Tamil Nadu

StateCommission

CC/117/2013

A. Anbalagan - Complainant(s)

Versus

Dr. Kalavalli, M/s. K.V. Hospital & 4 Ors. - Opp.Party(s)

Vasugi Ramanan

15 Dec 2021

ORDER

IN THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI

BEFORE       Hon’ble Thiru Justice R. SUBBIAH                   PRESIDENT

                   Tmt. Dr. S.M.LATHA MAHESWARI                     MEMBER

 

CC.NO. 117/2013

 DATED THIS THE 15^th DAY OF DECEMBER 2021

A. Anbalagan

S/o. Ayyasamy

67A, Mitta Nulahalli Village & Post

Annasagaram Via

Dharmapuri – 636 704                                                         ....Complainant

 

                                                  Vs 

1.       Dr. Kalavalli, M.B.B.S., D.G.O.,

W/o. Dr. Elagovan

M/s. K.V.Hospital

107, Nethaji by Pass Road

Dharmapuri – 636 705

 

2.       Dr. Elangovan

M/s. K.V. Hospital

107, Nethaji by Pass Road

Dharmapuri – 636 705

 

3.       Dr. E. Mohan Senthil, M.S., M.ch., (Urology)

M/s. K.V.Hospital

 

4.       The Administrative Officer

Sri Gokulam Hospital

3/60, Meyyanur Road

Salem – 636 004

 

5.       Dr. J. Murali, DNB (Surg. Gastro) FMAS

Sri Gokulam Hospital

3/60, Meyyanur Road

Salem – 636 004                                               ....Opposite parties

 

Counsel for complainant                               :   M/s Vasugi Ramanan

Counsel for Opposite parties 1 to 3                :  M/s.K. Ganesan

Counsel for 4^th Opposite party                       :  M/s. K.T.Rajan

Counsel for 5^th Opposite party                       :  M/s. AAV Partners

 

                This complaint coming before us for hearing finally on 3.11.2021 and on hearing the arguments of counsel appearing on bothsides, and upon perusing the material records this Commission made the following order:

ORDER

Justice R. SUBBIAH,  PRESIDENT   

1.       This complaint has been filed under Sec.17 of Consumer Protection Act 1986, against the opposite parties claiming a sum of Rs.30,00,000/- towards  compensation for wrongful operation, Rs.5,00,000/- compensation for mental agony,   alongwith cost of Rs.20,000/-.

 

2.       The case of the complainant in brief is as follows:

          The complainant is a resident of Mitta Nullahalli Village in Dharmapuri District.  He is an agriculturist.  His wife Manimegalai aged about 37 years was suffering from uterine bleeding.  Hence she came for consultation to the 1^st opposite party.  Upon examining her, the 1^st opposite party suggested that the bleeding could be stopped only by removing the uterus and pressurized the complainant’s wife to undergo an operation at the 1^st opposite party hospital, where the 1^st opposite party’s son viz. the 3^rd opposite party is a partner and the 2^nd opposite party is the proprietor, who is the husband of the 1^st opposite party.  The 1^st opposite party Dr. Kalavalli had also fixed the date of operation, which was performed by her son/ 3^rd opposite party.  The 3^rd opposite party is an urologist and not a specialist in obstetrics and gynecology.  The complainant paid Rs.1 lakh for surgery to 2^nd opposite party.   The complainant’s wife was forced to agree for the removal of the uterus and they did so on the fond hope that uterine bleeding can be stopped permanently if the uterus is removed.      To their shock, even after the operation the bleeding didn’t stop and the abdomen got bulged and the complainant’s wife suffered breathlessness.  Since the health condition of the complainant’s wife deteriorated further, the 3^rd opposite party fearing the worst had referred her for further care, and he himself took her to Sri Gokulam Hospital at Salem/4^th opposite party and admitted her on 1.3.2012.  On admitting the complainant’s wife at the 4^th opposite party’s hospital, the doctors therein diagnosed it as “Abdominal Hysterectomy for DUB/Ileal perforation with peritonitis and Sepsis”, which is nothing but causing perforation in the ileal (the lower part of the small intestine, located beyond the duodenum and jejunum, just before the large intestine) which lead to sepsis (Sepsis is the systemic inflammatory response, infection and the presence of organ dysfunction and perforation).  After examination, the 5^th opposite party insisted on corrective surgery immediately to close the perforation made by the 3^rd opposite party.  The complainant was so desperate to save his wife, that he agreed for the corrective surgery procedure i.e., “Exploratory and Laparotomy and perforation closure the peritoneal lavage” was done on 2.3.2012 treating the patient with IV fluids and other medicines.  The patient was checked by the doctors of 5^th opposite party and the  4^th opposite party had charged heavily for the operation but the patient collapsed because of the failure in taking right procedure.  At about 3.30 pm on 3.3.2012 the 4^th opposite party’s doctors informed that the complainant’s wife went on ventricular tachycardia and by 3.45 pm they informed the complainant that his wife was dead.  Though the complainant’s wife died on the previous night itself, the doctors of the 4^th opposite party had not informed the same. On the next day afternoon after some high drama   the patient was declared only with a sole motive to extract money from the complainant.  1^st to 3^rd opposite parties hospital lacked all necessary infrastructure essential for surgery and the hospital was in a bad condition and the sanitary conditions were worse, therefore the patients were more prone to secondary infection.  In fact there was no need for a surgery to correct DUB (Dysfunctional Uterine Bleeding).  The 2^nd opposite party in order to enrich themselves decided to perform operation.  The 3^rd opposite party performed operation so negligently and caused perforation of ileum with peritonitis and sepsis.  The deceased was only 37 years old and she had only one son.  The 3^rd opposite party performed abdominal hysterectomy.  But he is not qualified to perform abdominal hysterectomy.  Hence there was negligence on the part of the opposite parties in performing surgery.  The complainant had issued legal notice to the opposite parties.  Even after receipt  of the notice, the opposite parties have not sent any reply.  Hence the complaint is filed praying for a direction to the opposite parties to pay a sum of Rs.30,00,000/- as compensation for wrongful operation, alongwith compensation of Rs.5,00,000/- for mental agony and a sum of Rs.20000/- towards cost.

 

3.       By filing common version, the opposite parties 1 to 3 have resisted the complaint as follows:

          In their version, before traversing the allegations made in the complaint, the opposite parties 1 to 3 had explained the medical terms and terminologies in detail upto 20 pages.  However we are not extracting the same here and we are dealing with the reply made to the allegations in the complaint. 

          The complainant’s wife Manimegalai was a known diabetic for the past 7 years who had excess bleeding per vagina for the past six months hence came to the 1^st opposite party, who is the gynaecologist.     She came to the 1^st opposite party on 27.2.2012 with the complaints of Leucorrhoea i.e. a thick whitish or yellowish vaginal discharge.  Therefore the 1^st opposite party had decided to remove the uterus which is in medical terms known as Hysterectomy.  Hysterectomy is the surgical removal of the uterus ad if done via abdomen it is called abdominal hysterectomy where the total uterus is removed it is called total abdominal hysterectomy (TAH).  It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures.  Salpingo-ophorectomy is the surgical removal of a fallopian tube and an ovary.  If both sets of fallopian tubes and ovaries are removed, the procedure is called a bilateral salpingo-oophorectomy.  After all laboratory tests were over, when the patient was found surgically and anaesthetically fit to undergo the procedure with the patient having consented for the procedure, she was prepared to the operating room with all necessary skin preparations and with IV canula inserted with IV fluids on flow was taken to the operating room on 27.2.2012 at about 1.30 pm.   Spinal anesthesia was also administered.  As the patient was euglycemic and other parameters were normal where the situation requiring immediate surgical intervention, the patient was taken to the operation theatre and under spinal anaesthesia administered by Dr.N.Seethapathy who is a qualified anaesthesiologist, the procedure namely abdominal hysterectomy with bilateral salphingo oophrectomy was done in the usual way.  After obtaining perfect haemostasis abdomen was closed in layers. The surgery was done by the 1^st opposite party assisted by the 3^rd opposite party.  The procedure was uneventful where the patient withstood the procedure and tolerated the same.  As the patient was a known diabetic, she was transferred to the ward in the evening and the surgery was over in between 1.30 to 3.00 pm on 27.2.2012 and was moved to the ward at 8.00 pm.  The necessary post operative instructions including the hourly monitoring of blood sugar and other things were properly ordered and the patient received all necessary care as required to be given for a post operative patient.  On the first post operative day, the patient’s general conditions were fine, but her blood sugar level slightly elevated and she was administered with insulin.   On the second post operative day, the status of the patient was stable, except she had a spike of fever on 29^th day of February 2012, and at 10 pm on the same day, blood sugar controlled.  Higher antibiotic was administered due to the fluctuating glucose level.  On 1.3.2012, at 12.00 am, the patient was seen by surgeon Dr.Muthu and it was suspected that the patient may have some other surgical problem caused due to pancreatitis etc., after which it was seen by the said doctor who also advised to look for serum electrolytes urine for ketones to rule out diabetic keto-acidosis or to rule out ketonuria and also advised insertion of orally Ryles tube with hourly aspiration.  As the patient became dyspnoea at 5.00 pm and 6.00 pm on 1.3.2012, O₂ started but her cell count reduced to 88000 and as the patient had previous fever history the physician opinion was obtained whose diagnosis was “Dengue fever? Pneumonitis? Viral Pheumonitis?”  and advised to referral to higher centre for further treatment and as per the choice of the patient’s husband and relatives she was referred to Sri Gokulam Hospital, Salem for further management. 

          As per his advise the patient was discharged and referred to Sri Gokulam Hospital, Salem on 1.3.2012 at about 8.00 p.m, with the discharge summary notes and other relevant records. Thus timely referral was made from the 1 to 3 opposite parties hospital at the instance of the experts to prevent further harm and better management.  Absolutely, there is no deficiency in service on the part of the opposite parties.  The patient was having DUB, where the treatment of choice as accepted by standard medical books being surgical correction the standard procedure of surgical treatment was given to the patient by the 3^rd opposite party for the purpose of surgery.  Thus they prayed for dismissal of the complaint. 

 

 4.      In their version, the 4^th opposite party had stated as follows:

          On 1.3.2012, the patient Mrs. Manimegalai, 37 years old, was admitted into the 4^th opposite party hospital with the complaint of acute breathlessness and abdominal distention.  The patient had the past history of having undergone abdominal hysterectomy 4 days ago at K.V.Hospital, Dharmapuri.  The patient was examined by Dr.Senthil Kumaran.  On examination the patient was conscious, oriented, febrile (103^oF) and dehydrated.  A clinical diagnosis of septicemia was made.  Dr.Senthil Kumaran had explained the critical state of the patient to the relatives at that point of time.  Patient was resuscitated and simultaneously investigations like haemogram with PS, RBS, urea, creatinine, electrolytes, ABG, lft, ECG, blood investigation and chest x-ray beside were done. The patient was connected to ventilator because of increasing breathlessness. The ultrasound abdomen was done and USG  abdomen revealed ascites, right pleural effusion and omental oedema.  CT abdomen revealed gross pneumoperitoneum.  The patient was diagnosed to have hollow viscus perforation with peritonitis and sepsis status post abdominal hysterectomy.  Expert opinion was obtained from Dr.P.Chellammal MD DGO (obs & Gync)., Dr.V.Karthikeyan M.D.(Gen)., and Dr.J. Murali MS, DNB (Surg. Gastro) FMAS.  On 2.3.2012 exploratory laparotomy, perforation closure and peritoneal lavage were done under general anesthesia and epidural by 5^th opposite party, assisted by the anesthesiologist Dr.Shankar.  The patient was treated with IV fluids inj.Meropenem, inj. Amikacin, inj.Metrogy, inj.Mgso4, inj.Panocid, inj.Lasix, Epidural infusion, inj. Midaz and inotropic supports were given.  On 3.3.2012 the patient continued to be hypotensive requiring vasopressor support which worsened by afternoon.  The patient was periodically seen by Dr.Murai .J, Dr.Senthilkumaran and Dr.V.Karthikeyan.  On 3.3.2012 at 3.30 pm, the patient had ventricular tachycardia.  Immediately CPR started according to ACLS guidelines.  After active CPR for 15 minutes according to ACLS guidelines the patient could not be revived.  ECG showed straight line.  On 3.3.2012 at 3.45 pm the patient was declared dead and the cause of death was perforation peritonitis and septicemia.  It is false to state that the patient collapsed due to the failure in taking right procedure and had been charged heavily. Those allegations were made by the complainant only to extract money from the 4^th opposite party.  The patient’s relatives were clearly informed about the procedure and the high risk involved in the procedure in detail.  After obtaining informed consent from the patient’s relative the procedure was carried out.  The procedure carried out was medically accepted one.  At the time of admission the patient was breathless.  Her respiratory rate was 38/minute however the normal respiratory rate was around 16/minute.  Her heart rate was 156/minute, which is very high.  The patient had high temperature of 103^o. Dr. Senthikumaran, the emergency physician had examined the patient and had explained the critical state of the patient to the relatives.  After explaining the patient was connected to ventilator, since she was breathless Dr.J.Murali was called to see the patient on 2.3.2012.  On examination the patient he made a clinical diagnosis of peritonitis and sepsis which was confirmed by CT scan.  The patient’s relatives viz. her brother and son were informed in detail about the critical condition of the patient and need for a life saving surgery, which includes opening the abdomen and removal of pus with closure of intestinal rent.  The informed written consent was obtained in tamil.

          At the time of surgery, there was rent in the distal ileum with pus and intestinal contents in the abdominal cavity.  Thorough wash was given and rent closed as per standard care.  The patient was given broad spectrum abtibiotics of highest coverage to take care of the infection.  After the surgery, the patient continued to be on ventilator because of severe sepsis.  Her BP was low, which required additional medicinal support (Vasopressors).  The condition of the patient was explained at regular intervals to the patient’s relatives.  The allegation that the relatives of the patient was not informed is bald and without any iota of proof.

 On 3.3.2012 the condition of the patient still remained critical with gross metabolic acidosis and hypotension requiring vasopressor.  The condition was again explained to the relatives.  By afternoon the patient’s BP started dropping further and inspite of all the efforts by the opposite parties the patient could not be revived and was declared dead at 3.45 pm on 3.3.2012.  The cause of death was perforation peritonitis and septicaemia.  The allegation that the patient died on 2.3.2012 night itself and they were informed only on 3.3.2012 is totally baseless since the medical records shows clear documentation of the patient’s condition from time to time.  Therefore, there is no negligence on the part of this opposite party, and sought for dismissal of the complaint.   

 

5.       The 5^th opposite party is the doctor, who has filed a detailed counter in consonance with the version filed by the 4^th opposite party.

 

6.       In order to prove the claim on the side of the parties, proof affidavits were filed, documents filed by the complainant were marked as Ex.A1 to A13 and documents filed by the opposite parties 1 to 3 were marked as Ex.B1 to B14 and by the opposite parties 4 & 5 were marked as Ex.B15 to B17.

 

7.       By way of filing petition praying to cross examine the 5^th opposite party by the complainant, the 5^th opposite party / Dr.J. Murali was cross examined by way of filing questioner, for which reply has been filed by the 5^th opposite party. 

 

8.       We have carefully appreciated the facts involved in this matter, on evaluating the submissions of the parties, and on perusal of the material records placed before us.

 

9.       The learned counsel for the complainant submitted that the complainant’s wife was suffering from uterine bleeding.  Hence he consulted the 1^st opposite party.  Upon examining her the 1^st opposite party suggested that the bleeding could be stopped only by removing the uterus.  Normally the removing of uterus will arise only if there is a symptom of cancer.  But in the instant case, even as per the statement in the version, there is no symptom of cancer.  Under such circumstances, the 1^st opposite party ought to have attempted for non-surgical treatment to cure the patient before venturing surgery.  In most of the cases DUB can be treated medically.   The surgical measures should be reserved for a situation when medical therapy has failed or any contra indicated.  In this regard the learned counsel for the complainant also  argued in detail about various medical therapy for treating DUB.

  D&C is an appropriate diagnostic step in a patient who fails to respond to hormonal management. 

The addition of hysteroscopy will air in the treatment of endometrial polyps or the performance of directed uterine biopsies.

 As a rule, apply D&C rarely for therapeutic use in DUB because it has not been shown to be very efficacious. 

Abdominal or vaginal hysterectomy might be necessary in patients who have failed or declined hormonal therapy, have symptomatic anemia, and who experience a disruption in their quality of life from persistent, unscheduled bleeding.

Endometrial ablation is an alternative for those who wish to avoid hysterectomy or who are not candidates for major surgery.

          But without resorting to the medical therapy, the complainant was forced to agree for the removal of the uterus.  The opposite parties 1 to 3 did so on the fond hope that uterine bleeding can be stopped permanently if the uterus is removed. But even after the operation, the bleeding did not stop.  On the other hand the abdomen got bulged and the complainant’s wife suffered breathlessness.  Therefore, they have referred the patient to a higher institution viz. 4^th opposite party hospital, and she was admitted there.  In fact in the proof affidavit filed, the 1^st opposite party had admitted that the patient was having DUB with Pelvic inflammatory disease PID and was suffering from high BP during the time of admission.  The proof affidavit of the 1^st opposite party and the medical records would clearly show that she had been treated for Pelvic Infection which is not correct, because before treating in a surgical procedure, infections have to be removed.  The opposite party has not taken any steps to resolve pelvic Leukorrhea as admitted in their proof affidavit.  Even in the version, they have admitted that the patient was having the history of diabetic.  When the patient was having the history of a diabetic, they ought not to have attempted for surgery when other theraphies are available.  Had the patient and the complainant been informed about the consequences of the surgical proceedings, they might not have opted for surgery.  They would have opted for the non-surgical method like medical therapy way, further more there is no informed consent for removal of organ. 

          The learned counsel for the complainant also would submit that whenever a patient comes for treatment, it is mandatory on the part of the doctors to record the family history and patient history.  In the instant case, the family history was not recorded.  When the patient was admitted with the 4th opposite party, they diagnosed a hollow viscus perforation with peritonitis and sepsis status post abdominal hysterectomy, which is nothing but causing perforation in the ileum.  Therefore, the 5^th opposite party insisted for a corrective surgery.   Inspite of that on 3.3.2012 at 3.30 pm the patient had ventricular tachycardia and at 3.45 pm it was declared that the patient was dead.  The 1^st to 3^rd opposite party lack infrastructure essential for surgery.  The equipments used for surgery were not properly sterilized, because of which the patients were more prone to infection.  In order to enrich themselves, the surgery was done by the opposite parties negligently.  The 5^th opposite party had stated in his proof affidavit that patient was brought to the 4^th opposite party hospital in a critical condition.  In the cross examination of 5^th opposite party he had clearly stated in his answer for question No.11 that  intestinal perforation means a hole anywhere in the GI tract starting from stomach to rectum, resulting in spillage of contents inside the abdominal cavity.  This leads to infection and inflammatory reaction called peritonitis.  This intestinal perforation was caused by the opposite parties 1 and 2 while performing surgery, which had ultimately taken away the life of the victim.  Thus the learned counsel for the complainant submitted that there is deficiency in service on the part of the opposite parties 1 and 3.   

 

10.     Countering the submissions, the learned counsel for the opposite parties 1 t 3 submitted that there are two types of treatment viz. treating with medicine and other is by intervening procedure, where the treatment is extraction. Medical treatment consists of anti-fibrinolytic tranexamic acid, on-steroidal anti-infammatory drugs, the combined contraception pill, progestrogen, danazon, or analogues of gonadotrophin releasing hormone.  The levonorgestrel releasing intra uterine device is developed for contraception, but is also effective in the treatment of dysfunctional uterine bleeding.     Now it is the contention of the complainant that non use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) as one of the deficiency in treatment, and without resorting to this therapy surgery ought not to have been advanced, for this the opposite parties relying upon the Medical Literature called “Treatment of menorrhagia” submitted that as per the literature where excessive uterine bleeding may be cyclical or non-cyclical, where it has been concluded as “while no one NSAID  shown to be superior to another, where NSAIDs are commonly associated with gastrointestinal (GI) side effects, they are contraindicated in women with peptic ulceration” and have also quoted as “Hysterectomy is perhaps the most definitive treatment for menorrhagia, but it is quite costly.  Therefore, the submission of the learned counsel for complainant that without resorting to the medical therapy the opposite parties 1 to 3 directly resorted hysterectomy has no significance.  It is further submitted that the hysterectomy is a surgical procedure that removes the uterus.  Salphingo-oophorectomy is the removal of fallopian tubes and ovaries.  Reasons for this surgery include abnormal bleeding, uterine prolapsed, fibroids and cancer and the need for choosing surgery procedure has been fully explained in the version.  It is for the medical reasons the patient was referred to 4^th opposite party hospital for medical management, which is evident from the case records submitted by the opposite parties 1 to 3.  Because of the low platelet count and difficulty in breathing the SPO2 was not satisfactory.    But the patient was put on ventilator in the 4^th opposite party hospital.  There is no record to show the reason for putting the patient on ventilator in the 4^th opposite party hospital.  In the case sheet of the patient of opposite parties 4 & 5 it has been stated as  “Perforatial Peritonitis and Septicemia”,  thereby the death is due to perforation and in the case sheet from the moment of admission till the patient was examined by 5^th opposite party there is no mention of perforation.  The case sheet of the 4^th opposite party never states the cause of the alleged bowel injury that happened during the period of stay in the 1^st opposite party hospital.  The bowel injury would have happened when the corrective surgery was done by the opposite parties 4 and 5 hospital also, when there is no material to show that the perforation in the ileum was caused by the opposite parties 1 to 3.  Merely based on some bald allegations, the opposite parties 1 to 3 cannot be blamed with deficiency in service on their part, especially when there is a possibility for perforation in the ileum during the corrective surgery done by the 4^th opposite party hospital.  Thus he submitted that the complainant has miserably failed to establish the deficiency of service on the part of the opposite parties 1 and 3.  Thus there is no deficiency in service on their part. 

 

11.     The counter submissions of the opposite parties 4 and 5 are as follows:

          The patient Mrs.Manimegalai was admitted on 1.3.2012 at 9.30 pm based on a referral letter from KV Hospital, Salem.  The referral letter stated that the patient   underwent a hysterectomy 4 day back, and had developed dyspnea, low platelet count and tachycardia.  Though the referral letter mentioned only the above bare ailments, the patient was actually suffering from kidney failure, septicaemia, need for immediate ventilation, abdominal distension, fever and obstipation.  Hence she was immediately examined by a team of doctors including a gynaecologist, emergency physician, gastroenterologist, anesthetist.  Ultrasound was taken, CT scan taken and was diagnosed with gross peumo peritoneum (free air in the abdomen that signifies injury inside) and suspected bowel injury post abdominal hysterectomy.  A laparotomy procedure was done through incision, 4 litres of free fluid were drained by the 5^th opposite party and the injury/ perforation was located and sutured.  Post – surgery the patient had acidosis and her condition started to deteriorate and resuscitative measures were started at once but the patient did not show response to the treatment and was declared dead.  Cause of the death was due to perforational pneumoperitoneum and septicaemia.  Entire case sheet as seen from Ex.B15, including consent letters from the relatives of the patient and a detailed hand written letter from husband of the patient, categorically establishes the condition of the patient on admission and the prognosis explained by the doctors of the 4^th opposite party hospital.  The overall mortality rate of perforation peritonitis ranges from 6% to 36% depending upon the site and cause of perforation.  Major causes of post-operative morbidity in such patients are respiratory complications such as pneumonia, atelectasis, pleural effusion, wound infection, septicemia and dyselectrolytemia.  Informed consent shows that the patient was brought to the opposite parties 4 and 5 in a critical condition and only in the scan it came to light that the patient had developed pus in the abdomen at the time of referral itself.  The need to remove the pus by a laparotomy procedure and also that dialysis ought to be performed as the kidneys were damaged.  There is only 20-30% chances of survival and even if she survives she will require extended ventilation and hospitalisation which was also explained to the patient’s attenders. As per the CT scan findings as seen in the case sheet, the 5^th opposite party suspected bowel injury.  The 5h opposite party with his team had performed an exploratory laparotomy through incision in the lower midline of the abdomen.  4 litres of frank enteric content (fluid) in the abdomen were drained.  The edges of the hole were sutured.  It is pertinent to note that on draining the free fluid and closing of the hole the 5^th opposite party confirmed the pre-operative findings that the patient had developed distal ileal perforation with peritonitis and sepsis post abdominal hysterectomy.  This was confirmed by the 5^th opposite party/ doctor, while he was cross examined.  The patient was seen by the 5^th opposite party at 7.30 pm., and was found with acidosis.  The patient’s kidneys were damaged when she was admitted in the 4^th opposite party hospital.  The condition of the patient started to deteriorate around 2.45 p.m as she has tachycardia,.  At 3 p.m the patient’s BP was still low  and she was declared dead at 3.45 pm.  The cause of death as opined by the 5^th opposite party is that perforational peritonitis and septicaemia.  It is also further submitted that the perforation was caused by the opposite parties 4 & 5   only to mislead this commission.  The allegation that an “aspiration procedure” was done by the 5^th opposite party is an argument manufactured and introduced by the opposite parties 1 to 3 and at the last minute when they came to understand that the evidence was squarely pointing towards them for having caused the perforation and the said perforation was not diagnosed for 3 days when the patient was under their care.  In the case sheet of the opposite parties 1 to 3 under Ex.B14 at 12 AM on 1.3.2012 there is a noting as “illeous”.  This means that at that point of time itself, the opposite parties 1 to 3 have suspected that the patient had some problem in the ileous, which is in the morning prior to the patient being admitted in the 4^th opposite party hospital at 9.30 pm on 1.3.2012.   Moreover, after the opposite parties 1 to 3 started suspecting a problem in the illeous on 1.3.2012, but they have failed to treat the patient according to their own diagnosis and waited from 27.2.2012 to 1.3.2012 to send the patient to the 4^th opposite party hospital.  Moreover no expert evidence was adduced on the part of the opposite parties 1 to 3 and thus submitted that the complaint has to be dismissed as against these opposite parties. 

 

12.     After analysing the entire submissions made by the counsels, it is clear that the cause for death was  due to perforational peritonoties and septicaemia.  According to opposite parties 4 & 5 the perforation and ileous was caused due to hysterectomy done by the opposite parties 1 to 3. 

          Whereas, according to the opposite parties 1 to 3, the perforation could have been caused when the opposite parties 4 & 5 were conducting exploratory laparotomy and perforation closure i.e., corrective surgery. 

 

13.     For deciding the matter, it has to be analysed to find out as to who has caused the perforation/ bowel injury, and that would suffice to fix the negligence.

14.     The wife of the complainant, who was suffering from uterine bleeding, consulted the 1^st opposite party/ Dr.Kalavalli, at K.V.Hospital who suggested   removing the uterus to stop the bleeding.  As per the direction, the complainant had admitted his wife with the 2^nd opposite party, wherein the husband and son of the 1^st opposite party are doctors viz 2^nd and 3^rd opposite parties.   The date of operation was fixed on 27.2.2012.  When she was admitted in the hospital, she was having pelvic infection.  But the opposite parties 1 to 3 without resorting to the non-surgical methods, compelled the complainant to undergo hysterectomy, and the surgery was done by the 3^rd opposite party, alongwith the 1^st opposite party.  Even after the operation, the bleeding did not stop, and the abdomen got bulged, and the patient suffered breathlessness.  Her health condition started to deteriorate.  Hence on reference, she was sent to Sri Gokulam Hospital at Salem on 1.3.3012.  Till reference was made, the opposite parties 1 to 3 cannot diagnose the actual problem.  But the complainant’s wife was brought to the 4^th opposite party’s hospital in critical condition.  Only in the scan taken by the 4^th opposite party / Gokulam Hospital it came to light that the patient developed pus in the abdomen at the time of admission itself.  On investigation by the 5^th opposite party/Dr.J. Murali, a perforation with peritonitis and sepsis status was found post abdominal hysterectomy.  Since there was a chance of 20-30% for survival, she required ventilation and hospitalisation.  This fact was also informed to the attendees of the patient in detail.  The informed consent was also obtained from the complainant which is evident from Ex.B15.  On examination by the 5^th opposite party it was decided to conduct exploratory laparotomy, perforation closure and peritoneal lavage which is a corrective surgery on 2.3.2012.  The 5^th opposite party had performed an exploratory laparotomy through an incision in the lower midline of the abdomen.  4 litres of frank enteric content (fluid) in the abdomen were drained.  The edges of the hole were sutured. 

          On cross examination of the 5^th opposite party/ Dr.J.Murali, by the complainant by way of serving questionnaire, a question had been put forth to the doctor as follows:

          Q: Did perforation with peritonitis and sepsis occur only after the hysterectomy done at KV hospital?

          Reply:  Yes

          Q: What are the reasons for carrying out this procedure?

          Reply:  Patient was admitted with hollow viscus perforation, peritonitis and septicaemia which is a life threatening condition.  I had to do emergency surgery to evacuate the pus and close the perforation in the intestine (source control) to prevent further infection and thereby attempted to save the life of the patient. 

          Now it is the submission of the opposite parties 1 to 3 that the bowel injury i.e, perforation would have been caused during the course of laparotomy done by the 4^th and 5^th opposite parties. 

          In this connection it is pertinent to see the case record of the opposite parties 1 to 3 as seen from Ex.B14. 

          At the time of hysterectomy operation conducted by the opposite parties 1 to 3 the blood pressure of the patient was 120/80 mm/Hg.  But on the same day the blood sugar started shooting up and went upto 498 mg/dl as per the notings on 1.3.2012 morning 8 am.  Then on administering inj. insulin it started coming down slowly. 

          As seen from Ex.B14, case sheet of opposite parties 1 to 3 on 1.3.2012, at about 5 pm, the pulse rate shot up to 140/mint and the oxygen saturation was also came down to 83.  It is also pertinent to note that it is noted in the case sheet as patient is ‘dyspneic’, which means her condition of breathing was progressively worsening.  It is also noticed that the noting made by the surgeon Dr.Muthu as ‘?ileous’. 

          As seen from the above noting, and as seen from the other parameters of the patient as noted by the opposite parties 1 to 3 it is clear, that the opposite parties have themselves suspected that there was some intestinal obstruction.  Hence safely they have referred the patient to the 4^th opposite party hospital. 

          As seen from the Reply to the questionnaire by way of cross examination of the 5^th opposite party, the doctor had deposed that there was gross pneumo peritoneum i.e, significant free air inside the abdominal cavity outside the intestine were seen in the patient as per the clinical report, and this could have occurred because of perforation of small intestine. 

          The 5^th opposite party doctor is an expert, who performed the operation viz. the corrective surgery in the patient, had opined that there was hole in the small intestine which could have been caused due to the surgery/ hysterectomy done by the opposite parties 1   to 3. 

          After evaluating the above, we are of the considered opinion that while approaching the 1^st opposite party, the patient was not having any intestinal or breathing problem, and she was having only the problem of over bleeding.  Though the opposite parties have produced 14 documents, most of them were the extracts from the medical journals to establish that the procedure they have adopted viz hysterectomy was the correct one.  But they have failed to prove, that whether the hysterectomy done to this patient was correct and essential to be done at that time, and whether all other pre-operative protocols were correctly followed before performing the hysterectomy.  On perusal of the documents we could see nothing materially produced viz. Scan report, blood sugar parameter, etc.,, to hold that the hysterectomy performed was certainly necessary to save the patient. 

          In this juncture, it is pertinent to note the elaborate submissions of the learned counsel for the complainant that there are so many other therapy methods available to treat this DUB, but without resorting to those methods, the opposite parties straightly advised the patient to undergo surgery.  It is not the case of the opposite parties 1 to 3 that the patient was at the beginning stage of malignancy, or there was any benign appearance which was threatening the life of the patient.   The opposite parties 1 to 3 have not given any reason for the excessive bleeding.  These are all clear evidences for the negligence of the opposite parties 1 to 3.  Therefore, we are of the considered opinion that the perforation would have been caused while performing the hysterectomy.

          Though the opposite parties 1 to 3 have made an allegation that the 4^th & 5^th opposite parties might have caused the perforation at the time of laparotomy, which cannot be accepted, since the case sheet produced by the opposite parties 4 and 5 would clearly show the condition of the patient at the time of admission, and the diagnosis of the doctor based on the CT scan.   Since the condition of the patient was worse, the opposite parties 4 and 5 had to resort to the surgical procedure to   correct the flaw done by the opposite parties 1 to 3.   The need for the 2^nd surgery had been perfectly explained by the opposite parties 4 and 5.  Though very many contentions were raised by the opposite parties 1 to 3 against the opposite parties 4 & 5, during the course of arguments, no allegations have been put forth against them in their version.  Therefore, looking at any angle, the evidence on record would show that there is negligence on the part of the opposite parties 1 to 3.    

 

15.     In view of the above, since we hold that there is deficiency in service on the part of the opposite parties 1 to 3, obviously the complainant has to be compensated.

          At the time of death of the patient, she was only 37 years old.   The complainant lost his life companion and his son lost the love and affection of his mother.  Above all, the patient had suffered pain and torture due to the negligent attitude of the opposite parties 1 to 3.  Doctors are portrayed as a representative of God. But the opposite parties 1 to 3 because of their greediness and due to the lethargic attitude, had betrayed the patient, and ultimately made her soul to rest in peace in the lotus feet of the God, thus made her son to become a motherless child. Though awarding any amount as compensation will not wipe the tears of the complainant and his son, but the opposite parties 1 to 3 have to be penalised for their deficiency in service by awarding a suitable compensation. Therefore considering the trauma that had undergone by the complainant and his son and the pathetic situation, we are of the considered opinion that the entire amount claimed by the complainant towards compensation for wrongful operation, can be awarded as compensation.

 

16.     Since we find no deficiency on the part of the opposite parties 4 and 5, the complaint against the opposite parties 4 and 5 are liable to be dismissed.

   

17.     In the result, the complaint is allowed in part.  The opposite parties 1 to 3 are directed to pay a sum of Rs.30,00,000/- towards compensation for wrongful operation and the death of the complainant’s wife, alongwith a sum of Rs.2,00,000/- towards compensation for mental agony and cost of Rs.20000/-.  Time for compliance two months from the date of receipt of copy of the order, failing which the amount awarded above shall carry interest @9% p.a., from the date of default till realisation. 

           

 

  S.M.LATHAMAHESWARI                                                                 R SUBBIAH     

           MEMBER                                                                                        PRESIDENT

 

 

 

 

Exhibits filed on the side of complainant

A1      28.02.2012    Report by the 1^st opposite party

A2      01.03.2012    Scan report

A3      02.03.2012    Cash receipts by the 2^nd opposite party

A4      03.03.2012    Treatment summary by 2^nd opposite party

A5          -do-                   Death declaration by the 4^th opposite party

A6      19.05.2012    Legal notice

A7      09.10.2012              -do-

A8      01.05.2012    News paper cuttings

A9      22.04.2012    Hand bill

A10                        Hand bill

A11     04.06.2012    Complaint to SP

A12     10.08.2012    Reply through RTI Act

A13     06.08.2012    Demolition order by Municipality

 

Exhibits of the 1^st to 3^rd opposite parties:

B1      01.03.2012    The Discharge Summary handed over to the patient’s relatives

B2                         Extract from a medical journal  

B3                         Extract from a medical journal

B4                         Extract from a medical journal

B5                         Extract from a medical journal

B6                         Extract from a medical journal

B7                         Extract from a medical journal

B8                         Extract from a medical journal

B9                         Extract from a medical journal

B10                        Extract from a medical journal

B11                        Extract from a medical journal

B12                        Extract from a medical journal

B13     27.02.2012    Admission and consent form

B14     01.03.2012    Copy of laboratory report

 

Exhibits of the 4^th and 5^th  opposite parties:

B15                        Copy of case sheet

B16                        Copy of “journal o anesthesiology clinical pharmacology

B17                        Extract from a medical journal

 

 

 

  S.M.LATHAMAHESWARI                                                               R SUBBIAH     

           MEMBER                                                                                        PRESIDENT

 

INDEX : YES / NO

Rsh/d/rsj/ Orders