SMT.MOLYKUTTY MATHEW : MEMBER

        This is a complaint filed by the complainant U/S 12 of the Consumer Protection Act 1986  for an order directing  the OP’s to pay compensation to the complainant for an amount  of Rs.3,00,000/-for  the deficiency in service, negligent to treating the complainant on the part of  all OP’s.

The brief of the complaint :

     On 19/12/2011 the first complainant sustained a prick injury on his left hand to be inflicted by thorn while working in the field.  On the  very same day the  1^st complainant consulted 3^rd OP at Deepa Hospital, Alakkode and he underwent exploration of the injured site under local anaesthesia .  He also  advised injection  and antibiotics. Then after 2 days again he came to  3^rd OP’s clinic for pain and swelling of the left hand.  3^rd OP advised to consult a surgeon.  On 22/12/2011 the 1^st complainant consult 1^st OP with a complaint of pain and swelling of the left hand.  The clinical examination revealed  swelling, tenderness with redness over left hand in the injured area. He was thoroughly examined  but no foreign body could be  visualised or palpated  and  he gave injection and antibiotics .  Then he advised review on 26/12/2011.  On 26/12/2011 the pain , swelling and redness markedly increased and also continue the antibiotics.  Then  again the pain increased and the complainant approached 1^st OP on 31/12/2011 and he advised  Ultra Sound Sonogram on left hand to ascertain whether there is any foreign body localised.  Then the 2^nd OP performed the Ultra sound scan and reported that no foreign body was found.  Then the 1^st OP prescribed some oral medicine and told the 1^st complainant not to come back.  But the 1^st complainant’s pain and swelling did not subside and he consulted a local Ayurvedic physician and received treatment  also.  At  last on 21/1/2012 the 1^st complainant consulted a Surgeon at Koyili Hospital.  The surgeon found a foreign body inside the complainant’s left hand and removed.  The wound then healed.  So the 1^st complainant alleged that the 1^st and 2^nd OP’s  were negligent  in treating him and he suffered much mental and physical pain.  The act of  OP’s the complainant caused much mental pain and  financial loss.  So there is  deficiency of service and unfair trade practice on the part of OP’s.  Hence the complaint.

       After  receiving notice all OP’s entered before the commission  and filed their written version.  1^st OP contended that on 19//12/2011, the 1^st complainant sustained a prick injury on his left hand to be  inflicted by thorn while working  in the field.  On the same day he consulted the 3^rd OP  and underwent exploration of the injured site.  Then on 22/12/2011 the 1^st complainant consulted 1^st OP with complaint of pain and swelling on the left hand.  The 1^st  OP examined him and diagnosed a secondary  surgical site infection.  He was advised a course of intravenous antibiotics and then oral antibiotics.  Again on 31/12/2011 the 1^st complainant reported pain in the left hand and the 1^st OP advised an ultra Sonogram.  The USG report showed no foreign body and the  1^st OP advised the complainant to continue medicines to prevent infection.  Moreover 1^st OP contended that the 1^st complainant consulted the 1^st OP on the 4^th day of sustaining injury following  an immediate and detailed initial wound exploration  and removal of foreign body.  The complainant have no allegation against 3^rd OP who had failed to remove the foreign body as a  whole even by conducting an immediate exploration on the date of sustaining injury itself.  The 1^st OP had treated the 1^st complainant with all reasonable degree of skill and care in tune with accepted medical practice.  1^st OP is not liable to  pay any amount to the complainant either towards compensation or otherwise.  There was no negligence or deficiency in service on the part of 1^st OP.  So the complaint may be dismissed.   

   2^nd OP contended that on 31/12/2011 for Ultra Sound examination of the left hand of the 1^st complainant was done  incision  and drainage case with a suspected foreign body.  The 2^nd  OP had spent over 30 minutes for scanning all the relevant areas and had imaged the hand in multiple planes.  The sonography is the 1^st investigation to be done in a suspected radiolucent  foreign body like wood, it may fail to spot the foreign body in post surgical exploration patients even if the radiologist exercises utmost skill and expertise.  The hand was moderately swollen and had significant air in the tissue planes due to a previous incision and drainage .  2^nd OP could not sonographically identify the raw wood, it is however not a 100% foolproof method to identify and locate the foreign body and it has to be correlated with clinical findings.  2^nd OP had failed to identify the impacted foreign body through USG examination and which was later found out and removed by the surgeon Dr.V.Suresh on 21/1/2012 cannot be the basis for an inference that it was easily detected for the obvious scientific reason  that the impacted foreign body will have a tendency to migrate by lapse of time especially after previous I & D rendering the detection easier by efflux of time.  2^nd OP had exercised due diligence, skill and expertise in conducting USG diagnostic examination as per accepted medical practice.  So there was no negligence or   deficiency in service  on the part of 2^nd  OP and  2^nd OP is not  liable to compensate the 1^st  complainant.

  Supplemental 3^rd OP contended that on 19/11/2011 after examination of 1^st complainant this OP did  incision and drainage under local anaesthesia but no foreign body was obtained.  The pain and swelling were persisting this OP being a general practitioner and had done only primary treatment and referred the 1^st complainant for surgical  consultation and management.  The 1^st complainant has no cause of action against this  3^rd OP.  So there is no deficiency of service on the part of 3^rd OP.  So the complaint may be dismissed.

          On the basis  of the rival contentions by the pleadings the  following  issues  were framed for consideration.

1. Whether there is  any deficiency of service   on the part of the opposite parties?
2. Whether the complainant is entitled for any relief?
3. Relief and cost.

     The evidence consists of the oral testimony of PW1 and Exts. A1 to A7 were marked. On OP’s side 2^nd OP  was examined  as DW1.

Issue No.1: 

                The  2^nd complainant  adduced evidence before the commission by submitting  his chief affidavit in lieu of  his chief examination to the tune of the pleadings in the complaint and denying the  contentions in the version.  He was cross examined as PW1 by the OP’s.  He relied upon the documents  Exts.A1 to A7(series) to substantiate his case.  In the evidence of PW1 in cross examination,  he stated that “ Deepak നിങ്ങൾക്ക് മുക്താർ നൽകിയിരുന്നോ? ഇല്ല. ദീപക് 2000/- രൂപയുടെ മരുന്ന് വാങ്ങിച്ചു എന്ന് കാണിക്കുന്നതിന്ർറെ billകൾ ഹാജരാക്കിയിരുന്നോ? ബില്ല് ഉണ്ട്. ഹാജരാക്കിയ bill നോക്കിയാൽ 750/- രൂപയുടേതാണ്? ശരിയാണ്. ദീപക്കിനെ ആശുപത്രിയിൽ അഡ്മിറ്റ് ചെയ്യേണ്ടി വന്നിട്ടില്ല.  കൊയിലി ആശുപത്രിയിൽ 500/- രൂപയായി.  In this case the 2^nd complainant was examined as PW1.  The injured person  who is the 1^st complainant , aged 24 years, in this case and he is not examined and not proved his case also.  Moreover, the allegation of the complainant are personal in nature, the affected party should appear before the commission and give evidence.  The non-examination of the 1^st complainant is fatal to the  complaint also.  Moreover, the evidence of PW1 stated that   പരിക്ക് പറ്റിയ അന്നു തന്നെയാണ് ദീപക് OP.3 യെ കാണാൻ പോയത്. മൂന്നാം എതൃകക്ഷിയുടെ പരിശോധനയിൽ ഒന്നും തന്നെ മുറിവിന്ർറെ ഉള്ളിൽ അന്യവസ്തുക്കൾ ഉള്ളതായി കണ്ടിട്ടില്ല .പരിക്ക് പറ്റിയ 4-ാം ദിവസമാണ് ദീപക് OP.No.1 നെ കാണുന്നത്. ഒന്നാം എതൃകക്ഷിയെ ദീപക് 2 തവണ കണ്ടിരുന്നു.  അതിനുശേഷമാണ് കോരൻ വൈദ്യരെ കാണാൻ പോയത്.  കോരൻ വൈദ്യർക്കും അന്യവസ്തുക്കൾ ഉള്ളതായി തോന്നിയില്ല. Thereafter on 21/1/2012 the 1^st complainant approached Koyili hospital and  consulted the surgeon Dr.V.Suresh  കൊയിലി ആശുപത്രിയിൽ വെച്ച് scan ചെയ്യാതെ തന്നെ മുറിവിൽ അന്യവസ്തു ഉണ്ടെന്നു മനസ്സിലാക്കുകയും, ഓപ്പറേഷൻ ചെയ്യാതെ വസ്തു എടുത്ത് ദീപക്കിന് കൊടുത്തു. So the detection and removal of foreign body by the surgeon on 21/1/2012 cannot be the basis for an inference that it was easily detectable  for the obvious scientific reason  that the impacted foreign body will have a tendency to migrate by lapse of time especially after previous  I & D and rendering the detection easier by  efflux  of time.  Considering the evidence of  DW1 she spent over  30 minutes scanning  in multiple planes, using proper technique with due care and skill as per accepted medical practice.  2^nd OP could not sonographically identify the raw wood.  The foreign body being  raw wood(composed of cellulose fibbers) its acoustic impedance might  have been identical with that of the fibrous human fascial layers.  Even though the  Sonography is the first investigation to be done in a suspected radiolucent foreign body like wood, it is however not a 100% fool proof method of identify and locate the foreign body and it has to be correlated with clinical findings. In Ext.A6 shows the modern equipment was used “Philips”.  In the evidence of DW1 also states that  നേരത്തെ കീറി തുറന്നിരിക്കുന്ന wound ൽ ആണ് Ultra sound scan നടത്തിയത്. The OP’s counsel argued and produced some articles.  It is a well settled position that the failure of a party to put his case to the OP while the latter is in the witness box amounts to his acceptance.  It is noted in 2016(3) KLJ 561, 1987 (1) KLT 15(short note), AIR 2002 SC 3652.

   In OP’s counsel also submitted that an article published by Mike Health  from DMU Auckland Radiology group.  Difficulties in detection can be  encountered due to the distance from the puncture site, an unexpected location, or poor access, foreign bodies located between the  bones of the hand and foot can present access difficulties.  Moreover Removal of foreign bodies from soft tissues in emergency is very challenging and becomes more problematic  when it is radiolucent.  USG scanning can be  challenging in areas of the body that are in close proximity to bone  air etc.

  The Article published in the journal Ultra sound in medicine: JUM Sep:1,2009 Volu 28, stated  soft tissue foreign bodies can be easily missed.  Radiolucent foreign bodies such as wood are not  detected by radiography.  Such foreign bodies are missed in up to 38% of patients at first examination.  An Indian study reported by the department of  orthopaedic skin  ,Medial College Srinagar says: out of 30 suspected foreign bodies, ultra sonography was able to detect 28 foreign body with  2 false  negatives.

   In an  article published by American Institute of Ultra sound medicines observed that” air typically  produces a sonographic pattern of bright echoes and complex shadowing  that can be  confused with a  foreign body.  The judgment reported  in 2022(1) CPR(NC) 380 the Hon’ble  National commission  held that “ As per the  medical literature, the USG had limited  role in detection of renal calculi, it is an accessible and inexpensive imaging  method without the risk of exposure  to  ionising radiation during CT study.  In several studies the accuracy of detecting  renal , ureteric and urinary  bladder calculi are 67%,80%,98% respectively.  The Hon’ble National Commission also would show that Ultra sonogram is not a foolproof method to detect a foreign body hence the report of 2^nd OP cannot be held as wrong for any reason.  PW1 has no case that they  obtained another scan report after or prior the scan from  2^nd OP which revealed the presence of a foreign body.  So there is no  deficiency in service and no negligent in treating the 1^st complainant by Ops 1 to 4.  So the issue No.1 found in favour of the OP’s and answered accordingly.

Issue No.2&3:

   As discussed above due to the  aforesaid deficiency in service and unfair trade practice on the part of OPs 1 to 4 were not proved by the complainant.  So the complainant is miserably failed  to prove his case.  Thus the issue No.2&3 are also found against the  1^st complainant.

   Hence the complaint is dismissed on the ground that the 1^st complainant is not proved the deficiency in service, negligent in treatment and unfair trade practice against opposite parties 1 to 4.  So the compensation and cost not allowed.

   In the result , the complaint is dismissed.  No order as to cost.

Exts: 

A1- Bill issued  by Deepa hospital Alakode dt.19/12/2011

A2-OP card dtd.26/11/2011

A3-Prescription  issued by 2^nd OP dtd.31/12/2011

A4-Bill issued by  Koyili hospital dtd.21/1/2012

A5-Precription dtd.21/1/2012

A6-copy of image on scan report

A7-cash bill for scanning

PW1- Cyriac Joseph- 2^nd complainant

DW1-Dr.Sushma.A- 2^nd OP

Sd/                                                             Sd/                                                   Sd/

PRESIDENT                                             MEMBER                                               MEMBER

Ravi Susha                                       Molykutty Mathew                                    Sajeesh K.P

eva           

                                                                        /Forwarded by Order/

                                                                   ASSISTANT REGISTRAR