SMT. SYEDA SHAHNUR ALI, PRESIDENT-IN-CHARGE

This is a case over alleged medical negligence on the part of the OPs.

In a nutshell, case of the Complainant, is that his daughter, Shampa Maity, aged 8 years, was suffering from urinary ailments, including abdominal pain and others, for which she underwent treatment at Purba Medinipur District Hospital. She was discharged from the said hospital on 25-11-2013 with diagnosis as “Kochs Abd (IC)”, but still the ailment continued.  So, the patient was taken to the OP No. 1 and as per his advice, the patient got admitted at the OP No. 2 Nursing Home on 22-03-2015 and underwent operation overthere.  The patient was discharged on 10-04-2015 with diagnosis “Multiple stricture (Kochs).  It is the case of the Complainant that following operation at the OP No. 2 Nursing Home, the condition of the patient deteriorated and allegedly huge stool was coming with the urine.  So, the patient was again taken to the OP No. 1 for follow up treatment and after checking the patient, the OP No. 1 advised some medicines which was scrupulously followed, but it did not yield any positive result.  So, the patient was taken to some other doctors at Tamluk, who referred the patient to any medical institution in Kolkata.  Out of his wit’s end, the Complainant took her to SSKM Hospital.  After seeing the patient, doctors of SSKM Hospital decided to operate the patient.  However, in view of long queue, the patient was asked to come back in the year 2016.  In such circumstances, taking into consideration the gravity of the situation, the Complainant went to CMC, Vellore, where she again went under the knife.  It is stated that following treatment at CMC, Vellore, the Complainant started recovering gradually.  It is alleged that due to wrong treatment on the part of the OPs, the misery of the patient compounded considerably.  It is stated that the Complainant has already spent Rs. 12,00,000/- to cure his minor child and further treatment of the child entails lot of expenditure which he cannot afford because of his financial constrains.  Accusing the OPs of gross medical negligence, Complainant filed the instant case for relief.

Case of the OPs, on the other hand, is that the Complainant took her daughter for the first time to the chamber of the OP No. 1 on 22-03-2015. On examination, and as per the medical documents supplied by the patient party, it revealed that the said patient was suffering from Kochs Abdomen (IC), i.e., Intestinal Tuberculosis for which she got treated at the Purba Medinipur District Hospital in the year 2013, with specific direction/advice to continue ATD from DTC.  It is stated that the patient was taking ATD at Government Institution from 02-12-2013 to 26-05-2014.  The patient was admitted at the OP No. 2 Nursing Home on 22-03-2015 with diagnosi, “intestinal kochs and obstruction”.  On her admission, she was first treated in a conservative way till 30-03-2015.  It is further stated that after admission, the patient was initially doing well.  However, on 27-03-2015, she felt recurrent abdominal pain after taking oral food.  Meanwhile, she was also administered ATD, namely, Forecox on 26-03-2015.  In any case, as there was persistent pain and unrelenting intestinal obstruction, the OP No. 1 decided to go for surgery.  Accordingly, another surgeon, namely, Dr. Suchindran Bandopadhyay and anesthetist, Dr. Bikramaditya Khanra were contacted by the OP No. 2 Nursing Home.  After observing all formalities, exploratory laparotomy as well as ileotransverse anastomosis was done following necessary medical protocols.  Subsequently, on 10-04-2015, the patient was discharged from the said Nursing Home in a favourable condition. The patient was followed up with A. T. drug.  However, she developed urinary tract infection on 01-05-2015 for which levofioxacin was instituted on that day.  On 27-06-2015, the patient was referred to DOT for AT drug.  It is also stated that patient visited the OP again on 28-10-2015 with vesico colonic fistula.  This time the OP No. 1 referred the patient to the pediatric surgery department of SSKM Hospital and the said hospital asked the patient to come again on 03-01-2016 for operation.  It is pointed out that the patient developed fistula after at least 2 ½ - 3 months of surgery.  Allegedly, the patient was irregularly taking A.T. drug for induced falatulance for which she might have developed multi drug resistance tuberculosis and in natural course of the disease, colovesical fistula might have developed. Stating that no evidence of deficiency in service is brought forth by the Complainant against the OPs, they prayed for dismissal of the instant case.

Points for consideration

1. Whether the line of treatment devised by the OP No. 1 conformed to standard medical protocol?

2. Whether there was any shortcoming/negligence, as alleged, on the part of the OPs in treating the patient, i.e., Complainant’s daughter?

3. Whether the Complainant is entitled to any relief?

Decision with reasons

Point No. 1 & 2:

Both these points are taken up together for the sake of brevity of discussion.

It is stated by the OPs that on 22-03-2015, the patient was admitted at the OP No. 2 Nursing Home with diagnosis, “Intestinal Kochs and obstruction”.  On her admission, she was firstly treated in a conservative way (Non operative treatment) till 30-03-2015.  It would be evident from the BHT that on 22-03-2015, the patient was stable, her abdomen was soft, and it continued till 25-03-2015 with minor fluctuations in parameters and symptoms.  On 25-03-2015, she was allowed liquid oral food and on 26-03-2015, an ATD, namely, Forecox was administered.  However, on and from 27-03-2015, she felt recurrent abdominal pain after taking oral food.  According to the OP No. 1, as there was persistent pain and unrelenting intestinal obstruction, the need for surgery was felt on 28-03-2015.  On 29-03-2015, as the pain again returned, urgent need for surgery was felt.  For this purpose, another experienced surgeon and an anesthetist were contacted to perform the surgery and on 31-03-2015, at first exploratory laparotomy was done for the purpose of removal of intestinal obstruction.  It is further stated that after discussion, and to be on the safe side, side to side ileotransverse anastomosis was done in a non-involved part of terminal ileum and transverse colon.  It is stated that the post operative phase remained uneventful, she passed stool on the 4^th day and was discharged in a favourable condition on 10-04-2015.  Subsequently, the patient developed urinary tract infection on 01-05-2015.  On 27-06-2015, she was referred to DOT for AT drug.  During her next visit on 28-10-2015, the OP No.1 felt the need for consultation and second surgery.  Accordingly, the patient was referred to the pediatric surgery department of SSKM Hospital. Ld. Lawyer for the OPs claimed that the CMC, Vellore and SSKM Hospital, Kolkata did not find any fault with the treatment plan chalked out by the OP No. 1, nor they pointed out any negligence on the part of the OPs in treating the patient.  Ld. Lawyer for the OPs strongly denied the allegation of mixing up of stools with urine post surgery.  Pointing out the Discharge Summary of CMC, Vellore dated 09-03-2016, he contended that the said report clearly states that the treating doctors did not find any leak in the bladder.         

Now, we are to consider as to whether the aforesaid line of treatment was at par with standard treatment protocol, or not.    

Be it mentioned here that, insofar as the OP No. 1 primarily diagnosed the ailment of the patient as a case of “”Intestinal Kochs and obstruction”, we have referred to some scholarly articles on this matter, viz., Textbook of Family Medicine, Editor-in-Chief, S. K. Sharma, published by Foster’s Publications; an article titled, “Abdominal tuberculosis of the gastrointestinal tract: Revisited”, authored by Vasudevan Ravisankar & Ors., published in the World Journal of Gastroenterology, 2014 October 28; 20(40): 14831-14840, ISSN 1007-9327; “Diagnosis of abdominal tuberculosis: the importance of laparoscopy” by S. Rai, MS, FRCS & W. M. Thomas, MD, FRCS, published in the Journal of the Royal Society of Medicine, Vol. 96, December 2003; “Abdominal Tuberculosis – Current Concepts in Diagnosis and Management” by S. N. Chugh and Vinesh Jain, Chapter 102, page 600 – 607; “Abdominal tuberculosis” by M. P. Sharma & Vikram Bhatia, Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, published in the Indian J. Med. Res. October, 2004, pp 305 – 315; “Abdominal tuberculosis” by V. K. Kapoor, Associate Professor, Surgical Gastroenterology, Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, published in the Postgraduate Medical Journal 1998; 74:459 -467.

On careful perusal of the same, it appears that, Abdominal tuberculosis is one of the most common types of extra-pulmonary tuberculosis, comprising of tuberculosis of gastrointestinal tract, peritoneum, omentum, mysentery and its lymph nodes and other abdominal organs such as liver, spleen, and pancreas.  Abdominal tuberculosis can mimic a variety of other abdominal conditions/diseases and only a high degree of suspicion can help in the diagnosis.  Otherwise, it is likely to be missed or delayed resulting in high morbidity and mortality. It also appears that, abdominal TB is of four types: tubercular lymphadenopathy, peritoneal TB, gastrointestinal TB and visceral TB

The most common symptoms of intestinal kochs are pain in the abdomen, loss of weight, anorexia, recurrent diarrhea, low grade fever, cough and distension of abdomen. The symptom of chronic abdominal TB is insidious, and includes fever, night sweats, malaise, weakness, anorexia, and weight loss.  The stool is often watery and foul smelling.  Other symptoms include flatulence, nausea, altered bowel habits, and borborygmi.  The doctor on examination may feel a lump, fluid in the abdomen or a doughy feel of the abdomen.  Also, there may be enlarged lymph glands elsewhere in the body.  Patients with intestinal involvement may also present with acute symptoms due to intestinal obstruction, perforation or gangrene.

Abdominal TB is generally responsive to medical treatment alone.  So, early diagnosis can prevent unnecessary surgical intervention. In general, with the advent of antituberculous therapy, surgery is usually reserved for those cases where it is absolutely indicated as in cases of non-resolving intestinal obstruction, perforation and abscess or fistula formation. Even in cases of tuberculous strictures medical management with antituberculous drugs will result in significant resolution of symptoms in most of patients. Endoscopic balloon dilation offers an alternative to the surgical management of GI strictures.

We also find that, diagnosis of abdominal TB can be confirmed by isolating the TB germ from the digestive system either through biopsy or endoscopy.  However, other supportive tests that may be done are the Mantoux test, Chest Xray, Abdominal Xray (with or without barium) and scans such as ultrasound and CT scan.  Barium meal series, barium enema, and small bowel enemata (enteroclysis) are useful investigative procedures in the diagnosis of gastrointestinal TB. 

Now let us see the advantages/disadvantages of various clinical investigations. Plain X-ray abdomen and Chest: Plain X-ray of abdomen (erect and supine films) is useful simple investigation.  It may show presence of multiple air-fluid levels and dilated loops of gut in case there is subacute or acute intestinal obstruction.  Plain X-ray Chest done simultaneously may reveal either healed or active pulmonary tuberculosis.  Although finding of tubercular lesion on chest X-ray supports the diagnosis of abdominal tuberculosis, but a normal chest X-ray does not rule it out.  Barium Studies: Enteroclysis followed by a barium enema may be the best protocol for evaluation of intestinal tuberculosis. Ultrasound: It is very useful, especially for imaging peritoneal tuberculosis. The following features may be seen, usually in combination : a) Intra-abdominal fluid which may be free or loculated; and clear or complex, b) “Club sandwich” or “sliced bread” sign  due to interloop ascitis, c) Lymphadenopathy which may be discrete or conglomerated. Small discrete anechoic areas representing zones of caseation may be seen within the nodes. Calcification in healing lesions may also be seen, d) Bowel wall thickening best appreciated in the ileocaecal region, e) Pseudokidney sign – involvement of the ileocaecal region which is pulled up to a subhepatic position. Computed tomographic (CT) scan: It is a good modality of investigation which can provide vital clue leading to diagnosis of abdominal TB as it can show intestinal lesions, lymphnodal lesions, ommental thickening, ascitis and solid organ involvement. Endoscopy: It visualizes the tubercular lesion directly, hence, is a useful tool in the diagnosis of colonic and gastro-duodenal tuberculosis; and helps in the confirmation of the diagnosis by obtaining histo-pathological evidence of tuberculosis.  Endoscopy offers the advantage of being minimally invasive and in avoiding surgery in certain cases, upper GI endoscopy for esophageal and gastric lesions and colonoscopy for rectal, colonic and terminal ileal lesions. Endoscopic biopsy and brush cytology often clinch the diagnosis. Capsule endoscopy is useful for lesions not seen by UGI & LGI scopes however tissue diagnosis is not possible with this modality.

Laparoscopy a minimally invasive procedure with minimal morbidity is now considered a very useful adjunct in the diagnosis as it can visualize the peritoneal cavity in detail and take biopsy from the suspected lesions.

In recent years, various molecular and immunological techniques are used as a new approach for the rapid diagnosis of abdominal TB. The clinical samples can be ascitic fluid, lymphnode, thickened omentum or mesentery. The insertion sequence IS6110 is used as a target for polymerase chain reaction (PCR) amplification in these samples. Real time assay using fluorescence resonance energy transfer hybridization probes show a positivity index of 36% in those patients with clinical and radiological suspicion of TB, but with negative acid fast bacilli (AFB) and culture. In addition, immune characterization show depleted CD + count and increased levels of interferon-γ and tumor necrosis factor-α cytokines. Multiplex PCR using MPB64 and IS6110 are useful in rapid diagnosis of gastrointestinal TB. Multiplex PCR has sensitivity and specificity of 90% and 100%, respectively in confirmed (AFB/culture/histopathology) cases of gastrointestinal TB and positive results in 72.41% of the suspected gastrointestinal TB cases.

All the diagnosed cases of gastrointestinal TB should receive at least 6 months of antituberculous therapy which includes initial two months of therapy with isoniazid, rifampicin, pyrazinamide and ethambutol thrice weekly. Although 6 months treatment regime is recommended as per the revised national tuberculosis program guidelines, many clinicians extend the treatment regimen to 9 or 12 months. However, no difference is seen in effectiveness between the 6 month short course therapy regime with rifampicin, isoniazid and pyrazinamide for 2 months followed by rifampicin with isoniazid for another 4 months and 12 months standard regimen of ethambutol and isoniazid with streptomycin supplemented for 2 weeks.

The surgeries performed in the gastrointestinal TB are of three types. The first type is the surgery which is done to bypass the involved segments of bowel as in case of an entero-enterostomy or an ileotransverse colostomy. These surgeries are usually complicated by blind loop syndrome, fistula formation and recurrent disease in the remaining segments and hence usually not performed routinely. The second type of surgeries are those involving the radical resection like a right hemicolectomy which are feasible with the advent of effective antituberculous drugs so as to eradicate the disease completely. However, these surgeries are also hindered by malnourished status of most of the patients which make them poor surgical candidates. Also the lesions can be widely placed and radical resection may not be possible in all the cases. The third type of surgeries is usually conservative like a strictureplasty in those strictures which cause more than 50% luminal compromise. The tuberculous bowel perforations are usually treated with resection of involved segments with primary anastomosis.

Now, we proceed to compare the line of treatment followed by the OP No. 1 vis-à-vis standard treatment protocol advocated by renowned authors.

It appears from the petition of complaint that on an earlier occasion in the year 2013, the patient was diagnosed with “Kochs Abdomen (IC)” and was subjected to ATD during the period from 02-12-2013 to 26-05-2014.  Usually, such medicines are discontinued after intensely verifying the clinical reports that is taken after completion of the requisite course.  There is no reason to believe that any exception was made in the case of the patient concerned.

Now, when the patient was presented before the OP No. 1 on 22-03-2015 with complaint of abdominal pain, it was incumbent upon the treating doctor to suggest necessary tests to find out whether the said disease relapsed or not.  We find, after examining the patient, the OP No. 1 diagnosed it as a case of “Intestinal Kochs and obstruction” and suggested some blood tests and xray. 

Here, it bears mentioning that notwithstanding the OP No. 1 made a preliminary diagnose as above, he did not prescribe any ATD for the first four days and only on 26-03-2015, he prescribed one ATD, Forecox for the first time.  There is no explanation from the side of the OPs why he did not prescribe ATD on 22-03-2015 itself and waited for four long days to do so.  In absence of any noting in the BHT as regards results of clinical test reports, there is no way to find out whether any of the test results, those were suggested by the OP No. 1, gave any conclusive indication of the said ailment.  Incidentally, no authentic medical guideline is presented before us by the OPs to show that such prescription of only one ATD conformed to standard medical protocol.

Also, as against the various symptoms for Intestinal Kochs, as stated hereinabove, on going through the prescription of the OP No. 1/BHT, apart from abdominal pain, we do not find mention of any other symptom that prompted the OP No. 1 to draw such conclusion. 

In any case, although the OPs have not admitted it in so many words, it appears that the OP No. 1 was in two minds about his own diagnosis of the ailment in respect of the patient.  Otherwise, he would certainly not venture to carry out exploratory laparotomy on 31-03-2015.  As we know, exploratory laparotomy is a common general surgery procedure. By definition, an exploratory laparotomy procedure is done with the aim of finding out what is wrong with the patient, when clinical examination and imaging studies are not definitive.

Against this backdrop, let us find out, how justified the OP No. 1 to perform exploratory laparotomy on a minor child of only 8 years. 

On a reference to the afore mentioned articles on Abdominal TB, we find that patients, usually present with abdominal pain, are subjected to a combination of radiologic, endoscopic, microbiologic, histologicnand molecular techniques.  Surgery is occasionally required. In the last decade, the role of exploratory laparotomy has declined because of the availability of sensitive imaging techniques. Both CT scan and MRI offer state of the imaging with excellent resolution. In many cases, the cause of the abdominal pathology can be revealed with these imaging studies. Further rapid advances in laparoscopic surgery now provide a minimally invasive method of inspecting the abdominal cavity with minimal morbidity.

It requires no emphasis that, every effort should be made to make a diagnosis prior to surgery. In some cases, diagnostic peritoneal lavage (DPL) may be used to determine the cause of the abdominal pathology. If the DPL is positive then an exploratory laparotomy is needed. If the results are negative, the patient still needs to be monitored very closely.  It appears that diagnostic laparoscopy has resulted in avoiding laparotomy in large number of patients.  Accessible strictures are being treated by balloon dilatation reducing the need for surgery. What puts us in a fix is the fact that although the OP No. 1 was totally clueless about the exact cause of abdominal pain, instead of advising other state-of-art investigative tests, like endoscopy, CT Scan etc., he preferred an invasive procedure like exploratory laparotomy that has lost its prominence in the wake of rapid advancement in imaging techniques.    

There is a strong possibility that absence of proper endoscopic/advanced imaging facilities like CT Scan at the OP No. 2 Nursing Home handicapped the choice of OP No. 1.  But, this is no alibi to expose a minor child – or for that matter any patient – face the hazards of surgery.  In fact, we find that even after doing exploratory laparotomy, the OP No. 1 could not find out the cause of ailment.  Also, the CMC, Vellore did not rely on the procedure done by the OP No. 1 and they performed laparotomy on 02-03-2016. If the OP No. 1 so desired, he could get the tests done from outside.  After all, the condition of the patient was not so worse that she could not endure the transportation hazards. 

It is claimed by the Ld. Lawyer of the OPs that the surgery had to be carried out on an emergency basis on the face of persistent pain and unrelenting obstruction.  However, we find from the WV that the patient was doing well till 26-03-2015 and after taking oral food on 27-03-2015, the abdominal pain resurfaced.  On 28-03-2015, seeing the condition of the patient, the OP No. 1 felt the necessity of performing surgery.  It is further stated that on 29-03-2015 evening the pain again returned and so, surgery was planned and accordingly, some other doctors were contacted for this purpose and operation was ultimately done on 31-03-2015. Keeping in mind the fact that the surgery was planned on 29-03-2015 itself and it was done after two days, by no stretch of imagination it can be termed as an emergency operation as the OPs have sought to paint it.

We feel, two days time was sufficient enough to carry out requisite tests as mentioned above to eradicate the diagnostic dilemma that the OP No. 1 was suffering from.  When due technology is available at our disposal, we wonder, whether any person of reasonable prudence would develop cold feet and refrain from making most of the technological advancement in the concerned field. Indeed, his decision to go for surgery straightway instead of giving non-invasive procedures a chance is highly questionable.

It is cautioned that anticipation of the diagnosis is necessary, and a hasty exploration should be avoided if the centre is not well equipped to perform the therapeutic procedure that will be necessary if the suspected condition is confirmed.

Once the surgeon finds the cause, the exploratory laparotomy can then be continued as a therapeutic procedure. This may mean removing the offending lesion or performing a biopsy of an abdominal mass if the patient is inoperable. It is important to understand that in a routine laparotomy, the diagnosis is known beforehand and offers a specific treatment to the patient. In an exploratory laparotomy, the surgeon does not know what therapeutic measure he/she will undertake until the abdomen is opened and explored. So, it is of paramount importance that such procedure is done only in a hospital that possess excellent therapeutic infrastructure.  We afraid, no such credible evidence is put forth from the side of the OPs that the OP No. 2 possess due infrastructure in this regard.  A Nursing Home, that does not have even a dedicated pediatric doctor/department to take care of pediatric patients, or good endoscopic and advanced imaging facilities, like CT Scan/MRI, probably, it is too much to expect such advanced infrastructure at such a health care centre. In fact, in his OT Note, the OP No. 1 suggested the name of IPGME&R, Kolkata for performing second sitting of surgery to resect diseased portion of gut.   This leaves nothing to imagination that the OP No. 2 lacked institutional infrastructure to deal with such cases.  It also appears that the exact cause of abdominal pain eluded the OP No. 1 even after doing exploratory laprotomy.  We come to such conclusion on due consideration of the BHT on record which does not throw any definite findings as to the root cause of abdominal pain. 

Be that as it may, fact remains that bypass surgery such as entero-enterostomy, ileotransverse colostomy is not recommended for obstructive lesions as they may cause formation of blood loops, leading to obstruction, fistulation, malabsorption etc. We learn that, it has been proved by few studies that, antitubercular drugs alone can relieve obstructing intestinal lesions. Anand et al reported clinical and radiological resolution of tuberculous strictures with drug therapy even in patients with subacute intestinal obstruction.  Similar observation has been made by Blasubramaniam et al.

Postoperative complications of ileotransverse colostomy include anastomotic leak resulting in a faecal fistula, peritonitis and intra-abdominal sepsis, persistent obstruction, wound infection, and dehiscence.  In the present case, as we find, the OP No. 1 decided to sail against the wind and in the process, messed up everything.  On a reference to the treatment papers of CMC, Vellore, we find that they found traces of anastomotic leak with three openings, persistent obstruction, fistulation in the patient. 

Whether we like it or not, fact remains that the OP No. 1 was wide out of array in diagnosing the ailment properly and consequently, went terribly wrong in treating the patient.  First, he diagnosed the patient’s ailment as a case of Intestinal Kochs with obstruction which has been subsequently ruled out by the CMC, Vellore.  Timely diagnosis, an algorithmic diagnostic approach using radiology, imaging and endoscopy, and management with a judicious combination of anti-tubercular therapy and conservative surgery can reduce the mortality of this easily curable yet potentially lethal disease. However, the OP No. 1, without any definite finding to confirm his reading of the patient, simply on the basis of suspicion, on the fifth day of patient’s stay at the OP No. 2 Nursing Home, administered ATD and on 27-06-2015, referred the patient to DOT for AT drug.  We must state that we have our reasonable doubt as to whether such administration of ATD is mandated by the appropriate authority.  The irony is that, CMC, Vellore later on completely ruled out such ailment.  It is a clear pointer of the fact that the patient was subjected to wrong treatment by the OPs.  Secondly, the patient, who happened to be a minor child of 8 years at that time, was unnecessarily subjected to invasive surgery, thanks to the aversion of the OP No. 1 to give sensitive imaging techniques a try. Thirdly, despite being fully aware of the lack of infrastructural facilities at the OP No. 2 Nursing Home, he went ahead with a risky operation, putting the life of a minor child at great danger.  Fourthly, being totally unmindful of the drawbacks of ileotransverse colostomy, the anastomosis of choice, he went ahead with the said procedure and in the process caused more harm to the patient. Fifthly, the patient was exposed to irrational ATD regime without due evaluation of the ailment.

It is surely a sad commentary on the diagnostic skill of the OP No. 1 that despite performing exploratory laparotomy, the OP No. 1 miserably failed to find out the exact cause of abdominal pain of the patient. Despite watching the patient for more than 7 months, the OP No. 1 could not figure out that the patient was actually suffering from Colovesical Fistula.

We are fully appreciative of the fact that mere deviation from normal practice or a wrong diagnosis does not construe medical negligence.  To establish liability, it is essential to prove (1) that there is a usual and normal practice which has not been scrupulously followed and (2) that the course in fact adopted is one no professional man of ordinary prudence would venture into had he been acting with ordinary care and caution.

In the case in hand, rightly or wrongly, the OP No. 1 made a diagnosis of the patient.  There is an established procedure to treat such patients.  However, the OP No. 1 did not opt for it. As he was not certain about his own diagnosis, then it was only expected of him not to leave any stone unturned to get into the bottom of the problem and for this purpose, when due technology was readily available, it was only expected of him to take due assistance. As observed hereinabove, rapid advancement in the arena of imaging/endoscopic field has decreased the necessity of undertaking surgical procedures to come to a definite conclusion about the cause of the ailment. It is hard not to wonder, whether any person of ordinary prudence would have chosen an invasive procedure over non-invasive procedure to confirm the root cause of abdominal pain. It is also notable that although nowadays bypass surgery like ileotransverse colostomy is not recommended for obstructive lesions, the OP No. 1 performed the said surgery deviating from the beaten path. Similarly questionable was his decision to undertake a risky operation like ileotransverse colostomy without having due institutional infrastructure at the OP No. 2 Nursing Home, thereby putting the life of a patient at great risk. The manner in which the OP No. 1 administered ATD, Forecox from 26-03-2015 onwards indeed caught us by surprise.  Let us not forget that even on 26-03-2015, he was uncertain as to whether the patient was at all suffering from intestinal kochs.  There can be no two opinions as to the fact that treatment of abdominal TB requires some degree of sincerity on the part of the treating doctor.  Till there is due clarity as to the root cause of a disease, unlike any layman, a doctor cannot shot indiscriminately in the dark.     

In the present case, applying the twin tests stated above to hold one guilty of medical negligence, we have no qualms holding that OPs were grossly negligent in attending the Complainant’s daughter properly. Not only he miserably failed to make a proper diagnose of the patient, but also deviated from established norms in treating the patient without any rationale. This is an open-and-shut case of gross laxity/negligence/shortcoming on the part of the OPs in rendering proper treatment to the patient.   

Both these points are, thus, decided in favour of the Complainant.

Point No. 3:

Delayed diagnosis and injudicious treatment, either due to limited experience or poor understanding of the disease, often put the life of patients at danger. That the line of treatment devised by the OP No. 1 was faulty can be ascertained from the fact that there was no improvement to the condition of the patient.  Rather, her condition deteriorated further as a fall out of the wrong operating procedures adopted by the OP No. 1.  No doubt, insofar as he was not certain about his diagnosis, had the OP No. 1 been little wise to refer her to some other specialist doctors, it would have saved the patient from the ignominy of undergoing unnecessary surgeries.  Also, timely treatment of the patient could have lessened her sufferings to a great extent. However, only because of the negligence of the OP No. 1, the patient had to endure immense sufferings for more than a year.     Mercifully, CMC, Vellore correctly diagnosed the disease of the patient and took corrective steps to cure the patient.

The OP No. 1 has flaunted his vast experience to deal with such cases. We have no such desire to caste any doubt about his competence.  However, in this particular case, we find, he miserably failed to impart due expertise/skill to properly treat the minor girl causing great hardship to the patient as well as her family members, both physically/mentally and financially.  We find that the Complainant hails from a humble background.  Yet, thanks to the neglectful act of the OP No. 1, he had to burn a deep hole in his pocket in a bid to save the life of his child.  Keeping such facts in mind, we deem it fit and proper to direct the OPs compensate the loss suffered by the Complainant. 

It is stated by the Complainant that till date he has spent more than Rs. 12,00,000/- for the treatment of his daughter.  We afraid, the photocopies of bills/vouchers on record do not support such whooping claim.  On due scrutiny of the bills/vouchers/cash receipts, we find bills/vouchers worth Rs. 1,15,000/- (pprox.) towards treatment cost of the patient. To this can be added other incidental expenses like conveyance/travelling cost, fooding expenses, cost of medicines prescribed by different doctors, fee paid to doctors besides the mental and physical stress/pain/agony that the patient and her family members endured.  Considering all aspects, in order to impart justice to an aggrieved family, we deem it appropriate to award a compensation of Rs. 3,00,000/- in favour of the Complainant that should be borne jointly and severally by the OPs.  That apart, the Complainant is also entitled to litigation cost for a sum of Rs. 10,000/-.

This point too, thus, answers in favour of the Complainant.

Hence,

O R D E R E D

that C. C. No.  100/2015 be and the same is allowed on contest against the OPs.  OPs are directed to pay, jointly and severally, within 40 days hence, a sum of Rs. 3,00,000/- as compensation and another sum of Rs. 10,000/- as litigation cost to the Complainant.  In case the order is not complied with within the stipulated time frame, Complainant would be at liberty to execute this order in accordance with law and in that case, OPs shall be liable to pay interest @ 8% p. a. over Rs. 3,00,000/- from this day till the order is complied with in toto.