DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BATHINDA
CC.No.110 of 07-03-2011
Decided on 13-12-2011
Rashpinder Singh, aged about 35 years, son of Sh. Darshan Singh son of Sh. Mukand Singh, Resident of village and
P.O. Jodhpur Romana, Tehsil & Distt. Bathinda. .......Complainant
Versus
Chabra Hosptial, near Stadium, 80 Ft. Road, Bathinda, through its owner/ proprietor Dr. Vikas Chabra.
Dr. Vikas Chabra (M.S.Surgery) C/o Chabra Hospital, near Stadium, 80 Ft. Road, Bathinda.
Sidhu Medial Hall, retail Chemist and Druggist, Back side sports stadium 80 Ft. Road, Bathinda.
United India Insurance Company Limited, 54 Janpath Cannaught Place, New Delhi-110001, through its Manager/In
-charge (Insurer of opposite party No.1) vide policy No.040100/46/10/35/00001483.
......Opposite parties
Complaint under Section 12 of the Consumer Protection Act, 1986
QUORUM
Smt. Vikramjit Kaur Soni, President
Sh. Amarjeet Paul, Member
Smt. Sukhwinder Kaur, Member
Present:-
For the Complainant: Sh. N.M. Aggarwal, counsel for the complainant
For Opposite parties: Sh. Ajay Singla and Sh. Lalit Garg, counsels for opposite parties
ORDER
Vikramjit Kaur Soni, President:-
1. The present complaint has been filed by the complainant under Section 12 of the Consumer Protection Act, 1986 as amended up-to-date (Here-in-after referred to as an 'Act'). The brief facts of the complaint are that the complainant is a businessman and running his shop of sale of spare parts at Talwandi Sabo, he daily up and down from village Jodhpur Romana to Talwandi Sabo. On 24.09.2010, while the complainant was coming back around 6.00 pm to his village on his motorcycle, he met with an accident on account of negligent driving of a Tractor Trolly at village Kot Shameer. On receiving the information regarding the complainant having met with an accident, the volunteers of Sahara Club, Bathinda took the complainant to Civil Hospital, Bathinda where Angrej Singh brother of the complainant also reached by that time. The Emergency Medical Officer on duty, after examining the complainant, disclosed to Angrej Singh brother of the complainant that there are injuries with fracture in mandible. The Civil Hospital has no immediate treatment and advised that the complainant be treated by a private doctor or he may be taken to Patiala or Chandigarh for his treatment. Some persons standing in the Civil Hospital gave a reference of opposite party No.2 and suggested that the complainant may be taken to Chabra Hospital, Bathinda for his treatment. The complainant alongwith his brother Angrej Singh bonafidely believing the advise of the persons who met in the hospital to be correct, took the complainant to Chabra Hospital-the opposite party No.1 and the opposite party No.2 who is In-charge of the hospital, examined the complainant and advised them that surgery is required immediately, which of course will costs about Rs.30,000/- to Rs.40,000/- by which the complainant will be normal approximately within a fortnight. The complainant and his brother Angrej Singh agreed to get the needful done from the opposite party as assurance given by them. The complainant was got admitted with the opposite parties on 24.09.2010 and a sum of Rs.40,000/- was got deposited by the opposite party No.2 in advance on 24.09.2010 before starting the operation but no receipt had been issued to the complainant at that time. On 25.09.2010, after getting a pipe inserted in the neck for breathing, he got the operation done by calling some other doctor from outside who later on was learnt to be a doctor of Ear, Nose and Throat and another doctor whose identity was not disclosed to the complainant. The complainant remained an indoor patient till 04.10.2010. He was discharged by the opposite party Nos.1&2 after getting a sum of Rs.70,000/- in the presence of Sukhpal Singh and gave a discharge summary. He had further advised the complainant to visit the hospital for getting the required dressings for about a fortnight daily. Accordingly, the complainant had been visiting the hospital daily for about one month, his dressing was done by the doctor despite that the complainant did not feel normal and he had complained that to the opposite parties and the opposite party No.2 had in turn advised the complainant that with the passage of time, everything will set right of its own. After waiting for a period of about two months after the operation, having been performed by the opposite party No.2 when the complaint of the complainant persisted, the complainant was left with no other option to contact some other doctor. Accordingly, the complainant approached Amandeep Hospital, Amritsar who was learnt to be expert for Accidental Treatment. The complainant was examined by the doctors there and after examining the complainant, the said doctor suggested that bone grafting over the anterior part of the mandible has been wrongly done by the doctor at Bathinda on account of which the face of the complainant has been defaced from its normal shape and the complainant shall have to undergo another surgery for setting the same. Since, the complainant was not feeling normal so he opted to go for second surgery. He was admitted in Amandeep Hospital, Amritsar on 20.12.2010 vide Registration No.4450-12-10 and remained there till 26.12.2010. He was uprooted there and the exposed sequestrated bone grafts over the anterior part of the mandible were removed, the mini plates and screws were also removed. Lower segment of the mandible central segment found healthy and viable and the closure of the mucosa was done and was discharged from the said hospital on 26.12.2010. The doctor at Amritsar has specifically disclosed that Iliac Crest bone graft, plates and screws were not required in the case of the complainant and only wiring was required and the doctor at Bathinda has wrongly done bone grafting to charge extra. In the said operation, bone grafting has been done which is not known in the mandible, the discharge shows # (fracture) mandible as diagnosis for which the whole T/T was done whereas the radiographic examination does not mention the # of mandible instead reveals the fracture of Maxilla including Sigomatic arch and left wall of right max-sinus. This shows gross discrepancies in diagnosis and the treatment purported to have been given to the patient. The complainant has further learnt that the case of the complainant was not a case which was required to be handled by a general Surgeon but was to be treated only by a dental surgeon who treats mandible cases. The opposite party himself not being a Dental Surgeon, was incompetent to perform the surgery, the brother of the complainant No.2, Aman Chabra, who is stated to have joined the operation, is also not a Dental Surgeon. Therefore, the opposite party ought not have admitted the complainant in his hospital and would have referred or advised him to go to some Dental Surgeon. It clearly amounts to deficiency in service on the part of the opposite parties as he himself was not competent to deal with such like cases nor he has ever asked the complainant that he will call some other Surgeon for doing the surgery for which the consent has never been given by the complainant. Had the opposite party disclosed that he is not competent to do the surgery of Dental/Mandible cases and that he will charge this much exorbitant fee, the complainant would have never got himself admitted in the hospital of the opposite party nor would have got the surgery done. The complainant has been deceived by the opposite parties. While discharging the complainant, the discharge summary has been provided along with medicine bills of Sidhu Medical Hall, which is his own medical shop, located within the Hospital Premises worth Rs.26,528/- and has thus retained Rs.83,472/- for himself. On further enquires, it has revealed that the price of the medicines having been charged in those bills bearing No.1449,1450,1452,1456,1457 & 1462 are also exorbitant. The complainant though was not fully cured but he was discharged by the opposite party on 10.10.2010 from the hospital by issuing the bill No.1550 dated 04.10.2010 for Rs.40,300/-. Though the opposite parties have actually got deposited Rs.1,10,000/- from the complainant in installments during his stay in the hospital of the opposite party. After seeing the bill of Rs.40,300/-, the complainant had demanded the bill/receipt regarding the remaining amount but he had refused to do so and told that he does not issue any receipt for the amount which is not chargeable. Since, the complainant was not perfectly well, he had consulted Amandeep Hospital, Amritsar whereupon he was advised by doctor, he will have to undergo another operation to set right his Jaw and Chin. Accordingly, the complainant got himself admitted in the hospital on 20.12.2010 and remained admitted till 26.12.2010 as was advised by the surgeon. Hence, the complainant has filed the present complaint.
2. Notice was issued to the opposite parties. The opposite parties after appearing before this Forum,have filed written statements.The opposite party Nos.1to3 have filed their joint separate written statement and pleaded that the present complaint is not supported by any medical expert opinion. It is essential to annex medical report opinion before filing a consumer case as envisaged by Hon'ble Supreme Court Judgment titled Martin F.D. Souza Doctor Vs Mohd. Ishfaq, Civil Appeal No.3541 of 2002,2009(1)CRR 231 (SC). The diagnosis of disease and the complications subsequent to that are always a matter of fact and not of speculations and if the benefit of treatment have to go to the patient, its complications, untoward effect and unwarranted results will also go to the patient and these untoward result cannot be garbed as negligence. The opposite parties being treating doctor, have tried their best and used their highest degree of skill, care, knowledge, infrastructures, efforts and precautions and also tried to avoid all complications. The treating doctor cannot avoid any inherent complication which are basis ingredients either of disease pathology itself or treatment procedure, about which the complainant was well informed and was well in knowledge also, precautionary steps can be taken/advised by the opposite parties as any other prudent qualified doctor who is engaged in treatment of the complainant. Until and unless, the complainant is able to prove that the prescribed line of the treatments applicable to the particular case/disease conditions to label that as negligence, then only such a complaint can be tried by the Forum. The complainant was properly examined, investigated, diagnosed and treated by the opposite parties and which was as per prescribed norms of general practice. On merits, the opposite party Nos.1 to 3 have pleaded that the complainant met with an accident on 24.09.2010 and the volunteers of Sahara Club, Bathinda took the complainant to Civil Hospital, Bathinda but the Emergency Medical Officer on duty after examining the complainant, disclosed Angrej Singh, brother of the complainant that no immediate treatment can be done there and he was referred to higher centre or some private hospital. The complainant was taken by his relatives to the Clinic of Dr. Vaneet Bansal, B.D.S. Situated at G.T. Road, Bathinda in Govt. Hospital's Ambulance. The complainant was examined by Dr. Vineet Bansal, B.D.S. and Dr. Pradeep Goyal (M.D.S.) within the ambulance and looking on to serious condition of the complainant, advised to take him to any hospital with O.T. and I.C.U. facilities. The complainant was brought to Chabra Hospital i.e. opposite party No.1 so the statement of the complainant clearly indicates the seriousness of injuries sustained by the complainant. The complainant was brought in Chabra Hospital on 24.09.2010. Dr. Vikas Chabra after examining the patient in emergency, found that he was having multiple injuries with laceration on left side of face and chin area with bleeding from the wounds and mouth. Oral cavity was full of clots, dirt, bone pieces and loose teeth. The opposite party No.2 as a part of his duty in emergency conditions to maintain Airway, Breathing and Circulation did oral suction, removed clots and other debris form oral cavity, started and rushed IV fluid and bid all other necessary emergency care. After that the patient/ complainant was sent for X-ray, CT Scan and Ultrasound to Radiology Centre. After getting patient's radiological investigation done, the complainant's relatives were explained about the injuries by the opposite party No.2 and it was also told to the relatives of the complainant that Dr. Pradeep Goyal (M.D.S.) who is on the panel of Hospital, has been called and he will tell the relatives of the complainant, the course of treatment. Dr. Pradeep Goyal after examining the complainant/patient, explained the complainant and his relatives that there is bone loss in central part of Mandible, so bone grafting will be required to correct the loss and it will be taken from Iliac crest and there are always possibilities of resorption of bone graft or infection for which graft might require even removal in the later stage. No assurance of treatment or graft uptake was given by the opposite party No.2 or by Dr. Pradeep Goyal. No discussion about expenses took place with the patient or his relatives. The complainant and his relatives well aware that Dr. Pradeep Goyal had examined the complainant in Dr. Vaneet Bansal's Hospital and even in Chabra Hospital, they were explained about injury, course of treatment and bone graft by Dr. Pradeep Goyal. Further, no money was deposited by the relatives of the complainant before surgery but was deposited in the morning of 25.09.2010 after completion of surgery against the fee of visiting doctors and implants, the due receipt of which was given to the relatives at the same time. The opposite party No.2 has not got deposited Rs.40,300/- in advance on 24.09.2010 rather a sum of Rs.35,000/- was got deposited by the opposite parties from the relatives of the complainant on 25.09.2010 and Rs.40,300/- was got deposited by the opposite parties on 04.10.2010. The opposite parties have received a sum of Rs.35,000/- and Rs.40,000/- from the complainant against receipts which were given to the relatives of the complainant on 25.09.2010 and 04.10.2010. The complainant was advised to get his dressing done daily after discharge but the complainant never complied with the above said instructions and he turned up for first dressing on 10.10.2010 i.e. after six days of discharge. He came on 11.10.2010, 12.10.2010 and thereafter on 17.10.2010. The surgery and post operative dressing of the complainant were done by qualified (MDS) doctor. Bone grafting is a recommended treatment modality in cases of severely comminuted fractures with bone loss. In such a case, only wiring was not sufficient to bring all separated bone pieces together in case of bone and multiple teeth loss. Further, the complainant has not furnished any document from doctors of Amandeep Hospital, Amritsar stating that the treatment done at Chabra Hospital, Bathinda was in any way wrong. On the contrary, the discharge summary of Amandeep Hospital mentions in its operative notes that the graft in the central part of mandible was healthy and viable which further proves that the treatment at Chabra Hospital, Bathinda was done in a correct way. If it was such a simple case and wiring only was required, it could have been managed at Civil Hospital, Bathinda only and his referral to higher centtre was not required as facility of wiring is always available at Civil Hospital, Bathinda. The OPG, X-ray of the complainant/ patient clearly shows comminuted fracture of mandible which has also been reported by radiological. So, the allegations that the clinical and radiological diagnosis does not match, are totally false. It is denied that the grafting over the anterior part of the mandible was wrongly done by doctors at Chabra Hospital or on account of that, face of the complainant had become defaced from its normal shape. The opposite party Nos.1&2 and Dr. Pradeep Goyal who are well qualified and experienced doctors, had treated the complainant to the best of their knowledge and ability. The opposite parties have taken photographs of the injured/complainant before and after treatment. The opposite parties have further pleaded that the emergency care, post operative care and general care only, of the patient was done by General Surgeon Dr. Vikas Chabra and the procedure for mandible fracture was done by a qualified Oral-maxillofacial Dental Surgeon (M.D.S.) Dr. Pradeep Goyal. The Orthopedic Surgeon of Chabra Hospital, Dr. Aman Chabra joined the surgery to take bone graft from Iliac crest and again not to handle mandible fracture. Further, the tracheotomy was done by Dr. B.K. Bansal, M.S. (E.N.T.) i.e. the whole treatment was done by a team of qualified doctors. The opposite opposite party Nos.1 to 3 have further pleaded that Dr. Vikas Chabra is neither owner nor partner of M/s Sidhu Medical Hall which is a separate firm. However, the firm has been running business in a portion of Chabra Hospital but is a separate legal entity. The complainant had purchased the medicines from the opposite party No.3 vide bill Nos.1449,1450,1452,1456,1457 and 1462 but it is denied that the price of the medicines charged by the opposite party No.3 were very exorbitant. A further perusal of bills of M/s Amandeep Hospital, Amritsar produced by the complainant with the complaint shows that many medicines were commonly used in Chabra Hospital, Bathinda and Amandeep Hospital, Amritsar. These medicines were purchased by the complainant from the opposite party No.3 as well as from M/s Kartar Medicos, Amritsar. From the discharge slip filed with the complaint, it is clear that the complainant remained admitted in Amandeep Hospital from 20.12.2010 to 26.12.2010 but the opposite parties have denied that he was again operated on 27.12.2010.
3. The opposite party No.4 has pleaded that Dr. Vikas Chhabra i.e. opposite party No.2 is insured with the opposite party No.4, during the period, the patient-Rashpinder Singh was treated by the opposite party No.2 on 25.09.2010. The opposite party No.4 has issued Professional Indemnity Policy No.040100/46/10/35/00001483 w.e.f. 26.06.2010 to 25.06.2011 to the opposite party No.2.
4. Parties have led their evidence in support of their respective pleadings.
5. Arguments heard. Record alongwith written submissions submitted by the parties perused.
6. The complainant met with an accident on 24.09.2010, while coming back from Talwandi Sabo to his home around 6.00 pm. The volunteers of Sahara Club, Bathinda took the complainant to Civil Hospital, Bathinda where Angrej Singh brother of the complainant, reached. The Emergency Medical Officer who was on duty, after examining the complainant disclosed Angrej Singh that there are injuries with fracture in mandible and many teeth have come out. It being night time, no immediate treatment is possible at Civil Hospital so it was advised, if the complainant be treated by a private doctor or may be taken to Patiala or Chandigarh for his treatment. On the reference of some persons, standing in the civil hospital itself, the complainant was taken to Chabra Hospital, Bathinda for his treatment. The opposite party No.2 has examined the complainant/ patient and asked them that immediate surgery is needed which will cost about Rs.30,000/- to Rs.40,000/-. Angrej Singh in consultation with Sukhpal Singh, asked the opposite party No.2 to do the needful because of assurance given by him that Rashpinder Singh will be normal within a fortnight. Dr. Vikas Chabra received Rs.40,000/- on 24.09.2010 from Angrej Singh as advance money before performance of the operation but not issued any receipt for the same. No consent of the complainant was obtained on 24.09.2010 on the Consent Form. It does not bear the signatures of the complainant. The complainant has further submitted that although he was brought in serious condition, yet he was capable of appending his signatures on the said printed Form. The second Consent Form having been prepared on the blank paper, is also a forged and fabricated document which appears to have been created subsequently. The complainant does not have any nephew namely Amarjeet Singh as has been wrongly written on the second consent. Moreover, the wording used in the Consent Form appears to have been got written from some of his employees may be after performance of the operation. The complainant was operated on 25.09.2010 by some outside doctors which was later on learnt to be opposite party No.2 and a pipe was also got inserted in the neck of the complainant by calling another outside doctors, whose identity was not disclosed to the complainant. The complainant was kept as indoor patient by the opposite party No.1 till 04.10.2010 when he was discharged after receiving another sum of Rs.70,000/- in the presence of Sukhpal Singh but had not given any receipt even for this amount. An amount of Rs.70,000/- was paid by Angrej Singh after withdrawing the same from his bank account. The discharge summary given to the complainant is Ex.C-2 and he was advised to visit the opposite party No.1 daily for about a fortnight for getting the dressing done and accordingly, the complainant continuously visited the hospital of the opposite party No.1 for about one month for getting the dressing but the complainant when, not felt normal even after a month, had complained to the opposite party No.1 by whom assurance was given that the complainant will be normal but the opposite party further advised that with the passage of time, everything will be normal. The complainant has followed the advise of the opposite parties and has turned up for dressing on 10.10.2010, though have admitted that the complainant came on 11.10.2010, 12.10.2010 and thereafter on 17.10.2010. The complainant has been visiting each and every day as advised by the opposite parties. The complainant was given dressing even on 05.10.2010 i.e. the next day of the discharge from the hospital. The complainant had waited for a period of two months of the operation but could not get the required relief. Thereafter, he approached Amandeep Hospital at Amritsar which was learnt to be expert for accidental treatments. After examining the complainant, the doctor had suggested that bone grafting over the interior part of the mandible has been wrongly and unnecessarily done by the doctor at Bathinda, on account of which the face of the complainant has been defaced from the normal shape and the complainant will have to undergo another surgery for resetting the same in its original position. The complainant was suggested that another sum of Rs.30,000/- to Rs.40,000/- will cost for the second surgery and in order to become normal, the complainant opted to go in for the second surgery and got himself admitted on 20.12.2010 and remained as indoor patient till 26.12.2010. The doctor removed the interior part of the mandible and the mini plates and screws which was wrongly and unnecessarily put in by the opposite parties at Bathinda. While discharging the complainant, the doctor at Amritsar has specifically told to the complainant and his brother Angrej Singh that Iliac Crest, bone grafts, plates and screws were not required in the case of the complainant and only wiring was required to be done by the doctor at Bathinda and that the doctor at Bathinda has wrongly done bone grafting with a view to inflate his bill because bone grafting is not known in mandible fracture cases. It was also told by the doctor at Amritsar that in the diagnosis made by the opposite party as written in the discharge summary, it has been mentioned # (fracture) mandible for which the whole T/T was done whereas in radiographic examination report, it does not find mention, rather it reveals fracture of few maxillary teeth including zygomatic arch and left wall of right maxillary sinuses. The CT-Scan report pertaining to examination of head shows that the said report has been subsequently forged and fabricated unauthorizedly by some other person than the radiologist. The complainant has further submitted that the report reveals that the same is not in the hand of the radiologist namely Dr. Gurpreet Singh and the instructions used in fabricating the said document for adding lateral wall of right orbit, is also different than the instrument having been used from signing the reports. The complainant has further submitted that his case was not a case to be handled by general surgeon and he was to be treated only by a dental surgeon who treats mandible cases. The opposite party No.1 is neither himself dental surgeon nor his brother Aman Chabra is dental surgeon. The opposite parties ought not have admitted the complainant and would have referred him to go to some dental surgeon or an expert in that line because they were not competent to deal with such like cases. On discharging the complainant, the opposite party No.1 had provided his bill dated 04.10.2010 for Rs.40,300/- which is Ex.C-5 apart from the bills purported of the opposite party No.1 amounting to Rs.26,528/- which have been placed on file Ex.C-6 to Ex.C-11. The complainant has further submitted that these bills shows that excess number of medicines have been charged, just to inflate the figure. The complainant had made inquiries from other chemist shop in the city to prove that the prices of most of the items have been charged even higher than the MRP printed thereon. The complainant has purchased some of medicine, IV Sets, VT Sets, Surgical Gloves etc from Jan Aushadhi Generic Drug Store, Bathinda vide bill Nos.102464 to 102466 Ex.C-12 to Ex.C-14 and he has collected the bills from other patient namely Jagsir Singh vide Ex.C-15 to Ex.C-17 to prove the rates of medicine available in the market. In normal course, the chemist sells the medicine at the price lesser than the market rate and usually give discount of 10% to 20% to the customers. The bills regarding use of medicine at Amritsar are Ex.C-18 to Ex.C-35 and the bills regarding amount charged by Amadeep Hospital Ex.C-36. The complainant has further submitted that he has suffered a loss of Rs.1,10,000/- having been unnecessarily charged by the opposite party and had to incur another expenditure of Rs.29,886/- at Amandeep Hospital, Amritsar.
7. On the other hand, the opposite party Nos.1 to 3 have submitted that the volunteers of Sahara Club, Bathinda took the complainant to Civil Hospital, Bathinda but the Emergency Medical Officer who was on duty after examining the complainant, told Angrej Singh, brother of the complainant that no immediate treatment can be done there and he was referred to higher centre or some private hospital. The complainant was brought by his relatives to the Clinic of Dr. Vaneet Bansal. The complainant was examined by Dr. Vaneet Bansal, B.D.S. and Dr. Pradeep Goyal (M.D.S.) within the ambulance and looking on to serious condition of the complainant, advised to take him to any hospital with O.T. and I.C.U. facilities. The complainant was brought to hospital of the opposite party No.1. The complainant was brought in Chabra Hospital on 24.09.2010 where the Dr. Vikas Chabra after examining the patient/complainant in emergency, found that he was having multiple injuries with laceration on left side of face and chin area with bleeding from the wounds and mouth. Oral cavity was full of clots, dirt, bone pieces and loose teeth. The opposite party No.2 as a part of his duty in emergency conditions to maintain A,B&C i.e. Airway, Breathing and Circulation did oral suction, removed clots and other debris form oral cavity, started and rushed IV fluid and bid all other necessary emergency care. After that the patient/complainant was sent for X-ray, CT Scan and Ultrasound to Radiology Centre. After getting patient's radiological investigation done, the complainant's relatives were explained about the injuries by the opposite party No.2. They were told that Dr. Pradeep Goyal (M.D.S.) has been called and he will explain the treatment of the complainant/patient to his relatives. Dr. Pradeep Goyal after examining the complainant/patient, explained the complainant/patient and his relatives that there is bone loss in central part of mandible and bone grafting will be required to correct the loss and it will be taken from Iliac crest and there are always possibilities of resorption of bone graft or infection for which graft might require even removal in the later stage. The opposite party Nos.1 to 3 have further submitted that no assurance of treatment or graft uptake was given by Dr. Pradeep Goyal. The complainant/patient and his relatives were well aware that Dr. Pradeep Goyal had examined the complainant/patient in Dr. Vaneet Bansal's Hospital and even in Chabra Hospital. They were fully explained about injury, course of treatment and bone graft by the opposite party No.2. No money was deposited by the relatives of the complainant before surgery but was deposited on 25.09.2010 after completion of surgery against the fee of visiting doctors and implants. The opposite party No.2 has got deposited Rs.35,000/- on 25.09.2010 and Rs.40,300/- on 04.10.2010. At the time of discharging, the complainant/patient was advised to get his dressing done daily after discharge but the complainant/patient has never complied with the instructions given by the opposite party No.2 and he came for first dressing on 10.10.2010 i.e. after six days of discharge. Thereafter, he came on 11.10.2010, 12.10.2010 and 17.10.2010. The complainant/patient has not furnished any document from doctors of Amandeep Hospital, Amritsar stating that the treatment done at Chabra Hospital, Bathinda was in any way wrong. On the contrary, the discharge summary of Amandeep Hospital mentions in its operative notes that the graft in the central part of mandible was healthy and viable which further proves that the treatment done at Chabra Hospital, Bathinda was done in a correct way. The opposite party Nos.1 to 3 have further submitted that if it was such a simple case and only wiring was required, it could have been managed at Civil Hospital, Bathinda only and his referral to higher centre was not required as facility of wiring is always available at Civil Hospital, Bathinda. The OPG, X-ray of the complainant/patient clearly shows comminuted fracture of mandible which has also been reported by Radiological. The opposite party Nos.1 to 3 have further submitted that the treatment given by the opposite party No.2 is according to the prescribed norms. The opposite party Nos.1&2 and Dr. Pradeep Goyal who were well qualified and experienced doctors, had treated the complainant/patient to the best of their knowledge and ability. The opposite parties have taken photographs of the injured/complainant/patient before and after treatment. The emergency care, post operative care and general care only of the patient was done by General Surgeon Dr. Vikas Chabra whereas the procedure for mandible fracture was done by a qualified oral-maxillofacial Dental Surgeon (M.D.S.) Dr. Pradeep Goyal. The Orthopedic Surgeon of Chabra Hospital, Dr. Aman Chabra joined the surgery to take bone graft from Iliac crest and again not to handle mandible fracture. Tracheotomy was done by Dr. B.K. Bansal, M.S. (E.N.T.) i.e. the whole treatment was done by the team of qualified doctors. The opposite opposite party Nos.1 to 3 have further submitted that Dr. Vikas Chabra is neither owner nor partner of M/s Sidhu Medical Hall rather he is a separate legal entity. The complainant had purchased the medicines from the opposite party No.3 vide bill Nos.1449,1450,1452,1456,1457 and 1462. The price of the medicines charged by the opposite party No.3 were not in any way exorbitant. A further comparison of bills of M/s Amandeep Hospital and Chabra Hospital shows that many medicines were commonly used by both the hospitals. These medicines were purchased by the complainant from the opposite party No.3 as well as from M/s Kartar Medicos, Amritsar. The complainant has pleaded that he has been operated on 27.12.2010 but no such record has been placed on file by the complainant. The complainant was discharged from the Amandeep Hospital on 26.12.2010 as such no question arises that he was admitted on 27.12.2010 again in the hospital.
8. The opposite party No.2 is professionally indemnified by United India Insurance Company vide Policy No.040100/46/10/35/ 00001483 effective from 26.06.2010 to 25.06.2011.
9. The Treatment Chart Ex.C-2 shows the diagnosis:- Multiple Injuries with # (fracture) Mandible.
Operative Notes:- Tracheotomy (Dr. B.K. Bansal) followed by reconstruction of mandible (Dr. Pradeep Goyal). Graft taken from iliac crest (Dr. Aman Chabra), Assisted by Dr. Vikas Chabra.
10. The complainant has specifically mentioned in his complaint that he has been visiting the opposite parties for dressing regularly but the opposite parties have denied that he has not been visiting regularly as such he does not adhere the advise of the opposite parties, given at the time of discharge. The complainant has been advised by the opposite party No.2 to come regularly but he has failed to visit the opposite parties regularly.
11. The complainant has further alleged that his treatment has not been done by well qualified doctor as Dr. Vikas Chabra is a General Surgeon, he is not Dental Surgeon and as he was not Dental Surgeon, he should have referred the patient/complainant to some other Dental Surgeon. A perusal of documents placed on file reveals that the surgery and post operative dressing of the complainant were done by qualified (MDS) doctor. Bone grafting is a recommended treatment modality in cases of severely comminuted fractures with bone loss. In such a case, wiring only was not sufficient to bring all separated bone pieces together in case of bone and multiple teeth loss. The above mentioned treatment chart Ex.C-2 shows that the diagnosis:-Multiple Injuries with # Mandible.
Operative Notes:- Tracheotomy (Dr. B.K. Bansal) followed by reconstruction of mandible (Dr. Pradeep Goyal). Graft taken from iliac crest (Dr. Aman Chabra), Assisted by Dr. Vikas Chabra.
It is clear from the Operative Note that the reconstruction of the mandible was done by Dr. Pradeep Goyal assisted by Dr. Vikas Chabra, Bone Grafting was done by Dr. Aman Chabra and Tracheotomy was done by Dr. B.K. Bansal. The discharge summary clearly shows that the complainant has been operated by well qualified doctors who are qualified in his field.
12. The complainant has alleged that when he was not cured, he approached Amandeep Hospital, Amritsar where he was told by treating doctor that the reconstruction of the mandible was not required as such bone grafting was not required, as the case can be managed by wiring only. The opposite parties have submitted that bone grafting is a recommended treatment modality in cases of severely comminuted fractures with bone loss. In such a case, wiring only was not sufficient to bring all separated bone pieces together in case of bone and multiple teeth loss. Further, with regard to these allegations, the complainant has not placed on file that what other treatment has been given by doctor of Amandeep Hospital.
13. A perusal of Discharge Summary Ex.C-4 dated 26.12.2010 issued by Amandeep Hospital shows that:-
Operation Notes
The exposed sequestrated bone grafts over the anterior part of the mandible were removed.
The mini plates & screws were removed.
The lower segment of the mandible central segment were found healthy & viable.
The closure of the mucosa done.
In this discharge summary, it has not been mentioned that the complainant had been treated wrongly or has suggested any other line of treatment.
15. Another allegation of the complainant is that the consent letter is not signed by the complainant/patient. A perusal of consent letter Ex.R-1 dated 24.09.2010 shows that it has signed by son and brother of the complainant/patient. The complainant has submitted that he was conscious/in senses to sign the consent letter, whereas a perusal of photographs Ex.R-13 to Ex.R-18 shows that the condition of the complainant was very serious and he was not in the position to sign the consent letter. The complainant has further alleged that when one consent letter has been got signed, what was the need of other consent letter Ex.R-2 and has also alleged that the opposite parties have fabricated this document as Amarjeet Singh is not nephew of the complainant.
16. A perusal of photographs shows that he was in serious condition. The consent letter Ex.R-1 is printed performa whereas Ex.R-2 is hand written consent, given by brother of the complainant, as the condition of the complainant was critical and they have explained everything written in Punjabi. If the case of the complainant was as simple as alleged by him that only wiring was required then there was no need to bring the complainant/patient from Civil Hospital, Bathinda to the said hospital.
17. Ex.R-7 and Ex.R-8 i.e. X-ray reports dated 24.09.2010 which are read as under:-
Part Examined:-Mandible (Orthopantomogram View)
There is seen comminuted fracture of central part of body of mandible with displacement of fracture segments with evidence of fracture of few maxillary teeth.
Part Examined:-P.N.S.
- Both the frontal sinuses are hazy.
- Both the anterior ethmoid sinuses are hazy.
- Both the maxillary antra are hazy.
- There is evidence of fracture involving right zygomatic arch, lateral wall of right orbit with ill defined walls of both maxillary sinuses.
18. On seeing the above said X-ray reports, the opposite party No.2 conducted surgery. The complainant has further alleged that the clinical and radiological diagnosis does not match whereas the opposite parties have submitted that the grafting over the anterior part of the mandible was correctly done by doctors at Chabra Hospital or on account of that, face of the complainant had become perfectly all right and came to normal shape. Ex.R-21 also shows that the face of the complainant after surgery was well in shape/normal shape. His allegation that his face is defaced is also false in the light of Ex.R-21.
19. The complainant has alleged that some items and medicine have been sold on exorbitant rates. For this, he has produced the bills of another patient Jagsir Singh Ex.C-15 to Ex.C-17 whereas the opposite parties have produced on file Ex.R-33 i.e. list of comparison of rates of medicines. A perusal of this list shows that there is no major difference in their rates.
20. There are two lines of treatment which are to be followed by the doctors. In the case in hand, the opposite party No.2 has followed one method of treatment whereas doctor at Amandeep Hospital, Amritsar has only removed the mini plates and screws from the mandible of the complainant. Amandeep Hospital is nowhere mentioned that the treatment given by doctor at Chabra Hospital, Bathinda has been wrong. Moreover, the opposite parties have preformed their duty well according to the medical norms.
As per Consumer Protection Act and Medical Profession by M.K.Balachandran – Department of Consumer Affairs, Government of India – in association with – Indian Institute of Public Administration New Delhi, the Duties of a doctor are:-
Doctors generally have certain duties towards their patients. Some of the important duties are:
: to exercise a reasonable degree of skill and knowledge and a reasonable degree of care;
: to exercise reasonable care in deciding whether to undertake the case and also in deciding what treatment to give and how to administer that treatment;
: to extent his service with due expertise for protecting the life of the patient and to stabilize his condition in emergency situation;
: to attend to his patient when required and not to withdraw his services without giving him sufficient notice;
: to study symptoms and complaint of the patient carefully and to administer standard treatment:
: to carry out necessary investigations through appropriate laboratory tests wherever required to arrive at a proper diagnosis;
: to advise and assist the patient to get a second opinion and call a specialist if necessary;
: to obtain informed consent from the patient for procedures with inherent risk of life;
: to take appropriate precautionary measures before administering injections and medicines and to meet emergency situations;
: to inform the patient or his relatives the relevant facts about his illness;
: to keep secret the confidential information received from the patient in the course of his professional engagement;
: to notify the appropriate authorities of dangerous and communicable disease.
The adoption of other line of treatment by the other doctor does not prove medical negligence. The support can be sought by the law laid down by the Hon'ble National Commission, New Delhi, in case titled 2010(1) CPJ 1 (NC) Pushkar Dutt Vs. Christian Medical College and Hospital, Ludhiana and Another wherein it has been held that:-
Medical Negligence – Surgery – Necessity dispatched – 70%, 50% blockage of arteries reported in angiography report – Petitioner suffered two heart attack in quick succession – Immediate surgery decided by doctors – Surgery abandoned after reopening of heart, as blood found in pericardium, surgery could have been dangerous to life of patient – No deficiency in service/medical negligence proved – Contention surgery not required to be conducted nor acceptable in absence of expert evidence in support – No relief entitled.”
The complainant has not produced any evidence that doctor was negligent in treating him, no expert opinion has been placed on file. The onus to prove medical negligence lies on the complainant himself which he has failed to do.
The support can be sought by law laid down by Hon'ble Supreme Court of India in case titled C.P.Sreekumar, M.S.(Ortho) Vs S.Ramanujam, 2009 (7) SCC 130, wherein it has been held:-
“Evidence Act, 1872, Sections 101 and 102 – Consumer Protection Act, 1986 – Section 2(1)(b), (c),(o) and (g) – Tort – Medical negligence – Pleading and particulars necessary to establish – Burden of proof – Onus to prove medical negligence lies on the complainant – Mere vague averment in the complaint is not sufficient – Same has to be proved by cogent evidence - Complainant has to provide facta probanda as well as facta probantia – During handling of patient, simple hairline fracture developed into more serious type of fracture requiring operation – Complainant alleged rough handling by hospital staff and that the doctor lacked basic skills in performing the operation – The doctor has 15 days of experience in the field of Orthopedics – Complainant failed to produce any evidence as to doctor's lack of skill and expertise in performing the operation – Held, bald statement of complainant cannot be accepted – When he has neither produced contrary evidence nor rebutted doctor's version that aggravation was due to muscular spasm – Negligence cannot be attributed to the hospital staff with certainty.
Consumer Protection Act, 1986 – Section 2(1)(b), (c),(o) and (g) – Deficiency in services – Medical services – Medical negligence – What is – Divergence of opinion as to choice of procedure – Particular procedure adopted after consultation and consent of the patient – Effect of – Out of the two options as to methods, doctor opting for a method felt to be appropriate does not amount to professional negligence – Hemiarthoplasty, partial hip joint replacement operation on respondent – Contention that doctor adopted inappropriate procedure of hemiarthroplasty in view of young age of the patient instead of internal fixation method – Held that, in view of divergence of opinion as to proper procedure to be adopted, doctor cannot be said to have chosen wrong method – Decision of doctor in choosing hemiarthoroplasty with respect to a patient of 42 years of age was not so palpably erroneous or unacceptable as to dub it as a case of professional negligence – Moreover, it was established that the consent complaint taken in respect of the procedure opted for.”
The support can be sought by the law laid down by the Hon'ble Supreme Court in the case cited 2010(1) CPJ 29 (SC) in case titled Kusum Sharma & Ors. Vs Batra Hospital & Medical Research Centre & Others wherein it has been held that:-
“....Medical negligence – Pre-operative evaluation made – Hemiarthroplasly decided to perform on considering various option available – Respondent consented for choice of surgery after various options explained to him – Decision for choosing hemiarthroplasly not so erroneous to prove it as professional negligence – Doctor not guilty of medical negligence as long as they perform their duties and exercise ordinary degree of professional skill and competence – Medical negligence not proved in view of settled principles of medical negligence – No relief entitled.”
The Hon'ble Supreme Court in the aforesaid case has observed that:-
“According to Halsbury's Laws of England Ed.4 Vol. 26 pages 17-18, the definition of Negligence is as under:-
“22. Negligence; Duties owed to patient – A person who holds himself out as ready to give medical (a) advice or treatment impliedly undertake that he is possessed of skill and knowledge for the purpose. Such a person, whether he is a registered medical practitioner or not, who is consulted by a patient, owes him certain duties, namely, a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give and a duty of care in his administration of that treatment (b) A branch of any of these duties will support an action for negligence by the patient.”
It has also bee discussed in the aforementioned case that:
“In a celebrated and oftenly cited judgment in Bolam V. Friern Hospital Management Committee (1957) 1 WLR 582: (1957) 2 ALL ER 118 (Queen's Bench Division – Lord Justice McNair observed:-
“(i) a doctor is not negligent, if he is acting in accordance with a practice accepted as proper by a reasonable body of medical men skilled in that particular art, merely because there is a body of such opinion that takes a contrary view. The direction that, where there are two different schools of medical practice, both having recognition among practitioners, it is not negligent for a practitioner to follow line in preference to the other accords also with American law : See 70 Corpus Juris Secundum (1951) 952,953, para 44. Moreover, it seems that by American law a failure to warn the patient of dangers of treatment is not, of itself negligence ibid 971, para 48). Lord justice McNair also observed : Before I turn that, I must explain what in law we mean by “negligence”. In the ordinary case which does not involve any special skill, negligence in law means this ; some failure to do some act which a reasonable man in the circumstances would do, or doing some act which a reasonable man in the circumstances would not do; and if that failure or doing of that act results in injury, then there is a cause of action. How do you test whether this act or failure is negligent ? In an ordinary case, it is generally said that you judge that by the action of the man in the street. He is the ordinary man. In one case it has been said that you judge it by the conduct of the man on the top of a Clapham omnibus. He is the ordinary man. But where you get a situation which involves the use of some special skill or competence, then the test whether there has been negligence or not is not the test of the man on the top of a Claphm omnibus because he has not got this man exercising and professing to have that special skill. A man need not possess the highest expert skill at the risk of being found negligence. It is well established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art.”
21. With utmost regard and humility to the authorities produced by the complainant are distinguishable on facts and circumstances.
22. Therefore, in view of what has been discussed above, this Forum is of the considered view that there is no deficiency in service on the part of the opposite parties. Hence, this complaint is dismissed without any order as to cost.
A copy of this order be sent to the parties concerned free of cost and file be consigned for record. '
Pronounced in open Forum
13-12-2011 (Vikramjit Kaur Soni)
President
(Sukhwinder Kaur) (Amarjeet Paul)
Member Member
