BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANGALORE

Dated this the 31^ST January 2013

PRESENT

                                                            SMT. ASHA SHETTY           :   HON’BLE PRESIDENT

                                                             SMT.LAVANYA M. RAI       :   MEMBER

                                                             SRI. ARUN KUMAR K.        :   MEMBER

COMPLAINT NO.217/2010

(Admitted on 21.08.2010)

Sri V. Subrahmanya Bhat (V.S. Bhat),

So Late V. Narayana Bhat,

Aged 59 years,

Residing at Adarsha,

1^st Cross, Kottara Cross,

Mangalore 575 004.                           …….. COMPLAINANT

(Advocate for the Complainant: Sri K.S. Sharma).

          VERSUS

Dr. B. Rajendra Prasad, M.D.S.

Oral and Maxillo Facial Surgeon and

Implantologist,

Parentage is not known,

Sandhya Dental Clinic,

Anjum Courts, Opp. Infosys,

Kottara, Mangalore  575 006.               ……. OPPOSITE PARTY

(Advocate for the Opposite Party: K.S. Bhat).

                                      ***************

ORDER DELIVERED BY HON’BLE PRESIDENT

SMT. ASHA SHETTY:

I.       1. This complaint is filed under Section 12 of the Consumer Protection Act alleging deficiency in service against the Opposite Party claiming certain reliefs. 

The brief facts of the case are as under:

The complainant stated that, he was working as Senior Manager in Canara Bank, took voluntary retirement in March 2001 at the age of 51 years, though he had serviced till September 2010.

It is stated that the complainant was very hale and healthy till he had experienced shooting pain in the right floor of mouth below the tongue and adjacent area in Muly 2007.  Immediately in order to get suitable treatment, complainant consulted the opposite party i.e., Dr B Rajendra Prasad, who is running a Dental Clinic in Mangalore.  The opposite party examined the complainant and advised him to go for Biopsy for finding out the cause of the disease.  The complainant agreed and the opposite party did Biopsy and sent the specimen to Mangalore Diagnostic Laboratory for the test.  The Pathologist Dr. P.D. Bhandary, B.D., had informed his findings as per his report dated 14.07.2007 to the opposite party. 

The opposite party on receiving the said report called upon the complainant discussed about the report and told the complainant that the cause of the pain from which he was suffering was due to an infection in the Salivary Gland.  Further he had advised the complainant to undergo surgery immediately for removal of the Salivary Gland or else there will be much more problems to his internal oral region.  The complainant stated that he trusted the advise of the opposite party and agreed for the surgery and the same was done on 18.07.2007 at 5 A.M. in Mangalore Nursing Home.  The complainant was admitted to the Hospital on 17.07.2007.  As per the advise of the opposite party and the surgery was done on the above said day and discharged from the said Hospital on 23.07.2007 with all related reports of the Pathologist.  It is stated that the opposite party once again done the Biopsy and procured the report dated 18.07.2007 / 20.07.2007and informed the complainant that the surgery was successful and put him on hopes that he will be totally free from disease. 

The complainant stated that even after the surgery, he experienced his right side of the tongue was still not normal, he was feeling some sort of stiffness and not able to speak properly and fluently and also the pain was recurring time and again.  In view of the above said problem, the complainant contacted the opposite party personally for his advise, but the opposite party has opined that there will be such pain for some time to cure the consequences of the surgery and advised the complainant that gradually the complainant will able to speak. 

It is further stated that when the time passed like this till September 2009, thereafter the complainant started feeling the pain again below the right floor of the mouth under the tongue.  Complainant once again approached the opposite party on 24.10.2009 and narrated all his problems ever since the surgery, which he has undergone through the opposite party.  But the opposite party prescribed some medicines to the complainant and advised that it will be cured.  Since there was no relief, the complainant contacted the opposite party on 29.10.2009 and once again prescribed some other medicine and also advised to get the CT Scanning.  The same has been done in Mangalore and the scanning report dated 29.10.2009 along with scanning sheet, the complainant approached the opposite party, the opposite party on viewing the scanning sheet and going through the report advised certain medicine on the said day.  The complainant started to take medicine from 29.10.2009 as per the advise of the opponent. 

It is further stated that as there was no relief from recurring pain, the complainant contacted the opposite party on 16.11.2009 and once again the opposite party prescribed some different medicine on the above said day writing on the obverse of the previous chit dated 29.10.2009.  Since there was no cure, the complainant again contacted the opposite party on 20.01.2010 and informed the problems suffered by the complainant.  It is stated that inspite of the above said problems, the opposite party did not tell the complainant about the exact cause of pain in his mouth.  However, he has given vague and evasive reasons that the pain would be there for quite sometime and also advised the complainant to undergo one more surgery for immediate relief from the recurring pain. 

It is stated that when the opposite party advised one more surgery, the complainant told the opposite party that he was not in a position to undergo immediate surgery as his elder son’s marriage was schedule to be held on 19.03.2010.  It is stated that as he was not aware of the exact cause of his pain, asked the opposite party as to whether the operation can be done after the said function.  The opposite party told the complainant that he could wait for quite sometime and he would prescribe a medicine as stop gap arrangement, which would relieved him from pain for two months and again prescribed some medicine and advised the complainant to approach later. 

It is further stated that the complainant started feeling shooting pain in his mouth soon after his son’s wedding ceremonies.  As there was no improvement in the condition due to the medicine prescribed by the opposite party, the complainant though of going for second opinion. 

It is stated that in the last week of March, the complainant approached to one Doctor by name Dr. Dinesh Kadam, Plastic Surgeon, A.J. Hospital, Mangalore, along with all previous reports of Pathologist and Scanning Centre with scanning sheet and prescription given the opposite party.  After examining the previous report, the above said doctor informed the complainant in simple language that the complainant has been suffering from cancer in the internal region of his mouth, where exactly the surgery got done by the opposite party and it has spread over larger area of the mouth.  The said doctor disclosed that the said fact was clearly indicated in earlier Biopsy reports in medical terminology ‘Adenoid Cystic Careinoma’.  The above said doctor suggested the complainant to remove the impacted parts undergoing by surgery and asked the complainant for follow up treatment with radiation.  It is stated that the said doctor opined that the disease has reached Grade-II and had the complainant being treated by Oncologist in the initial stage itself, the above said disease would not have gain its present proposition causing additional pain to the body and mind of the complainant.  It is stated that the complainant till then was never told by the opposite party about the said facts.  Instead, he has totally misled the complainant willfully for unlawful enrichment and has done surgery upon him being incompetent to do the same. 

It is further stated that the disclosure of actual disease from which the complainant had been suffering from by the above said Dr. Dinesh Kadam was totally surprising, shocking to the complainant not only with regard to the serious disease facts and misleading advise of the opposite party.  The complainant being a layman was totally kept in dark by the opposite party for the sake of money. 

It is further stated that the complainant got admitted at A.J. Hospital once again on 26.03.2010 as per the advise of Dr. Dinesh Kadamk and undergone surgery on 27.03.2010 and discharged on 10.04.2010 from the said Hospital and at the same time undergone for Radiation Therapy from 05.05.2010 to 29.06.2010.  The complainant now relieved from pain after the treatment of Dr. Dinesh Kadam and Radiation Therapy. 

It is further stated that the complainant was in Hospital for the surgery and he was under only liquid diet through nasal pipes.  On account of the maltreatment and surgery conducted by the opposite party, the disease has flared up damaging major portion of the mouth and neck of the complainant, which was later dissected by Dr. Dinesh Kadam when it was Grade-II. 

It is further stated that the opposite party ought to have guided the complainant for proper treatment by referring him to Oncologist when the disease was at its initial stage on receiving the first report of Pathologist dated 14.07.2007, instead of conducting surgery upon the complainant as aforesaid in most incompetent and negligent manner.  The opposite party has even continued the said act, even after receiving the second report of Pathologist dated 18.07.2007 / 20.07.2007.  In both the reports, the oral cancer of the complainant has been noted in medical terminology ‘Adenoid Cystic Careinoma’.  It is stated that the opposite party deliberately failed to disclose the said fact to the complainant.  The opposite party being a Post Graduate in Dental Science must be aware and acquainted with the said medical terminology.  But he has kept the said information as guarded secret from the complainant with malafide intention in order to make unlawful gain from the complainant.  If at all opposite party informed the complainant, the complainant would not have suffered the extent he was forced to suffer. 

It is further stated that the large portion of muscles from the right side of the chest of the complainant was removed for implanting the same in the place of dissection by the Dr. Dinesh Kadam as there was no option for him to fill up that portion.  The complainant has lost strength in his right hand and he cannot lift weight as before nor he can drive the vehicle.  He cannot use his right hand for his day to day life and he has been suffering lot of physical discomfort on account of removal of large portion of muscles from the right side of his chest.  The complainant constrained to take the assistance to drive his vehicle and not able to do any house hold work.  As a result, he is constrained to appoint a servant to do the same. 

It is further stated that the opposite party ought to have guided the complainant for proper treatment by referring him to Oncologist when the disease was detected by the opposite party at the initial stage.  But the same was not done.  It shows a gross negligence on the part of the opposite party.  It is further stated that the complainant had spent Rs.24,584=62 towards the professional charges of the opposite party and in addition to that Nursing Home charges, cost of surgery and other medicines etc.,

It is stated that the opposite party has committed gross professional misconduct, negligence and criminal breach of trust and fraud upon the complainant.  The complainant bonafide believes that from day one he approached the opposite party and acted as per the advise of the opposite party.  But the opposite party intentionally deceived the complainant and misrepresented the complainant, thereby the complainant suffered untold hardship and because of the deficiency and negligence and professional misconduct in rendering service to the complainant, the complainant was put to great loss and hardship. 

It is stated that feeling aggrieved by the above the complainant issued a legal notice and called upon the opposite party to pay the damages.  But the opposite party failed comply the same.  Hence, the above complaint is filed by the complainant under Section 12 of the Consumer Protection Act, seeking direction from this Hon’ble Forum to the opposite party to pay a sum of Rs.19,42,324=62 and also sought for compensation and cost of the proceedings.

2.       Version notice served to the Opposite Party by RPAD. Opposite Party appeared through his counsel and filed version admitted that the complainant approached this opponent in July 2007 with the complaints of ulceration, selling and pain in the floor of the mouth on the right side below the tongue. Further stated that the pain had started about 3 months back and so he had consulted one Dr. Jithesh, Dental Surgeon and received treatment from him and thereafter he was referred to Dr. Dayakar Punja, an ENT Surgeon, who told that it was an infection.  So that doctor attempted to incise and drain the pus.  Even after that there was no relief and that must have promoted him to approach this opposite party on the oral recommendation of one Dr. Sharma from Uppinangady. 

          This opposite party stated that he had suspected ‘Adenoid Cystic Carcinoma’ (Oral Cancer) and advised him to undergo a biopsy to recognize the type and nature of the tumor and the same was done on 12.07.2007 and the report disclosed that the complainant was indeed suffering from ‘Adenoid Cystic Carcinoma’ of the salivary gland.  It is stated that the complainant was clearly informed that it was a type of malignancy (cancer) of the floor of the mouth requiring surgery.  The complainant was explained in detail about the nature of the surgery and the risk and consequences of the surgery, which can generally be expected and after understanding this, complainant had agreed for the surgery. 

          It is further stated that complainant got admitted in Mangalore Nursing Home on 17.07.2007 at 7.10 P.M. and surgery was done on 18.07.2007.  At the time of admission once again explained that he had oral cancer and the affected portion will be removed by surgery.  It is also informed that cancer is such a disease that inspite of the surgery and removal of the affected part, recurrence cannot be ruled out and further informed that after the surgery he may experience some difficulty in tongue movement and limitation for clear speech. 

          It is stated that the surgery was done.  The test report confirmed the earlier diagnosis that it was a case of Adenoid Cystic Carcinoma.  It is also showed that resected margins appeared clear and no lymph node infiltration was seen.  In other words, edges of the remover issue free of cancer cells, which is a confirmation that the entire portion affected by the cancer was left behind and the surgery was successful. 

          It is further stated that at the time of discharge, the complainant was in a fit condition and he was advised to come for regular follow up.  During his further visits, the complainant had complained of slight difficulty in moving his tongue, which impaired his speech.  Opposite party advised advised remedial measures to adjust to these limitations.

          It is further stated that after the first surgery, the complainant again consulted the opposite party on or around 24.10.2009 i.e., after about 27 months of the surgery with complaints of pain.  He was advised to undergo a CT scan and the same was done at Mangalore and the report dated 29.10.2009 revealed that there was growth of around 3 by 4 centimeters in the floor of the mouth adjacent to the base of the tongue.  It was a clear case of recurrence of the cancer, which is one of the well documented possibilities in most cancer cases.  It is stated that cancer are known to recur after sometime inspite of complete and successful surgery of the cancer affected part. 

          It is further stated that based on the CT scanning report, opposite part informed the complainant that the cancer has recurred again and the only option is to surgically remove the affected part followed by further treatment in the form of radiation emphasizing that he should take a decision at the earliest.  However the complainant asked for extra time to decide as his children were busy and could not support him during the time of surgery.  Apart from that the marriage of his eldest son was in the offing and he decided to postpone the surgery till after his son’s marriage.  Meanwhile, he requested for some medications to control the pain till that time.  Opposite party had no other go but to prescribe conservative measures like pain killers and antibiotics to prevent super-infection of the lesion in order to provide him some temporary relief till the marriage was over.  That was the reason, he was given prescription during his visits on 29.10.2009, 16.11.2009 and 20.01.2010.  Thereafter, he did not consult this opposite party and this opposite party is not aware of his consulting Dr. Dinesh Kadam or what he advised the complainant and the nature of surgery undertaken by him. 

          It is further stated that the complainant was informed about the oral cancer and he is instigated by somebody to blame opposite party and extort money and try to make a fortune out of his misfortune.  The Histopathology reports were in his hands from the beginning and the diagnosis stated that it is a case of ‘Adenoid Cystic Carcinoma’ and the complainant knew fully well that it was an oral cancer. 

          Further stated that the opposite party is a Post-Graduate (Master) in Oral & Maxillofacial Surgery (M.D.S.) is very well qualified and copetent in the thorough “management of all the tumors of the salivary gland” including surgeries on the same and also staging of the salivary gland tumors.  The treatment for these tumors comes under the purview of a sub-division called ‘Maxillofacial Surgery’, which is infact one of the specializations of opposite party as he is an oral and Maxillofacial Surgeon.  Though Oncology is one of the topics that the surgeons are made adept at handling during their post-graduation, Oncology as a specialized branch of study is of recent origin and there was no Orofacial Oncologist as such in 2007-08 in Mangalore.  It is stated that Dr. Dinesh Kadam is also not an Oncologist.  Thousands of surgeries of cancer are being performed in various hospitals in Mangalore and elsewhere by general surgeons and oral cancer surgeries by Oral and Maxillofacial Surgeons.  It is further stated that the opposite party is competent for doing such surgeries and the opposite party has thrown all professional ethics and morality into winds.  It is further stated that several allegations made against this opposite party and his profession are uncharitable.  There may be some black sheep in the medical profession as is the case in any and every profession, including the profession of advocates.  But that does not mean that opposite party should be tarnished in the same brush. Opposite party has got vast experience of over 26 years as a dental surgeon and denied that there was a deficiency or professional negligence on the part of the opposite party and contended that there was no act of negligence whatsoever on the part of the opposite party.  The attack of oral cancer or recurrence of the cancer is not due to any act or omission of the opposite party and denied the deficiency in service and prayed for dismissal of the complaint. 

3.       In view of the above said facts, the points now that arise for our consideration in this case are as under:

(i) Whether the complainant proves that the opposite party has committed tortuous act of negligence / battery which amounted deficiency in service?

4.         In support of the complaint, Mr. V. Subrahmanya Bhat (V.S. Bhat) (CW1) filed affidavit reiterating what has been stated in the complaint and answered the interrogatories served on him.   One Dr. Dinesh Kadam (CW2) – Plastic Micro Vascular & Costetic Surgeon, A.J. Hospital, Mangalore and one Dr. Suresh Rao (CW3) – Radiation Oncologist, Fr. Muller’s Medical College, Mangalore - summoned witnesses of the Complainant were examined and cross-examined by the learned counsel for the parties.  Ex C1 to C20 were marked for the Complainant as listed in the annexure.   One Dr. Rajendra Prasad (RW1), Opposite Party filed counter affidavit and subjected him for cross-examination.  Ex R1 to R were marked for the Opposite Party as listed in the annexure.   The Complainant and Opposite Party produced notes of arguments, citations, some texts and medical authorities. 

          We have considered the notes/oral arguments submitted by the learned counsels and also considered the materials that was placed before this Forum and answer the points are as follows:                

          Point No.(i): Affirmative.

          Point No.(ii) & (iii): As per the final order.    

Reasons

5.  Point No. (i):

          In the instant case, the facts which are admitted is that the complainant was working as Senior Manger in Canara Bank took voluntary retirement in March 2001 at the age of 51 years.  It is further admitted that the complainant had experienced shooting pain in the right floor of mouth below the tongue and adjacent area in July 2007.  Immediately, in order to get suitable treatment complainant consulted the opposite party i.e., Dr. B. Rajendra Prasad, who is running a dental clinic in Mangalore.  The opposite party doctor in turn advised him to go for Biopsy for finding out the cause of the disease.  The complainant agreed for biopsy and opposite party did biopsy and sent the specimen to Mangalore Diagnostic Laboratory for the test.  The Pathologist Dr. P.D. Bhandary had informed his findings as per his report dated 14.07.2007 i.e., as per Ex.C1.  It is also not in dispute and admitted that on receiving the said report the complainant subjected for surgery in Mangalore Nursing Home as per the reference letter issued by the opposite party doctor, the complainant got admitted to the said Hospital on 17.07.2007, undergone surgery on 18.07.2007 in the said Hospital.  It is further admitted that as per the advise of the opposite party, the complainant discharged from the Hospital on 23.07.2007 as per Ex.C1(a) i.e., a discharge summary issued by the opposite party doctor.  After the discharge from the Hospital i.e., on 18.07.2007 / 20.07.2007, once again biopsy was done and the report were obtained from the opposite party doctor in respect of the surgery done by the opposite party doctor.  The contents of the above said report also not disputed by the parties.  Further it is admitted that the complainant developed once again shooting pain on the very same region on which the surgery was conducted, the complainant once again consulted opposite party in the month of September 2009.    The opposite party on 24.10.2009 prescribed certain medicines and thereafter, since there was no relief the complainant once again contacted the opposite party on 29.10.2009 and the opposite party once again prescribed some other medicine and also advised to get the C.T. Scanning.  The complainant undergone C.T. Scanning and submitted the report dated 29.10.2009 i.e., Ex.C7 before the opposite party.  The opposite party once again prescribed certain medicines even on 16.11.2009, 20.01.2010. 

Now the points are in dispute between the parties before this FORA is that the complainant with the above background contended that he was very hale and healthy had experienced shooting pain in the right floor of mouth below the tongue and adjacent area in July 2007, immediately complainant approached the Opposite Party in order to get suitable treatment, the Opposite Party in turn examined the complainant and advised him to undergo biopsy for finding out the cause of the disease and thereby the complainant undergone biopsy and obtained the report dated 14.07.2007.  The opposite party after seeing the report told the complainant that the cause of the pain from which he was suffering from due to an infection in salivary gland and advised to undergo surgery for removal of salivary gland and told that there will be much problems / damage to his internal oral region, but not disclosed that the complainant was suffering from oral cancer i.e., ‘Adenoid Cystic Carcinoma’. 

The another contention of the complainant is that the opposite party after seeing the biopsy report subjected the complainant for surgery in Mangalore Nursing Home and discharged on 23.07.2007, even after the surgery his right side of the tongue was still not normal and he was feeling some sort of stiffness and not able to speak properly and fluently and pain was recurring time and again.  The complainant being uncured fully of his disease contacted the Opposite Party personally for his advise and treatment, but the Opposite Party has opined that there will be such pain for some time to cure the consequences of the surgery and the complainant will gradually able to speak as before.  Even though the Opposite Party doctor not disclosed the disease, which he was suffering when the time passed like this till September 2009, the complainant started feeling the pain once again below the right floor of the mouth under the tongue and contacted the Opposite Party on 24.10.2009.  The Opposite Party instead of subjecting him for any test, prescribed certain medicines even though the pain was not relieved the complainant contacted the Opposite Party on 29.10.2009 and the Opposite Party doctor subjected the complainant to get C.T. Scan report.  Even after seeing the C.T. Scan report, wherein the said report was disclosing of the cancer disease but the Opposite Party doctor instead of explaining the seriousness of the disease, which he was suffering prescribed certain different medicines time and again.  Since the complainant was not aware of the seriousness and he was suffering from cancer disease, the complainant again contacted Opposite Party on 20.01.2010, but the Opposite Party did not tell the exact cause of pain and gave vague and evasive reasons and told that the pain would be there for quite sometime and advised to undergo one more surgery for immediate relief from the recurring pain.  But did not told the complainant that he was suffering from oral cancer and there is every danger to his life etc., etc., the complainant since not aware of the disease, which he was suffering told the Opposite Party that he was not in a position to undergo immediate surgery as his elder’s son marriage was scheduled to be held on 19.03.2010 as he was not aware of the exact cause of his pain.  But the Opposite Party not told about the disease and prescribed certain medicines and told the complainant that which would relieve the pain for two months.  Thereafter the complainant developed more shooting pain in his mouth and there was no improvement in the condition, the complainant contacted and gone for second opinion and approached the Dr. Dinesh Kadam, i.e., CW.2 and taken treatment only at that time he came to know that he was suffering from oral cancer and the said diseased has reached Grade-II.  The complainant contended that the Opposite Party doctor misled the complainant and the complainant being a layman was totally kept in dark by the Opposite Party and because of his inadequate treatment, the complainant had to undergo second time surgery in A.J. Hospital and at that time the disease was reached Grade-II level and the Opposite Party treated the patient herein the complainant negligently and carelessly, thereby the complainant suffered to the extent that the large portion of muscles from the right side of the chest of the complainant was removed for implanting the same in the place of dissection by the Dr. Dinesh Kadam as there was no option for him to fill up that portion the complainant has lost strength in his right hand and cannot lift weight as before nor he can drive the vehicle, he cannot use his right hand for his day to day life and suffering lot of physical discomfort on every second and the complainant is now constrained to take the assistance to drive the vehicle and to do the house hold work.  It is contended that the opposite party being a doctor ought to have guided the complainant for proper treatment by referring him to Oncologist, when the disease was detected by the Opposite Party at its initial stage, on receiving the first report dated 14.07.2007 instead of conducting surgery upon the complainant.  It is further contended that the Opposite Party is the totally incompetent to do such surgery of that nature. It is further stated that the Opposite Party has continued his fraud and an act of cheating against the complainant, even after receiving the second report or Pathologist dated 18.07.2007, the oral cancer of the complainant has been noted in medical terminology ‘Adenoid Cystic Carcinoma’.  The Opposite Party being a dentist and acquainted with the medical terminology has kept the information as guarded secret from the complainant.  The Opposite Party should have consulted with the Oncologist or at least should have referred the complainant to the Oncologist in this case.  But the Opposite Party has committed gross profession misconduct, medical negligence and criminal breach of trust upon the complainant and thereby the complainant lost his life and suffered in the hands of the Opposite Party now the complainant is having physical and facial disfigurement apart from other sufferings.  Hence, came up with this complaint.  In order to substantiate the above contentions, the complainant himself examined as CW.1 as stated supra and also produced expert opinions i.e., Ex.CW.2 and CW3 before this FORA and produced Ex.C1 to C20 along with medical authority and the reliance was placed on the judgements reported by the Hon’ble Supreme Court as well as other Courts.

The Opposite Party on the contrary denied the allegations made by the complainant in his complaint and stated that the Opposite Party is a competent doctor to do the surgery as well as to treat the patient and denied the medical negligence alleged by the complainant.  The Opposite Party also examined himself as RW.1 and produced medical authorities and the reliance was placed by quoting the several judgements reported by Hon’ble Supreme Court as well as other Courts. 

We have perused the oral as well as documentary evidence available on record and after examining the material evidence, we find that in a case of medical negligence, it is the initial burden on the complainant to prove that what the doctor should have done which he did not do, or, what he did which should not have been done?  In case, the initial burden to prove medical negligence discharged by the complainant by making out a case of negligence on the part of the Hospital or the Doctor consulted / treated the onus then shifts on to the attending / treating doctors and it is for the doctors to satisfy Court / FORA that there was no lack of care and diligence. 

Similarly, in the present case on perusing the material evidence relied by the complainant supported by affidavit and also the medical literature and the oral as well as written arguments submitted by the counsel appearing for the complainant in length, wherein the complainant discharged the initial burden that the Opposite Party Doctor committed tortuous act of negligence thereby committed deficiency in service. 

However, before discussing the points on merits, we would like to take into consideration of the following landmark decisions held by the Hon’ble Supreme Court, wherein the Hon’ble Supreme Court considering the duties which a doctor owes to his patient in Dr. Lakshman Balakrishna Joshi V/s Dr. Trimbak Bapu Godbole and Another AIR 1969 SC 128 has held that:

“The duties which a doctor owes to his patient are clear.  A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose.  Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give or a duty of care in the administration of that treatment.  A breach of any of those duties gives a right of action for negligence to the patient.  The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care.  Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires (of. Halsbury’s Laws of England, 3^rd Edition Volume 26 Page 17).  The doctor no doubt has a discretion in choosing treatment which he proposes to give to the patient and such discretion is relatively ampler in cases of emergency.”  

In another Landmark decision i.e., in Bolam vs. Friern Hospital Management Committee: 1957(2) All.E.R.118, the Queen’s Bench Division, considering the care which is expected of medical practitioner has held as follows:-

                   “Before we turn to that, we must explain what in law we mean by negligence.  In the ordinary case which does not involve any special skill, negligence in law mean 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 of doing of what act results in injury, then there is a cause of action”. 

In another case, in Achutrao Haribhau Khodwa and others vs. State of Maharashtra and Others: 1996(2) SCC 634, the Supreme Court considering the degree of skill of medical practitioners has held as follows:

“The skill of medical practitioners differs from doctor to doctor.  The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treatment a patient.  Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution.  Medical opinion may differ with regard to the course of action to be taken by a doctor treatment a patient, but as long as a doctor acts in a manner which is acceptable to the medical profession and the Court finds that he has attended on the patient with due care, skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence”.

In cases where the doctors act carelessly and in a manner which is not expected of a medical practitioner, then in such a case an action in torts would be maintainable. A medical practitioner has various duties towards his patient and he must act with a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. This is the least which a patient expects from a doctor.

The Hon’ble Supreme Court in a case, Savitha Garg (Smt.) V. Director, National Heart Institute; VI(2004) SLT 385=IV(2004) CPJ 40 (SC)=(2004) 8 SCC 56, wherein, Lordships observed as under:-

                   “Once an allegation is made that the patient was admitted in a particular hospital and evidence is produced to satisfy that patient died because of lack of proper care and negligence, then the burden lies on the hospital to justify that there was no negligence on the part of the treating doctor or hospital.  Therefore, in any case, the hospital / doctor are in a better position to disclose what care was taken or what medicine was administered to the patient.   It is the duty of the hospital to satisfy that there was no lack of care or diligence.  The hospitals are institutions, people expect better and efficient service, if the hospital / doctors fail to discharge their duties, it is the hospital / doctor which has to justify or else they are not absolved from the liabilities.”

In the above authority, it is made very clear that in a case where the doctors act carelessly and in a manner which is not expected of a medical practitioner, then in such a case an action in torts would be maintainable, further a medical practitioner has various duties towards his patients and he must act with a reasonable degree of skill and knowledge and must exercise a reasonable decree of care, this is the least which a patient expects from a doctor. 

In the instant case, the complainant being a layman, it is nothing wrong which is expecting from the Opposite Party that the disease which he was suffering and undergone the major surgery.  However, before touching to the expert evidence, we have perused the various biopsy reports pertaining to the patient herein the complainant produced before this authority as follows:

(2009) 9 Supreme Court Cases 221

(BEFORE S.B. SINHA AND DEEPAK VERMA JJ.)

Criminal Appeals Nos.1191-94 of 2005

Malay Kumar Ganguly           :        Appellant

                                                V/s

Dr. Sukumar Mukherjee

And Others                             :        Respondents

With

Civil Appeal No.1727 of 2007

Kunal Saha (DR)          :        Appellant

                                                V/s

Dr. Sukumar Mukherjee

& Ohters                                 :        Respondents

Criminal Appeals Nos.1191-94 of 2005 with Civil Appeal No.1727 of 2007, decided on August 7, 2009

          A. Consumer Protection – Medical negligence – Doctors concerned not having requisite expertise – Course to be followed – Need to undertake research – Not following medical treatment protocols laid down by experts – Liability for – Patient suffering from Toxic Epidermal Necrolysis (TEN) (a skin disease) – Failure to diagnose the disease at initial stage by doctor (not a Dermatologist), coupled with his prescription of high dose of long-acting steroid, depomedrol, held was negligence on his part Second doctor who stopped use of depomedrol but prescribed quick-acting steroid, prednisolone, without considering harmful effect of steroid (depomedrol) already accumulated inpatient’s body, further held, was also guilty of medical negligence – Excessive dose of steroids led to immunosuppression and sepsis – Third doctor who failed to provide supportive therapy when TEN was disgnosed and patient’s condition was considerably serious, held, too was guilty of medical negligence – Patient’s death, held, was caused due to cumulative effect of giving treatment contrary to established medical treatment protocols – Case remitted to National Commission for assessment of compensation – Costs also imposed on defaulting hospital and the doctor who first treated patient, keeping in view their conduct and stand taken by them – Medical Practice and Practitioners – Supreme Court Rules, 1966, Or. 41 R.1 – Tort Law – Practice and Procedure – Costs – Exemplary costs

THE

SUPREME COURT CASES

(2008) 2 SCC

(2008) 2 Supreme Court Cases 1

(BEFORE B.N. AGRAWAL, P.P. NAOLEKAR AND R.V. RAVEENDRAN, JJ.)

SAMIRA KOHLI                                             ::       Appellant

Versus

DR. PRABHA MANCHANDA AND ANOTHER    ::       Respondents

Civil Appeal No.1949 of 2004, decided on January 16, 2008

          A. Medical Profession – Medical ethics – Consent – Consent of patient required for surgical procedure – Nature of such consent and nature and extent of information necessary to be furnished to secure such consent – Principles relating to, stated – Consent, unless it can be clearly or obviously implied, held, should be express consent – Difference in the nature of express consent, known as “real consent” in UK and “informed consent” in America pointed out – An unauthorized further or additional procedure can, in an action for negligence / battery, be justified under the principle of necessity only where the patient is temporarily incompetent (being unconscious) to permit the same and delaying of that procedure would be unreasonable because of imminent danger to the life or health of the patient – Consent for disagnostic procedure / surgery would not amount to authorization to perform therapeutic surgery except in life-threatening or ermergent situations – In India, the extent and nature of information required to be given by doctors to the patient in order to obtain a valid consent is governed by the Bolam test laid down in (1957) 1 WLR 582 and not by the “reasonably prudential patient” test evolved in Canterbury, 464 F 2d 772 (1972) – It is for the doctor to decide, with reference to the condition of patient, nature of illness and the prevailing established practices as to how much information regarding the risks and consequences should be given and how they should be couched in the best interest of the patient – A doctor acting accordingly with normal care and in accordance with a recognized medical practice, held, cannot be said to be negligent merely because a body of opinion takes a contrary view – In the present case, on evidence, held, thepatient had given consent for laparoscopy and not for. 

          32. Hunter v. Hanley  a Scottish case is also worth noticing.  In that decision, Lord President Clyde held:

          “In the realm of diagnosis and treatement there is ample scope for genuine difference of opinion and one man clearly is not negligent merely because his conclusion differs from that of other professional men, nor because he has displayed less skill or knowledge than others would have shown.  The true test for establishing negligence in diagnosis or treatment on the part of a doctor is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would be guilty of if acting with ordinary care.”

The impression / observation made by the Pathologist in a report dated 14.07.2007 and subsequent reports 18.07.2007 reproduced here below:

The Biopsy Report (Histopathology) dated 11.07.2007 observed as under:

Microscopy: Sestion shows group of accessory salivary gland with an ‘Adenoid Cystic Carcinoma’ showing early infiltration into the surrounding stroma.  No alround clearance made out in the exercised tissue.

                                                                             Sd/-

                                                                       Pathologist

One more report dated 18.07.2007 (after the first surgery)

Microscopy: Sestion show an infiltrating ‘Adenoid Cystic Carcinoma’ of the salivary gland, the covering mucosa shows ulceration with inflammatory infiltrate.  The adjacent salivary gland shows chronic sialadenitis.  The recepted margins appeared. 

                                                                             Sd/-

                                                                       Pathologist

Apart from the above report we have perused the another report C.T. Scan report dated 29.10.2010 i.e., Ex.C7 (after 2 years of the surgery).  The report reads thus:

Impression “Enlarged Soft Tissue Density Area in right submandublour region, right pressed gloid paraperegenial space with effacement, adjacent fat planes (needs correlation with previous surgical findings)

Sd/-

Consultant Radiolgist

After going through the above reports as well as the hospital documents produced before this authority it is proved beyond doubt that the complainant was suffering from ‘Adenoid Cystic Carcinoma’, it is an oral cancer. 

First of all we would like to know what is the ‘Adenoid Cystic Carcinoma’. 

The Medical Authority relied by the counsel appearing for the parties shows that (Wikipedia, the preenclosypedia) ‘Adenoid Cystic Cancer (Carcinoma)’ is a rare type of cancer that can exist in many different body sides. It most often occurs in the areas of the head and neck in particular the salivary glands.  But has also been reported in the best, lacriman gland of the eye, lung, brain, bartholan gland, trachea, and paranisal cyanosis, it is the second most common menignment salivant gland tumor overall.  It represents 28% of malignant submandublour tumors, making it a single most common malignant salivary gland tumor in this region.  The patients may survive for years with metastascs because this tumor is generally well differentiated and slow growing. 

TREATMENT:  Primary treatment for this cancer, regardness of body site, is surgical removal with clean margins.  This surgery can prove challenging in the head and neck region due to this tumors tendency spread along nerve tracts.  Adjuvant or palliative radio therapy is commonly given following surgery. In some case surgery is not a reasonable option, however radiation used alone may provide an effective treatment ……………………………………………………………………………………………

SURGERY: Surgical remover of the treatment is the best treatment for ADCC, provided it can be done safely and is likely to have a good out come.  A surgical Oncologist is a doctor, who specializes in treating cancer using surgery.  During surgery, the surgeon will remove the tumor and an area of tissues surrounding it called a margin. If the margin removed during surgery is found to be clean, meaning at least 2 millimeters of tissue i.e., cancer free surrounding the tumor, this signals total tumor removal and gives the best chance for successful treatment at the site of origin.

3. Oral & Maxillofacial Surgery

Oral and Maxillofacial surgery and Implantology deals with the diagnosis and surgical and adjunctive treatment of diseases, injuries and defects of the human jaws and associated oral and facial structures.

3. ORAL AND MAXILLOFACIAL SURGERY

OBJECTIVES:

The training program in Oral and Maxillofacial Surgery is structured to achieve the following four objectives-

.         Knowledge

.         Skills

.         Attitude

.         Communicative skills and ability

.         Research

KNOWLEDGE:

.         To have acquired adequate knowledge and understanding of the etiology, pathophysiology and diagnosis, treatment planning of various common oral and Maxillofacial surgical problems both minor and major in nature

.         To have understood the general surgical priniciples like pre and post surgical management, particularly evaluation, post surgical care, fluid and electrolyte management, blood transfusion and post surgical pain management. 

.         Understanding of basic sciences relevant to practice of oral and maxillofacial surgery

.         Able to identify social, cultural,economic, genetic and environmental factors and their relevance to disease process management in the oral and Maxillofacial region. 

.         Essential knowledge of personal hygiene and infection control, prevention of cross infection and safe disposal of hospital waste keeping in view the high prevalence of hepatitis and HIV.

.         Develop attitude to adopt ethical principles in all aspect of surgical practice, professional honesty and integrity are to be fostered.  Surgical care is to be delivered irrespective of the social status, caste, creed or religion of the patient.

.         Willing to share the knowledge and clinical experience with professional colleagues.

.         Willing to adopt new techniques of surgical management developed from time to time based on scientific research which are in the best interest of the patient. 

.         Respect patient right and privileges, including patients right to information and right to seek a second opnion.

.         Develop attitude to seek opinion from an allied medical and dental specialists as and when required. 

COMMUNCIATION SKILLS:

.         Develop adequate communication skills particularly with the patients giving them the various options available to manage a particular surgical problem and obtain a true informed consent from them for the most appropriate treatment available at that point of time. 

.         Develop the ability to communicate with professional colleagues.

.         Develop ability to teach undergraduates.

PAPER-III : MAXILLOFACIAL SURGERY

Salivary gland

.         Sialography

.         Salivary fistula and management

.         Diseases of salivary gland – developmental disturbances, cysts, inflammation and sialolithiasis

.         Mucocele and Ranula

.         Tumors of salivary gland and their management

.         Staging of salivary gland tumors

.         Parotidectomy

17. Bangalore      (i) Bachelor of Dental            B.D.S. Bangalore

          University          Surgery                             

  (ii) Master of Dental

       Surgery

    - Orthodontics                     M.D.S. (Ortho.),

                                              Bangalore

    - Oral Surgery                  M.D.S.,(Oral Surgery)

                                               Bangalore

    - Periodontia                    M.D.S., (Perio.)

                                               Bangalore

                    15 [-Oral diagnosis and        M.D.S.(Oral Diagnosis

      Dental Radiology                    and Dental  -

                                                   Radiology),

                                                  Bangalore.

   - Public Health                 M.D.S. (Public Health

     Dentistry                       Dentistry) Bangalore]

 16 [-Operative Dentist)        M.D.S. (Operative)

                                         Bangalore]

3. Oral and Maxillofacial Surgery

          Oral and Maxillofacial surgery deals with the surgical and adjunctive treatment of diseases, injuries and defects of the human jaws and associated oral and facial structures.

          The first contention raised by the complainant in other words the complainant’s case primarily depends on three points.  Firstly it is said he is a layman, he was not told about his disease for which he was suffering was an oral cancer.  The Opposite Party is negligent in failing to inform the complainant or give warning of the risk involved.  So that he might have at a chance to decide whether he was going to take those risk or not. 

          Secondly, it is that for the second time, the C.T. Scann Report showed that the complainant once again reoccurred that cancer disease.  Opposite Party should have warned the risk that he is suffering which that came again, if told, complainant would have immediately undergone surgery.  The point 1, which the counsel appearing for the complainant laid most emphasis that if it is told that the complainant was suffering from oral cancer and if it is not immediately undergone surgery, there is a risk and danger to the life of the complainant, the complainant and his family, who are financially well, all given first thought to the surgery of the complainant rather than the marriage of his son scheduled to be held on 19.03.2010.

          Thirdly, the Opposite Party counsel, who is a Dental Surgeon is not competent to trade / conduct the surgery on the complainant for the disease, which he was suffering i.e, ‘Adenoid Cystic Careinoma’, the Opposite Party doctor should have referred to the Oncologist / Oncology Surgeon to trade the patient or the worst cum worst should have taken opinion from the Oncologist as the complainant being a layman honestly trusted the Opposite Party doctor and the Opposite Party doctor, who is not competent to trade the above disease prescribed certain medicines / antibiotics even after seeing the C.T. Scan Report dated 29.10.2009, he should not have done this and should have explained all the risk instead prescribing the medicines and contended that he has fallen below his standard of practice recognize as proper by a competent reasonable body of opinion. 

          Let us examine those three points, bear in mind that our task is to see whether in failing to take the action, which if he said Opposite Party should have informed instead to prescribing certain medicines or subjecting him to surgery, he has fallen below the standard of practice recognized as proper by a competent reasonable body of opinion?  There are two questions that we have to considered first does good medical practitioner required to inform the disease to the patients and give warning and risks involved should be given to the patient before he subject the patient for surgery / treatment?

          Secondly if a warning had given what difference whould it have made?

          In the instant case, we are not satisfied by the Opposite Party doctor that in our opinion the doctor told the complainant regarding the oral cancer in a common man language known to him complainant would have more conveniently got treated at cancer hospital rather than approached the Opposite Party doctor now and again.  From the material on record, it appears that the patient herein the complainant has consulted the Opposite Party doctor for the first time on 11.07.2007 and the Opposite Party doctor after conducting the biopsy and obtaining the report found that the complainant was suffering from oral cancer and it was in the initial stage and thereafter the Opposite Party himself claiming that he is competent to trade the Oncology case and subjected the complainant for surgery in one Mnagalore Nursing Home and discharged the patient on 23.07.2007, but did not adivse the patient for follow up treatment at least once in a three months or six months.  There it appears the treatment of the Opposite Party is again inadequate. In a cancerous patient like this nature, the Opposite Party doctor should have advise the patient in the worst cum worst at least for once in a month or once in three months or at least once in a six months, but failed and further we observed that the complainant developed in other words recurred the cancer once again and the complainant approached once again the Opposite Party doctor on 24.09.2009.  The Opposite Party doctor instead of subjecting him to any of the test, prescribed certain medicines one after another again fateled to the case of the complainant.  However, ultimately i.e., on 29.10.2009.  The Opposite Party doctor advised the complainant to obtain C.T. Scanning Report and the said Report clearly shows that the complainant once again attacked with the very same disease.  But the Opposite Party has not subjected or referred the complainant to any of the Oncologist or not subjected the patient for immediate surgery.  The Opposite Party doctor failed to assign any reason why he did not involve the Oncologist or referred the complainant to the Oncologist / Oncology Surgeon, who is competent / specialized in the said subject.  Further the Opposite Party doctor was not told about the oral cancer, but informed the complainant that some infection was suggested for the surgery etc., etc.,  No doubt with all these background, the counsel appeared for the complainant vehemently argued that the Opposite Party is not competent to treat the disease like cancer.  He ought to have referred the patient to any Oncologist or at least he should have taken assistance of the Oncologist or worst cum worst taken opinion from the Oncologist.   But in the instant case, the above aspects lacks.  Despite of these backgrounds, the Opposite Party doctor not specified the FORA why did not refer the patient to the Oncologist rather he claimed that he is competent to trade the patient, which is not acceptable in the case on hand.  The evidence of the Opposite Party doctor as well as the medical authority, which we have referred herein, Oncology Surgeon is / are competent to treat the above disease in question.  Further we observed that if at all the complainant was informed that he was suffering from oral cancer and if at all the surgery was not done there is every chance of danger to the life of the complainant then definitedly the complainant and his family could have given first priority to the surgery rather than the marriage of their son. As we know the marriage can be postponed at any future date when the life of the mother or father is in risk or danger.  But once the disease is aggrevated, which cannot be taken back or in other words to that extent in a case of like this nature, the life of the complainant is fallen short.  The cancer is a disease, as soon as it has been detected to begin with the treatment is the ultimate and delay is curbed in a case of like this nature_______________________  

Complaint No.217/2010

RW-1

Date:09/08/2011

V. Subrahmanya Bhat             ::        Complainant

And

Dr. B. Rajendraprasad            ::        Opposite Party

CHIEF EXAM. BY AFFIDAVIT

Name                    :         Dr. Rajendra Prasad

Age                       :         57 yrs,

R/a                       :         Kottara, Mangalore,

During his stay in the hospital he as well as his wife and sons used to come and they were fully aware that the complainant was suffering from oral cancer.  The complainant and also his sons are well educated.  When it was found that he was in a fit condition for discharge, he was discharged from the hospital on 23.07.07 with the advice to come for regular follow up.  I did not refer to Radiation Oncologist nor I advise the complainant for radiation because the resected margins were clear.  Normally when the resected margins are clear radiation is not advised.  The radiation thereapy around the face has got serious side effects on the patient like eruption of ulcers in the mouth, fibrosis of tissues, dryness of mouth due to fibrosis of salivary glands, dental caries, removal of some of the teeth to prevent caries and infection required, disfigurement of the facial skin apart from cost of about Rs.30,000/- to Rs.40,000/- for radiation therapy.  Therefore, radiation is advised only in the case of confirmed spread of cancer beyond the resected portion.  As per the Biopsy report there was no spread of cancer beyond the resected margins radiation was not advised in the interest of the complainant.  As per the medical literature also the benefits of radiation in the case of adenoid cystic carcinoma are not established though it may be helpful to prevent spread of cancer in other types of cancer. 

The cancer of the complainant is of tubular pattern and that represents lower grade growths as per the medical literature.  In such cases the tumors may be adequately treated with surgery only.  Further salivary gland cancers have traditionally been considered radio-resistant.

Cancers are known to recur after some time inspite of complete and successful surgery of the cancer affected part and also radiation and chemotherapy treatments.  That is the reason why inspite of surgeries, chemotherapy or radiation the patient gets cancer again and again and thus the life span is shortened in several cases. 

At that time his wife as well as his eldest son were present.  Thereafter he did not consult me.  I was not aware of his consulting Dr. Dinesh Kadam, Plastic Surgeon at A.J. Hospital, Mangalore or what he advised the complainant and the nature of surgery undertaken by him. 

The Histopathology reports were always in his hands from the beginning which clearly stated his diagnosis as ‘Adenoid Cystic Carcinoma’ and he knew fully well that it was oral cancer. It is unimaginable that, he being educated and being a graduate and having served as a bank manager, did not know the nature of the disease he was suffering till the end of 209 inspite of such major surgery. 

A Post Graduate (i.e., a Master) in Oral & Maxillofacial Surgery (M.D.S.) is very well-qualified and competent in the thorough “management of all the tumours of the salivary gland” including surgeries on the same and also, ‘staging of the salivary gland tumors’.  The treatment for these tumours comes under the purview of a sub-division called ‘Maxillofacial Surgery’.

Date:08-09-2011

RW-1

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       12-07-2007 gÀ°è vÉUÉzÀAvÀºÀ §0iÀiÁ¦ì j¥ÉÇÃmïð£ÀÄß £Áå0iÀiÁ®0iÀÄPÉÌ ¤ÃrzÉÝãÉÆà E®èªÉÇà JAzÀÄ £À£ÀUÉ £É£À¦®è.  £Á£ÀÄ F ªÉÄð£À §0iÀiÁ¦ì j¥ÉÇÃlð£ÀÄß ªÀÄAUÀ¼Á ¯Áå¨ÉÆgÁålj, ªÀÄAUÀ¼ÀÆgÀÄ E°èAzÀ ¥ÀqÉzÀÄPÉÆArgÀÄvÉÛãÉ.  F ªÉÄð£À j¥ÉÇÃlð£ÀÄß ¦0iÀiÁðzÀÄzÁgÀjUÉ ¤ÃrzÀÄÝ CzÀgÀ°è MgÀ¯ï PÁå£Àìgï J£ÀÄߪÀ «µÀ0iÀĪÀÅ ºÁPÀ°®è JAzÀgÉ ¸Àj.  £À£Àß ¥ÀæªÀiÁt¥ÀvÀæzÀ°è ¥ÀæxÀªÀĪÁV PÁå£Àìgï J£ÀÄߪÀ ¥ÀzÀªÀ£ÀÄß vÉÆÃj¹gÀÄwÛÃj JAzÀgÉ ¸Àj.  ¯Áå¨ÉÆÃgÉÃlj0iÀÄ°è 0iÀiÁªÀÅzÉà j¥ÉÇÃlð£ÀÄß ¤ÃrzÁUÀ CªÀgÀ°è D j¥ÉÇÃnð£À ¢é¥Àæw EgÀÄvÀÛzÉ JAzÀgÉ EgÀ§ºÀÄzÀÄ.  F ªÉÄð£À j¥ÉÇÃnð£À ¥Àæw0iÀÄÄ £À£Àß°è EgÀĪÀÅ¢®è.  D ¥Àæw0iÀÄ£ÀÄß vÀj¹ £Áå0iÀiÁ®0iÀÄPÉÌ ºÁdgÀÄ¥Àr¸À®Ä ¥Àæ0iÀÄw߸ÀÄvÉÛãÉ.  ¦0iÀiÁðzÀÄzÁgÀgÀÄ F £Áå0iÀiÁ®0iÀÄPÉÌ §0iÀiÁ¦ì j¥ÉÇÃlð£ÀÄß ºÁdgÀÄ¥Àr¹zÀÄÝ CzÀ£ÀÄß £ÉÆÃrgÀÄvÉÛãÉ.  ¦0iÀiÁðzÀÄzÁgÀgÀ ªÀQîgÀÄ ¸ÁQëUÉ §0iÀiÁ¦ì j¥ÉÇÃlð£ÀÄß ¢£ÁAPÀ:11-7-2007 vÉÆÃj¸ÀÄwÛzÀÄÝ, CzÀgÀ°è MgÀ¯ï PÁå£Àìgï J£ÀÄߪÀ ¥ÀzÀªÀÅ PÁtĪÀÅ¢®è JAzÀgÉ ¸Àj.  17-7-2007 gÀAzÀÄ ¦0iÀiÁðzÀÄzÁgÀgÀÄ D¸ÀàvÉæUÉ zÁR¯ÁzÀ £ÀAvÀgÀzÀ°è ¸ÀºÀ CªÀjUÉ ¸ÀA§AzsÀ¥ÀlÖ zÁR¯ÉUÀ¼À°è MgÀ¯ï PÁå£Àìgï §gÉ¢®è JAzÀgÉ ¸Àj.  CzÉà jÃw F ªÉÄð£À D¸ÀàvÉæ0iÀÄ zÁR¯É0iÀÄ°è F gÉÆÃUÀªÀÅ PÁå£Àìgï DVzÀÄÝ CzÀ£ÀÄß ¸Àdðj ªÀiÁr vÉUÉzÀ £ÀAvÀgÀzÀ°è0iÀÄÆ ¸ÀºÀ ¥ÀÅ£À: ªÀÄgÀÄPÀ½¸ÀÄvÀÛzÉ J£ÀÄߪÀ «µÀ0iÀĪÀ£ÀÄß £ÀªÀÄÆ¢¸À°®è JAzÀgÉ ¸Àj.  £Á£ÀÄ ¢ UÉdmï D¥sï EAr0iÀiÁ ¢:£ÀªÉA§gï 21, 2007 F CxÁgÀn0iÀÄ£ÀÄß £Áå0iÀiÁ®0iÀÄPÉÌ ¸À°è¹zÀ GzÉÝñÀ K£ÉAzÀgÉ ©.r.J¸ï.  JA.r.J¸ï. ªÀÄvÀÄÛ MgÀ¯ï CAqï ªÀiÁåQì¯ÉÆà ¥sÉò0iÉÆà ¸Àdðj F «µÀ0iÀÄzÀ §UÉÎ EgÀĪÀ ¥Àjtw ºÁUÀÆ ªÁå¦Û ºÁUÀÆ ¸ÁÖZÀÄlj PË£Àì°£À £ÉÆÃn¦üPÉõÀ£ï DV ºÁdgÀÄ¥Àr¹gÀÄvÉÛãÉ.  F ªÉÄð£À CxÁgÀn0iÀÄ£ÀÄß ªÀiÁåQì¯ÉÆà ¦Ã²0iÉÆà ¸Àdðj0iÀÄ PÀvÀðªÀåªÀ£ÀÄß ¸ÀºÀ vÉÆÃj¸ÀÄvÀÛzÉ JAzÀgÉ ¸Àj.  F ªÉÄð£À CxÁgÀn0iÀÄ°è mɸÀÖ¸ï ªÀÄvÀÄÛ EAlgï¥ÉæmÉzɪÀiï J£ÀÄߪÀ «µÀ0iÀÄ EzÉ JAzÀgÉ ¸Àj. CzÉà jÃw F ªÉÄð£À CxÁjn0iÀÄ°è E£ï¥sÁªÀiïØ PÀ£ï¸ÉAl£ÀÄß ¥ÀqÉzÀÄPÉƼÀî¨ÉÃPÀÄ J£ÀÄߪÀ «µÀ0iÀÄ EgÀÄvÀÛzÉ JAzÀgÉ ¸Àj.  ¦0iÀiÁðzÀÄzÁgÀgÀ ªÀQîgÀÄ PÁå£Àìgï £Émï ªÉ¨ï¸ÉÊn¤AzÀ ¥ÀqÉzÀAvÀºÀ JqÉ£Á¬ÄØ ¹¹ÖPï PÁ¹ð£ÉÆêÀÄ J£ÀÄߪÀ «µÀ0iÀÄzÀ §UÉÎ vÉUÉzÀAvÀºÀ CxÁjn0iÀÄ£ÀÄß ¸ÁQëUÉ vÉÆÃj¹zÁUÀ £Á£ÀÄ F ªÉÄð£À CxÁjn0iÀÄ£ÀÄß £ÉÆÃqÀÄvÁÛ EgÀÄvÉÛÃ£É JAzÀÄ M¦àPÉÆAqÀgÀÄ.  D CxÁjn0iÀÄ£ÀÄß ¤±Á£É ¹.21 JAzÀÄ UÀÄgÀÄw¸À¯Á¬ÄvÀÄ. 

       PÁå£ÀìgÀ£ÀÄß aQvÉìªÀiÁqÀĪÀÅzÀÄ ¸Àdð£ï ªÉÊzÀågÀÄ JAzÀgÉ ¸Àj.  F ªÉÄð£À gÉÆÃUÀªÀ£ÀÄß aQvÉì ªÀiÁqÀ®Ä gÉÃr0iÉÄõÀ£ï CAPÁ®f¸ïÖ.  ¥ÉxÁ®f¸ïÖ, C¸É¸ÀÛn¸ïÖ, ¦¹¶0iÀÄ£ï ªÉÊzsÀågÀÄUÀ¼ÀÄ ¨ÉÃPÁUÀÄvÀÛzÉ JAzÀgÉ ¸Àj.  F ¥ÀæPÀgÀtzÀ°è ¦0iÀiÁðzÀÄzÁgÀjUÉ CAPÁ®f gÉÃr0iÀiÁ®f¸ïÖ£ÀÄß ¸À®ºÉ ¥ÀqÉzÀÄPÉƼÀÄî®Ä ¦0iÀiÁðzÀÄzÁgÀjUÉ £Á£ÀÄ ¸À®ºÉ ªÀiÁqÀ°®è ºÁUÀÆ £Á£ÀÄ ¸ÀºÀ ¸À®ºÉ0iÀÄ£ÀÄß ¥ÀqÉzÀÄPÉƼÀî°®è.  £Á£ÀÄ £À£Àß ¥ÀæªÀiÁt¥ÀvÀæzÀ°è ¥ÁågÁ 8 gÀ°è ¦0iÀiÁðzÀÄzÁgÀjUÉ 1£Éà ªÁPÀåzÀ°è ©Ã¸Àqï C£ï…………… F «µÀ0iÀĪÀ£ÀÄß ¦0iÀiÁðzÀÄzÁgÀjUÉ ¸À®ºÉ ªÀiÁrzÀ §UÉÎ §gÀªÀtÂUÉ0iÀÄ°è 0iÀiÁªÀÅzÉà DzsÁgÀUÀ½®è.  £À£Àß ¥ÀæªÀiÁt¥ÀvÀæzÀ°è 7£Éà ¥ÁågÁzÀ°è ºÉýzÀAvÀºÀ «µÀ0iÀĪÀÅ CAzÀgÉ ¢ j¥ÉÇÃmïð qÉÃmÉqï…………………… ªÀÄAUÀ¼ÀÆgÀÄ ªÀÄ°èPÀmÉÖ0iÀÄ°ègÀĪÀ ¹n ¸ÁÌ÷å£ï ¸ÉAlgï£À°ègÀÄvÀÛzÉ.  FUÀ £Áå0iÀiÁ®0iÀÄzÀ°è E®è.  F ªÉÄð£À «µÀ0iÀÄ CAzÀgÉ UÉÆæÃvï CgËAqï 3-4…………… F «µÀ0iÀĪÀÅ ¹n ¸ÁÌ÷å£ï j¥ÉÇÃmïð£À°è £ÀªÀÄÆzÀÄ EgÀĪÀÅ¢®è JAzÀgÉ ¸Àj.  £À£Àß ¥ÀæªÀiÁt¥ÀvÀæzÀ 7£Éà ¥ÁågÁzÀ°è §gÉ¢gÀĪÀ «µÀ0iÀÄUÀ¼ÀÄ ¹n ¸ÁÌ÷å£ï j¥ÉÇÃmïð£À°è £ÀªÀÄÆzÀÄ EgÀĪÀÅ¢®è JAzÀgÉ ¸Àj. 

       gÉÃr0iÉÄõÀ£ï xÉgÀ¦ 0iÀiÁªÀÅzÀPÉÌ EgÀĪÀ «µÀ0iÀÄ J£ÀÄߪÀÅzÀÄ £À£ÀUÉ UÉÆwÛ®è.  gÉÃr0iÉÄõÀ£ï vÉgÀ¦0iÀÄÄ ¥ÉÇøïÖ ¸Àdðj ªÀÄvÀÄÛ ¦æ ¸Àdðj0iÀÄ ªÀÄÄ£Àß ªÀiÁqÀ¯ÁUÀÄvÀÛzÉ.  ¸ÁQë0iÀÄÄ F ªÉÄð£À CxÁjn: (¹ 21) EzÀgÀ°è ºÉýgÀĪÀ «µÀ0iÀÄUÀ¼ÀÄ §zÀ¯ÁªÀuÉ DUÀÄvÁÛ EgÀÄvÀÛzÉ DzÀÝjAzÀ 2009 gÀ°è gÉÃr0iÉÄõÀ£ï vÉgÀ¦0iÀÄ£ÀÄß D¥ÀgÉõÀ£ï ªÀiÁqÀĪÀ ªÉÆzÀ®Ä G¥À0iÉÆÃV¸ÀĪÀÅ¢®è JAzÀÄ §gÉ¢gÀĪÀ «µÀ0iÀĪÀ£ÀÄß M¥ÀÅöàvÉÛãÉ. 

          £Á£ÀÄ ¥ÀæxÀªÀÄxÀªÁV ¦0iÀiÁðzÀÄzÁgÀgÀ£ÀÄß £ÉÆÃqÀĪÁUÀ CªÀgÀ SÁ¬Ä¯É0iÀÄÄ      ¥ÉæöʪÀÄj ¸ÉÖÃeï (¸ÉÖÃeï 2) £À°èvÀÄÛ.  £Á£ÀÄ D¥ÀgÉõÀ£ï ªÀiÁrzÁUÀ ¦0iÀiÁðzÀÄzÁgÀjUÉ r¸ï¦üUÀgïªÉÄAmï DVgÀĪÀÅ¢®è.  £À£Àß ¥ÀæªÀiÁt¥ÀvÀæzÀ 4£Éà ¥ÁågÁzÀ°è ¯Á¸ïÖ §mï M£ï ªÁPÀåzÀ°è ºÉýgÀĪÀ «µÀ0iÀĪÀ£ÀÄß ªÉÄrPÀ¯ï °lgÉÃZÀgï£À DzsÁgÀzÀ°è ºÉýgÀÄvÉÛãÉ.

Date:04-01-2012

RW-1

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¦0iÀiÁðzÀÄzÁgÀgÀ ªÀÄUÀ£À ªÀÄzÀÄªÉ 19-3-2010 gÀAzÀÄ EvÀÄÛ JAzÀgÉ ¸Àj.  £À£Àß ¥ÀæPÁgÀ ¦0iÀiÁðzÀÄzÁgÀjUÉ D¥ÀgÉõÀ£ï PÀÆqÀ¯É DUÀ¨ÉÃPÁVvÀÄÛ.  PÀÆqÀ¯Éà DUÀ¨ÉÃPÁVvÀÄÛ ¸ÀªÀÄ0iÀÄ vÉUÉ0iÀÄĪÀAw®è JAzÀÄ §gÀªÀtÂUÉ0iÀÄ°è £Á£ÀÄ ¤ÃqÀ°®è.  2£Éà D¥ÀgÉõÀ£ï£ÀÄß £Á£Éà ªÀiÁqÀ¨ÉÃPÉAzÀÄ ¤zsÀðj¹zÉÝ.  2£Éà D¥ÀgÉõÀ£ï ªÀiÁqÀ®Ä ¤zsÀðj¹zÀ ¸ÀªÀÄ0iÀÄzÀ°è ¦0iÀiÁðzÀÄzÁgÀgÀ£ÀÄß CAPÁ®f¸ïÖUÉ gÉ¥sÀgï ªÀiÁrgÀĪÀÅ¢®è.  PÁå£Àìgï SÁ¬Ä¯É ¨É¼ÀªÀtÂUÉ CzÀgÀ ¥Àæ¸ÀjPÉ0iÀÄ£ÀÄß CAPÁ®f¸ïÖ ªÀÄvÀÄÛ ¸Àdð£ïUÀ¼ÀÄ ¸ÉÃj ¤zsÀðj¸À§ºÀÄzÀÄ.  (nÃA ªÀPïð).  £Á£ÀÄ ¸À£Àvï ºÉUÉØ, PÀȵÀÚ ¥Àæ¸Ázï ªÀÄvÀÄÛ ¸ÀÄgÉñï gÁªï CAPÁ®f¸ïÖUÀ¼À£ÀÄß £À£Àß nÃAUÉ vÉUÉzÀÄPÉƼÀÄîvÉÛãÉ.  ¸ÀÄgÉñï gÁªï F ¦0iÀiÁð¢0iÀÄ°è ¦0iÀiÁðzÀÄzÁgÀgÀ §UÉÎ ¸ÁQë £ÀÄr¹zÁÝgÉ JAzÀgÉ ¸Àj.  ¸ÀÄgÉñï gÁªï gÀªÀgÀ ¥Àwß0iÀÄÄ £ÀªÀÄä PÁ¯ÉÃf£À°è PÉ®¸À ªÀiÁqÀÄwÛzÀÝgÀÄ JAzÀgÉ ¸Àj.  ¦0iÀiÁðzÀÄzÁgÀgÀ ªÀÄUÀ£À ªÀÄzÀÄªÉ EzÀÝ PÁgÀt vÀPÀët D¥ÀgÉõÀ£ï ªÀiÁzÀ®Ä vÀ0iÀiÁgÀÄ EgÀ°®è DzÀÝjAzÀ CAnç0iÀiÁnPïì OµÀzsÀ ªÀÄvÀÄÛ £ÉÆêÀÅ ±ÀªÀÄ£À ªÀiÁqÀĪÀ OµÀzsÀ ¤ÃrgÀÄvÉÛÃ£É JAzÀÄ ¸ÀļÀÄî ¸ÁQë NgÀ¯ï PÁå£Àìgï EzÉ ªÀÄvÀÄÛ PÀÆqÀ¯Éà D¥ÀgÉõÀ£ï ªÀiÁqÀ¨ÉÃPÁUÀÄvÀÛzÉ J£ÀÄߪÀ «µÀ0iÀĪÀ£ÀÄß ºÉüÀ¯Éà E®è JAzÀgÉ ¸Àj0iÀÄ®è.  £À£Àß vÀ¥Àà£ÀÄß ªÀÄgÀªÀiÁZÀĪÀ zÀȶ֬ÄAzÀ ¸ÀļÀÄî ¸ÁQë ºÉüÀÄwÛzÉÝãÉ.  JAzÀgÉ ¸Àj0iÀÄ®è.  ¦0iÀiÁðzÀÄzÁgÀjUÉ CªÀgÀ SÁ¬Ä¯É0iÀÄÄ PÉêÀ® NgÀ¯ï E£ï¥sÉPÀë£ï JAzÀÄ w½¹ OµÀzsÀªÀ£ÀÄß ¤ÃrzÉÝÃ£É JAzÀgÉ ¸Àj0iÀÄ®è. 

¦0iÀiÁðzÀÄzÁgÀgÀ DyðPÀ ¥Àj¹Üw «µÀ0iÀÄ £À£ÀUÉ UÉÆwÛ®è CªÀgÀÄ K£ÁVzÀÝgÀÄ J£ÀÄߪÀ «µÀ0iÀÄ UÉÆwÛzÉ.  ¦0iÀiÁðzÀÄzÁgÀgÀÄ ºÀtPÉÆ̸ÀÌgÀ ¦Ãr¸ÀÄvÁÛgÉÆà E®èªÉÇà J£ÀÄߪÀ «µÀ0iÀĪÀÅ £À£Àß UÀªÀÄ£ÀPÉÌ §gÀ°®è.  ¦0iÀiÁðzÀÄzÁgÀgÀÄ ¨Á0iÉÄÝgÉ0iÀiÁV £À£ÀUÉ ºÀtªÀ£ÀÄß ¤ÃqÀ¨ÉÃPÀÄ JAzÀÄ £À£ÀߣÀÄß PÉüÀ°®è.  F PÉøÀ£ÀÄß ºÁPÀ®Ä 0iÀiÁgÀzÀgÀÆ CªÀjUÉ E£ï¶ÖÃUÉõÀ£ï ªÀiÁrzÁÝgÉÆà E®èªÉÇà JAzÀÄ £À£ÀUÉ UÉÆwÛ®è.  CªÀgÀ ªÉĪÉÆj0iÀÄ£ÀÄß ¥ÀjÃQë¸À®Ä CªÀgÀ£ÀÄß 0iÀiÁjUÀÆ gÉ¥sÀgï ªÀiÁrgÀĪÀÅ¢®è.  £Á£ÀÄ ¦0iÀiÁðzÀÄzÁgÀjUÉ ªÀiÁrzÀ ¸Àdðj0iÀÄÄ ªÉÄÃdgï ¸Àdðj DVgÀÄvÀÛzÉ. 

£Á£ÀÄ ¦0iÀiÁðzÀÄzÁgÀjUÉ £Á£ÀÄ ¸Àdðj ªÀiÁrzÀ ªÉÄÃ¯É gÉÃr0iÉÄõÀ£ï xÉgÀ¦UÁV ¸À®ºÉ ªÀiÁrgÀĪÀÅ¢®è.  ¸ÀÄgÉñï gÁªï gÀªÀgÀÄ gÉr0iÉÄõÀ£ï vÉgÀ¦ §UÉÎ F £Áå0iÀiÁ®0iÀÄzÀ°è ¸ÁQë £ÀÄr¢zÁÝgÉ £Á£ÀÄ D ¸ÀªÀÄ0iÀÄzÀ°è £Áå0iÀiÁ®0iÀÄzÀ°è G¥À¹ÜvÀ¤zÉÝ. 

0iÀiÁªÀÅzÉà MAzÀÄ SÁ¬Ä¯É0iÀÄ UÀÄt®PÀëtUÀ¼ÀÄ ¨sËUÉÆýPÀªÁV ºÉZÀÄÑ PÀrªÉÄ (ªÀåvÁå¸À) ªÁUÀÄvÀÛzÉ JAzÀgÉ ¸Àj.  ªÉÄÃ¯É ºÉýzÀ £À£Àß C©ü¥Áæ0iÀĪÀÅ ªÀÄAUÀ¼ÀÆj£À ¨sËUÉÆýPÀªÁV ¸ÀA§AzsÀ¥ÀlÖAvÉ EgÀĪÀÅ¢®è DzÀgÉ eÁUÀwÃPÀªÁV (UÉÆèç°) EgÀÄvÀÛzÉ.  J¯Áè gÉÆÃUÀUÀ½UÉ ¸ÀA§AzsÀ¥ÀlÖAvÉ qÀ§Æè.ºÉZï.M.UÉÊqï¯ÉÊ£ïì EgÀÄvÀÛzÉ JAzÀgÉ £À£ÀUÉ UÉÆwÛ®è.  0iÀiÁªÀÅzÉà MAzÀÄ SÁ¬Ä¯ÉUÀ¼À£ÀÄß aQvÉì ªÀiÁqÀĪÁUÀ qÀ§Æè.ºÉZï.M.UÉÊqï¯ÉÊ£ïìUÀ¼À£ÀÄß ¥sÁ¯ÉÆà ªÀiÁqÀ¨ÉÃPÀÄ JAzÀgÉ £À£ÀUÉ UÉÆwÛ®è DzÀgÉ qÉAl¯ï Pˤì¯ïgÀªÀgÀ UÉÊqï¯ÉÊ£ïì ¥sÁ¯ÉÆà ªÀiÁqÀ¨ÉÃPÀÄ JAzÀgÉ £À£ÀUÉ UÉÆwÛ®è qÉAl¯ï Pˤì¯ï£À UÉÊqï¯ÉÊ£ï£À ¥ÀæPÁgÀ PÁå£Àìgï SÁ¬Ä¯É D¥ÀgÉõÀ£ï DzÀ D£ÀAvÀgÀzÀ®Äè G½zÀ ¨ÁqÀðjUÉ gÉÃr0iÉÄõÀ£ï vÉgÀ¦0iÀÄ£ÀÄß ªÀiÁqÀĪÀ CUÀvÀå«®è JAzÀÄ UÉÊqï¯ÉÊ£ïì EgÀÄvÀÛzÉ.  qÉAl¯ï Pˤì¯ï UÉÊqï¯ÉÊ£ïì£ÀÄß £Áå0iÀiÁ®0iÀÄPÉÌ ºÁdj¸À§ºÀÄzÀÄ. 

gÉÆÃVUÉ DvÀ£À SÁ¬Ä¯É0iÀÄ «µÀ0iÀĪÀ£ÀÄß DvÀ¤UÉ CxÀðªÁUÀĪÀ jÃw0iÀÄ°è w½¸À¨ÉÃPÀÄ JAzÀÄ ¤0iÀĪÀÄ EzÉ JAzÀgÉ ¸Àj.  SÁ¬Ä¯É «µÀ0iÀÄPÉÌ ¸ÀA§AzsÀ¥ÀlÖAvÀºÀ §gÀªÀtÂUÉ0iÀÄ£ÀÄß ¸ÀºÀ DvÀ¤UÉ w½0iÀÄĪÀAvÉ £ÀªÀÄÆ¢¸À¨ÉÃPÀÄ CAvÀ ¤0iÀĪÀÄ«zÉ JAzÀgÉ ¸Àj. 

Date:24-01-2012

RW-1

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Further we observed that the Opposite Party in his own evidence admitted before this FORA that the cancer for the first time detected on 04.10.2007 and there is a rule that the patient should be informed about the disease the way he understands and it should be written so as to make him understand.  Further he admitted in the above deposition of affidavit before this FORA that he has not recorded that the disease would recur even after the operation and further admitted that for treating the said disease, Oncologist, Pathologist, Anesthetist and physician are required and also admitted that in this case he has not taken the advise of the Oncologist nor advised to consult Oncologist.  Apart from the above, Opposite Party also admitted that when he treated the complainant the disease was in the primary stage though the Opposite Party referred names of several doctors in his version as well as in his chief examination in order to attribute the knowledge to the complainant regarding the exact cause he was suffering from, but failed to examine any one of the doctors in support of his defence.  Non examination of those doctors by the Opposite Party goes to show that the Opposite Party not submitted the case truly and correctly before the FORA.  Apart from the admission from the Opposite Party we have also reproduced the evidence of CW.2 i.e., one Mr. Dr. Dinesh Kadam i.e., CW.2, who treated the complainant subsequently in A.J. Hospital, who is a plastic surgeon (the relevant portion of the chief examination and cross examination part reproduced herebelow)

Complaint No.217 / 2010

CW.2 witness for Complainant

Name                    :         Dr. Dinesh Kadam

Father’s Name     :         Dattu

Age                       :         40

Occupation                    :         Plastic Micro-vascular & Costetic

Residence             :         Surgeon, A.J. Hospital, Mangalore. 

Duly sworn on 01-03-2011

Examination in Chief by : ²æà PÉ.J¸ï.J¸ï. gÀªÀjAzÀ ¦0iÀiÁðzÀÄzÁgÀgÀ ¥ÀgÀ.

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From the evidence of CW.2, it is made very clear that when the complainant first came to him, he was not aware of the disease from which he was suffering. 

F ªÉÄð£À ªÀåQÛ0iÀÄ£ÀÄß ¥ÀjÃQë¹zÀ £ÀAvÀgÀ DvÀ¤UÉ K£ÀÄ SÁ¬Ä¯É EzÉ J£ÀÄߪÀ §UÉÎ DvÀ¤UÉ CxÁðéUÀĪÀ jÃw0iÀÄ°è w½¹gÀÄvÉÛãÉ.  £Á£ÀÄ F ªÉÄð£À ªÀåQÛ0iÀÄ£ÀÄß ¥ÀjÃQë¹ DvÀ¤UÉ CxÀðªÁUÀĪÀAvÉ PÁå£Àìgï SÁ¬Ä¯É¬ÄgÀÄvÀÛzÉ CzÀPÉÌ D¥ÀgÉõÀ£ï ªÀiÁqÀ¨ÉÃPÀÄ JAzÀÄ w½¹gÀÄvÉÛãÉ.  F ªÉÄð£À ªÀåQÛ0iÀÄÄ £À£Àß §½ ¥ÀæxÀªÀÄvÀªÁV §AzÁUÀ DvÀ 0iÀiÁªÀ SÁ¬Ä¯É¬ÄAzÀ §¼À®ÄwÛzÀÝ J£ÀÄߪÀ §UÉÎ DvÀ¤UÉ w½¢gÀ°®è. 

The above evidence substantiated that the complainant was not aware of the disease from which he was suffering.  It is settled rule that the Opposite Party being a treating doctor shall disclose and it is obligatory to give warning about risk and it must be ensured that instructions are given in comprehensive terms making sure that the patient understands both the instructions and the importance of strictly adhering to them.  Failure to communicate with other health care professtionals herein, the Opposite Party failed to refer the patient to the Oncologist as well as the assistance of the Oncology surgeon shows the lapse on the part of the Opposite Party in this case.  Further we observed that not referring cancer patient herein the complainant with the advanced disease like ‘Adenoid Cystic Carcinoma’ to a Hospital with proper facilities shows another lapse on the part of the Opposite Party doctor in this case.  However, the CW.2 who is a Plastic Surgeon categorically stated that the patient should have been referred to an Oncologist (reference page No.3 of deposition of CW.2 25^th and 26^th line).  Further stated that if the patient would have been subjected to radiation therapy after the first operation, there was a possibility of preventing the recurrence and spread of the disease.  From the above admission of the CW.2 further made more clear that the Opposite Party should have subjected the patient before the Oncologist or atleast should have obtained the opinion from the Oncologist then definitely we should have appreciated the steps taken by the Opposite Party doctor.  But in the instant case, Opposite Party doctor not even taken the assistance of the Oncologist nor referred the patient Oncology Surgeon even after or before the surgery or atleast the Opposite Party doctor should have advised the complainant for follow up / review once in a 3 months or 6 months.  It shows the Opposite Party doctor though claims that he is a competent doctor, but we have no comment about the degree he possesses and experience he holds, but treating complicated diseases like cancer the duty of care plays an important role rather degree he possesses and the experience he holds as stated above. Opposite Party being a treating doctor aware about the serious disease like cancer, duty of doctor to give proper prescription with clear instructions is mandate.  Oral advise contrary to the usual code of conduct of Medical Practice 1956. So far as duty of the medical profession is concerned, it is coupled with human instinct and needs no decision nor any code of ethics because immediate treatment was required to be given when the patient was suffered / undergone surgery for the serious disease like cancer.  There is nothing on record to suggest that the Opposite Party doctor informed to the patient or relative or the person, who was approached to the Opposite Party with regard to the dangers ahead or the risk involved by going without operation / treatment at the earliest.  Hence, the deficiency of service on the part of the Opposite Party is apparent.  In a case of critical cancer, it becomes the duty of physician or surgeon to be mindful of the disease which the patient was suffering and the responsibility in the discharge of his duties, which finds no place in this case.

However, the counsel appearing for the Opposite Party vehemently argued that the Opposite Party is a Oral and Maxillo Facial Surgeon competent to do the above said surgery and argued that he was told that the complainant was suffering from oral cancer and contended that the Opposite Party doctor need not refer the patient to Oncologist and the decision whether the radiation should be given or not, the consultation of the Oral and Maxillo Facial Surgeon is required and further argued that the biopsy report dated 24.10.2009 showed cancer in the area adjoining to the earlier excised portion and not on the same location and stated that it is in right sub-mandbular region.  Further argued that the Opposite Party has prescribed certain pain killers and antibiotics to the complainant because the complainant was not cooperated for the operation for the second time as his son’s marriage scheduled to be held on 19.03.2010.  Apart from the above, it is argued that there was no medical Oncologist in Mangalore in 2007 or in 2009.   Opposite Party counsel argued that one or two Oncologist were available in Mangalore since they were not able to cope up with hundreds of cancer patient, he has not referred the complainant to medical Oncologist and denied the allegations. 

We are not convinced with the argument as well as the material evidence placed before us on behalf of the Opposite Party doctor because from the material on record it appears that patient had consulted the doctor in the way back i.e., on 11.07.2007 with a biopsy report and the Opposite Party doctor was aware of the serious disease like cancer i.e., ‘Adenoid Cystic Carcinoma’ in this case and subsequently, the complainant developed recurring cancer and again consulted the very same doctor in the year 2009 and the Opposite Party doctor inspite of aware of the disease prescribed certain pain killers and antibiotics it shows he is not competent to treat the disease like cancer, he ought to have referred the patient to any Oncologist or atleast he should have taken assistance of the Oncologist or Oncology Surgeon.  The Opposite Party counsel cannot argue that in Mangalore one or two Oncologist are available, they were not able to cope up with hundreds of cancer patient.  The above argument appears to be perverse because without referring or suggesting the complainant to consult a Oncologist or Oncology Surgeon in this case.  The Opposite Party doctor has no right to say that the Oncologist were not able to cope up with the complainant herein.   In our opinion had the doctor referred the complainant to Oncologist or Oncology Hospital, which is situated in our own State, the complainant would have more conveniently got treated at the Cancer Hospital rather than approaching the Opposite Party doctor now and again.  It is quite apparent to reproduce some of the very significant paras of the deposition of CW.2 i.e., Dr. Dinesh Kadamba, Plastic Surgeon, A.J. Hospital and CW.3 i.e., Dr. Suresh Rao, Oncologist. 

Complaint No.217 / 2010

CW.3 witness for Complainant

Name                    :         Dr. Suresh Rao

Father’s Name     :         Professor Ramanath Rao

Age                       :         47

Occupation                    :         Radiation Oncologist, Fr. Muller’s 

Residence             :         Medical College Hospital, Mangalore. 

Duly sworn on 01-03-2011

Examination in chief by: Sri K.S.S., Advocate for

  Complainant

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After perusing the deposition of CW.3 reveals that he has give radiation treatment to the complainant and he has been referred by Dr. Dinesh Kadam i.e., CW.2 in this case.  In cross examination, he has categorically stated that the patient should be treated with radiation therapy or not is decided by the Oncologist and not the Surgeon.  Further he deposed that the recepted margin is clear in entirety means the cancer has not spread to other parts, he has stated that the cancer can spread to other parts and does not mean it has not spread.  The above evidence of the Radiation Oncologist made further clear that the Opposite Party doctor is not a Oncologist nor a Oncology Surgeon.  The argument that Opposite Party is competent is not justifiable as stated supra because though he claims competent to do surgery but at the same time in a serious case like cancer, he should have taken opinion of the Oncology Surgeon or Oncologist at the initial stage of the surgery.  But no attempt has been made in this case.   No doubt there was no specialization on the subject on the earlier days, but we are now living in new era with all specialists on each field of medical science and exclusive hospital in Oncology working in our own State. At least even the after second diagnosis, the treatment is inadequate and the medical authority quoted by the counsel appearing for the complainant shows that the treatment given by the Opposite Party after the first surgery i.e., the medicines prescribed to the patient was significantly below recommended levels.  Understandably, the expert evidence, C.T. Scan report and other reports obtained by the Opposite Party in this case show that the condition on the second arrival of the complainant was worse the evidence of the CW.2 made more clear that there was no delay an no proper treatment, sub optimal treatment and inadequate monitoring of the condition of the patient by prescribing medicines a matter of much graver concern in this case.  On which the treatment is supposed to be given on the right time was no given and it is indicative of very poor monitoring the patient and needs to be viewed very seriously because the complainant is totally disfigured and the span of life has been diminished because of the inadequate treatment by the Opposite Party doctor on the right time. 

Apart from the above, we further observed that there is nothing on record to suggest that Opposite Party doctor informed the patient or relative with regard to the oral cancer, in a case of critical cancer, it becomes the duty of the Opposite Party doctor required to give immediate attention. But the Opposite Party failed to perform or treat the patient efficiently not only at the initial stage, but even after the subsequent treatment. We observed that the Opposite Party admitted that he owns his clinic in Mangalore apart from he is serving in a reputed Hospital but there is no word or document about administering / treating the cancer patient like complainant maintained in his clinic.  The Opposite Party doctor is aware that he is not a Oncology Specialist or Surgeon.  When a patient is attended by a doctor, it is done with the belief that the treatment given by qualified doctor under Indian Medical Council Act, 1956.  The patients are not questioning the competency of the doctors.  But the doctor one, who evaluating the disease must borne in mind that he is possessing a knowledge and skill and at the same time put an effort to make proper co-ordination with the Oncologist by getting an opinion because in a case of serious cancer, the life is in the hands of a doctor.  In the instant case, the Opposite Party doctor being a treating doctor aware about the serious disease.  The duty of doctor to give proper prescription with clear instructions is very much mandate.   But in the instant case, the same is lacking and the Opposite Party not even maintained the records in his clinic.

From the detailed discussion above, of the facts and circumstances of this case as well as the evidence adduced on of the two parties the following conclusions clearly emerge:

(a) The claim of the complainant, he is a layman but the Opposite Party doctor not informed that he was suffering from oral cancer and the Opposite Party doctor should have referred the complainant to Oncologist / Oncology Surgeon or atleast should have taken the opinion from the Oncologist rather he claims that he is competent to conduct surgery. The above claim of the complainant is fair and acceptable in this case.

(b) The argument that the Opposite Party is competent is not justifiable because though he claims competent to do the surgery but at the same in serious disease like cancer he should have taken opinion of the Oncology Surgeon at the initial stage, the life of the complainant should have been protected from the deterioration like disfigurement, which is facing right now.

(c) The Opposite Party doctor should have taken opinion from the Oncologist as we are living with all specialists on each field of medical science and exclusive hospital like Oncology working in our State. Further the Opposite Party doctor did not advise the complainant to take immediate surgery or did not advise the complainant the risks and the consequences involved even after the second diagnosis in the year 2009, the treatment is inadequate.The Medical Authority relied by the parties shows that the medicines prescribed by the Opposite Party doctor to the patient on __________were significantly below recommended levels.Understandably, the expert evidence and the reports shows that condition on the second arrival was worse.There was delay and no proper treatment, sub optimal treatment and inadequate monitoring of the condition of the patient by prescribing medicines, a matter of much graver concern in this case.On which the treatment is supposed to be given / treated is indicative of very poor monitoring the patient and needs to be viewed seriously.

In the light of the above conclusions, we are of the opinion that the Opposite Party doctor while treating the complainant committed deficiency in the treatment.  Because the medical negligence is when a doctor does not do what a doctor has average knowledge, experience and capability would do or he does what large body of doctors would not do.  Even in the instant case, the Opposite Party doctor even though he claims to be a competent and capability to do the above acts but did not do with some ulterior motive, which amounts to medical negligence for that the complainant is entitled adequate damages under the Consumer Protection Act. 

As far as damages are concerned there are two heads one is the general damages and another one is special damages.  The complainant’s case primarily depends that he is a layman, he was not told about the disease for which he was suffering oral cancer. Opposite Party is negligent in failing to inform the complainant or give warning of the risks involve so that he might have had a chance to decide whether he was going to take those risks or not.  Opposite Party should warned the risk that he is suffering that he is having a cancer, if told, complainant would have immediately consulted or admitted to the Oncology Hospital.  He is a retired Bank Employee, who is financially well off given first thought to get admitted / consulted with the Oncologist and the right treatment at the right point of time could have saved his disfigurement and physically handicapped.  This FORA visualized the condition of the complainant in open court and recorded as follows:

CW.1

CHIEF-EXAMINATION OF THE COMPLAINANT AS CW1 BY WAY OF AFFIDAVIT

Name                    :        V. Subrahmanya Bhat (V.S. Bhat)

Father’s Name       :        Late V. Narayana Bhat

Age                       :        59 years

Occupation            :        Retired Senior Manager, Canara Bank.

Address                 :        “Adarsha”, 1^st Cross, Kottara Cross,

                                      Mangalore – 575 004.

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The above observation made very clear that at present the complainant is not in a position to speak or utter the pronunciation of al the wordings in a understanding manner. Further we observed that the physical condition of the complainant appears to be very weak and there is a visible disfiguration and there is every likely of embarrassment to move in general public because of the disfiguration.  Apart from the above, the mental agony, which he was undergone and now he is undergoing cannot be termed with money.  We are of the opinion that in a case of like this nature the patient shall be treated under the specialists like Oncologist / Oncology Surgeon or any Tarshary Care Hospital like exclusive Oncology Hospital. The Opposite Party doctor being an experienced man should have referred the patient to a Oncology Hospital, where the patient gets all sort of treatment at the initial stage and the condition of the patient herein the complainant should not have been reached to this extent.  The Opposite Party doctor not served the patient herein the complainant free of service.  Whatever the service done by the Opposite Party doctor has been charged and hence the Opposite Party doctor shall pay adequate compensation in this case.  By considering the above aspect, we hereby directed the Opposite Party doctor to pay Rs._______________ to the complainant under the head of general and special damages.  Apart from the above, we also directed the Opposite Party to pay Rs.5,000/- as cost of the litigation expenses, which includes the payment made to the summoned witnesses i.e., experts examined before this FORA. The payment shall be made within 30 days from the date of this order. 

6.       In the result, we pass the following:                          

31.07.2010:

                    ::  Order pronounced ::

The complaint is allowed. The Opposite Party doctor shall pay Rs.___________ to the complainant towards the compensation and also pay Rs.5,000/- towards the cost of litigation expenses which includes the payment made to the summoned witnesses i.e., experts examined before this FORA. The payment shall be made within 30 days from the date of this order. 

In case of failure to pay the above said amount within the stipulated time, the Opposite Party shall pay interest at the rate of 10% per annum from the date of failure till the date of payment. 

The copy of this order as per the statutory requirements be forwarded to the parties free of charge and therefore the file be consigned to record.

    PRESIDENT                           MEMBER                 MEMBER

ANNEXURE

Witnesses examined on behalf of the Complainant:

CW1 – Sri V. Subrahmanya Bhat (V.S. Bhat) - Complainant.

CW2 – Dr. Dinesh Kadam, A.J. Hospital, Mangalore.

CW3 – Cr. Suresh Rao, Fr. Muller’s Medical College Hospital, Mangalore.

Witnesses examined on behalf of the Opposite Party:

RW1 – Dr. Rajendra Prasad - Opponent.

Documents produced on behalf of the Complainant:

                                  Ex C1       – 14.07.2007:  Report given by the Opponent Dr. B.

                                                                         Rajendra Prasad on the first visit of the

                                                                         complainant.

                                  Ex C1(a)  - 23.07.2007:    Prescritption.

                                  Ex C1(b)  - 24.10.2009:    Prescritption.

Ex C1(c)  - 29.10.2009:    Prescritption.

                                  Ex C1(d)  - 20.01.2010:    Prescritption.

Ex.C2      -  11-07-2007:   Histopathology Report

Ex.C3      -  18-07-2007: Histopathology Report

Ex.C4      -  23-07-2007:   Medical Report given by the Opposite

                                      Party.

Ex.C5      -  11-07-2007:   Receipt

Ex.C5(a)  -  23-07-2007: Receipt

Ex.C6      -  23-07-2007:   Medical Bill

Ex.C6(a)

to C6(k)   -                   : Medical Bills

Ex.C7      -  29-10-2009: Mallikatta Neuro Center

                                  Ex.C8      -  24-03-2010: Cash Bill of A.J. Hospital, Mangalore

                                  Ex.C8(1)

to C8(49)-                     : Medical Invoices and Bills. 

Ex.C9     -   26-0-2010  : Discharge Summary of A.J. Hospital,

                                      Mangalore.

Ex.C10   -   29-06-2010:   Medical Certificate.

Ex.C10(a)

to C10(f) -                     : Cash Receipts pertaining to the

                                       Medical treatment

                                  Ex.C11    -07-06-2010   : Medical Bill

                                  Ex.C11(a)

to                               to C11(f) -                     : Medical Bills

                                  Ex.C12    -                      : Histopathology Report

                                  Ex.C13    -                      : Photographs of the complainant

`                                Ex.C14    -15-07-2010   : Legal Notice dated 15.07.2010

                                                                         issued on behalf of the complainant. 

                                  Ex.C15   -                       : Acknowledgement

                                  Ex.C16   - 26-07-2010   : Reply Notice by the Opposite Party

                                  Ex.C17   - 24-03-2010   : Prescription

                                  Ex.C17(a)

                                  to C17(f)                        : Medical Records

                                  Ex.C18   - 09-03-2011   :  Discharge Summary of A.J. Hospital,

                                                                         Mangalore.

                                  Ex.C19   - 30-03-2011   : Inpatient Bill of the complainant

                                  Ex.C20   - 30-03-2011   :  Cash Bill

Witnesses examined on behalf of the Opposite Party:

RW1 – Dr. Rajendra Prasad - Opponent.

Documents produced on behalf of the Complainant:

Ex.R1 –    10-02-2011      : Case Sheet pertaining to the

                                        Complainant

Ex.R2 -                            : Bangalore University Certificate

Ex.R3 -                            : Copy of letter issued by Dental

  Council of India.

Dated:31.01.2013                                                PRESIDENT