TMI Blog2022 (11) TMI 35X X X X Extracts X X X X X X X X Extracts X X X X ..... ield of eyes. Tracheal Intubation may be done under deep inhalation anesthesia (Halothane) or with the use of other muscle relaxants. In the Instant case, as the vocal cord was anterior, it was not possible to intubate the patient in the first attempt. It is not clear from the record that Scoline was administered before first intubation, as such the possibility cannot be ruled out. It was the Oculocardiac Reflex (OCR), also known as the Aschner reflex or trigeminovagal reflex (TVR). It is a reduction in the heart rate secondary to direct pressure placed on the eyeball. It is defined by a decrease in heart rate by greater than 20% following globe pressure or traction of the extraocular muscles. Most commonly, the reflex induces bradycardia. However, OCR also has a reported association with reduced arterial pressure, arrhythmia, asystole, and even cardiac arrest. This reflex has most notably been depicted during ophthalmologic procedures, more specifically during squint/strabismus Ocular Surgery - 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 a ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... Kanan (OP-3) the Anesthetist. The Complaint was filed under Section 21 of the Consumer Protection Act, 1986 by the parents of deceased for alleged gross medical negligence and deficiency in service causing death of their only child during surgery for squint correction. 2. The Complainants' son Anmitra, about 6 years of age (hereinafter referred 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 fo ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... 0,20,000/- as compensation. Defense: 4. The Opposite Parties filed their replies and denied allegations of negligence. They expressed their deep sympathies for the death of patient. They took preliminary objection of jurisdiction that such complaint needs extensive and elaborate evidence, therefore Civil Court would be effective for adjudication. It was 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 a ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... avenously and cardiac massage continued. At 3.25 P.M, the EGG monitor showed ill sustained agonal rhythm with Asystole. Physician joined the team. DC shocks were repeated twice with 50 Joules and cardiac massage was continued with 100% oxygen ventilation. Dr. S. Bhaskaran, Cardiologist joined in the resuscitation efforts. Other resuscitative measures to correct acidosis 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 ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... rocedure, which could be avoided death of child. 13. The squint surgery was an elective surgery and it was not an emergency. The operating surgeon was not aware about the special warnings to use of Scoline in pediatric cases and the anesthetist failed to warn to the surgeon about it. It was further argued that the Opposite Parties have manipulated the documents. The child died at 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. H ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... child was suffering from bilateral squint and chest deformity, which were congenital anomalies. Therefore, the cardiac anomalies cannot be ruled out in this case. Moreover, if one physician (MD) notices functional murmur, then the expected skill from the Super Specialist i.e. the Cardiologist was more and higher degree of care should be there. It is lacking in the instant case and unfortunately, the 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 casua ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... also has a reported association with reduced arterial pressure, arrhythmia, asystole, and even cardiac arrest. This reflex has most notably been depicted during ophthalmologic procedures, more specifically during squint/strabismus Ocular Surgery. The complications secondary to the OCR are related to the vagal responses and may include Sinus bradycardia, Arrhythmia, Ventricular fibrillation, Asystole Cardiac 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 ch ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... octor does not adopt proper procedure in treating his patient and does not exhibit the reasonable skill, he can be held liable for medical negligence. Similarly, in Dr. Laxman Balakrishna Joshi vs. Dr. Trimbak Bapu Godbole Anr - AIR 1969 SC 128 and A.S. Mittal vs. State of U.P. - AIR 1989 SC 1570, certain duties of the doctor have been laid down. The doctor owes to his patient certain duties which are (a) a duty 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 ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... not sustained the wrong. Thus, having regard to the finding that the incidence occurred in year 2000 and we are now in 2022, the litigation has been pending for over 2 decades. 29. In the case National Insurance Co. Ltd. v. Kusuma - (2011) 13 SCC 306, the Hon'ble Supreme Court has held that payment of compensation to parents for the death of a child, including a stillborn, in an accident must be just and not be a pittance. 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 liabl ..... 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