BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, ERNAKULAM.

Date of filing : 01/07/2010

Date of Order : 30/12/2011

Present :-

Shri. A. Rajesh, President.

Shri. Paul Gomez, Member.

Smt. C.K. Lekhamma, Member.

C.C. No. 370/2010

Between

And

O R D E R

Paul Gomez, Member.

1. The complaint was induced by the following facts :

The complainant is the father of a 12 year child who was admitted in the 1^st opposite party hospital with the complaint of excruciating pain in his right hand consequent on a fall. The 2^nd opposite party examined the child and detected fracture of the bone in the right hand and plaster was applied in the affected hand at 7 p.m. on 16-02-2011 and was discharged on the next day and was advised review on 25-02-2010. On the appointed day, check x-ray was taken and was found that the broken joints have not united well and therefore again the procedure that was carried out on 16-02-2011 was repeated and plaster was again applied and was advised to come back on 05-03-2010. On 05-03-2010, complaints regarding severe pain was brought to the notice of the doctor but he did not give much significance to the same and asked them to make a come back on 26-03-2010. On the visit on that day, the plaster was removed and check x-ray was taken. The doctor told them that there was angulation in the hand and that an operation was required to correct the deformity. But the complainant took him to another hospital and the boy underwent correctional surgery there. The child is improving since the surgery. In the complaint, the complainant seeks 1 lakh rupees by way of compensation on various counts.

2. The version was filed on behalf of the opposite parties :

When the patient visited with the fracture, the standard procedure of closed reduction and POP casing was followed in his case. This was done under image intensifier guidance under short anesthesia. The image intensifier gives continuous x-ray pictures on the screen so that the position of the fracture before, during and after the procedure can be viewed. On 25-02-2010, check x-ray of the right forearm showed minimal displacement of fracture fragments. The POP was removed and the procedure done on first admission was repeated and was asked to come back on 05-03-2010 for review. On 05-03-2010 the patient was reviewed, he had no complaints and on clinical examination the cast was in site, there was no obvious deformity and no pain on permissible movement of the limb. So the patient was asked to review on 26-03-2010 for removal of plaster and check x-ray. The check x-ray on 26-03-2020 showed angulation at the fracture site and the patient was advised surgery which was not acceptable to the relatives. World renowned authorities have acknowledged the closed reduction as the standard procedure in children on such situations. In children surgery is the last resort in such occasions because surgery will interfere with the natural growth of bones. The patient was asked to review on 05-03-2010 to see for edema or any other clinical alterations. At that time, when the patient was examined clinically, he was symptomatic and plaster was intact. So the patient was asked to come after one month to remove the plaster. The alleged remark that is said to have been made by Dr. Mathew Issac is not correct and hence denied. The complainant has raised exaggerated claims without any footing on evidence. The 2^nd opposite party has treated the patient with care and diligence and the allegations made in the complaint are devoid of merit. Hence it is urged on us to dismiss the complaint with costs of the proceedings to the opposite party.

3. The complainant was examined as PW1. Exts. A1 to A44 were marked on his side. The 2^nd opposite party was examined as DW1. The witness for the opposite parties was examined as DW2. Ext. B1 case sheet and x-ray were marked as Ext. X1 series. Both sides were heard.

4. The following points emerge for settlement :

1. Whether the 2^nd opposite party has followed standard procedure in treating the patient?

2. Whether the 2^nd opposite party has committed negligence in his omission to cause check x-ray to be taken?

3. What are the allowable reliefs, if any?

5. Point No. i. :- The dispute raised in this complaint is regarding deficiency in service mainly on the part of the 2^nd opposite party in treating a young boy of 12 years who was brought to the 1^st opposite party hospital with severe pain in his right had consequent on fall from a height. The procedure adopted by the doctor was closed reduction and POP cast. After one week, he was reviewed and when it was found that there was no proper union, there was re-do of the procedure and he was again asked to come after approximately one week. This time there was no complaint of any pain, and therefore, he was asked to make revisit after one month for removal of the plaster. But when check x-ray at that time was done it was noticed that there was angulation at the site, and therefore, the 2^nd opposite party suggested open reduction which was not acceptable to the near ones of the patient and hence they sought refuge in another hospital. This is the gist of facts, we have gathered on perusal of complaint and version together along with evaluation of materials produced in the Forum.

6. As we understand, the complainant is aggrieved because the mode of treatment followed by the 2^nd opposite party was not the standard procedure. The kind of procedure adopted by the doctor is commonly known in medical field as closed reduction. It was done under requisite anesthesia and such other instrumental assistance. When it was found to be not successful on review, the same procedure was repeated. Again when it was noted that there was angulation, the 2^nd opposite party thought of switching over to open reduction which is known as surgery in common parlance, to correct the deformity by fixing rod inside. There is no difference of opinion regarding the fact that this was the method followed by the doctor in the instant case. The only dispute is whether this is a recognized standard procedure allowed in such a situation. In support of the proposition that this is a well accepted method of treatment universally followed, the opposite parties have produced the copy of the relevant page from a standard text book on orthopedic surgery, by name Compbells Operative Orthopedics. At page 1068/1069 of the work, it is stated as follows :

“Fractures of the middle third of the forearm rarely require open reduction, especially in younger children ........ We agree with Neilson and Simonsen that open reduction also is indicated in an older child when several attempts at closed reduction have failed. ........ Of the 177 fractures of the forearm in children in our series only two had open reduction and internal fixation and both were middle third fractures in older children with mal-reductions after several closed attempts.”

From the above authoritative exposition of the method to be adopted in young children, it is crystal clear that closed reduction is the well recognized procedure to be followed in cases like that of the instant one. Open reduction is suggested only when several attempts of closed reduction have failed to achieve the desired result. In that perspective, the allegation regarding the method of treatment is only a wild allegation without appreciating the implications of various modes of procedure. It is clear from the deposition of the complainant that he had no clear understanding of the treatment and he had not gone through the treatment records. Also it has been stated by the complainant that the doctor who had treated the boy subsequently had suggested that open reduction with implantation was the proper method and had the boy been initially brought to his hospital the fiasco would have been avoided. When the said doctor was examined in the Forum as DW2 he denied the above statements. On an overall appreciation of material evidence before us, the conclusion is inescapable that the procedure followed by the 2^nd opposite party was the standard procedure recognized and supported by recognized authorities on the subject. Hence the allegation regarding the method of treatment seems devoid of any substance.

7. Point No. ii. :- The 2^nd allegation raised against the 2^nd opposite party is that he had committed negligence in his service in as much as he had not cared to take check x-ray on 05-03-2010. According to the complainant had he done so, it would have come to light that the joints were not in proper position. On his examination, the 2^nd opposite party has stated in the box that x-ray was not taken on 05-03-2010 because the patient had not made any complaint. Moreover, the doctor asserted that his stance of not taking x-ray was justified because there was nothing unusual in the finger movements also. Not only that, x-ray has in its own hazards. Ext. B1 case sheet contain what has been recorded by the doctor. He has recorded as follows :

“Moreover, if the pain were unbearable the complainant would have taken the child to another hospital for relief.”

Hence the statement made by the complainant that the patient had made complaints regarding severe pain in the affected area can hardly be believed. In this context, the opinion of DW2 is relevant. He has deposed that even if x-ray had been taken nothing would have come out, because stable union would be effected only after 4-5 weeks. On an overall evaluation of the materials produced before us, we are of the view that the 2^nd opposite party was justified in no taking check x-ray on 05-03-2010 and consequently one cannot find fault with the doctor on that score as well.

8. It is unfortunate to notice the practice of patients frequently getting inpatient with the doctor, when the desired result is not readily obtained. After all, medicine is an inexact science and it depends mainly on inferences, speculations and anticipations. Therefore, results will not be forthcoming with arithmetical precision. Eventhough the act of healing is divine, the physician cannot be approximated with divinity, because he is dealing with the most complex of all machines, namely human body. In that context, one would desire that people avoid complaints on flimsy grounds.

9. Point No. iii. :- In view of the finding on Point Nos. ( i.) and (ii.), point No. (iii.) has become infructous.

10. Accordingly, in view of the aforesaid discussions, the complaint stands dismissed .

Pronounced in open Forum on this the 30^th day of December 2011.

Sd/- Paul Gomez, Member. Sd/- A. Rajesh, President. Sd/- C.K. Lekhamma, Member.

Forwarded/By order,

Senior Superintendent.

A P P E N D I X

Complainant's Exhibits :-

Opposite party's Exhibit :-

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