District Consumer Disputes Redressal Forum
Civil Station, Palakkad – 678 001, Kerala
Dated this the 15th day of December, 2010
Present: Smt.Seena.H, President
Smt.Preetha.G.Nair, Member
Smt.Bhanumathi.A.K, Member Date of filing: 06/01/2009
CC. No.4/2009
Mathews.M.Mathew
S/o.E.M.Mathew(Late)
Mathurappoikayil House
Thekkemuri
Kalleppully Post
Palakkad 678 005. - Complainant
(By Adv.U.Suresh & K.Dhananjayan)
Vs
1. The Executive Director
Paalana Institute of Medical Sciences
Kannadi Post
Palakkad
(By Adv.C.Ramachandran)
2. Dr.Shibu Mathew,MBBS, MS
Ortho Surgeon of Paalana Institute of
Medical Sciences
Kannadi
Palakkad
(By Adv.V.K.Venugopalan)
3. Dr.Sunil Sreedhar,MS,Mch
Malabar Hospital
N.H.Bye Pass
West Yakkara
Palakkad
(By Adv.A.Ranjit Unni)
4. K.Govindaswami Naidu
Medical Trust
K.G.Hospital
No.5, Govt. Arts College Road
Coimbatore 641018. - Opposite parties
(By Adv.N.Anoopkumar)
O R D E R
By Smt.SEENA.H, PRESIDENT
Brief case of the complainant:
Complaint is regarding the medical negligence committed by 1st and 2nd opposite parties in providing treatment to the mother of the complainant following a fall from the bath room. The complainant’s mother was admitted to 1st opposite party hospital on 8/12/2007 for the treatment due to fracture on her left thigh. 2nd opposite party suggested an urgent operation. Surgery was carried on 10/12/2007 and a steel rod was inserted in the bone. Later the patient developed bedsore which when informed has stated to be common by 1st and 2nd opposite parties. On 14/12/2007, patient was shifted to medical ICU as she developed breathing trouble. 2nd opposite party Doctor left the ICU without giving any information as to the condition of the patient. On the next day when she was shifted to her room also the same problem was still there. According to the complainant it was due to infection in the lungs. On 22/12/2007 patient was discharged on advice to review on 29/12/2007. But before the date itself as there was discharge from the wound complainant enquired about the Doctor, but it was informed that he went to his native place to participate in Christmas celebrations. On review date the wound was dressed and the patient was sent back. Complainant has told the Doctor that the discharge from the wound may be due to infection, but it was replied that he has taken care of everything.
By 3rd January, 2008 the patient’s condition became very bad and she was not able to travel to 1st opposite party hospital which was far away. As per the direction of the Doctor from District Hospital, Palakkad the patient contacted 3rd opposite party of Malabar Hospital and was admitted there. There it was diagnosed that she had developed septicemia from the infected steel rod used for nailing inside the femur and it was already affected her lungs, kidney, heart and brain. As per the opinion of 3rd opposite party infection was contracted from the operation theatre and the condition of the patient was very critical as the infection was from the inside of the bone. On 11/01/2008 the patient was admitted in K.G.Hospital, Coimbatore for higher treatment as per the advice of 3rd opposite party. But the patient died on 19/1/2008 due to the basic reason of septicemia from the infected rod. Complainant submits that the mishap was due to the negligence on the part of 1st and 2nd opposite parties. Further bedsore has developed due to the existence of infectious germs in the ICU and poor nursing of inexperienced nursing staff. A notice stating all the facts was sent through a consumer association for an amicable settlement for which 1st opposite party was not amenable. Hence the complaint. Complainant prays for a compensation for Rs.10,00,000/- with 12% interest which includes the hospital expenses and compensation for mental agony and further the cost of the proceedings.
All opposite parties entered appearance and filed versions. 1st opposite party in their version contented that the patient was admitted in the hospital on 8/12/2007 with the problem of fracture on the left thigh. The patient was having multiple diseases like; diabetes, hypertension etc. The Surgery was carried out after prognosis and the need for surgical fixation of the fracture were explained to the relatives of the patient. Every care including good nursing was taken during the post-operative period by the hospital staff and no bedsore was seen during the period of hospitalization. Patient’s relatives were briefed about the patient’s condition and progress twice daily. The patient was shifted to the MICU on 13/12/2007 for observation for disorientation probably due to electrolytic imbalance. The condition of the patient was then briefed to the bystanders by the Physician. On 14/12/2007 the patient was shifted to room and there was no lung infection at that time. On 22/12/2007 the patient was discharged after good healing of the wound and removal of the suture. The patient had a protective dressing over the wound. The patient was brought to the hospital only on 29/12/2007 for a routine review. As a policy of the hospital the wound was dressed by Dr.Shibhu Mathew. At the time of review it was noticed that the patient showed signs of neglect at home after discharge from the hospital. She had perineal hygiene and was showing signs of gluteal redness, probably the start of pressure sore. The patient did not complain of neck pain or breathing difficulty during review. All the allegations in the complaint against the doctor and hospital are false and hence denied. The allegations that Dr.Sunil Sreedhar diagnosed that the patient had developed septicemia from the infected rods used for nailing inside the femur and it has spread throughout the body are absolutely false. Further the treatment in K.G.Hospital if any could not be in relation to any surgical complication as alleged by the complainant. All other allegations including poor nursing and infectious germs even in the ICU are false and purposefully made to defame the hospital. Opposite party submits that there is no deficiency in service on their part and they are not liable to compensate the complainant. There was no septicemia or wound infection for the reasons stated in the complaint and no mental agony caused to the complainant. Hence the opposite party prayed to dismiss the complaint with compensatory costs.
2nd opposite party admitted in their version that he has treated the patient and conducted operation on 10/12/2007 after prognosis explaining the need for surgical fixation to the relatives of the patient. On 11/12/2007 the patient was shifted to ward, the operative site drain was removed on 12/12/2007. On 13/12/2007 the patient showed some disorientation and was shifted to the Medical ICU on the advice of the physician. The patient was then managed by the physician and became alright by evening. On 14/12/2007, she was shifted back to the ward. The patient was on parenteral antibiotics and on anti-diabetic and anti-hypertensive medication. Alternative day dressings were done and wound healing was found to progress satisfactorily. On 22/12/2007 sutures were removed and discharged with advice to come for review on 29/12/2007.
The patient was reviewed on 29/12/2007. On examination the patient was found to be conscious, oriented and afebrile. She was noticed to have bad perineal hygiene and had gluteal redness indicating early signs of pressure sores. The operative scar was healthy and showed no evidence of infection. Further he explained the importance of sitting up frequently and changing position to prevent the bed sore and adviced to come for review on 01/01/2008.
On 12/12/2007, the complainant came to opposite party hospital and behaved indecently to the opposite party, nursing staff and students and the Director of hospital lodged a complaint against the complainant in the local police station. The opposite party No.2 submits that this complaint is an outburst of it. The opposite party successfully conducted the surgery and there was no signs of septicemia in the form of fever, increased pulse rate or any other symptoms till the patient left the hospital. It is only thereafter perineal hygiene became poor probably due to neglect at home. The infection most probably was on respiratory tract due to neglect and poor care at home and subsequently spread to operation site. Being a diabetic patient it is common to have secondary infection at operative sites. The opposite party submits that there was absolutely no medical negligence on their part and prayed for dismissal of the complaint with compensatory cost.
3rd opposite party filed version contending the following. That the complainant’s mother was brought to 3rd opposite party hospital on 4/1/2008 with complaints of drowsiness, mild discharge from the site of the surgical wound, bedsore and difficulty in breathing having history of fracture of the left femur bone following a fall. On examination the patient was seen drowsy and her oxygen saturation was only 79%. The patient had bed sore over the sacral region and had redness around the surgical site with a mild discharge from the wound. Despite all the requisite treatment it was observed that the renal function was rapidly deteriorating. On 11/01/2008 patient’s renal function deteriorated further and fluid began accumulating in her body. After discussion with her relatives and in the best interest of the patient and on their suggestion the patient was referred and shifted to K.G.Hospital, Coimbatore in a fully equipped ventilator supported ambulance.
The 3rd opposite party had informed the complainant that the patient had developed septicemia leading to acute renal failure and respiratory distress syndrome but had never opined that it was due to the steel rod introduced by the 2nd opposite party for correcting the fracture of the femur. Further informed that the patient developed septicemia and other complications since she was a diabetic and hypertensive. There is absolutely no negligence or deficiency of service on the part of this 3rd opposite party and 3rd opposite party had in fact exercised utmost care and diligence in treating the patient. Opposite party 3 prayed to dismiss the complaint with cost.
4th opposite party also filed version and admitted that the complainant’s mother was transferred from Malabar Hospital, Palakkad and admitted there on 11/01/2008. 4th opposite party was informed about the surgery followed by wound infection and treated with antibiotics. The patient found to be in septicemia and hypotension managed with antibiotics and ventilator support etc. The patient was admitted in septic shock with acute renal failure and required ventilator support which was provided. All possible measures to save the patient were done by this opposite party. Her pneumonia worsened during her hospital stay and she died due to sever sepsis, in spite of all supportive measures. Prognosis is guarded due to multi organ failure. 4th opposite party admits that the complainant’s mother died due to septicemia. There are so many reasons for developing septicemia. The amount shown as expenses in 3rd opposite party’s hospital is false. Hence this opposite party prays to dismiss the complaint with cost.
Evidence adduced consists of affidavit of complainant and affidavit of 1st, 2nd and 3rd opposite parties. Complainant filed questionnaire and 3rd and 4th opposite parties filed answers to the questionnaire. Exts.A1 to A11 marked on the side of complainant.
Issues to be considered are;
1. Whether there is any deficiency in service on the part of 1st and 2nd opposite parties?
2. If so, what is the relief and cost?
Sum of the instances of medical negligence and deficiency of service on the part of opposite parties as stated by the complainant is as follows:
1. That the patient developed bedsore due to the existence of infectious germs in the ICU and also due to the poor nursing of inexperienced nursing staff.
2. That on 14/12/2007 when the patient was shifted to medical ICU following breathing trouble, 2nd opposite party left ICU without giving any information as to the condition of patient.
3. That the death of the patient was due to septicemia which in turn was the result of the infected steel rod used in the surgery.
The contention put forwarded by 1st and 2nd opposite parties regarding the said issues is as follows:
Opposite parties 1 and 2 admit that the patient was admitted in 1st opposite party hospital and was treated by 2nd opposite party Doctor. Opposite parties 1 and 2 denied the say of the complainant that the patient developed bedsore due to the infectious germs in the ICU and poor nursing of the nursing staff. It is submitted that no bedsore was seen neither on the post operative shifting to the ward nor all through the hospital stay. It is also submitted that the patient was on a water bed all through out with frequent position change and good nursing care.
On 29/12/2007 when the patient came for review the patient showed signs of neglect at home. She showed sign of gluteal redness probably the start of pressure sore. It was informed by the daughter in law of the patient that as the patient was too heavy it was difficult to manage her at home.
Regarding the allegation that 2nd opposite party did not give any information regarding the condition of the patient when the patient was shifted to medical ICU on 14/12/2007 due to breathing trouble, 2nd opposite party submits that it was not the complainant but his brother and wife who has brought the patient to the hospital following a fall. All family members including the complainant were merely visitors. Opposite parties deny the say of the complainant that on 14/12/2007 the patient developed breathing trouble and was shifted to medical ICU. According to opposite parties complainant did not know the real facts as he was not attending his mother properly. Patient was shifted to medical ICU on 13/12/2007 for observation for disorientation probably due to electrolyte imbalance. It has nothing to do with the breathlessness as alleged by the complainant. The condition of the patient was briefed to the bystanders by the physician. Again the patient was shifted to the ward on 15/12/2007 and breathing trouble was still there and he came to know that it was due to lung infection etc are also denied by opposite parties. Patient was shifted back to room on 14/12/2007 and at that time there was no lung infection.
Further say of the complainant that after discharge patient was adviced to come back for review on 29/12/2007 and before the said date when the patient had colourless discharge from the wound, the complainant enquired about the Doctor and he came to know that the Doctor went to his native place for Christmas celebrations are denied by opposite parties. According to opposite parties, it is true that the patient was adviced to come for review on 29/12/2007 and Doctor was on leave from 24th to 26th December. But 1st opposite party hospital is a hospital in which all the departments are available 24 hours a day. Duty Othopaedic Doctor was available even in the absence of 2nd opposite party. According to opposite parties if the patient has any such problem as alleged, the relatives could have brought to the hospital immediately or at least on 27th December, the day on which 2nd opposite party rejoined duty.
Regarding the main contention that death of the patient was due to the use of infected steel rods in surgery, opposite parties submit that the complainant was brought to 1st opposite party hospital on 8/12/07 following a fall at home by the brother and wife of the complainant. The patient was 83 years old, a known chronic diabetic, hypertensive and obese. After the patients blood sugar was made under control and after she was declared fit by medicines, cardiology and anesthesiology departments, she was taken up for surgery after taking informed consent on 10/12/2007. Here preoperative and post operative period were uneventful. On the next day itself she was shifted to the ward. She was monitored daily by the physician for diabetic control. Her operative site drain was removed on 12/12/2007. On 13/12/2007 she was shifted to medical ICU as the patient showed some disorientation. She become alright by evening and was shifted back to ward on 14/12/2007. Alternative day dressings were done and wound healing was found to be in progress. On 22/12/2007 her suture were removed and was discharged with advice to review on 29/12/2007. On 29/12/2007, the operative scar was healthy and showed no evidence of infection. 2nd opposite party himself dressed the wound. But she was noticed to have bad perineal hygiene and had gluteal redness indicating early signs of pressure sores. Patient’s relatives were adviced of the importance of sitting up frequently and changing of position to prevent the development of pressure sore. She was adviced to come on 01/01/2008 but patient did not come for further follow up. 2nd opposite party submits that the death of the patient is due to septicemia which developed from the infected steel rod used by him is false. Exact cause of death can be ascertained only from postmortem report which is not done in this case. No signs of infection or septicemia in the form of fever or increased pulse rate was there till she left the hospital. According to opposite parties the infection if it had occurred most probably was respiratory brought on by neglect and poor care at home which subsequently spread to the operative site also. Further it is a known fact that in diabetic patients it is common for secondary infection to occur at operative sites if patient’s general health deteriorates. According to 1st and 2nd opposite parties there is no negligence or deficiency in service on their part.
Opposite party 3 who is the consultant orthopaedic surgeon of Malabar Hospital, Palakkad wherein the complainant has undergone further treatment submits that he has informed the complainant that the patient had developed septicemia leading to acute renal failure and acute respiratory and distress syndrome but had never opined that it was due to the steel rod introduced by the 2nd opposite party for correcting the fracture. It was also informed that the patient developed septicemia and other complication since she was a diabetic and hypertensive. It is also submitted that the patient was 85 years of age and hence ability to withstand stress was less. Patient when brought to 3rd opposite party on 04/01/2008, on examination was found to be drowsy and her oxygen saturation was only 79%. She had bed sore over the sacral region and redness around the surgical site with mild discharge from the wound. All the requisite treatments were done by 3rd opposite party, but in spite of that her renal function was rapidly deteriorating. On 11/1/2008, her renal function deteriorated further and with the consent of the relatives she was referred to K.G.Hospital, Coimbatore as it was felt that she requires further management at the hands of Nephrologist. Opposite party 3 submits that he was not aware about the asepsis of the operation theatre at the 1st opposite party hospital and he has not made any comments that the infection happened from the said theatre.
4th opposite party submits that the patient was admitted there on 11/1/2008. All possible measures to save the patient was done but her life could not be saved. According to 4th opposite party it is true that the patient died due to septicemia but opposite party 4 does not know how the same has occurred. There are so many reasons for developing septicemia.
Complainant and opposite parties filed argument notes. We perused all the relevant documents on record.
Records show that complainant is an 82 years old lady who is also a known diabetic and hypertensive patient. According to the complainant, patient has developed bedsore due to the existence of infectious germs in the ICU and also due to the poor nursing of inexperienced nursing staff. The say of the complainant is seen denied by 1st and 2nd opposite party stating that she has been provided with water bed and also frequent position changing was done by the nursing staffs and there was no bedsore at the time of discharge. It’s only when she came for review there was signs of pressure sore.
It is noted that complainant has neither produced the case sheet of the patient nor taken any steps to call for the same from opposite parties 1 and 2. Ext.A6 which is the discharge summary issued by 1st opposite party hospital does not reveal that whether the complainant has bedsore. Ext.A6 shows that wound was healed and medicines are also prescribed. 3rd opposite party while answering the questionnaire filed by the complainant has stated that she has bedsore when opposite party 3 has examined her. But we find that opposite party 3 has examined the patient on 4/1/2008 and from that answer it cannot be concluded that same existed from opposite party 1 hospital also. So we find that there is no tangible evidence to prove the said averment.
One of the reason for the death of the patient was due to septicemia is stated by 4th opposite party. But whether it was due to the use of infected steel rod during surgery is answered by opposite party 4 as follows.
“Even in the best operating theatre, it is not possible to eliminate septicemia. The
Patient can harbour, the infective organism in their body either in the skin or GI track, narsal mucosa, urinary tract etc. This is very common in diabetic and old age. So the source of infection can be from the patients own body itself”.
So apart from the infected surgical appliances there are many other causes for contracting septicemia. We find that there is no credible evidence so as to show that source of infection is the steel rod. No expert evidence has been adduced by the complainant to prove this aspect. It is also to be noted that complainant has no case that he has stayed with the patient through out the hospitalization period. Instead it is brother and wife of the complainant who was with the patient. Complainant has also not taken any steps to examine them in order to ascertain true facts.
For establishing medical negligence on the part of the Doctor, there must be sufficient evidence that the Doctor or hospital has not taken reasonable care while treating the patient or the patient is treated by the Doctor who do not have the requisite skill, knowledge and expertise. Opposite party 4 Doctor has opined that even in the best operating theatre, it is not possible to eliminate septicemia. No postmortem was done on the patient. In the absence of any convincing and cogent evidence we are not in a position to attribute deficiency in service on the part of opposite parties.
In the result, complaint dismissed.
Pronounced in the open court on this the 15th day of December, 2010
Sd/-
Smt.Seena.H,
President
Sd/- Smt.Preetha.G.Nair,
Member
Sd/-
Smt.Bhanumathi.A.K
Member
Appendix
Witnesses examined on the side of complainant
Nil
Witnesses examined on the side of opposite parties
Nil
Exhibits marked on the side of complainant
Ext.A1 – Copy of letter dt.7/2/08 sent by the complainant to the 1st opposite party
Ext.A2 – Copy of letter sent by complainant to the 1st opposite party
Ext.A3 – Copy of letter sent by complainant to Palakkad District Consumers’ Association
Ext.A4 – Copy of letter sent by Palakkad District Consumers’ Association to 1st opposite party
Ext.A5 – Copy of reply letter
Ext.A6 – Copy of discharged summary issued by 1st opposite party
Ext.A7 – Copy of receipt issued by 1st opposite party for Rs.32,180/-
Ext.A8 – Cash bill issued by 1st opposite party for Rs.21,300/-
Ext.A9 – Cash bills issued by 1st opposite party
Ext.A10 – Discharged summary issued by 3rd opposite party
Ext.A11 – Death summary issued from K.G.Hospital, Coimbatore
Exhibits marked on the side of opposite parties
Nil
