1. -THE complainants allege that due to the medical negligence and defective operation conducted by the opposite party Nos. 2 and 3, Ullolakanti Bhuyan died. The complainant No. l is the widow of Ullolakanti Bhuyan (hereinafter referred to as the deceased ). The complainant No. 2 is their minor son. The complainant Nos. 3 and 4 are the parents of the deceased. The case of the complainants is that the deceased was a healthy young man and was a practising lawyer at Balasore. On 28. 2. 2000, it was diagnosed in the Durga Nursing Home, Balasore that he was suffering from R. H. D. M/s. A local Cardiologist (Dr. Gopinath Parida) was treating him. He took his x-ray, E. C. G. and ECHO at Balasore and referred the case to Dr. Mahendra Prasad Tripathy (opposite party No. 3) at Kalinga Hospital, Bhubaneswar (opposite party No. 1) on 1. 4. 2000. On 2. 4. 2000, the E. C. G.-AFC, EVR, etc. of the deceased were recorded at the Kalinga Hospital. Dr. J. P. Das, a visiting Cardiologist of the Kalinga Hospital examined the deceased and diagnosed as Heart M/s. He also took ECHO, etc. and did not find any LA clot. On 11. 7. 2000, the opposite party No. 3 took ECHO cardiogram of the deceased. The opposite party No. 2 - Dr. R. C. Raichoudhury examined the deceased and even after going through the ECG report, x-ray report, etc. did not pay any importance to the gravity of his health condition. He did not prefer C. M. V. /mvr/angioplast treatment which are less costly, but insisted for DVR which was not required. The allegation of the complainants is that opposite party No. 2 preferred DVR to earn higher income. He fixed 12. 2. 2001 and 13. 2. 2001 for admission and operation of the deceased. Although he advised the complainant No. 4 to collect six units of fresh blood, he did not advise for fresh ECHO/2d/echo/tee, etc. to ascertain the cardiac position before conducting operation. On 12. 2. 2001, the deceased took admission in the Kalinga Hospital at about 9 a. m. He was physically and mentally good. As required for the surgery, a sum of Rs. 2,08,000 was deposited towards package charge of operation, cost of valves, medicine, etc. The opposite party No. 2 without taking fresh ECHO, etc. did open heart surgery of the deceased on 13. 2. 2001. He replaced mitral valve and aortic valve. The surgery/operation commenced at 10 a. m. and was over by 4. 30 p. m. Around 7. 30 p. m. , the deceased came to senses. He started talking next day morning. The complainants desired to get the deceased checked by Dr. J. P. Das - the visiting Cardiologist, but the hospital authorities did not allow it to be done. The opposite party No. 2 and his associates left Bhubaneswar for Calcutta to attend a conference on 16. 2. 2001 without attending to the deceased. The opposite party No. 2 returned from the conference on 18. 2. 2001. During the period from 14. 2. 2001 to 20. 2. 2001, the complainants were told that the condition of the patient was stable. On 19. 2. 2001 at 10 a. m. E. C. G. of the deceased was done. On 20. 2. 2001 at 8 a. m. he was forcibly shifted from ICU-I to ICU-II, although the complainants insisted for his stay in ICU-I for some more days to observe his condition and stability. In ICU-II there was no life support equipments. From 8 a. m. till mid-day his condition was usual and he was eating, reading, talking, walking, etc. He was also watching T. V. and was going to bath room. At about 1 p. m. , the deceased felt pain in his heart and requested the attending nurse to call for the doctors to attend him immediately as there was no doctor in ICU-II. At 2. 30 p. m. he became unconscious. Opposite party No. 2 and his associates Dr. Mohanty and Dr. Patra all were in O. T. room, but they did not come immediately to attend the deceased. At 3 p. m. , opposite party No. 2 came and reopened the heart of the deceased on the bed itself and massaged it. He reoperated the heart without fitting life support machine. Due to such reopening of the heart and vigorous massage, the condition of the deceased became critical and functioning of his both kidneys was affected. Blood pressure came down and he was taken to ICU-I. At about 5 p. m. , the complainant No. 4 was asked to collect four units of fresh blood which was arranged immediately. The opposite party No. 2 stated that due to excess bleeding from the heart, the condition of the deceased became serious and re-operation was taken up to avoid it. On 21. 2. 2001 morning passing of urine of the deceased was stopped and both the kidneys failed functioning. The opposite party No. 2 was requested to take up dialysis to bring both the kidneys of the deceased to function, but it was not done, probably dialysis facilities were not available in the hospital. On 22. 2. 2001, the condition of the deceased became serious and he ultimately died on 23. 2. 2001. According to the complainants, the deceased died due to negligence of the opposite party No. 2.
2. WRITTEN version has been filed on behalf of the opposite party Nos. l and 2. Opposite party No. 3 has filed a separate written version denying his involvement in the operation of the deceased. He has stated that the deceased consulted him as an outdoor patient in the Kalinga Hospital and he had not taken any part in his operation. Opposite party Nos. l and 2 in their written version denied the allegation of negligence.
Two questions arise for consideration: (i) Was the open heart surgery done by the opposite party No. 2 on 13. 2. 2001 successful? (ii) If it was successful, did the deceased die on 23. 2. 2001 due to negligence of the attending doctors or some other reasons? the death certificate shows that the deceased was aged about 40 years and irnmediate cause of his death was "cardiac pulmonary failure". The antecedent cause was "post DVR Arrythmia leading to acute renal failure".
The legal position is now well settled that a doctor will not be guilty of negligence if he has acted in accordance with the practice accepted as proper by a responsible body of medical men skilled in that particular area and if he has acted in accordance with such practice merely because there is another opinion taking a contrary view, it will not make him liable for negligence. In this connection, it is appropriate to refer the weighty observation of Mcnair J. in Bolam v. Friem Hospital Management Committee. It is as follows:
"i myself would prefer to put it this way: a doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art. Putting it the other way round, a doctor is not negligent, if he is acting in accordance with such a practice, merely because there is a body of opinion that takes a contrary view. "
3. LET us first consider whether there was any negligence in conducting the open heart surgery done by the opposite party No. 2 on 13. 2. 2001. The complainants claim that the deceased was in healthy condition when he was admitted in the Kalinga Hospital. We cannot accept the above claim to be correct. In February, 2000 the deceased was examined by the cardiologist (Dr. Gopinath Parida) in Balasore Sadar Hospital, who diagnosed it to be a case of R. H. D. M/s. (Sev.) P. A. H. (Sev. ). He suggested for immediate treatment. This indicates that the healthy condition of the deceased was not good. In open heart surgery, the damaged valves are replaced. The complainants argue that replacement of aortic valve was not necessary. The complainants are not experts. If a surgeon has adopted one method, it cannot be contended as to why he did not adopt another method. It is alleged that the opposite party No. 2 should have held fresh ECHO and 2d ECHO before operation was conducted. In our opinion it was not necessary inasmuch as the location of repairing of his heart by replacement of valves was already made by the opposite party No. 2. It is an admitted fact that the operation commenced at about 10 a. m. on 13. 2. 2001 and it continued till 4. 30 p. m. and the deceased got sense by 7. 30 p. m. Within seven days of operation i. e. by 20. 2. 2001, the deceased pursued his normal habits like eating, reading and talking. If the operation was unsuccessful, the deceased would have died on the very day. But he survived for seven days and was slowly getting used to do his routine habits. In these circumstances, it cannot be said that there was negligence in diagnosing the condition of the deceased or in giving him the required treatment. The open heart surgery was successful.
Let us examine the second issue i. e. was there any post-operation negligence by the opposite party No. 2 leading to his death. The complainants contend that the deceased should not have been shifted to ICU-II from ICU-I. The opposite party Nos. 1 and 2 assert that since the condition of the patient was getting normal he was taken to ICU-II to get himself acquainted/adapted with natural condition. In paragraph 6 of the written version, the opposite party Nos. l and 2 say that when the deceased was examined on 20. 2. 2001 it was found that cardiac arrest had already ensued for which the heart was massaged on the bed and at the O. T. on re-opening the chest cavity. The allegation that there was re-operation of the heart is denied by the opposite party Nos. l and 2, who assert that no re-operation of the heart was done since after operation within seven days i. e. by 20. 2. 2001, everything had healed up. On that day when cardiac arrest started, the opposite party No. 2 was present in the hospital and attended the deceased which fact is not disputed.
4. IT is common knowledge that valves of the heart are natural machines which regulate pumping of blood to lungs and thereafter blood to different parts of the body. The muscles wall of the heart is also vital to cause pumping. The opposite party Nos. l and 2 say that although valves were replaced, the wall of the heart was not repaired as it was not repairable. By the time of admission into the Kalinga Hospital, the deceased heart muscles/wall had already reached the stage of malfunctioning to cause cardiac arrest. In case of cardiac arrest, blood pressure falls gradually and in case of very low blood pressure functioning of kidney stops and no urine is made by the kidney. When the deceased was allowed to lie in natural condition in ICU-II on 20. 2. 2001 there was no excess bleeding from the heart. Had it occurred, he would have died instantaneously. It is nobody''s case that there was excess bleeding from the heart due to malfunctioning of pumping mechanism leading to cardiac arrest. Cardiac arrest not only stops functioning of kidney but also functioning of brain. The allegation that no dialysis was made as there was no facility is denied by the opposite party Nos. l and 2. It is asserted by the opposite party Nos. l and 2 that opposite party No. 2 is a noted heart specialist and surgeon of U. S. A. who comes to Orissa to make lifesaving major operations. After repairing of the heart, when suddenly it started malfunctioning, the deceased was given massage to revive the heart. Due to this setback, his urine output diminished and his condition deteriorated despite active corrective treatment. He was given ventilation with a cardiac pacemaker from 21. 2. 2001. On 23. 2. 2001 at about 6 a. m. his blood pressure and heart rate were not recordable. Resuscitation was carried out but the deceased could not revive and he died at about 6. 10 a. m. During admission of the deceased, his heart was already enlarged and the heart muscles wall had already started malfunctioning. The claim of the complainants that at the enlargement stage, medicines could have been applied to bring the heart to normal size and thereafter operation could have been done is a layman''s plea. Once the heart is enlarged it is the valve to be replaced. As mentioned above, in open heart surgery, the damaged valves were replaced. It is not correct to say that "replacement of aortic valve was not necessary". In the instant case the only accepted method to replace two valves in single open heart surgery (which is accepted all over the world) was adopted, but the heart muscles wall was already damaged. If the operation would not have made, the deceased would have died soon due to cardiac arrest.
Considering the facts and circumstances, we have no hesitation to hold that there was no negligence in diagnosing the condition of the deceased or in giving treatment to him.
In the result, we do not find any merit in this complaint which is hereby dismissed. Complaint dismissed.
