Tamil Nadu

Nagapattinam

CC/13/2009

Aruna - Complainant(s)

Versus

Dr.R.Sarojini, Venkadasa Nurshing Home, - Opp.Party(s)

S.Veerapandian

10 Sep 2014

ORDER

  Date of Filing      :09.12.2009

                                                                                        Date of Disposal:10.09.2014

           

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

NAGAPATTINAM

 

PRESENT: THIRU.P.G.RAJAGOPAL, B.A.B.L.,         …..PRESIDENT

    THIRU.A.BASHEER AHAMED,B.Com., ….  MEMBER I

               Tmt. R.GEETHA, B.A.,                             …. MEMER II

 

 

CC. No.13/2009

 

DECIDED ON THIS 10^th    DAY OF SEPTEMBER 2014.

 

 

            Tmt.Aruna,

            W/o. Anandharaj

            Villi Nagar, Ammapettai,

            Chidambaram, South Arcot District.                                 ….. Complainant

                                                                                                                          

                                                                /versus/

                                   

            Dr.R.Sarojini,M.B.B.S., DGO.,

            Venkatesh Nursing Home.

    No.134, Pattamangala Street,

    Mayiladuthurai, Nagapattinam District.                ….. Opposite party

 

   

            This complaint having come up for final hearing before us on 05.09.2014, on perusal of the material records and on hearing the arguments of Thiru.S.Veerapandiyan, Counsel for the complainant and Thiru.S.Raman, counsel for the opposite party and having stood for consideration, till this day the Forum passed the following

 

      ORDER.

     By the President, Thiru. P.G.Rajagopal, B.A.B.L., 

This complaint is filed by the complainant u/s 12 of the Consumer Protection Act 1986. 

                        2. The gist o the complaint filed by the complainant is that the complainant was admitted in the Nursing Home of the opposite party on 28.04.2007,  abdominal Hysterectomy Surgery was done by the latter on 29.04.2007 and after having been discharged from the nursing home on 05.05.2007, the complainant developed further complications in her urinary bladder.  There was no control of urination owing to the rupture caused in the Urinary Bladder during the said surgery by the opposite party. Vesico Vaginal Fistula repair was done on 09.08.2007 at Thanjavur by Dr.Michael, and she was discharged on 16.08.2007, and subsequently again the complainant had undergone V.V.F. repair operation by Dr.Jayakar at the Chidambaram, Raja Annamalai Medical College Hospital during the period from 15.11.2007 to 07.12.2007 and even thereafter the complainant has not been fully cured and she is still having the complaint of incontinence.   The complainant being a Police Constable by profession could not discharge her function properly and she has under gone mental agony untold physical suffering, inconvenience, hardship and has incurred heavy expenditure towards treatment. and therefore the complainant prays for an order to direct the opposite party to pay Rs.8,65,000/-  towards compensation for her deficiency of her service  Rs.1,00,000/- towards compensation for mental agony and hardship caused to the complainant and Rs.25,000/- towards her medical expenses and transport expenditure and Rs.10,000/- towards cost of this litigation.

                        3. The gist of the counter filed by the opposite party is that there is neither any medical negligence nor any deficiency of service on her part as alleged by the complainant.  All the averments in the complaint are denied by the opposite party.  The opposite party has reserved the right to file an additional counter after report of the panel of doctors is filed. In the absence of any acceptable documents in proof of the allegations made by the complainant, the complaint is liable to be dismissed in limine.

 

4. The complainant has filed her proof affidavit reiterating all the averments made in the complaint and has filed 23 documents which are marked as Exhibits A1 to A23.  The opposite party has filed a memo to treat the written version which is filed in the form of an affidavit to be treated as her proof affidavit also.   No document is filed on the opposite party’s side.   Written arguments have been filed by both the sides.

5. Points for consideration:-

1. Whether there is deficiency of service on the part of the opposite party?
2. Whether the complainant is entitled to any relief? If so to what?

                  6. Point 1: The allegation of the complainant is that Hysterectomy Surgery is done by the opposite party to her negligently, having  caused a hole to the Urinary Bladder negligently resulting in incontinence of the complainant in the urinary system.  The opposite party has suppressed the said damage caused to the Urinary Bladder and in consequence thereof, the complainant had to undergo great   suffering both mental and physical having been driven from pillar to post from one Hospital to another Hospital for the diagnosis and further treatment for the said ailment.  The complainant had to undergo V.V.F. (Vesico Vaginal Fistula) treatment for more than once and she is yet to get complete cure of her problem in urination.  Admittedly Hysterectomy Surgery was done on 29.04.2007 by the opposite party to the complainant and she was discharged on 05.05.2007.  Having incontinence of urination to the Urethra, the complainant had contacted the opposite party who referred her to Dr.Sivakumar advising her to get treatment from him, as she suspected the formation of the stone in the Kidney. Having had treatment from Dr.Sivakumar as in patient in the Rohini Hospital, Thanjavur during the period from 28.05.2007 to 01.06.2007, the complainant had been referred to Dr.Chinnasamy of the Vijaya Hospital at Chennai,  who first found out that some rupture had been caused to the urinary bladder of the complainant and subsequently the complainant had undergone V.V.F repair treatment by Dr.Michael in MVK Nursing Home, Thanjavur during the period from 09.08.2007 to 16.08.2007 and subsequently as the aliment was not set right, the complainant again underwent  V.V.F. treatment at Rajah Muthiah Medical College Hospital at Chidambaram by Dr.Jayakar during the period from 15.11.2007 to 07.12.2007. The VVF repair treatment done by the Dr.Michael, at MVK Nursing Home stands proved by the Exhibit A13 and the further VVF repair treatment at the Rajah Muthiah Medical College Hospital Chidambaram stands proved by Exhibit A16.  The Hysterectomy Surgery done by the opposite party to the complainant and reference by the opposite party to Dr.Sivakumar and to Dr.Rajamaheshwari for further diagnosis and treatment are also admitted facts.  During the course of the cross examination of the opposite party by the complainant’s counsel the former has admitted that Hysterectomy Surgery was done by her on 29.04.2009 and the complainant was discharged on 05.05.2007.  It is the opposite party who referred the complainant to Dr.Sivakumar, to give treatment to the complainant during the period from 28.05.2007 and 01.06.2007 and the said Dr.Sivakumar had in turn referred the complainant to Dr.Chinnasamy at Vijaya Hospital, Chennai. The opposite party having suspected some obstruction in the Urethra of the complainant ought to have straight way referred her to an Urologist apprehending damage to the urinary bladder of the complainant.   The opposite party has deposed during the course of the cross examination as follows:-

புகார்தாரர் தானே டாக்‌டர் சிவகுமார் மூலம் நேரடியாக டாக்டர் சின்னசாமியிடம் சென்றார். மேற்படி சின்னசாமி மருத்துவர் மேற்படி புகார்தாரரை பரிசோதித்து சிறுநீர் பையில் துவாரம் இருப்பதாக கண்டறிந்து சொன்னார் என்றால் சரிதான். புகார்தாரர் என்னிடம் தனது சிறுநீர் பையில் துவாரம் உள்ளதாக டாக்‌டர் சின்னசாமி  கூறிய விபரத்தை என்னிடம் சொன்னார். அத்தனை ஊர்சிதம் செய்து கொள்வதற்காக சென்னையில் உள்ள டாக்‌டர். ராஜ மகேஷ்வரியிடம் சிறுநீர் மற்றும் கர்ப்பப்பை பிரச்சனைக்கு தீர்வு காணும் நிபுனரிடம் அனுப்பி வைத்தேன். அவரும் புகார்தாரர்க்கு சிறுநீர் பையில் துவாரம் இருப்பதை ஊர்சீதம்  செய்துள்ளார் என்றால் சரிதான்.   புகார்தாரர் தஞ்சாவூரிலுள்ள எம்.வீ.கே மருத்துவமனையில் உள்ள டாக்டர். மைக்கேல் என்பவரிடம் சிறுநீரகபையில் உள்ள துவாரத்தை சரிசெய்வதற்காக சிகிச்சை (வீ.வீ.எப்) மேற்கொண்டார்.  மூன்று வாரத்தில் புகர்தாரருக்கு சிறுநீரக பிரச்சனை தீராததால் மருத்துவர்  மைக்கேலியிடம் வீ.வீ.எப்  அறுவை சிகிச்சை செய்துகொண்டார் என்றால் சரிதான்.

                        7. The contention of the opposite party is that no damage or rupture is caused to the Urinary Bladder of the complainant by her alleged negligence.   Only the infection caused to the opposite party has resulted in VVF repair treatment.    In Exhibit A23, the reply notice, the opposite party has stated that the complications and repair to the Urinary Bladder is caused only because of the Ischemia infection necrosis and not caused by her in the course of the Hysterectomy done by her.  Under Exhibit A23 the reply notice the opposite party relied on the medical Literature Vesico Vaginal and Ureterovaginal Fistula:- Last updated:May25, 2006. Author: Sandip P Vasavads, MD., Wherein it is stated  

“Vesicovaginal and ureterovaginal fistulas are perhaps the most feared complications of female pelvic surgery.  More than 50% of fistulas occur after hysterectomy for benign diseases such as uterine fibroids, menstrual dysfunction and uterine prolapse.”

In the Obstetrician Gynecologist October 2001 Vol.3 No.4 another Medical Literature it is extracted as follows:-

 “Urogential fistula following surgery within the pelvis can result from direct injury at the time of surgery or more commonly, as a delayed event.  In a series of 135 gential fistulae referred to the Senior Author over a period of ten years, 97 have been associated with pelvic surgery, including 73 following hysterectomy (Figure2).  Of these, only five presented with leakage of urine on the first postoperative day.  If the fistula is a delayed event, it is presumed that the fistula occurs as a result of compromised blood supply to part of the urinary tract, leading to tissue necrosis and the formation of a fistula.  Alternatively, a small pelvic haematoma associated with the vaginal vault and/or urinary tract may become infected and discharges, causing the abnormal communication to Form.”

                        8. As far as this complaint is concerned it has to be decided whether the injury to the urinary bladder of the complainant is caused by the negligence of the opposite party during the Hysterectomy done by her as alleged by the complainant or the incontinence is the result of the infection already caused to the complainant as contented by the opposite party.  The learned counsel for the opposite party has also relied on the judgment of the National Consumer Disputes Redressal Commission, reported in 2007 CPJ, Page no.349. in which it is held that

  “The very fact that VVF had developed nearly about three months after the operation clearly indicates that the said complication had not perhaps developed due to any negligence and act/omission on the part of the opposite party.”

The said decision is not at all applicable to this case because the complainant had developed VVF immediately after the surgery and there is no long lapse of time, between the date of surgery and the time from when onwards the complainant had developed the complications of VVF.

                        9. Even though the opposite party has contended that the complication of incontinence and VVF are caused only because of the ischemia infection necrosis, there is no concrete documentary evidence to substantiate her version.  On the other hand the Exhibit A11, the copy of the letter given by the opposite party to Dr.Rajamaheshwari, an Urogyanecologist, Chennai, has disclosed that she has referred the complainant for the VVF repair surgery under taking the full responsibility of making even the payment of the expenditure for the treatment be to given to the complainant.  In the course of the cross examination the opposite party has deposed நான் எனது மருத்துவமனையில் புகர்தாரருக்கு செய்த சிகிச்சை உரிய கட்டணம் பெற்றுக்கொண்டேன் என்றால் சரிதான்.  நான் திருமதி. ராஜ மகேஷ்வரிக்கு புகர்தாரருக்கு உள்ள பிரச்சனை குறித்து  சிகிச்சை அளிக்கும்படியும் அவருக்கு உண்டான சிகிச்சைக்கு நான் உரிய கட்டணம் தருவதாக சொல்லி கடிதம் அனுப்பினேன் என்றால் சரிதான். புகார்தாரர் தன்னிடம் மேற்படி சிகிச்சைக்கு போதுமான தொகை இல்லை என்று கூறியதால் அந்த சிகிச்சைக்கான பணம் இல்லாமல் அறுவை சிகிச்சை தள்ளி போக கூடாது என்பதற்காக நான் சிகிச்சை செலவை ஏற்றுக்கொள்வதாக மேற்படி கடிதத்தில் குறிப்பிட்டு உள்ளேன். ஆனால் புகர்தரார் பின்னிட்டு நான் செலவழிக்கும் பணத்தை கொடுத்துவிடுவதாக சொல்லியதன் பேரில் அவ்வாறு கடிதம் கொடுத்தேன். நான் புகர்தரார் தன்னிடம் அந்த சமயம் பணம் இல்லை என்பதால் நான் சிகிச்சை செலவை ஏற்றுக்கொண்டால் பின்னர் தன்னிடம் கொடுத்துவிடுவதாக சொன்ன விபரத்தை மேற்படி கடிதத்தில் குறிப்பிடவில்லை. எனது பதில் அறிவிப்பிலோ அல்லது இம்மன்றத்தில் தாக்கல் செய்துள்ள பதில் அறிவிப்பிலோ குறிப்பிடவில்லை என்றால் சரிதான்.  நான் புகார்தாரரிடம்  நான் அவருக்காக சிகிச்சைக்கு செலவழிக்கும் தொகையை அவர் திருப்பி செலுத்திவிடுவார் என்று எழுதிவாங்கவில்லை.  கர்ப்பப்பையும் சிறுநீர் பையும்  அடுத்தடுத்து அருகிலேயே அமைந்துள்ளன என்றால் சரிதான்.  கர்ப்பப்பையை  அகற்றும்போது சிறுநீர் பையில்  காயம் ஏற்பட சாத்யகூறு உள்ளது என்றால் சரிதான்.

                        10.  Therefore the opposite party even undertook to pay the treatment expenses for VVF repair treatment by the said Dr.Rajamaheshwari.  Even though the  explanation  given by the opposite party for under taking to bear the expenses for the VVF repair treatment to the complainant, is that the complainant was not having sufficient funds at the time and as the surgery should not be postponed and as the complainant also under took to repay the expenditure to her, she came forward to bear the expenditure that would be incurred for the said urinary treatment to the complainant.  The said explanation cannot be accepted to be a true and even probable one as there is no such whisper either in her reply notice or in her written version in that regard.

                        11. Therefore the very acceptance of the opposite party to bear the expenditure to Dr.Rajameshwari for the VVF repair surgery to be done to the complainant, itself gives an inference that only because of her negligence in the Hysterectomy   causing the rupture to the bladder, she had under taken the said liability.  Had she under taken her liability to meet the expenditure of the complainant for the VVF repair surgery on condition that the complainant should repay the amount to be spent by her, as any ordinary prudent person would do, she would have got a document from the complainant to that effect as an evidence of her version. The absence of such pleading either in the reply notice or in her written version would make it clear that she under took to incur the expenditure of the treatment only, because of her guilty conscience having committed negligence in causing the rupture of the urinary bladder of the complainant, during the said Hysterectomy.

                        12. The Medical Board Report which is marked as Exhibit C1, is of no use at all for the purpose of deciding this dispute.  The said report appears to be a bald and informal one, without having any evidentiary value at all.  The board has given a general information that “Urinary Fistula may occur after Hysterectomy 45%, the urinary fistula are due to pelvic surgery in Britton and North America.”  The said observation of the Board is nothing, but an extract from page no.250 of the 5^th edition of “Joffcoates’ Principles of Gynecology” The said report is a wasteful one as the board has not given any finding with reference to the particulars of treatment given to the complainant by the opposite party and the documents relating to the treatment.

                        13. In view of the delicate and intricate nature of the performance of the hysterectomy and the impending danger of causing damage to the Urinary Bladder during the course of the said surgery, a Gynecologist such as the opposite party doing the hysterectomy should have always had an urologist also by her side, so that in case of such contingency of causing damage to the urinary bladder of the patient it could have been set right by the specialist.  Or at least the patient should be caused to be examined by an urologist, whenever the patient after discharge comes with the complaint of incontinence or leakage of urine through vagina.

                        14. Therefore this Forum finds that it is proved, without any doubt, that the urinary bladder of the complainant was damaged by the negligence of the opposite party during the Hysterectomy and it has resulted in incontinence which had to be cured by way of VVF repair treatment. From the extracts from the medical literature, quoted in the Exhibit A23 the reply notice given by the opposite party that,

“fistula coming to operation 70% are gynecological and  30% obstetrical”

“in nearly all gynecological operations one or other part of the urinary tract is in      

  danger.”

 

“The bladder is liable to injury during total hysterectomy and during all operations involving the anterior vaginal wall.”

 

“Vesicovaginal and ureterovaginal fistulas are perhaps the most feared complications of female pelvic surgery.”

 

“Urogential fistulae following surgery within the pelvis can result from direct injury at the time of surgery or more comply as a delayed event.”

 

It is evident that the opposite party has got the knowledge of the intricate nature of the surgery.

 

                        15. The said observations would go to establish the fact that the doctor doing Hysterectomy should pay 100% care and attention during the time of surgery so as to avoid causing of any injury to the urinary bladder as in the case of the complainant.  It is brought to notice of the complainant by Dr.Chinnasamy for the first time that the complainant has to get incontinence VVF repair treatment as her urinary bladder was punctured.  The damage to the urinary bladder caused during the time of Hysterectomy should have been set right by the opposite party with the help of an Urologist like Dr.Michael immediately.  Or at least when the complainant approached her a few days of her discharge complaining of the leakage of urine through vagina, the opposite party ought to have herself arranged for examination of the complainant by an Urologist immediately as it is quite common that urinary bladder is likely to get damaged or punctured during the hysterectomy.  The opposite party had not only been negligent in the hysterectomy, but also not acted in good faith when the complainant came to her after the surgery with the complaint of incontinence and leakage of urine through vagina.  The opposite party ought to have done hysterectomy with utmost care and attention required for that sort of surgery and only because of her negligence and lack of due care and attention, the complainant had suffered from incontinence and consequent leakage of urination through vagina also.  Therefore this is the clear case of negligence and deficiency of service on the part of the opposite party, in providing the medical treatment to the complainant.

16. Point 2: In the result the complaint is partly allowed.  The opposite party is directed to pay the sum of Rs.4,00,000/-(Rupees four lakhs only) to the complainant for her suffering, mental agony, hardship, inconvenience and expenditure caused to her, owing to the negligent and deficient of service of the opposite  party within 45 days from the date of this order failing which the opposite party shall be liable to pay the interest on the said amount at the rate of 12% per annum from the date of this order till the date of its realization.  The opposite party is further directed to pay the sum of Rs.5,000/-(Rupees five thousand only) towards cost of this litigation to the complainant within the said period of 45 days, failing which the said amount shall also carry an interest at the rate of 12% per annum from the date of this order till the date of its realization.

This order is dictated by me to the Steno-Typist, transcribed, typed by him, corrected and pronounced by me on this 10^th   day of  September 2014.

 

 

 

    MEMBER I                                    MEMER II                                   PRESIDENT

 

List of documents filed by the complainant

 

Ex.A1/Dt.28.04.2007: The Xerox copy of the Gymac Case Record of the complainant given

    by the opposite party.

Ex.A2/Dt.29.04.2007: The Xerox copy Lab report of the Mr.Boobalan given by the Ganesh Lab

Ex.A3/Dt.07.05.2007: The Xerox copy of the Clinical Diagnosis Report of the complainant

    given by the Sakthi Diagnostic Centre.

Ex.A4/Dt.23.05.2007:The Xerox copy of the Abdominal and Pelvic Sonogram report of the

  complainant given by the opposite party.

Ex.A5/Dt.01.06.2007: The Xerox copy of the Discharge summaries and patient reports of the  

    complainant given by the said Rohini Hospital, Thanjavur.

 

Ex.A6/Dt.04.06.2007: The Xerox copy of the Ultrasound study for KUB Region Report of the

   complainant given by the said Vijaya Hospital, Chennai   

Ex.A7/Dt.08.06.2007:The Xerox copy of the Cysto-Urethroscopy report of the  complainant 
                                   given by the Vijaya Hospital, Chennai.

 

Ex.A8/Dt.09.06.2007: The Xerox copy of the discharge summary of the complainant given

    by the Tamil Nadu Urological Research Centre, Chennai.

Ex.A9/Dt.18.06.2007: The Xerox copy of the Medical Prescription of the complainant given by

              the said Dr.Michael.

Ex.A10/Dt.25.06.2007: The Xerox copy of the Medical Prescription of the complainant

    given by the opposite party.

Ex.A11/Dt.02.08.2007:The Xerox copy of the Referral letter to the said Dr.RajaMaheswari

     by the opposite party of the complainant.

Ex.A12/Dt.03.08.2007: The Xerox copy of the Diagnostics report of the complainant given

    by the said Dr.Rajamaheshwari, Chennai.

Ex.A13/Dt.16.08.2007: The Xerox copy of the VVF Repair surgery report of the complainant

     given by the said MVK Nursing Home, Thanjavur.   

Ex.A14/Dt.24.08.2007:The Xerox copy of the Medical prescription of the complainant given by   
                                    the said Dr.Michael.

Ex.A15/Dt.26.09.2007: The Xerox copy of the Blood Test Report of the complainant given

    by the Kamala Computerized Blood Test Centre, Chidambaram.

Ex.A16/Dt.07.12.2007:Xerox copy Discharge Summary of the complainant given by the Rajah

     Muthiah Medical College Hospital, Annamalai Nagar, Chidambaram.

Ex.A17/Dt.28.12.2007: The Xerox copy of the speciality  out patient Ticket of the complainant

    given by the Rajah Muthiah Medical College Hospital, Chidambaram.

Ex.A18/Dt.     Nil           : The Xerox copy of the letter of the opposite party.

Ex.A19/Dt.     Nil          : The Xerox copy of the Drs. Address copies. 

Ex.A20/Dt.31.08.2007: Copy of the notice sent by the complainant’s counsel to the opposite

      party.

Ex.A21/Dt.12.09.2007: Copy of the reply notice sent by the opposite party to the complainant’s

      counsel.

Ex.A22/Dt.05.09.2007: The Acknowledgement card of the complainant’s counsel.

Ex.A23/Dt.24.09.2007: Copy of the another reply sent by the opposite party to the

      complainant’s  Counsel.

 

 

 

    MEMBER I                                    MEMER II                                   PRESIDENT

 

 

DISTRICT CONSUMER DISPUTES

    REDRESSAL FORUM,

         NAGAPATTINAM.

 

          CC.No.13/ 2009

      Order Dt.: 10.09.2014.