KERALA STATE CONSUMER DISPUTES REDRESSL COMMISSION
VAZHUTHACAD, THIRUVANANTHAPURAM
APPEAL 635/2005
JUDGMENT DATED:30..09..2011
PRESENT
JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT
SRI.M.K.ABDULLA SONA : MEMBER
1. Dr.Reena Varghese MS(ENT), : APPELLANTS
Lisie Hospital, P.B.No3053,
Ernakulam, Kochi – 682 018.
2. The Director,
Lisie Hospital,
Ernakulam, Kochi – 682 018
(By Adv.George Thomas Mevada))
Vs.
1. Ammini Jose, aged 55 years, : RESPONDENTS
W/o Jose, Karottupuram House,
Kaipattoor Kara, Kalady.P.O.,
2. Shainy Antony aged 32 years,
W/o Antony, Thottangara House,
Kaipattoor Kara, Kalady.P.O.,
(By Adv.Roy Varghese)
JUDGMENT
JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT
The appellants are the opposite parties the doctor and the hospital respectively in OP.169/04 in the file of CDRF, Ernakulam. The appellants are under orders to pay a sum of Rs.40000/- as compensation and Rs.2000/- as cost.
2.The complainants are the mother aged 55 and her daughter. It is the case that on 5.2.04 the 1st complainant/mother was taken to the 2nd opposite party hospital for a removal of fish bone stuck in her throat. It is stated that the 1st opposite party ENT Surgeon after examination found that there is no fishbone and discharged the patient on the next day with advice to come for review after 8 days. Due to severe pain and inflammation in throat after 4 days 1st complainant was again taken to 2nd opposite party’s hospital on 10.2.04 and was admitted. On the next day she conducted the procedure of oesophagoscopy under general anaesthesia and the fishbone was removed. She was an inpatient therein upto 15.2.04 on which date she was referred to PVS Memorial Hospital on account of severe bleeding. The doctors at PVS hospital noted massive bleeding from cricopharynx which developed subsequent to removal of the fishbone from the oesophagus. From PVS hospital she was rushed to Lakeshore hospital in a critical condition on the same day itself. The blood report showed considerable loss of blood. At Lakeshore hospital it was noticed that there is a linear tear in the lateral wall of upper oesophagus at cricopharynx and severe bleeding from the spot. It was noted that there is an abcess cavity lateral to the oesophagus with a linear tear in the common carotid artery around 1cm. long. It is alleged that the 1st opposite party ENT Surgeon is guilty of rash and negligent treatment. It is alleged that the 1st opposite party failed to detect the presence of fishbone in the throat although the complainants have asserted the presence of fishbone in the throat. It is also alleged that linear tear in the carotid artery and injury to lateral wall of upper oesophagus was the result of carelessness on the part of the doctor. Even the injuries to the organs were also not detected by the doctor. Further details were suppressed in the reference letter to PVS hospital. The complainants were made to spend more than Rs.90000/- towards treatment. She had to spent around Rs.50000/- for other expenses . She has claimed a sum of Rs.2lakhs as compensation apart from the alleged treatment expenses of Rs.90000/-.
3. The opposite parties have filed separate versions contending that only an indirect Laryngoscopy examination could be done on 5.2.04 the date on which she was admitted at 7.45pm. No fishbone was visualised in the above examination. Oesophagoscopy could not be done on that day as the same required general anaesthesia but the stomach was not empty. On the next day ie, on 6.2.04 the complainant informed the doctor that the foreign body had slipped into the stomach and that she is not having any pain and she insisted for discharge against the medical advice. It is pointed out that the X-ray was not conclusive and gave a suspicion of existence of foreign body. The condition of the patient needed observation as pain, dysphagia, fever or neck swelling being the manifestation of the presence of foreign body in the oesophagia could recur at any time. Further more she was a diabetic patient. The 1st opposite party insisted to undergo oesophagoscopy but the patient and the bystander insisted for discharge. She again come to the hospital on 10.2.04 with complaints of pain in the throat, dysphagia and fever. Antibiotics and injections were given and with informed consent oesophagoscopy was conducted on 11.2.04 under general anaesthesis. The procedure was uneventful and the foreign body was removed and ryle’s tube feeding and intravenous antibiotics were started. On 13.2.04 minimal amount of blood was seen in the vomitus. The patient was stable otherwise. At 4am and 5,45am on 14.2.04 episodes of bleeding were detected. She was shifted to surgical ICU and one unit of blood was transfused on a provisional diagnoses of gastritis. The head of the department of surgery was also consulted. The complainant was managed conservatively. At 11.10.am on 16.2.04 she developed another bout of bleeding. Hence she was referred to PVS hospital after contacting PVS hospital. The case summary was also provided. Thus it is denied that there was negligence on the part of the 1st opposite party and the doctors of the 2nd opposite party hospital.
4. The evidence adduced consisted of the testimony of PWs 1 to 3 and DWs 1 to 3; Exts.A1 to A6 series, B1 and B1(a).
5. PW1 is the 2nd complainant the daughter of the 1st complainant. PW2 is the Gastroenterologist at PVS hospital who attended the complainant. PW3 is the ENT Surgeon of Lakeshore hospital who conducted surgery on the complainant. DW1 is the 1st opposite party, ENT Surgeon. DW2 is the Porfessor of ENT at Amritha Institute of Medical Sciences and Technology who was examined as the expert at the instance of the opposite parties. DW3 is the Surgeon at the 2nd opposite party hospital who had examined the complainant. Ext.A2 is the copy of the reference letter issued by the 1st opposite party doctor to Gastroenterologist of PVS hospital. Therein it is mentioned that on 11.2.04 the complainant underwent oesophagoscopy under general anaesthesia for removal of the fishbone in the oesophagus of five days duration. It is also mentioned that on 13.2.04 she had mild haemoptysis and there was profuse haemoptysis on 14.2.04 and 15.2.04. It is also mentioned that one unit of blood was transfused on 14.2.04. Ext.A3 is the discharge summary from PVS hospital wherein it is mentioned that on 15.2.04 on admission upper GI(gastrointestinal) endoscopy was attempted and multiple ulcers were seen in the stomach. She was having massive bleeding from cricopharynx. As she required ENT surgery she was rushed to Lakeshore hospital in a critical condition. As to the upper GI endoscopy it is mentioned that the scope passed upto D2. The upper GI endoscopy report incorporated therein mentions throat full of blood during the procedure. As the patient suddenly started bleeding profusely through mouth further scopy was abandoned. In the blood report incorporated therein hemoglobin count is mentioned as 6.6. Ext.A4 is the discharge summary from the Lakeshore hospital wherein she was admitted on 15.2.04 and discharged on 25.2.04. It is mentioned that the patient at the above hospital had exploration of neck and repair of tear in the right common carotid artery under general anaesthesia. Endoscopy revealed a linear tear in the lateral wall of upper esophagus at the cricopharynx with severe bleeding from it. On exploration there was an abcess cavity lateral to the esophagus with a linear tear in the common carotid artery around at 1cm long. Tear repaired using(4-0) proline and patched with carotid sheath. It is also mentioned that complete haemostacis obtained. Ext.B1 is the case sheet of the 2nd opposite party hospital. The impression with respect to the bleeding noted therein at page 28 is suspected acute gastritis. On 14.2.04 the 1st opposite party doctor referred the patient to the surgeon of the above hospital. In the above diagnosis in the reference note it is mentioned that the patient is vomiting blood for the last 2 days(profuse since last night). If so the profuse bleeding would have started was 13th night which is not the case of the opposite parties. It is also noted at page 35 that the patient was shifted to PVS hospital at 12 noon on 15.2.04. The patient has reached Lakeshore hospital at 2pm which is as mentioned in Ext.A4. Hence she was in the PVS hospital only for 2 hours. At PVS hospital the upper GI endoscopy was attempted only. On account of profuse bleeding they referred the patient to the Lakeshore hospital as the examination by ENT Surgeon was required and the ENT surgeon at the PVS hospital was on leave which is mentioned by PW2 the Gastroenterologist of PVS hospital. The suggestion that the injury to common carotid artery might have happened at the PVS hospital cannot be sustained especially in view of the fact that the hemoglobin count noted in Ext.A3 discharge summary of PVS hospital is just 6.6.. Evidently the patient was having considerable blood loss at the 2nd opposite party hospital and also in view of the fact that the patient was at PVS hospital only for a short period of about 2 hours. Another aspect that is not favourable to the case set up by the opposite parties is the statement of DW3 the General Surgeon of the 2nd opposite party’s hospital who examined the complainant on 15.2.04 and suggested reference to PVS. He has stated that endoscopy was not attended as the patient had history of fishbone injury in the esophagus. In such cases if endoscopy is done there is possibility of bleeding from the site of injury . The above is not noted in the Ext.B1 case sheet or in the reference letter to PVS hospital . It has also to be noted that there was no suggestion to PW2 the Gastroenterologist that the injury would have happened at PVS hospital.
6. DW3 the ENT Surgeon who conducted the procedure at Lakeshore hospital has stated that on exploration he found that there was injury at common carotid artery. He has stated that there are modern treatment methods to remove fishbone. He has also stated that the fishbone should be removed without resulting in injury although he has stated that he did not know that the injury was occasioned due to carelessness. He has also stated that injury to common carotid artery can result in on the spot death. He has also stated that the injury to the common carotid artery if any can be diagnosed by the ENT Surgeon. He has also stated that the fishbone should have been removed on the date of admission of the patient itself. He has stated that there is no negligence on the part of the opposite parties. He has further stated that the injury to the common carotid artery was on account of infection and that if the fishbone was removed in time there would not have been any infection.
7. DW1, the 1st opposite party has asserted that it was on account of the insistence of the patient that she was discharged on the next day. DW2 the Professor of ENT at Amrita Institute of Medical Science has stated that a if a linear tear to carotid artery is occasioned the patient would have died .immediately. He has stated that linear tear would not occur due to infection and that infection injury is irregular in nature. Anything sharp could cause linear tear. He has stated that there was no deviation of standard procedure at the opposite party hospital. He has also stated that if the bleeding was from common carotid artery the same can be found out by the ENT surgeon.
8. The case of the opposite parties that the complainant insisted for discharge on 6.2.04 is denied by PW1 the 2nd complainant/daughter. The counsel for the appellants has stressed the fact that the 1st complainant was not examined before the Forum. PW1 has stated that her mother is not in a position to depose. The counsel for the appellants has also stressed the fact that injury to the common carotid artery can result in pumping of blood out and consequent death. But we find no reason to disbelieve the version of PW3 the ENT Surgeon of Lakeshore hospital who has issued Ext.A4 discharge summary wherein the above injury is mentioned. We find that there is lapse on the part of the opposite parties in not referring the complainant to a higher centre soon after bleeding was detected. It is seen that complainant is having episodes of bleeding from the throat at the 2nd opposite party’s hospital. It is evident from the fact the in the blood test done at PVS hospital the hemoglobin level was just 6.6. blood transfusion at the opposite party hospital also. In the circumstances we find no reason to interfere in the order of the Forum.
9. The complainants have expended considerable amounts for treatment as evident from Ext.A6 series of bills. She was in ICU for four days and altogether inpatient for 10 days at Lakeshore Hospital. The Forum has only ordered to pay a compensation of Rs.40,000/- and cost of Rs.2,000/-. There is no order with respect to the payment of interest also. In this regard also no interference is called for.
10. Appellants are directed to make the payments as ordered by the Forum within 2 months from the date of receipt of this order failing which the opposite parties are liable to pay interest at 12% from the date of this order ie 30.9.11.
The office will forward the LCR to the Forum along with the copy of this order.
JUSTICE K.R.UDAYABHANU : PRESIDENT
M.K.ABDULLA SONA : MEMBER
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