IN THE CONSUMER DISPUTES REDRESSAL FORUM, KOLLAM
DATED THIS THE 30th DAY OF MARCH , 2013
Present: Smt. G.Vasanthakumari,President
Adv.Ravisusha, Member
CC.NO.47/2008
Mr. Sudharsana Babu,S/o Surendran,
Lecturer (Selection Grade),
D.B. College, Sasthamkotta,
Residing yadavam, Kavand P.O,
Kollam.
(BY Adv.Vellayani Sundhara Raju) - Complainant
Vs
1. Dr. Joshy John ,
Department of Gastroentrology Surgery,
Bishop Benziger Hospital,
P.O. Box No. 515, Beach Road,
Kollam.
(Adv. A.Sudheer Bose, Kollam )
2. Bishop Benziger Hospital,
P.O. Box No. 515, Beach Road,
Kollam.
Represented by its Director,
Bishop Benziger Hospital.
(Adv. George Mathew, Kollam) - Opposite Parties
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ORDER
SMT.G.VASANTHAKUMARI, PRESIDENT
Complainants case is that, the complainant is a PhD Degree holder working as selection Grade lecturer in the Department of Malayalam at D.B. College Sasthamkotta, Kollam, that the complainant felt a kind of exhaustion on 17/02/2007 hence he went to the Govt, Hospital, Karunagappally, on 18/02/2007 hence was examined there as an outpatient with OP No.20068 of 18/02/2007 that as no cure was felt the complainant was admitted and treated as an inpatient at the Upasana Hospital, Kollam from 20/02/2007 to 02/03/2007 , that on 02/03/2007 Dr. Pankajakshan M.D, Consultant Physician of the said hospital referred the complainant to the Bishop Benziger Hospital for expert evaluation, especially advising the complainant to undergo endoscopy on him to detect properly his ailment, that before referring the complainant to Bishop Benziger hospital lab test and scan were conducted on him and it was found in the lab test that the Bilirubin level in the complainant was exorbitantly high that after consulting with the 1st opposite party Dr.Pankajaksan, M.D. referred the complainant on 02/03/2007 to the 1st opposite party , that the
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complainant and his wife met the 1st opposite party at 3.pm on 02/03/2007at the Bishop Benziger Hospital, Kollam, that the 1st opposite party admitted the complainant in the 2nd opposite party hospital on that day itself and informed to the complainant at 8.pm that he had to take an ultra sound scan from the Travancore Diagnostic pvt. Ltd. on the next day morning stating that as the scan earlier taken by the complainant was not clear, that accordingly an ultra sound scan was taken on the next day but nothing was found abnormal, that after examination of the scan report the 1st opposite party insisted the complainant to undergo a Liver Biopsy soon on 03/03/2007 itself instead of endoscopy, that the complainant then told the 1st opposite party that it was not appropriate to inflict any wound on any part of his body as he was having high level of Bilirubin content, that the 1st opposite party sarcastically brushed aside the above statement of the complainant and asked the complainant and his wife to put their signatures on various papers as permission from them for conducting liver Biopsy on the complainant , that in the absence of the complainant the 1st opposite party informed to the wife of the complainant that the 1st opposite party was suspecting some cancerous growth in the liver of the complainant hence liver Biopsy was the only means to ascertain that, that the 1st opposite party
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assured to the wife of the complainant that liver biopsy on her husband would be over within 2 hours and the complainant would be brought back to the ward before 5.30 pm, that the complainant was not brought back even after elapsing 5 hours after he was taken to the operation theatre of the 2nd opposite party hospital at the instructions of the 1st opposite party on 03/03/2007 and hence the wife of the complainant became panic and she frantically searched the 1st opposite party, that suddenly the 1st opposite party reached to the complainant’s wife and informed to her that her husband’s condition was highly critical and he needs blood that further the 1st opposite party told to the wife of the complainant that it was imperative to conduct a major operation on the complainant to stop the flow of the blood, that on information given by the wife of the complainant 22 relatives of the complainant reached to the 2nd opposite party hospital and donated their blood, that the wife of the complainant was told by the 1st opposite party after conducting a major emergency laprotomy on her husband that he was given 9 bottles of blood and 8 units of plasma to save the life of the complainant from danger and his condition was not satisfactory and he was not out of danger, that the 1st opposite party was solely responsible for making the life of the complainant in a precarious condition, that it is reliably learned
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from the believable sources that the 2nd opposite party hospital authorities set apart 40% of surgery charges to the doctor who is conducting the operation on the patients, that it is for getting easy personal monetary gains to the 1st opposite party and also to get undue monetary gains to the 2nd opposite party hospital and to cause unnecessary monetary loss to the complainant and to his family the first opposite party conducted liver biopsy on the complainant on 03/03/2007 and thereby caused him irreparable mental agony, hardships and inconveniences and also heavy financial loss, that the 1st opposite party conducted an emergency laprotomy on the complainant due to his negligence in conducting the liver biopsy, that the complainant underwent a major laprotomy and suffered excruciating pain thereafter on account of the deficient medical treatment administered on him by the 1st opposite party in a most irresponsible and negligent manner, that the faulty and negligent manner of conducting of the liver biopsy on the complainant by the 1st opposite party made the life of the complainant extremely critical, that the complainant incurred an expense of Rs. 48,923.33 at the 2nd opposite party hospital unnecessarily for a period of 5 days from 02/03/2007 to 07/03/2007, that the medical care and treatment administered to the complainant at the 2nd opposite party hospital under the
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supervision and guidance of the 1st opposite party were understood to be faulty and deficient, hence the wife of the complainant requested to the 1st opposite party to refer the complainant to the Department of Gastroentrology, Lakeshore Hospital, Kochi, that accordingly the complainant was referred to Lakeshore hospital on 07/03/2007,that the complainant was taken to Lakeshore Hospital, Kochi, on 07/03/2007 and admitted him there as an inpatient from that day to 19/03/2007, that the complainant had to spend Rs.46,073.95 there as hospital charges, that on account of conducting of liver biopsy and laprotomy and the resultaned infusion of 9 units of blood and 8 units of plasma on the complainant had generated itching and painful swelling on all parts of the body of the complainant and he had to undergo treatments from the Lakeshore Hospital and thereafter from the Consmopolitan hospital, Thiruvananthapuram for its cure, that the complainant was admitted and treated in the Cosmopolitan hospital as inpatient from 24/04/2007 to 27/05/2007, that the complainant spent Rs. 39,506.00 at the cosmopolitan hospital, that besides the above hospital expenses the complainant incurred heavy financial loss due to loss of pay for not attending duty for 5 months continuously that the complainant has a monthly pay of Rs. 30000/- and for 5 months he lost an
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amount of Rs. 1,50,000 that for the expenses incurred by the complainant in the 2nd opposite party hospital and 3 other hospitals, he is not entitled to get any medical reimbursement, still the complainant is undergoing treatment for his ailments, that the complainant sent a Regd. Lawyer notice dated 21/02/2008 to the opposite parties demanding compensation for the loss and damages caused to the complainant on account of the deficient medical treatment administered on the complainant ignorantly by the 1st opposite party, that the 2nd opposite party being the employer of the 1st opposite party is vicariously liable to compensate the complainant and hence this complaint to direct the opposite parties to pay Rs. 2,50000.00 towards compensation for the financial loss, hardship, inconvenience and mental agony caused to the complainant on account of administering deficient medical service, care and treatment. Opposite party filed version contending that the complaint is not maintainable either in law or on facts, that it is frivolous, vexatious and devoid of truth or bonafides, that there is no negligence or deficiency in service as alleged by the complainant, that the complainant is not entitled to get any relief as prayed for in the complaint, that the 1st opposite party is a consultant Gastroenterology surgeon working in Benziger Hospital,Kollam, that on 02-03-2007 the complainant herein
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also referred to as patient, consulted the 2nd opposite party Hospital with the complaints of jaundice, the exact cause of which was not known that the patient was referred to the 1st opposite party by Dr. Pankajakshan, consultant physician of upasana hospital, that Dr. Pankajakshan had advised several laboratory investigations, Ultrasonogram (USG) abdomen and CT Scan, that however the investigations done there did not reveal the exact cause for jaundice that the patient was thus referred to the 1st opposite party for the purpose of obtaining expert opinion on the cause of jaundice, and also for further management of jaundice, that the 1st opposite party conducted a detailed clinical examination of the patient and also went through all the investigation reports and the scans that were performed at Upasana Hospital, that he also advised some blood investigations which showed a normal blood routine and bleeding profile, but liver function Test (LFT) showed elevated bilirubin (20.3mg/dL), elevated Hepatic Transaminases (SGOT 428 and SGPT 1004 IU/L) and a disproportionately raised Serum Alkaline Phosphatase value (2375 IU/L), that such a blood picture would suggest that there is Cholestasis ( stoppage or suppression of flow of bile ) besides inflammation of liver, that the cause for jaundice had already been partly evaluated at Upasana Hospital, that viral markers like HbsAg, Anti-HCV and
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IgMHAV and other special tests for evaluation of jaundice were all negative that thus none of the available results gave a proper explanation for his jaundice, that Cholestasis, which was suggested by the LFT, can be of two types -Intrahepatic or extra hepatic,that the investigation of choice to identify Extra Hepatic Cholestasis is Ultrasound scan and to identify Intra Hepatic Cholestasis is Ultrasound scan and to identify Intra Hepatic Cholestasis (if no other cause is found ) is liver biopsy, that thus after explaining the importance of repeating the USG in this patient the 1st opposite party advised them to have it done from Tranvacore Diagnosis Pvt Ltd, Kollam, that the next day (i.e. on 03/03/07) when Ultrasound scan was repeated in the morning, it was found that, there was no evidence of extra Hepatic Cholestasis, thus inferring that the nature of his jaundice was that of intra Hepatic Cholestasis, that when Blood Reports did not reveal a cause for intra Hepatic Cholestasis, the next investigation of choice in the medical work up of a patient with jaundice is Liver Biopsy, that this matter was explained to the patient and his wife and a written consent signed by both of them was obtained, that the procedure was done in the ICU under close monitoring, that the site of puncture was first marked and depth of penetration was assessed by a screening Ultrasound by the 1st opposite party in the
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Diagnostic Unit of 2nd opposite party Hospital as part of preparation and planning for the procedure of liver Biopsy, that the patient was then shifted to the Gastro ICU at around 4 PM on 03/03/07, that the procedure of liver biopsy was done with the automatic spring loaded disposable liver biopsy needle (Bard Max core Disposable biopsy instrument size 18 GX16 cm length and penetration depth 22mm) following all standard and aseptic precautions, with extreme caution and care through the site marked, that the procedure went on uneventfully and the 1st opposite party left the ICU after 1 hour after ensuring that there was no immediate complication, that before leaving the ICU, the 1st opposite party gave instructions to the nurses on duty to closely monitor the vital signs of the patient, that at around 6.20 PM, the 1st opposite party was informed from the ICU that there was sudden fall in the blood pressure of the patient , that the junior Doctor on ward duty, Dr. Premchand Prabhu, MBBS, examined the patient and infused IV fluids after consulting the matter with the 1st opposite party over phone, that though the blood pressure picked up transiently, it started dropping again by 7.30 PM, that the 1st opposite party immediately rushed to the ICU and after examining the clinical condition of the patient, continued with the fluid resuscitation, that bladder catheterization
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and central venous cannulation were done for more accurate monitoring of vital parameters, that by 9.15 PM, an emergency bedside screening USG was done by the 1st opposite party in the ICU, which confirmed blood in the free peritoneal cavity, that thus it was inferred that, there was bleeding from the site of liver biopsy into the abdominal cavity and that was the reason for his dropping of blood pressure, that the 1st opposite party called the patient’s wife to the ICU and briefed her and a friend/ relative, who accompanied her, about the situation that they were informed about the need for blood transfusions to replace the blood being lost, for which as many number of donors as possible would have to be arranged as soon as possible, that however for the time being, a few units of blood would be arranged from the blood bank of the 2nd opposite party Hospital, that the 1st opposite party also informed her that an emergency laparotomy ( Surgery to open up the abdomen) would be needed at the earliest for controlling the haemorrhage, that within a short while some relative or friends approached the first opposite party asking whether the patient could be referred to Trivandrum for further management , that another relative had also contacted over phone from Trivandrum asking the same thing, that the first opposite party explained to them what had happened and the
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gravity the situation, that the patient was continuously loosing blood into the abdominal cavity with steady dropping of blood pressure, that the general condition of the patient, more particularly, his blood pressure, was being sustained by continuously transfusing large volume of fluids and blood, that it was also told to them that it is absolutely unsafe to shift the patient to another centre in that condition, as there is every chance to lose the patient during transit, that however if they still wished to shift the patient, it could be done at their own risk, but against medical advice, that after discussing among themselves, the relatives and friends informed the 1st opposite party that they are willing to proceed with surgery in the 2nd opposite party Hospital itself, that a hand written informed consent mentioning all these matters including the indication for performing an emergency surgery at that point of time and the possible outcomes, was prepared and it was signed by the patient’s wife, Smt. K.Shyla and two other witnesses – Mr. S.Ranjith and Mr. Jayasingh that the Anaesthetist on duty that day,Dr.George Varkey, MD, PDCC (Cardiac Anaesthesia) also examined the patient to assess whether the patient was fit to undergo surgery under General Anaesthesia, that he also separately called upon the relatives and reiterated the seriousness of the situation to them,
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that the patient was prepared and shifted to the operation Theater by about 10.45 PM, that the 1st opposite party then carried out the surgery with utmost care and caution, which lasted for 2 hours and 30 minutes (starting at 11 PM at night and ending at 1.30 AM), that on opening up the abdomen, the peritoneal cavity was found to contain about 4 litres of fresh blood , that the bleeding point on the liver was then identified, which was brought under control , that a separate piece of liver biopsy was also taken( just in case the earlier percutaneous biopsy report would be inconclusive), that to replace the lost blood and to further enhance the clotting of the blood, the patient was transfused with 9 bottles of whole blood and 8 units of fresh frozen plasma as per instructions of the 1st opposite party and the duty Anaesthetist, that the transfusion requirements decided were strictly based on the requirement as indicated by various clinical and laboratory parameters monitored on the patient at different points of time before, during and after the surgery, that the patient was then shifted to the postoperative ICU where his hemodynamic parameters were closely monitored, that by the next day morning (i.e on 04.03.2007), the patient was extubated, hemodynamically stable and out of danger, that the condition of the patient was informed from time to time to the relatives outside
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the ICU, that on 06.03.2007, though the condition of the patient was steadily improving and he was recovering satisfactorily after the surgical procedure, the wife of patient requested that he may please be discharged from the 2nd opposite party Hospital and referred to Lakeshore Hospital, Ernakulam, for a second opinion, that since the patient was stable and fit to travel unlike on 03-03-2007, when they had requested the patient to be referred to Trivandrum, the 1st opposite party immediately obliged, that a detailed discharge summary of all the treatments that the patient had received from the 2nd opposite party Hospital in the last 4 days and a reference letter was issued and the patient was shifted by Ambulance on 07-03-2007 to Lakeshore Hospital, Cochin.
It is further contended that the averment made by the complaint in Para 1 of the complainant that he was referred from Upasana Hospital by Dr. Pankajakshan for endoscopy alone is false, baseless and hence denied, that the patient was referred by Dr. Pankajakshan to the 1st opposite party for the purpose of obtaining expert opinion on the cause of jaundice and for further management of his jaundice and not for an endoscopy as alleged, that the copy of the reference letter clearly mentions it,that the averment made by the
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complainant in Para 2 of the complaint that he was advised to do a USG Study from Travancore Diagnostic Pvt Ltd, the next day since the scan taken earlier was not clear is only partially true and hence not admitted, that LFT done was suggestive of Cholestasis, which can be of two types, Intra Hepatic or Extra Hepatic, then the investigation of choice to identify extra hepatic Cholestasis is Ultrasound scan and to identify intrahepatic Cholestasis ( if no other cause is found) is liver biopsy, that Ultrasound scan is a relatively cheap and non-invasive investigation, but grossly dependent on the Radiologist, who performs it, that in this particular case, the Report of the Scan is very crucial in deciding the further line of management, that if any cause for biliary obstruction was missed out in the previously done scan, a further invasive investigation like liver biopsy could be avoided, that thus after explaining the importance of repeating the USG in this patient, the 1st opposite party asked them to have it done from Travancore Diagnosis Pvt Ltd, Kollam, that the 1st opposite party had preferred to do it from that particular Diagnostic Centre because there was no Radiologist in the 2nd opposite party Hospital then and also because Radiologist working there was a highly experienced Doctor, that the averment made by the complainant in Para 2 of the complaint that after seeing the USG Report, the 1st opposite party
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insisted to do a liver Biopsy instead of an Endoscopy is not true that the patient was first seen by Dr.Pankajakshan of Upasana Hospital, where several Lab investigations, USG abdomen and CT Scan had been performed, that however the investigations done there did not reveal the exact cause for jaundice, that it is for the purpose of obtaining expert opinion on the cause of jaundice and for further management of his jaundice that Dr.Pankajakshan referred the patient to the 1st opposite party and not for an endoscopy as alleged, that the copy of the reference letter mentions it, that Endoscopy is not an investigation done for evaluation of jaundice, and it was not for Endoscopy that the patient was referred to the 1st opposite party , that moreover the 1st opposite party is working in the capacity of a Consultant in the super Specialty Department of surgical Gastroenterology in the 2nd opposite party Hospital, that though he routinely receives patients who are referred from various general practitioners and specialists including physicians and surgeons working in other hospitals, it is the prerogative of the 1st opposite party to decide the line of management for these referred patients on the basis of his professional competence and judgment, that the averment made by the complainant in Para 2 of the complaint that he told the 1st opposite party that it is not appropriate to inflict
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any wound on any part of his body as he was having high level of bilirubin content is false, baseless and hence denied, that the patient had never made such a remark, (He had only said that he is very apprehensive to undergo such a procedure) , that the 1st opposite party as part of the informed consent, had explained to the complainant and his wife the various possible complications, that during the explanation, the 1st opposite party had informed that elevation of bilirubin, no matter however high, is never a contraindication for doing liver biopsy, and this concern of the patient was also clarified by explanation, that on the other hand, unexplained elevation in bilirubin and hepatic enzymes suggesting intrahepatic cholestasis, the cause of which has to be investigated, is precisely the indication for performing liver biopsy on this patient, that the standard accepted contraindications for the procedure in medical literature (when a liver biopsy should not be done on a patient) are excessive bleeding tendency ( prolonged prothrombin time and low platelet count), an uncooperative patient, hemangioma or vascular tumour of liver or massive ascites, that the complainant, at that time, had none of these contraindications for doing this test, that however the final decision to perform the procedure of liver biopsy was taken only after discussing all these things with the patient and
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his wife and after obtaining a written consent signed by both of them after convincing them, that the averment made by the complainant in Para 2 of the complaint that when the complainant expressed his apprehension regarding the liver biopsy the 1st opposite party sarcastically brushed it aside and informed the wife of the patient in his absence that he was suspecting a cancerous growth in the liver and hence the biopsy is absolutely necessary is only partially true and hence not admitted, that as mentioned above, the 1st opposite party had explained in detail regarding the possibility of some intrahepatic cause for cholestasis, which can ideally be diagnosed only by biopsy, that there was no sarcasm as alleged nor was it explained only to the wife of the complainant but to both the patient and his wife, that the averment made by the complainant in Para 3 of the complaint that the 1st opposite party had assured the wife of the complainant that liver biopsy would be over within 2 hours is false, baseless and hence denied, that the 1st opposite party gave no such assurances or time limit to the complainant’s wife and there was no such occasion also, that the averment made by the complainant in Para 4 of the complaint that the intention of doing a liver biopsy was only for monetary gain for the opposite party is absurd, ill motivated and hence denied, that the complainant has a post
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Graduate Degree and is a lecturer by profession, that being an educated man, it is sure that he would have understood the reason for doing a biopsy, that it is unfortunate that an educated man of such qualification is making such absurd allegations, that the indication to perform liver biopsy in this patient is based on well accepted medical guidelines and not for any personal gains or monetary benefits as alleged , that the remuneration package that the 1st opposite party receives from the 2nd opposite party is a salary irrespective of the number of surgeries or other investigations procedures done by him, that it would be extremely below the standards of medical ethics to presume that the 1st opposite party performed this invasive investigation on this patient for the sake of monetary benefit, that moreover the surgery done was solely for controlling haemorrhage and saving the life of the patient and if that surgery had not been done that night, the patient would possibly have been no more, that the 1st opposite party had carried out the surgery with utmost care and caution, which lasted for 2 hours and 30 minutes (starting at 11 PM and ending at 1.30 AM), that it is highly unfortunate that after doing a life saving surgery under considerate stress and after forgoing his sleep the complainant had accused him of doing the surgery for monetary purpose, that the averment made by the
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complainant in Para 4 of the complaint that the 1st opposite party conducted an emergency laprotomy on the complainant due to his negligence in conducting the liver biopsy is false, baseless and hence denied, that Liver biopsy is a procedure routinely performed by the 1st opposite party in the department of Gastroenterology of the 2nd opposite party Hospital and is well versed with the technique of performing this procedure, its indications, contraindications, precautions and complications and how they should be managed, that the site of puncture was first marked and depth of penetration assessed by a screening ultrasound done by the 1st opposite party in the Diagnostic unit of 2nd opposite party Hospital prior to inserting the biopsy needle, that the procedure of liver biopsy was done with the automatic spring loaded disposable liver biopsy needle ( Bard Max core Disposable biopsy instrument size 18GX16 cm length and penetration depth 22 mm) following all standard and aseptic precautions, with extreme caution and care through the site marked, that the 1st opposite party always follows the same standard accepted technique and uses the same type of instrument for performing all percutaneous liver biopsies, that in the imported disposable automatic spring liver biopsy gun (Bard company), which is the standard instrument used in most centers worldwide for taking liver
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biopsy, the needle advances by about 2cm on firing, that the procedure went on uneventfully and 1st opposite party left the ICU after one hour after ensuring that there was no immediate complication, that before leaving the ICU, the 1st opposite party gave instructions to the nurses on duty to closely monitor the vital signs of the patient, that unfortunately after about 2 hours, the patient started showing the features of internal bleeding from the site of biopsy, that like in any invasive procedure in medical science, this procedure of liver biopsy also has its share of inherent complications irrespective of the expertise and experience of the person performing it or the centre where it is performed. It is further contended quoting from the Textbook of Diseases of the Liver and Biliary system by Sheila Sherlock and James Dooley, 11th Edition (2002) (which is the internationally most accepted Text book on liver diseases followed worldwide), intra peritoneal hemorrhage following liver biopsy, though rare, is a well recognized complication of percutaneous liver biopsy procedure, that non-fatal hemorrhages have been reported in 0.24% (i.e.2 out of 1000 patients), that “Hemorrhage usually develops when least expected and when at the time of biopsy, the risk seemed small, that it might be related to factors other than peripheral clotting, for instance the compression of the needle tract by elastic
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tissue,”that “ serious hemorrhage is usually intraperitoneal, but may be intrathoracic from an intercostal artery, that the bleeding results from perforation of distended portal or hepatic veins or aberrant arteries, that the occasional laceration of a major intrahepatic vessel cannot be avoided that in some cases, a tear of the liver follows deep breathing during the intercostals procedure”, that this bleeding is a known complication, which can never be predicted or prevented and since the patient was being continuously monitored, the 1st opposite party could take the requisite action immediately to save the life of the patient.
It is further contended that the averment made by the complainant in Para 6 of the complaint that the wife of the complainant requested the patient to be referred to Lakeshore Hospital, Cochin, because the treatment provided at the 2nd opposite party Hospital under the supervision of the 1st opposite party is faulty and deficient is flase, baseless and hence denied, that on 03-03-07, the 1st opposite party had informed the complainant’s wife that an emergency laparotomy ( Surgery to open up the abdomen) would be needed at the earliest for controlling the hemorrhage from the site of biopsy, that within a short while,
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some relatives or friends approached the 1st opposite party asking whether the patient could be referred to Trivandrum for further management, that another relative had also contacted over phone from Trivandrum asking the same thing, that the 1st opposite party explained to them the gravity of the situation , that the patient was continuously loosing blood into the abdominal cavity with steady dropping of blood pressure, that the blood pressure was being sustained by continuously transfusing large volume of fluids and blood, that it was also told to them that it is absolutely in safe to shift the patient to another centre in that condition, as there is every chance to loose the patient during transit, that after discussing among themselves, the relatives and friends informed the 1st opposite party that they are willing to proceed with the surgery in the 2nd opposite party Hospital itself, that however on 06-03-2007, though the condition of the patient was steadily improving and he was recovering satisfactorily after the surgical procedure, the wife of patient requested that he may please be discharged from the 2nd opposite party and referred to Lakeshore Hospital, Ernakulam, since they would like to have a second opinion, that it was not because the treatment provided at the 2nd opposite party hospital under the supervision of 1st opposite party was faulty or deficient as alleged, that since the
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patient was stable and fit to travel unlike on 03-03-07 (When they had requested the patient to be referred to Trivandrum), the 1st opposite party immediately obliged, that a detailed discharge summary of all the treatments that the patient had received from the 2nd opposite party Hospital in the last 4 days and a reference letter was issued, that the patient was shifted by Ambulance on 07-03-2007 to Lakeshore hospital, Cochin, that the averment made by the complainant in Para 8 of the complaint that the patient developed itching and painful swelling of body after which he underwent treatment at Lakeshore Hospital and Cosmopolitan Hospital, Trivandrum, is due to the infusion of blood and plasma is false, baseless and hence denied , that the patient was having itching from the time he was under the treatment of Dr.Pankajakshan of Upasana Hospital, that the reference letter of Dr. Pankajakshan clearly mentions that he was having itching that the itching is a symptom due to cholestasis, that to replace the lost blood and to further enhance the clotting of the blood, the patient was transfused with 9 bottles of whole blood and 8 units of fresh frozen plasma as per instructions of the 1st opposite party and Duty Anesthetist, that the transfusion requirements decided were strictly based on the requirement as indicated by various clinical and laboratory parameters monitored on the
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patient at different points of time before, during and after the surgery, that no unnecessary transfusions were given to the patient, that if the blood and plasma transfusions were not given at that time, the patient would probably have succumbed or would have developed other life threatening complications like DIC (Disseminated Intravascular Coagulation),that neither of these occurred because of the timely intervention and appropriate transfusions that he received at the opposite party Hospital, that Medical Science has not reached a stage where the adoption of a particular treatment, medical or surgical, would produce definite positive result in all case of illness or disease, that the outcome of treatment would greatly depend on a variety of facts such
as the severity of the condition treated, co-existence of other disease, immunological status of the individual, limitation of the treatment involved, sensitivity of the individual to the drugs, resistance of the organism to the drugs, patient’s compliance etc., many of which are not under the control of the treating doctors or the Hospital and hence merely because a patient is not relieved from pain or has not received the relief, one cannot say that no proper treatment was given, that when the Doctor exercised reasonable standard of
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care and caution in handling a case and acted in accordance with the accepted medical practice and ethics, there is no negligence on the part of the treating Doctor, that the 1st opposite party is a qualified surgical Gastroenterologist, that after passing MBBS Degree from Government Medical College , Trivandrum, in 1992, he has done his Post Graduation in General Surgery (MS) at Government Medical College, Calicut in 1996, that he has passed Dip.NB(General Surgery) from the Diplomate of National Board,New Delhi, in 1997 and then he took FRCS Degree from Royal College of Physicians and Surgeons of Glasgow, UK, in 1998, that then he has obtained Super Specialty Degree of M.Ch in Surgical Gastroenterology from Government Medical College, Trivandrum,in 2002, that he has published two scientific papers in the field of Surgical Gastroenterology and presented other 16 scientific papers at various National Conferences, that he is the recipient of National Award for Best Scientific paper in Surgical Gastroenterology for the year 2001, that he had been working as Lecturer in Surgery at the Government Medical College, Calicut, for 3 ½ years and six months as a Specialist in Gastrointestinal Surgery at Amrita Institute of Medical Science and for the last six years , this opposite party is working as Consultant Gastroenterology Surgeon at Bishop Benzigar Hospital , Kollam.
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Without prejudice to the above raised contentions, it is submitted that the amount claimed as compensation on the ground of medical negligence is extremely high and unreasonable, that it has no nexus with the actual expenditure and the alleged sufferings of the complainant, that admittedly the complainant is a college Professor drawing salary from the Government, that being a Government servant, the complainant had reimbursed all the medical expenses he had expended in connection with this treatment, that further it is also disputed that the complainant lost an amount of Rs. 1,50,000/- towards loss of earning, that there is nothing on evidence to indicate that the complainant has availed five months leave on loss of pay during the alleged period, that when the complainant sent the notice, this opposite party has replied denying all the allegations raised against him, that the compensation claimed under different heads are exaggerated and without any basis, that the alleged difficulties of inconvenience were never caused due to any medical negligence or deficiency in service on the part of the opposite party and hence the complainant is not entitled to get any amount as compensation from the 1st opposite party
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Opposite party 2 filed separate version raising more or less the similar contentions raised by Opposite party 1.
In this case the complainant was examined as PW1 and his wife as PW2 ,OP1 doctor as Dw1, expert doctor as Dw2 and Dr. Pankajakshan of Upasana hospital as DW3 and marked Exbts P1 to P8, D1 ,X1 and X2.
The points that would arise for consideration are:
(1)Whether the complainant was actually referred to the 1st opposite party by Dr. Pankajakshan of Upasana Hospital for expert opinion and management on 2.03.2007?
(2)Whether there is any negligence in the treatment of the patient?
(3)Whether there is any deficiency in service on the part of the opposite party ?
Points 1 to 3:- For the sake of convenience these three points can be considered together. PWs1 and 2 would swear before the Forum in tune with the allegations in the complaint. Opposite party 1 as Dw1 would swear before the Forum that on 02-03-2007 the complainant consulted him for the complaint of jaundice, the exact cause of which was not known, that the patient was
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referred to him by Dr. Pankajakshan, consultant physician of Upasana hospital, that Dr. Pankajakshan had advised several laboratory investigations,Ultrasonogram (USG) abdomen and CT Scan, that however the investigations done there did not reveal the exact cause for jaundice, that the patient was thus referred to him for the purpose of obtaining expert opinion on the cause of jaundice and also for further management of jaundice and accordingly opposite party 1 conducted a detailed clinical examination of the patient and also went through all the investigation reports and the scans that were performed at Upasana Hospital, that the patient was also advised some blood investigations which showed a normal blood routine and bleeding profile but liver function test(LFT) showed elevated bilirubin ( 20.3MG / dL) , elevated Hepatic Transaminases (SGOT 428 and SGPT 1004 IU/L) and a disproportionately raised Serum Alkaline Phosphate value 2375IU/L), that such blood picture would suggest that there is Cholestasis (Stoppage or suppression of flow of bile) besides inflammation of liver, that the cause for jaundice had already been partly evaluated at Upasana Hospital, that Viral Markers like HbsAg, Anti –HCV and IgMHAV and other special tests for evaluation of jaundice were all negative and thus none of the available results gave a proper explanation for his
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jaundice that Cholestasis, which was suggested by the LFT, can be of two types- intrahepatic or extra hepatic that the investigation of choice to identify Extra Hepatic Cholestasis is Ultrasound scan and to identify Intra Hepatic Cholestasis (If no other cause is found) is liver biopsy and thus after explaining the importance of repeating the USG in this patient he advised them to have it done from Tranvacore Diagnosis Pvt Ltd, Kollam, that the next day (i.e. on 03/03/2007) When ultrasound scan was repeated in the morning, it was found that, there was no evidence of extra Hepatic Cholestasis, thus inferring that the nature of his jaundice was that of Intra Hepatic Cholestasis, that when Blood Reports did not reveal a cause for intra Hepatic Cholestasis, the next investigation of choice in the medical work up of a patient with jaundice is Liver Biopsy, that this matter was explained to the patient and his wife and a written consent signed by both of them was obtained, that the procedure was done by him in the ICU under close Monitoring, that the site of puncture was first marked and depth of penetration was assessed by a screening Ultrasound by him in the Diagnostic unit of 2nd opposite party Hospital as part of preparation and planning for the procedure of liver biopsy, that the patient was then shifted to the Gastro ICU at about 4 PM on 03/03/2007, that the procedure of liver
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biopsy was done with the automatic spring loaded disposable liver biopsy needle (Bard Max core Disposable biopsy instrument size 18GX16 cm length and penetration depth 22mm) following all standard and aseptic precautions, with extreme caution and care through the site marked, that The procedure went on uneventfully and he left the ICU, one hour after ensuring that there was no immediate problem, that before leaving the ICU he gave instructions to the nurses on duty to closely monitor the vital signs of the patient, that at around 6.20PM, he was informed from the ICU that there was sudden fall in the blood pressure of the patient, that the Doctor on ward duty,Dr.Premchand Prabhu, examined the patient and infused IV fluids after consulting the matter with opposite party over phone, that though the blood pressure picked up transiently, it started dropping again by 7.30 PM, that he immediately rushed to the ICU and after examining the clinical condition of the patient, continued with the fluid resuscitation, that Bladder catheterization and central venous cannulation were done for more accurate monitoring of vital Parameters, that by 9.15 PM , an emergency bedside screening USG was done by him in the ICU, which confirmed blood in the free peritoneal cavity that Thus it was inferred that, there was bleeding from the site of liver biopsy into the abdominal cavity
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and that was the reason for his dropping of blood pressure that then called the patient’s wife to the ICU and briefed her and a friend / relative, who accompanied her, about the situation, they were informed about the need for blood transfusions to replace the blood being lost, for which donors would have to be arranged from the blood bank of the 2nd opposite party Hospital, that Opposite party 1 also informed her that an emergency laparotomy (Surgery to open up the abdomen) would be needed at the earliest for controlling the haemorrhage, that within a short while, some relatives or friends approached me asking whether the patient could be referred to Trivandrum for further management, that another relative had also contacted over phone from Trivandrum asking the same thing, that opposite party 1 have explained to them what had happened and the gravity of the situation, that the patient was continuously loosing blood into the abdominal cavity with steady dropping of blood pressure, that the general condition of the patient, more particularly, his blood pressure was being sustained by continuously transfusing large volume of fluids and blood, that It was also told to them that it is absolutely unsafe to shift the patient to another Centre in that condition, as there is every chance to lose the patient during transit, that however if they still wished to shift the
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patient, it could be done at their own risk, but against medical advice, that after discussing among themselves, the relatives and friends informed me that they were willing to proceed with surgery in the 2nd opposite party Hospital itself, that a hand written informed consent mentioning all these matters including the indication for performing an emergency surgery at that point of time and the possible outcomes , was prepared and it was signed by the patient’s wife, Smt.K.Shyla and two other witnesses-Mr. S.Ranjith and Mr. Jayasing, that the Anaesthetist on duty that day, Dr. George Varkey, MD, PDCC (Cardiac Anaesthesia) also examined the patient to assess whether the patient was fit to undergo surgery under General Anaesthesia. That he also separately called upon the relatives and reiterated the seriousness of the situation to them, that the patient was prepared and shifted to the operation Theater by about 10.45 PM, that the 1st Opposite Party then carried out the surgery with utmost care and caution, which lasted for 2 hours and 30 minutes (starting at 11 PM at night and ending at 1.30 AM), that on opening up the abdomen, the peritoneal cavity was found to contain about 4litres of fresh blood, that the bleeding point on the liver was then identified , which was brought under control, and to replace the lost blood and to further enhance the clotting of
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the blood, the patient was transfused whole blood and fresh frozen plasma as per instructions from him and the duty Anaesthetist, that the transfusion requirements decided were strictly based on the requirement as indicated by various clinical and laboratory parameters monitored on the patient at different points of time before, during and after the surgery, that after the operation, the patient was shifted to the postoperative ICU where his hemodynamic parameters were closely monitored and by the next day morning (i.e.on 04-03-07), the patient was extubated, hemodynamically stable and out of danger, that the condition of the patient was informed from time to time to the relatives outside the ICU, that on 06-03-2007, though the condition of the patient was steadily improving and he was recovering satisfactorily after the surgical procedure, the wife of the patient requested that he may please be discharged from the 2nd opposite party Hospital and referred to Lakeshore Hospital, Ernakulam, for a second opinion and since the patient was stable and fit to travel unlike on 03-03-07,when they had requested the patient to be referred to Trivandrum, Opposite party 1 immediately obliged, and a detailed discharge summary of all the treatments the patient had received from the 2nd opposite party Hospital in the last 4 days and a reference letter was issued, and
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that the patient was shifted by Ambulance on 07-03-07 to Lakeshore Hospital, Cochin. Nothing has been brought out in cross examination to discredit the above version given by the treating doctor. This evidence is amply corroborated by the evidence of DW2 , expert witness and Ext X1 and X2 the medical literature referred by the expert witness.
The first and farmost allegation of the complainant is that the liver biopsy done to him was un-necessary and unwarranted and he was referred to the opposite party 2 hospital for the purpose of conducting endoscopy alone. It is contended by opposite party saying that the patient was referred by Dr.Pankajakshan for obtaining an expert opinion about the cause of jaundice and for further Management. PW1 in Cross examination itself admitted that he was treated for 12 days in the Upasana Hospital by Dr.Pankajakshan. Though blood test, urine test etc. were done there was no cure to the jaundice. Hence referred to OP doctor. “ The reason for jaundice could not be traced by 12 days treatment hence referred to OP Hospital” and admitted therein. Dr. Pankajakshan who was examined as DW3 also deposed that the patient was not referred for endoscopy alone but for further evaluation and management in the
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opposite party hospital. Now the complainant would vigorously try to allege that the patient need not have been subjected to liver biopsy but only for endoscopy, whereas it has now come in evidence that the patient was not referred for endoscopy alone but for further evaluation and Management in the OP Hospital.
Further it is alleged that the opposite party has done the liver biopsy unnecessarily instead of endoscopy. So also it was not appropriated to inflict any wound on any part of body as he was having high level of bilirubin content . In this regard the OP would content that the cause of jaundice had already been partly evaluated at Upasana Hospital by means of various investigations including Hbs Ag, anti Hcv and IgMHAB. They all are found negative. Thus none of the available results gave a proper explanation for his jaundice. The investigation of choice to identify extra hepatic cholestasis is ultrasound scan and to identify intra hepatic cholestasis is liver biopsy. So OP doctor advised the patient have to do an ultra sound investigation from the Travancore diagnostics, Kollam as the previous one taken at the Upasana Hospital is not obvious and indicative. Accordingly on 03.03.2007 ultrasound
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scan was repeated at the Trivandrum Diagnostics, Kollam. But even as per this report there was no evidence of extra Hepatic cholestasis. When blood report did not reveal a cause for intra hepatic cholestasis, the next investigation choice is medical work up by means of a liver biopsy only. This matter was explained to the patient and his wife and it was done as per their consent. The ultrasound result of Trivandrum Diagnostic centre, Kollam is incorporated in page No. 5 & 6 of the Ext.D1 case sheet. The conclusion is “fatty infiltration of liver. No evidence of intra or extra hepatic bilary radicals dilatation”. These being the fact it is evident that even the repeated ultrasound scans done at the Trivandrum Diagnostic centre was not helpful to find out the actual cause of jaundice. Hence the next option is none other than liver biopsy. This fact is confirmed by the DW2 expert witness also while he was in box. “ When lab reports and scans report does not give specific diagnosis, what will be the next choice of investigation? Liver biopsy is the next choice of investigation. Is there any other known invasive investigation as substitute for liver biopsy in the given circumstances? A liver biopsy helps to clinch the diagnosis. Tissue diagnosis is the appropriate method of deriving a proper diagnosis”. The expert witness while in box also referred Ext.X1 , Text Book of Diseases of Liver and
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Biopsy system by Shella Sherlock- Chapter 12, Page No.212, wherein the needle liver biopsy is mentioned. It says that “ acute jaundice rarely merits liver biopsy, which is reserved for the patient who present diagnostic difficulties and where an intra hepatic cause is suspected “. So the evidence of the expert witness coupled with Ext.X1 medical literature would sufficiently support the contention that liver biopsy was necessitated in this patient since no previous investigation would help to diagnose the actual cause of jaundice. The further allegation in this regard by the complainant is that since his bilirubin content was high at that time, it was inappropriate to inflict any wound on his part. Actually there was no such comment or observation on the part of the patient. On the other hand he was also convinced that to find out his actual cause of ailment the next investigation procedure is none other than liver biopsy. The fact that the patient was fully convinced of the situation and he had given consent for liver biopsy is evident from page No.1 of the case sheet. This “consent” for liver biopsy was signed by the patient as well as his wife Shyla PW2. Both of them admitted this fact in cross examination also. They have no case or allegation that the liver biopsy was done by the doctor without their consent or knowledge. Further the elevation of bilirubin, however high is never a contra
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indication for doing liver biopsy. This fact was also testified by DW2 expert witness in his examination. “High Bilirubin is a contraindication for doing liver biopsy ? No. Deep jaundice is not a contra indication”. The witness referred Ext X1 (Page No.212) to substantiate his opinion. A specific question was asked to the expert witness about the contra indications of the liver biopsy. He answered “ abnormal coagulation profile, vascular lesion of liver, massive ascites, uncooperative patients. Whether the patient shows any of these contra indications at time of liver biopsy? No. The above evidence rendered by DW2 and Ext.X1 literature would nullify and rule out the apprehension of the complainant that high bilirubin was a contra indication for liver biopsy”.
Further it is argued by the learned counsel appearing for the complainant that the 1st opposite party is not duly experienced to conduct liver biopsy on the complainant on 3-3-07. It is pertinent to note that the complainant here in has no case either in his complaint or affidavit that 1st opposite party doctor is not a qualified surgeon who performs liver biopsy. There is no such pleading at any point of time. DW1 has sworn before this Forum by way of affidavit “ I am a qualified surgical Gastroenterologist having 7 years of unblemished
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professional experience to my credit in this “ specialty”. After passing MBBS Degree from Government Medical College, Trivandrum, in 1992 I have done my post Graduation in General Surgery (MS) at Government Medical College, Calicut in 1996. I passed Dip. NB(general Surgery ) from the Diplomat of National Board, New Delhi, in 1997 and then I took FRCS from Royal College of physicians and Surgeons of Glasgow,UK, in 1998. Then I have obtained Super Specialty Degree of M.Ch in Surgical Gastroenterology from Government Medical College, Trivandrum, in 2002. I have also published two scientific papers in the field of Surgical Gastroenterology and presented other 16 scientific papers at various National conferences. I am the recipient of National Award for Best scientific paper in Surgical Gastroenterology for the year 2001. I had been worked as Lecturer in Surgery at the Government Medical College, Calicut, for 3 ½ years and Six months as specialist in Gastrointestinal surgery at Amrita institute of medical science. For the last seven years, I have been working as consultant Gastroenterology surgeon at Bishop Benziger Hospital, Kollam”. These being the facts it cannot be said that the 1st opposite party doctor was not duly experienced to conduct a liver biopsy as on 3.3.2007. DW2 expert doctor also opined that the 1st opposite party doctor has observed all the necessary
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standard precautions while doing this liver biopsy and he cannot attribute any negligence of the treating doctor.
Further it is argued by the learned counsel appearing for the complainant that the opposite party 1 committed carelessness and negligence in conducting the Liver Biopsy on the complainant due to his lack of experience and expertise. According to opposite party 1 the procedure was done by him in the ICU under close monitoring. The site of puncture was first marked and depth of penetration was assessed by a screening ultrasound by him in the Diagnostic Unit of 2nd opposite party Hospital as part of preparation and planning for the procedure of liver biopsy. The patient was then shifted to the Gastro ICU at about 4 PM on 03/03/2007. The procedure of liver biopsy was done with the automatic spring loaded disposable liver biopsy needle (Bard Max Core Disposable biopsy instrument size 18GX16 cm length and penetration depth 22mm) following all standard and aseptic precautions, with extreme caution and care through the site marked. The procedure went on uneventfully and he left the ICU 1 hour later after ensuring that there was no immediate problem. Before leaving the ICU, he gave instructions to the nurses on duty to closely
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monitor the vital signs of the patient. The procedure of liver biopsy done by the opposite party doctor was properly explained in Ext.D1 case sheet. When DW2 expert witness was in box , Ext.D1 case sheet was given to him for perusal followed by question “Do you feel that the opposite party has observed all necessary standard precautions while doing this liver biopsy? “Yes”. He also answered to a specific question. “On perusal of Ext.D1 case sheet do you find any element of negligence on the part of the opposite party doctor at any point of time? “I don’t find any negligence”. The complainant in this case has no case that the procedure of liver biopsy done by the opposite party is apparently wrong. Though DW1 & 2 was cross examined, nothing has been elicited to prove that the procedure is wrong or some other procedure is available. The complainant has not adduced any expert evidence by examining any other doctor of the relevant field to assume that the procedure of liver biopsy done by the doctor was negligent or improper. The complainant in this case is presuming negligence for the mere fact that there was oozing of blood after the liver biopsy. It should be noted that the liver biopsy procedure was done with automatic spring loaded liver biopsy needle with all precautions. The procedure went uneventful and the patient was shifted to ICU. At around
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6.20 pm it was noticed in the ICU that there was sudden fall in the blood pressure of the patient. Immediately IV fluids were infused and the matter was informed to the treating doctor. He immediately rushed to ICU and examined the patient. Fluid resuscitation was continued along with bladder catheterization and central venous canalization was done for more accurate monitoring. By 9.15 p.m. an emergency bedside screening USG was done by 1st OP doctor in the ICU itself which conformed blood in the free peritoneal cavity. Thus it was inferred that there was bleeding from the site of liver biopsy. The matter was informed to the relatives of the patient about the need of blood transfusion. However for the time being few units of blood was arranged from the blood bank of the Hospital and after some time emergency laprotomy was done. In such circumstances it is only probable for the complainant to suspect negligence on the part of the doctor in conducting the liver biopsy procedure. Simply because bleeding was occurred from the liver puncture site, doesn’t mean that the procedure was done wrongly or negligently. Though it is rare, it is an accepted complication. When DW2 expert witness was examined, he also opined like way. He is presently the Asst. Prof. and HOD of the Gastroenterology department in MCH, Trivandrum. As a gastroenterology surgeon specific
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questions were put to him Q. “How commonly you get bleeding after liver biopsy? A. “Bleeding after liver biopsy is rare. Then all precautions are to be taken. One in Thousand can have bleeding after liver biopsy”. The witness also referred chapter 3 of Ext. X2 text book page No.40 and 41 , where the percentage of bleeding after liver biopsy is shown as 0.11% to 0.24%, i.e.2 per 1000. Dw2 also opined that even if the procedure is done by a qualified and competent doctor with due care and caution still there is a chance of bleeding after liver biopsy . If that is so, it cannot be attributed as negligence on the treating doctor. The above evidence of the DW2 expert witness supported by Ext.X2 medical literature would go to show that the oozing of blood from the liver site after the liver biopsy does not indicate that it is due to the negligent modus operandi of liver biopsy but it is a rare and accepted complication.
Further it is argued by the Learned counsel appearing for the complainant that what was the cause for accumulating 4 liters of blood in the peritoneal cavity of the complainant after undergoing Liver Biopsy? . It is in evidence that the liver biopsy procedure was done on 4 P.M and after that the patient was shifted to ICU for monitoring. BP fall was noticed at the first time in
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ICU at 6.20 p.m. After the immediate available treatment at about 9.15 p.m. emergency bedside USG was done which conformed blood in the peritoneal cavity. Only at that time it was conformed that there was bleeding from the site of liver biopsy into the abdominal cavity. Immediately the patient’s relatives were consulted about the need for an emergency laprotomy and also the blood transfusion. The patient was prepared and shifted to the operation theatre at about 10.45 p.m Laprotomy was lasted for 2 hours 30 minutes starting from 11 p.m. On opening up the abdomen, the peritoneal cavity was containing 4 liters of fresh blood. The bleeding point of the liver was then identified which was brought under control. The above sequence of the events would go to show the
cause for accumulating 4 liters of blood in the peritoneal cavity of the patient is after liver biopsy. It goes without saying that the procedure of laprotomy is indicated and is required to be done only after the conformation of collection of blood in the peritoneal cavity. After liver biopsy at 4.p.m it was started to oozing and controlled at 11 p.m. and laprotomy was done. Till this time there was collection of blood. However on laprotomy the bleeding site was controlled. The lost blood was replaced with transfusion of whole blood and plasma. Even
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before getting the blood donated by the patient’s relatives, the OP doctor started transfusion with the available blood from the blood bank in the hospital. The volume of blood accumulated in the peritoneal cavity has nothing to do with the extent of liver injury. Any amount of blood can continue to flow even from this small puncture on the liver if it continues to bleed and if it not controlled promptly.
The next question to be considered is whether it is the result of conducting unnecessary, improper and untimely liver biopsy on the complainant he had to undergo treatments in various Hospitals incurring heavy financial loss and suffering mental agony and other hardships and inconveriences? It is argued by the learned counsel appearing far 1st opposite party that It is the wrong notion of the complainant that he had to undergo further treatment in various hospitals because of the untimely and unnecessary liver biopsy. As stated earlier after the liver biopsy there was bleeding on the same day which was controlled by means of laprotomy on the same night. Along with laprotomy blood transfusion was also done. On the next day morning i.e. on 04.03.2007 the patient was extubated, haemodynamically stable and out of danger. The
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patient was monitored in the remaining 2 days. On 06.03.2007 the relatives of the patient wanted to take the patient to Lakeshore Hospital for 2nd opinion. Since the patient was fit for travel by that time the patient was shifted by ambulance on 07-03-2007 to Lakeshore Hospital. A detailed reference letter was also given to the patient. At the time of reference to Lakeshore Hospital, that patient was fully relived from the complication of bleeding followed by liver biopsy. The bleeding was identified and controlled on the same night. But inspite of that the original disease status of the patient remains non diagnosed and hence the patient was referred to a major center for “2nd opinion” at their request. It is further learnt that the patient was again treated in Cosmopolitan Hospital, Trivandurm for his treatment of jaundice on 24.04.2007. That means the patient continued his treatment in the two major centers for the treatment of his basic ailments of jaundice. None of the treatment that he subsequently received at the Lakeshore Hospital and the Cosmopolitan Hospital were related to liver biopsy but for his original ailment of jaundice.This fact was fortified by the evidence of DW2 . Q. “ Since the complication of liver biopsy test was managed successfully then and there at OP Hospital, the patient was taken to another major center not for any further Management of complication of liver
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biopsy but for the treatment of the primary problem of undiagnosed jaundice”. A. “I agree”. As per Ext.P6 discharge summary from the Cosmopolitan Hospital it is seen that the patient was admitted with his jaundice and generalized itching all over the body. DW2 expert witness was specifically asked about this thing. Q.”Do you think that the clinical problem of itching and skin rahes which the patient now alleged could be due to surgery and blood transfusion done as early as in 2007? A. “No”. Both DW1 and DW2 opined that the patient was referred to Lakeshore Hospital for his preliminary problem of undiagnosed jaundice. All problems that available subsequent to the complication of hemorrhage following liver biopsy was promptly tackled and settled by the time he left the Benziger Hospital. The complainant underwent treatment at various other hospitals after discharge from OP hospital is to identify the primary problem of cause for jaundice. It is also pertinent to note that the complainant has neither produced any evidence nor examined any doctor from Lakeshore or Cosmopolitan Hospital to prove that they have treated the patient for any subsequent complication arising out of the liver biopsy. Therefore the allegation that the complainant has undergone treatment
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in various hospitals and suffered heavy financial loss and mental agony due to the improper liver biopsy cannot be believed.
Admittedly the patient in this case was under the initial treatment of Govt. Hospital,Karunagappally as per Ext.P1. Then he was referred to another Hospital for Gastroenterological consultaion. But patient went to Upasana Hospital and under the treatment of Dr.Pankajakshan, a senior physician, who is his relative also. Though he was investigated and treated for about 12 days nothing was diagnosed and hence Dr. Pankajakshan referred to 1st OP doctor, who is a Gastroenterologist for expert opinion and Management. The patient was particularly referred for specific diagnosis and for further Management. On reaching the OP Hospital, he also carried the Ultrasound and other routine investigations done at Upasana Hospital. On seeing such investigation nothing would be elicited since the previous ultrasound itself was not clear and conclusive. Thus after explaining the importance of repeating USG the patient was advised to get a fresh ultrasound from the Travancore diagnosis Pvt. Ltd. The patient without any protest repeated the USG. But there was no evidence of extra hepatic cholestasis. When the blood report did not reveal cause for intra
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hepatic cholestasis, the next investigation choice in the medical work up of a patient with jaundice is liver biopsy. After appraising the need for liver biopsy the patient has undergone liver biopsy test. But unfortunately after liver biopsy there was unexpected bleeding which is an accepted complication though it was rare. Whatever may be the complication was managed on the same night by conducting laprotomy and arrested the bleeding. Sufficient blood transfusion was also done to make good the lost blood. After that the patient was normal and completely relieved from the complication of bleeding from liver biopsy. Inspite of that the patient’s relatives wanted to have reference to higher center for 2nd opinion. The patient was referred to Lakeshore Hospital on the 3rd day in an ambulance and nurse supplied by OP hospital. As long as the patient was in OP Hospital all required treatment was given and there is no negligence or insufficient treatment on the part of the OP. Even DW2 admitted that “ If there is any delay in conducting laprotomy and arresting the bleeding the results would have been fatal and outcome may lead to death. So the emergency laprotomy was done as a life saving measure”.
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It is the basic principle of law that the allegation of negligence must be proved by the complainant with convincing and cogent evidence more particularly with expert evidence. Admittedly apart from the interested testimony of the complainant no expert evidence was adduced by the complainant and thereby discharged his burden. Not even any medical literature or authorities on the subject has been produced by the complainant to substantiate the allegation. Even as per the latest decision of Hon. National Commission has reported in 2010 (3) CPR 223 (NC) it has been held that mere allegation regarding medical negligence is not sufficient. The patient has undergone some sufferings but they by itself could not justify allegation of deficiency of service by doctor.
In the result, the complaint is dismissed but without costs.
Dated this the 30th day of March, 2013.
G. VASANTHAKUMARI-Sd/-
Adv.RAVI SUSHA-Sd/-
Forwarded by Order
Senior Superintendent
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APPENDIX
Witness of the Complainant
PW1- Sudharsana Babu
PW2- Smt. Shyla
Documents of the Complainant
Exbt.P1- OP Ticket
Exbt. P2- Form of essentiality Certificate
Exbt.P3- Form of Essentiality Certificate
Exbt.P4-Clinical Recorded form.
Exbt.P5-Form of Essentiality Certificate
Exbt.P6- Discharge Summary
Exbt.P7-Form of Essentiality Cerficate
Exbt. P8- Lawyer Notice
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Exbt. P9- Medical Certificate
Witness of the Opposite party
DW1- Dr. Joshy John
DW2- Dr. P.Bonny Nadesh
DW3- Dr. Pankajakshan
Documents of the opposite party
Exbts.-D-1 Series-Duty Registar
Court Exbts
Exbt.X1- Medical Records
Exbt.X2- Medical Records
