CONSUMER DISPUTES REDRESSAL FORUM,PALAKKAD

Dated this the 25^th January, 2016

PRESENT :  SMT. SHINY.P.R, PRESIDENT

               :  SMT. SUMA. K.P, MEMBER                      Date  of filing : 20/12/2013

CC /214/2013

Pushpalatha,

W/o.I.S.M.Nair, B-150,

Yadhav Nagar, Samaypur,                                         :        Complainant

Delhi -110 042 (Rep.by her

Power of Attorney Holder)

I.S.M.Nair, S/o.K.V.Madhavan Nair,

 B-150,  Yadhav Nagar,

Samaypur, Delhi -110 042

(By Adv.A.T.Leela & Adv.Thottathil Gopalankutty)     

             Vs

1. Dr.Shanmughan.C.V,

    Anugraha, Kanniyampuram,                                  :        Opposite parties

    Doctor in Valluvanad Hospital, Ottapalam,

    Ottapalam Taluk, Palakkad

    (By Adv.V.K.Venugopalan)

2. The Managing Director,

    Valluvanad Hospital, Ottapalam,

    Ottapalam Taluk, Palakkad

    (By Adv.V.K.Venugopalan)

O R D E R

By Smt. Suma. K.P, Member,

The above complaint is filed by the complainant against the opposite parties alleging medical negligence on the part of the opposite parties.  The complainant is represented by her husband who is the power of attorney holder.  The complainant states that she along with her family are residing in Delhi and that she was working as a stamp vendor.  Her husband belonged to Ambalapara in Ottapalam Taluk.  During January 2013, they had come to their native place.  While traveling from Delhi to Kerala she developed abdominal pain and fever.  She along with her husband consulted the 1^st opposite party in his residence and the 1^st opposite party directed her to got admitted in the 2^nd opposite party’s hospital.  On her admission the duty nurse as per the direction of the 1^st opposite party gave her an injection. It is further alleged that due to the reaction of the injection the complainant started getting boils all over her body, which subsequently burst and her skin started to peel off.  The complainant states that there was negligence on the part of the opposite parties in treating her and that on 5/2/2013 she was shifted to Amala Institute of Medical Sciences in Thrissur.  There she was admitted and treated in a very serious condition up to 9/03/2013 as inpatient.  The complainant seeks compensation for the negligence on the part of the opposite parties. 

Opposite parties entered appearance after accepting notice.  1^st opposite party filed  version denying all the allegations.  And the 2^nd opposite party has only adopted the version filed by the 1^st opposite party.  1^st opposite party contented that the complainant came to his clinic in the afternoon on 28/01/2013 and she was found to be in a state of shock.  As per the history given by the complainant, she was travelling from Delhi to Kerala in a train for the past 3-4 days and she developed high fever, headache, vomiting and erythematous rashes all over the body along with blister formation at few areas.  Her symptoms became worse when she reached at Ottapalam.  On examination the complainant was having high temperature and low BP and she was in a state of shock and considering the possibility of septicaemia, the 1^st opposite party advised admission to the 2^nd opposite party’s hospital for emergency care.   The complainant was admitted to the hospital at 6.p.m. on the same day.  The complainant was started on medicines and blood investigation revealed that total count of platelets was very low and dengue antibody test result was negative.  Based on blood investigation, the complainant was empirically started on antibiotics and supportive care including platelet transfusion.  The condition of the complainant remained stable and she slept well during night.  On 29/1/2013 blisters were found extended all over the body.  Fever subsided and antibiotics and general supportive measures continued on the basis of a provisional diagnosis of necrotising epidermolysis of an unknown aetiology .  The complainant and her bystanders were informed about the diseased condition and general supportive treatment with IV antibiotics continued.  On 30/01/2013 the general condition was stable and the 1^st opposite party advised dermatological consultation.  The Dermatologist Dr.Anupama had seen the complainant  and confirmed the diagnosis and advised sterile liquid paraffin for local application.  The complainant and her relative were explained the need for the prolonged treatment for the diagnosed epidermolysis with supportive antibiotics in the light of the clinically manifested septicaemia.  Since affected skin problem could take prolonged course to heal and the complainant had complaints of pain and burning sensations and improvement was gradual than expected, the 1^st opposite party had discussed with the option to refer the complainant to higher centre for further management.  The relatives of the complainant preferred reference to Amala Institute of Medical Sciences Thrissur and accordingly on 5/2/2013 the complainant was referred the said hospital for further management.  The condition of the patient was stable at the time of reference.  The complainant was treated in the 2^nd opposite party’s hospital with antibiotics and supportive medical measures as per accepted medical practice.  No negligence can be attributed against the 1^st opposite  party on complainant’s case that her allergic skin condition did not give sudden response to the treatment.  The disease condition of the complainant  was of gradual prognosis and requires prolonged treatment.  This fact was well explained to the patient and her relatives and they preferred continuation of treatment at higher centre and reference was given accordingly.  The said disease condition was not caused due to any act or omission on the part of the 1^st opposite party.  The 1^st opposite party had exercised reasonable degree of skill, care and caution in the treatment provided and there was no negligence or deficiency of service in his part and he is not liable to pay any amount to the complainant by way of compensation or otherwise.  The 1^st opposite party had issued reply to the allegations raised against him in the complainant’s lawyer notice stating true facts and denying the liability.  Therefore the complaint has to be dismissed.

Both the parties have filed their chief affidavit along with supporting documents. Opposite parties also  filed petition seeking permission to cross examine the complainant.  Application was allowed.  Complainant filed application to call for the documents from Amala Hospital, Thrissur.  Documents were produced as per order in IA.  Complainant’s power of attorney holder was cross examined as PW1.   Ext.A1- A9 was marked from the part of the complainant.    Ext.B1 was marked from the part of the opposite parties.  Complainant filed application for cross examination of 1^st opposite party.  1^st opposite party was cross examined as DW1.  The relevant pages of Ext.B1 was marked as Ext.B1 a to d.   Complainant filed application to examine the doctor from Amala hospital as expert witness.  Application was allowed and doctor from Amala hospital  was examined as PW2.  Evidence was closed and  the matter was heard.

The following issues are to be considered.

1. Whether the 1^st  opposite party had properly diagnosed the disease of the complainant?
2. Whether that complainant was managed with due diligence and reasonable care at the 2^nd opposite party hospital?
3. Whether there was any negligence on the side of the opposite party in treating the complainant?
4. Whether the complainant is entitled for any compensation? 

 ISSUE No. 1

The complainant’s husband who was the power of attorney holder was examined as PW1 and Ext.A1-A5 was marked. Ext.A1 is the lawyer notice dtd.16/04/2013, A2 is the reply notice and A3 is Admission card issued by 2^nd opposite party,  A4 series are medical bills (108 in nos.)  A5 series are the medical prescriptions.  1^st opposite party was examined as DW1.  Dr.Sebastian Criton  was examined as PW2 who had examined the patient at Amala Hospital.  Points 1-3 can be considered together for convenience.  From the oral evidence and the document produced and from the evidence of the expert it is an undisputed fact that the complainant had a rare life threatening skin condition i.e. usually caused by a reaction to drugs known as Toxic Epidermal Necrolysis (TEN).  The 1^st opposite party in their version had stated that at the time of her first visit she had rashes all over the body along with blister formation at few areas.  She had high temperature, low BP and was in a state of shock when brought to him.  Considering the possibility of septicaemia 1^st opposite party advised admission in 2^nd opposite party hospital for emergency care at 6 p. m on the same day. Having noticed blisters and rashes all over the body of the complainant during her first visit 1^st opposite party ought to have referred her to a dermatologist.  From the chief affidavit of the 1^st opposite party he has admitted that he had advised that she had admission to the 2^nd opposite party hospital for emergency care.  Having known that the complainant was in a serious condition and that she was in severe shock the 1^st opposite party ought to have advised her admission in the intensive care unit.  Nowhere in the version or chief affidavit filed by the 1^st opposite party it is stated that the complainant had TEN.  The 1^st opposite party failed to recognize that the complainant was suffering from TEN.  During cross examination 1^st opposite party had no idea of what disease the patient was actually suffering from.  In his cross examination page 2 DW1 states that the first diagnosis is most likely septicemia and that septicemia is an infection that affects the organs. Further he states that “ I have diagnosed the complainant to have TEN on 29/1/2013” but this will not find a place in any of the records in page 3 of the case sheet. He states that he is not in a position to read this portion in the hand writing of RMO.  He even admits that he does not know what is meant by allergic/manifestation /generic which finds a place in the case records dtd.29/01/2013.  He further admits that the complainant was not admitted in the ICU.  DW1 further submits that from the very first consultation “I understood that she had blisters in her body and would peel off.  Till 30^th morning I did not think fit to consult the dermatologist.  On 30^th morning 60 to 70% of the skin had peeled off”.  From the above statements it can be seen that the 1^st opposite party not only had any idea of what the complainant was suffering from but was also very casual in his attitude as he failed to consult the dermatologist till the 30^th and by then the complainant had already lost 60-70%  of the skin.  He is not even able to state what the doctor meant by the word “patches” in the case sheet which was marked as Ext.B1”C”.  Here the principle of res ipsa loquitor applies and the doctor who was having an experience of 24 years as a consultant physician should not have treated the complainant who was suffering from a serious condition of skin disease.  He would have referred the complainant then and there to a dermatologist.  Having continued the treatment without referring to the dermatologist itself will amounts to negligence on his part. During cross examination DW1 states that the dermatologist Dr.Anupama diagnosed the complainant to have TEN but this also does not find a place in the hospital records.  It is clear from cross examination of DW1 that he was not able to diagnosed from what the complainant suffered from.  He even disagrees that TEN is a rare life threatening skin condition usually caused by a reaction to a drug.  Materials by medical experts were shown to the witness and he disagreed with the same.   He submits that TEN is a symptom and not a disease.  In page 5 of the deposition he states that “Loss of skin leaves the patient vulnerable to infections from fungal and bacteria and can result in sepsin and also to a critical condition.  Even death can be caused by respiratory distress”.  He eventually states “ I have not diagnosed the patient to have TEN”.  Despite the above condition the complainant was not admitted to the ICU which would reveal that she was managed in a careless manner without due care and diligence and that ought to have been down in the said circumstances.  In the re examination DW1 states that “Usually in this type of disease patient will be admitted in ICU but since she was having a contagious disease and the hospital does not have an isolated ICU she was not admitted in the ICU”.  This itself would show that the doctor had no basic knowledge  regarding the disease the complainant had.  Whereas the expert PW2 has specifically stated the complainant did not have any contagious disease and TEN is not contagious.  PW2 the expert Dr.S.Criton is a Professor in Dermatology having 29 yrs of experience in various medical colleges of Kerala admits that he had treated the complainant from 5/2/2013 and that her condition at that time was that the skin was peeling more than 90% of the body surface area and edema of whole body for 10 days.  PW2 diagnosed that the complainant was having TEN and that she was having a severe form of the same.  PW2 also states that 90% of TEN will be caused due to drugs and that in TEN cases the complainant is susceptible to severe infections that had affected the life.  He had also stated that food adulteration is a remote possibility as a cause for TEN.  He states that when such patients are admitted in wards there is a possibility of infection and it is always advisable to admit the patient in skin ICU or burn unit or ordinary ICU and that if the patient is in a shock she should be admitted in an ICU.  Here 1^st opposite party during cross examination had admitted that the patient was in a shock.  His only reason for not admitting the complainant in ICU was that the complainant had a contagious disease but the expert witness had stated that TEN is not a contagious.  From the above discussions it can be seen that 1^st opposite party had not only failed to diagnose the disease but also failed to manage her properly and with reasonable care and diligence.  By the time the seriousness of the disease was realized, 90% of her skin had already peeled off.  PW2 had categorically stated that TEN is not a symptom and it is a disease.  The 2^nd opposite party’s hospital failed to give proper care to the complainant and have neither filed version nor adduced any evidence before this Forum.  It was the negligence in the treatment of 1^st opposite party that had forced the complainant to take further treatment under PW2.  She had also incurred huge expenses for her treatment.  1^st opposite party had failed to exercise reasonable degree of skill, care and caution and thus there was gross negligence on his side and the opposite parties are bound to compensate the complainant. 

The complainant had submitted that she was a stamp vendor and since she was informed that there was a chance of developing further skin lesions if she went out in the sun she had to quit her job which had affected her livelihood.  She had also incurred a huge amount to meet her medical expenses for which she became indebted to persons and reached a stage where she was unable to pay off her loans.  She had stated that she suffered financial loss to the tune of Rs.4 lakhs.  She needs Rs.2 lakhs for permanent disfigurement caused to her skin.  She had also advised further treatment.  Considering the above circumstances the complaint is allowed and we direct the  opposite parties jointly and severally  to pay an amount of Rs.5,00,000/-(Rupees Five lakhs only)  towards the medical expenses incurred by the complainant along with Rs.1,00,000/- (Rupees One lakhs only)  as compensation for mental agony suffered by her.  We also direct the opposite parties to pay Rs.5,000/- (Rupees Five thousand only) as cost of litigation.  The aforesaid amount shall be paid within one month from the date of receipt of this order failing which complainant is entitled to get 9% interest for the compensation amount from the date of order till realization.

Pronounced in the open court on this the 25^th  day of January, 2016.

                                                                 Sd/-

                                                                   Smt. Shiny.P.R

                                                                     President

                                                                      Sd/-                                                                                                              Smt. Suma. K.P

                                                                       Member

A P P E N D I X

Exhibits marked on the side of complainant

Ext.A1 series –Copy of lawyer notice dtd.18/4/2013  issued to opposite parties along with receipts and acknowledgement card of 1^st opposite party  

Ext.A2 – Reply notice issued by 1^st opposite party dtd.29/04/2013 along with cover

Ext.A3-  The admission card issued by  Valluvanad Hospital

Ext.A4 series– Medical bills (108 in Nos.)

Ext.A5 series-Medical Prescriptions  (OP tickets)

Ext.A6- Discharge summary of complainant

Ext.A7- CD  

Ext.A8series – Photos 3 nos,

Ext.A9- Inpatient Record of Pushpalatha issued by Amala Institute of medical sciences, Thrissur

Witness marked on the side of complainant

PW1-S.M.Nair

PW2-Dr,S.Criton

Exhibits marked on the side of opposite party

Ext.B1- Original case sheets of complainant issued by Valluvanad Hospital, Ottapalam

Witness examined on the side of opposite party

DW1-Dr.Shanmughan.C.V

Cost Allowed

Rs.5000/- as cost.