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TMI Blog2022 (11) TMI 35X X X X Extracts X X X X X X X X Extracts X X X X ..... d to as the 'patient') for his squint eyes was taken to Chennai at Sankara Nethralaya (hereinafter referred to as the 'OP-1 - Hospital'). Dr. (Mrs.) S. Agarkar examined the child on 12.06.2000 and advised minor surgery to correct the squint. She proposed the name of Senior Surgeon - Dr. T.S. Surendran for the operation to be done on 14.06.2000. The preoperative investigations, blood and urine tests were conducted. On 13.06.2000, Dr. Sujatha clinically examined the child and noticed faint functional systolic 'murmur' and chest wall abnormality. The same was brought to the notice of Dr. S. Bhaskaran, a Senior Cardiologist, who further examined the child with some exercises and concluded about no murmur and he also ruled out further need for any tests like ECG, ECHO or Chest X-ray etc. He declared the child "Fit for General Anesthesia". The surgery was fixed on 14.06.2000. As advised, the Complainants took their child on empty stomach to the hospital at 9.00 a.m., but the bed to the child was allotted at around 2.00 p.m. The child was administered three injections and at about 3.00 p.m., he was taken to Operation Theatre. At about 6.00 p.m. the Complainants wer ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... as further submitted that the parents took the child to OPD on 12.06.2000 with the complaints of squint of eyes, developed after attack of malaria. Initially, the patient was examined by Optometrist, Ms. J. Jayajdnee, and subsequently by a Squint Specialist, Dr. Agarkar. After examination, corrective surgery for both eyes was advised. The patient was further referred to neuro-ophthalmic examination to rule out any associated neurological problems. 5. Thereafter, Ms. Latha Suresh, the Head of Surgery fixing center, gave the date of 14.06.2000 for surgery. The Physician, Dr. S. Sujatha examined the patient on 13.06.2000 and requested the Cardiologist - Dr. Bhaskaran, to see the patient since she felt a questionable faint murmur. Dr. Bhaskaran reviewed the case sheet and lab investigation reports, took the history and further ascertained that the child was able to play games and climb three storied stairs without any difficulty. Dr. Bhaskaran put the child to various positions and exercise, and auscultated. He concluded no cardiac problem to undergo surgery under General Anesthesia (GA). It was submitted that as per medical guidelines, routine pre-operative ECG, ECHO and X-ray were n ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... dosis were carried out with Injection Sodium bicarbonate, administration of Hydrocortisone, Injection Ephedrine and cardiac massage was continued. In spite of all resuscitative measures, the patient could not be saved and around 5.30 p.m., the team abandoned the CPR and declared the patient dead. 8. The OP-1 submitted that it extended all cooperation to the Complainants to see the dead body, but they refused. There was no mortuary in the Sankara Nethralaya; therefore the body of the child was shifted to the mortuary in the General Hospital, Chennai with the permission of the parents. After postmortem the body was handed over to the Complainants on 15.06.2000. 9. The Opposite Parties denied the contention of the Complainants about non issuance of medical record. The required details and the entire medical record were issued on the request letter dated 30.10.2000. Therefore, there was no deficiency in service. 10. The Government of Tamilnadu, in response to the representation made by the Complainants to the Prime Minster and the Railway Minister, appointed four - committees to enquire the matter. After enquiry, the committees did not observe any adverse comment or report on the ho ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... 3.30 pm but the Complainants were informed after 5.30 pm, for the reason that the doctors were busy in reviving in child for 2 hours. The learned Counsel brought our attention that the deceased was the only child and the mother already underwent hysterectomy in 1997. Thus, she lost the chance of other child. 14. The learned Counsel for the Opposite Parties argued that Sankara Nethralaya is a charitable non-commercial, non-profit making institution in Ophthalmology, started in September, 1978. About '40% of the' patients are treated entirely free of cost every year. He further submitted that Complainants have made vague and sweeping allegations against the OPs. Even after the filing of Complaint, they carried media trial, compelling the OPs to obtain orders of restraint from this Commission. He reiterated the entire treatment details as per the standard of practice. The treatment given to the patient was reviewed by four independent committees of experts, who had not made any adverse comment or report on the treatment aspect and hospital facilities etc. The learned Counsel submitted that the Complainants have not produced any expert evidence to justify their allegations of ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... he child was declared fit for GA. ii) We have perused the evidence of Dr K P Mishra, a senior Cardiologist and an author of books on Cardiology. According to him the maneuvers as conducted for the child by the cardiologist were sufficient to rule out murmur and it was standard practice. There was no requirement to do any further tests by way of X-Ray, EGG, Echo Cardiogram etc. Dr. Mishra has further stated that if the murmur is Grade I, the patient will be examined in two or three positions or with some exercises, and then if the murmur is not heard, no further investigation is required. The PM did not show any cardiac disease. iii) We do not accept the evidence of Dr. Mishra in totality for the reasons stated in para (i). In our view, it was the failure of duty of care and the casual approach of the Cardiologist. Moreover, the entries made in the progress report appear to be an afterthought and added later on. 19. We do not find any significance about fasting state of child. Several studies revealed that there is no uniform fasting practice for children before effective surgery. Fluids in small quantity are acceptable 2-3 hours prior to GA. The Complainant No. 2 (father) sign ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ac arrest etc. Therefore, in the instant case the Intra-Operative diagnosis of OCR was missed and the child suffered Cardiac Arrest. The patients who are considered at-risk for the OCR should warrant particular attention. 23. It is pertinent to note that all drugs used in anesthesia have adverse minor to major life threatening complications. Anesthetists are aware of such effects and use the drugs depending on the patient, nature and requirements of surgery, disease profile and the situation. The anaesthetist after ensuring that all vital parameters of the patient were normal with oxygen saturation of 99% use Scoline 50 mg IV as a short acting drug as compared to other drugs such as Atracurium, Vecuronium, etc. As per the treating doctors the scheduled squint surgery of the child was only a short duration surgery. It is not clear from the record that whether and when Atropine was given as a premedication before induction or following episode of bradycardia. It is also not clear that whether it was administered IV or Intramuscularly (IM). In the instant case Halothane was an elective choice of OP-3, therefore anticholinergic like atropine or glycopyrolate has to be given prior. Hal ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... y of care in deciding whether to undertake the case; (b) a duty of care in deciding what treatment to give; and (c) a duty of care in the administration of that treatment. A breach of any of the above duties may give a cause of action for negligence and the patient may on that basis recover damages from his Doctor. 26. In the instant case the Cardiologist Dr. Bhaskaran, the OP-2 and OP-3 have failed to exercise their duty of care with required ordinary skills and standards, thus, we hold them liable for medical negligence. The doctors are liable for medical negligence, where they act carelessly, results an action in torts. The Hon'ble Supreme Court in the case of Spring Meadows Hospital v Harjyot Ahluwalia - (1998) 4 SCC 39, observed as: "Very often in a claim for compensation arising out of medical negligence a plea is taken that it is a case of bona fide mistake which under certain circumstances may be excusable, but a mistake which would tantamount to negligence cannot be pardoned. In the former case a court can accept that ordinary human fallibility precludes the liability while in the latter the conduct of the defendant is considered to have gone beyond the bounds of wh ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ittance. Thus, in our view, no amount can be just and adequate in an absolute sense. By no stretch of imagination, we should award a paltry sum for gross negligence; conversely exemplary compensation need not be awarded in case minimal negligence. 30. Based on the discussion above, having medical negligence conclusively attributed to the treating doctor at Sankara Nethralaya and having regard to that the Complainants lost their only son, in the ends of justice, we are of the considered view the compensation of Rs. 1 Crore is just and fair in the instant case. 31. In the instant case, since, the Cardiologist - Dr. Bhaskaran has not been arrayed as a party, therefore, monitory liability cannot be fixed upon him, and therefore, the OP-1 is held vicariously liable. Accordingly, we direct the Sankara Nethralaya (OP-1) to pay Rs. 85 lakh; the Anesthetist, Dr. R. Kanan (OP-3) shall pay Rs. 10 lakh and the operating Ophthalmologist, Dr. T.S. Surendran (OP-2) shall pay Rs. 5 lakh to the parents of the deceased child (Complainants) within 6 weeks from today. Beyond 6 weeks, the amount shall carry interest at 9% per annum till its realization. The OP-1 shall further pay Rs. 1 lakh towards c ..... 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