DATE OF FILING : 08.05.2008
BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, IDUKKI Dated this the 29th day of January, 2010
Present: SRI.LAIJU RAMAKRISHNAN PRESIDENT SMT.SHEELA JACOB MEMBER SMT.BINDU SOMAN MEMBER C.C No.37/2008 Between Complainant : Remya W/o Rajesh, Kottarathil House, Marygiri P.O, Njarakavala Kara, Thopramkudy, Idukki District. (By Adv: Babichen.V.George) And Opposite Parties : 1. Dr.N.N.Prasad, Gynaecologist, St.John's Hospital, Kattappana P.O, Idukki District Presently working at Assistant Professor, Raja Rajeswari Medical College, Bangalore. (By Adv: Benny Joseph) 2. The Director, St.John's Hospital, Kattappana P.O, Idukki District. (By Adv: Baby Joseph) O R D E R SRI.LAIJU RAMAKRISHNAN(PRESIDENT)
The complainant approached the 2nd opposite party hospital in which the Ist opposite party doctor who is a Gynaecologist, for medical consultation in relation to her pregnancy. When her pregnancy was about 2 ½ months old, as the growth of the foetus was not upto the optimum, the doctor advised her to terminate the pregnancy and it was done. After one month when called on the doctor then the doctor advised her only to enter the family way after six months. After 7 months again she consulted the doctor and the doctor advised her that she can conceive only after taking one month medicine and she did accordingly. She was again pregnant in August 2006 and she continued her consultation with the same doctor. After the expiry of two months, the doctor told the complainant that the foetus is lacking one week growth but he advised her to continue. On the fourth month's check up it was told that the foetus keeps fair position. Believing the doctor complainant continued the pregnancy and the complainant reached the hospital for fifth month's check up. On 24.03.2007 the complainant was advised for a scan and on perusing the scanning report the doctor revealed that the foetus is not having the required growth and suggested for termination of pregnancy. On 25.03.2006 the opposite party doctor had done D&C in the 2nd opposite party's hospital. After that the doctor directed her to meet him after one month. After a few days of D&C, complainant experienced a feeble stomach ache and she approached the doctor. The doctor opined that it may be due to absence of menstruation and medicines were given for the same. On 8.04.2006 by 8 p.m, complainant underwent severe thick bleeding. Complainant reached the hospital by 9 p.m but she was examined by the doctor only on the next day evening. After the examination, the doctor said that there is nothing wrong and there is possibility of bleeding after abortion for 2 to 4 months. Complainant and her husband enquired whether any scanning or other investigations are required. The doctor replied that those things are not required and taking sufficient rest will solve the problem. The complainant was discharged on the same day. The bleeding continued every day and complainant suffered heavy stomach ache too. Bleeding gradually increased and so the complainant and her husband felt doubt in the treatment of opposite parties. So she was taken to Medical Trust Hospital, Nedumkandam on 13.05.2007. In Medical Trust Hospital, different doctors of Gynaecology department examined her and complainant underwent scanning. On going through the scanning report, they opined either multiple cysts in the ovary or degenerated retained parts of conception would be the reason for pain and bleeding of complainant. She was referred to Medical College Hospital, Kottayam for expert management through a letter explaining investigation and findings conducted at Medical Trust Hospital, Nedumkandam. The complainant and her husband consulted Dr.T.J.Cicily along with the letter given by the hospital authorities. As per the advice of Dr.T.J.Cicily, scanning was done. After perusing the scanning report, she advised to meet Dr.Beenakumari, Assistant of Dr.T.J.Cicily. Dr.T.J.Cicily stated that there was infection in the uterus since there was retained portions of conception after the previous abortion. The complainant was admitted in the Medical College Hospital on 18.05.2007 and surgery was conducted on 22.05.2007 for removing the degenerated products of conception. Scanning was done on 23.05.2007 to analyse the situation after surgery. It was found that still there are portions of retained products in the uterus. The doctor told to the complainant that since the last abortion was before 2 months, the decomposed portions were adhering to the walls of the uterus which made it uneasy to remove all the retained products at one stretch. On 25.05.2007, the complainant was subjected to second surgery in the Medical College Hospital, Kottayam and the entire retained products of conception were removed. On 26.05.2007 again scanning was done and Dr.Cicily made sure that no retained products of conception is left in the uterus of the complainant. After that the complainant is alright and holds perfect health at present. She continued the medicines for 21 days. All these incidents occurred due to the sheer negligent act of the Ist opposite party. The Ist opposite party ought to have made sure that all the products of conception were removed in abortion conducted by him, the whole episode after that could have been avoided. The stomach ache, heavy bleeding and other inconveniences were caused due to the careless and negligent act of the Ist opposite party for 2 months. The Ist opposite party is acting under the supervision of the 2nd opposite party, hence the 2nd opposite party is also a necessary party in this proceedings. The complainant expended Rs.18,301/- from 3.05.2007 to 4.07.2007 towards treatment and other expenses. So this petition is filed for getting compensation to the tune of Rs.2 lakhs and such other relief.
2. As per the written version of the Ist opposite party, the Ist opposite party treated her with utmost care, each time the patient has approached him. A lot of effort was put to save her second pregnancy, but due to natural causes she lost it. The fact that evenafter loosing the first pregnancy, they continued treatment with me that they had faith in my ability and were convinced that, I had taken care of them during the first pregnancy. The complainant did not come to this opposite party's hospital on 8.04.2006 as alleged. Firstly there is discrepancy in the dates mentioned in the petition and the actual dates of the events. D&C was done on 25.03.2007, patient came for follow up on 3.05.2007, with history of not having bleeding. She was reassured as it is common to have irregular cycles after D&C. The fact that she had no bleeding for one and half months after D&C goes against the claim of incomplete evacuation. If the patient had retained products of conception she would have continued to bleed after D&C. The patient was admitted on 8.05.2007 at 10.45 p.m with complaints of excessive bleeding, again a common phenomenon after abortion. The first three cycles after abortion can be heavy. She was advised treatment by causality medical officer in consultation with him. On 9.05.2007 she was found to be stable and was shifted out of labour room to ward on his advice at 7 a.m. She was seen by me at 1.15 p.m and was reassured and the same treatment continued as she had responded. Eventhough she wanted to go home on the same day, she was asked to stay back and were discharged the next day after her complaints were totally treated. D&C done to clear products of conception, after missed abortion is a blind procedure. So utmost care should be taken to avoid any injury to uterus and other internal organs. In view to prevent injury to uterus, at times there can be some products retained, it is one of the commonest complication of this procedure. More so when done at an advanced stage of pregnancy as in this case. There was no indication to conduct ultrasound scanning, so it was not suggested and done. If the patient had returned to the Ist opposite party instead of going elsewhere, she would have been subjected to scanning and necessary remedial measure would have being done as he has taken care of her throughout the pregnancy and even after. We handle a good number of cases of retained products after D&C as ours is a referral hospital. So this case would have being treated here without the need of having to stay out station for 14 days, for which they claim compensation. Retained products of conception can only be confirmed by histopathology report. Complainant had not produced any such result and the complainant has not produced any satisfactory evidence to prove that there is retained products. What all treatments are done in Medical Trust Hospital, Nedumkandam and Medical College Hospital, Kottayam are known to the complainant only and are to be strictly proved by the complainant herself. There is no negligence, deficiency in service or careless or wilful latches from the part of the Ist opposite party in treating the complainant. The complainant has not caused or sustained any damages or loss due to any fault of the opposite parties. Hence the complainant is not at all entitled to get any of the relief as claimed in the petition. 3. As per the written version of the 2nd opposite party, it is admitted that the complainant came for pregnancy check up in the opposite party's hospital. In Gynaecology Department itself three qualified and efficient doctors are working in the opposite party's hospital and the complainant on her choice selected Dr.N.N.Prasad, as her doctor, who is working elsewhere now. It is true that the growth of the foetus of complainant is not upto the optimum level and the treated doctor advised about the consequences and hence the complainant and her husband decide to dilatation and curation and it was done. The further averment that after one month when she called on the doctor, then he advised her only to enter the family way only after six months is denied being false. Normally some gap should be there otherwise it will create health problems and will affect the future pregnancy. The complainant again got pregnant and that too was lacking growth. So again as per the decision of the complainant the doctor was constrained to done dilatation and curation of the complainant on 25.03.2007 and advised bed rest for one month. The averment that the complainant reached the hospital by 9 p.m and she was examined by the doctor only in the next day evening is false and hence denied. The complainant did not come to this opposite party's hospital on 8.04.2006 as alleged. As per the treatment chart it is seen that the complainant came to the causality at 10.45 p.m on 8.05.2007 with complaints of bleeding P/V since 5 days and abdominal pain since one hour. She was shifted to the labour room at 11 p.m and necessary medicines and injections were given. On 9.05.2007 at about 7 a.m, the complainant was shifted to the ward as per the direction of the Gynaecologist, since her bleeding and pain subsided. Thereafter the first opposite party examined the complainant and medicines were given. Since the complainant was cured she was discharged on 10.05.2007. Complainant is fully satisfied for the treatments and she is well cured at the time of discharge. There is no indication to conduct ultrasound scanning, so it was not suggested and done. Dilatation and curation is only a blind procedure and there is every chance of there being residual products. Ist opposite party is not working in the 2nd opposite party's hospital now. There is no negligence, deficiency in service or careless or wilful latches from the part of the opposite parties or from the part of the doctors in the opposite party's hospital. The 2nd opposite party's hospital is a well equipped hospital having all departments and several well equipped operation theatres with qualified doctors. The complainant has not caused or sustained any damage or loss due to any fault of the opposite parties. So the opposite party hospital is not at all liable for any compensation as alleged by the complainant.
4. The point for consideration is whether there was any deficiency in service on the part of the opposite parties, and if so, for what relief the complainant is entitled to?
5. The evidence consists of the oral testimony of PWs 1 and 2 and Exts.P1 to P13(series) marked on the side of the complainant and the oral testimony of DW1 and Exts.R1 and R2 marked on the side of the opposite parties.
6. The POINT :- The complaint is filed for getting compensation against the negligence of the Ist opposite party doctor, who was working in the 2nd opposite party hospital, who conducted D&C on the complainant. Complainant was examined as PW1. PW1 was consulting the Ist opposite party doctor Dr.N.N.Prasad, who is the Gynaecologist for her pregnancy. When the pregnancy was about 2 ½ months old, the growth of the foetus was not upto the optimum, the doctor advised her to terminate the pregnancy and that was done on PW1. Again she became pregnant in August 2006 and continued treatment with the same doctor. In the fifth month check-up on 24.03.2007, the doctor advised for a scanning and on perusing the scanning report, the doctor revealed that the foetus is not having the required growth and suggested for termination of pregnancy and D&C was done on 25.03.2007 in the 2nd opposite party hospital. Ext.P1 is the scanning report of the opposite party hospital dated 24.03.2007. The discharge summary from the opposite party hospital is marked as Ext.P2. The biopsy report is marked as Ext.P3. After a few days of abortion PW1 experienced a feeble stomach ache and she approached the doctor. The doctor opined that it may be due to the absence of first menstruation and medicines were given for the same. On 8.05.2007 by 9 P.M, PW1 again admitted in the hospital because of severe thick bleeding. The doctor examined her only on the next day evening. The doctor advised that there is nothing wrong and there is possibility of bleeding after abortion for 2 to 4 months. PW1 and her husband enquired whether any scanning or other investigations are required. The doctor replied that those things are not required and suggested sufficient rest will solve the problem. She was discharged on the same day. The bleeding continued every day and PW1 suffered heavy stomach ache also. On 9.05.2007 bleeding increased and she went to hospital. On the next day doctor examined her and repeated the same medicines and discharged on 10.05.2007. Bleeding gradually increased and PW1 and her husband felt doubt in the treatment of the opposite parties and she was taken to Medical Trust Hospital, Nedumkandam on 13.05.2007. On conducting scanning there, the doctor opined either multiple cysts in the ovary or degenerated retained parts of conception would be the reason for pain and bleeding of complainant. So she was referred to Medical College Hospital, Kottayam. The treatment records from the Medical Trust Hospital, Nedumkandam and referring letter to Medical College Hospital, Kottayam is marked as Ext.P4(series). There Dr.T.J.Cicily advised PW1 to meet Dr.Beenakumari, the Assistant of Dr.T.J.Cicily, and was admitted in the hospital on 18.05.2007. Surgery was conducted on 22.05.2007 for removing the degenerated products of conception. Again scanning was done on 23.05.2007 to analyse the situations after surgery and it was found that still there were portions of retained products in the uterus. The doctor told that since the last abortion was before 2 months, the decomposed portions were adhering to the walls of uterus which made it uneasy to remove all the retained products at one stretch. On 25.05.2007 another surgery was done and the entire retained products of conception were removed. On 26.05.2007 again scanning was done and Dr.T.J.Cicily made sure that no retained products of conception left in the uterus of the complainant. She continued the medicines for 21 days. The treatment chart issued by Dr.T.J.Cicily of Medical College Hospital, Kottayam is marked as Ext.P5. The scanning report dated 17.05.2007 as per the direction from Medical College Hospital, Kottayam is marked as Ext.P6. The scan report dated 23.05.2007 is marked as Ext.P7. The third scanning report dated 26.05.2007 is marked as Ext.P8. The copy of the discharge summary from Medical College Hospital, Kottayam is marked as Ext.P9. The statement of expenditure made by the complainant for hospitalisation is marked as Ext.P11 and that of the Medical Trust Hospital, Nedumkandam is marked as Ext.P12. The bill for the lab test at Medical College Hospital, Kottayam is marked as Ext.P13(series).
As per the cross examination of the learned counsel for the Ist opposite party, PW1 deposed that Ist opposite party is a senior doctor and he is having a number of patients. The two missed abortions caused because of the natural reasons and may be because of the physical conditions of PW1. There is no complaint against the doctor or against the hospital for the same. When the opposite party's counsel asked whether she consulted the opposite party doctor on 3.05.2007 after the D&C, she answered that she is not aware of the date when she consulted the doctor. Due to the absence of menstruation that the delay was caused for consulting the doctor. The second time when she met the doctor on 8.05.2007 at 9 p.m, she was admitted there in the labour room, the nurses treated her and admitted in the Ward. She was not aware whether any other treatment or injections were given on that day because she was affected with heavy pain and bleeding. But she was discharged on 10.05.2007 after consumption of medicine and curing the pain. She also answered that it is not correct that the complainant was discharged on the same day on 8.04.2006 which is written in the complaint. There is some mistake happened in the complaint.
PW2 is an expert doctor, she is having 19 years experience in Gynaecology. PW2 examined the patient when she was referred to Medical College Hospital, Kottayam. She was referred to the Medical College Hospital, Kottayam because bleeding started after 1 ½ months of the D&C and she was admitted in another hospital, Medical Trust Hospital, Nedumkandam. There ultra sound scan was done on 14.05.2007. There they diagnosed that some retained products of conception and also a doubt of Choriocarcinoma of uterus, means cancer in the uterus after pregnancy. But in the Medical College Hospital, Kottayam after scanning, it is confirmed that the bleeding was due to degenerated products of conception and not Choriocarcinoma. The treatment done in the Medical College Hospital, Kottayam could be done in the local hospitals also. But they referred to the Medical College Hospital, Kottayam in suspicion of Choriocarcinoma. Evacuation was done twice on the patient. The retained products were decomposed and was adhering in the uterus. That is why evacuation was done on several times. If it was continued, infection and bleeding may be caused to the patient. If not treated it will cause danger to the life of the patient. As per the opinion of the expert doctor, the first D&C was done on 25.03.2007. After that the patient was admitted on 8.05.2007 because of thick bleeding. At that time the opposite party doctor may have suspected that bleeding may be because of the first menstruation period. So further investigation was not conducted. As per the cross examination of the learned counsel for the complainant, PW2 deposed that the bleeding may be continued to 5 to 7 days in normal case. Again if it continued it need treatment. Scanning and other investigations can be done so that the complication can be detected. The Ist opposite party was examined as DW1. DW1 was treated the complainant with utmost care. She was admitted in the opposite party's hospital on 8.05.2007 at about 10.45 p.m and discharged on 10.05.2007. Excessive bleeding was the cause of abortion. It was not consequent to D&C but was consequent to abortion that was his diagnosis. She was discharged on 10.05.2007, at that time bleeding was stopped, pain was healed and she was improved. The copy of the inpatient record from the opposite party hospital is marked as Ext.R1 and copy of the outpatient record is marked as Ext.R2. As per Ext.R1 report, the patient was admitted on 8.05.2007 at 10.40 p.m. and discharged on 10.05.2007 at 1.30 p.m. As per the complaint, PW1 was admitted in the opposite party hospital on 8.04.2006 by 9 p.m due to severe thick bleeding. But she was examined by the doctor only in the next day evening. After examination the doctor told that there is nothing to worry and there is possibility of bleeding after abortion for 2 to 4 months. The complainant and her husband enquired whether any scanning or other investigations were required. But the doctor replied that nothing was required. The complainant was discharged on the same day. But before 8.04.2006 she approached the opposite party hospital because of feeble stomach ache and the doctor opined that it may be due to the absence of menstruation and medicines were given for the same. But the date was not mentioned in the complaint. As per the affidavit filed by the complainant, she was admitted in the opposite party hospital on 8.05.2007 at 9 p.m. But the doctor examined her only in the next day evening. The doctor told that there is nothing to worry and sufficient rest will solve the problem and she was discharged on the very same day. The bleeding continued everyday and PW1 suffered heavy stomach ache too. On 9.05.2007 bleeding increased and again she admitted in the hospital on 9.05.2007 at 9 p.m. The doctor examined her and she returned home on 10.05.2007. As per the cross examination of the learned counsel for the opposite party, the complainant deposed that it was not correct that the complainant was discharged on the same day on 8.04.2006. She do not remember the date of consultation with the doctor after the D&C on 25.03.2007. As per the treatment records produced by DW1 and as per the deposition, it is stated that PW1 was admitted in the hospital on 8.05.2007 at 10.40 p.m and she was discharged on 10.05.2007 at 1.30 p.m after when the bleeding was stopped and she was improved.
The only point to be considered is that whether there is any deficiency in the part of the opposite party hospital. PW1 deposed that the missed abortion caused because of the natural reasons and may be because of the physical condition of her body. There is no complaint against the doctor for any of the treatments conducted by the doctor at anywherelse. But the only dispute is that when she was admitted in the hospital on 8.05.2007, the complainant and her husband enquired whether scanning or other investigations were required. But the doctor replied that those things are not required and taking sufficient rest will solve the problem. As per the complainant, if an ultra sound scan was done on that day, the doctor ought to have revealed about the decomposed portions adhering to the walls of the uterus which may caused heavy bleeding and pain to her. But as per DW1, the patient approached the doctor on 3.05.2007 because of feeble stomach ache. The doctor opined that it may be due to the absence of menstruation and medicines were given for the same. Again the patient was approached the doctor on 8.05.2007 at 10.40 p.m with complaints of excessive bleeding, which is a common phenomenon after abortion. The first 3 cycles after abortion can be heavy. On 9.05.2007 she was found to be stable and she was shifted out of the labour room to ward at 7 a.m. DW1 again examined her at 1.15 p.m and was reassured and the same treatment continued as she had responded. Eventhough she wanted to discharge on the same day, she was asked to stay back and discharged the next day after the complaints were totally treated. PW2 also deposed that on 8.05.2007, the doctor treated the patient, may assumed that it was bleeding due to the first menstruation period after D&C and further investigation was not done. PW2 also deposed that in normal course bleeding will be extended to 5 to7 days. If it continued afters that treatment will be needed. PW2 also deposed that uterus cannot be seen with naked eye. The contents inside the uterus were completely cleared, can be detected only through experience. In this case, the patient had missed abortions before that. So in those patients there is more possibilities of retained products. Evenif the doctor has taken due care sometimes it can be understand there are retained products. Evacuation is a blind procedure and there is every chance of there being retained products. Histopathology report is needed for confirmation of retained products. As per the cross examination, DW1 deposed that if a patient admitted in the hospital on 8.05.2007 with the complaint of bleeding and she was discharged on 10.05.2007, it can be considered as a normal bleeding. So scanning is not needed for the normal bleeding. After evacuation there may be irregular cycles of bleeding. It is only a common complication that the retained products can be seen after evacuation. It cannot be say that it is because of the negligence of the doctor. In early stages there is a missed abortion and so there is chance of retained products after the second evacuation. It can be caused even the doctor is an expert one. The treatment that can be done in the opposite party hospital was done in the Medical College Hospital also. There is a doubt of Choriocarcinoma expressed in the referring letter, so she was referred to the Medical College Hospital. That is not a negligence from the part of the treated doctor.
We think that the patient was referred to the Medical College Hospital only because of the suspicion regarding Choriocarcinoma and not because of the retained products after evacuation. The treatment done in the Medical College Hospital can be done in the opposite party hospital also. So there is no negligence or deficiency is seen from the part of the opposite party or proved by the complainant. The complainant is not sure of the date of treatments done at the opposite party hospital and what all treatments done in the opposite party hospital, three different stories were delivered by the complainant in the complaint, in the affidavit and in cross examination. As per the expert opinion we think that the version of the complainant itself is not at all believable and there is no deficiency is seen against the opposite parties.
Hence the petition dismissed. Pronounced in the Open Forum on this the 29th day of January, 2010
Sd/- SRI.LAIJU RAMAKRISHNAN(PRESIDENT)
Sd/- I agree SMT.SHEELA JACOB(MEMBER)
Sd/- I agree SMT.BINDU SOMAN(MEMBER)
APPENDIX Depositions : On the side of Complainant : PW1 - Remya Rajeshkumar PW2 - Dr.T.J.Cicily On the side of Opposite Parties : DW1 - Dr.N.Napendra Prasad Exhibits: On the side of Complainant: Ext.P1 - Obstetric Scan Report dated 24.03.2007 issued from St.John's Hospital, Kattappana Ext.P2 - Discharge Summary issued from St.John's Hospital, Kattappana dated 26.03.2007 Ext.P3 - Biopsy Report dated 30.03.2007 Ext.P4(series) - Treatment Records from the Medical Trust Hospital, Nedumkandam andReferal letter issued from Medical Trust Hospital, Nedumkandam to Medical College Hospital, Kottayam dated 14.05.2007 Ext.P5 - Treatment Chart issued by Dr.T.J.Cicily(PW2) dated 17.05.2007 Ext.P6 - Scan Report dated 17.05.2007 issued from Mediscan, Kottayam Ext.P7 - Ultra Sonography Report – pelvic dated 23.05.2007 Ext.P8 - Pelvic Sonography Report issued from Mediscan Centre, Kottayam dated 26.05.2007 Ext.P9 - Discharge Card issued from Medical College Hospital, Kottayam dated 26.05.2007 Ext.P10 - Statement of Expenditure made by the complainant Ext.P11(series) - Statement of Expenditure made by the complainant for hospitalisation in opposite party hospital Ext.P12(series) - Statement of Expenditure made by the complainant for hospitalisation in Medical Trust Hospital, Nedumkandam Ext.P13 (series)- The Bill for the lab test at Medical College Hospital, Kottayam On the side of Opposite Parties : Ext.R1 - Photocopy of Inpatient Record from the opposite party hospital Ext.R2 - Photocopy of Outpatient Record from the opposite party hospital
| | [HONORABLE Sheela Jacob] Member[HONORABLE Laiju Ramakrishnan] PRESIDENT[HONORABLE Bindu Soman] Member | |
