DR. S. M. KANTIKAR, PRESIDING MEMBER

1.         This is a case of alleged medical negligence.

2.         The allegation in the complaint is that the complainant’s wife, Mrs. Balwinder Kaur (deceased), was a victim of medical negligence.

3.         In the written version the opposite party doctor denied any negligence during treatment of the patient. He further stated that on 06.02.2010 he performed ureteroscopic removal of the stone from the right ureter and DJ stent was placed from right kidney to the bladder for smooth ejection of urine. The patient was discharged from the hospital on 13.02.2010 with instructions to come after one month for removal of the DJ stent but the patient did not turn up for removal of the DJ stent.  The follow up instructions were given on the reverse of the discharge card. However, the complainant did not file the original discharge card or a photocopy of the entire discharge card including its reverse side before the District Forum. On 26.07.2010 the patient and her husband approached the opposite party doctor with complaint of different disease (chest infection) and she was treated accordingly and discharged on 02.08.2010 in normal condition. There was a long gap between the initial treatment for removal of stone (on 06.02.2010) and the death of the patient (on 09.08.2011). The death of the patient was not due to non-removal of DJ stent, but was due to lung cancer. The opposite party doctor also relied on the expert medical opinion given by the Principal, Guru Gobind Singh Medical College, Faridkot, wherein no negligence was mentioned on the part of the opposite party doctor.

4.         The District Forum and the State Commission, in concurrent findings, have held the opposite party doctor guilty of medical negligence for non - removal of DJ stent from the body of Mrs. Balwinder Kaur (deceased) which thereby ultimately caused  her death.

5.         This revision petition has been filed by the opposite party doctor.

6.         We heard the arguments from the learned counsel for both the parties. The opposite party doctor (Dr. Sidhu) was also present during the arguments.

7.         The learned counsel for the complainant submitted that the patient got admitted at Amrit Hospital run by opposite party doctor (Dr. Harjinder Singh Sidhu) on 06.02.2010 for removal of stone in her right  kidney. She was operated upon on 06.02.2010 and discharged from the hospital opposite party doctor’s hospital on 13.02.2010. Thereafter, the patient again suffered abdominal pain, so the complainant took his wife to the opposite party doctor for check-up, but he ignored it and told that the patient would be cured soon. Being dissatisfied, the complainant, on 22.02.2010, took his wife to Virdi Nursing Home at Lodhi Wala, Tehsil Jagraon, District Ludhiana. The doctor at Virdi Nursing Home treated the patient till 03.03.2010 and again sent her back to the opposite party doctor for further management.  In the meantime, the patient took treatment at Civil Hospital, Makhu from 03.06.2010 to 22.06.2010. Thereafter, from 26.07.2010 to 02.08.2010, the patient was treated by the opposite party doctor but her abdominal pain did not subside. Then she got treatment from Patti Hospital during 05.07.2011 to 11.07.2011 and later got admitted in Military Hospital at Ferozepur on 11.07.2011, but the patient was referred to E.C.H. Military Hospital, Ludhiana on 13.07.2011 in serious condition. On the same day, she was referred to Satguru Partap Singh Apollo Hospital at Ludhiana (for short, ‘Apollo Hospital’).  According to the complainant, the ultrasonography (USG) revealed ‘Ctow pipe’ in the stomach of the patient, which was alleged to be lying since the time of her operation conducted by the opposite party doctor. It was the cause of infection which led to the death of the patient on 09.08.2011.  

8.         Learned counsel for the petitioner denied the negligence and made his submissions as stated in the written version.

9.         We have given our thoughtful consideration to the arguments and carefully perused the medical record.

10.       Admittedly, on 06.02.2010, the opposite party doctor had performed ureteroscopic removal of ureteric stone from the right ureter and after the procedure DJ stent was placed in the right ureter for free passage of urine from kidney to bladder. The patient was discharged on 13.02.2010 with follow up instructions. However, the patient did not turn up for the follow up. After 5 months, i.e on 26.07.2010, for a different problem of difficulty in breathing and pain on both sides of the lower chest, the patient approached the opposite party doctor. 

11.       We note the word ‘Ctow’ mentioned by complainant is a misnomer, and that it should be ‘in situ’. The lower fora relied upon the discharge summary of Apollo Hospital wherein it was mentioned that DJ stent ‘in Ctow’ (meaning thereby DJ stent ‘in situ’) was still present and it was removed on 19.07.2011 at Apollo Hospital.

12.       However, both the fora below ignored crucial and material details mentioned in the discharge summary (annexure J). Those details are reproduced below:

In view of sepsis PCN was done as USG abdomen showed hydronephrosis with DJ stent in situ. Patient continued to deteriorate so in emergency DJ stent was removed on 19-07-2011.  Her condition improved slightly after this. Her X-ray was done which showed ?SOL? Pneumonitis left lung for which CT scan with contrast was done.  Once her renal function tests improved.  FNAC of mass showed -? Non small cell carcinoma.  She had hypercalcemia secondary to parancoplastic requiring calcitonin & bisphosphonates.  For her CA lung, she was started on T-Xefsa 250 gm  Once daily. However she continued to deteriorate.  She was intubated & put on ventilatory support for respiratory distress.  The patient’s condition was explained to relatives they took a discharge on request.

13.       We note that the patient was diagnosed at Apollo Hospital as a case of Left Lung Carcinoma with brain metastasis on chemotherapy with hypercalcemia (Paraneoplastic) i.e. Lung cancer. However, the District Forum made its observations on the discharge summary of Apollo Hospital in para 12 of its Order as below:

……the patient developed cancer disease due to negligence on the part of the opposite party, who left DJ stent in the body of the patient.  The version of the opposite party is also contradictory about the removal of DJ stent and the opposite party has failed to prove that the post operative complication resulting into cancer has not been occurred due to his negligence.

 14.      In continuation, the State Commission, without considering the Lung cancer of the patient, affirmed the Order of the District Forum as below:

We find that the District Forum has correctly found OP now appellant medically negligent in not removing the DJ stent after putting it, when operation was performed on her.  The order of District Forum on this point is sustainable and order is affirmed in this appeal.

15.       We note, firstly, that the opposite party doctor at the time of discharge of the patient from the opposite party hospital on 13.02.2010 had given follow-up instructions. The same as averred by him (the opposite party doctor) were mentioned on the reverse of the discharge card. The complainant failed to produce the original discharge card or a photocopy of the entire discharge card including its reverse side before the District Forum or the State Commission (and also before this Commission).

Secondly, we note that the patient did not turn up to the opposite party doctor till 26.07.2010, but she approached various hospitals including Navpreet Hospital at Amritsar.

Thirdly, we note that she got the DJ- stent removed on 29.06.2010 at Navpreet Hospital. We have perused a certificate issued by Dr. Navpreet Singh of Navpreet Hospital in this regard. It is reproduced below:-

To whom it may concern

As per hospital record, patient Balwinder Kaur W/o Harmander Singh , 52 yrs female got her stent removed from R Side on 29.6.2010.

Fourthly, we note that the patient approached the opposite party doctor on 26.07.2010 for her chest problems and she was treated by the opposite party doctor from 26.07.2010 to 02.08.2010.

Subsequently, after about 1 year, in July 2011, she approached Apollo Hospital wherein she was diagnosed as a case of Left Lung Carcinoma with brain metastasis and chemotherapy treatment was started. Her condition continued to deteriorate and resulted in her death on 09.08.2011.

16.     We do not find any direct nexus between the DJ- stent ‘in situ’ and the occurrence of Carcinoma – Lung; the same was erroneously observed by both the lower fora. A patient is (generally and ordinarily) required to follow the instructions of the treating doctor. Here, the patient ignored the medical instructions of the opposite party doctor.  She consulted different doctors from time to time. In all contingencies, occurrence of Lung cancer after a well protracted period, and a categorical certificate from Dr. Navpreet Singh of Navpreet Hospital confirming removal of a DJ stent in between, are well – evident from the material available on the case-file. We also take note, in perspective, of the expert medical opinion of the Principal, Guru Gobind Singh Medical College, Faridkot. And, for the sake of discussion, a DJ stent in the kidney does not cause cancer in the lungs.

17.       Based on the entirety of the discussion above, we find that the two fora below have erred and mis-appreciated the facts and medical record.

18.       The Revision Petition is allowed. The impugned Order of the State Commission is set- aside. The complaint is dismissed. No order as to cost.