M/S. Aa Hospital Pvt. Ltd. & Anr. vs Simple Bhandari & 2 Ors.

on 20 October, 2020

National Consumer Disputes Redressal

M/S. Aa Hospital Pvt. Ltd. & Anr. vs Simple Bhandari & 2 Ors. on 20 October, 2020
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI FIRST APPEAL NO.
Through his natural gurdain and Mother Smt. Simple Bhandari,
Residents of City Enclave, G.T.Road, Jagraon, Punjab. 3. Master Sunish, Minor, S/o Late A
Near Octroi Post, Firozpur Road, Ludhiana-142 027, Punjab. 5. M/s Ludhiana Mediciti (Unit
CMC/ Brown Road, Ludhiana Punjab 11. Apex Insurance Consultants Ltd (AICL), Through its D

LUDHIANA PUNJAB 141001. 5. DR. BIKRAMJIT SINGH SANDHU MS (GENERAL &

LAPROSCOPIC SURGEON), LUDHIANA MEDICITI, NEAR OCTROI POST, FIROZPUR ROAD,
LUDHIANA -142027 PUNJAB 6. DR. RAMAN SINGLA, MS (ORTHOPAEDICS), LUDHIANA
MEDICITI, NEAR OCTROI POST, FIROZPUR ROAD, LUDHIANA-142027 PUNJAB 7. DR.
PARVEEN POPLI, COUNSULTANT RADIOLOGIST, LUDHIANA MEDICITI, NEAR OCTROI
POST, FIROZPUR ROAD, LUDHIANA-142027 PUNJAB 8. DR. CHRISTIAN MEDICAL COLLEGE
& HOSPITA THROUGH ITS DIRECTOR, CMC/BROWN ROAD, LUDHIANA, PUNJAB 9. APEX
INSURANCE CONSULTANT LTD. (AICL) THROUGH ITS DIRECTOR, REGD. OFFICE:
VINOBAPUR, LAJPAT NAGAR-II, NEW DELHI-110024 10. UNITED INDIA INSURANCE
COMPANY THROUGH ITS DIRECTOR, 54, JANPATH COUNNAUGHT PLACE, NEW
DELHI-110001 11. HIGHVALUES INSURANCE CONSULTANTS LTD. (HICL) THROUGH
DIRECTOR, COMMAND OFFICE: 223, 2ND FLOOR, VARDHMAN TOWER, COMMERCIAL
COMPLEX, PREET VIHAR, VIKAS MARG, NEW DELHI-110092 12. NATIONAL INSURANCE CO.
THROUGH ITS REGIONAL MANAGER, RO-3, II FLOOR, VARDHMAN PLAZA, GARH ROAD,
MEERUT, U.P. ...........Respondent(s) BEFORE: HON'BLE MR. JUSTICE V.K. JAIN,PRESIDING
MEMBER For the Appellant : Mr K.G. Sharma, Advocate and Mr. Sanjay Kumar, Advocate For the
Respondent : Mr. Piyush Kant Jain, Advocate for R-1 to 3 Mr. Amit Wadhwa, Advocate for R-4 & 5
Mr. S.K. Jha, Advocate for R-7 & 8 Mr. Harsh Kumar, Advocate for R-11 Dr. Sushil Kr. Gupta,
Advocate for R-13 NEMO for R-6, 9, 10 & 12 Dated : 20 Oct 2020 ORDER HON'BLE MR. JUSTICE
V.K.JAIN, PRESIDING MEMBER (ORAL) Late Sh. Anshu Bhandari, husband of respondent
no.1 and father of respondents 2 & 3 met with a roadside accident at about 7 pm on 17.04.2009 and
was taken to Civil Hospital, Jagraon. After giving first aid to him, he was advised to be taken to a
well-equipped hospital for further management. The deceased Anshu Bhandari was accompanied
by respondent no.1 his wife Mrs. Simple Bhandari at the time he met with the accident and she had
also sustained some injuries in the said accident. Both of them were brought to the emergency
department of Ludhiana Medicity, a unit of AA Hospital Pvt. Ltd. at about 9 pm. Deceased Anshu
Bhandari was in a critical condition at the time he was brought to Ludhiana Mediciti. He was
examined by the doctor on duty namely Dr. Pankaj who informed Dr. B. S. Sekhon, MD
(Anaesthesia). Dr. B.S. Sekhon examined him at about 9-10 pm and called Dr. Bikramjit Singh
Sandhu, appellant in FA/481/2014. Dr. Sandhu examined him at about 09:30 pm. At that time,
blood pressure of the deceased was 90/60 and his heart rate was 120. After starting intravenous
fluids and inserting a urinary catheter besides giving the pain killers, several investigations were
advised by Dr. Sandhu. He was shifted to ICU at about 10 pm and his bed side X-ray and ultrasound
was done. The X-ray did not indicate pneumothorax. The ultrasound started at about 10:15 pm and
took about 20 minutes. The ultrasound indicated haemoperitoneum and pelvic hematoma. The
deceased was discharged from Medicity, Ludhiana at the responsibility of his family members at
about 11:30 pm and was taken to CMC Hospital where he expired at about 01:45 am on 18.04.2009.

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 M/S. Aa Hospital Pvt. Ltd. & Anr. vs Simple Bhandari & 2 Ors. on 20 October, 2020

As per the post-mortem report, his death was caused due to hemorrhagic shock resulting from
multiple injuries in a road side accident. Alleging negligence in the treatment of late Sh. Anshu
Bhandari, the complainants approached the concerned State Commission by way of a Consumer
Complaint filed on 09.12.2009.

2. Dr. Gaurav Sachdeva, Dr. Raman Singla, Dr. Parveen Popli and Dr. Bikramjit Singh Sandhu of
Mediciti, Ludhiana were also impleaded as parties in the Consumer Complaint besides impleading
the insurance companies and insurance consultants.

3. The complaint was resisted by the hospital as well as by the doctors who were impleaded as the
OPs in the Consumer Complaint. It was inter-alia stated in its written version that there was no
negligence in the treatment of the deceased at Medicity, Ludhiana and that the treating doctors had
planned a laparotomy for the treatment of haemoperitoneum but the family members of the
deceased refused the consent required for the aforesaid procedure and they took discharge at their
own responsibility when the patient was in a critical condition and was not in a position to travel
upto CMC Hospital.

4. The State Commission, vide impugned order dated 22.05.2014, directed as under:

21. The next point is quantum of compensation. The deceased patient was an Advocate, aged about
30 years. In 2007-08 his return was Rs. 99,300/- and in 2008-09, it was Rs. 1,14,600/-. As a round
figure it is to be taken as Rs. 1,14,000/- and after deducting 1/3rd, the dependency is Rs. 76,380/-
and after applying the multiplier of 16, it will come to Rs. 12,22,080/- and after giving the future
prospectus to the extent of 30%, it will come to Rs.3,66,624/-, its total will come to Rs. 15,88,704/-
and after taking into consideration the expenses on treatment, it can be taken as Rs.16 lacs.
Rs.2,00,000/- are awarded on account of pain and suffering and Rs.21,000/- are awarded as
litigation expenses. Out of this amount Rs.10 lacs will be paid by OP Nos. 1 & 2 and remaining
amount by OP No.4.

22. So far as OP No.4 is concerned, he has pleaded that he is covered with the insurance policy of
United India Insurance Co. Ltd. There is written reply/statement filed by OP No. 9 that OP No.4 and
OP No. 5 were covered with the insurance policy. So far as the amount of the policy was Rs. 5 lacs,
therefore, to that extent the liability will be shared by OP No. 9 to cover the claim of OP No.4.

23. The above mentioned opposite parties are directed to comply with the above directions within 45
days from the receipt of copy of the order, otherwise proceedings under Section 27 of the CP Act
shall be initiated against them.

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 M/S. Aa Hospital Pvt. Ltd. & Anr. vs Simple Bhandari & 2 Ors. on 20 October, 2020

5. Being aggrieved from the order passed by the State Commission, Dr. Bikramjit Singh Sandhu is
before this Commission by way of FA/481/2014 whereas M/s A.A. Hospital Pvt. Ltd. and M/s
Ludhiana Mediciti are before this Commission by way of FA/1186/2014.

6. A perusal of the impugned order would show that the State Commission found negligence on
the part of Dr. Bikramjit Singh Sandhu and the hospital primarily on the ground that no treatment
to the deceased was given for haemoperitoneum and pneumothorax.

7. As far as pneumothorax is concerned, the case of the appellants is that it was not indicated
either in the X-Ray report or in the ultrasound report and therefore, there was no basis for giving
treatment for pneumothorax to the deceased.

8. An article on evaluating and managing pneumothorax available on page no.408 of the

paper-book deals with the diagnosis of pneumothorax and to the extent it is relevant, the said article
reads as under:

DIAGNOSIS BY CHEST X-RAY The diagnosis of pneumothorax is radiologic in all cases except
when a tension pneumothorax is suspected. The first and often only test required in a standard
anteroposterior (AP) chest film. The diagnosis is made by identifying a viscera pleural line
separated by a space without pulmonary vasculature or lung markings adjacent to the chest wall.
The overall sensitivity of chest x-rays in detecting pneumothorax is around 80%.

Traditionally, expiratory chest x-rays have been thought to have a higher sensitivity than inspiratory
films, but the current literature does not support that. Theoretically, the volume of the
pneumothorax will not change with the various stages of respiration, which should make it more
obvious on expiratory films. Recent studies have refuted this medical axiom, however, and
inspiratory films should suffice to rule out a pneumothorax.

Supine chest AP films are notoriously inaccurate. Because they result in air spreading out over the
anterior chest, supine films often appear normal, even in the presence of significant air. Frequently,
the only indication is the "deep sulcus sign", so named because of the appearance of an essentially
deep costovertebral sulcus.

COMPUTED TOMOGRAPHY AND ULTRASOUND Computed Tomography (CT) is exquisitely

sensitive for picking up a small, occult pneumothorax and is the best choice for diagnosing the
condition in the supine trauma patient. The more prevalent use of CT scans in trauma patients has
led to increased detection of pneumothorax, but the clinical utility of this is unclear. Many of these
small pneumothoraces will resolve spontaneously without intervention, although their presence may
have management implications in patients requiring mechanical ventilation or air transport or
planning air travel. Pneumothorax is frequently and inadvertently diagnosed in the supine trauma
patient undergoing CT for other concerns.

Another promising modality is ultrasound, preliminary evidence with experienced

ultrasonographers both in Europe and the United States show sensitivities for diagnosing

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 M/S. Aa Hospital Pvt. Ltd. & Anr. vs Simple Bhandari & 2 Ors. on 20 October, 2020

pneumothorax approaching 100% in skilled hands. Ultrasound may also be helpful to physicians
practicing in an austere environment where radiologic studies are not readily available. With proper
training and experience, ultrasound should become a more useful tool for the emergency physician
to utilize for the supine trauma patient too unstable for CT.

These pneumothoraces can be divided into three classes; simple, communicating, and tension (see
table).

Traumatic Pneumothorax Type Definition Management Simple pneumothorax No communication

with outside air and no mediastinal shift.

Observation if small and asymptomatic

Aspiration, observation and repeat chest X-Ray
Tube thoracostomy and admission

Communicating pneumothorax ("sucking chest wound")

Open hole in chest with free communication to outside air.

Cover hole, then tube thoracostomy and admission.

Tension pneumothorax

Flap-valve effect creates increasing intrathoracic pressure with hemodynamic compromise

Needle decompression, tube thoracostomy and admission.

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 M/S. Aa Hospital Pvt. Ltd. & Anr. vs Simple Bhandari & 2 Ors. on 20 October, 2020

Catamenial pneumothorax

Occurs in women during menses from thoracic endometriosis

Observation, aspiration or tube thoracostomy

Refer for preventive procedues and hormonal therapy.

TENSION PNEUMOTHORAX. A tension pneumothorax occurs when an injury creates a flap-valve

effect, permitting ingress but not egress of air from the thoracic cavity. Each time the patient takes a
breath, more air enters into the thoracic cavity. The result is increasing intrathoracic pressure with
subsequent shifting of the mediastinal structures to the opposite side. If the pneumothorax may
present with tachycardian, hypotension, jugular vein distension, tracheal deviation, and absent
breath sounds on the involved side. The diagnosis should be based on clinical, not radiographic
findings.

9. It would thus be seen that though X-ray chest is one of the diagnostic tools to confirm
pneumothorax, the sensitivity of the chest X-ray in detecting pneumothorax is only about 80%. The
medical literature extracted hereinabove would show that CT Scan would clearly pick up even small
pneumothorax and is the best choice for diagnosing the complainant in the supine trauma patient.
The literature would also show that ultrasound scan, if done by a good Sonologist, has 100%
accuracy in diagnosing pneumothorax. The literature also shows that ultrasound may be a more
useful tool for emergency diagnosis of pneumothorax. In the present case, there is no evidence of
Dr. Sandhu having advised CT Scan of the deceased. The medical literature extracted hereinabove
would show that patients with tension pneumothorax may inter-alia have tachycardia and
hypotension. The record of the hospital would show that the Blood Pressure of the deceased 90/60
and his pulse rate was 120 at the time he was brought to the hospital. Therefore, not only he had

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 M/S. Aa Hospital Pvt. Ltd. & Anr. vs Simple Bhandari & 2 Ors. on 20 October, 2020

tachycardia, he also had hypotension. Therefore, clinical symptoms indicating tension

pneumothorax were certainly present. The question which arises for consideration is as to whether
Dr. Sandhu can be said to be negligent in not treating the deceased for pneumothorax/tension
pneumothorax despite the above referred clinical symptoms, relying upon X-ray report and
ultrasound which did not indicate pneumothorax/tension pneumothorax. It is quite possible that
some other doctor, in place of Dr. Sandhu might have advised CT Scan of the deceased or might
have started treatment for pneumothorax/tension pneumothorax despite the X-ray report and
ultrasound report, considering the tachycardia and hypertension noticed during the clinical
evaluation of the patient. Such an approach might have been more prudent but, not treating the
patient in pneumothorax/tension pneumothorax would not constitute negligence in the treatment
of the patient when the ultrasound report and X-ray report did not give any indication of the
aforesaid ailment. This would be a case of error of judgment but not a case of negligence as far as
the failure to treat the patient for pneumothorax/tension pneumothorax is concerned.

10. It is an admitted position that the haemoperitoneum was suspected in the clinical evaluation
and was confirmed in the ultrasound report. This is not the case of the appellants that the deceased
did not have symptoms of haemoperitoneum and did not require treatment for the same. The case
of the appellants rather is that they had planned laparotomy For the treatment of haemoperitoneum
but the laparotomy could not be done, the family members of the deceased having refused consent
sought by them for performing the said procedure. The case of the complainant is that no consent
for performing laparotomy was sought from them and in fact, no worthwhile treatment was given to
the deceased and that was the reason they had to shift him to CMC Hospital even at a time when the
deceased was in a critical condition. There is absolutely no documentary evidence of the appellants
having sought consent to perform laparotomy on the deceased for the purpose of treatment of
haemoperitoneum. Had such a consent been sought and refused, this would certainly have been
noted in the record of the treatment maintained in the hospital. Seeking of consent to perform
laparotomy on a patient admitted in a highly critical stage and denial of such a consent by the family
members despite they being present in the hospital, was too important a fact to be inadvertently
omitted from being noted in the treatment record of the patient.

11. The appellants have relied upon the record of the hospital prepared at the time when the
patient was discharged on the request and at the responsibility of his family members. It was
specifically noted in the record that the patient was in a critical condition and was not in a position
to travel upto CMC Hospital. But, there was no mention of the consent for performing laparotomy
having been sought and refused. Thus, the alleged seeking and refusal of consent for laparotomy
was not recorded either at the time the consent was sought nor at the time the patient was
discharged from the hospital against the advice of the treating doctors. In fact, considering the
critical condition of the patient at the time haemoperitoneum was conformed in the ultrasound
report, no consent from the family members of the deceased was necessary and the treating doctor
could, in such an emergency, have gone ahead with the procedure without seeking such a consent, in
order to save the life of the patient. A reference in this regard can be made to the decision of the
Hon'ble Supreme Court in Samira Kohli Vs. Prabha Manchanda (Dr.) & Anr., I (2008) CPJ 56 (SC)
decided on 16.01.2008.

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 M/S. Aa Hospital Pvt. Ltd. & Anr. vs Simple Bhandari & 2 Ors. on 20 October, 2020

12. For the reasons stated hereinabove, I have no hesitation in holding the finding of the State
Commission that despite haemoperitoneum having been confirmed, no attempt was made by the
hospital and the treating doctor to undertake laparotomy even till the patient was discharged at
about 11:30 pm. There was a time lag of about one hour between confirmation of haemoperitoneum
through ultrasound report and the discharge of the patient from the hospital on the responsibility of
his family members. Every minute is important in the case of such a critically injured person.
Therefore, the appellants were clearly negligent in the treatment of the deceased by not undertaking
laparotomy even till the time he was discharged at about 11:30 pm.

13. Coming to the quantum of compensation, the learned counsel for the appellants submits that
the legal heirs of the deceased have been awarded compensation of about Rs.14 lacs by the Motor
Accident Claims Tribunal. Considering all the facts and circumstances of the case, including the age
of the deceased, I feel that a compensation amounting to Rs.15,00,000/- to the complainants would
be justified. Out of the aforesaid amount of Rs.15,00,000/-, Rs.10,00,000/- will be paid by the
appellants in FA No.1186 of 2014 whereas the remaining Rs.5,00,000/- will be paid by the appellant
in FA No.481 of 2014. Since the insurance cover of Rs.5,00,000/- was taken by Dr. Bikramjit Singh
Sandhu, the aforesaid amount of Rs.5,00,000/- will be payable by the insurer United India
Insurance Co. Ltd. If the liability of the appellants in FA No.1186 of 2014 was covered under an
insurance cover, the payment will be made by the insurer. The complainants shall also be entitled to
interest which may have accrued on the deposits made in compliance of the interim order of this
Commission.

The payment in terms of this order shall be made within two months from today failing which it
shall carry interest @ 9% per annum from the date of order of the State Commission.

It is informed that the appellant in FA No. 481 of 2014 had deposited 50% of the amount awarded
by the State Commission. The interest which has accrued on that amount, shall be paid to the
complainants. The principal amount shall be released to the aforesaid appellant after the
complainants have been paid by his insurer.

......................J V.K. JAIN PRESIDING MEMBER

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