;"> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p style="text-align: justify;"> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p style="text-align: justify;"> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p style="text-align: justify;"> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p style="text-align: justify;"> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p style="text-align: justify;"> Hence, we pass the following order:-</p><p style="text-align: justify;"> <strong><u>ORDER</u></strong></p><p style="text-align: justify;"> The complaint stands dismissed.</p><p style="text-align: justify;"> No order as to costs.</p><p style="text-align: justify;"> Inform the parties accordingly.</p>',
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		'court' => 'Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai',
		'court_type' => 'TRI',
		'decidedon' => '2012-06-26',
		'deposition' => null,
		'favorof' => null,
		'findings' => null,
		'judge' => 'HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER &amp; HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER',
		'judgement' => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.</p><p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.</p><p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.</p><p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.</p><p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.</p><p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.</p><p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.</p><p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.</p><p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.</p><p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.</p><p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.</p><p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.</p><p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.</p><p> Hence, we pass the following order:-</p><p> <strong><u>ORDER</u></strong></p><p> The complaint stands dismissed.</p><p> No order as to costs.</p><p> Inform the parties accordingly.</p>',
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	(int) 0 => '<p><strong><u>Honble Mr. P. N. Kashalkar, Presiding Judicial Member</u></strong><p> This is a consumer complaint filed by Smt. Pushpa Dinesh Tiwari alleging medical negligence on the part of the Opponent No.1, namely â Dr. S. M. Shah and the Opponent No.2, namely â The Chairman, HolySpiritHospital. According to the Complainant, her husband, Late Mr. Dinesh Premnarayan Tiwari was admitted in the Opponent No.2 Hospital on 29/12/1997 for liver problem. Opponent No.1, Dr. S. M. Shah was the doctor giving treatment to her husband and the Complainant alleges that on 2/1/1998 the Opponent No.1, Dr. S. M. Shah had given one injection after operating her husband and thereafter her husband started to shout and within three minutes the Complainants husband died because of negligence on the part of the Opponent No.1 Doctor. Alongwith the complaint, the Complainant has produced on the record death certificate of her husband issued by Municipal Corporation of Greater Mumbai. The Complainant pleaded that her deceased husband, Mr. Dinesh Tiwari was working as an assistant teacher in primary section of R.C. Maruti High School, Andheri (East), Mumbai and he was getting basic pay of `2,860/- + Dearness Allowance and House Rent Allowance and his total emoluments were around `3,000/- per month and he died at the age of 30 years on 2/1/1998 and he had 25 years more service at his credit and, therefore, the Opponents are liable to pay her compensation for their negligence and she has claimed an amount of `9,00,000/- from the Opponents. According to the Complainant, after the death of her husband in the Opponent No.2 Hospital the dead body of her husband was sent to Additional Coroner Court at Juhu, Mumbai for post-mortem and at Exhibit-C the Complainant has produced on the record a copy of the certificate issued by Additional Coroners Court at Juhu, Mumbai. The Complainant pleaded that she had lodged a complaint before the Additional Coroners Court at Juhu, Mumbai and also with the MIDC Police Station regarding death of her husband due to negligence on the part of the Opponent No.1. The Complainant pleaded that death of her husband was caused because of negligence in the treatment given in the operation performed by the Opponent No.1 Doctor and because of death of her husband she and her children have lost their livelihood and, therefore, she has filed this consumer complaint claiming damages of `9,00,000/- from both the Opponents.',
	(int) 1 => '<p> [2] The Opponent No.1, namely â Dr. Suketu M. Shah filed his written version and contested the complaint. According to the Opponent No.1, the complaint is malafide and the Complainant has not come with clean hands and, therefore, the complaint may be dismissed. He also pleaded that the complaint involves complicated questions of facts and as such, the complaint may not be decided in a summary jurisdiction under the provisions of the Consumer Protection Act, 1986 and on this ground the complaint may be summarily dismissed. The Opponent No.1 Doctor also pleaded that case requires recording of oral and documentary evidence and the Consumer Protection Act, 1986 does not provide for a full-dressed trial and so, under summary jurisdiction this case may not be tried. According to the Opponent No.1 Doctor, he is a qualified, trained and experienced general surgeon and laparoscopic surgeon. He states that he had acted with due care, caution, diligence and competence while dealing with the case of the patient. The patient was properly examined and evaluated clinically. The Opponent No.1 Doctor further states that he acted in accordance with the prevalent standards of a reasonably competent medical person while attending the husband of the Complainant. According to the Opponent No.1 Doctor, on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. The Opponent No.1 Doctor states that he examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The Opponent No.1 Doctor states that patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. According to the Opponent No.1 Doctor, on 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. He further states that on 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. Relatives were duly informed about the patients condition all throughout. The Opponent No.1 Doctor further submitted that procedure of bone-marrow aspiration was not carried out by him and the Complainant is evidently unwarrantedly raising such allegations against the Opponent No.1 Doctor in this regard. In any event there is no negligence in so far as Opponent No.1 Doctor is concerned. The Opponent No.1 Doctor has denied that he had operated upon the patient as alleged by the Complainant. He denied that he is liable to pay any compensation to the Complainant. The Opponent No.1 Doctor pleaded that he cannot be held responsible for the death of the Complainants husband. The Opponent No.1 Doctor further pleaded that there was no negligence on his part because the patient was checked repeatedly by various specialists and everything was explained to the patient and his relatives from time to time and that the procedure of bone-marrow aspiration was not carried out by the Opponent No.1 Doctor. The Opponent No.1 Doctor pleaded that while attending the case of the Complainants husband the Opponent No.1 had taken utmost care will all reasonable skill and he had duly performed his dues with due care and caution keeping in mind best interests of health of the patient. The Opponent No.1 Doctor pleaded that he is not guilty of medical negligence of any kind and, therefore, complaint may be dismissed with costs.',
	(int) 2 => '<p> [3] The Opponent No.2, namely â Holy Spirit Hospital filed its written version through its Medical Superintendent, namely â Dr. M. B. Shah. The Opponent No.2 Hospital also took up various objections to the tenability of the complaint as has been done by the Opponent No.1 Doctor in his written version. The Opponent No.2 Hospital pleaded that HolySpiritHospital is having full-fledged machinery to look after complaints including arising out of lack of Medical Services. It is submitted that there is a suggestion box in every ward and a patient and/or his relatives can record complaints in the register. They can also make oral complaints to the Superintendent (Administration). These officers take prompt action in case any complaint is received from a patient or his relatives. The Opponent No.2 Hospital pleaded that Holy Spirit Hospital is run and managed by a public charitable trust and the Hospital is operated on a âno-profit basis. It is a 300 bed hospital with full-fledged diagnostic centre having the latest MRI Scan facility, CAT Scan, 24 hours Casualty Department, ICU, ICCU and an Out Patients Department, amongst other facilities and it is considered as a premier institute in the suburb of Mumbai. It has got a panel of consultants who are eminent doctors in their respective fields and it has got 50 full time resident doctors besides trained para-medical, nursing and domiciliary employees engaged for carrying out day to day activities of the Hospital. The Opponent No.2 Hospital denied that there was any negligence on the part of the Opponent No.1 Doctor or on its part. It pleaded that the doctors and the medical staff carried out their duties as per the instructions laid down by treating doctors. The Opponent No.2 Hospital pleaded that the Complainant had not made any complaint or suggestion by putting any complaint in the complaint box or in the register maintained in the Hospital. It pleaded that as per regular protocol the patient was admitted by the Opponent No.1 Doctor and was treated by concerned specialists as required by the patients clinical setting from time to time. The Opponent No.2 Hospital denied that the Opponent No.1 Doctor had administered any injection as sought to be made out by the Complainant. It denied that the Opponent No.2 Hospital is liable to pay compensation as claimed by the Complainant. It pleaded that after the death of the patient his body was sent for post-mortem. The Opponent No.2 Hospital denied that the patients death was caused due to negligence on the part of the Opponents Nos.1 and 2. It denied that the Opponent No.1 Doctor operated upon the patient as alleged by the Complainant. It denied that it was liable to pay compensation as claimed by the Complainant. It pleaded that the patient had not died due to negligence on the part of the Opponents Nos.1 and 2. It, therefore, pleaded that the complaint may be dismissed with costs.',
	(int) 3 => '<p> [4] The Complainant filed her affidavit and some relevant documents including hospital papers pertaining to the patient. The Complainant did not file any evidence of an expert doctor in support of her case. Whereas the Opponents have produced on the record an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hospital; an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah; an affidavit of Dr. Abhay Bhave, a Haematologist; and an affidavit of Dr. Alan Soares, Consulting Physician.',
	(int) 4 => '<p> [5] We heard Adv. Y. C. Naidu on behalf of the Opponent No.1 Doctor and Adv. B. K. Ahluwalia on behalf of the Opponent No.2 Hospital. Complainant as well as Learned Advocate for the Complainant remained absent and did not advance oral submissions.',
	(int) 5 => '<p> [6] As far as medical negligence is concerned, case of the Complainant is not supported by any evidence worth the name. The Complainant is after all a layman, a teacher working in a local school where her late husband also worked as an assistant teacher. The Complainant had admitted her husband, namely â Mr. Dinesh Premnaryan Tiwari in the Opponent No.2 Hospital on 29/12/1997. Doctors had made preliminary check-ups and decided to do surgical intervention on 2/1/1998 at about 02:00 p.m. According to the Complainants affidavit evidence, the doctors took her husband in the check-up room. Doctors had put up an injection in her husbands neck and thereafter within three minutes her husband had cried three times and became silent. The Complainant was not allowed to go inside the room. The Complainant was waiting up to 05:00 p.m. Doctors had informed her that her husband was in a serious condition and had to be recovered and they were shifting the patient to ICU and at 05:00 p.m. she was told that her husband had died. After the death of her husband the Opponent No.2 Hospital had sent the dead body of her husband for post-mortem after intimating MIDC Police Station, Andheri about the death of the patient. Post-mortem was conducted on the death body of the Complainants husband at Additional Coroners Court at Juhu, Mumbai and in post-mortem notes it has been mentioned that immediate cause of death is âNeurogenic shock in a case of Gauchers Disease. The Complainant has no other evidence except hospital papers, post-mortem report and the report she has submitted to the police. In absence of any evidence of an expert adduced on behalf of the Complainant on these bare facts testified by the Complainant herself we cannot hold the Opponents Nos.1 and 2 guilty of medical negligence.',
	(int) 6 => '<p> [7] On the other hand the Opponents have filed affidavits of four doctors. One is an affidavit of Dr. Mugat B. Shah, Medical Director, Holy Spirit Hopsital. Dr. Mugat B. Shah in his affidavit has testified that the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant had evidently expired consequent to vasovagal shock which is not unknown in cases of interventional procedures. This he has testified after he had made an enquiry in his capacity as a medical superintendent as per normal hospital protocol. In paragraph (04) of his affidavit, Dr. Mugat B. Shah testified that appropriate medical protocol has been followed by the doctors and para-medical staff attending the patient and there was no negligence what-so-ever in treating the patient or in carrying out any procedure. In paragraph (03) of his affidavit, Dr. Mugat B. Shah has stated that he had visited the patient on 30/12/1997 and he had advised complete haematological workup on the patient and he had recorded his notes in the indoor case-papers. Dr. Mugat B. Shah in paragraph (07) of his affidavit has stated that the Complainant had received an insurance claim from the insurance company. We are not concerned with the insurance claim received or not received by the Complainant.',
	(int) 7 => '<p> [8] Then, we have an affidavit of the Opponent No.1, namely â Dr. Suketu M. Shah who has testified that what-ever he has stated in his written version was correct and in his written version he has mentioned that on 29/12/1997 patient was referred from Medical OPD as a case of hyper-splenism and gross hepatomegaly for Spleenectomy. He examined and evaluated the patient and prescribed appropriate investigations and advised blood transfusion, medical evaluation with a caution that surgery may be required in case of emergency. Dr. M. B. Shah was also consulted about the patient. The patient was stable throughout 30/12/1997 and was duly monitored. Patient was referred to Dr. M. B. Shah who also examined the patient who advised appropriate haematological check up before spleenectomy. Patient was duly monitored and on 31/12/1997 patient was seen by Dr. Alan Soares as well as by Dr. S. M. Shah. On 1/1/1998 patient was duly examined by Dr. Alan Soares. Patients condition was stable and appropriate medical therapy and nursing care was administered. On 2/1/1998 the patient was stable and the patient was duly examined by Dr. Alan Soares who perused the reports and evaluated the patient. In the patients then prevailing medical settings necessary investigations were advised, including bone-marrow examination. Patient was duly posted for bone-marrow aspiration on 2/1/1998. Prior to aspiration procedure being carried out appropriate preliminary procedures were carried out, including administration of test dose of Xylocaine. It is stated that the patient was taken up for procedure under Dr. Alan Soares on 2/1/1998 at around 02:30 p.m. During the procedure the patient had sudden onset of blackout and patient collapsed. Patient was duly revived by appropriate CPR and shifted to ICU. On the way patient again collapsed and was administered appropriate treatment even as he was being rushed to the ICU. Once the patient reached the ICU the doctors in the ICU immediately commenced CPR measures but patient did not respond. After prolonged resuscitation patient was declared dead by 05:00 p.m. Patients body was handed over to the police for autopsy/post-mortem examination. The Opponent No.1 Doctor in his written version which is supported by an affidavit clearly stated that procedure of bone-marrow aspiration was not carried out by him and it was carried out by Dr. Alan Soares and his other team-mates.',
	(int) 8 => '<p> [9] Then, we have an affidavit of Dr. Abhay Bhave, a Haematologist of considerable repute. He has worked in SionHospital in the Department of Haematology, CMCCollege and Hospital, Vellore; SultanQaboosUniversityHospital, Muscat, Oman and WestmeadHospital, Sydney, Australia. He states that he was shown all the papers of the Opponent No.2 Hospital pertaining to the patient, namely â Mr. Dinesh Tiwari and on going through the OPD papers and indoor papers of the Opponent No.2 Hospital he has opined that patient was admitted on 29/12/1997 with a complaint of Heptosplenomegaly and fever and that the patient was advised to undergo splenectomy. That prior to the procedure of splenctomy appropriate investigation and pre-procedure workup including bone-marrow aspiration study were advised and carried out. He has further opined that bone-marrow aspiration study was necessary to decipher the likely cause of Heptosplenomegaly. He has also opined that vascovagal shock/attack is not an unknown complication in case of interventional procedure. He further opined that the treating doctors have carried out the procedure correctly. He noted that prior to the procedure injection Atropine was administered to the patient and this injection is administered with a view to preempt vascovagal shock/attack. However, it is mentioned that it is known in medical science that despite administration of injection Atropine in some rare cases a vascovagal shock/attack may be triggered. He also mentioned that the patient was rightly administered test dose of injection Xylocaine to which patient did not show any allergic reaction/side effect. He further opined that no sooner the patient expressed signs/symptoms of vascovagal shock the treating doctors have rightly commenced resuscitation measures immediately in classic protocol prescribed in medical text. He clearly opined that there was no negligence in diagnosing the condition of the patient, in the medical therapy and management of the patient or in carrying out the investigation bone marrow aspiration procedure or in detecting and treating the sudden vascovagal shock which arose during the procedure. Thus, according to Dr. Abhay Bhave treatment given by the doctors at the Opponent No.2 Hospital was appropriate, their diagnosis was proper and protocol and procedure followed by the treating doctors was proper and the patient had sustained vascovagal shock in the course of procedure despite having given injection Atropine which normally is given to the patient so that the patient should not get vascovagal shock during the procedure. So despite injection being given to arrest the vascovagal shock the patient had suffered a vascovagal shock/attack which ultimately proved to be fatal for the patient. So this is an evidence of an independent expert witness adduced on behalf of the Opponents Nos.1 and 2.',
	(int) 9 => '<p> [10] Then, we have an affidavit of Dr. Alan Soares, Consulting Physician who had examined the patient on 31/12/1997 at the Opponent No.2 Hospital. He had examined the patient in the ward and he had clinically evaluated the patient. He had perused the indoor notes, investigation done so far and he confirmed that the patients earlier diagnosis of Hepto-splenomegaly and in the then prevailing clinical setting a differential diagnosis (provisionally) was arrived at ranging from myelo-fibrosis (myelo proliferative disease) to NCPH (Non Cirrhotic Portal Hypertension) to Kala Azar/Tropical spleno megaly and he advised to continue appropriate line of medical therapy already advised and he also advised appropriate investigations. On 1/1/1998, he visited the patient in ward. He discussed his condition with him and clinically evaluated the patient and he advised that the patient must not be administered any NSAID. He noted that at that time the patients BUN and Serum creatinine were elevated. On the following day <strong><u>i.e.</u></strong> on 2/1/1998 he visited the patient in the ward. He clinically examined the patient and he ordered a bone marrow biopsy. Appropriate pre-procedure preparations were carried out. Appropriate consents were taken. On 2/1/1998, procedure of FNAC was carried out under his guidance and supervision by Dr. Tushar. Injection Atropine was administered half an hour prior to the procedure. Thereafter, the patient was brought to the procedure room where test dose of Xylocaine was administered. Patient was duly monitored for any reaction/side effects/allergic reaction. The patient responded well and there was no allergic reaction or side effects. The patient was made comfortable on the table in supine position and procedure commenced. As per prevailing protocol a 5ml plastic syringe with Bone Marrow Aspiration needle with a guard 1 Â½ cum from the tip was used for the procedure. The needle was inserted in the mid-sternum area 1cm below the sternal angle at an angle of 90 degrees. The needle penetrated well without much difficulty. Aspiration was carried out by retracting the plunger of the syringe. No material was extracted and hence dry Tap was reported. Even as the needle was retracted, the patient complained of dizziness and had a sudden blackout. Pulse and BP were not recordable. Suspecting the same to be a vasovogal shock/attack, immediate resuscitative measures were commenced. IV fluids, Injection Atropine, Injection Adrenaline, Injection Sodabicarb were administered and CPR was given. At 02:50 p.m. the patient recovered. Patients pulse was 110/minute regular, patients blood pressure was 90/60 mm Hg. Patient was breathing spontaneously. Patients heart sounds were audible. The patient was removed with ambubag with oxygen on flow to the ICU. The patient suffered another collapse enroute to the ICU at 03:00 p.m. The patient was resuscitated even as he was being moved to the ICU. At the ICU all measures to revive the patient was continued for almost two hours during which he was responding and an ECG recorded showed a cardiac rhythm. During this period DC shock 200 J given. Closed cardiac massage was continued. The patient was put on a ventilator at 03:45 p.m. Adrenaline drip was continued. The condition was explained to the patients relatives. Despite all efforts the patient could not be resuscitated and was declared dead at around 05:00 p.m. when he stopped responding to the treatment. Dr. Alan Soares in paragraph (04) of his affidavit clearly stated that complication of vasovagal attack/vasovagal shock is a known complication in any interventional procedure and cannot be prevented. Injection Atropine is mainly administered with a view to preempt such a condition but such injection is not known to prevent it in all cases. He has relied upon two books, namely â Harrison Principles of Internal Medicine and Braunwald Heart Diseases wherein this fact is clearly mentioned by the authors. Thus, in paragraph (08) of his affidavit, Dr. Alan Soares has clearly testified that there was no negligence in diagnosing the condition, in prescribing medical therapy, investigations carried out or the execution of the procedure in any manner whatsoever. He further stated that unfortunate complication is known to occur in 1% of cases and the patient evidently suffered such a complication. The complication rate of a bone marrow aspiration also depends upon the underlying disease of the patient. Thus, the evidence of Dr. Alan Soares is the evidence of first person account because he was all the while present in the procedure room and under his supervision the patient was undergoing procedure and treatment. So, while the procedure was going on the patient suffered a vasovagal attack/shock and that proved to be fatal for the patient and the patient could not be revived at all and in the ICU ultimately after all efforts of resuscitation patient was declared dead at around 05:00 p.m. Patients dead body was sent for post-mortem and from the post-mortem notes it is clear that the death as occurred due to âNeurogenic shock in a case of Gauchers Disease.',
	(int) 10 => '<p> [11] Gauchers Disease is stated to be a rare, inherited disorder that causes too much of a substance called glucocerebroside to build up in your spleen, liver, lungs, bones and sometimes in your brain. The build up prevents these organs from working properly. This is mentioned in the pamphlet â âMedlinePlus published by U. S. National Library of Medicine NIH National Institutes of Health. It has been mentioned that in type 3 Gauchers disease there may be liver and spleen enlargement and signs of brain involvement appears gradually. Gauchers Disease has no cure. Treatment options for types 1 and 3 include medicine and enzyme replacement therapy, which is usually very effective. However, there is no good treatment for the brain damage of type 2. Post-mortem report of the patients dead body specifically mentions that the patient died due to Gauchers Disease.',
	(int) 11 => '<p> [12] World Health Organization mentions that Kala Azar (Visceral Leishmaniasis) is a deadly disease caused by parasitic protozoa Leishmania donovani transmitted to humans by the bite of infected female sandfly, Phlebotomus argentipes. It lowers immunity, causes persistent fever, anemia, liver and spleen enlargement, loss of body weight and if left untreated, it kills. The vector thrives in cracks and crevices of mud plastered house, poor housing conditions, heaps of cow dung, in rat burrows, in bushes and vegetations around the houses.',
	(int) 12 => '<p> [13] Thus, we are finding that death of the patient, namely â Mr. Dinesh Tiwari, deceased husband of the Complainant is on account of Gauchers Disease coupled with Vasovagal Shock/Attack which he received when bone marrow aspiration was going on and despite best efforts put in by the Opponents Nos.1 and 2 and the other doctors attached to the Opponent No.2 Hospital the patient could not be revived and he expired at about 05:00 p.m. on 2/1/1998. In the circumstances, we are finding that this was not at all case of medical negligence. It was a case of giving proper treatment after diagnosing the ailment the patient was suffering from and in order to give further treatment bone marrow aspiration was required to be undergone and when this was being done with all due care and caution even after administration of Injection Atropine and test dose of Xylocaine, the vasovagal attack could not be avoided and vasovagal attack appears to be ultimate cause of the death of the patient. In the circumstances, we are of the view that allegations of medical negligence leveled against the Opponents Nos.1 and 2 are appearing to be devoid of any substance and on the basis of available material on the record in absence of any expert evidence adduced by the Complainant and relying on the affidavits put forth by the Opponents, we come to a guarded conclusion that this is not a case of deficiency in service or medical negligence on the part of the Opponents. In the result, we hold that the Complainant has failed to prove that there was any medical negligence on the part of the Opponents Nos.1 and 2.',
	(int) 13 => '<p> Hence, we pass the following order:-',
	(int) 14 => '<p> <strong><u>ORDER</u></strong>',
	(int) 15 => '<p> The complaint stands dismissed.',
	(int) 16 => '<p> No order as to costs.',
	(int) 17 => '<p> Inform the parties accordingly.',
	(int) 18 => ''
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Court	Maharashtra State Consumer Disputes Redressal Commission SCDRC Mumbai
Decided On	Jun-26-2012
Case Number	Complaint Case No. CC/99/99
Judge	HONOURABLE MR. P.N. KASHALKAR PRESIDING MEMBER & HONOURABLE MR. DHANRAJ KHAMATKAR MEMBER
Appellant	Smt. Pushpa Dinesh Tiwari
Respondent	Dr. S.M.Shah Holy Spirit Hospital and Another

Smt. Pushpa Dinesh Tiwari Vs. Dr. S.M.Shah Holy Spirit Hospital and Another - Court Judgment