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                                    NON-REPORTABLE IN THE SUPREME COURT OF INDIA CIVIL APPELLATE JURISDICTION CIVIL APPEAL NO. 6284  OF 2014

(@SPECIAL LEAVE PETITION (CIVIL.) NO. 18367 OF 2012) MRS. KANTA      … APPELLANT

VERSUS

TAGORE HEART CARE & RESEARCH CENTRE PVT. LTD.& ANR.      …RESPONDENTS

J U D G M E N T

CHANDRAMAULI KR. PRASAD, J.

The  complainant-appellant,  aggrieved  by  the  

order dated May 27, 2011 passed by the National  

Consumer 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’)

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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  

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  

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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.  

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  

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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  

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  

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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  

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,  

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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  

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  

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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  

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  

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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  

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  

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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  

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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  

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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  

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  

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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  

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  

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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.

                            …....………..……………………………….J.

   (CHANDRAMAULI KR. PRASAD)   

………………….………………………………….J.   (PINAKI CHANDRA GHOSE)

NEW DELHI, JULY 10, 2014.

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