BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SIRSA.
Consumer Complaint no. 128 of 2014.
Date of Institution : 09.09.2014
Date of Decision : 09.01.2017.
Malkeet Kaur aged about 47 years wife of Shri Mewa Singh, resident of village Jagatgarh Bandran, Tehsil Sardulgarh, District Mansa.
……Complainant.
Versus.
- Aastha Hospital, Multi Specialty Hospital and Trauma Centre, Dabwali Road, Sirsa through its Director Dr. Sat Pal Narula.
- Dr. Sat Pal Narula, M.D., (Medical and Heart Specialist) Director Aastha Hospital, Multi Specialty Hospital and Trauma Centre, Dabwali Road, Sirsa.
- Dr. Rajneesh Narula, M.S., General Surgeon and Laparoscopic Specialist, Aastha Hospital, Multi Specialty Hospital and Trauma Centre, Dabwali Road, Sirsa.
...…Opposite parties.
Complaint under Section 12 of the Consumer Protection Act,1986.
Before: SH.S.B.LOHIA………………. ……PRESIDENT.
SHRI RANBIR SINGH PANGHAL ……… MEMBER.
Present: Sh. Ajay Bansal, Advocate for the complainant.
Sh. A.K.Gupta, Advocate for the opposite parties.
ORDER
The case of the complainant in brief is that she approached the opposite party no.2 with the complaint of pain in the right side of abdomen. After conducting various tests, op no.2 diagnosed the complainant as a patient of Cholecystitis (inflammation of the gall bladder) and also cholelithiasis (presence of gall stones in the gall bladder). The op no.2 referred her to op no.3 who got conducted various tests on 13.7.2013 and opined that there was a necessity of removing the gall bladder because there was collection of gall stones therein. The complainant was admitted in the hospital on 22.7.2013 when her gall bladder was removed by op no.3 through surgery and she was discharged on 24.4.2013 (it should be 24.7.2013). An amount of Rs.25,000/- was got deposited from the husband of complainant by the ops. It is further averred that just after four-five days of the operation, she felt severe abdominal pain and started vomiting. The husband of complainant brought her to op no.1- hospital and contacted the op no.3 with the complaint of post operational complications and she was admitted in the hospital on 30.7.2013. The op no.3 stated that such complications are bound to occur after removing of the gall bladder and advised her to consult with op no.2 for medicines. The op no.2 prescribed some antacids and pain killers but the things remained unchanged. As the complainant got no relief, therefore, her husband took her to Bathinda where Dr. G.S. Shekhawat, M.D. (Radio-diagnosis) Director Adesh Diagnostics Centre Bathinda conducted some radio logical tests (MRCP) and opined that there was bile leak from the stump side and the same was collected in the abdomen and opined that she should be taken to some higher institute as the bile leakage could cause death. Then she was taken to Dayanand Medical College & Hospital Ludhiana where she was admitted on 7.9.2013. After conducting various tests, the doctors found that there was collection of bile in the abdomen and bile leak was present due to injury to the bile duct. The doctors opined that there was serious threat to the life of the complainant and advised surgery immediately for draining the bile from the abdomen initially and repairing of the CBD injury in second stage. The further investigation conducted by the doctors revealed that at the time of conducting operation, the op no.3 legated the CBD (cystic bile duct) which hampered the flow of bile and it started flowing into abdomen directly because of such injury which ought not to have been done. Due to the leakage of bile severe pain in the abdomen occurred and she could not eat as ulcers developed. Accordingly, surgery was done at Dayanand Medical College & Hospital, Ludhiana and in order to drain the bile passage was created. The complainant remained in the said hospital from 7.9.2013 to 24.9.2013. It is further averred that for second stage i.e. for repairing injury to the bile duct, she was taken to Post Graduate Institute of Medical Education and Research Chandigarh. As per the tests conducted there, the post cholecystectomy status was diagnosed as CBD injury (tight stricture there) and choledodudinal fistula i.e. peptic ulcers developed due to bile duct injury and free flow of bile juice in the abdomen. The complainant remained there from 2.12.2013 to 22.12.2013 in a private ward and underwent a major operation for repairing the bile duct. It can be said as bye-pass surgery of the abdomen. Now the complainant is feeling some relief but she has become very weak. The ops no.2 & 3 remained extremely negligent in handling the case of the complainant. The op no.3 failed to exercise the care and caution which is required from the expert, not only at the stage of operation but also after the operation. The op no.3 failed to diagnose the negligence committed by him in legating the CBD even after the operation. She underwent extreme pain, mental as well as physical harassment. Had she not been taken to DMC Hospital Ludhiana and the bile had not been drained from her abdomen, she would have died. Her husband has to spend huge amount on her treatment. The act of the ops amounts to gross deficiency in service. It is further averred that on her treatment, Rs.1,81,580/- approximately were spent at DMC Ludhiana, Rs.1,00,000/- were spent towards medicines and fee at PGI Chandigarh and Rs.25,000/- were spent at the ops hospital for surgery and doctor fee etc. Apart from that the complainant had to make rounds to above said hospitals not only for surgeries but for follow up treatments. Rs.2,00,000/- approximately were spent for transportation and Rs.2,50,000/- were spent on the food, boarding etc. of the complainant and her attendants. The husband of the complainant approached the ops several times for highlighting their acute medical negligence and demanding the entire aforesaid amount but they flatly refused to admit their negligence and to pay any amount. Hence, this complaint for a direction to the ops to pay the above said amount besides compensation of Rs.10,00,000/- for mental pain and agony suffered by complainant.
2. On notice, opposite parties appeared and contested the complaint by filing written statement taking various preliminary objections that complaint is not maintainable in the present form; that complainant has no cause of action to file the present complaint; that complainant is estopped by her own act and conduct to file the present complaint and that complainant has not produced any document or any expert opinion showing the deficiency on the part of ops in treating the complainant. It has been also submitted that op no.3 is a well qualified M.S. general surgery and is laparoscopic specialist and has been carrying out the surgeries for the last more than ten years. The hospital is well equipped with the operation theatre and all necessary equipments. All the precautions were taken before conducting the surgery and the hospital is having well qualified staff physician, anesthetist as well as the nursing staff. On merits, it has been submitted that complainant was diagnosed as having stones in the gallbladder and inflammation and as such she was advised to undergo the surgery for removing the gallbladder and after surgery she was discharged. It is wrong and incorrect that the answering ops charged Rs.25,000/- from the complainant. The surgery was done according to the accepted procedure through laparoscopy. The complainant was discharged from the hospital as the post operative recovery of the complainant was smooth and uneventful. She was admitted on 30.7.2013 as she was complaining of some chest pain as she has been a heart patient previously as well. So, the op no.2 who is a physician M.D. prescribed medicines accordingly. Even the ultrasound was also conducted and there was no free fluid and there was no dilation of bile ducts. The complainant being of panicky nature went to Bathinda. No doctor has given any such opinion that the operation was not conducted according to accepted medical practice. Had it been so the liver of the complainant definitely would have failed immediately within 24 hours. It is only the cystic duct which is to be legated with clips at its stem. As a matter of fact the bile is stored in the gallbladder and it passes through the hepatic duct and thereafter the gallbladder release the same into the common bile duct which further takes it to the duodenum and in this type of surgery the cystic duct is legated with claips and the gallbladder is removed. The hepatic duct is not touched. It is incorrect that the op no.3 has legated the common bile duct. Even the records of Daya Nand Medical College, Ludhiana do not depict whatever has been stated by complainant and do not depict any negligence on the part of op no.3. Remaining contents of the complaint have also been denied.
3. By way of evidence, complainant has tendered her affidavit Ex.C1, treatment record of complainant of the ops hospital and laboratory reports (from pages 19 to 73) Ex.C2, report of CECT abdomen (from page 75 to 82) Ex.C3, medical certificate of Dayanand Medical College & Hospital Ludhiana alongwith treatment record and tests reports (from page 83 to 98) Ex.C4, various bills Ex.C5 to Ex.C133, MRI Scan report of Department of Radiogiagnosis & Imaging P.G.I.M.E.R., Chandigarh with treatment record (from page 357 to 364 Ex.C134, bill Ex.C135, affidavit of Dr. Chiranjiv Singh Gill, Professor of Surgery, General Surgery Department, Dayanand Medical College and Hospital Ludhiana Ex.CW2/A, report of CECT Abdomen of Pioneer Imaging & Diagnostics, Bathinda Ex.C136, lab report of Adesh Diagnostics, Bathinda Ex.C137. On the other hand, opposite parties have tendered affidavit of Sh. Rajneesh Narula Ex.R1.
4. We have heard learned counsel for the parties and have gone through the case file carefully.
5. Learned counsel for the complainant while reiterating the averments made in the complaint has contended that from the material available on the record in the shape of treatment records of complainant from Hospitals of Ludhiana and Chandigarh after operation conducted by opposite party no.3 coupled with affidavit of Dr. Chiranjiv Singh Gill, the complainant has been able to prove medical negligence on the part of opposite parties and complainant is entitled to reimbursement of the aforesaid amounts as well as compensation from the opposite parties. He has relied upon authority of the Hon’ble National Consumer Disputes Redressal Commission, New Delhi in case titled as Dr. Hari Ram Gupta & Anr. Vs. Ashok Kumar Rawat & Ors. 2015(3) CPJ 71 and also authority of the Hon’ble Punjab State Consumer Disputes Redressal Commission, Chandigarh in case titled as Patel Hospital Private Limited Vs. Pawan Kumar & Ors. III (2009) CPJ 401 and prayed for acceptance of the complaint.
6. On the other hand, learned counsel for the opposite parties while reiterating the averments made in the written statement has contended that all the precautions were taken before conducting the surgery and opposite parties have not committed any medical negligence and has prayed for dismissal of the complaint.
7. We have considered the rival contentions of the parties. From the material available on record, it is evident on 5.7.2013 that opposite party no.2 after ultra sound report of the complainant diagnosed her suffering from cholecytitis with cholelithiasis as is evident from ultrasound report (at page No.33) of Ex.C1 and then referred her to Dr. Rajneesh Narula i.e opposite party no.3 of the same hospital i.e. Aastha Hospital, Dabwali road Sirsa. Then opposite party no.3 on the same day i.e. on 5.7.2013 advised USG abdomen which was got conducted from Ridhi Siddhi Diagnostic & Research Centre, Sirsa on 13.7.2013 and Dr. Mohit Mahipal, MD, Consultant Radiologisst opined cholelithiasis with thick walled GB (gallbladder). Then the complainant was admitted in the hospital of opposite parties on 22.7.2013 and her gall bladder was removed by opposite party no.3 by way of surgery (cholecystectomy) and she was discharged on 24.7.2013 as is evident from discharge card (at page No.43) of Ex.C1 and she was also advised bed rest for 10 days and was asked to come again for check up on 30.7.2013 as is evident from prescription slip (page No.47). According to the complainant four-five days after the operation, she felt severe abdominal pain and started vomiting, therefore, she was brought to the hospital of opposite parties with complaint of post operational complications. She was admitted in the hospital on 30.7.2013 at which time op no.3 told that such complications are bound to occur after removal of the gall bladder and advised her to consult with op no.2 for medicines. Besides this, the said doctor i.e. Dr. Rajneesh Narula op no.3 also got conducted some laboratory tests of the complainant as is evident from laboratory test report dated 30.7.2013 (at page No.67). The opposite party no.2 got conducted ultra sound of the complainant on the same day i.e. 30.7.2013 and reported that “Bulky uterus, no free fluid” as is evident from ultrasound report dated 30.7.2013 (at page No.51) and then on 9.8.2013 and on 18.8.2013 prescribed medicines to the complainant and during this period, the said doctor S.P. Narula opposite party no.2 also got conducted some laboratory tests of the complainant and in this regard laboratory test report dated 18.8.2013 of Ravi Computerized Laboratory is placed on file (at page No.73). However, when the complainant got no relief, she was taken to Dr. Gagandeep Goyal of Bathinda who got conducted report of CECT abdomen from Dr. G.S. Shekhawat, M.D. (Radio Diagnosis) on 5.9.2013 and as per the said report there was significant amount of free fluid in perihepatic, perisplenic region, paracolic gutters and pelvis and after MRCP of complainant on 6.9.2013 reported that bile surrounding the CHD near cystic duct stump. The complainant ultimately was taken to Dayanand Medical College & Hospital Ludhiana on 7.9.2013 where after various tests of the complainant, the doctors found that there was collection of bile in the abdomen and bile leak was present due to injury to the bile duct. In this regard, Dr. Chiranjiv Singh Gill, Professor of Surgery, General Surgery Department, Dayanand Medical College and Hospital Ludhiana who treated the complainant at the said hospital has tendered his affidavit on 26.5.2016 and has testified that the patient Malkeet Kaur wife of Sh. Mewa Singh i.e. complainant was admitted in their hospital on 7.9.2013 vide C.R. No.2013-138220 with complaint of distension and pain of abdomen for past 20 days. On examination of the entire medical record of the patient it revealed that she was operated upon for removing gall bladder at Aastha Hospital, Sirsa, Haryana. At Bathinda the patient was diagnosed with Ultra Sound and C.T. Scan of abdomen and it was found that there has been massive collection in abdomen. Somebody has tried ERCP (Endoscopic Retro Cholangiogram Pancratogram) but failed to cannulate common bile duct. He has further testified that on 8.9.2013, the patient was operated upon by him for draining the bilious fluid approximately four liters collected in the abdomen. As it was a case of bile leak from common bile duct so definitive procedure i.e. repairs of CBD is always done at a later stage, however, before it the life saving draining is done with immediate effect. Patient remained sick and on ventilator for few days but was saved and discharged on 24.9.2013 with drains in side abdomen. Since there had been a need of repair of CBD, the patient was advised to come for the same later on as per protocol. He has further testified that on the perusal of entire earlier medical record of the patient, the deponent found that there had been CBD injury/ clipping but the doctors at Sirsa failed to diagnose the same. It was the duty of the doctor to get the patient diagnosed through some Specialist Radiologist. At the time of removal of gall bladder only cystic duct was to be clipped whereas the common bile duct was clipped and injured which led to leakage of bile juice. There had been failure of diagnoses post operational complications. He has further testified that the record suggested that only at Bathinda proper diagnosed was done and the patient was referred to Higher Institute by the doctors at Bathinda. From the abovesaid history/ treatment record of complainant coupled with affidavit of Dr. Chiranjiv Singh Gill, it is crystal clear that opposite party no.3 remained negligent while conducting operation of the complainant as at the time of removal of gall bladder only cystic duct was to be clipped whereas the common bile duct was clipped and injured which led to leakage of bile juice and as a result of which approximately four liters of bile juice (fluid) collected in the abdomen of the complainant which was drained in the hospital at Ludhiana. Both the opposite parties i.e. op no.2 and op no.3 also failed to diagnose post operational complications because as per medical term as told by Dr. Chiranjiv Singh Gill in case of bile leak from common bile duct, repairs of CBD is always done at a later stage and before it the life saving drainage is done with immediate effect. Learned counsel for the opposite parties has drawn our attention towards literature regarding Minimally invasive management of bile leak after laparoscopic cholecystecomy according to which Bile leak after laparoscopic cholecystectomy is generally due to a minor biliary complication, although it can sometimes herald a major duct injury. Several series have reported bile leakage rates of 1.2-4.0 per cent in laparoscopic cholecystectomy, which is higher than the incidence with open cholecystectomy. We do not differ with the said literature but it was the duty of the ops doctors to know post operative complications/ bile leak through requisite tests from some Specialist Radiologist but they themselves have acted against the said literature/ medical term and got conducted only some routine tests/ ultra sound and op no.2 reported ‘No Free fluid.” which was wrong as proved from various tests reports conducted at Bathinda and Ludhiana. There was failure of duty of care and deficiency in service because the medical records clearly establish that ops doctors failed to diagnose the post operative complications. In this regard we are also fortified with the observations of Hon’ble National Commission in case titled as Dr. Hari Ram Gupta & Anr. Vs. Ashok Kumar Rawat & ors cited by learned counsel for complainant the facts of which case are similar and identical to that of present case. The complainant has to visit Bathinda, Ludhiana and Chandigarh for further treatment after operation conducted by opposite party no.3. The complainant has to visit P.G.I. Chandigarh for repair of injury to the bile duct and not only the complainant has suffered lot of harassment, pain and financial loss but her attendants have also suffered a lot and therefore, complainant is entitled to compensation and reimbursement of bills from the opposite parties due to deficiency in service and negligence on the part of ops doctors. The authority cited by learned counsel for complainant in case titled as Patel Hospital Private ltd. Vs. Pawan Kumar & Ors. (supra) is also fully applicable in this case in which it has been held that “Stones diagnosed in gall bladder, patient operated and clips fixed. Pain and vomiting reported. No proper attention paid by treating doctors and patient was taken to another hospital. Two liters of bile in peritoneal cavity found, clip also found lying in peritoneal cavity. Huge quantity of bile could not have been collected in one/two days. Bile started collecting immediately after operation. Patient needed medical attention. Required attention not paid. Condition of patient deteriorated day by day, proved fatal within 4/5 days after operation. Deficiency in service proved. Compensation granted.”
8. Now we come to the quantum of the compensation to be awarded to the complainant. The complainant has alleged that Rs.1,81,580/- approximately were spent at DMC Ludhiana and has placed on file various bills in this regard from Ex.C5 to Ex.C133 and from the perusal of bills, it can be said that she has spent the above said amount on her treatment at DMC Ludhiana. Therefore, she is entitled to reimbursement of the above said amount of Rs.1,81,580/- from the ops doctors. Then she has claimed that she has spent an amount of Rs.1,00,000/- in PGI Chandigarh, but same seems to be on higher side and as per bill Ex.C135 of PGI, Chandigarh, it is evident that total amount of Rs.54,175/- was incurred on the treatment of complainant at PGI, Chandigarh and therefore, she is entitled to reimbursement of that amount of Rs.54,175/- from the ops doctors. She has further claimed that Rs.25,000/- were incurred in the hospital of opposite parties for surgery and doctor fee etc. but the opposite parties have stated that it is wrong and incorrect that they have charged Rs.25,000/- from the complainant. Although, complainant has not placed on file bills/ receipts in this regard but keeping in view the nature of treatment, surgery, various test reports done in the hospital and medicines provided by the ops doctors, it can be said that opposite parties have charged the said amount of Rs.25,000/- from the complainant but due to above said negligence of ops doctors, they are also liable to refund that amount to the complainant. The total amount in this regard spent on treatment of complainant comes to Rs.2,60,755/- (Rs.1,81,580+Rs.54,175/-+Rs.25,000/- = Rs.2,60,755). She has further claimed that an amount of Rs.4,50,000/- was spent on diet, her attendants and for transportation to the higher institutes but that too is on higher side. In our view, the complainant is entitled to Rs.50,000/- for diet and transportation etc. and further entitled to an amount of Rs.2,00,000/- as compensation for physical harassment and pain including litigation expenses from the ops doctors and the total amount payable by the ops doctors comes to Rs.5,10,755/-.
9. Thus, as a sequel to our above discussion, we allow the present complaint and direct the opposite parties to pay a sum of Rs.5,10,755/- to the complainant jointly and severally within a period of two months, failing which the complainant will be entitled to interest on the said amount @9% per annum from the date of order till actual payment. A copy of this order be supplied to the parties as per rules. File be consigned to record room after due compliance.
Announced in open Forum. President,
Dated: 09.01.2017. Member. District Consumer Disputes
Redressal Forum, Sirsa.
