Two Branches of the Apollo Group of Hospitals; one the Apollo Hospital at Hyderguda and the other the Apollo Hospital at Jubilee Hills, both situated in the city of Hyderabad, have filed this revision petition challenging the order dated 06.04.2010 passed by the Andhra Pradesh State Consumer Disputes Redressal Commission, Hyderabad (State Commission for short), by which the State Commission has set aside the dismissal order of the complaint by District Consumer Disputes Redressal Forum-I, Hyderabad (District Forum for short) and held these hospitals accountable for medical negligence and has directed the petitioner/hospitals to pay to the complainants Rs.2,21,000/- towards pecuniary loss, Rs.15,000/- towards consortium, Rs.15,000/- towards loss of estate, Rs.1,00,000/- as compensation and Rs.3000/- towards mental agony and costs.
The brief facts leading to the filing of the complaint by the respondents, who were the parents of the deceased M. Ramakrishna, are that while operating a paddy harvesting machine their son suffered crush injury to his left arm on 19.12.2003 at 9.30 a.m. He was rushed to Apollo Hospital, Hyderguda and was admitted the same day. Dr. Sudhakar Prasad of the said hospital conducted an operation on the injured M. Ramakrishna on the next day i.e. 20.12.2003. The parents thereafter were told that everything was all right and even the mother who had offered some juice to the injured son found that he was OK. However, two days thereafter on the 23.12.2003 the parents were suddenly informed that condition of their son has become serious and that he needed to be shifted to their main hospital at Jubilee Hills for better management. The injured M. Ramakrishna thereafter remained under the treatment of the Apollo Hospital, Jubilee Hills from 23.12.2003 until his death on the 27.12.2003 due to cardiac arrest secondary to sepsis leading septicemia, respiratory failure, renal failure etc. Shocked at the rapid development and the death of their son within a few days of his sustaining a crush injury, which could not be properly handled by the hospitals, the parents wanted to get the medical records examined. They requested the Apollo Hospital, Hyderguda to provide the treatment records from the time of the admission of their son on 19.12.2003 until he was transferred to their Jubilee Hills Hospital on 23.12.2003. He even sent a DD of Rs.500/- to facilitate the supply of the said documents but the hospital failed to provide any such record. Alleging that their son was not properly treated by the doctors of Apollo Hospital, Hyderguda, as a result of which serious complications developed that could not be properly managed even by their main hospital at Jubilee Hills, the complainants approached the District Forum with a complaint seeking compensation in the sum of Rs.3,54,000/- on various counts as already stated. The District Forum, relying upon Exh. A-5, which is the death summary prepared by the Jubilee Hills Hospital narrating the details with regard to the treatment given to the deceased, did not find the missing treatment record of Hyderguda Hospital of great relevance and dismissed the complaint. Aggrieved thereupon, the complainants filed an appeal before the State Commission, who, as already stated, did not agree with the findings of the District Forum and set aside their order resulting in the impugned order.
I have heard the learned counsel for the parties and perused the records of the case carefully. Mrs. K. Radha Rao, learned counsel arguing on behalf of the petitioners contends that the State Commission has failed to consider that the onus to prove medical negligence was squarely on the complainants which they have failed to discharge. They have produced no expert evidence showing that the line of treatment adopted by the doctors of the hospital was not in consonance with the procedure normally followed. The doctors concerned have filed their affidavits and the complainants have not cross-examined them and the State Commission, therefore, ought to have accepted the explanation offered by the doctors in their affidavits. She further contends that on the face of the detailed description of the treatment given to the deceased narrated in the death summary and in view of the affidavits of the doctors, the overriding importance given by the State Commission to the missing case sheets pertaining to the period 19.12.2003 to 23.12.2003, which were misplaced, was not warranted. The expert doctors have done their best to give the best treatment possible to save the life of the deceased and just because their efforts did not succeed, they should not be held negligent.
Learned counsel for the respondents/complainants has contended that the State Commission has passed a well reasoned and detailed order duly supported by the medical literature and rulings of the Supreme Court and has contended that the order is fully justified and needs no interference at the stage of revision.
Having heard the learned for the parties, the following facts on which there is no dispute may be noted. The deceased was a young man of 22 years. He suffered a crush injury of his left arm on 19.12.2003 while operating a paddy harvesting machine. He was admitted to the Hyderguda hospital of the petitioners on 19.12.2003 and remained under their care until the 23.12.2003, when the doctors of Apollo Hospital, Hyderguda themselves decided to shift the patient to their Jubilee Hills hospital for better management as the patient was not responding to their verbal stimuli. There is also no dispute that deceased Ramakrishna remained under the treatment of the Jubilee Hills hospital of the petitioners from 23.12.2003 until his death on the 27.12.2003. It is further admitted by the petitioners that the treatment records of the deceased for the period from 19.12.2003 to 23.12.2003, the period he remained under the treatment of their Hyderguda hospital has been misplaced. In this backdrop, it has to be considered as to whether it is sufficient to go by the affidavits of the two treating doctors i.e. the operating surgeon Dr. Sudhakar Prasad and his colleague Dr. Sanjay Maitra, a nephrologist, who have defended the petitioners by contending that even though the patient was administered appropriate anti-biotics from day one, he developed crush syndrome, resulting in injury to muscles which led to kidney failure, sepsis, ARDS etc. and that his transfer to the Jubilee Hills hospital was only to put him on haemodialysis? While the learned counsel for the petitioners urged this Commission to believe that the say of these doctors in their affidavits should be believed in entirety, she has not been able to explain as to why the history recorded at the Jubilee Hills hospital when they received the patient did not mention any details with regard to the crush syndrome, resulting in an injury to muscles which led to kidney failure, sepsis, ARDS etc. It further does not make mention of any anti-microbial therapy, if any, given by the previous hospital. It may be further noted that the discharge/death summary which has been appended to the revision petition is a document which runs into 12 pages. This is very unusual. It contains the entire history, case details of the various tests conducted and the treatment provided without mentioning the dates. It is very surprising as to how these details have been incorporated in the discharge/death summary when it is the admitted position of the petitioners that the treatment records have been misplaced. It may also be observed here that even though the patient was shifted from the Hyderguda hospital to the Jubilee Hills hospital for better management of the patient, it is the same team of the doctors i.e. Dr. Sudhakar Prasad and Dr. Sanjay Maitra who continued to take care of the patient. The contention of the petitioners that the complications warranting haemodialysis arose not because of any lapse/negligence on part of the operating surgeon and that it was as a result of the renal failure secondary to crush injury of muscles could have been established only if the original record of treatment at the Hyderguda hospital had been made available. In the absence of the original record it is difficult to believe even the contents so vividly described in the discharge/death summary. The possibility of the records having been prepared as an afterthought also cannot be ruled out. The rulings cited by the learned counsel for the petitioners with regard to medical negligence would not support her case since on the face of the petitioners own admission that they have misplaced the original records, the onus to prove that there was absolutely no negligence squarely shifted to the petitioners, which they have failed to do. Regulation 1.3 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, states as under :-
?1.3 Maintenance of medical records :
1.3.1 Every physician shall maintain the medical records pertaining to his/her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3.
1.3.2 If any request is made for medical records either by the patients/authorized attendant or legal authorities involved, the same may be duly acknowledged and document shall be issued within the period of 72 hours.
1.3.4 Efforts shall be made to computerize medical records for quick retrieval.?
While this regulation mandates maintenance of the medical records at least for a period of
Please Login To View The Full Judgment!
three years, it is very difficult to believe that a highly professional, sophisticated and computerized system of admission and treatment adopted by the Apollo Hospitals has misplaced the treatment records of the patient, specially in the process of transfer of patient to their main hospital. Surely, the computerized records could have been retrieved and produced before the State Commission. In this regard, the learned counsel for the respondent/complainant has rightly relied upon the orders passed by this Commission in the cases of Dr. Balagopal Vs. K.V. Radhakrishna Menon & Ors. [2007 STPL (CL) 882 NC] and H.S. Sharma Vs. Indraprastha Apollo Hospital & Anr. [II (2007) CPJ 21 (NC)]. Having regard to the earlier decisions, this Commission does not find anything wrong or illegal in the State Commission drawing an adverse inference and giving benefit to the complainant. The State Commission has committed no illegality, material irregularity and jurisdictional error. The revision petition accordingly is dismissed with no order as to costs.