BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT  HYDERABAD.

F.A.No.292 OF 2010  AGAINST  C.C.NO. 101 OF 2008 DISTRICT FORUM NIZAMABAD

Between:

G.Abbaiah S/o Gangaram

Aged about 51 yeaqrs, Occ: Wathman

In ANM Training School, Govt. Hqrs Hospital

Nizamabad R/o Near Usha Mayuri Theatre

Kotagalli, Nizamabad

                                                                Appellant/complainant

        A N D

Dr.D.Narayan Rao

Aged: Major, Occ: Consultant Surgeon

C/o Ashwini Hospitalo, Khaleelwadi
Nizamabad.

                                                                Respondent/opposite party

Counsel for the  Appellant :                   M/s Bhaskar Poluri

Counsel for the  Respondent:                M/s A.Alavender Gound

QUORUM:   SRI R.LAKSHMINARASIMHA RAO, HON’BLE MEMBER

AND

SRI THOTA ASHOK KUMAR, HON’BLE MEMBER

                            TUESDAY THE TWENTIETH DAY OF MARCH

TWO THOUSAND TWELVE

Oral Order (As per Sri R.Lakshminarasimha Rao, Hon’ble Member)

                                        ***

1.            The unsuccessful complainant is the appellant. The District Forum dismissed his complaint on the premise that he failed to prove medical negligence on the part of the respondent and that treatment administered by the respondent to the appellant was on proper lines as also that the doctor who attended on the appellant is not a junior doctor and is an experienced doctor.

2.             The appellant developed severe pain in his stomach and peri anal region and swelling in previl area and on 17.03.2007 consulted the respondent pm 17.03.2007 on whose advice the appellant had undergone scanning, biochemical tests and after going through the reports, the respondent opined that the appellant was suffering from ‘Fournier Gangrene of Scrolium & Public Area peri Anal’ and  on the same day the appellant was admitted to the hospital of the respondent. On 19.03.2007, the respondent opened the wound and dressed it up and thereafter he had prescribed medicine and  left for Hyderabad.

3.             The appellant developed pain and a junior doctor on telephonic instructions from the respondent treated the appellant for four days by prescribing pain killers and the wound site began to emit foul smell. The appellant’s wife and children got him discharged from the respondent’s hospital on 23.03.2007 and got him admitted to Yashoda Hospital in Hyderabad where the doctors had done the debridement of Fournier Gangrene and treated the appellant as inpatient from 24.03.2007 till 1.04.2007 and after cleaning and dressing up, the doctors advised the appellant to attend for review after the wound is dried up.

4.             The appellant, after the wound is dried up was admitted to Yashoda Hospital  on 19.04.2007  and was treated till 23.04.2007. The appellant said to have incurred an expenditure of `1,12,445/- towards medical expenses, `2,000/- for purchase of medicine and `10,000/- towards transportation charges. The appellant claimed an amount of `1,60,000/- towards expenses and `4,00,000/- towards compensation for suffering mental agony and suffering .

5.             The respondent resisted the claim contending that the appellant approached him on 17.8.2007 with peri anal and 0020 scrotal area and he was diagnosed with Fournier’s gangrene of the scrotum.  The appellant was diabetic and his condition was serious.  The respondent informed the appellant and his attendants about the serious condition and the stage of the disease and the possible complications as also death due to the disease even with proper treatment.  The respondent had obtained consent from the appellant and his attendants for the purpose of treatment.  The respondent performed surgery on 19.3.2008 under anesthesia and he made incision and drainage.  The skin was cut open and let out the trapped pus under the wound.  A lot of foul smelling puss and damaged tissue was drained out.  The operated part was kept open for the gangrenous tissue to drain out.  After the surgery antibiotic treatment was continued and regular follow up was done by the duty doctor.  A qualified senior doctor with surgical experience attendant on the patient during the postoperative stage.  The duty doctor was in constant touch with the appellant.

6.             The daily treatment included administration of antibiotics and dressings.  The emanating of foul smell was not due to negligence on the part of the appellant or the duty doctor and it was inevitable due to discharge of pus from the wound.  The appellant got himself discharged “against medical advice on 23.3.2008” before he was completely cured.  Fournier’s gangrene is an acute and rapidly spreading fatal disease manifested by gangrene of scrotum and perineum which is caused by synergistic bacterial infection and it is more common and more fatal in diabetic.  The patient dies without proper treatment.  The treatment consists of intense antibiotic therapy and surgical intervention.   Surgical intervention consists of multiple incisions to let out the integral material and removing of dead tissue.  The death rate of patient in such treatment is 30%.  The appellant was in serious condition when he approached the respondent.  The respondent managed the diabetes and infection

7.             In Yashoda Hospital also the appellant was diagnosed with Fournier Gangrene debridement.  There was no negligence on the part of the respondent.  The appellant survived because of the treatment of the respondent and he went out of the respondent’s hospital against the medical advice.  Had he stayed in the respondent’s hospital he would have been without spending any amount in Yashoda Hospital.  The respondent is not liable to pay any amount of compensation or damages to the respondent.

8.             The appellant was examined as PW1 and Exs.A1 to A31 are marked.  On behalf of the respondents  RWs 1 and 2 are examined and no document had been marked.

9.             The District Forum has dismissed the complaint opining that the diagnoses and treatment rendered at Yashoda Hospital is the same as that was extended by the respondent and in view of the evidence of the doctor who subsequently treated the appellant at Yashoda Hospital no negligence or deficiency in service can be attributed to the respondent.

10.            The complainant has filed the appeal contending that the evidence of the doctor at Yashoda Hospital would support the case of the appellant and that mere matching of the diagnosis at Nizamabad at the hospital of the respondent with that of the one made at Yashoda Hospital cannot be made consideration dismissed the complaint.  It is contended that though the appellant against the medical advice, he continued to be under the treatment of the doctors at Yashoda Hospital and that  the respondent had not given the details of the doctor who treated the appellant during the postoperative stage as also that  no adverse inference can be drawn against the appellant for not cross examining the respondent as the cross examination is not a matter of right in the proceedings before the consumer forum.  

11.            The appellant approached the respondent on 17.3.2007 with pain in perianal-scrotal area and he was diagnosed with Fournier Gangrene of the scrotum.  The respondent advised for admission and surgery of the appellant and prescribed tab lets.  The scan report issued by Sheetal Scanning & Diagnostic Centre on 17.3.2007 had shown normal scan of both tests and also “bilateral diffuse enlargement and thickening of epididymis and VAS.  Mild grade-I Varicocele and Mild RT.Hydrocele”.  The blood examination report issued on the same day had shown non-reactive for HIV-I/HIV2 antibodies and the Haematology report had shown normal values except for polymorphs which was shown 80% against the referral value ranging from 60%-70% and on 23.3.2007 blood glucose level was reported as 150 mg/dl against the normal range till 140mg/dl.  The respondent prescribed Ciplox, Metrogyl, Menraz and human actrapid on 23.3.2007 .e., after 4 days of the surgery he had undergone on 19.3.2007 under spinal anesthesia.  At the time of discharge, the respondent advised the appellant that he needs desloughive of gangrene area which means he needed further treatment.

12.            The respondent contends that Fournier Gangrene is “an acute and rapidly fatal disease manifested by gangrene (rooting away) of scrotum and perineum.  This is caused by synergistic bacterial infect.  It is more common and more fatal in diabetics.  The patient dies without proper treatment.  The intervention consists of multiple incisions to let out the infected material and removing dead tissue.  This surgical procedure is called Incision, drainage and excision.  The death rate of the patients in such treatment is 30%.  The treatment given to the patient is proper and good.  The patient was in serious condition when he came to me.  His problem was complicated by diabetes.  I managed both the diabetes and infection caused to the patient.  The proper drainage was done to let out the infected materials.  The drainage of the foul smelling puss is not a complication of the treatment.  It is the normal consequence of treatment and actually the operation in such cases will be done to let out the pus trapped inside.  Only after taking consent of the patient and his attendant’s treatment was given.”

13.            Dr.G.L.N.Malleswar Rao who subsequently treated the appellant at Yashoda Hospital deposed that the appellant was not fit for discharge to go home at the time of discharge by the respondent and he has stated that when going for multiple operations had the same treatment continued by the respondent, the patient would have died.  The statement of PW2 is sufficient to fix negligence and deficiency in service on the part of the respondent who has stated that had the appellant stayed back at his hospital he would have administered the same treatment as was rendered at Yashoda Hospital.  The respondent had performed operation upon the appellant on 19.3.2008 and he left for Hyderabad entrusting the duty to take care of the appellant during postoperative stage, to the doctor who was on duty.  For about four days the respondent had not cared for, particularly, when according to the statement of the respondent, the condition of the appellant was serious and even if the treatment was administered in time there was no possibility of the appellant getting cured as also that it was probably that the appellant would die even after undergoing treatment.  In such precarious condition the respondent had left the appellant to his fate at the mercy of a duty doctor whose experience and qualification has been challenged by the appellant who had categorically stated that the doctor on duty is junior doctor without having requisite qualification to treat a patient of diabetes and also having undergone surgery.    Except stating that the duty doctor is a senior doctor with much experience behind him, the respondent had not adduced evidence in support of the plea that the doctor was highly skilled as also a senior most doctor with plenty of experience gained over the period of time. 

14.            The hospital or nursing home by its care would indicate and assure the patient of proper care and treatment at the hands of skilled and experienced doctors.  The respondent having performed surgery upon the appellant, ought to have experienced due care at least by attending on him for aday during the postoperative stage and he ought not to have left the appellant to his fate at the hands of a duty doctor who stated to have treated the appellant on telephonic instructions from the respondent.  The episode itself is an indication of the situation which compelled the appellant to get himself discharged.’

15.            The Hon’ble Supreme Court in “Savita Garg Vs National Heart Institute” 2004 (8) SCC 56  held Had dealt with the care and caution exercised by the nursing homes and hospitals  and the faith the patients reposed in them as also the duty of the hospitals to take care of the patients.  The Supreme Court has observed thus:

It is the common experience that when a patient goes to a private clinic, he goes by the reputation of the clinic and with the hope that proper care will be taken by the Hospital authorities. It is not possible for the patient to know that which doctor will treat him. When a patient is admitted to a private clinic/ hospital it is hospital/ clinic which engages the doctors for treatment. In the present case, the appellant's husband was admitted to the best of the hospital and it is not possible for the appellant to find out that who is the best doctor and who is not. Normally, the private clinics go by the reputation and people look forward for best treatment when they are run commercially. It is the responsibility of the clinic that they must provide best of the services when they charge for the services rendered by them.

16.            The appellant after getting himself discharged from the respondent hospital was admitted to Yashoda Hospital and he was treated there as inpatient from 24.3.2007 to 1.4.2007.  During the course of his stay at Yashoda Hospital he was diagnosed as Fournier’s Gangrene followed by debridement.

PRESENT HISTORY:  A 50 year old male patient presented with fever followed by swelling scrotal region associated with discharge of pus.  He was admitted in some local hospital at Nizamabad where incision was done.  AA. After with discharge become extensive.

PAST HISTORY:  No H/o DM/HTN/COPD

17.            And the course of treatment he had undergone has been described at page 5 of the discharge summary as under:

Course in the Hospital:  A 50 year old male patient presented with H/o fever of 10 days duration associated with chills & rigors, associated with swelling in scrotal region.  H/o discharge of puss.  He was admitted in some local hospital at Nizamabad where incision under A.A. done & after with discharge become extensive not a known case of DM.HTN.COPD.

All necessary investigations done & diagnosed as Fournier’s gangrene so decided for debridement in OT.  Under G.A. debridement of Fournier’s gangrene done, wound irrigated with 112 O2 Betadin & normal saline

18.            The evidence of Dr.G.L.N.Malleswara Rao coupled with callous attitude and negligently entrusting of the appellant to the doctor whose experience and qualification has been very much under the attack by the appellant as also the way the operation was performed on the appellant would constitute deficiency in service on the part of the respondent on account of which the appellant had to undergo treatment at Yashoda Hospital and incurred the amount of `1,12,445/-.

19.            The appellant has claimed an amount of `4,99,000/- on all counts.  Before coming to a conclusion as to the claim of amount awarded as compensation several factors such as the statement of the respondent that the very same treatment that was administered at his hospital was also administered at Yashoda Hospital, the appellant getting himself discharged against medical advice etc., have to be considered particularly in the teeth of contention of the respondent that he had taken all precautions during pre-operative stage and performed surgery in accordance with the norms prescribed therefor.  Taking into consideration to totality of circumstances, we are of the considered opinion that on account of negligence and deficiency in service on the part of the respondent, the appellant is entitled to the amount of `50,000/- towards compensation.

20.            In the result the appeal is allowed in part by setting aside the order of the District forum.  Consequently the complaint is allowed.  The opposite party is directed to pay `50,000/- to the complainant together with costs of `2,000/- Time for compliance four weeks. 

                                                                                MEMBER

                                                                                MEMBER

                                                                            Dt.20.03.2012

KMK*