JUDGMENT : Asper N.K. Jain, J. (President ) : - Bythis complaint under Section 12/17 of the Consumer Protection Act, complainantsclaim damages Rs . 12 lacs besides refund of treatment charges Rs . 1,57,214/-from opposite parties for the alleged negligence in the matter of treatment oflate Smt . Sheela Bhargava . 2.O.P. No. l-"Convenient Hospital Ltd." is a company registered underthe Indian Companies Act and owns and runs O.P. No. 2-CHL Apollo Hospital at Indore . O.P. No. 3-Dr. Vinod Somani is a consultantinterventional cardiologist working in O.P .- Hospital .O.P. No. 3-Dr. Somani was insured with O.P. No. 4-theUnited India Insurance Company Ltd. for a sum of Rs .10 lacs for the period of one year from 9-1-2002 to8-1-2003 for any liability arising on account of any professional negligence,error and commission or omission. 3.Late Smt . Sheela Bhargava was wife of complainant No. 1-Shankerlal Bhargava and mother of other complainants namely Gopal Bhargava , Shri Ram Bhargava and Smt . Laxmi Bhargava .It is no more in dispute that complainant- Shri Ramwas admitted and receiving treatment in O.P. No. 2-Hospital since before11-3-2002 when on that date late Smt . Sheela Bhargava was seen by Dr. Vinod Somani who clinicallydiagnosed her to be a case of " Ess .Hypertension, chr . Stable angina NIDDM". He directed for her admission insemi-private ward for coronary angiography. Her X- ray and Echocardiographywere performed on 11-3-2002 and 12-3-2002 . On 14-3-2002 her cardiac cathederisation was done which revealed as follows : - "Coronary Angiography : Leftcoronary angio in various view shows: Left Main : Normal LAD : 80% stial lesion, Type B LAD TIMI III flow. LCx : Normal . Dl:diffusely diseased. Rightcoronary angio in various view shows: Dominant RCA. Mid RCA having intimal irregularity. LV angio in RAO 30 shows : NoMR. NoRWMA. LVEF :60 %" Lateron the same day PTCA with stent to LAD was done. She was discharged on 18-3-2002 with following findings and advice:- "PTCAwith stent LAD ,explained to the attendant, willing for PTCA. PTCA with stent done. Big haematoma due to oozing from venous sheath. Pulseswell felt. Post cath period was uneventful". Shedied while on way to her home Garhakota , District Sagar , on 21-3-2002 . 4.It is alleged by the complainants that angiography as also angioplasty werehurriedly and rashly performed leading to formation of thombosed groin haematoma . PTCA with stent done. Big haematoma due to oozing from venous sheath. Pulseswell felt. Post cath period was uneventful". Shedied while on way to her home Garhakota , District Sagar , on 21-3-2002 . 4.It is alleged by the complainants that angiography as also angioplasty werehurriedly and rashly performed leading to formation of thombosed groin haematoma . False passage created in rightcommon femoral artery also later developed into a pseudo aneurysm. Although thesame was tried to be closed later on the same day by adopting prob pressure technique, but that by itself was notsufficient and required to be managed by surgical intervention. It is furtheralleged that the patient was deliberately and hurriedly discharged by theopposite parties wrongly stating that her condition is stable and that coronaryperfusion is normal. The LVF of the patient was 60% of the normal which mighthave sustained her comfortably for long time. Proper control of diabetes andblood pressure and medical treatment of angina by drugs alone might havehelped. A conservative approach and holistic treatment might have saved herfrom all the complications which ultimately led to her death. The stent used was non-medicated and which also contributed tothe said complication. The post-mortem of the deceased revealed that thepatient had multiple subcutaneous haemorrhages in herabdomen, thigh and groin on right side of her body which was the result ofleakage from ruptured blood vessels. Consent for the said procedure wasobtained without explaining the prognosis of the treatment which in the factsand circumstances of the case, was in fact not warranted. It was thus allegedthat opposite parties- Hospital and doctor, were guilty of negligence intreating the patient and were liable to compensate the complainants. Theyclaimed refund of Rs . 1 ,57,214 /-paid by them to opposite party Nos. 1 to 3 towards treatment charges and Rs . 12 lacs damages for the deathof the patient. 5.Opposite party Nos. 1, 2 and 3 by their joint reply denied all the allegationsand raised objection as to the tenability of the complaint as against oppositeparty Nos. 1 and 2. It was contended that it was not a formal or routine checkup, but since the patient was in bad health and was in condition ofbreathlessness, suffocation and high tension with pain in chest that she wasadmitted in semi private room for coronary angiography and other relatedcheckups. Her angiography revealed 80% ostial lesionof LAD which required PTCA with stent B LAD . Her angiography revealed 80% ostial lesionof LAD which required PTCA with stent B LAD . Theprocedure undertaken by O.P. No. 3-Doctor was in accordance with the medicalscience. The prognosis of the treatment was also explained to the patient andher attendants. In fact, her family doctor was also consulted and that he hadalso agreed for the procedure. ' Pseudoaneurysm ' whichthe patient developed was a known-complication which in the instant case waswell attended and taken care of. The patient, it is contended, was treatedproperly by O.P. No. 3 in consultation with his other senior members of hisfaculty and after due consent of her son and daughter-in-law. It is furthercontended that medicated stent were in the stage ofevolution at the relevant time and there was thus no occasion for using anysuch stent . On noticing thombosed groin haematoma in the right common femoral artery prob pressure technique was applied, besides givingadequate blood transfusion to the patient. It was thus, contended that therewas no negligence on the part of opposite parties in treating the patient. 6.It was on disclosure by opposite parties that O.P. 3- Dr. Somani on the relevant dates was insured with O.P. 4- Insurance Company,that this Insurance Company was made opposite party (No. 4) to the case.The Insurance Company supported the defence set-up byother opposite parties and it was contended that complainants are not entitledto any compensation either from opposite party Nos. 1,2 and 3 or from oppositeparty No. 4. 7.Both parties have led evidence in the form of affidavits and documents. Whilecomplainant has filed affidavit of Dr. Gurudutt Tiwari - a Physician, the opposite parties have filedaffidavits of Dr. Somani and those of threephysicians/cardiologists of the town namely Dr. A.K. Pacholiya ,Dr. G.P. Sepaha and Dr. Vidhyut Jain. Their joint report justifying the procedure adopted by O.P. No. 3-doctoris also filed in evidence. We have also sent for the report given by an expertcommittee constituted by the Superintendent of Police, Indore to examine whether or notthere has been any negligence on the part of opposite party-doctors. We havealso summoned and examined Dr. Anil Bharani ,Professor of Medicine and Head of the Division of Cardiology, MGM MedicalCollege, Indore and who had headed the said penal ofdoctors. 8.We have heard learned Counsel for parties and also gone through the entirematerial on record. We havealso summoned and examined Dr. Anil Bharani ,Professor of Medicine and Head of the Division of Cardiology, MGM MedicalCollege, Indore and who had headed the said penal ofdoctors. 8.We have heard learned Counsel for parties and also gone through the entirematerial on record. 9.The facts of the case already stated hereinabove are more or less admitted.There are however, certain salient features of the case which stare in theface. As already stated late Smt . Sheela Bhargava though a known case of HT and N1DDN, did not seem to have come to Indore for treatment of her anysuch ailment but happened to be there in O.P. Hospital in connection with thetreatment of her son admitted in the said hospital. It appears that she alsogot herself examined by O.P. No. 3-Dr. Somani .Although this fact is denied by opposite parties and it is submitted that shewas in a condition of breathlessness, suffocation, hyper tension and pain inchest when she was first examined by Dr. Somani . Itis however, significant to note that Dr. Somani inhis first examination sheet dated 11-3-2002 (vide page 40) recorded no such findings beyond stating "ESS hypertension, Chr . Stable angina NIDDN" (emphasissupplied). He straightway directed for admission of the patient for coronaryangiography without even going for normal tests like ECG, TMT etc. 10.Interestingly in the discharge summary the deceased patient is shown to be acase of unstable angina even when Dr. Somani in hisexamination sheet dated 11-3-2002 under his own handwriting mentioned it to be a case of stable angina. Thisinconsistency remained wholly unexplained by the opposite parties who hadnothing about it either in their reply or affidavits. Dr. Anil Bharani who headed the panel ofdoctors which examined the treatment papers and gave "no fault"report dated 28-4-2004 , wasexamined by this Commission on oath. While he supported the findings of thepanel but in cross-examination by the complainant, he admitted that thetreatment papers revealed no urgency for undertaking the aforesaid two proceduresin one go. He further admitted that there was no angina during her stay in thehospital. He further agreed that in a case of stable angina test likeTMT/Thallium are carried out before planning angioplasty. All this supports thecomplainant's allegation that decision to undertake the said two procedures inone sitting was taken in undue haste. Dr. He further admitted that there was no angina during her stay in thehospital. He further agreed that in a case of stable angina test likeTMT/Thallium are carried out before planning angioplasty. All this supports thecomplainant's allegation that decision to undertake the said two procedures inone sitting was taken in undue haste. Dr. Gurudatt Tiwari , a qualified physician (MD) with 16 years'experience, in his affidavit has testified that the examination reports of the'patient, in their totality never indicated any emergency or urgency forangioplasty and that she might have lived comfortably on medication and dietaryrestrictions for a long time. The facts and circumstances of the case tend tocorroborate his testimony. 11.It is submitted by opposite parties that before undertaking the procedure notonly the due consent of the patient and her attendants was obtained, but thematter was also discussed with their family doctor. However, the name of saidfamily doctor is not disclosed in the reply or in affidavits. As against it,the complainants emphatically stated that no such family doctor was everinvolved in any such discussions. They further alleged that signatures onconsent papers (all are in English) were obtained in haste without explainingthe prognosis-of the procedure. It is significant to note that it is for thefirst time that name of Dr. A. Chaudhari , M.D. D.M.is mentioned as a referral doctor in the Cardiac Cathederisation Report and PTCA with Stent To Lad Report both dated 14-3-2003 .Complainants have denied on oath having ever consulted any such Dr. Chaudhari who they further stated is not even known tothem. Surprisingly name of this doctor is not mentioned in any otherexamination papers not even in the discharge summary dated 18-3-2002 . On the contrary, in the dischargesummary the column for the name of referral doctor has been left blank. Noreference letter is filed or proved in evidence. Again no explanation isfurnished as to how name of this Dr. Chaudhari hadcrept in suddenly in those two reports. We are afraid, there has beenunsuccessful attempt on the part of opposite parties to show that the decisionto undertake the procedure was taken with due consent and in consultation withthe patient, her attendants and their family doctor, while in fact it was notso. Chaudhari hadcrept in suddenly in those two reports. We are afraid, there has beenunsuccessful attempt on the part of opposite parties to show that the decisionto undertake the procedure was taken with due consent and in consultation withthe patient, her attendants and their family doctor, while in fact it was notso. 12.Coming to the actual procedure (PTCA & Sterjt to LAD )it is seen that it met with three complications : one, pseudoaneurysms , two, severe heamorrhage (bleeding from PTCA site) and three, heamotoma at thegroin which grew quite large (8 cm x 8 cm). 13.It is true that pseudoaneurysms is a known complication of PTCA procedure but the questionof questions is whether it was properly managed. As per Radiologist's reportdated 15-3-2002 (vide page48), "A partly throm-bosed groin heamotoma was sited in close vicinity of right commonfemoral artery. This heamotoma harbours a pseudoaneurysms measuring 1.9 x 1.8 cm with a longneck of 1.2 cm and a high PSV of about 8.0 cm is seen at the neck with aturbulent flow". According to this report, USG guided " brobe pressure technique" was employed with pressuretargets for about 20 minutes. However, as testified by Dr. Tiwari ,Doppler photos showed closure and thrombosis in 10 minutes only. He furthertestified that closure of pseudoaneurysms of the sizesuffered by the patient seemed unlikely in such a short time. It is furthersignificant to note that the patient was receiving very patent anticoagulantsand antiplatlet drugs and, e.g., asprin , clopidogrel and ticcopidine together with integreun being administered I/ V. Integreun also acts againstplatelets. ' Combiflam ' was also given for pain.Surprisingly no vascular surgeon was even called or consulted. We tend to agreeby Dr. Gurudatt Tiwari's testimony that a vascular surgeon best treats pseudoaneurysms of this size. 14.The severity of haemarrhage in this case was evidentfrom the fact that while investigations on 11-3-2002 revealed hemoglobin level11.7% the same after procedure dropped to 7.8%. Certainly it required specialcare and management by a vascular surgeon. Dr. Bharani's panel in its report opined that groin complication seemed to have been attendedwell by the treating team of the doctors inasmuch as four blood transfusionswere given to the patient. Similar opinion is expressed by Cardiological Society of India (Vide Page 24). However, the treatment papers revealed thatwhile four units of donors blood were arranged, onlyone such was transfused. Dr. Bharani's panel in its report opined that groin complication seemed to have been attendedwell by the treating team of the doctors inasmuch as four blood transfusionswere given to the patient. Similar opinion is expressed by Cardiological Society of India (Vide Page 24). However, the treatment papers revealed thatwhile four units of donors blood were arranged, onlyone such was transfused. Dr. Bharani in his cross-examinationfurther admitted that it was incorrect to mention in the discharge summary thatpost cathederization period was uneventful because asper treatment papers big heamotoma due to oozing fromvenous sheath was already there. The patient was not evaluated for coagulationparameters except on 14-3-2002 at 3.00 P.M. and on one more occasionof which no date or time is disclosed. 15.The patient was a female aged 67 years. She was hypertensive and diatetic . As admitted by Dr. Bharani "Ideally in a case like this medicated stent ispreferred". Although he qualified his statement by saying that in the year2002 the drug coated stents were at a stage ofevolution. However, the treatment papers carry no such explanation. Literatureis also available to show that medicated stents werewell established in 2002. 16.The patient was discharged on 18-3-2002 even when she was having big haematoma . As alreadystated the haematoma was the result of severebleeding immediately following the procedure. The post-mortem report of thepatient indicated that this groin haematoma was ofconsiderable big size 8 cm x 8 cm with subcutaneous haemorrhage on right side of abdomen and back and upto knee inright lower limb (both anteriorly and posteriorly ). Obviously all this was ante-mortem. Althoughtin the discharge summary, it was stated that it was a case venous oozing.However, the fact that within hours of the procedure thehemoglobin level dropped by 4% clearly go to show that the bleeding was anterial requiring more than ordinary care and managementby a vascular surgeon. There has been thus an attempt to undisplay the seriousness of the problem. Again a big question mark, was it advisable todischarge the patient in that condition even when she continued to be on antiplatlet aggregation and anticogulent drugs ? Question remains wholly unanswered by theopposite party- doctor who seemed to have acted rather rashly in dischargingthe patient in that condition. 17.Although as per discharge summary, the patient was discharged on 18th March, 2002 . However, theprogress sheet carries an entry of the patient being seen on March 19, 2002 by Dr. Question remains wholly unanswered by theopposite party- doctor who seemed to have acted rather rashly in dischargingthe patient in that condition. 17.Although as per discharge summary, the patient was discharged on 18th March, 2002 . However, theprogress sheet carries an entry of the patient being seen on March 19, 2002 by Dr. Porwal on whose advice some aspiration was done. Firstlythis noting is contrary to the discharge summary, secondly it also raises aquestion as to why the aspiration was required which could dislodge the clotsand led to further haemorrhage . The patient on 19-3-2002 was complaining pain inright leg. This again goes to show that she needed more hospitalization andpost-operative care. We have ACC/AHA Practice Guidelines issued by the American College of Cardiology/AmericanHeart Association Task Force revising the earlier guidelines of 1993 for PTCA.This document lays down parameters for hospitals and cardiologists so as toentitle them to undertake procedure like angiography and PTCA. Although twopanels of doctors have given clean chit to the opposite party-Hospital and Dr. Somani , but they say nothing about fulfillment of theserequirements. Two affidavits of Dr. Somani himselfand those of Dr. Sepaha , Dr. Pancholiya and Dr. Vidyut Jain filed by opposite parties aretotally silent on the point. It could be thus said that opposite party-Hospitaland the doctor at the relevant time were not fully equipped to undertake theprocedure. 18.For what we have said above the conclusion is irresistible that opposite partyNo. 3-Dr. Somani was negligent in treating thedeceased patient which led or at least contributed, to her unfortunate death.Opposite party No. 1- Company and opposite party No. 2-Hospital are alsovicariously liable for the said act of commission or omission of Dr. Somani . We hold so. We may however, clarify that thisfinding of ours will have no binding effect on the criminal investigation orprosecution if any, initiated against the opposite party-Hospital or thedoctor. 19.As regards the compensation, the complainants have claimed damages Rs . 12 ,00,000 /-, besides refund oftreatment charges Rs . 1,57,214/-from oppositeparties. However, having regard to the age of the patient and keeping in viewthe fact that she was a housewife, we are of the considered view that a lumpsum award of Rs . 5,00,000/-(inclusive of refund of the treatment charges) will meet the ends of justice.Dr. Somani on the relevant date was insured withopposite party No. 4-the United India Insurance Company Ltd. for any suchliability. 5,00,000/-(inclusive of refund of the treatment charges) will meet the ends of justice.Dr. Somani on the relevant date was insured withopposite party No. 4-the United India Insurance Company Ltd. for any suchliability. The O.P. No. 4-Insurance Company has therefore, to be held liablejointly and severally alongwith opposite party No.3-Dr. Somani to compensate the complainant asaforesaid. 20.We accordingly allow the complaint to the extent indicated above. Oppositeparties are directed to pay to complainants, jointly and severally,compensation Rs . 5 ,00,000 /-(Rupees Five lacs only). They shall also bearcomplainant's cost of this case and the same is quantified at Rs . 5,000/-.