Haryana

StateCommission

CC/61/2014

Bimla Devi - Complainant(s)

Versus

Dr. Ajay Aggrawal - Opp.Party(s)

14 Dec 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

Complaint No     :       61 of 2014

Date of Institution:     20.06.2014

Date of Decision :     14.12.2016

 

Bimla Devi w/o Sh. Sube Singh s/o Sh. Mohar Singh, Resident of Village Gokal Garh, Tehsil and District Rewari-now deceased represented through her legal representatives:-

1.     Sube Singh s/o Sh. Mohar Singh, Resident of Village and Post Office Gokalgarh, Tehsil and District Rewari, Haryana.

2.     Smt. Shashi Mehta d/o Sh. Sube Singh and Bimla Devi, Resident of House No.U-24/19, Pink Town House, DLF, Phase-3, Gurgaon.

                                      Complainants

Versus

 

1.      Dr. Ajay Aggarwal, Deep Hospital, Opposite Government Girls School, Circular Road, Rewari, Tehsil and District Rewari.

2.      Deep Hospital, Opposite Government Girls School, Circular Road, Rewari, Tehsil and District, Rewari through its proprietor/partner Dr. Ajay Aggarwal.

3.      Dr. Gajendra Yadav, Dr. Gajendra Yadav Pathology Lab, Garhi Bolni Road, Rewari.

4.      Dr. Gajendra Yadav Pathology Lab, Garhi Bolni Road, Rewari through its Proprietor/partner Dr. Gajendra Yadav.

5.      Oriental Insurance Company Limited, Branch Office 134/135, Sneh Nagar, 3^rd Floor, Sahu Plaza, near Awadh Hospital, Alambagh, Lucknow-226005.

6.      All India Institute of Medical Sciences, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, Department of Pathology, New Delhi through its Managing Director/concerned officer.

 

                                      Opposite Parties

7.      Dr. Rajesh Goyal, K. Lal Ultrasound & Imaging Clinic, 21, Brass Market, Rewari.

8.      Dr. D.P. Das, Micro Path Labs, Micro Pathology Services Private Limited, Sector-4 & 7 Circle, near Airtel Billing Centre, New Railway Road, Gurgaon.

9.      Dr. Moushumi Suryavanshi, Dr. Lal Path Labs, Sector 18, Block-E, Rohini, New Delhi; and ‘Eakay House’ 54, Hanuman Road, New Delhi.

10.    Rajiv Gandhi Cancer Institute and Research Centre (Unit of Indraprastha Cancer Society and Research Centre), Sector-V, Rohini, Delhi.

Performa Opposite Parties

11.    The New India Assurance Company Limited, 1652-D, Kath Mandi, above State Bank Bikaner and Jaipur, Rewari, Haryana-123401.

Opposite Party

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Shri B.M. Bedi, Judicial Member.

                             Shri Diwan Singh Chauhan, Member   

 

Argued by:          Shri D.K. Jangra, Advocate for complainants.

Shri Anirudh Kush, Advocate for Opposite Parties No.1 to 4. 

None for Opposite Parties No.5 & 6 (dispensed with).

None for Opposite Parties No.7, 8 and 10.

Shri Punit Tuli, Advocate for opposite Party No.9.

Shri Vinod Chaudhri, Advocate for Opposite Party No.11.

 

O R D E R

 

B.M. BEDI, JUDICIAL MEMBER

 

           Bimla Devi (since deceased)-complainant (hereinafter referred to as ‘the patient’), filed complaint with the allegations that she noticed swelling and clots in her breast and got herself checked from Dr. Kaushal Goyal of Rewari. She was referred for pathological test to Dr. Ajay Aggarwal-Opposite Party No.1, proprietor of Deep Hospital-Opposite Party No.2 for diagnosis. Opposite Parties No.3 & 4 diagnosed the disease as cancer vide report dated 06.01.2012 (Exhibits C-1). The Prescription Slip is Exhibit C-2. The Opposite Party No1 carried out surgery and removed a portion of left breast on 09.01.2012. It was alleged that the Opposite Party No.1 did not subject the patient to further test for confirmation.

2.                On 14.01.2012 the patient was subjected to ultrasound when everything was found normal vide report of K. Lal Ultrasound & Imaging Clinic (Exhibit C-3). It was further stated that upon receipt of biopsy report (Exhibit C-10) issued by Micro Path Lab-Opposite Party No.8, it was found “INFILTRATING DUCT CARCINOMA WITH LYMPH NODE METASTASIS”, however vide report Exhibit C-10/1 “adjacent margins negative for tumor cell infiltration”. It was stated that patient was wrongly operated upon, however to be sure and not being satisfied with the treatment, the patient approached All India Institute of Medical Sciences (AIIMS)-Opposite Party No.6, where she was again advised for further test from Path Lab, where again she was advised to be not suffering from any cancer vide report Exhibit C-11. Dr. Paras of AIIMS called for specimen for further checking and diagnosis. However, the doctors of AIIMS with a view to protect Dr. Ajay Aggarwal-Oposite Party No.1, started Chemotherapy treatment, vide prescription slips Exhibit C-12/1 to C-12/21, without supplying any document to the patient. Thereafter, the patient was subjected to bone scan and vide Cytopathology  Report (Exhibit C-12/14), she was again found negative for cancer. The patient thereafter stopped for further Chemotherapy treatment and she was again referred to Rajiv Gandhi Cancer Institute and Research Centre-Opposite Party No.10. However, nothing was revealed even at the Rajiv Gandhi Cancer Institute and Research Centre. Thus, alleging that the patient was wrongly advised cancer by Dr. Gajendra Yadav (Opposite Parties No.3 & 4) and wrongly operated by Dr. Ajay Aggarwal (Opposite Parties No.1 & 2) and had spent more than rupees one lac on treatment besides pain and suffering and also alleging that the patient was subjected to Chemotherapy treatment and remained under tension, she sought compensation of Rs.30.00 lacs besides interest and litigation expenses.

3.                The Opposite Parties contested the complaint. Opposite Parties No.1 and 2 in their written version denied the allegations stating that the patient was advised for Fine Needle Aspiration Cytology (FNAC) test which was conducted by Dr. Gajendra Yadav, vide report Exhibit C-1; it was found positive of cancer in left breast and after operation, the part removed being sent for biopsy to Micro Path Lab, where also it was confirmed that “Infiltrating duct carcinoma with lymph node metastasis”. Thus, the status was found positive. Therefore, there was no doubt of patient having not been found suffering from cancer or having been given wrong treatment by the opposite parties. It was further stated that even as per report of Dr. Lal Path Labs (Exhibit C-11), where the patient was referred by AIIMS, again it was found “7/7 Metastatic lymph nodes with no perinodal spread” thus again confirmed cancer. Even the allegations of wrong FNAC were denied.

4.                Opposite Parties No.3 and 4 also filed their joint written version denying the allegations stating that the patient being referred to was subjected to FNAC and was found positive of cancer and that even at Micro Path Lab, it was again found cancer in removed portion of breast after surgery. Denying the allegations to be false, the opposite party No.5 – Oriental Insurance Company Limited also filed its written version.

5.                Opposite Party No.6-AIIMS vide its letter denied the allegations of the complainants.

6.                Opposite Party No.7 – Dr. Rajesh Goyal stated that the patient-Bimla Devi was referred for X-ray chest and ultrasound (whole abdomen) and after test, report was submitted on 14.01.2012 and that no allegation of any negligence were against him.

7.                Opposite Party No.8 – Dr. D.P. Das, Micro Path Labs, filed short reply denying the allegations and submitted that the patient was referred by AIIMS for certain tests and report Exhibit C-10 was submitted.

8.                Opposite Party No.9- Dr. Moushumi Suryavanshi, also filed short reply stating that there was no allegation of negligence against it.

9.                Opposite Party No.10 – Rajiv Gandhi Cancer Institute and Research Centre, did not file any reply.

10.              Opposite Party No.11 – The New India Assurance Company Limited, in its reply denied the allegation of the complainants.

11.              During the pendency of the complaint, complainant-Bimla Devi died and her legal representatives were brought on the record.

12.              Sube Singh-husband of deceased-complainant tendered his affidavit in evidence alongwith documents Exhibit C-1 to C-15.

13.              On behalf of Opposite Parties Dr. Ajay Aggarwal-Opposite Party No.1, Dr. Gajender Yadav-Opposite Party No.3 and Tarsem Chand-Manager New India Assurance Company filed their affidavits Exhibits OP-1/A, OP2/A and OP11/A-1 respectively.

14.              Counsel for the parties have been heard. File perused.

15.              Undisputed facts are that Bimla Devi (deceased-complainant) observing swelling and clots in her left breast, approached Dr. Kaushal Goel of Rewari who referred her further to Opposite Parties No.1 and 2. Opposite Party No.1 referred her to Dr. Gajender Yadav-opposite party No.3 for FNAC and other tests, vide report Exhibit C-1, which reads as under:-

                   “DESCRIPTION OF THE SWELLING/FNAC SITE

                   Left breast lump

                   MICROSCOPIC EXAMINATION

Smears reveal malignant cells in groups and dispersed singly alongwith few lymphocytes and necrosis in background. The neoplastic cells are large with high n:c  ratio and prominent nucleoli.

DIAGNOSIS

Picture is consistent with Duct Carcinoma/left breast”.

16.              Based on the report (Exhibit C-1) Dr. Ajay Aggarwal, diagnosed the patient to be a case of duct carcinoma/left breast, vide prescription Exhibit C-2 and after carrying out surgery recorded operation notes of having removed the breast and sent the removed portion for biopsy to Micro Path Labs as well as for X-ray and ultrasound to K. Lal Ultrasound & Imaging Clinic. Opposite Party No.7- Dr. Rajesh Goyal, K. Lal Ultrasound & Imaging Clinic, gave report (Exhibit C-3) while Micro Path Labs gave ultrasound report (Exhibit C-10) of the removed portion of left breast. The report (Exhibit C-10) reads as under:-

                   “BIOPSY (LARGE)

                   Gross Examination

                   Specimen sent to comment on lymph node metastases

Received mastectomy specimen, measuring 9.5 x 11.5 cms with overlying skin and nipple along with the surrounding fat.

Cut surface yellowish, firm with infiltrating margings.

Excised lymph nodes received: thr5ee lymph nodes found measuring 2.0 x 2.0 cms, 1.5 x 1.4 cms and 2.3 x 1.8 cms respectively.

MICROSCOPIC EXAMINATION

Tumour area:

Microscopic examination revealed a tumor with predominantly solid and nested growth pattern.

The tumor cells were large size with pleomorphism, with relatively uniform and round nuclei, small nudeoli and scant to moderate amount of cytoplasm.

Lymph nodes:

All the lymph nodes show extensive infiltration with tumour cells.

IMPRESSION

INFILTRATING DUCT CARCINOMA WITH LYMPH NODE METASTASIS

BIOPSY (LARGE).”

17.              Micro Path Labs also gave report of Sections taken from margins adjacent to tumour area. While the biopsy of removed portion (report C-10) was positive with Infiltrating duct carcinoma with lymph node metastasis; however sections taken from margins were found negative vide report Exhibit C10/1.

18.              It is not disputed that the patient on approaching AIIMS was again advised to Surgical Pathology Report (Exhibit C-11) which reads as under:-

“SPECIMEN:      Mastectomy (blocks and slides for review).

Clinical History: IDC

Gross:                 Received 5 paraffin embedded blocks and 5 H&E stained slides labeled as Zx-673/12 for IInd opinion.

Microscopy & Impression:

Mastectomy (Blocks and slides for review):

1.      Blocks received show normal breast tissue.

2.      Slides received show unremarkable overlying skin and metastatic lymph nodes.

3.      7/7 Metastatic lymph nodes with no perionodal spread.

4.      No evidence of primary malignancy seen in blocks and slides examined.”

19.              The question is as to whether the patient was suffering from cancer or not? And whether she was wrongly operated upon by Dr. Ajay Aggarwal-Opposite Party No.1?

20.              The allegations of complainants are that Dr. Ajay Aggarwal-Opposite Party No.1, should not have rested upon the report of Dr. Gajendra Yadav, whereby vide FNAC report she was found positive of cancer; he should have subjected the patient for further test to verify the same. The report of Dr.Ganendra Yadav (Exhibit C-1) by subjecting the patient to FNAC was positive of cancer. Even the biopsy report (Exhibit C-10) of Micro Path Labs of the removed portion of breast is also positive of cancer. In the report (Exhibit C-10) of Micro Path Labs, impression found was “Infiltrating duct carcinoma with lymph node metastasis”.  For “Sections taken from margins adjacent to tumour area was negative vide report Annexure C-10/1.  

21.              Learned counsel for the complainants has based his argument on the report (Exhibit C-10/1) that “Adjacent Margins were found negative for tumour cell infiltration”. This report is of sections taken from margins adjacent to tumour area, the tumour area being removed by surgery. The margins were found negative which would mean that the left over area was not spreaded with tumour cells. Even the report of Dr. Lal Path Labs on being referred by AIIMS observed as under:-

“3.     7/7 Metastatic lymph nodes with no perinodal spread.”

22.              This has been explained by Dr. Ajay Aggarwal who while appearing as witness during cross-examination, stated as under:-

“Before 09.01.2012, I had conducted physical examination of the patient besides routine tests for mastectomy operation and have also seen FNAC report.  I have not mentioned about the above said tests in my above said affidavit.  I have also not annexed any document alongwith the affidavit tendered today about the above said tests having been conducted by me. 

Q.      Is it correct that there is observation in the report dated 16.02.2012 now marked as C-10/1 under the heading impression it is mentioned adjacent margins negative for tumor cell infiltration?       

A.      This impression means that margins of tissue removed do not contain cancer cell.  Meaning thereby, the tumor was removed so perfectly that cancer cells remained inside the tumor and the resceted margins are free of cancer cells.

In the report dated 23.02.2012 (Exhibit C-11) of Dr. Lal’s Path Lab, under the heading of Microscopy and Impression, Observation at No.3 says “7/7 Metastatic Lymph Nodes” means that Cancer has spread from breast to all the seven lymph nodes in axilla and cancer has not gone beyond these lymph nodes. Observation No.4 indicates that no primarily malignancy is seen in block and slides examined by Lal’s Path Lab.  It means that whatever slides they have seen or examined they have not found any malignancy.  So, in advice they have asked to review the tumor container blocks.  This clearly indicates that more slides and blocks of the primary tissue are to be examined to see the primary cancer.

Note: Counsel for the complainant states that since he has not asked for explanation to Note No.3, therefore, this should not be read into evidence as it was not part of this question.  Since it is a case of medical negligence, the medical terms have to be explained by the doctor, who is appearing as a witness.

I have seen all the documents annexed with the complaint.  It is incorrect to suggest that I have wrongly operated the complainant only to grab the money from the complainant. It is incorrect to suggest that I have wrongly interpreted the reports dated 21.01.2012 (Exhibit C-1) and 16.02.2012 (Mark C10/1) to have in my favour.  It is incorrect to suggest that I have deposed falsely as there are other reports, which clearly says or indicates that complainant was suffering from breast cancer.  It is further incorrect to suggest that I have performed the operation negligently without confirming that the complainant was suffering from breast cancer.” 

 23.             On being cross-examined witness stated that it means cancer had spread from breast to all the 7 Lymph nodes, same is the explanation of Dr. Ganendra Yadav in his statement, relevant part of which reads as under:-

“I have seen the report dated 23.02.2012 of Dr. Lal Path Labs (Exhibit C-11). Note No.3 under the heading 7/7 Metastatic Lymph Nodes with no Perinodal Spread means that all the seven lymph nodes are positive for cancer and the cancer cells are limited to the lymph nodes and they are not over spilling”.

24.              The patient Bimla was also subjected to Chemotherapy at AIIMS vide Chemotherapy Cancer record Exhibits C-12/16 to C-12/20. No evidence has been led on behalf of the complainants to prove that the impression “7/7 Metastatic lymph nodes with no perinodal spread” means something different or to mean that the patient was not suffering from cancer.

25.              No expert opinion has been brought on the record by the complainants to prove their case. Onus was upon the complainants to prove that there was negligence and deficiency in service on the part of the operating/treating doctors while giving treatment to the patient-Bimla Devi. Thus, without any cogent and convincing evidence being brought on record by the complainants, the complainants are not entitled for any compensation.

26.              In view of the above, this Commission is of the view that no medical negligence has been established against the opposite parties while treating the patient Bimla Devi.

27.              Hence the complaint is dismissed. No order as to costs.  

 

Announced 14.12.2016

(Diwan Singh Chauhan) Member

(B.M. Bedi) Judicial Member

(Nawab Singh) President

CL