The complainant-appellant, aggrieved by the
order dated May 27, 2011 passed by the National
JUDGMENTConsumer Disputes Redressal Commission (hereinafter
referred to as ‘the National Commission’), setting
aside the Order dated July 14, 2006 of the Punjab
State Consumer Disputes Redressal Commission
(hereinafter referred to as ‘the State Commission’)
granting her compensation of Rupees five lacs, has
preferred this Special Leave Petition.
Leave granted.
Bereft of unnecessary details, facts giving
rise to the present appeal are that the
complainant-appellant Mrs. Kanta, aged about 55
years at the relevant time, suffered acute chest
pain in the last week of August, 1999. She
consulted a medical practitioner at Amritsar who
found her symptoms to be of heart attack.
Accordingly, she was advised to obtain opinion and
treatment of a cardiologist and cardio vascular
surgeon. She was taken to Jalandhar by her family JUDGMENT members where they consulted Dr. Raman Chawla
(Respondent No.2 herein), attached to Tagore Heart
Care and Research Centre Pvt. Ltd., hereinafter
referred to as ‘the Research Centre’, (Respondent
No.1 herein). Dr. Chawla examined the complainant
clinically on September 1, 1999 and conducted Echo
test. Dr. Chawla noticed that there was
possibility of blockages which needed appropriate
confirmation and medical treatment and accordingly
he advised for admission of the complainant in the
Research Centre for conducting angiography. It was
made known by the complainant that she is allergic
to almost all the antibiotics except few. Dr.
Chawla with the consent of the complainant’s son, a
medical practitioner, decided to conduct
angiography on September 2, 1999.
It is the allegation of the complainant that
the angiography was to be performed in the morning
of September 2, 1999 but it was not done at the
scheduled time but was performed in the afternoon. JUDGMENT The complainant was not allowed to take any food
the previous night. The complainant has alleged
that during the angiography procedure, she felt
severe pain in the abdomen and brought the said
fact to the notice of Dr. Chawla but he ignored the
same and continued with the procedure. After the
procedure was completed, according to the
complainant, she was shifted to the recovery room.
Angiogram showed LAD artery blockage to the extent
of 95 per cent. It has been specifically alleged
by the complainant that Dr. Chawla took consent of
her son for performance of PTCA or angioplasty for
removal of the blockage, yet it was given up in the
midway after about 15-20 minutes on the pretext
that she was allergic to many drugs. According to
the complainant, she was shifted to Intensive Care
Unit (ICU) and though she had severe pain
throughout the night, yet nobody attended her. On
September 3, 1999, according to the complainant,
Dr. Chawla alongwith another consultant namely Dr.
Suri examined her who found pulse of her right leg JUDGMENT practically absent and as such he reprimanded Dr.
Chawla. The complainant was discharged from the
Research Centre and thereafter she came to Delhi
and consulted Dr. Trehan of the Escorts Heart
Institute, Delhi and was admitted in the said
Institute on September 13, 1999. Another
angiography was conducted at the Escorts Heart
Institute through radial artery of the right arm
and on that basis, according to the complainant,
Dr. Trehan opined that aorta dissection has taken
place during the angiography procedure done by Dr.
Chawla at Tagore Heart Care and Research Centre,
Mahavir Nagar, Jalandhar, Punjab and that was
iatrogenic in nature. Ultimately, she had
undergone angioplasty on October 18, 1999 and was
discharged after ten days.
The complainant alleged medical negligence on
the part of Dr. Chawla and the Research Centre
while conducting the angiography on September 2,
1999 resulting into dissection of aorta. She has JUDGMENT alleged that she had to obtain further treatment
and due to the sheer negligent act of Dr. Chawla
incurred heavy expenditure in undergoing
angioplasty and angiography at Escorts Heart
Institute. Alleging the aforesaid, the complainant
filed petition before State Commission, interalia,
praying compensation of Rupees Eleven lacs from Dr.
Chawla-Respondent No.2 and the Research Centre-
Respondent No.1.
After issuance of notice, Dr. Chawla-Respondent
No.2 and the Research Centre-Respondent No.1
entered their appearance and denied allegations
made by the complainant that former was negligent
while conducting the angiography on the complainant
on September 2, 1999. According to them, the
complainant was a patient of hypertension and had a
history of ischaemia as also allergic to most of
the antibiotics and as such there was risk involved
in conducting the angiography on the complainant on
September 2, 1999. Dr. Chawla and the Research JUDGMENT Centre further averred that coronary angiography
was done successfully and the complainant was
shifted to ICU in a stable condition. According to
them, after about a couple of days of
stabilization, the coronary angioplasty was
planned. However, on September 3, 1999 in the
morning, the complainant got acute pain in abdomen
and thereafter Dr. Suri, a Cardio-thoracic Surgeon
was called for examining her. He suspected aorta
dissection and as such CT scan of the abdomen and
thereafter MRI was done immediately and on that
basis the dissection of aorta was confirmed and
further treatment in consultation with Dr. Suri was
planned. According to them, the complainant was
stable and discharged on September 8, 1999. They
have further averred that conservative management
was planned for 4 to 6 weeks to ensure healing of
the aorta dissection prior to conducting of
contemplated angioplasty. According to them, the
complainant did not turn up after the discharge.
She took further treatment at the Escorts Heart JUDGMENT Institute, Delhi and in fact developed allergy due
to side effects of the drug called ‘Ticlopidin’
prescribed at the Escorts Heart Institute after the
angioplasty procedure. According to them, they
were not at all responsible for deterioration of
her condition nor deficiency in their medical
service. They have also denied the allegation of
negligence made against Dr. Chawla (Respondent
No.2) while conducting the angiography on September
2, 1999.
The State Commission directed both the parties
to file affidavits and place such other materials
which were relevant for decision of the issue
before it. On the basis of the materials placed on
record, the State Commission came to the conclusion
that aortic dissection occurred during the
angiography conducted by Dr. Chawla when he forced
the catheter through artery in a negligent manner.
For coming to the aforesaid conclusion, the State
Commission heavily relied on the assertion of the JUDGMENT complainant that she felt severe pain in the
abdomen during angiography. In this connection, it
is apt to reproduce the observations made by the
State Commission in this regard:
“….It is true that hypertension is one
of the factors of causing aorta dissection
but in the present case, the aortic
dissection had taken place when respondent
no.2 was passing the catheter through
iliac artery travelling through aorta
blood vessel reaching inside the arteries
adjoining the heart. The dissection of
aorta had taken place because respondent
no.2 was negligent. In fact, it is case
of res ipsa loquitur i.e. the facts speak
themselves and point out that it has taken
place due to negligence of respondent no.
2.If he taken due care and caution, then
this dissection of aorta would not have
taken place because it is a very rare
phenomenon. Hence, we hold that the
respondent had not taken due care and
caution and had acted negligently in
passing the catheter through iliac artery
by performing angiography and this led to
severe pain in her abdomen and she even
complained but unmindful with the pain of
complainant, he continued with the process
and completed the same. This again
suggests that he was insensitive to the
pain and agony of the complainant.”
On appeal by Dr. Chawla and the Research
Centre, the National Commission set aside the finding of the State Commission that aortic
dissection had taken place during angiography done
negligently by Dr. Chawla. In this regard, the
National Commission has observed as follows:
“18. We are of the opinion that the
State Commission committed an error
while reaching a finding that the doctrine
of Res ipsa loquitur is applicable to the
fact situation of the present case. In
fact, we do not find any basis to support
such finding, particularly, when the
medical record shows that complainant –
Smt. Kanta was stable when she was
discharged on 8.9.1999 from the hospital
and could later on travel to Delhi for the
purpose of coronary surgery. We think it
proper to hold that there was no
negligence committed by the appellants
while conducting the angiography
procedure.”
Undisputedly, the complainant had suffered
aorta dissection. The CT scan and MRI conducted on
September 3, 1999 confirmed it. However, the
controversy is when did it occur? According to the
complainant, it happened while angiography was
being done by Dr. Chawla on September 2, 1999
whereas according to Dr. Chawla and the Research
Centre, she suffered the same not during angiography but the day following that because of
high blood pressure. It is further beyond
controversy that Dr. Chawla completed the
angiography on September 2, 1999 which showed LAD
artery blockage to the extent of 95 per cent. It
is the plea of the respondents that had complainant
suffered aortic dissection during the angiography,
it could not have been completed.
We have heard Mr. Mahabir Singh, Senior Counsel
for the appellant as also Mr. Amarendra Sharan,
Senior Counsel for the respondent. Undoubtedly,
the complainant had aorta dissection. The question
is as to whether it was the direct result of any
negligent or rash act committed by Dr. Chawla while
conducting the angiography. From the entries made
in the discharge summary, we do not find that there
was any emergency to treat the aortic dissection.
Aortic dissection came to be noticed beyond all
reasonable doubt on September 3, 1999. She was not
operated upon. It may be mentioned here that in
case of acute aortic dissection, emergency open JUDGMENT heart surgery is required. However, in case of
sub-acute aortic dissection, treatment with
medication may be sufficient. There is sufficient
material to come to the conclusion that the
complainant was found stable after third day of
angiography and till the date of discharge on
September 8, 1999. The only allegation of the
complainant is of abdominal pain during the process
of angiography. There is no dispute that she was
aged about 55 years and suffering from hypertension
when the angiography procedure was conducted on
her. It is probable that due to such associated
causes the passage of the catheter through aortic
space was not smooth. There is no material to
infer that Dr. Chawla had undertaken any
adventurous step. There is nothing on record which
points out that Dr. Chawla used any brutal force to
push the catheter. In our opinion, mere completion
of the angiography does not rule out aorta
dissection during the procedure. We find that the
complainant did not had a serious aorta dissection JUDGMENT but was having sub-acute aorta dissection and this
is the reason that the complainant was subjected to
clinical management and, in fact, her condition
became stable without any surgical interference.
It is nobody’s case that Dr. Chawla is not a
competent coronary expert or he lacked adequate
knowledge in the field of coronary surgery. He is
duly qualified and has good academic credentials.
We have not found his conduct to be below the
normal standard of a reasonably competent
practitioner in his field. We are in agreement
with the reasoning and the conclusion arrived at by
the National Commission that the complainant has
not been able to prove medical negligence on the
part of Dr. Chawla.
In the result, we do not find any merit in the
appeal and it is dismissed without any order as to
costs.