SMT. RAVI SUSHA: PRESIDENT

                Complainant filed this complaint for getting an order directing opposite parties to pay Rs.10,00,000/- towards compensation to the complainant along with interest and also cost of this case.

            Facts in brief are that on 06/04/2019 the complainant was admitted in the hospital of OP with a complaint displaced fracture Right Modular bipolar, Prosthesis.  The complainant approached the OP No.1 for consult the case of her displaced bone fracture.  Believing his words agreed for surgery and a s advised by him underwent Orho surgery on the right Modular Bipolar, Prosthesis and fixed implant.  As per the advice of OP No.1 the complainant was appeared before him for consultation and review thereafter on different days of same month and subsequent months.  Even on those days the complainant had informed OP No.1 .  But no change or improvement for the pain of the complainant.  At last in the month of October the pain was uncontrolled and complainant could not move her right leg.  The complainant was again consulted to OP No.1 and explained the difficulties of severe pain and restricted movement of her right leg due to tenderness.  Even that day the OPNo.1 did not inform the complainant the seriousness.  Due to severe pain, swelling and restricted movement at last on 29/10/2019  again the complainant approached the OP No.1 and was consulted by him.  OP No.1 referred the complaiant to Pariyaram Medicla College.  As advised by him the complainant was taken to Pariyarmam Medical College and admitted there on 01/11/2019.  From there after an elaborate diagnosis Dr.Sunil Kumar told that the infections caused to fractured bones even after the surgery failed uncemented and the deep palpation and tenderness caused and there by lead to restricted movement.  As advised by Dr. Sunil Kumar on 05/11/2019 implant were removed and underwent cemented modular bipolar hemiarthroplasty.  Thereafter on 18/11/2019 the complainant was discharged from there after better improvement and started to walk by aid of walker as advised by the doctor and continued review and treatment for few months.  Even now she is having lame on walking due the careless surgery of OP No.1.  The act of OP No.1 was a defect in service, deficiency service and dereliction of duty and gross medical negligence.  If OP No.1 applied little bit caution, care and duty, the unfortunate incident would not have been happened.  It is submitted that the complainant caused to send a lawyer notice to the OPs 24/12/2019 to pay Rs.10,00,000/-  to the complainant as compensation.  The OPs received the same on 26/12/2019 and send a false frivolous reply and no amount is paid so far.  Hence the complaint.

            In the reply filed by OP No.1 contended that the complainant was brought to 2^nd OP hospital on 06/04/2019 with history of fall on the previous day and initial treatment at co-operative Hospital, Taliparamba and later at District Hospital Kannur and from there she was referred to the 2^nd OP hospital.  On the basis of X-ray evaluation she was diagnosed to have fracture neck of femur on right side and admitted to the hospital and primary care was given.  Based on clinical evaluation and X-ray examination, the fracture neck of femur required surgery with modular bipolar prosthesis since the fracture was complete and totally displace.  The 1^st OP had explained the complainant and her bystanders about and cons of the planned surgery and the possible complications involved in surgical treatment.  After fully conversant with surgery and possible complications the complainant and her bystander gave written consent for surgery.  Under all aseptic care and precaution the 1^st OP conducted modular bipolar prosthesis as per accepted protocol.  Since the stem fixation was found snug fit and young age tight intra operatively no cement was used.  Post-operative X-ray showed the stem fixation in the tight fitting condition.  The patient was started on full weight bearing and ambulation on 3^rd post operative day an started walking the next day onwards for 3-4 time as per day.  Wound inspection shoed wound cleaned healthy and there was no sign of infecting and the patient was discharge on 14/04/2019 without any complaints. The complainant turned up for suture removal on the next follow up review as advised and thereafter she was found to be absolutely normal for the next 3 to 4 months.  When the complainant reported after 4 months for review she had complained pain at right hip and serial X-ray revealed evidence of aseptic ostolysis.  On the basis of the diagnose of ostolysis, the complainant was advised a revision surgery with bone cement and modular prosthesis.  Even though the 1^st OP could have done the revision surgery, the complainant was referred to Pariyaram Medical College Hospital for further management as preferred by the complainant.  The complainant did not develop infection in fracture site which is well evident from blood investigation.  Hence obviously the problem was due to aseptic ostolysi which is a reported known complication involved t in the treatment of dip laced fracture neck of femur. The complainant required revision surgery solely because of aseptic ostolysis caused due to factors beyond the control of the 1^st OP.    Primary bipolar prosthesis surgery is the medically accepted standard treatment for the nature of fracture caused to the complainant.  In the treatment of the complainant the 1st OP had exercised reasonable care and caution and followed practice acceptable to medical science and no negligence can be attributed upon the 1^st OP simply for the reason that the patient required a revision surgery due to aseptic ostolysis developed as a late onset complication.  This complication was not caused due to any act or omission on the part of the 1^st OP.  There is no negligence or deficiency in service on the part of the 1^st OP as alleged by the complainant.  The complainant is not entitled to get any relief as prayed for in the complaint. Hence, prayed for the dismissal of the complaint.

            Parties led evidence in support of their respective contention.  Complainant filed his proof affidavit and documents.  Examined as Pw1.  Marked Ext.A1 to A9 series.  Another witness Dr. Sunil V who had treated and conducted 2^nd surgery on the complainant at Pariyaram Medical College was examined as Pw2.  Pws1 and 2 were cross-examined by OPs. On the side of OPs, OP No.1 filed chief-affidavit and examined as Dw1. Marked the case record of the complainant kept in OP No.2 hospital as Ext.B1.  The case record of the complainant from Pariyaram Medical college Hospital, was summoned as per the petition of the complainant and was marked as Ext.X1.  Dw1   was cross-examined for complainant.

            After that the learned counsel for the OPs, made oral argument and filed written argument note and also submitted Text book of Medical literature.  The learned counsel of complainant also filed written argument note.

            We have gone through the pleadings of the parties, perused the medical records available, submissions of the learned counsels of complainant and Op and also referred the medical literature produced. OP’s learned counsel also submitted judgments of Apex court.

            Learned counsel for the complainant has contended that OP1 had conducted surgery by un cemented modular bipolar prosthesis. After long 7 months of treatment the OP1 could not identify the root cause of severe pain and restricted movement of complainant.  As Dw1 has admitted in the box when he was examined, that he had not prescribed any medicines for osteolysis.  All the medicines he prescribed in Ext.A1 discharge summary of AKG Hospital are steroids, vitamins and boosters.  Then the material question arises that why he reviewed and treated the complainant till 29/10/2019 long time even after discharged from OP No.1 hospital.  Further submitted that no documents before the commission to show that Dw1 was ready to conduct re-surgery and having advanced facilities in the Hospital.  Instead of that OP 1 referred the complainant to Kannur Govt. Medical College at Pariyaram with a suggestion of Cemented Hemi Arthroplasty and that reference is denied by Pw2, Dr. Sunil Kumar who had conducted re-Surgery.  Dr. Sunil conducted revision surgery by cemented modular prosthesis and that same proves that Dw1 ought to have done cemented modular bipolar prosthesis on the complainant.  It shows the clear laches and negligence on part of his duty and service towards the complainant and for that OP1 has to compensate her loses. 

            On the other hand learned counsel for the OP submitted that during the follow-up, the complainant informed OP No.1 about severe pain in the fracture area; that he could not walk after the removal of the plaster and that although OP No.1 prescribed medicines, there were no changes or improvements.  She was cross examined for the OP and she deposed as നിങ്ങൾക്കുണ്ടായ പരുക്ക് വലത് തുടയെല്ലിലെ മുകൾ ഭാഗം പൊട്ടിയതാണ് എന്ന് പറഞ്ഞാൽ ശരിയാണ്.  അത് ശിരിയാക്കാൻ വേണ്ട ഓപ്പറേഷൻ നടത്തി സ്റ്റീൽ  ഘടിപ്പിച്ചിട്ടുണ്ടായിരുന്നു.  സ്റ്റീൽ  വെക്കുന്ന കാര്യമൊക്കെ ഡോക്ടർ മനസിലാക്കി തന്നിരുന്നു.  ഇത് ഘടിപ്പിച്ച് കഴിഞ്ഞാൽ സാധ്യതയുള്ള കുഴപ്പങ്ങളെ കുറിച്ച് ഡോക്ടർ പറഞ്ഞിരുന്നോ? പറഞ്ഞിരുന്നില്ല.  (it is false statement.  Pw1 admitted that സമ്മതപത്രം ഒപ്പിട്ട് കൊടുത്ത്ത് മോഹനൻ,രാജേഷ് എന്നവരാണ്.  അതിൽ മോഹനൻ എ െൻറ ഭർത്താവാണ്.  The expected complication are explicitly described in the informed consent)

സർജ്ജറി കഴിഞ്ഞ  മൂന്നാം ദിവസം വെയിറ്റ് എടുത്ത് കാലിെൻറ  സർജ്ജറി ശരിയാണെന്ന് ഉറപ്പ് വരുത്തി എന്ന് പറഞ്ഞാൽ ശരിയാണ്.   നാലാമത്തെ ദിവസം കുറച്ച് നടന്നു നോക്കിയിരുന്നു.  ഡിസ്ച്ചാർജ്ജ് സമ്മറി ഞാൻ വായിച്ച് നോക്കിയിട്ടില്ല അതിൽ ഉണ്ടാവാൻ സാധ്യതയുള്ള കോമ്പ്ലിക്കേഷനെ പറ്റി പറഞ്ഞിട്ടുണ്ടോ എന്നെനിക്കറിയില്ല.  ഡിസ്ച്ചാർജ്ജ് ആയതിന് ശേഷം ഡോക്ടറെ കണ്ടു എന്ന് കാണിക്കാനുള്ള രേഖ ഹാജരാക്കിയിട്ടുണ്ട്.  അത് മെഡിക്കൽ ബിൽസ് ആണ്.  ഡിസ്ച്ചാർജ്ജ് ആയതിന് ശേഷം ഡോക്ടറെ കണ്ടു എന്ന് കാണിക്കാനുള്ള രേഖ ഹാജരാക്കിയിട്ടുണ്ട്.  അത് മെഡിക്കൽ ബിൽസ് ആണ്.  The learned counsel submitted that if there is any review as alleged by the complainant it is to be proved by producing prescriptions issued at the time of review.  Nothing is produced.  ഡിസ്ച്ചാർജ്ജ് ചെയ്തതിന് ശേഷം വേദനയുണ്ട് എന്ന് പറഞ്ഞിരുന്നു എങ്കിൽ ആയത് പ്രിസ്ക്രിപ്ഷനിൽ രേഖപ്പെടുത്തിയിട്ടുണ്ടാകും, വേദനക്ക് മരുന്ന് കുറിച്ച് തന്നിട്ടുണ്ട്.  ഇഞ്ചക്ഷൻ  എടുത്തിട്ടുണ്ട്.(Ext.A3). Ext.A3 is not the prescription of the OP1.  A3 is the case sheet issued at Pariyaram Medical college.  ഡിസ്ച്ചാർജ്ജ് ആയതിന് ശേഷം 4 മാസക്കാലം നിങ്ങൾ ഒരു ചികിത്സയും എടുത്തിട്ടില്ല എന്ന് പറയുന്നു? ശരിയാണ്.  4 മാസം കഴിഞ്ഞ് OP യെ കണ്ടപ്പോൾ എക്സറെ എടുത്ത് പരിശോധിച്ചിട്ടുണ്ടായിരുന്നു എന്ന് പറഞ്ഞാൽ ശരിയാണ്.  അപ്പോൾ ഇംപ്ലാൻറ് ഘടുപ്പിച്ച എല്ലിന് തേയ്മാനം ഉണ്ടായി എന്നാണ് ഡോക്ടർ പറഞ്ഞത്? അതെ.

            From the above facts and evidence, it is revealed that the complainant had no complaints for the 1^st four months after the surgery.  It is also evident that after four months when the complainant approached OP No.1 and complaint about pain at the operated site, OP No.1 had advised to take X-ray and diagnosed osteolysis and referred to Pariyaram Medical College on the request of the complainant.

Here complainant has examined Dr. Sunil V (as Pw2) the orthopaedic surgeon who conducted 2^nd surgery on the complainant at Pariyaram Medical College.  The evidence of Pw2 is crucial in this case.  On analysis of the evidence tendered by Pw2 it is seen that during cross-examination the learned counsel of OP put forward a question, “was there any infection on the wound at the time of examination? No.” ( it means there was no infection).  Aceptic Ostiolysis is a well known complications on hip surgery where modular bipolar prosthesis is used.  In uncemented modular bipolar cases osteolysis is an accepted complication.  Can you explain what is uncemented? Life of the prosthesis is only 15 to 20 years.  Uncemented surgery has certain advantages because in future when we go for revision surgery ie., total hip replacement is required in cemented modular bipolar cases. The 1^st surgery without cement done by oP1 is perfect? Yes.  It is perfect.  Did you find any complications in the patient that was happened due to the negligence by the OP1?  No there was no negligence on the side of the OP1.  As per Ext.A9 surgery done by the OP1 is perfect? Yes.  He clearly stated the asceptic osteolysis is a known complication of this type of surgery and affirmed that the surgery performed by OP1 was perfect.  The counsel submitted that there was not even suggestion on the side of the complainant made to discredit the witness during the proceedings.

            On analysis of the evidence of OP No.1 (Dw1) in Re-examination he has deposed that

ആദ്യം Cemented prosthesis എന്തുകൊണ്ടാണ് ഉപയോഗിക്കാതിരുന്നത്? ഒരാളുടെ  life expectancy 80 (78-80) വയസ്സാണ്.  ഇപ്പോള് 55 വയസ്സുള്ള ഈ പേഷ്യൻറിന് 80 വയസ്സുവരെ life expectancy ഉണ്ടെന്ന് വിചാരിച്ചാണ് ചികിത്സിക്കുന്നത്.  prosthesis ഉപയോഗിക്കുന്നത് Cemented ആണെങ്കിലും cement less ആണെങ്കിലും lifespan 15 വർഷമാണ്.  ഈ രോഗിയുടെപ്രായം 55+15 (70 വയസ്സ്) ആയിരിക്കും. prosthesis കാലാവധി 15 years എന്നതുകൊണ്ട്70 വയസ്സിൽ revision surgery വേണ്ടിവന്നേക്കാം എന്ന ആൻറിസിപ്പേഷനിൽ cement less surgery ചെയ്തു. prosthesis surgery യുടെ സമയത്ത് tight fitting  ആയിരുന്നു.  സിമൻറ് ഉപയോഗിച്ച് ആദ്യം ചെയ്യുകയായിരുന്നെങ്കിൽ cement remove ചെയ്തതിന് ശേഷമേ revision surgery ചെയ്യാൻ പറ്റുകയുള്ളൂ.  ഇത് bone damage ആകാനുള്ള സാധ്യത കൂടുതലാണ്. 

            The learned counsel of OP submitted Text book Camp Bells operative orthopedic for reference.  In which it is observed that “Younger patients with good quality femoral bone are the best candidates for cement less femoral fixation.”, he further opined “cement fixation is indicated especially when the femoral cortex is thin or osteoporotic and secure press fit fixation  is less predictably achieved.”  In a study published in https://www.orthobullets.com/evidence/34150332?section=pdf it is stated that “the existing evidence indicates that uncemented bipolar hemiarthroplasty offers shorter operative time, less blood loss, lower local complications and a similar rate of systemic complications and reoperations as compared to cemented implantation.”

            Also submitted number of citations of Hon’ble Supreme Court ie every surgical operation is attended by risks.  We cannot take the benefits without taking risks.  Every advance in technique is also attended by risks. “Kusum Sharma’s case (2010(3) SCC 480).  It is well known that, the rare risks and complication of r all surgeries.  Manju Anil Chawla Vs Jivandhra Hospital 2014 2 CPJ(NC) 261; 2014 1 CPR(NC) 236.  The doctors are expected to take reasonable care but no professional can assure that het patient will come back home after overcoming the crisis Chanda Rani v Methusethupathi 2022 0 Sup(SC)335. in Jacob Mathew case [(2005 6 SCC 1: 2005 SCC (Cri) 1369] the onus to prove medical negligence  lies largely on the claimant and that  this onus can be discharged by leading cogent evidence.  A mere averment in a complaint which is denied by the other side cane, by no stretch of imagination, be said to be evidence by which the case of the complainant can be said to be proved.  It is the obligation of the complainant to provide the facta probanda as well as the facta probantia.  C P Sreekumar (Dr.), Ms (ortho) v S Ramanjuam, (2009 7 SCC 130). 

Further in the judgment 2010 (1) Supreme 519 the Hon’ble State Commission held that a mere deviation from normal professional practice is not necessarily evidence of negligence.  Negligence cannot be attributed to a doctor so long as he is performing his duties to the best of his ability and with due care and caution.  Merely because the doctor chooses one course of action in preference to the other one available, he would not b e liable if the course of action chosen by him was acceptable to the medical profession.

            Thus from the above discussion, from the evidence o Pw2 Doctor, from Medical literature, and the principles as well as practice followed by the doctors, it is clear that there was no negligence in performing the operation and opting a particular, surgery Modular bipolar prosthesis (sung fit and no cement was used) by OP No.1 and developing pain at the fracture site due to asceptic ostolysis after about 4 months cannot be equated with negligence.  From the expert  evidence it is revealed that OP No.1 has taken the due care and chose one of the best methods for conducting the operation considering the age of the patient and there is nothing on record and it is due to his  negligence, the complainant has to undergo operation second time, at Pariyarm medical college, Kannur.

            Here the complainant failed to prove her case against OP No.1 doctor.  So the complainant is dismissed.  No order as to cost.

Exts.

A1-Discharge summary dated 14/04/2019

A2-Discharge bill

A3-Discharge card issued by Pariyaram MCH  dated 118/11/2019

A4-Copy of lawyer notice dated 24/12/2019

A5(series)- Postal receipts

A6 (series)- Acknowledgment card

A7- Reply notice dated 02/01/2019

A8(series)- Medical bills (23 in numbers)

A9(series)- X-ray (6 in Nos.)

B1-Case recorded of the complainant kept in OP2

X1- Case recorded of the complainant from Pariyaram MCH

Pw1-Complainant

Pw2-Dr. Sunil V- Witness of complainant

Dw1-OP1

      Sd/                                                                          Sd/                                                     Sd/

PRESIDENT                                                                   MEMBER                                                   MEMBER

Ravi Susha                                                               Molykutty Mathew                                     Sajeesh K.P

(mnp)

/Forward by order/

Assistant Registrar