S.K. Iyengar vs Bombay Hospital & Medical ... on 20 December, 2000

National Consumer Disputes Redressal

ORDER Suhas C. Sen, J. President

1. This is an appeal against the order of the State Commission in a case where medical negligence has been alleged against the Bombay Hospital and Medical Research Centre and two Doctors, Dr. M.L. Saraf, Consultant, Orthopaedic Surgeon and Dr. P.L. Tiwari, Consultant Physician. The allegation is that Smt. Janaki K. Iyengar, the mother of the Complainant died because of medical negligence on the part of the Opposite Parties. The deceased was 86 years of age. She was suffering from (i) Diabetes Mellitus; (ii) Hypentation; and (iii) Senile Dementia due to Alzheimebs Disease. The deceased on 27th November, 1997, fell from her bed and suffered a fracture of the thigh bone. The nature of the fracture was such that surgical treatment was necessary. There were risks involved in the surgery which were explained to the relatives to the patient including the Complainant by Dr. Saraf. After fully understanding and after balancing the risks involved in operative versus non-operative treatment, the Complainant opted for surgery. After following the usual procedure and taking every precaution the surgery was carried out on 29th November, 1997. Thereafter, some complications developed and the patient ultimately died on 20th December, 1997.

2. The Complainant has no grievance about the decision to operate upon the patient or the surgery that was done. The grievance raised before us is that the patient having considered her physical condition and old age, should have been taken the post-operative ICU which was not done. It may be mentioned that the State Commission has elaborately gone into this aspect of the matter and examined all the medical reports/medical records of the hospital in this regard. The Commission has come to the finding that although initially the patient was advised to be taken to ICU, the decision was later on changed, but care was taken to watch the pulse, blood-pressure, breathing status of the patient and to control the fluid intake with urine output. This decision was taken not to transfer the patient to ICU in the interests of the patient as it was felt that isolated atmosphere of ICU will not be conducive to the patient's recovery. The patient got the full medical care and attention from the nurses and doctors who looked after the patient. The members of the patient's family were also visited the patient.

3. It has further been found that initially the advice was given by Dr. Tiwari that the patient would require "post-operative care/or post operative ICU". A decision was taken bay the Doctors in the best interest of the patient to provide her with best possible attention and personal care of special nurses and the Doctors and not to keep the patient in ICU. The patient's condition after the first few days of the surgery was stable. Unfortunately, the condition of the patient deteriorated. Thereafter, the patient was taken to ICU. However, in spite of the best efforts, the patient died.

4. It has been stated that the post-operative ICU bed was kept ready for the patient as a precautionary measure on 29th November, 1997, the date of the operation. The surgery went off well. She was under observation for a few hours and a decision was taken after taking into consideration of the factors including the patient's progress and response to the post-operative treatment, to shift the patient to her own private room. The Doctors visited the patient several times during the day and night. At night around 1.30 a.m. and 3.30 a.m. Dr. Saraf personally visited the patient to find out that everything was normal. On 30.11.1997 it was noticed that the blood pressure of the patient had gone down. This was attended to by the Doctors, the Nurses very promptly. After initial treatment, she was shifted to the ICU. Her blood-pressure became normal by 5 p.m. on the same day. On 4th December, 1997, as her condition had improved, she was brought back to her own room. By this time, her surgical wound had healed and sutures were removed and she was able to lift her leg. Due to the problem of Senile Dementia, the patient refused oral nutiriton. She had to be shifted to the ICCU on 16th December, 1997 for adequate electrolyte and fluid balancing. The patient developed Aspiration Penumonitisis and expired on 20th December, 1997.

5. The State Commission has examined the facts in extenso and has found that there was no lack of care and attention on the part of the Doctors and the Nurses in treating the patient. What has been highlighted before us is that the patient was not immediately taken to ICU after the operation. But, it has not been proved before us in any way that this has lead ultimately to the death of the patient. Moreover, a conscious decision was taken to keep the Petitioner in her cabin having regard to the stable condition of her at that time. The decision was taken after taking into consideration various factors which we have referred to earlier in the judgment. It cannot be said that the decision was 

taken arbitrarily or without considering the pros and cons of the age and the condition of the patient.

6. On the facts found by the State Commission, we are of the view that it is difficult to hold that the patient's death was caused by any negligence or by the fact that the patient was not immediately kept in ICU, after the operation. The appeal is dismissed with no order as to costs.