Karnataka
Chitradurga
CC/72/2016
R.Kavya D/O V.H.Ravi - Complainant(s)
Versus
Dr.Ambarish,Orthopedic Surgeon - Opp.Party(s)
Shri.G.V.Sandeep
14 Sep 2017
ORDER
COMPLAINT FILED ON:25/07/2016
DISPOSED ON:14/09/2017
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHITRADURGA.
CC.NO: 72/2016
DATED: 14th SEPTEMBER 2017
PRESENT: - SRI. T.N. SREENIVASAIAH : PRESIDENT B.A., LL.B.,
SRI.N. THIPPESWAMY : MEMBER
B.A., LL.B.,
……COMPLAINANT/S |
(Rep by Sri.G.V. Sandeep, Advocate) | ||||
V/S | |||||
…..OPPOSITE PARTIES |
| ||||
ORDER
SRI. T.N. SREENIVASAIAH: PRESIDENT
The above complaint has been filed by the complainant u/Sec.12 of the C.P Act, 1986 for the relief to award compensation of Rs.19,95,000/- in favour of complainant against the OPs and such other reliefs.
2. The brief facts of the case of the above complainant are that, on 14.08.2018, R.Kavya, aged about 11 years, i.e., the complainant, D/o Sri. V.H.Ravi met with twisting injury to her left ankle after slipping over stone in her school. For that on 15.08.2014 the patient was taken to Government Hospital, Chitradurga whereas the OPD slip showed the date of 14.08.2014. She was brought with injury to her left foot for which X-ray of left foot was advised bearing X-ray No. 6975 dated 15.08.2014. The OPD slip did not mention any treatment given to the patient. Whereas the complainant stated that concerned doctor advised that she had not sustained any serious injury and not to worry. She was treated on OPD basis and went home on the same day. It is further submitted that, on 16.08.2014 she was taken to Basaveshwara Medical College and Hospital, Chitradurga. She was seen first in Pediatric Department and then by another doctor who gave painkiller injection to her. She was then seen by OP.No.1. When OP. No 1 saw the patient there was a pain and swelling left ankle and purple coloration inner aspect of left ankle. She was sent for X-ray and then a below knee POP SLAB was applied. The patient was advised to get admitted to Female Orthopedic Ward and advised to get few blood investigations. But the patient did not get admitted or got blood tests done hence was sent home after prescription of medicines. It is further submitted that, on 17.08.2014 she was brought to Casualty of Basaveshwara Medical College and Hospital, Chitradurga where POP SLAB was removed and there was swelling of left limb with discoloration. Patient was advised to undergo Fasciotomy but, patient attenders were not willing for the procedure and further management hence was referred to higher center. Thereafter, she was taken to Kasturaba Hospital, Manipal on 17.08.2014 at 10:25 P.M. In the said Hospital, she was attended by a team of Orthopedic Surgeon, Vascular Surgeon and Pediatrician and advised to undergo amputation. But attenders discharged her against medical advise and took her to Victoria Hospital, Bangalore on 29-08-2014, where she underwent below knee amputation on 03-09-2014 and was discharged on 15.09.2015. The Complainant side has alleged that OP No.1 has applied POP SLAB, that is the cause of this amputation hence alleging medical negligence the complainant has filed a complaint before this forum.
3. On service of notice on OPs, Sri. B.M. Ravichandra, Advocate appeared on behalf of OP No.1 and Sri. M. Umesh, Advocate appeared on behalf of OP No.2 and filed their notice.
4. OP No.1 filed version stating that, complainant had met with twisting injury to her left ankle after slipping over stone in her school on 14.08.2014 at Gutthinadu Village Chitradurga. For that on 15.08.2014 the complainant went to Govt. Hospital, Chitradurga where she took treatment and in the said hospital the concerned doctor has advised that she has not sustained any serious injury and not to worry. Complainant had approached Government Hospital, Chitradurga on 15.08.2014. But the OPD record issued by the said hospital shows the date as 14.08.2014. There is factual discrepancy between the version of complainant and the record produced. The OPD record of Government Hospital, Chitradurga does not mention any treatment whatsoever given to the complainant apart from the X-ray which was taken there on 15.08.2014. It is further submitted that, if the concerned Doctor at District Hospital, Chitradurga had advised that there was nothing serious then there was no need for the complainant to come to BMCH on 16.08.2014. The complainant had sustained twisting injury to her left ankle because of slipping over stone for that complainant came up with severe pain in her ankle. In a case of twisting injury to the ankle most of the times X-ray will not show any fracture as in a case of ankle sprain which had been sustained by the complainant, hence no bony injury was seen in the X-ray of the complainant. For the injury sustained by the complainant, OP No. 1 had applied supportive POP Slab and the same is mentioned in the OPD card of Basaveshwara Medical College Hospital & Research Centre henceforth called as BMCH & RC. The application of POP for a case of ankle sprain is as per medical literature and is mentioned in orthopedic books and hence the most appropriate treatment was given to the complainant. It is further submitted that the complainant was advised to undergo a set of routine Blood Investigations namely Hb% (Hemoglobin Percentage), TC (Total Count of White Blood Cells), DC (Differential Count of White Blood Cells) and ESR (Erythrocyte Sedimentation Rate). This set of Routine blood tests was advised to rule out other remote possibilities of Inflammation, Infection etc.. But this important advice which is documented in OPD card of BMCH & RC was again neglected by the Complainant and attenders. OP No. 1 had advised and treated the Complainant in most appropriate and professional manner. Had it not been the negligent and callus attitude of the Complainant and Attenders who did not follow golden advises given by OP no. 1 the Complainant would not have landed with amputation of her limb. On 17.08.2014 the complainant was brought to Casualty of OP No. 2 at around 11-00 A.M with complaint of pain and swelling of left lower limb. Upon arrival of any patient to Casualty, the patient is first attended to by Casualty Medical Officer. After removal of supportive POP Slab and on examination of the limb the Complainant was advised to undergo Fasciotomy. In this surgery skin of the limb is cut open and the underlying muscle compartments are released to decrease pressure within muscle compartments so as to reestablish blood supply. This important advise was as usual neglected by the complainant and attenders despite having been explained the complications, prognosis and need for early intervention which is again mentioned in the referral card. The attenders wasted precious 10 and half hours from the time Referral Card was issued i.e., at 11-27 AM till the time they reached Kasturaba Hospital, Manipal at 10-00 PM. That if the attenders had followed the advice of emergency fasciotomy to the complainant it would have made a significant difference in the final outcome. It is further submitted that, the treatment given to the complainant for the injury sustained by slipping over stone which led to twisting of ankle by OP No. 1 at OP No. 2 Hospital was as per the guidelines mentioned in medical literature and while giving treatment proper care had been taken without any deficiency or negligence. As per the Discharge Summary of the Complainant issued by Department of Pediatric Surgery, Victoria Hospital, Bangalore dated 15.09.2014 where left below knee amputation was performed, the amputated part was sent for Histo Pathological Report. The HPR gives the most accurate diagnosis as it is done by seeing the cells of the part under microscope. The HPR of the complainant was suggestive of Necrotizing Vacuities which has finally been recognized only after the amputated part was sent for HPR has not been mentioned as a diagnosis either in the Discharge Summary issued by Kasturaba Hospital, Manipal or by Department of Pediatric Surgery, Victoria Hospital, Bangalore. These two very good hospitals of Karnataka with best of infrastructure in terms of Materials/Equipments, Testing facilities and Manpower with highest standards of Super specialty were not able to identify this entity of Necrotizing Vacuities prior to amputation. This fact itself is self-explanatory that the condition with which the Complainant was suffering was one of the rarest of rare disorders. That despite so many super-specialty doctors having failed to diagnose/identify this disease prior to amputation, how can OP no. 1 be blamed for the outcome/amputation of complainant who never supported or followed the instructions of OP no. 1 given at OP No.2 on 16.08.2014 and by the CMO of OP No. 2 on 17-08-2014. The cause of amputation of left leg of the Complainant is the disease which the complainant was suffering and their negligent attitude in not following the advice given by OP no. 1 and not any deficiency on part of OP No.1 and OP No.2. OP No. 1 is a competent doctor who has completed his Master of Surgery in Orthopedics in 2006 and since then has been working for OP No. 2 gained experience of about 8 years as a consultant and has applied thousands of POP slabs without any complications. From the above said reasons, it shows the complainant has filed this complaint on flimsy and untenable grounds without any proper reasons and there is no deficiency in service on part of opponent No. 1. Hence prayed for dismissal of the complaint.
5. OP.No. 2 filed version stating that, complainant had met with twisting injury to her left ankle after slipping over stone in her school on 14.08.2014 at Gutthinadu Village Chitradurga. For that on 15.08.2014 the complainant went to Govt. Hospital, Chitradurga where she took treatment and in the said hospital the concerned doctor has advised that she has not sustained any serious injury and not to worry. There is factual discrepancy between the version of complainant and the record produced. The OPD record of Government Hospital, Chitradurga does not mention any treatment whatsoever given to the complainant apart from the X-ray which was taken there on 15.08.2014. It is further submitted that, the concerned Doctor at District Hospital, Chitradurga had advised that there was nothing serious then there was no need for the higher hospital for further treatment. Thereafter, complainant went to BMCH on 16.08.2014. It is further submitted that, the complainant had sustained twisting injury to her left ankle because of slipping over stone for that complainant came up with severe pain in her ankle to OP No.2. In a case of twisting injury to the ankle most of the times X-ray will not show any fracture as in a case of ankle sprain which had been sustained by the complainant, hence no bony injury was seen in the X-ray of the complainant. For the injury sustained by the complainant. For that, OP No. 1 had applied supportive POP Slab and the same is mentioned in the OPD card of Basaveshwara Medical College Hospital & Research Centre henceforth called as BMCH & RC. The application of POP for a case of ankle sprain is as per medical literature and is mentioned in orthopedic books and hence the most appropriate treatment was given to the complainant. It is further submitted that, the POP slab is used to give support to injured limb. The complainant was not sent to house by OP No.1. Complainant after application of supportive POP slab advised by OP No.1 to admit to Female Orthopedic ward in the best interest of patient. However, this important advise given by OP No.1 was not accepted. The complainant was advised to undergo a set of routine Blood Investigations namely Hb% (Hemoglobin Percentage), TC (Total Count of White Blood Cells), DC (Differential Count of White Blood Cells) and ESR (Erythrocyte Sedimentation Rate). This set of Routine blood tests was advised to rule out other remote possibilities of Inflammation, Infection etc.. But this important advice which is documented in OPD card of BMCH & RC was again neglected by the Complainant and attenders. OP No. 1 had advised and treated the Complainant in most appropriate and professional manner. Had it not been the negligent and callus attitude of the Complainant and Attenders who did not follow golden advises given by OP No.1 the Complainant would not have landed with amputation of her limb. On 17.08.2014 the complainant was brought to Casualty of OP No. 2 at around 11-00 A.M with complaint of pain and swelling of left lower limb. Upon arrival of any patient to Casualty, the patient is first attended to by Casualty Medical Officer. After removal of supportive POP Slab and on examination of the limb the Complainant was advised to undergo Fasciotomy. In this surgery skin of the limb is cut open and the underlying muscle compartments are released to decrease pressure within muscle compartments so as to reestablish blood supply. This important advise was as usual neglected by the complainant and attenders despite having been explained the complications, prognosis and need for early intervention which is again mentioned in the referral card. The attenders wasted precious 10 and half hours from the time Referral Card was issued i.e., at 11-27 AM till the time they reached Kasturaba Hospital, Manipal at 10-00 PM. That if the attenders had followed the advice of emergency fasciotomy to the complainant it would have made a significant difference in the final outcome. It is further submitted that, the treatment given to the complainant for the injury sustained by slipping over stone which led to twisting of ankle by OP No. 1 at OP No. 2 Hospital was as per the guidelines mentioned in medical literature and while giving treatment proper care had been taken without any deficiency or negligence. As per the Discharge Summary of the Complainant issued by Department of Pediatric Surgery, Victoria Hospital, Bangalore dated 15.09.2014 where left below knee amputation was performed, the amputated part was sent for Histo Pathological Report. The HPR gives the most accurate diagnosis as it is done by seeing the cells of the part under microscope. The HPR of the complainant was suggestive of Necrotizing Vacuities which has finally been recognized only after the amputated part was sent for HPR has not been mentioned as a diagnosis either in the Discharge Summary issued by Kasturaba Hospital, Manipal or by Department of Pediatric Surgery, Victoria Hospital, Bangalore. These two very good hospitals of Karnataka with best of infrastructure in terms of Materials/Equipments, Testing facilities and Manpower with highest standards of Super specialty were not able to identify this entity of Necrotizing Vacuities prior to amputation. This fact itself is self-explanatory that the condition with which the Complainant was suffering was one of the rarest of rare disorders. That despite so many super-specialty doctors having failed to diagnose/identify this disease prior to amputation, how can OP no. 1 be blamed for the outcome/amputation of complainant who never supported or followed the instructions of OP no. 1 given at OP No.2 on 16.08.2014 and by the CMO of OP No. 2 on 17.08.2014. The cause of amputation of left leg of the Complainant is the disease which the complainant was suffering and their negligent attitude in not following the advice given by OP no. 1 and not any deficiency on the part of OP No.1 and OP No.2. OP No. 1 is a competent doctor who has completed his Master of Surgery in Orthopedics in 2006 and since then has been working for OP No. 2 gained experience of about 8 years as a consultant and has applied thousands of POP slabs without any complications. From the above said reasons, it shows the complainant has filed this complaint on flimsy and untenable grounds without any proper reasons and there is no deficiency in service on part of opponent No. 1, therefore, prayed for dismissal of the complaint.
6. One Sri.V.H. Ravi, the natural guardian/father of Complainant has examined as PW-1 by filing affidavit evidence and the documents Ex.A-1 to A-11 were got marked. OP No.1, Dr. Ambarish. S has examined as DW-1 by filing affidavit evidence and Dr. Palakshappa, the Medical Superintendent of OP No.2 has examined as DW-2 by filing affidavit evidence and Ex.B-1 and B-2 documents have been got marked.
7. Arguments heard.
8. Now the points that arise for our consideration for decision of above complaints are that:
- Whether the Complainant proves that OPs have done deficiency in service and negligence on their part while giving treatment to the complainant?
- What order?
9. Our findings on the above points are as follows:-
Point No. 1:- Partly in Affirmative.
Point No. 2:- As per final order.
REASONS
10. Point No.1:- We have pursued the medical record on file which includes OPD slip of Government Hospital, Chitradurga, OPD card of Basaveshwara Medical College and Hospital, Chitradurga, Referral Card of Basaveshwara Medical College and Hospital, Chitradurga, Case Sheet and Discharge Summary summoned from Kasturaba Hospital, Manipal, Case Sheet and Discharge Summary of Victoria Hospital, Bangalore, Medical Literature submitted by OP No.1 and Memo No. 1, 2 and 3 submitted by OP No.1 and 2.
11. We are of considered view that, when the complainant approached OP No. 1, on basis of the history given that is pain after twisting of left ankle after slipping over stone and purplish coloration inner/medial aspect of ankle suspected to be a case of ankle sprain, which is a common injury following twisting of ankle. OP No.1 applied POP SLAB for the complainant to give support to the injured part. We went through medical literature for POP SLAB and Ankle sprain as well as memo no. 1 filed by OP No.1. Putting of POP SLAB is one of the methods of treatment for ankle sprain as well as a POP SLAB is a supporting bandage which can accommodate swelling and is applied in any case of injury where rest is needed as well as swelling is present as it does not cover the whole circumference of limb. It is pertinent to note that, after going through the case sheet of Kasturaba Hospital, Manipal, we found that above knee POP SLAB was applied on 3 different dates i.e, 19.08.2014, 21.08.2014 and 26.08.2014. If application of below knee POP SLAB by OP No.1 is the cause of accusation of OP No.1 then we are of the opinion that Complainant and her Counsel are biased in filing this case against OP No.1 and that application of POP SLAB at Kasturaba Hospital Manipal does not find any mention in the version or written argument of the complainant.
12. OP No.1 had advised the complainant to get admitted to Female Orthopedic Ward and to get a set of routine blood investigations. The complainant and her attenders ignored this advise as, if the child was admitted she could have been given proper care in ward by nursing staff, doctors of Orthopedic Department as well as if need arose she could have been shown to doctors from other department. Since these important advises given by OP No. 1 was ignored by Complainant and her attender, which is negligence on their part.
13. Counsel for Complainant has mentioned that in the discharge summary of Victoria Hospital in the history column it is mentioned that, POP CAST was applied for suspected fracture by OP No. 1 for suspected fracture, Cast was removed on 2nd day for severe pain and blackish discoloration of left foot of the complainant, hence it was the cause of amputation. We cannot rely on the history given at Victoria Hospital, Bangalore as the patient went there only after getting Discharged Against Medical Advice from Kasturaba Hospital, Manipal. The OPD Card from BMCH, Chitradurga clearly mentions that it was not a POP CAST but a POP SLAB. As far as coloration of limb is concerned the documents summoned from Kasturaba Hospital, Manipal mentions that there was bluish coloration and not blackish coloration. In this case counsel for OP No. 1 suggested expert opinion from various hospitals in Karnataka but, the same was not accepted by counsel for complainant. Therefore, are of considered view that OP No. 1 having treated the patient for ankle sprain by application of POP SLAB is correct and don’t find any flaw with treatment. It was as per standard of practice. The advise for getting admitted to ward and getting a set of routine blood investigations was proper and bonafide advise by OP No.1 and there was no deficiency in service or negligence by OP No.1 as he took proper care of the complainant. The amputated part when sent for biopsy revealed that it was a case of Necrotizing Vacuities as per the discharge summary of Victoria Hospital, Bangalore. The medical literature clearly mentions that Necrotizing Vacuities is very rare in children. It is unfortunate that the child was suffering from a very rare disease and had to undergo amputation.
We would like to rely upon various judgments from Hon’ble Supreme Court. In “Martin F. D’Souza V.s Mohd. Ishfaq” AIR 2009 SC 2049” it was observed that,
“Simply because a patient has not favourably responded to a treatment given by a doctor or a surgery has failed, the doctor cannot be held straightway liable for medical negligence by applying the doctrine of resipsa loquitur. No sensible professional would intentionally commit an act or omission which would result in harm or injury to the patient since the professional reputation of the professional would be at stake. A single failure may cost him dear in his lapse”.
In Jacob Mathew Vs. State of Punjab & Another (2005) 6 SCC 1 the Hon’ble Supreme Court had concluded that,
“a professional may be held liable on one of two findings : either he was not possessed of requisite skill which he professed to have possessed, or, he did not exercise with reasonable competence in given case, the skill which he did possess.”
14. In this case OP No. 1 who was working at the time of incident was Associate Professor in Department of Orthopaedics of Basaveshwara Medical College and Hospital, Chitradurga since many years hence he possessed requisite skill as well as he exercised his skill with reasonable competence in this case.
15. The Hon’ble Supreme Court Bench of Justice Dalveer Bhandari and H.S. Bedi has made 11 point guidelines for courts to adjudicate complaint against doctors. One of the points is that, “Medical professional is expected to bring a reasonable degree of skill and knowledge along with a reasonable degree of care but neither the highest nor the lowest degree of care and competence”. In this case reasonable degree of skill and knowledge along with reasonable degree of care was shown by OP No. 1, but the complainant was suffering from a rare disease as well as did not follow the advise of OP No. 1, hence we do not find any deficiency in service or negligence by OP No. 1.
16. The patient was referred to higher centre by other doctors of OP No. 2 as the advise of Fasciotomy which was given in Casualty, for which the complainant and attenders did not agree, the same surgery (Fasciotomy) was done at Kasturaba Hospital Manipal on 19-08-2017. We do not find OP No. 2 negligent as proper advise was given at proper time.
17. On basis of the medical documents produced before this forum we are of considered view that on merits of the case, this case be dismissed as OP No. 1 AND op No. 2 are not negligent in discharge of their duties. It is only on humanitarian grounds as the child has lost her limb that we are ordering OP No. 1 to pay Rs. 10,000/- and OP No-2 to pay a sum of Rs. 90,000/-.
18. Point No.2:- As discussed on the above point and for the reasons stated therein we pass the following:-
ORDER
The complaint filed by the complainant U/s 12 of CP Act 1986 is partly allowed.
It is ordered that, the OP No.1 is hereby directed to pay a sum of Rs.10,000/- and OP No.2 to pay a sum of Rs.90,000/- in all a sum of Rs.1,00,000/- to the complainant. Out of which, Rs.80,000/- is ordered to be deposited in any nationalized Bank in the name of minor complainant Kumari. R. Kavya till she attains majority.
It is further ordered that, the father of the complainant by name Sri. V.H. Ravi is at liberty to receive the remaining sum of Rs.20,000/-.
It is further ordered that, the father of the complainant by name Sri. V.H. Ravi is at liberty to receive the interest amount in three months once from the deposited amount from the Bank for the benefit of his minor daughter.
It is further ordered that, the OP No.2 is hereby directed to pay Rs.10,000/- towards mental agony and Rs.10,000/- towards costs of this proceedings.
It is further ordered that, the OPs are hereby directed to comply the above order within 30 days from the date of this order.
(This order is made with the consent of Member after the correction of the draft on 14/09/2017 and it is pronounced in the open Court after our signatures)
MEMBER PRESIDENT
-:ANNEXURES:-
Witnesses examined on behalf of Complainant:
PW-1: Sri. V.H. Ravi, by way of affidavit evidence.
Witnesses examined on behalf of OPs:
DW-1: OP No.1 by way of affidavit evidence.
DW-2:- Medical Superintendent of OP No.2 by way of affidavit evidence.
Documents marked on behalf of Complainant:
01 | Ex-A-1:- | OPD Card dated 16.08.2014 of BMC Hospital, Chitradurga |
02 | Ex-A-2:- | Referrel Card |
03 | Ex-A-3:- | Report of Radiology issued b y KMC Hospital, Manipal |
04 | Ex-A-4:- | Registration Slip issued by Victoria Hospital, Bangalore |
05 | Ex.A-5;- | Discharge Summary issued by Dept. of Pediatric Surgery, BMC and RI Super Specialty Hospital, Bangalore |
06 | Ex.A-6:- | Legal Notice dated 12.05.2015 |
07 | Ex.A-7:- | Postal receipts |
08 | Ex.A-8:- | Postal Acknowledgement |
09 | Ex.A-9:- | OPD Book of District Hospital, Chitradurga |
10 | Ex.A-10:- | Bill issued by Basaveshwara Hospital, Chitradurga |
11 | Ex.A-11:- | Photo |
Documents marked on behalf of OPs:
01 | Ex-B-1:- | Out Patient Registration Form with discharge summary |
02 | Ex-B-2:- | OPD and Admission records |
MEMBER PRESIDENT
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