Tamil Nadu

North Chennai

CC/127/2021

Mr.C.Ganesh,S/o.K.Chandrasekaran - Complainant(s)

Versus

Dr.R.P.Shanmugam,R.P.S Hospital Pvt.Ltd - Opp.Party(s)

E.Lakshmi party in person

05 Jan 2024

ORDER

Complaint presented on  :05.07.2021    Date of disposal            :05.01.2024

                                                                                  

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,

CHENNAI (NORTH)

@ 2^ND Floor, T.N.P.S.C. Road, V.O.C. Nagar, Park Town, Chennai – 600 003.

 

PRESENT: THIRU. G. VINOBHA, M.A., B.L.           : PRESIDENT

                                         TMT. KAVITHA KANNAN, M.E.,         : MEMBER-I

                                         THIRU V. RAMAMURTHY, B.A., B.L., PGDLA : MEMBER-II

 

C.C. No.127/2021

 

DATED THIS FRIDAY THE 5^th DAY OF JANUARY 2024

Mr.C.Ganesh,

S/o.K.Chandrasekaran,

No.2/44, T.T.Garden, 3^rd Street,

Perambur, Chennai-600 011.

                                                                                         .. Complainant.                                                                  ..Vs..

 

Dr.R.P.Shanmugam, M.S.,M.C.H,

(Gastro Surgeon)

R.P.S.Hospital Pvt.Ltd.,

No.65/2, Water Canal Road,

Korattur North, Chennai-600 080.

                                                    ...  Opposite party.

 

 

 

Counsel for the Complainant                      : M/s.E.Lakshmipathy

Counsel for Opposite party                         : M/s. Dr.B.Cheran and another

 

 

ORDER

THIRU. G. VINOBHA, M.A., B.L., PRESIDENT

          This complaint has been filed by the complainant against the opposite party under section 35 of the Consumer Protection Act, 2019 prayed to direct the Opposite party to pay the complainant Rs.5,00,000/- as compensation towards mental agony and to pay the complainant Rs.5,00,000/- for the negligence, dereliction of duty and deficiency of service and to pay Rs.10,000/- towards the cost of the complaint.

1.THE COMPLAINT IN BRIEF:

         The complainant submits that on 26.11.2019 he felt severe pain in his anus, so his father namely Mr.K.Chandrasekaran took him to the hospital of the opposite party. The complainant states that after admitting the complainant in his hospital opposite party wrongly diagnosed the complaint as acute fistula in Ano, instead of prolapsed Grade III Haemorrgoids. While so, on 02.12.2019 as stated in the discharge summary issued by the opposite party, the complainant had under spinal anesthesia, he was in lithotomy position perennial abscess evacuated, since patient had 10Mg, history of constipation and sphinetcrotomy was done, this is as per the Hospital Discharge summary. As per the hospital records of opposite party, the patient not a known case of DM/HTN and IHD as such he has no previous history of surgery. It is came to light through the Discharge summary as if he has done perianal Hematoma evacuation as well as sphinetcrotomy But the opposite party collected full fees for entire surgery of removal of entire piles (i.e prolapsed piles) which caused severe pain and inconvenient to the complainant. The complainant submits that after discharged from the hospital on 03.12.2019 at around 6.00pm the complainant attempted to attend the call of nature, while so the said mass protruding pile was came out with severe pain with bleeding then only it was came to light that the opposite party does not done any surgery and totally cleared the prolapsed piles except evacute the perianal abscess, which surrounding the area of the anus of the complainant,  The complainant submits that he was unnecessarily given general anaesthesia by administering spinal injection by the opposite party during the alleged evacuation done by him. Even though due to aforesaid treatment the complainant instead of recovering from the severe pain in his anus, the problem of severe pain and irritation etc in his anus further complicated his ailment, since the complainant unable to tolerate the severe pain and bleeding in the anus, and thus his father had taken the complainant to the another hospital called “Noble Hospital” wherein the Doctor’s advised the complainant to go for an operation then only the complainant and his father came to knew that the Modus of surgery done as per discharge summary the same was not a perfect one and imperfect and negligent conduct on the part of the opposite party. The complainant further submits that on 05.12.2019 at No.4, Audiappa Street, Alagppa Road, Purasaiwakkam, Chennai 84 wherein one Dr.Balaji Ravila Baskaran M.S, has finally diagnosed as prolapsed Grade III Hemorrhoids and thus as per his advice the complainant once again admitted in the hospital on 05.12.2019 at 9.50pm and on 06.12.2019 in the said hospital performed stapler hemorrhoidtomy and sphincterotomy, in lithotomy, PR and Proctoescopy to the complainant. Above findings noted anus placed in position after applying puse sling suture, stapler applied, sphinctonotomy done. Complete homeostasis applied. After the procedure entire pile protruding from anus was cleared. Now the complainant is alright, i.e, after second time admitted in the another hospital and again general anaesthesia given and removed the mass protruding from anus, by the second surgery he underwent which caused him painful and hardship and mental agony as well as physical agony to the complainant. Hence it is stated that due to opposite party’s imperfect and negligent service, caused huge sum of Rs.84,455/- as loss to the complainant. The expenses spent in the Noble Hospital is vide bills annexed herewith. The complainant further submits that as a doctor of the complainant the opposite party is liable for his acts and only due to his negligence and deficiency in service, the health condition of the complainant was deteriorated.Hence the complaint.

2. WRITTEN VERSION OF OPPOSITE PARTY IN BRIEF:

The opposite party namely Dr.R.P.Shanmugam, 76 year old is a pioneer in the filed of Gastroenterology and has more than 5 decades of experience in providing quality health care. He is the first certified Gastroenterologist in India. He has done more than 30,000 surgeries and trained more than 300 Surgeons. He had exercised good care and professional skill in managing the case. On examination, he was diagnosed to be suffering from Perianal haematoma (Anal Swelling) Acute fissure in ano and haemorrhoids. As the patient had very severe pain in his anus he came back to the hospital on 02.12.2019. He was diagnosed to be suffering from Acute fissure in Ano with perianal haematoma and haemorrhoids. Anaesthetist Dr.Rukesh examined the patient evaluated the pre-operative check list and explained the anesthetic procedure which was spinal anaesthesia and the patient gave an informed consent. Inj.TT and injection Xylocaine were given. Surgery was started at 2.45pm and ended up at 03.15pm. Under spinal anaesthesia, patient was kept in lithotomy position. Perianal haematoma was found to be infected. It was evacuated. Since patient had 10 years history of constipation, Sphincterotomy was done. Syrup Duphalac and sitz bath were advised. Patient was treated with IV fluids, IV antibiotics and other supportive measures. Patient general condition improved and was discharged with advise and medications. As there was no intra operative or post operative complications, patient was discharged on very next day i.e.03.12.2019. Once the sphincter is wide, there is no necessity to strain to pass motion. Once there is no straining, the pressure will disappear and the piles mass will automatically shrink over a period of time. This is the sure way of curing the piles permanently. There was no need to do surgery for piles for this young patient which will be unnecessary. The piles can recur even after the surgery. The opposite party has not been doing piles surgery for years and he had been successfully managing in the piles in a Non Surgical Way. There are other non surgical methods even if this conservative management fails. The final fees was collected only after the surgery. The hospital where the piles surgery was performed had collected more than Rs.80,000/- the opposite party had collected only Rs.30,000/- the complainant was making allegation that amount for piles surgery was collected by the opposite party. Now it will be clear that amount for piles surgery was not collected and Rs.30,000/- was only collected. The surgery done by the opposite party is successful. The Noble hospital doctor would have performed the surgery for piles because of the strong insistence of the complainant who was not willing to wait for few days. If one looks at the emergency advise at Noble Hospital, it can be seen that the pain may recur. And piles may also recur. It is not the case that the opposite party had fraudulently stated that he had performed pile surgery. Once the patient came out of the operation theatre he was informed of not doing piles surgery. The alleged loss and damage is not due to any negligence, deficiency or action of opposite party.

3. POINTS FOR CONSIDERATION:

1. Whether there is any deficiency in service on the part of the opposite party as alleged in the complaint?

2. Whether the complainant is entitled to the reliefs prayed in the complaint. If, so to what extent?

The complainant had filed proof affidavit, written arguments and documents Ex.A1 to Ex.A12 were marked on his side.The opposite party had filed proof affidavit, written arguments and documents Ex.B1 was marked by the opposite party.

5. Point No.1:-

          The fact that the complainant felt severe pain in his anus and approached the opposite party on 26.11.2019 and he was given certain medicines for which he was charged Rs.400/- and inspite of taking medicines due to severe pain the complainant again approached the opposite party on 02.12.2019 and he was admitted as in patient on that day and was allotted a single Air Conditioned ward and the further fact that the complainant was diagnosed acute fistula in Ano and he underwent a surgery under spinal anaesthesia in lithotomy position and perianal abscess evacuated and opposite party hospital totally charged Rs.31,221/- from the complainant and he was discharged on 03.12.2019 from the opposite party hospital is not in dispute between the parties. But according to the complainant the opposite party collected full fees for entire surgery of removal of piles but instead of doing pile surgery it has done only perianal Hematoma evacuation which came to like through discharge summary and further alleged that when the complainant attended to attend natural call on the next day the said mass protruding came out with severe pain and bleeding and then only the complainant came to know that the opposite party has not done any surgery and only evacuate perianal abscess which surrounds the area of Anus of the complainant and the complainant approach the opposite party hospital on 04.12.2019 at 1.15pm and he was prescribed and injection to be injected on the spot of the Anus were surgery was done and he also purchased the injection with medicine but later the opposite party declined to give that medicine and injection at that stage and sent back the complainant after taking into operation theatre and hence the medicine with injection was returned by the complainant and since the complainant was not able to tolerate severe pain and bleeding in the anus he went to noble hospital were he underwent another surgery for stapler hemorrhoidectomy and sphincterotomy in lithotomy and after applying purse sling suture stapler applied sphinctonotomy done and he was again given general anesthesia and mass protruding from anus was removed by 2^nd surgery and thereafter he became already for which he has to spent Rs.84 455/- and therefore the complainant alleged deficiency in service on the part of opposite party and hence claimed compensation.

          But on the other hand the opposite party mainly contended that he is a renowned gastroenterologist in India and he has done several surgeries and further contended when the patient came on 02.12.2019 as the patient was not willing to wait for few days for the medicines to act he was admitted in hospital and after examination he was diagnosed to be suffering from acute fissure in Ano with perianal hematoma and hemorrhoids and pre operative measures were taken and after getting informed content of the patient final anaesthesia was given and after getting his consent perianal hematoma which was infected was evacuated and sphincterotomy was done and further contended dietry advise was given to avoid constipation and he was discharged on 03.12.2019 and once the sphincter is vide there is no necessity to strain in passing motion and when there is no straining to pressure will disappear and the piles mass will automatically shrink over a period of time and this is the sure way of curing the piles permanently and there is no need for surgery for the young patient which will be unnecessary and further contended that Rs.30,000/- was not collected for piles surgery but only for the above said process and denied deficiency in service on the part of opposite party.

          Ex.A1 is registration fee paid to the opposite party hospital on 02.12.2019 and Ex.A2 and A5 were bills for payment of advance amount and medicines bill by the complainant on 02.12.2019 and 03.12.2019 Ex.A4  is mediclaim policy and it is found from Ex.A3 discharge summary that the complainant underwent perianal abscess evacuation in the opposite party hospital under spinal anaesthesia on 02.12.2019 and he was diagnosed with acute fistula in Ano and it is found that in Ex.A3 no signature of the doctor or seal of the hospital was found and it is alleged by the opposite party that before correcting the typographical mistakes and signature of the doctor the complainant manage to obtain to this discharge summary from the opposite party hospital and Ex.A7 is the spicemen of photocopy and biopsy test report dated 10.12.2019 and this report is based on the pile mass remove from the complainant anus at Noble hospital on 07.12.2019 it is found from Ex.A8 that the complainant has paid a sum of Rs.70560/- to the noble hospital on 07.12.2019 for the 2^nd surgery underwent by him Ex.A11 is legal notice issued by the complainant A12 is reply by the opposite party.

          The opposite party had filed Ex.B1 which copy of case sheet in which it is found that the complainant was admitted on 02.12.2019 and his concerned was obtained was admission as well as surgery and in the consent form the complainant is affixed his signature and it is further found that the complainant was suffering with pain in the anal region and having chronic constipation and bleeding and he was identified with perianal hematoma with acute fissure in ano and a surgery was done on 02.12.2019 in the opposite party hospital at 2pm after the necessary pre operative measure and it is further found that he underwent sphinctonotomy and perianal hematoma evacuation and he was discharged on 03.12.2019 it is further found that he was given injection Xylocaine on 02.12.2019 and he was discharged on 03.12.2019 from the opposite party hospital.

          On perusal of the records and averments of both the parties it is found that the complainant who was having severe pain in his anus approach the opposite party hospital on 02.12.2019 and he was diagnosed with perianal hematoma and acute fissure in ano for which medicines were prescribed to him on his earlier visit on 26.11.2019 and since the pain does not decrease and hence the opposite party conducted surgical procedure of perianal hematoma evacuation with sphincterotomy for the fissure and was discharged on 03.12.2019 and it is further found that due to severe pain and protrusion of mass from rectum he approached the opposite party again on 04.12.2019 and he wanted the mass to disappear immediately without waiting and as there was some infection sclerotheraphy could not be done and hence he was advised to continue the medicines and to take rich fibre diets and thereafter it seems that as the pain does not decrease he approached the noble hospital on 05.12.2019 where he was diagnosed having prolapsed grade III haemorrhoids and again a surgery was done under anaesthesia on 06.12.2019 and he underwent stapler hemorrhoidtomy and sphincterotomy in lithotomy position and after this procedure the entire pile protruding from anus was clear and he is alright after this 2^nd surgery for which he has spent Rs.84,455/- and hence according to the complainant the opposite party has done imperfect surgery and thereby committed deficiency in service which was denied by the opposite party.

          It is found from Ex.A3 is discharge summary which was not signed by authorised signatory the complainant was diagnosed with acute fistula in ano which is contrary to the diagnosis found in Ex.B1 wherein it is stated that the patient was suffering with acute fissure and perianal hematoma. It is alleged by the opposite party that even before correcting the typing mistake and before signing the discharge summary was obtained by the complainant by threatening the staff for which there is no proof and if really such contention is true the opposite party ought to have file the signed discharge summary which was not done by the opposite party it is found from Ex.A3 that the patient underwent perianal abscess evacuation and sphincterotomy under spinal anaesthesia on 02.12.2019 in the opposite party hospital and discharged on 03.12.2019. Sphincterotomy is dividing the sphincter under general anaesthesia by making a small cut near back passage and perianal abscess evacuation is removal of puse around the tissues in anus or rectum due to anal infection which is a small surgery generally done by giving general anesthesia from Ex.A6 it is found that the complainant again went to opposite party hospital on 04.12.2019 during which as per the pharmacy bill issued by the opposite party he has purchased the syringe and spinal needle and other medicines which according to the complainant was at the direction of the opposite party but later on the opposite party decided not to further proceed with the said injection and advised the complainant to take medicines and opposite party has not given proper explanation in the written version for not proceeding further on 04.12.2019 when the complainant alleges that he is still having heavy pain which has driven the complainant to approach the noble hospital on the next date where he underwent 2^nd surgery has narrated in the complaint. The opposite party could have given the authorised signed discharge summary atleast on 04.12.2019 when the patient approached to it and there was no explanation by the opposite party for not furnishing the same and for not filing before this commission. It is found from Ex.A7 that the complainant underwent stapler haemorrhoidectomy and sphincterotomy at noble hospital on 06.12.2019 and discharged on 07.12.2019 and the protruding mass measuring 4x2.5x0.9cms was removed from his anus and sent for biopsy by the noble hospital for which the complainant has paid Rs.70,560/- to the said hospital and the said procedure was again done under the anaesthesia and it is alleged by the complainant due to such giving of anaesthesia for 2 times he suffered pain and mental agony and he is still having back pain due to that. Haemorrhoids are inflamed veins of the rectum which is commonly called as piles and it is found from Ex.A7 and A8 that the complainant was having Grade III haemorrhoids and it is found from the medical literature as found in sabiston textbook of surgery Vol-I that in respect of Grade III haemorrhoids with bleeding protrusion manual reduction is required and it is further found that surgical excision of haemorrhoids is very effective in such cases. Though the opposite party in the written argument and in the version alleged that piles can be cured in conservative non surgical methods which is natural way of curing piles permanently and hence alleged that he has not opted for doing piles surgery to the complainant and instead has done only sphincterotomy and perianal abscess evacuation by giving spinal anaesthesia which will reduce the constipation and since the sphincter has been dilated there can be no chance of constipation any more and hence there will not be pain in passing motion any more and the pain would completely disappear post operatively after a week for which he relied upon certain medical literatures and alleged that conservative treatment of internal haemorrhoids as long term prevention and further alleged that and hence for the above said reason only the patient was advised to wait for few weeks so that the mass will automatically shrink in due course of time and advised fibre rich diet and he was advised sitzbath for 15 days and was also given antibiotics which is the sure way of curing piles permanently the facts of the present complaint and the size of the mass protruding from his anus as found in Ex.A7 will go to show that he was having haemorrhoids Grade III which requires immediate incession by which the patient will not feel pain while passing motion and even as per the medical literatures which is found in colorectal surgery. The stapled haemorrhoidtomy technique produce better results compared to traditional other procedures in respect of post operative, bleeding and length of hospital stay. Though in the same medical literature it is found that perianal hematoma and internal haemorrhoids were best managed conservatively wherein symptoms resolved within a couple of week by the use of laxatives, sitzbath, ice packs etc but the facts of the present complaint and the disease with which the complainant was diagnosed requires immediate surgical measures to remove the protruding mass which was not removed by the opposite party either on 02.12.2019 or 04.12.2019 which has caused the complainant much pain and mental agony for which he has to spent more than Rs.70000/- and he has to undergo another surgery within 2 days in different hospital that too again for sphincterotomy also which will clearly establish the omission on the part of the opposite party while doing the 1^st surgery on 02.12.2019 which amounted to negligent and deficiency in service on the part of opposite party. There is no force in the contention of the opposite party that suppose he had negligently missed doing pile surgery he could have made use of the opportunity when the complainant came back on 04.12.2019 but the opposite party having taken the complainant to the operation theatre decided not to do pile surgery as it can recur even after the surgery and further contention of the opposite party that he has not committed any omission or commission but he has done only good thing to the complainant is not acceptable in view of the presence of the large size of protruding mass which has caused great pain and mental agony to the complainant and the only immediate remedy in such cases is removing the said mass by surgical method and non performance of the same by the opposite party on 02.12.2019 at the time of 1^st operation itself which was done under spinal anaesthesia amounts to negligence and omission on the part of opposite party though he is a renowned doctor and a pioneer in gastroenterology field. It is found from Ex.A2, A5 and A6 bills that the opposite party had collected only Rs.30,000/- only for undergoing perianal hematoma evacuation and sphincterotomy and not for removal of piles also as alleged by the complainant it is further evident that the opposite party  has not stated falsely that he had performed piles surgery also.

The complainant counsel relied upon the following decisions:-

1. Reported in Dr.V.N.Shrikhande Vs Mrs.Anita Sena Fernandes SC Civil Appeal No.8983/2010.
2. Louie and another Vs Kannolil pathumma and another NCDRC dated 16.11.92.
3. Sabhia Hamid Vs Dr.M.Khan Hospital SCDRC Lucknow dated 30.09.2021.

 

From the above said facts it is evident that even after the surgery done by the opposite party on 02.12.2019 the complainant felt heavy pain and due to protruding of the pile mass outside his anus with bleeding he approached the opposite party again on 04.12.2019 and the fact that the opposite party has failed to remove the said mass by adopting any surgical procedure and the further fact that the Grade III Hemorrhoids as stated earlier requires surgical reduction and incession which was omitted to be performed by the opposite party and advising the complainant to wait for a week for reduction of pain amounts to negligence and omission on the part of opposite party and it is further found that the opposite party has directed and advise the complainant that pain will reduce slowly after healing of the wound which shows the imperfect way of performance of surgery by the opposite party on 02.12.2019.It is not out of place to mention here that the opposite party while advising the complainant for a permanent cure for piles without surgery at the same time he is also duty bound to give immediate relief to the complainant who was having severe pain due to the abnormal size of the mass protruding from his anus due to which he was unable to have free motion and failure on the part of the opposite party to give necessary relief to the pain will amount to deficiency in service on his part. The protruding mass would have been there on 02.12.2019 itselfbut there is no whisper about the same in Ex.A3 discharge summary issued by the opposite party hospital and there is no explanation by the opposite party for not making any attempt to remove the same on the said date itself. For the foregoing reasons it is found that the opposite party has done surgery on 02.12.2019 in a imperfect manner and thereby committed omission and negligence and hence it is found that the opposite party has committed deficiency in service. Point.No.1 answered accordingly.

Point No.2:

          Based on the findings given to the PointNo.1,since there is negligence and deficiency in service on the part of opposite party, the complainant is entitled for a sum of Rs.2lakhs as compensation from the opposite party towards negligence and deficiency in service and mental agony and also entitled for Rs.5000/- towards cost of the complaint. Point No.2 is answered accordingly.

 

In the result the complaint is partly allowed.  The opposite party is directed to pay Rs.2lakhs as compensation towards negligence and deficiency in service and mental agony and also directed to pay Rs.5000/- towards cost of the complaint.  The above amount shall be paid to the Complainant within two months from the date of receipt of the copy of this order, failing which the above said amount shall carry 9% interest from the date of order to till the date of payment.

Dictated  by President to the Steno-Typist taken down, transcribed and computerized by her, corrected by the President and pronounced by us in the open Commission on this the 5^th January 2024

 

MEMBER I                    MEMBER II                        PRESIDENT

LIST OF DOCUMENTS FILED BY THE COMPLAINANT:

Ex.A1	02.12.2019	Registration fee to the hospital Bill No.BN024946
Ex.A2	02.12.2019	Advance amount as Bill No.BL001346
Ex.A3	03.12.2019	Discharge Summary
Ex.A4		Mediclaim policy
Ex.A5		Bills of pharmacy
Ex.A6		Medicines Bill
Ex.A7		Specimen Photocopy (The original specimen to be produced at the time of Trial of the above case before this Forum)
Ex.A8		Payment made in Noble Hospital-Bills
Ex.A9		Goldsmith permit and I.T.Proof of complainant’s father
Ex.A10		Bsc (viscom) Degree certificate of the complainant
Ex.A11	21.01.2020	Legal notice sent by the complainant’s father on behalf of the complainant
Ex.A12	01.02.2020	Reply notice sent by the opposite party

 

 

LIST OF DOCUMENTS FILED BY THE  OPPOSITE PARTY:

 

Ex.B1

Copy  of Case sheet

 

MEMBER – I                         MEMBER II                          PRESIDENT