| ORDER | BEFORE THE DISTR7ICT CONSUMER DISPUTES REDRESSAL FORUM, AMRITSAR. Consumer Complaint No. 421 of 2013 Date of Institution: 07.06.2013 Date of Decision: 10.03.2016 Kamal Sharma aged 37 years son of Sh. Parmod Chander Sharma resident of 211-Shivala Colony, Near Shivala Bhayian,Amritsar Complainant Versus - Dr.U.S.Dhaliwal of Dhaliwal Hospital, 3-Batala Road, Amritsar
- Dhaliwal Hospital through its Prop./Partner/Officer Incharge Dr. U.S.Dhaliwal, 3-Batala Road, Amritsar
- United India Insurance Co. through its Office Incharge, Janpath Cannaught Palace, New Delhi
Opposite Parties Complaint under section 11 and 12 of the Consumer Protection Act, 1986 Present: For the Complainant : Sh.D.P. Singh, Advocate For the Opposite Parties No.1 & 2 : Sh. Vipan Bhasin,Advocate For the Opposite Party No.3 : Sh. P.N.Khanna,Advocate Quorum: Sh.Bhupinder Singh, President Ms.Kulwant Kaur Bajwa, Member Sh.Anoop Sharma,Member Order dictated by: Sh.Bhupinder Singh, President. - Present complaint has been filed by Kamal Sharma under the provisions of the Consumer Protection Act, alleging therein that he was suffering from pain in upper abdomen in the month of March 2013 and he approached his family doctor for treatment for which he got X-ray chest PA from Bharat X-ray Clinic, Amritsar. Thereafter the complainant approached the opposite party hospital on 6.3.2013 where he was checked by opposite party No.1. After checking, opposite party No.1 advised the complainant to get ultrasound from Dhillon Ultra Sound Scan Centre, Amritsar and other clinical examinations & tests from Bharat Diagnostic Centre, Amritsar which were got done by the complainant. On perusal of ultrasound report as well as other clinical tests reports, opposite party No.1 diagnosed a Calculus of 22 mm size in the gall bladder of the complainant and recommended Button Hole Surgery to remove the stone. On the assurance and advice of opposite party No.1, complainant was admitted in opposite party No.2 hospital on 8.3.2013 and opposite party No.1 Dr.U.S.Dhaliwal and his team conducted the Button Hole Surgery of the complainant. But after operation, the complainant was feeling pain in his abdomen and during his visit to opposite party No.1, he was assured that pain will not exist after fourth day of the operation. But even on 3rd and 4th day of operation the complainant was feeling severe pain in his abdomen and whenever complainant approached opposite party No.1 and made complaint about pain, he did not bother to give proper check up rather gave pain killer tablets and injections. Complainant has alleged that opposite party claimed his hospital as ISO 9001-2008 certified hospital but there are no facilities of certified hospital. The complainant was discharged from the hospital on 12.3.2013 even when he was suffering from severe pain in his abdomen, by prescribing some medicines. When, after reaching his home, complainant could not recover from pain and condition of the complainant became more critical, then complainant went to the opposite parties on 16.3.2013 and reported the matter to opposite party No.1. Opposite parties again admitted the complainant in the hospital and started treatment and gave some medicines and pain killer injections to the complainant. On 16.3.2013 and 18.3.2013 some lab tests were conducted on the advice of opposite party No.1. When there was no recovery from pain, opposite party No.1 referred the complainant to Amrit Diagnostic Centre, Amritsar on 18.3.2013 for ultrasound which was got conducted and the report of which was revealed as under :-
“CBD is obscured by bowel gas. There was large fluid collection of size of 15x11.7 cm in the inferior recess of the lesser sac & is seen extending into the left perthepatic space and left anterior pararenal space. There is some fluid in the perisplenic space. Streak of fluid is seen in the morrions pouch, Mild free fluid is seen in pelvis.” Complainant has alleged that on account of collection of fluid and wrong treatment, complainant was affected by jaundice. Again on 19.3.2013 the complainant was referred to Nijjar Scan & Diagnostic Centre, Amritsar for MRI of abdomen with MRPC and the MRI was got conducted on the complainant. After receipt of MRI report, on the next day i.e. on 20.3.2013 complainant was referred to Dayanand Medical College & Hospital, Ludhiana in Ambulance of opposite parties, having no facility of Oxygen and without attendant doctor. Opposite party No.1 issued reference slip without disclosing cuts in CBD and liver occurred during the Button Hole Surgery . In his report opposite party No.1 has wrongly mentioned that source of fluid could not be definitely made out and reported that CBD Gastec duct are found to be normal. Complainant has alleged that opposite party No.1 had further wrongly mentioned in his reference slip that complainant was referred to Dayanand Medical College & Hospital, Ludhiana on the desire of the attendants of the complainant rather complainant was referred by opposite party No.1 to Dayanand Medical College & Hospital, Ludhiana. Complainant remained admitted for two times in the hospital of opposite parties for which they have charged Rs. 80,000/- in cash without issuing any bill/cash memo because keeping the critical condition of the complainant and to reach DMC as early as possible, they made payment on assurance that bills will be given after few days and when after coming back from Ludhiana, complainant’s attendants demanded bills/cash memo, they flatly refused to issue the same. Complainant has further alleged that during the period from 6.3.2013 to 20.3.2013, complainant incurred approximately Rs. 40,000/- on ultrasound, MRI and many other clinical tests and medicines. Complainant also remained admitted in DMC ,Ludhiana on 20.3.2013 as referred by opposite party No.1 due to negligence of operating doctor during operation by Button Hole Surgery and incurred Rs. 84,278/- on his medical treatment at Dayanand Medical College & Hospital, Ludhiana against bill No. 201321512. After discharge from Dayanand Medical College & Hospital, Ludhiana on 28.3.2013, complainant could not recover and again approached Dayanand Medical College & Hospital, Ludhiana on 1.5.2013 and they again admitted the complainant in this hospital. Again complainant was operated and treatment was given and was discharged on 18.5.2013 and complainant again incurred Rs.42,617/- on his treatment. The complainant is totally on bed after discharge and so many problems have developed due to negligent treatment of the opposite parties. Complainant has alleged that on his treatment he has spent Rs. 6,01,895/- for the period from 6.3.2013 to 18.5.2013 which includes Rs. 80000/- charged by the opposite party, Rs. 45000/- on tests, ultrasounds, MRI and medicines, Rs. 1,26,895/- charged by Dayanand Medical College & Hospital, Ludhiana for two times , Rs. 3,50,000/- on medicines, tests, ultrasounds etc at Dayanand Medical College & Hospital, Ludhiana. Complainant has alleged that due to negligence of Opposite Party No.1, complainant had not only suffered financial loss of Rs. 6,01,895/- but he has also lost his health and still on the bed and developed so many other problems due to wrong treatment and negligence of Opposite Parties No.1 and 2. Alleging the same to be deficiency as well as negligence in service, complaint was filed seeking directions to the opposite parties to pay Rs. 19 lacs including expenses of Rs. 6,01,895/- alongwith interest @ 12% p.a. Litigation expenses were also demanded. - On notice, opposite parties appeared and filed written version in which it was submitted that complainant approached the opposite parties on 6.3.2013 with complaint of pain in abdomen. After thorough clinical examination , complainant was diagnosed as having acute cholecystitis. Complainant was advised surgical treatment for this problem in the form of cholecystectomy. Opposite party No.1 explained three common surgical options, in the form of small incision open cholecystectomy also called button hole cholecystectomy, laproscopic cholecystectomy and standard open cholecystectomy alongwith their complications and other limitations. On 8.3.2013 complainant came and opted small incision open cholecystectomy/ button hole cholecystectomy. Thereafter the complainant signed the well informed consent. Thereafter patient was examined by the medical specialist Dr. A.S. Multani MD, and Dr.Sukeerat Singh, MD Anesthetist. Both the doctors declared complainant suitable for surgery. At the time when surgery was started gall bladder was highly inflamed with friable walls. However, due to unclear anatomy and due to presence of marked inflammation due to acute cholecystitis, the surgical dissection of the procedure was a bit difficult and required slow and careful dissection which was uneventful. A big stone impacted at the neck region of the gall bladder which was pressing the surrounding structures i.e bile ducts. All important structures in the operative area were fully identified and protected including cystic duct, cystic artery and other bile ducts. The cystic duct and cystic artery were well recognized, ligated and cut separately under vision before removing the gall bladder from its liver bed as a routine in such cases. After removing the gall bladder a thorough check up and complete haemostasis was done, no bile leak was detected. The abdomen was closed in layers as per routine. It was submitted that complainant regularly visited by Dr.A.S. Multani and opposite party No.1 alongwith other medical and nursing staff, who gave him full care and medical treatment as required from time to time. The complainant was discharged on 12.3.2013 when the medical specialist and the operating surgeon i.e. Opposite Party No.1 found him in a satisfactory condition and that too at the request of the complainant and the attendants. On 16.3.2013 complainant came for check up and was having moderate pain abdomen, so the complainant was admitted and required treatment was given to him. Necessary investigations were done including ultrasound of abdomen by Amrit Diagnostic Centre. The report of ultrasound revealed fluid around the area of operation in the abdomen but there was no comment on CBD due to bowel gas over it. IHBR were not dilated with no S.O.L. The exact source and nature of fluid could not be established. The MRCP of the abdomen was done on 19.3.2013 which mentioned some fluid in abdomen, but CHD/CBD and cystic duct stump were detected as normal. There was some doubt regarding visibility of the right hepetic duct which is possible due to inflammation of the surrounding structures as was present in this case. On 20.3.2013 the attendants of the patient came to opposite party No.1 and wanted to take the patient to some other hospital and opposite party No.1 advised them to take the patient only to PGI Chandigarh or Dayanand Medical College & Hospital, Ludhiana. All the arrangements were made to send the patient to DMC including fully loaded hospital ambulance of opposite party No.1 and a summary of treatment and investigations done by the opposite parties were given to the attendants of the complainant. It was denied that in Ambulance of the opposite parties, there is no facility of Oxygen and attending doctor. It was denied that opposite party No.1 issued reference slip on hospital pad on 20.3.2013 without disclosing cuts in CBD and liver occurred during Button Hole Surgery. It was denied that in his report opposite party No.1 has wrongly mentioned that source of fluid could not be definitely made out and reported that CBD Gastec duct is found to be normal. It was denied that opposite party No.1 wrongly mentioned in his reference slip that complainant was referred to Dayanand Medical College & Hospital, Ludhiana upon the insistence of the attendants of the complainant. It was denied that complainant had charged Rs. 80,000/- in cash from the complainant and his attendants without issuing any bill/cash memo. It was denied that during the period from 6.3.2013 to 20.3.2013 the complainant had spent approximately Rs. 40,000/- as the complainant could not trace out receipts and bills for that. It was also denied that the total expenses made by the complainant through the family members in hospital of opposite parties were Rs. 1,25,000/-. Rather the total amount which was spent by the complainant on his treatment comes to Rs.40,019/-. It was denied that so many problems have developed in the complainant’s body due to wrong and negligent treatment of the opposite parties. It was rather submitted that opposite parties provided the treatment to the complainant as per medical standards. It was denied that the complainant has spent Rs. 3,50,000/- which include the expenses of the DMC Ludhiana. It was denied that due to negligence of the opposite parties during button hole surgery, the complainant had not only suffered financial loss of Rs. 6,01,895/- rather he has lost his health and is still in the bed. It was denied that the doctor at Dayanand Medical College & Hospital, Ludhiana told the complainant that opposite party No.1 came to know the negligence on the very first day of the operation but he did not intimate to the complainant and did not properly treated the complainant and discharged him from his hospital. It was submitted that only 15% bile leaks are noticeable at the time of operation. Bile leak is known complication of any type of cholecystectomy procedure including MLC/BHC. It was submitted that patient was advised to go to DMC hospital where such problems are treated in routine. While denying and controverting other allegations, dismissal of complaint was prayed.
- Opposite party No.3 in its written version has submitted that there is no privity of contract between the complainant and opposite party No.3, as such the present complaint against opposite party No.3 is not legally maintainable. It was submitted that if any liability against the hospital authorities or concerned doctor (insured) is fixed, the Insurance company will consider the same as per terms and conditions and exclusion clauses of the said policy. While denying and controverting other allegations, dismissal of complaint against Opposite Party No.3 was prayed.
- Complainant tendered into evidence his affidavit Ex.C-1 alongwith documents Ex.C-2 to Ex.C-133.
- Opposite parties No.1 & 2 tendered affidavit of Dr.Ujagar Singh Dhaliwal Ex.OP1,2/1 alongwith Annexures Ex,.A-1 to Ex.A-25, affidavit of expert Dr.Kuldip Singh Ex.OP1,2/2.
- Opposite party No.3 tendered affidavit of Mr. Surinder Singh,Divisional Manager Ex.OP.3/1, copy of Insurance policy with terms and conditions Ex.OP3/2.
- We have carefully gone through the pleadings of the parties, arguments advanced by the ld.counsel for the parties and have appreciated the evidence produced on record by both the parties with the valuable assistance of the ld.counsel for the parties.
- From the record i.e. pleadings of the parties and the evidence produced on record by both the parties, it is clear that complainant suffered pain in upper abdomen and he got x-ray chest PA from Bharat X-ray Clinic, Amritsar and approached opposite party hospital on 6.3.2013 where he was checked by opposite party No.1 and the complainant was further advised to get ultra sound and other clinical examinations/tests which were got done by the complainant. On perusal of ultrasound report as well as other clinical test reports of the complainant, opposite party No.1 diagnosed calculus of 22 mm size in the gall bladder and recommended surgery. Resultantly the complainant was admitted in opposite party No.2 hospital on 8.3.2013 and opposite party No.1 conducted surgery of the complainant in opposite party No.2 hospital for the removal of the gall bladder. But after operation, the complainant was feeling pain in his abdomen and he reported the matter to opposite party No.1, who gave assurance that pain will be cured after a few days of the operation. But the pain of the complainant in his abdomen increased and the opposite party did not bother to give proper check up/care, rather they gave painkiller tablets and injections and the complainant was discharged from the hospital on 12.3.2013 even when he was suffering from severe pain in his abdomen, after prescribing some medicines. The complainant further alleged that the opposite party has claimed his hospital as ISO 9001-2008 certified hospital but there are no facilities of certified hospital. As the complainant’s condition became more critical due to pain in the abdomen, then complainant alongwith his family members approached Opposite Party No.1 on 16.3.2013. Then opposite party again admitted the complainant in hospital on 16.3.2013 and started treatment. On 16.3.2013 and 18.3.2013 some lab tests of the complainant were conducted. But inspite of the treatment given by the opposite parties at their hospital, there was no recovery from pain, to the complainant. The opposite party referred the complainant for ultrasound abdomen on 18.3.2013, which was got conducted by the complainant from Amrit Diagnostic Centre, Amritsar on 18.3.2013, the report of which revealed:-
“CBD is obscured by bowel gas. There was large fluid collection of size of 15x11.7 cm in the inferior recess of the lesser sac & is seen extending into the left perthepatic space and left anterior pararenal space. There is some fluid in the perisplenic space. Streak of fluid is seen in the morrions pouch, Mild free fluid is seen in pelvis.” The complainant alleges that on account of collection of fluid due to wrong treatment and lapse in surgery by the opposite parties, the complainant also suffered jaundice. Then the complainant was again referred to Nijjar Scan and Diagnostic Centre, Amritsar for MRI of abdomen with MRPC on 19.3.2013 which was got conducted . After receipt of the MRI report in the evening of 19.3.2013, the next day i.e. on 20.3.2013 complainant was referred to Dayanand Medical College & Hospital, Ludhiana (herein-after referred to as ‘DMC’) in Ambulance of the opposite party without any facility of Oxygen and attendant doctor, thereby, causing mental tension, harassment and fear of death to the complainant and his family members. All this amounts to deficiency of service, medical negligence on the part of opposite parties No.1 & 2 qua the complainant. The complainant further alleged that opposite party No.1 issued reference slip dated 20.3.2013 Ex.C-14 without disclosing cuts in CBD pipes and liver during surgery by opposite party No.1 rather he mentioned that source of fluid could not be definitely made out and reported that CBD Gastec duct is found to be normal. The complainant further alleged that opposite party No.1 has wrongly mentioned in his reference slip that the complainant was referred to DMC on the desire of the attendants of the complainant; thereby opposite party No.1 had taken advantage of innocence of the complainant and his attendants. The complainant further alleged that opposite parties No.1 & 2 have charged Rs. 80,000/- in cash from the complainant and his attendants without issuing any bill/cash memo by stating that the bills will be given later on. But later on the opposite parties No.1 & 2 flatly refused to issue the bills/cash memos. The complainant submitted that he could not trace out receipts and bills of the amount he had spent on ultrasound, MRI and other clinical tests as well as for the purchase of medicines though he has approximately spent Rs. 1,25,000/- on his medical treatment. The complainant was admitted in Dayanand Medical College and Hospital, Ludhiana (DMC) on 20.3.2013 on reference of opposite party No.1 and was attended by Dr. Satpal Singh, who after thorough check up of the complainant, ultrasound, MRI and clinical reports concluded post operative CBD and liver injury during the operation conducted by opposite party No.1 on the complainant. The complainant was kept in ICU. Again ERCP, clinical examinations/tests, Ultrasound, etc. were conducted at DMC Hospital, Ludhiana, surgery was conducted and artificial drains were installed to drain out the fluid, to avoid infection and treatment was given at DMC Hospital, Ludhiana to the complainant for 9 days and was discharged on 28.3.2013 as per discharge slip Ex.C-27. DMC Ludhiana charged Rs. 84,278/- from the complainant as per bill Ex.C-19. After discharge from DMC, Ludhiana, the complainant remained on bed taking medicines, but could not recover. There was pain in upper abdomen and even whole in the body of the complainant. The complainant again approached DMC at Ludhiana on 1.5.2013 he was again admitted on 1.5.2013, where he was again operated and treatment was given and ultimately discharged on 18.5.2013 as per discharge slip Ex.C-28 and the complainant paid Rs. 42,617/-. Even after discharge the complainant suffered so many problems due to deficiency in service, wrong and negligent treatment given by opposite parties No.1 & 2. The complainant incurred huge amount on clinical tests, medicines for which the complainant could not trace out the bills/ slips, however, he has approximately spent Rs. 2 lacs. The complainant further alleged that to his estimate the complainant has spent about Rs. 3,50,000/- on his medical treatment. The complainant further alleged that to his opinion he has spent about Rs. 6,01,895/- on his entire medical treatment apart from harassment, physical and mental pain suffered by the complainant due to medical negligence/deficiency of service on the part of opposite parties No.1 & 2 qua the complainant. Ld.counsel for the complainant submitted that opposite parties No.1 & 2 are liable for deficiency of service and medical negligence on the part of opposite parties No.1 & 2 qua the complainant. - Whereas the case of Opposite Parties No.1 and 2 is that the complainant approached Opposite Party No.1 on 6.3.2013 with complaint of pain in abdomen. The patient had USG (ultrasound) report which was got conducted by him on 4.3.2013 from outside. After thorough clinical examination of the patient and checking report brought by the complainant, he was diagnosed as having acute cholecystitis. Complainant was advised surgical treatment for his problem in the form of cholecystectomy. The complainant had already undergone medical treatment for the pain in abdomen. Opposite party No.1 explained three common surgical options i.e. (i) small incision open cholecystectomy also called button hole cholecystectomy, (ii) lap chole and (iii) standard open cholecystectomy, alongwith their complications/ limitations. Thereafter, the complainant went with the promise to come back after discussion with his family. The complainant again came on 8.3.2013 and opted small incision open cholecystectomy/ button hole cholecystectomy. The complainant was again explained the possible complications/ limitation of small incision open cholecystectomy/ button hole cholecystectomy. Thereafter, the complainant signed the well informed consent (Ex.OPX) written in English as well as in Punjabi. The patient was examined by the medical specialist Dr. A.S. Multani MD, Retired Professor, HOD Government Medical College, Amritsar. Pre anesthesia check up was done by Dr.Sukeerat Singh, MD Anesthetist and they declared patient suitable/ fit for surgery under the natural course of events. When surgery was started, it was found that gall bladder was highly inflamed with friable walls. Due to unclear anatomy and due to presence of marked inflammation as a result of acute cholecystitis, the surgical dissection of the procedure was a bit difficult and required slow and careful dissection which was uneventful. A big stone (22 mm) impacted at the neck region of the gall bladder which was pressing the surrounding structures i.e bile ducts, etc. All important structures in the operative area were fully identified and protected including cystic duct, cystic artery and other bile ducts. The cystic duct and cystic artery were well recognized, ligated and cut separately under vision before removing the gall bladder from its liver bed. After removing the gall bladder a thorough check up and complete haemostasis was done, no bile leak was detected. The entire process was uneventful and was done under the general anesthesia. The abdomen was closed in layers as per routine. The patient was regularly visited by Dr.A.S. Multani, Dr.U.S.Dhaliwal (opposite party No.1) alongwith other medical and nursing staff, who gave him full care and medical treatment time to time. The patient was discharged on 12.3.2013 when the medical specialist and the operating surgeon i.e. opposite party No.2 found him in a satisfactory condition and that too on request of the patient and his attendants. On 16.3.2013 the patient came for check up and was having moderate pain in abdomen, so the complainant was admitted and put on required treatment. Necessary investigations including ultrasound of abdomen were done. The report of the ultra sound dated 18.3.2013 (Ex.C12) revealed fluid around the area of operation in the abdomen. But there was no CBD cut. However, right hepatic duct was not well visualized due to bowel gas over it. IHBR were not dilated with no S.O.L. The exact source and nature of fluid could not be ascertained/ established. Therefore, the MRCP of the abdomen of the patient was done on 19.3.2013 (Ex.C13) which mentioned some fluid in abdomen, but CHD/CBD and cystic duct stump were detected as normal. However, there was some doubt regarding visibility of the right hepetic duct which is possible due to inflammation of the surrounding structures as was present in this case. However, some cause of collection of fluid at that level was suspected. The patient and his attendants were well explained and advised further treatment including the possibility of re-operation. On 20.3.2013 the attendants of the patient came to Opposite Party No.1 and wanted to take the patient to some other hospital. Opposite Party No.1 advised the complainant/ his attendants to take the patient only to tertiary hospital like PGI, Chandigarh or DMC Ludhiana and the complainant/ his attendants opted to take the patient to DMC, Ludhiana. Resultantly, the patient was referred to DMC, Ludhiana and was sent to DMC, Ludhiana in fully equipped hospital ambulance of Opposite Party No.2. Summary of treatment and investigations done by Opposite Parties Ex.C14 was given to the attendants of patient so that the surgeon of the DMC may understand the problem without wasting further time. Opposite Parties No.1 and 2 treated the patient as per set standard of medical treatment/ practice. In this regard, Opposite Parties No.1 and 2 produced medical literature in support of the treatment given to the patient at Opposite Party No.2 Hospital. Opposite Parties No.1 and 2 further submitted that Opposite Party No.2 hospital is certified by ISO 9001:2008, by government general insurance, LIC, etc. who have approved hospital, after inspection. Opposite Parties No.1 and 2 denied that the complainant was discharged from the hospital on 12.3.2013 when he was suffering from severe pain in his abdomen. Opposite Parties No.1 and 2 further submitted that the complainant was sent to DMC, Ludhiana as per choice of the attendants of the patient, in well equipped ambulance of Opposite Party No.2 Hospital alongwith reference slip on hospital pad. There was no cut in CBD pipe and lever of the patient during the surgery conducted by Opposite Party No.1. The complainant and his attendants were never kept in dark, rather everything was explained to the attendants of the patient and the complainant was referred to the tertiary hospital as per medical literature/ procedure. Opposite Parties No.1 and 2 denied that the complainant was charged Rs. 80,000/- in cash and no bill/ cash memo was issued, rather the complainant was charged as per the proper bills given to him at the time of discharge on both times which were amounting to a sum of Rs.40,019/- only which included chemists bills and Delux AC room rent. Opposite Parties No.1 and 2 specifically denied that the complainant had spent on his medical treatment approximate Rs.2 lacs. Opposite Parties No.1 and 2 also denied that as per the estimate of the complainant, he has spent Rs.3.50 lacs. They further denied that to the opinion of the complainant, he has spent about Rs. 6,01,895/- on his entire medical treatment as alleged by the complainant without producing any bills, memos/ receipts, etc. The complainant was treated as per the medical standard and as per the literature regarding small incision open cholecystectomy/ button hole cholecystectomy and was referred to tertiary hospital i.e. DMC, Ludhiana as per the standard literature in this regard. Ld.counsel for Opposite Parties No.1 and 2 submitted that there is no deficiency of service or medical negligence on the part of Opposite Parties No.1 and 2 qua the complainant.
- From the entire above discussion, we have come to the conclusion that complainant approached Opposite Party No.1 at Opposite Party No.2 Hospital on 6.3.2013 with complaint of pain in abdomen. The complainant had already with him USG (Ultra sound report) dated 4.3.2013 (Ex.C3) which he got conducted on 4.3.2013 from Dhillon Ultrasound Centre, Amritsar which shows big calculus of 22 mm size in the gall bladder. After thorough examination of the patient and reports brought by the complainant, he was diagnosed as having acute cholecystitis and the Complainant was advised surgical treatment for his problem in the form of cholecystectomy. Opposite party No.1 explained three common surgical options i.e. (i) small incision open cholecystectomy also called button hole cholecystectomy, (ii) laproscopic cholecystectomy and (iii) standard open cholecystectomy and the complainant was also explained their complications/ limitations. The complainant after discussion with his family again came to Opposite Party No.1 at Opposite Party No.2-Hospital on 8.3.2013 and opted small incision open cholecystectomy/ button hole cholecystectomy. The complainant was again explained the possible complications/ limitation of small incision open cholecystectomy/ button hole cholecystectomy. Thereafter, the complainant signed the well informed consent (Ex.OPX) written in English as well as in Punjabi. The patient was examined by the medical specialist Dr. A.S. Multani MD, Retired Professor, HOD Government Medical College, Amritsar; pre anesthesia check up was done by Dr.Sukeerat Singh, MD Anesthetist and declared patient suitable/ fit for surgery under the natural course of events. At the time of surgery, it was found that gall bladder was highly inflamed with friable walls due to unclear anatomy and due to presence of marked inflammation as a result of acute cholecystitis, the surgical dissection of the procedure was a bit difficult and required slow and careful dissection. The entire surgery process was uneventful. A big calculus (stone) of 22 mm in size impacted at the neck region of the gall bladder which was pressing the surrounding structures i.e bile ducts, etc. As per the record and patient notes Ex.OPX (running into 17 pages), it shows that all important structures in the operative area were fully identified and protected including cystic duct, cystic artery and other bile ducts. The cystic duct and cystic artery were well recognized, ligated and cut separately under vision before removing the gall bladder from its liver bed. After that complete haemostasis was done, no bile leak was detected and the entire process was uneventful. The entire process was done under the general anesthesia. The abdomen was closed in layers as per routine. The patient was regularly visited by Dr.A.S. Multani and Dr.U.S.Dhaliwal alongwith other para medical and nursing staff as is evident from the hospital record of the patient Ex.OPX, time to time. The patient was discharged on 12.3.2013 when the medical specialist Dr.A.S.Multani and the operating surgeon/ staff of Opposite Party No.2 Hospital found the patient in a satisfactory condition as is evident at page No.7 (backside) of hospital record Ex.OPX and the patient was advised for follow re-check up. On 16.3.2013 patient came to Opposite Party No.1 at Opposite Party No.2-Hospital for check up and was having pain in abdomen. So, the complainant was admitted in Opposite Party No.2 Hospital and was put on required treatment. Necessary investigation including ultra sound of abdomen of patient was got done. The report of the ultra sound dated 18.3.2013 (Ex.C12) revealed fluid around the area of operation in the abdomen. However, the CBD was obscured due to bowel gas over it. IHBR were not dilated with no S.O.L. The exact source and nature of fluid could not be ascertained/ established. Therefore, the MRCP of the abdomen of the patient was got done on 19.3.2013, report of which is Ex.C13, which specified some fluid in abdomen, but CHD/CBD and cystic duct stump were detected as normal. However, there was some doubt regarding visibility of the right hepetic duct which is due to inflammation of the surrounding structures. However, some cause of collection of fluid at that level was suspected. The patient and his attendants were well explained and advised further treatment including the possibility of re-operation as is evident from the report of Amrit Diagnostic Centre, Amritsar Ex.C12 and MRI report Ex.C13 and certificate issued by Opposite Party No.2 Hospital Ex.C14. In the present case, the patient had specific surgical condition known as MIRIZZI-SYNDROME which was the cause of bile leak and the right hepatic duct stricture as is evident from the operation findings dated 8.3.2013 at Opposite Party No.2-Hospital. The complication of bile leakage/ bile duct injury in cholecystectomy is a known complication as per surgical literature/ expert opinion produced by the Opposite Parties i.e. Indian J. of Surgery, Lancet London published in November, 1992, Surgery of the Liver and Biliary Tract, third Edition, edited by L.H.Blumgart, Indian J.of Surgery published in August, 1996, International J. of Surgery, etc. On 20.3.2013 the attendants of the patient told to Opposite Party No.1 that they wanted to take the patient to some other hospital. Opposite Party No.1 advised the complainant/ his attendants to take the patient only to tertiary hospital like PGI, Chandigarh or Dayanand Medical College & Hospital, Ludhiana, etc. and the complainant/ his attendants opted to take the patient to Dayanand Medical College & Hospital, Ludhiana. Consequently, the patient was referred to Dayanand Medical College & Hospital, Ludhiana and was sent to Dayanand Medical College & Hospital, Ludhiana in fully equipped hospital ambulance of Opposite Party No.2. Summary of treatment and investigations done by Opposite Parties no.1 and 2 Ex.C14, were given to the attendants of patient so that the surgeon at Dayanand Medical College & Hospital, Ludhiana may understand the problem without wasting further time. The patient was sent in fully equipped ambulance of Opposite Party No.2 Hospital. As the patient was in need of exploration of the operation to drain and know the nature and source of the fluid collected in the operation area, in such situation the patient was advised to a tertiary (Super Specialty) hospital for further expert management where all the facilities for such treatment are available as per text book surgical protocol. In this regard, Opposite Party No.1 cited Bailey and love Text Book of Surgery edition 25th (2008) Page 1125. Opposite Party No.1 therefore, has rightly advised the patient/ his attendants to take the patient to tertiary (Super Specialty) hospital like PGI, Chandigarh or Dayanand Medical College & Hospital, Ludhiana where all the facilities for further expert management exist. The attendants of the patient opted for Dayanand Medical College & Hospital, Ludhiana. Therefore, Opposite Party No.1 has rightly referred the patient to Dayanand Medical College & Hospital, Ludhiana without any further delay and sent the patient to Dayanand Medical College & Hospital, Ludhiana in well equipped ambulance of Opposite Party No.2-Hospital and got the patient admitted in that hospital i.e. Dayanand Medical College & Hospital, Ludhiana. Plea of the complainant that Opposite Party No.1 sent the patient in ambulance of Opposite Party No.2-Hospital without any doctor or nursing staff and without any oxygen facility as the patient was in critical condition, so there was apprehension to the patient/ his attendants regarding the life of the patient, is not tenable because at the time of discharge/ referring the patient from Opposite Party No.2-Hospital to Dayanand Medical College & Hospital, Ludhiana all the vital parameters of the patient were in normal range as per nursing record of the case file i.e. BP 110/70, Temp 99 F, Pulse rate 84, Respiratory Rate 20 per/ minute. The patient was fully conscious and went walking from Opposite Party No.2- hospital to the ambulance. This fact is also corroborated by patient record at the time of admission at Dayanand Medical College & Hospital, Ludhiana Ex.C27. The complainant could not produce any evidence from Dayanand Medical College & Hospital, Ludhiana nor examined any doctor/ medical expert from Dayanand Medical College & Hospital, Ludhiana to prove that the condition of the complainant/ patient was serious at the time of admission in Dayanand Medical College & Hospital, Ludhiana on 20.3.2013, rather the record of Dayanand Medical College & Hospital, Ludhiana itself states that all the parameters were in the normal range at the time of admission of patient at Dayanand Medical College & Hospital, Ludhiana. Patient was fully conscious. So, there was no need of any medical/ nursing assistance to the patient on the way from Opposite Party No.2-Hospital to Dayanand Medical College & Hospital, Ludhiana. As per Dayanand Medical College & Hospital, Ludhiana discharge certificate Ex.C27 at the time of admission of the patient on 20.3.2013 all his vital parameters were in normal i.e. he had gradual and mild pain abdomen, mild nausea (+), urinary output satisfactory (++), mild fever (+) on and off which was recovered by medication. Past history of surgery of the patient for renal calculi (kidney stone) was positive (In his child hood which may be cause of his urinary problem if any) ICT (+) (Mild Jaundice), JVP normal (Showing his heart and lungs were normal), all vitals normal. Patient is conspicuous and well oriented with normal TRP (Temperature, Respiration and Pulse rate), Chest - - B/L air entry normal (+), Per abdomen examination - - abdomen soft, tender (++) in right hypochondrium region (site of Operation Area). Abdominal sounds present (normal), no guarding, no rigidity (Normal Abdomen). Investigation done at Dayanand Medical College & Hospital, Ludhiana on 20.3.2013 was bileculture-No growth (No infection). MRI - - Intra Abdominal Collection in lesser sac (Area of the operation done) and no bileduct injury detected. Ultrasound (USG) - - Post cholecystectomy collection (no bileduct injury detected). Even Blood Investigations prove vital parameters normal. Serium bilirubin - - 4.06 mg (slightly raised). As per record of Dayanand Medical College & Hospital, Ludhiana, procedure done on 21.3.2013 - - under general anesthesia laparoscopic drainage of biloma. Pelvic drain removed on 23.3.2013. Sub pherenic drain removed on 26.3.2013. Drains were removed when no more fluid was found coming out of the abdomen showing that leakage of bile has already stopped and the patient was discharged from Dayanand Medical College & Hospital, Ludhiana on 28.3.2013 in normal condition as is evident from the discharge summary of Dayanand Medical College & Hospital, Ludhiana Ex.C27. The record of Dayanand Medical College & Hospital, Ludhiana (Ex.C27) produced by the complainant himself proves that fluid/ biloma was drained out from the site of operation at Dayanand Medical College & Hospital, Ludhiana, under general anesthesia laparoscopic on 21.3.2013 as diagnosis of only biloma made on MRI and Ultrasound of abdomen at Dayanand Medical College & Hospital, Ludhiana, whereas all the blood investigations were within normal range except mildly raised Serum Bilirubin. Biloma was drained laparoscopically, patient recovered and was discharged in a satisfactory condition on 28.3.2013 after removing the drains. Patient was put on oral medication and oral feed. At the time of second admission at Dayanand Medical College & Hospital, Ludhiana on 1.5.2013, the patient had no fever, no vomiting, no pain abdomen, no jaundice. The patient was conscious, oriented, PR 88 per/ minute, BP 110/80, Afebrile (No Fever), Chest B/L air entry normal, per abdomen examination revealed abdomen soft, no distension, no tenderness (Normal). X-Ray revealed contrast opacified common hepatic biliary system, CBD and left hepatic biliary system (all normal) and MRI proves proximal common hepatic duct mildly attenuated in caliber (Milk narrowing – stricture i.e. no cut), distal common hepatic duct, CBD normal. Gall bladder not visualized. Similar was the position of ultrasound- Upper abdomen and pelvic –liver normal. Drain seen in left sub hepatic space. Gall Bladder not visualized. No gross collection in Glass Bladder fossa (Operation Area showing there is no leakage of bile at that time) at the time of second admission of patient at Dayanand Medical College & Hospital, Ludhiana on 1.5.2013, which fully proves that there was no bile leakage and all the bile ducts were normal except the right hepatic duct which was only mildly attenuated in caliber (Narrowing/ Stricture), thus no bile duct injury was detected at Dayanand Medical College & Hospital, Ludhiana. Right hepatic duct stricture could be only by the pressure effect of the big stone (22 mm size) lying over this duct area in the infundilum (neck area) of the gall blader as shown by the pre operative ultrasound and operation findings dated 8.3.2013 at Opposite Party No.2-Hospital. This pressure injury to the right hepatic bile duct is recognized cause of bile duct injuries under the name of MIRIZZI-SYNDROME wherein a small stone causing constant pressure on bile ducts can cause pressure necrosis/ ulceration through into the adjoining bile ducts and can cause its narrowing or perforation leading to leakage of bile/ stricture of bile duct. (Text Book of Surgery by Bailey and Love 25th edition(2008) page 1124 and Manipal Manual of surgery 4th edition (2014) page 562 produced by the Opposite Parties in the Forum and attached with the main file. In the present case, a big stone was stuck up in the neck (infundilum) of the inflamed gall bladder of the patient which could rightly be the cause of bile duct compression injury and bile leak due to MIRIZZI-SYNDROME and not due to any surgical injury. After the stone was removed, the compressed and thinned out part of the right hepadic duct turned into a attenuated/ stricture portion as is evident from MRI, Ultrasound, X-Ray and operation findings at Dayanand Medical College & Hospital, Ludhiana. So, the collection of fluid biloma was not due to any negligence or deficiency of service on the part of Opposite Party No.1 at Opposite Party No.2-Hospital during surgery of the patient at Opposite Party No.2 Hospital on 8.3.2013. It is well known complication of such surgery i.e. Mini cholecystectomy. As per literature regarding the mini hole cholecystectomy produced by Opposite Parties, as discussed above, the collection of fluid biloma at the site of operation us a known complication in such button hole cholecystectomy as per literature and fully explained to the complainant and that was due to pressure injury to the right hepatic duct which is recognized under the name of MIRIZZI-SYNDROME wherein a small stone causing constant pressure on bile ducts can cause pressure necrosis/ ulceration through into the adjoining bile ducts and can cause its narrowing or perforation leading to leakage of bile/ stricture of bile duct. All these facts were fully explained to the patient/ his attendants by Opposite Party No.1 at Opposite Party No.2-Hospital and advised the patient/ his attendants to take the patient to tertiary (Super Specialty) hospital like PGI, Chandigarh or Dayanand Medical College & Hospital, Ludhiana where all the facilities for further expert management are available and the attendants of the patient opted for Dayanand Medical College & Hospital, Ludhiana, therefore, Opposite Party No.1 has referred the patient to tertiary (Super Specialty) hospital i.e. Dayanand Medical College & Hospital, Ludhiana where all the facilities of expert management are available. Opposite Party No.1 has referred the patient to Dayanand Medical College & Hospital, Ludhiana and as per surgery protocol because in such like situation the patient is to be referred to tertiary (Super Specialty) hospital for further expert management. Opposite Party No.1 has referred the patient to Dayanand Medical College & Hospital, Ludhiana on the request of attendants of the patient and that too as per Text Book of Surgery by Bailey and Love 25th edition(2008) page 1124. So, we are of the opinion that there is no deficiency of service or negligence on the part of Opposite Party No.1 in the treatment and during surgical operation of the patient at Opposite Party No.2-Hospital and all happened to the patient i.e. collection of fluid/ biloma at the site of the operation after operation was known complication of mini hole cholecystectomy as per literature i.e. Text Books pertaining to cholecystectomy. Moreover, the complainant could not produce any evidence from Dayanand Medical College & Hospital, Ludhiana, to prove that there was any deficiency of service or negligence in the medical treatment/ surgical operation by Opposite Party No.1 at Opposite Party No.2-Hospital.
- Ld.counsel for the complainant submitted that there was common bile duct injury i.e. CBD was cut during the surgery conducted by Opposite Party No.1 at Opposite Party No.2-Hospital on 8.3.2013 which occurred due to the medical negligence on the part of surgeon i.e. Opposite Party No.1. Here we do not agree with this contention of the ld.counsel for the complainant because no doubt, Dayanand Medical College & Hospital, Ludhiana at the time of admission of operation had diagnosed CBD injury, but during tests and the treatment of the patient at Dayanand Medical College & Hospital, Ludhiana, the Dayanand Medical College & Hospital, Ludhiana authorities could not find any CBD cut/ injury to the patient.
- Resultantly, we hold that the complainant has failed to prove on record any injury to the CBD of the patient during the surgical operation conducted by Opposite Party No.1 at Opposite Party No.2-Hospital on 8.3.2013.
- Ld.counsel for the complainant submitted that Opposite Party No.1 has conducted surgical operation of the patient through button hole surgery which is not a recognized system that is why the complication arose to the patient and he has to get curative measure at Dayanand Medical College & Hospital, Ludhiana. Here we do not agree with this contention of the ld.counsel for the complainant because as per the informed consent Ex.OPX both in English and Punjabi duly signed by the complainant as well as his father, for surgical operation, the complainant has given consent to get operated through small incision open cholecystectomy also called button hole cholecystectomy, and in the consent Ex.OPX given both in English and Punjabi, it has been categorically mentioned that the operation to be done is small incision open cholecystectomy/ button hole cholecystectomy. Moreover, button hole cholecystectomy is nothing, but a small incision open cholecystectomy and this surgery is being done by various hospitals. In this regard, Opposite Party No.1 has produced literature of Mahajan Hospital, Inside Gate Khazana, Amritsar as well as Thesis written by Sh.Avtar Singh Gill on button hole cholecystectomy which was submitted to and accepted/ approved by Government Medical College, Amritsar. Apart from this, Opposite Parties No.1 and 2 examined Dr.Kuldeep Singh, Professor and Head of Department of Surgery (Retd.), Dayanand Medical College & Hospital, Ludhiana, who has categorically stated that button hole cholecystectomy is another name given to mini hole cholecystectomy and as per the consent given by the patient/ complainant Ex.OPX in this case, the patient agreed for his operation i.e. button hole cholecystectomy which is also called mini hole cholecystectomy in which a small hole is done and this witness has also deposed that this technique named button hole cholecystectomy is technically and absolutely same and similar surgically to the technique of Mini Lap cholecystectomy. This witness has also deposed that complication of bile leak is a common and accepted complication of this operation which was detected at his first follow up visit of the patient in this case and he was rightly referred taking minimum possible time, to Dayanand Medical College & Hospital, Ludhiana, where again he was managed and treated well by standard surgical procedure and was discharged in a satisfactory condition.
- So, in light of the above discussion, we are of the opinion that there is no deficiency of service or medical negligence on the part of Opposite Party No.1 in the medical treatment/ surgical operation conducted by Opposite Party No.1 at Opposite Party No.2-Hospital.
- Consequently, we do not find any merit in this complaint and the same is hereby dismissed with no order as to costs. Copies of the order be furnished to the parties free of cost. File is ordered to be consigned to the record room. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum.
Dated: 10.03.2016. (Bhupinder Singh) President hrg (Anoop Sharma) (Kulwant Kaur Bajwa) Member Member | |
