Date of filing: 15.11.2012.

                                                                                        Date of disposal: 11.04.2014.

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM - II:

VIJAYAWADA, KRISHNA DISTRICT

 Present: Sri A. M. L. Narasimha Rao, B.Sc., B. L., President

             Smt N. Tripura Sundari, B. Com., B. L.,   Member

   Sri S. Sreeram, B.A., B.Com., B.L.,           Member

Friday, the 11^th day of April, 2014

 C.C.No.191 of 2012

Between:

 Consumer Guidance Society Representing:  Smt P. Adilakshmi, C/o Ranga Rao, Aged about 47 years, R/o.D.No.74-20-1/1, Ashok Nagar, Vijayawada,

                                                                                                                        ….. Complainant            

                                                                         And

1.  Dr. Koneru Sridhar, M.D. (Gen.), Consultant Physician, Sowmya General Hospital, Beside Sonovision, Opp: Mohandas Theatre, Patamata, Vijayawada – 520010.

 2.  Gadde Diagnostics, Rep: by its Proprietor, Vemuru Vari Street, Suryaraopet,  Vijayawada – 2. 

                                                                   . … Opposite Parties.

            This complaint coming on before the Forum for final hearing on 28.03.2014, in the presence Consumer Guidance Society for complainant; Sri P. Chitti Babu, advocate for opposite parties and upon perusing the material available on record, this Forum delivers the following:

O R D E R

 (Delivered by Hon’ble President Sri A. M. L. Narasimha Rao,)

 1.         This complaint is filed under Section 12 of Consumer Protection Act, 1986 for a direction to the opposite parties 1 and 2 to refund the amount of Rs.53,030/- collected from the complainant for treatment, to pay Rs.2,00,000/- as compensation for mental agony and to pay costs.

2.         The averments of the complaint in brief are as follows:

            The complainant approached the 1^st opposite party on 24.8.2012 with high fever and general debility.  On the advice of the 1^st opposite party after examination, the complainant was admitted in the hospital as inpatient.  As instructed by the 1^st opposite party the complainant had given blood samples to the diagnostic lab in-charge of 2^nd opposite party which has a diagnostic unit in the cellar of the hospital of the 1^st opposite party.  The lab incharge of the 2^nd opposite party took blood samples of the complainant on 24.8.2012 and on every consecutive day there after till 30.8.2012 as directed by the 1^st opposite party.  The 2^nd opposite party had charged a sum of Rs.7,160/-.  The 2^nd opposite party issued 7 blood reports, signed by lab in-charge.  The name and designation of the signing person was not given.  The time of taking sample was also not noted in the reports.  The blood reports showed the platelets count hovering around 10,000 to 15,000.  On two occasions negative finding was given in the Dengue Duo test.  The 1^st opposite party insisted the relatives accompanying the complainant to give blood samples of the complainant at the 2^nd opposite party though the reports given by the 2^nd opposite party were erratic, inadequate and contained incorrect date pertaining to platelets count, hemoglobin etc.  The 1^st opposite party had made the complainant to get unnecessary diagnostic tests and directed the relatives of the complainant to purchase units of platelets from a blood bank to administer the same to the complainant for increasing platelets count.  But the platelets count did not improve and even went down some times.  The 1^st opposite party failed to undertake minute physical examination of the complainant to arrive at correct diagnosis.  The 1^st opposite party failed to exercise minimum degree of professional care, skill and diligence expected from any medical professional of his stature.  The 1^st opposite party had also advised the complainant to undergo ultra sound study of abdomen twice from Chinni Diagnostic Specialties, Vijayawada, though the 1^st report disclosed an impression of normal study.  The relatives accompanying the complainant suspected the findings in the blood report on referring them to family friend and they insisted the 1^st opposite party to another diagnostic centre for blood test.  Then the 1^st opposite party referred the complainant to Dr. Krishna Reddy of Manipal Hospital where complete blood picture of the complainant was analyzed.  It revealed the inaccuracies and blunders in the blood report issued by the 2^nd opposite party.  The complainant had to incur an expenditure of Rs.53,030/- towards medical bill of the opposite parties 1 and 2 due to negligence on the part of the opposite parties.  Therefore the present complaint is filed for the refund of the medical bill amount and for compensation. 

3.         The 1^st opposite party filed his version denying the allegations made in the complaint and further stating as follows:

            The 2^nd opposite party diagnostic lab is a registered lab as per the norms and is running successfully with equipment and with full qualified staff.  The 2^nd opposite party started branches in different places and likewise running business in the hospital of 1^st opposite party.  P. Syam Babu the lab incharge at 1^st opposite party hospital is qualified technician and he had given reports with accurate and correct readings.  The 1^st opposite party did not collect any amount towards charges.  The 1^st opposite party never insisted the complainant or her relatives to give blood samples to the 2^nd opposite party only. The nursing staff of the 1^st opposite party did not insist the patients for unnecessary tests.  As the complainant was suffering high grade fever it has become mandatory to get ultra sound scan for abdomen to rule out focus infection in the abdomen or deposit of unwanted fluids in the abdomen.  Ultra scan was advised for the 2^nd time as the complainant complained abdomen pain.  The complainant was referred to Dr. Krishna Reddy of Manipal hospital to correlate condition of the complainant and in view of hematological picture so as to rule out the possibility of rare diseases like myeloproliferative disease and aplastic anemia.  The reference was not to compare reports of the 2^nd opposite party with report of the Manipal super specialty hospital.  In high grade fevers the patients will recover from all of sudden as well as platelet count would increase suddenly.  The 1^st opposite party discharged the complainant on 1.9.2012 after satisfying with the condition of the patient.  Later the complainant visited the 1^st opposite party hospital on 4.9.2012 and 10.9.2012.  Infact the complainant was an old patient of the 1^st opposite party.  The opposite parties never collected any amount illegally or unwontedly.  There is no deficiency in service on the part of the opposite parties and complainant is not entitled to any amount as claimed.      

4.         The 2^nd opposite party filed separate version in the form counter denying the allegations made in the complaint and further stating as follows:

            Soon after admission of the complainant in the hospital of the 1^st opposite party, the lab technician had collected blood samples from the complainant for complete blood picture and the complainant paid charges.  The lab technician issued reports after conducting blood examination in the cell count machine the platelet count of the complainant had dropped to 16,000.  The 1^st opposite party immediately started treatment and the complainant responded well to the treatment and she recovered from day to day.  As the complainant had high grade fever and as there was speedy drop in platelet count it has become necessary to collect blood samples from time to time to know the condition of the patient from time to time.  The 2^nd opposite party lab is registered lab running with full equipment and qualified staff.  Later it started branch in the hospital of 1^st opposite party and extended services to the patient.  The lab incharge is a qualified technician.  He has given report with correct and accurate readings.  There is no wrong in the reports.  The opposite parties did not violate medical code and never conducted unnecessary tests.  Non-qualified staff are not entitled to question the reports given by the 2^nd opposite party.  Consumer Guidance Society is not competent to file this complaint.  There is no deficiency in service on the part of the opposite parties.  The complainant is not entitled to any relief.

5.         The complainant filed her affidavit and additional affidavit as deposition of PW.1.  The 1^st opposite party filed affidavit as deposition of DW.1.  DW.2 is the lab technician of the 2^nd opposite party.  All the witnesses were subjected to cross-examination.  Ex.A1 to A18 are marked on behalf of the complainant and Exs.B1 to B10 are marked on behalf of the opposite parties.

6.         Heard the arguments advanced by the learned counsel for both the parties.  The parties have filed memoranda of written arguments also.

7.         The points that fall for determination are:

1. Whether there is any negligence on the part of the opposite parties 1 and 2 in rendering treatment to the complainant?

1. Whether the complainant is entitled to the amounts claimed?

Point No.1:                

8.     The complainant was admitted in the hospital of the 1^st opposite party on 24.8.2012.  She was said to be running high fever.  The 1^st opposite party states in his written version that the 1^st opposite party was in a serious condition with acute febril illness of unexplained origin with hematological abnormality of thrombocytopenia and that immediately lab technician collected the blood samples from the complainant for complete blood picture and that after conducting blood examination in the cell count machine the lab technician issued report showing platelet counts dropped to 16,000.  The 1^st opposite party further states that he commenced treatment that the complainant responded well and recovered well from day to day.  The complainant was in the hospital of the 1^st opposite party from 24.8.2012 to 1.9.2012.  During that period the 2^nd opposite party laboratory had taken blood samples several times and issued blood reports under Exs.A1 to A7.  Ex.A1 contains of two reports for two samples taken on the same day, may be at different times.  Ex.A2 contains two reports for the two blood samples taken on 25.8.2012.  Ex.A3 contains three blood reports for the blood samples taken on two times or three times.  Time is mentioned in only one of the sheets of Ex.A3.  Ex.A4 consists of three reports two of which relate to blood tests of same investigation at different times and the 3^rd one relates to urine test and blood test without noting down the time.  Ex.A5 consists of two reports given on 28.8.2012 at 9.50 Am and 7.44 PM.  Ex.A6 consists of three reports of which two relate to same type investigation on two different samples taken from the complainant.  Ex.A7 contains two blood reports given on 30.8.2012 one of which does not give the time of taking sample or giving report.  In all of these blood reports the platelet count is noted within range between 10,000/Cu.mm and 16,000/ Cu.mm as against the normal range of 1.5 to 4.5 lakhs/ Cu.mm.  As against these readings it is necessary to see the temperature variation of the patient from 24.8.2012 to 30.8.2012.  Ex.B2 is the observation sheets maintained by the 1^st opposite party hospital for the treatment given to the complainant from 24.8.2012 to 1.9.2012.  The temperature noted in Ex.B2 are given in the table below: (high temperatures highlighted)  

            We have some doubt on the correction of this chart in Ex.B2.  According to Ex.A11 report the complainant was in Manipal hospital at 2.04 pm, but the chart in Ex.B2 shows a reading taken at 2.00 pm, not practicable as Manipal hospital is about 4 Kms away from the hospital of 1^st opposite party.

9.    On reference by the 1^st opposite party the complainant went to Dr. Krishna Reddy, DW-3 of Manipal hospital on 31.8.2012.  Ex.A11 blood report taken in Manipal hospital shows that the blood samples may have been taken at or after 2.04 PM on 31.8.2012 by then the platelet count was 2.5 lakhs as against normal range of 1.5 to 4.5 lakhs units.  By then the temperature of the complainant was normal as per the observations in Ex.B2.  Again 16.30 PM the temperature was 99.8º and 99º slightly above normal.  The opposite parties examined Dr. Krishna Reddy as DW-3 and he has given reason as to the variation in platelet count.

10.     DW-3 Krishna Reddy states during examination in chief that the platelet count rapidly increase in the recovery phase that platelet may have fluctuations depending on the patient having viral fever or in recovery phase of illness that while the patient is in recovery phase the collection of platelet may increase rapidly in multiples of normal as production increases and the consumption of platelets decreases.  He further states that when the patient is running high fever the platelet may not increase inspite of external supply as there will be high consumption.  He further deposed during cross examination that when the patient is running fever and has low platelet count the doctor will proceed to get platelet transfusion and that the 1^st opposite party explained him that platelet count was not raising in spite of external supply.  As per Ex.B2 two units of platelets were given for the 1^st time on 5.20 PM on 25.8.2012 and later platelets were given in two units at 10.45 PM on 25.8.2012, two units at 3.20 PM on 26.8.2012, from a single donar at 11 PM on 26.8.2012,  two units at 12.50 AM (00.50 AM) on 22.8.2012 and two units at 11.15 AM on 30.8.2012.  So lastly platelets were given at 11.15 AM on 30.8.2012.  Thereafter there was no external supply of platelet and it appears last blood report given by the 2^nd opposite party in Ex.A7 reveals the platelet count at 10,000 on 30.8.2012.  This 1^st sheet Ex.A7 must have been given later as the 2^nd sheet of Ex.A7 bears the time 10.17 AM and as the sample are taken normally once in the morning and once in the evening.  The 1^st sheet observations cannot be prior to 10.27 AM as there is no extreme abnormality found and noted in observation sheet Ex.B2 prior to 10 PM on 30.8.2012 except small rise in the temperature up to 100º.                                                                                                                                                                                                                                                                                                                                                                                                                        

11.       Platelets are tiny bits of protoplasm found in vertebral blood essential for blood clotting.  If the platelet count drops to below 20,000 there is high probability of the patient suffering bleeding (hemorrhage)due to highly insufficient clotting behavior.  In the discharge summary given by the 1^st opposite party it is noted that the patient was admitted with high fever of 105º, gen-toxic state with tentative diagnosis of Ac.pyrexial illness of probable viral aetilogy.  The 1^st opposite party further stated that the patient was administered drugs and 8 to 10 units of platelets concentrate and one packet sdp because of severe thrombocytopenia with mucosal bleeding as evidenced by microscopic hematemia (not legible) and one packet whole blood because of anemia.  The 1^st opposite party further stated that patient continued to suffer from high fever intermittently till 28.9.2012 along with severe abdominal pain etc.  According to discharge summary the patients general condition started improving from 30.8.2012.  According to this discharge summary there was thrombocytopenia (reduction in the number of platelets in the blood which results in bleeding into skin spontaneous bleeding and prolonged bleeding after injury).  The 1^st opposite party has not filed case record as such maintained by the hospital.  The complainant filed the case sheet papers under Ex.A8.  The 1^st opposite party did not make any mention as to mucosal bleeding and microscopic hematemia as noted in the discharge summary Ex.B1.  We do not find any such observation in Ex.A8 except one illegible writing on 29.8.2012 and an observation of yellowish Vomitting at 9 PM on 28.9.2012.  It is to be noted that the discharge summary was filed by the 1^st opposite party along with the version.  So it could have been prepared by the 1^st opposite party after receiving the copy of complaint and to suit the defence.  The ultra sound study of abdomen pain on 25.8.2012 and marked as Ex.A9 did not show any abnormality in the liver, gallbladder etc., and the impression was normal study.  Then we must hold that there was no hemorrhage due to thrombocytopenia which infers that the drop in platelet count to less than 20,000 throughout the period from 24.8.2012 to 30.8.2012 is not correct.  We do not find any report relating to examination of stool in the reports Exs.A1 to A7.  It is further to be noted that on 30.8.2012 the bleeding time and clotting time were in normal range while the platelet count was 10,000 only as per the blood report in the 1^st sheet on Ex.A7.  From the above discussion we are of the considered opinion that the reports issued by the 2^nd opposite party under Exs.A1 to A7 do not give the correct platelet count from the blood samples taken from the complainant from 24.8.2012 to 30.8.2012.

12.       The 1^st opposite party being an M.D. General Medicine would have easily detected the defect in the readings not tallying with the symptoms and observations of the patient, but he went on getting the reports from the lab incharge of the branch of 2^nd opposite party in the 1^st opposite party hospital.  The 1^st opposite party tried to explain that he did not refer the complainant to the 2^nd opposite party and the samples were taken at instance of the complainant and her attendants.  This looks very absurd.  It is not the statement of the 1^st opposite party that he had given any written advice to get blood test done anywhere and that the complainant had taken the services of the branch of 2^nd opposite party for blood test.  In all the reports Exs.A1 to A7 the 1^st opposite party is noted as the doctor referring the patient.  Therefore the 1^st opposite party ought to have taken normal care to see absurdity of the shockingly low platelet count in the blood reports given by the 2^nd opposite party.  To that extent we hold that there is deficiency in service on the part of the 2^nd opposite party as well as the 1^st opposite party.

13.       The learned counsel of the opposite party relied upon several rulings of the National Commission and Apex Court, on medical negligence.  It is not necessary to note all of them.  Suffice it to refer to the two decisions of Supreme Court relied on by the opposite party.

            In Martin F. Disonza V. Mohd. Ishfaq 2009 (3) 231 (SC) the apex court referred to some earlier rulings including the ruling in Jacb Mathew’s case (2005 (6) SCC 1).  The principles laid down in Jacob Mathew’s case for protecting doctors, were extracted in Martin F.D’Souza.  Relying on those principles and applying them to the facts of that case, the apex court found no medical negligence.  The Apex Court observed in paragraph 73 of the judgement that as long as the doctors do their duty with reasonable case, they will not be held liable even if their treatment was unsuccessful.

            In Kushan Sharma and Others V. Batra Hospital & Medical Research Center and another.  AIR 2010 SC 1050, the complaint was that the doctor adopted ‘anterior’ approach in a surgery for removal of adrenal tumor instead of ‘posterior’ approach and both approaches were well accepted by the medical field, depending on facts of the case.  It was held that there was no medical negligence.

            These rulings have no application since we found that there is no evidence of wrong treatment given to the complainant.  However we refer to the ruling of Apex court in V. Kishan Rao V. Nikhil Super Speciality hospital, 2010 (3) CPR 101 (SC) wherein the direction given by Martin D’souzas in paragraph 117 of the judgment was not accepted.  The Apex court further observed that in case where negligence is evident the principle of ‘res ipsa loquitur’ oprates and the complainant does not have to prove anything as the thing proves itself.       

14.       The learned counsel for the complainant verymuch harps upon non-registration of the branch of the 2^nd opposite party located in the hospital of the 1^st opposite party.  The 2^nd opposite party himself had stated that they opened a branch in the hospital of the 1^st opposite party.  The District Medical and Health Officer had stated that no branch of Gadde Diagnostics has been registered in Vijayawada.  No doubt the 1^st opposite party should have taken care to see that only the services of registered laboratory are availed for the benefit of the patient coming to the hospital.  The learned counsel for the complainant refers to a ruling of High Court of Gujarat at Ahmedabad in Association of pathologists of Bhavanagar and others Vs Secretary, Health Department and others in spl. Civil appeal No.7999 of 1998 decided on 17.9.2010.  The High Court held that the laboratory technicians, not being pathologists cannot run laboratory independently and cannot directly give any report to any patient or any other individual, or to any institution or practicing doctor without authentication of the same by the pathologist registered with medical counsel.  So the report given by the lab technician under Ex.A1 to A7 are not valid as they are not signed by the registered pathologist.  Ex.A5 given by proprietor of 2^nd opposite party has no value as she is not a pathologist.  However, the non-registration is of no consequence because non-registration by itself is not shown to have led to any deficiency.  DW.2 the lab incharge is said to have required qualification to conduct blood tests.  Therefore the plea relating to non-registration of the branch of 2^nd opposite party is not a tenable plea to constitute independent deficiency.  In fact that plea was not taken in the complaint and raised during inquiry.  However it would add weight to the want of reasonable care discovered earlier.   

15.       The 1^st opposite party has treated the complainant from 24.8.2012 to 1.9.2012 and after discharge the complainant again visited the 1^st opposite party on 4.9.2012 and 10.9.2012 as per the deposition of PW.1 during cross-examination.  At the time of discharge the complainant was not running fever but she is said to be weak.  The complainant is not shown to have suffered from any further illness and not shown to have taken treatment elsewhere soon after discharge from the 1^st opposite party hospital.  Therefore we can accept the contention of the 1^st opposite party that he treated the illness of the complainant to complete recovery.  The complainant has not produced any material to show that the nature of treatment given by the 1^st opposite party is either improper or defective.  Infact the complainant had recovered from illness from the treatment given by the 1^st opposite party.  If some platelets were externally supplied more than needed, we cannot weigh it with mathematical exactitude.  Therefore we cannot find fault with the nature of treatment given by the 1^st opposite party to the complainant and deficiency cannot be attributed in that regard.  Therefore we conclude on this point that the 2^nd opposite party was found to be deficient in service as regards giving incorrect reading of platelets on blood examination on about 14 times from 24.8.2012 to 30.8.2012.  The 1^st opposite party who failed to notice the absurd readings is also deficient in service as any doctor with his qualification and his stature would certainly doubt the reports given by the 2^nd opposite party as regards platelet count.

Point No.2:        

16.       In view of answer on point no.1 the complainant is entitled to compensation.  The compensation to be granted shall be proportionate to loss occasioned to the complainant and injury caused to her and any sufferance because of such deficiency.  It is observed that there is no defect in the nature of treatment.  The complainant had recovered well.  Only the reports of the 2^nd opposite party are found to be defective that too relating to platelet count.  The blood reports contain other investigations besides counting platelets.  Therefore entire amount paid to the 2^nd opposite party cannot be considered as loss occasioned to the complainant.  The complainant has not stated how much amount was spent to secure platelet units.  We cannot say certainly that some units of platelets were externally given more than needed.  We cannot assess how many unneeded units were secured.  In view of these factors we are of the opinion that a reasonable compensation is sufficient to meet the ends of justice.  We feel that a sum of Rs.10,000/- may be allowed as reasonable compensation in view of the deficiency on the part of both the opposite parties.  Both of them shall be made liable.  Therefore we are of the opinion that the complainant is entitled to compensation of Rs.10,000/- and costs assessed at Rs.1,000/- from the opposite parties 1 and 2.

16.       In the result this complaint is allowed in part and the opposite parties 1 and 2 are directed to pay jointly and severally a sum of Rs.10,000/- (Rupees ten thousand only) towards compensation and a sum of Rs.1,000/- (Rupees one thousand only) towards costs to the complainant.  The amounts awarded shall be paid within one month from the date of this order.  Complaint for rest of the reliefs is dismissed.

      Dictated to steno, N. Hazarathaiah, transcribed by him, corrected by me and pronounced by us in the open Forum, this the 11^th day of April, 2014.

PRESIDENT                                                MEMBER                                          MEMBER

Appendix of evidence

Witnesses examined

For the complainant:                                                         For the opposite party:

PW.1 : Smt P. Adilakshmi                                                   Dw.1 : Dr. Koneru Sridhar, OP-1.      

(by affidavit)                                                                           Dw.2 : P. Syambabu, Lab                                                                                                       Technician of OP.2           

                                                                                                Dw.3 : Dr. Krishna Reddy

Documents marked

On behalf of the complainant:

Ex.A1 to A7                           Original copies of blood reports.  

Ex.A8             24.08.2012    Original copy of case record.

Ex.A9             25.08.2012    Original copy of Ultra sound study of abdomen.

Ex.A10           30.08.2012    Original copy of Ultra sound study of abdomen.

Ex.A11           31.08.2012    Original copy of complete blood picture.

Ex.A12           31.08.2012    Original copy of complete blood examination.

Ex.A13                                   Copies of cash bills (38).

Ex.A14           20.09.2012    Copy of legal notice got issued by the complainant.

Ex.A15           08.10.2012    Copy of reply notice got issued by the Ops.

Ex.A16           14.10.2012    Copy of rejoinder notice got issued by complainant. 

Ex.A17                                   Postal cover.

Ex.A18           08.04.2013    Copy of letter issued by DMHO, Machilipatnam.

On behalf of the opposite party: 

Ex.B1             01.09.2012    Original copy of discharge summary.

Ex.B2             24.08.2012    Original nursing sheets.

Ex.B3             04.09.2012    Attested copy of OP register.

Ex.B4             10.09.2012    Attested copy of OP register.

Ex.B5             01.01.2013    Original copy of letter of authorization.

Ex.B6             21.10.2009    Notarized copy of certificate of registration.

Ex.B7             18.06.2010    Notarized copy of certificate of registration allopathic private                             medical care establishment.

Ex.B8                                     Notarized copy of degree certificate in medical lab                                               technology.

Ex.B9                                     Notarized copy of registration certificate.

Ex.B10                                   Attested copy of intermediate pass certificate.

            PRESIDENT