BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD.
CC 44 of 2010
Between:
K.Sanjeev Kumar @ Kamma Sanjeeva Rao
S/o K.Papa Rao @ Kamma Paparao and Dhanalaxmi
Aged 33 years, Occ: Agriculture, R/o Kopparthi Camp Village
Bodhan Mandal, Nizambad District
(Amended cause title is substituted as per the
Orders passed in CCIA No.800/2011 dated 02.03.2012
*** Complainant
A N D
- Krishna Institute of Medical Sciences (KIMS),
Rep. by its Managing Director
Minister Road, Secunderabad, A. P.
- Dr. B. Bhaskar Rao, s/o not known to the
Complainant, aged not known, Occ : Cardio Thorasic Surgeon,
Krishna Institute of Medical Sciences (KIMS),
Minister road, Secunderabad – 500003.
- Oriental Insurance Company Ltd,
Division office No. 4, first floor, 6-2-976, Pavan Estates,
Khairatabad, Hyderabad rep. by its Divisional Manager
(Proposed party is added as opposite party no. 3
As per the orders passed in CCIA no,. 801/2011
Dated 02.03.2012
*** Opposite Parties
Counsel for the complainant: Sri Vakkanti Narsimha Rao
Counsel for the Opposite parties 1&2 Sri G.Sudarshan Reddy
Counsel for the Opposite party No.3 Sri K.Venkateswhara Rao
QUORUM :
HON’BLE SRI JUSTICE B.N.RAO, PRESIDENT
&
SRI PATIL VITHAL RAO, MEMBER
THURSDAY THE THIRTY FIRST DAY OF AUGUST
TWO THOUSAND SEVENTEEN
Oral Order : (per Hon’ble Sri Justice B.N.Rao Nalla, Hon’ble President)
***
Initially this complaint was dismissed by this Commission on the ground of the complaint being barred by limitation. Aggrieved by the said order, the complainant preferred F.A.No.191 of 2013 before the Hon’ble National Commission and the National Commission vide its order dated 5.10.2015 allowed the appeal setting aside the order passed by this Commission and directed this Commission to restore the complaint for adjudication on merits.
2. This is a complaint filed by the complainant originally against the opposite parties 1 and 2 only seeking compensation of Rs.25 lakhs with interest @ 12% p.a. and costs alleging medical negligence and deficiency in service and during pendency of complainant opposite party no.3 insurance Company has been brought on record.
3. The brief facts of the complaint are that the complainant who is an Agriculturist suffering from heaviness in chest consulted Dr. B.L. Agarwal, a Cardiologist, Usha Mullapudi Hospital, Gajula Ramaram, Hyderabad on 21.05.2003, who, diagnosed him as “Severe Mitral Regurgitation (M.R). When the complainant consulted Dr. G. Ravi kanth of OP No.1 hospital on 29.10.2004, he estimated expenditure at Rs.1,50,000/- for MVR ( Mitral Valve Replacement) operation and that the operation was performed on 19.01.2005 by the surgeons, i.e. opposite party no. 2 , Dr. D. Vijaya Kumar and Dr. Baradwaj and that Mitral valve was replaced with no. 23 TTK Chitra Prosthetic valve. There after also, he is not relieved from the problems of chest heaviness and breathing. Therefore, he consulted Dr. G. Ravi Kanth on 02.02.2005, who, gave treatment from 02.022005 to 05.02.2005 and he has been visiting the hospital for every six months and the last visit was on 13.2.2008. For the first time, on 13.02.2008 Dr. Ravi Kanth told him that there was again some leaking and valve has to be again repaired or replaced. While asleep, the complainant suddenly wakes up he feels he is in utter confusion and death is looming large and would die within minutes, he gaps severely and he is unable to walk at least one Kilometer at a stretch. On 23.10.2008, he consulted Dr. A. V. Anjaneyulu of Care Hospital, Hyderabad who told him that as Valve replacement was not correctly done all these problems arose. Till 13.02.2008 the doctors of the OP concealed that fact that the valve was not correctly replaced. The quality of life of the complainant became worse as his life expectancy has come down and thus he filed the complaint alleging deficiency in service and negligence on the part of the opposite parties and prayed as stated in para no.1 supra.
4. Opposite parties filed their counter resisting the case and contending that the complainant got operated for Severe Mitral Regurgitation on 19.012005 and was discharged on 27.01.2005. Again, he was readmitted on 02.02.2005 with a complaint of chest heaviness and breathlessness and after giving treatment he was discharged on 05.02.2005. His post-operative Echo Cardiogram conducted on 24.01.2005 and 26.01.005 revealed moderate para valvular leak. On 05.02.2005 when he was discharged he was advised and asked to follow up every 2 to 3 months, but he did not do so. After lapse of three years, the complainant visited the hospital only on 13.2.2008. After MVR operation, the para vulvular leak is a known complication it may be mild, moderate or severe and it occurs between 5 to 15% of the cases. The mild and moderate leaks can be treated medically and sometimes the leaks may not progress to severe. Therefore the patient was asked to follow up treatment every two to three months to know the progression so that appropriate measures can be taken. The case of the complainant is a leak moderate but he did not care to visit the hospital for about three years and as such the hospital could not follow up his progress. In the meanwhile, he developed symptoms because of progression of leak. Had the complainant visited the hospital regularly as was advised the physician/surgeon could have treated him suitably by conducting surgery or catheter intervention to improve his symptoms. The OP hospital neither concealed nor delayed the treatment. There is no deficiency in service on the part of Ops so also evidence that OP hospital was negligent in conducting operation and on the other hand the complainant himself was negligent in not following the advice of the hospital to consult periodically. The complaint is vexatious one and only to extract money from Ops after a period of five years after undergoing surgery and thus the complaint is barred by limitation. Non attending the hospitals clearly proves that the patient was not suffering from any defect and thus no mental agony was caused by the Ops 1 & 2 and thus prayed to dismiss the complaint.
5. As per orders in I.A. No. 801/2011 dated 02.03.2012 opposite party no.3, Oriental Insurance Company has been ordered to be impleaded and though before remand of the case by the Hon’ble National Commission, the opposite party no.3 did not file any counter and after the remand of the matter, it had filed its counter contending that the Professional Indemnity Policy for doctors and medical practitioners/medical establishments is purely based on the principle of privity of contract between the insured and insurer. The liability of the insurer lies subject to the fulfillment of terms and conditions of the policy and the exceptions thereof. No stranger to the contract can have any right, interest or claim in the policy. Thus the complainant has no right to sue opposite party no.3 by instituting any complaint against it. The opposite party no.1 had never approached the opposite party no.3 for reimbursement of any claim arising out of their contract under the Medical Establishments Errors Insurance policy nor complained to this Commission against opposite party no.3 alleging that they have committed nay deficiency of services towards them. Neither the complainant nor the opposite party no.1 can implead opposite party no.3 in the present complaint as the dispute is between complainant and opposite party no.1. No cause of action arose so far to institute a claim or implead the opposite party no.3 in the present complaint as they have never committed any deficiency of service towards the opposite party no.1 either by way of repudiating any of their claims under the insurance policy. Hence, the opposite party no.3 prayed for dismissal of the complaint.
6. The complainant has filed his evidence affidavit and additional evidence affidavit reiterating his aforesaid contentions and got Exs.A1 to A20 marked. On behalf of the opposite parties no.1 and 2, the opposite party no.2 filed his evidence affidavit and got ExB1 marked. While on behalf of the opposite party no.3, its Regional Manager has filed his evidence affidavit and got Ex.B2 marked.
7. No representation for complainant and opposite party no.3. Counsel for opposite parties no.1 and 2 present and was heard. Written arguments of both parties filed.
8. Now the points for consideration are
- Whether there is any medical negligence and deficiency in service
on the part of opposite parties as alleged?
- Whether the complainant is entitled for compensation, if so, to
what relief?
9. Point No.1 : There is no dispute that the complainant consulted Dr. G. Ravikanth of opposite party no.1 hospital on 29.10.2004 and that for the operation of Mitral Valve Replacement an estimation for Rs.1,50,000/- was given by the said hospital. It is also not in dispute that opposite party no.2 and Dr. D. Vijayakumar and Dr Bharadwaj attended on the complainant and the surgery was done on 09.01.2005 and the Mitral Valve was replaced with number 23 TTK chitra Prosthetic valve. According to the complainant he was not relieved of his suffering and on the other hand the chest heaviness and breathing problem increased and therefore he consulted Dr. G. Ravikanth on second February, 2005 and then he gave some treatment in the said context from the said date to 05.02.2005. According to the complainant he has been visiting the hospital once in every six months and the last visit was on 13.2.2008 and that for the first time on 13.2.2008 Dr. Ravikanth disclosed to the complainant that operation was not successful and that was the reasons for the suffering and that the said doctor also informed him that there was again some leakage and valve has to be repaired or replaced. The complainant pleads that he feels that death is looming large and would die within minutes and he gasps severely and unable to walk , work and earn as before and hence it so happened on account of gross negligence of the doctors of opposite party no.1 which resulted in failure of the operation. It is also the case of the complainant on 23.10.2008 he consulted Dr. A. V. Anjaneyulu of Care Hospital, Hyderabad, who informed him that since valve replacement was not correctly done such problem arose to him and that till 13.2.2008 doctors of the opposite party hospital concealed the fact that the valve was not correctly replaced and that only on 13.2.2008 the negligence of the doctors of opposite party no.1 hospital came to light which was confirmed by Dr. A. V. Anjaneyulu on 23.10.2008 and that there is gross professional negligence on the part of the opposite parties no.1 and 2. There is no dispute that the complainant was admitted in the hospital of opposite party no.1 hospital on 17.01.2005 and that on 19.01.2005 surgery was conducted for replacement of Mitral Valve and that on 27.01.2005, he was discharged advising to come for review after one month with PT and INR reports. Thereafter, the complainant was admitted into the hospital; on 02.02.2005 with complaint of vomitings and Dyspnea and that after treatment he was discharged on 5.2.2005 advising him to come again for review after five days PT and INR after 15 days. It appears that the complainant went to the hospital on 17.02.2005 and again he was advised PT after 15 days by Dr. Ravikanth and thus there was no delay in review. Again on 02.03.2005 the complainant approached Dr. Ravikanth and then he was advised to consult Dr. M.B.V. Prasad for Cholelithiasis. After the said advice for consultation of Dr.MBV Prasad for Cholelithiasis, it is not known whether he consulted Dr.MBV Prasad or not. Instead after 8 months i.e., on 09.11.2005, he went to the hospital for review and then Dr. TNC Padmanabhan and Dr. Bhaskara Rao, treated him and advised for review after three months. But the complainant did not go to the hospital of opposite parties till 13.2.2008. On that day i.e., 13.02.2008 the doctors at opposite party no.1 advised him to review after one month. After one month, as per the documents filed by the complainant, he did not visit the opposite parties for followup treatment. On the other hand as per his version, he consulted Dr.Anjaneyuilu of Care Hospital on 23.10.2008 i.e., after eight months of the last visit at opposite parties.
10. Now the question that falls for consideration is as to whether, there was any medical negligence, on the part of the Doctors of Opposite Party No.1, in operating upon the complainant and, for the disease aforesaid, or not. The Honble Supreme Court in Kusum Sharma and Ors. Vs. Batra Hospital and Medical Research Centre and Ors. Reported in I(2010) CPJ 29 (SC), held in para-94 as under:-
94. On scrutiny of the leading cases of medical negligence both in our Country and other Countries specially United Kingdom, some basic principles emerge in dealing with the cases of medical negligence. While deciding whether the medical professional is guilty of medical negligence, the following well known principles must be kept in view:
I. Negligence is the breach of a duty exercised by omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do.
II. Negligence is an essential ingredient of the offence. The negligence to be established by the prosecution must be culpable or gross and not the negligence merely based upon an error of judgment.
III. The medical professional is expected to bring a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires.
IV. A medical practitioner would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field.
V. In the realm of diagnosis and treatment there is scope for genuine difference of opinion and one professional doctor is clearly not negligent merely because his conclusion differs from that of other professional doctor.
VI. The medical professional is often called upon to adopt a procedure which involves higher element of risk, but which he honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure. Just because a professional looking to the gravity of illness has taken higher element of risk to redeem the patient out of his/her suffering which did not yield the desired result may not amount to negligence.
VII. Negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession.
VIII. It would not be conducive to the efficiency of the medical profession if no Doctor could administer medicine without a halter round his neck.
IX. It is our bounden duty and obligation of the civil society to ensure that the medical professionals are not unnecessary harassed or humiliated so that they can perform their professional duties without fear and apprehension.
X. The medical practitioners at times also have to be saved from such a class of complainants who use criminal process as a tool for pressurizing the medical professionals/hospitals particularly private hospitals or clinics for extracting uncalled for compensation. Such malicious proceedings deserve to be discarded against the medical practitioners.
XI. The medical professionals are entitled to get protection so long as they perform their duties with reasonable skill and competence and in the interest of the patients. The interest and welfare of the patients have to be paramount for the medical professionals.
11. In the case of Jacob Mathew (Dr.) Vs. State of Punjab & Anr.-III (2005) CPJ 9 (SC), it was held by the Apex Court, that a physician would not assure the patient of full recovery in every case. A surgeon cannot and does not guarantee that the result of the surgery would invariably be beneficial much less to the extent of 100% for the person operated upon. The only assurance which such a professional can give or can be understood to have given by implication is that he is possessed of the reasonable skill, in that branch of profession, which he is practising and while undertaking the performance of the task entrusted to him, he would be exercising his skill, with reasonable competence.
12. In Laxman Balakrishan Joshi Vs. Trimbak Bapu Godbole and Anr.-AIR 1969 SC 128, the Apex Court laid down the criteria for determination of the professional duty of a medical man. The Honble Supreme Court held that a person who holds himself out ready to give medical advice, and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person, when consulted by a patient, owes himself certain duties viz. a duty of care, in deciding whether to undertake the case, in deciding what treatment to give or duty of care, in administration of that treatment.
13. It is evident, from the principle of law, laid down, in the aforesaid cases, that as long as, the Doctor performs his duties and exercises an ordinary degree of professional skill and competence, he cannot be held guilty of medical negligence. It is imperative that the doctor must be able to perform his professional duties, with free mind. Now, let us see, as to whether, the opposite party no.2 , in this case, performed his duty, by exercising an ordinary degree of professional skill and competence, in conducting operation on the complainant and treating him. It is evident, from operation notes of complainant of opposite party no.1 , that he was admitted therein, on 17.01.2005, and surgery was done on 19.01.2005 at 9.00 a.m. for replacement of mitral valve. Operative findings were LA enlarged, PA soft. MV (AML) Prolapse, Ruptured Chondae. Myxomatous degeneration. No calcium. No Fibrosis. Median Sternotomy, division lf thymus and pericardiotomy done. Heparin given. Patient put on Cardio Pulmonary Bypass with Aortic and RA cannulation. Aortic root cannulated with CP cannula. Patient cooled to 25C. Aorta cross clamped heart arrested by delivering antegrade, cold Cardioplegia. LA opened. Mitral valve excised, PML preserved MV replaced with NO.23 TTK Chitra Prosthetic Valve with 2-0 Polyester interrupted sutures. The complainant was discharged on 27.01.2005, from the opposite party no.1 hospital, in a satisfactory and comfortable condition. The valve tested and found satisfactory. Rewarming started. LA closed in two layers. Deairing done. Aortic cross clamp removed heart picked up in sinus rhythm with DC shock. After rewarming the patient to 370 C, weaned off from CPB with mild Iontropic support. Protamine given. Haemostatasis secured. Sternum closed with wires after keeping two mediastinal drains. Rest of the wound closed in layers. Patient shifted to CT. Post Operative ward with stable haemodynamics for electctive ventilation. Right pleura is open. The complainant had no complaint at the time of discharge as is evident, from the outpatient card. Had there been any complaint, on the part of the complainant, that he has any chest pain or had he been having any problem, at that time, he would have certainly told about the same, to the Doctor(s) attending on him, and the same would have certainly been taken care of. Thereafter, the complainant admitted in the opposite party no.1 hospital on 02.02.2005 with the complaint of vomiting and dyspnoea. On examination it was found that the chest was clear, prosthetic valve sounds well heard. During the stay in the hospital he was managed with Dobutamine infusion, Inj. Lasix, Tab. Enam, Lanoxin. Patient was found to have anaemic (Hb-8.6% gms%) and PT, INR was raised, Tab. Warf was withheld. The complainant was discharged on 05.02.2005 and advised to review after 5 days with Dr.G.Ravikanth with prior appointment. On 10.02.2005 the complainant visited Dr.G.Ravikanth and at that time the complainant had no fever and no cough after checking the complainant was advised to continue medicines and advised review after 15 days. On 02.03.2005 the complainant visited the opposite party no.1 hospital for follow up treatment. The complainant did not care to attend the hospital and after lapse of about 8 months on 09.11.2005 visited the opposite party no.1 hospital and after check up the doctors advised him review after 3 months. But the complainant did not turn up till 13.02.2008. The complainant alleged that on 13.02.2008 when he visited Dr.Ravi Kant he disclosed to the complainant that operation was not successful and that there was again some leakage and valve has to be again repaired or replaced. There is no proof that Dr.Ravikanth had informed about failure of the surgery nor any affidavit of him filed to prove the same.
13. On 13.02.2008 after attending the complainant by Dr.Ravikanth advised him review after 3 months. Had Dr.Ravikanth informed about failure of surgery he ought not to have advised him review after 3 months instead he could have advised for repair of valve or replacement of the same immediately. But the said doctor did not advise so instead advised review after three months but the complainant did not turn up and on the other hand after lapse of 8 months consulted Dr.Anjaneyulu of Care Hospital on 23.10.2008. After consulting Dr.Anjaneyulu what the complainant had alleged in his complaint, affidavit and written arguments that the said Dr.Anjaneyulu informed the complaint that the operation was failed and as such he has been suffering with chest pain, gasps, breathlessness etc. Except making bald allegations that the said Dr. Anjaneyulu commented that the operation failed, he did not file any proof to show that in fact the said doctor had passed such sort of comments. Even the complainant has not chosen to examine Dr.Ravikanth or Dr.Anjaneyulu to elicit the truth about the alleged failure of surgery. The complainant did not file any proof to show that he has been suffering with the complaints as mentioned by him in his complaint after the last review/visit at opposite party no.1 hospital till 13.02.2008 and from 23.10.2008 till filing complaint. At least the complainant failed to file the advices and prescriptions of the Dr.Anjaneyulu to show that he advised so and so medicines and what is the next course of treatment he required to be undergone. Simply he filed complaint in the y ear 2010 alleging that “after the operation quality of the life of the complainant became worse. While asleep he suddenly wakes up; he feels he is in utter confusion. Sometimes he feels death is looming large and would die within minutes, he gasps severally. He is unable to walk at least one kilometer at a stretch”. These are not complaints in fact they are his feelings. It is pertinent to note that had the complainant been suffering severely he would not have waited for not opting repair or replacement of the valve. If really the complainant had been suffering with such problems, he would have definitely undergone re-do surgery or would have got it repaired the mitral valve till now. But this has not happened if it had happened he would have filed some proof to show that he had taken treatment for such problems. Ex.C1 is the expert opinon given by NIMS doctors stating that “ peri-valvular leaks are known to occu in 0-1% cases following valve-replacement. The causes are technical factors surgery as well as patient factors like quality of the tissues, infection and calcification at the operative site. Mild leaks and asymptomatic patients can be treated with medicines alone. Significant leaks in symptomatic patients require redo surgery to tackle the leak and replacement of valve if necessary irrespective of the time when it is detected in relation to the primary surgery. In our opinion the valve surgery done on 19.01.2005 has not relieved the patient of his symptoms and he has significant per-valvular leak. He needs a re-do valve surgery of the same valve”. The report nowhere stated that the doctors were negligent in conducting surgery they said peri-valvular leaks are caused due to technical factors surgery as well as patient factors like qulity of the tissues, infection and calcification at the operative site. It may be also due to like quality of the tissues, infection and calcification at the operative site. If really the complainant had the problems as mentioned in the complaint, he definitely would have taken treatment immediately but he had not taken any treatment till now and he is on medicine which was prescribed by the opposite parties. It means he has mild to moderate known complications of MVR. Ex.A12 which is copy of 2D Echo Cardiograph report clearly shows that “ post MVR status, restricted prosihthetic valve function (MVA:1.1sqcm), Moderate Paravalvular MR NO PAH, Trival TR. Paradoxical septal motion Normal LV function” and he was not suffering with any problems as alleged.
14. According to European Heart Journal the recommendations for the management of patients after heart valve surgery are as follows:
Follow-up after surgery Recommendations
- The first post-operative visit to hospital or a cardiac specialist should be within 6 weeks of discharge if there has been no period of inpatient rehabilitation, or within 12 weeks if a rehabilitation programme has been completed.
- At the first post-operative visit, it is important to assess the completeness of wound healing and to establish baselines for continued follow-up in terms of:
- Symptomatic status and physical signs.
- Heart rhythm and ECG abnormalities.
- Chest X-ray, to ensure resolution of any post-operative abnormalities.
- Echocardiography to assess any pericardial effusion, ventricular function, prosthetic function, the competence of valve repair, and disease at other valve sites.
- Routine haematology and biochemistry and tests for haemolysis.
- The frequency of future follow-up should be determined by the patient's progress and by local facilities, but ideally all patients who have undergone valve surgery should continue to be followed-up at a cardiac centre in order to detect, at an early stage, deterioration in prosthetic function, recurrence of regurgitation following valve repair, or progression of disease at another valve site, any of which can occur with relatively little or no change in symptoms.2
- The frequency of echocardiography during follow-up should be determined by the results of previous echocardiography, symptomatic status, the type of surgery and the existence of other pathology.5,50 Patients requiring echocardiography at a clinic visit include:
- Patients in whom a previously identified abnormality requires monitoring for progression or response to treatment, e.g. mitral regurgitation, sewing ring thrombus, previous endocarditis, etc.
- Patients with new symptoms suggestive of prosthetic dysfunction, progression of another valve lesion, or worsening LV function. If prosthetic dysfunction is suspected, transoesophageal echocardiography and cinefluoroscopy may also be required to supplement transthoracic echocardiography.5 Cinefluoroscopy is useful for detecting early limitation of leaflet movement in bileaflet and tilting disc valves.51
- Patients with bioprostheses, homografts or autografts, to detect structural deterioration or, in the case of the Ross procedure, to detect aortic root dilatation,52 progressive aortic regurgitation, or structural deterioration in the pulmonary homograft.53 The likelihood of these complications increases after the first 5 years.
- Patients with Marfan's syndrome, to detect progressive dilatation of the aorta or progressive mitral regurgitation.54
15. The complainant admittedly did not take the follow up treatment as advised by the doctors at opposite party no.1. After the surgery when the complainant again admitted on 2.2.2005 in the opposite party no.1 hospital with the complaint of vomiting and dysphonia the doctors had treated him and discharged on 05.02.2005 with an advise to review after 15 days. Accordingly the complainant visited the opposite party no.1 hospital on 02.03.2005 and the doctors attended on him and advised to come for review. However, the complainant, took up the matter casually, and did not abide by the advice of the Doctor. He refused the treatment Guidelines, with an assurance to come, for regular follow ups, and did not return thereafter.
16. The complainant in his additional written arguments argued that the opposite parties were negligent in preferring surgical replacement of the mitral valve rather than its repair which is the best option. He also argued that inspite of continuous complaint of the problems, except carrying out PT test, 2D Echo was not done.
17. Heart valve repair or replacement is usually recommended once valve dysfunction becomes severe. Although symptoms of congestive heart failure may often be treated using medications, there are no good alternatives to surgical intervention for a severely dysfunctional heart valve, and without surgical correction many forms of heart valve disease will ultimately lead to progressive heart failure and death. Deciding when to proceed with surgical intervention depends upon a variety of factors including the patient’s symptoms and clinical presentation, which valve(s) are affected, the severity of valve dysfunction, the size and contractile function of the heart, whether the valve can be repaired or must be replaced, and the overall risks associated with surgery. It is the doctors who have to decide which one is better for the patient according to his condition. It is also to be noted that Mitral replacement had long been the standard surgical treatment for mitral regurgitation. Nearly 30 years of experience with modern mitral repair has now prompted mitral repair to be favored over replacement in most patients. However, many studies have now shown that mitral replacement with chordal preservation nearly eliminates the risk of ventricular-annular disruption and minimizes impairment of LV function. Preservation of the posterior chords provides the protection against ventricular-annular disruption and provides most preservation of LV function, but additional preservation of the anterior chords provides additional benefit in LV function. In fact, to date, no definitive data exist to say that mitral repair has advantage over chordal sparing mitral replacement, beyond the inherent issues of anticoagulation versus limited biological durability. Mitral replacement does have some inherent advantages over repair. The elimination of mitral regurgitation is more certain with replacement, especially when the quality of repair is in question.
18. 2D (PT) is a is working. Therefore, these two are different tests and advised by the doctors for different purposes. 2D Echo is advised for detection and quantification of MR. The echocardiographic assessment of the mitral valve can first provide a baseline evaluation to identify etiology and quantify the severity of MR. It will assess and quantify the left ventricular function and dimensions. It provides annual surveillance of the left ventricular function, estimated ejection fraction (EF) and the left ventricular end-systolic dimension (LVESD) in asymptomatic sever MR. Finally the role of echocardiography is to assess the adequacy of the surgical correction of the MR intra-operatively and postoperatively. The use of trans-esophageal echo and particularly intra-operatively, provides a precise assessment of the different components of the mitral valve. Mere bald allegation that though mitral valve repair is the best option rather than replacement the opposite parties chosen for replacement of mitral valve which shows the negligence on the part of the opposite parties and also that whenever the complainant visited for review the doctors at opposite party no.1 hospital prescribed PT test instead of 2D Echo are nothing but self-own statements which do not have any supporting evidence or any affidavit of the concerned specialist doctor. In the absence of any credible evidence, we are not inclined to accept the contention of the complainant. The complainant after remittance of the matter from the Hon’ble National commission has filed CCIA No.128 of 2017 before this commission praying to receive certain documents and the said petition was allowed and Exs.A17 to A20 were marked. These documents are nothing but receipts, discharge summary and 2D colour Doppler ECHO test reports. The discharge summary i.e., A18 shows that the complainant has suffered with Dengue fever with thrombocytopenia and has taken treatment in Sri Sri Holistic Hospitals from 5.10.2016 to 07.10.2016. Ex.A19 is the copy of 2D ECHO test report by which the complainant intend to show to this Commission that he has been still suffering with Mitral Valve Regurgitation. The Mitral Valve Replacement surgery was done on 19.05.2005 since then 12 years were elapsed still the complainant is going well with medicines. He also not filed any report of other hospitals or doctors to prove that he had been taking treatment elsewhere or he had undergone any surgery for the failure of earlier surgery.
19. According to website of National Center for Biotechnology Information, U.S. National Library of Medicine, after valve replacement, significant paravalvular leaks (PVL) may develop in up to 12.5% of the cases. Signs and symptoms include congestive heart failure and/or haemolysis and therefore may require re-intervention. Redo valve surgery is considered the therapy of choice for symptomatic patients, either by valve replacement or leak repair. Therefore, as per the literature the perivalvular leaks are known complication after mitral valve replacement. It could not attribute to the negligence of the doctors.
20. The complainant in his written arguments also argued that mere allegation of non-follow-up there is no evidence of any sort let-in by the opposite parties no.1 and 2. He also argued that Exs.A1 does not have any piece of advice in terms of next review or consultation which shows that there was no further review. If the argument of the complainant is considered, how could he keep quiet for all these years without consulting any doctors much less the opposite parties when he was suffering with problems.
21. At the cost of repetition, it may be said that the complainant did not explain as to why he did not go to the hospital of opposite parties for a considerable period of more than two years. According to the complainant, on 23.10.2008, he approached Dr. A. V. Anjaneyulu in Care Hospital, Hyderabad, and that he informed that the operation was not successful. As already described supra, even though, he was advised on 13.02.2008, to review after one month did not go to the said hospital or any other hospital till .23.10.2008 on which date he said to have consulted Dr. Anjaneyulu, Care Hospital. There is no evidence from the complainant’s side that after consulting Dr. Anjaneyulu he has undergone any treatment. There is no dependable evidence from the side of the complainant that he took medicines as advised during the said long period and in the circumstances of the case it is considered that since he was not feeling any inconvenience or discomfit he did not approach the opposite parties hospital. The said aspects clearly go to show that the complainant was irregular in getting treatment and also reviewed his case.
22. Therefore, Opposite Party No.2, under whose supervision the operation was conducted, along with other Doctors, performed their duties, by exercising an ordinary degree of professional skill and competence, in treating the complainant. Since no medical negligence was attributable to the Opposite Parties, by no stretch of imagination, it could not be said that they were deficient, in rendering service.
23. No doubt, according to the complainant, when he did not feel relief, he went to Dr.Anjaneyulu of Care Hospital who told that the Doctors of Opposite Party No.1 did not properly conduct the operation on him. However, such bald assertion, without any proof, could not be taken into consideration. No affidavit of Dr.Anjanaeyulu of Care Hospital was placed on the record, to the effect, that he examined the complainant, and found that the operation was not properly conducted on him, by the Doctors of Opposite Party No.1. Had Dr. Anjaneyulu, told the complainant that operation on him, by the Doctors of Opposite Party No.1, was not properly conducted, there would have been no hitch on his (Dr. Anjaneyulu) part, to submit his affidavit, in that regard. Had Dr. Anjaneyulu, submitted his affidavit, in that regard, the matter would have been different. The facts, in this case, did not speak for themselves that there was medical negligence, on the face of it, on the part of the Doctors of Opposite Party No.1, under whose supervision the operation was conducted.
24. In the final analysis, it is held that Dr.Bhaskar Rao /Opposite Party No.2, along with other Doctors of Opposite Party No.1, exercised an ordinary degree of skill and competence, in conducting operation on the complainant and treating him, in the best possible manner, and, as such, they were not at all guilty of medical negligence. There was, thus, no deficiency, in rendering service, on the part of Opposite Parties. Hence, point No.1 is answered accordingly.
In the result, the complaint is dismissed, but in the facts and circumstances of the case, we direct the parties to bear their respective costs.
PRESIDENT MEMBER
31.08.2017
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
NIL
EXHIBITS MARKED
For complainant
Ex. A1 Copy of the out Patient card issued by opposite party No.1 with
History, investigations , dated 13.02.2008
Ex. A2 Copy of estimation certificate issued by Opposite party No.1, dated
29.10.2004
Ex. A3 Copy of 2D ECHO Cardiograph report in favour of complainant,
dated 29.10.2004
Ex. A4 Copy of 2D ECHO Cardiograph report in favour of complainant,
dated 18.01.2005
Ex. A5 Copy of 2D ECHO Cardiograph report in favour of complainant,
dated 24.01.2005
Ex. A6 Copy of 2D ECHO Cardiograph report in favour of complainant,
dated 26.01.2005
Ex. A7 Copy of Discharge summary dated 27.01.2005 issued by OP. No. 2
Dept of Cardiothoracic Surgery.
Ex.A8 Copy of operation notes issued by CT Surgeon of Dept of
Cardiothoracic Surgery, dated 27.01.2005
Ex.A9 Copy of discharge summary in favour of complainant with advise dt. 05.02.2005 issued by dept of Cardiology.
Ex.A10 Copy of OP Consultation Slip in favour of complainant issued by
opposite party No. 1, dated 13.02.2008.
Ex.A11 Copy of registration slip in favour of complainant issued by
opposite party No.1, dated 13.02.2008
Ex.A12 Copy of 2D ECHO Cardiograph report in favour of complainant,
dated 13.02.2008
Ex.A13 Copy of 2D ECHO Cardiograph report issued by Care Hospital in
favour of complainant dated 23.10.2008
Ex.A14 Copy of Biochemistry Test Report in favour of complainant issued
by Care Hospital, dated 23.10.2008
Ex.A15 Copy of out Patient Card issued by Dr. Anjaneyulu A.V. of Care
Hospital, Hyderabad in favour of complaint, dated 23.10.2008
Ex.A16 Copy of Consultation Receipt issued by Care Hospital dt.
23.10.2008.
Ex.A17 Copy of Advance receipt for Rs.20,000/- dated 05.10.2016
Ex.A18 Copy of discharge summary dated 05.10.2016
Ex.A19 Copy of report of 2D Colour Doppler ECHO Cardiogrpah
Ex.A20 Copy of Advance Receipt dated 06.10.2016 for Rs.10,000/-
For opposite parties no.1 and 2
Ex.B1 Policy Schedule dated 16.12.2004
For opposite party no.3
Ex.B2 True copy of the policy with terms and conditions
EX.C1 Expert Medical opinion of the complainant issued by the NIMS,
Hyderabad.
PRESIDENT MEMBER
