CONSUMER DISPUTES REDRESSAL FORUM – X
GOVERNMENT OF N.C.T. OF DELHI
Udyog Sadan, C – 22 & 23, Institutional Area
(Behind Qutub Hotel)
New Delhi – 110 016
Case No.515/2006
LATE SMT. CHANDA DEVI
DIED ON 02.02.2016)
R/O H.NO.11, DURGA COLONY,
AT PO - KASHIPUR, DISTT. - UDDAM SINGH NAGAR,
STATE – UTTRANCHAL
PIN CODE -244713
…………. COMPLAINANT
(THROUGH LEGAL HEIRS)
- SH. SURENDER SINGH
(HUSBAND OF COMPLAINANT)
- MAMTA MANRAL
D/O SH. SURENDER SINGH
- RENU MANRAL
D/O SH. SURENDER SINGH
- ROHIT MANRAL
S/O SH. SURENDER SINGH
- MONIKA MANRAL
D/O SH. SURENDER SINGH
BEING MINOR REP. THROUGH HER FATHER SH. SURENDRA SINGH
ALL R/O H.NO.11, DURGA COLONY,
AT PO - KASHIPUR,
DISTT. - UDDAM SINGH NAGAR,
STATE – UTTRANCHAL
PIN CODE -244713
Vs.
- INDRAPRASTHA APPOLLO HOSPITALS
THROUGH ITS MEDICAL SUPERINTENDENT
SARITA VIHAR, MATHURA ROAD,
M.B. ROAD, NEW DELHI-110044
- DR. S.K. SOGANI,
M.S.M. CH(NEURO), SENIOR CONSULTANT,
SURGICAL NEUROLOGY,
INDRAPRASTHA APOLLO HOSPITALS,
SARITA VIHAR, MATHURA ROAD,
M.B. ROAD, NEW DELHI-110044
R/O 18 RAJINDRA PARK,RAJINDER NAGAR,
NEW DELHI-110060
- DR. AJAY MALHOTRA
RADIOLOGIST, INDRAPRASTHA APOLLO HOSPITALS,
SARITA VIHAR, MATHURA ROAD,
M.B. ROAD, NEW DELHI-110044
- DR. VIVEK VOHRA
RADIOLOGIST, INDRAPRASTHA APOLLO HOSPITALS,
SARITA VIHAR, MATHURA ROAD,
M.B. ROAD, NEW DELHI-110044
- DELHI MEDICAL COUNCIL
THROUGH ITS SECRETARY
368, 3RD FLOOR, PATHOLOGY BLOCK,
MOULANA AZAD MEDICAL COLLEGE,
BAHADUR SHAH MARG,
NEW DELHI
- MEDICAL COUNCIL OF INDIA
THROUGH ITS SECRETARY
AJWAN-E-GALIB MARG,
KOTLA ROAD, OPPOSITE TO MATA SUNDARI COLLEGE,
NEW DELHI-110002
…………..RESPONDENTS
Date of Order:27.05.2016
O R D E R
A.S. Yadav- President
Complainant was suffering from the headache anteriorly associated with Nausea, dizziness and vertigo in the neck since 8-9 months prior to September 2002. Brain scanning of the complainant was done on 03.09.2002 in the Sri Sai Hospital, Muradabad (Vide Annexure A) and on 07.09.2002 in the G.M.R. Institute of Imaging & Research, New Delhi (Vide Annexure N) which revealed lobulated mass tumor (lesion) measuring 2.1 Cm (S1)X2 (TR) X 1.6 Cm (AP) in the region of fourth ventricle (Vermain) of her brain.
On 07.09.2002 she was taken to the Indra Prastha Apollo Hospital, Sarita Vihar, Mathura Road, New Delhi and after deposit of the consultation charges Dr. S.K. Sogani, Senior Consultant Surgical Neurology of the said Hospitals examined the complainant and diagnosed that the complainant was suffering from “Mid line Post Fossa Tumor” with the advice for its urgent operation.
On 26.09.2002 complainant was admitted in the aforesaid hospital. On 27.9.2002 the complainant was taken to operation but instead of removing the tumor by surgical operation the area of the tumor was suppressed through micro surgical decompression and excision of the small portion of the size 0.1 CM (S.I)X0.2(T.R)X1.6CmX(A.P) as if the same was for biopsy test.
Complainant was discharged form the hospital and shifted to Apollo Millennium Hospital, New Delhi on 29.9.2002 where she was treated after operation upto 07.10.2002. During the said post operative treatment the plain C.T(Head) Scanning of the complaint was done on 30.9.2002 in the said Millennium Hospital which showed the presence of the residual brain tumour(Vide Annexure P).
After expiry of some time from the date of the operation the tumour relieved upto its potential due to which the complainant again suffered from the same trauma of ailment as underwent before the alleged operation.
Complainant was again taken to the Apollo Hospital on 09.11.2002 where Dr. S.K. Sogani examined her and prescribed some medicines. But there was no relief after use of those medicines. Thereafter brain scanning of the complainant was again got done in the Sri Sai Hospital on 23.11.2002 which indicates sizeable tumour in the brain. With this report complainant was admitted in the Apollo Hospital on 23.12.2002 and kept under treatment there upto 25.12.2002. During the treatment, C.T.(Brain) scanning was done on 24.12.2002(Vide Annexure J) in the hospital itself the report of which was set to show that there was no brain tumour. On the basis of this scanning report dated 23.12.2002 the earlier scanning report dated 23.11.2002 of Sri Sai Hospital was brushed aside as wrong by Dr. SK. Sogani giving false assurance that the complaint would be alright with the sue of the prescribed medicines in the long run. As per this advice the complainant was taking prescribed medicines for the next two years approximately but there was no remission in the suffering of the complainant rather her condition started decaying due to the reaction of the medicines.
In the meanwhile the complainant was also got examined in several hospitals which all attributed the sufferings of the complainant to the brain tumour only and accordingly advised M.R.I.(Brain) operation of the complainant.
Thereafter, the complainant was taken to Delhi and her brain scanning was got done once more on 16.7.04 in the N.M.C. Imaging the diagnostic centre VIMHANS, New Delhi (Vide Annexure O) which showed the alter of tumour measuring 2.0(S.1)X1.8(T.R)X6(A.P) in her brain. With this report the husband of the complainant took her again to the Apollo Hospitals on 27.7.04.
At last the husband of the complainant had lost faith and confidence in the prolonged treatment of the Dr. S.K. Sogani and having been perturbed very much by the sufferings and health deterioration of the complaint she was got operated on 20.8.2004 for the brain tumour of the size 2.0 cm(S1)X1.8(T.R) and 1.6cmX(A.P) by the Gamma Knife Radio Surgery in the VIMHANS Hospital, Nehru Nagar, New Delhi(Vide Annexure T).
The above facts on record would therefore clearly establish that this is a glaring case of enormous deficiency in the paid services due to medical negligence for which the Indra Prastha Hospitals and Dr. S.K. Sogani Sr. Consultant thereof are impleaded in the present complaint as the OP-1 and OP-2 respectively.
It is stated that this is a glaring case of deficiency in service on account of enormous negligence in rendering efficacious paid service for want to reasonable skill, care and expected professional expertise on the aprt of OP-2 who is a senior consultant, surgery neurology of the hospital of the OP-1 having world wide reputation for excellent medical service. The said deficiency is substantiated on the following grounds inter-alia:-
- because of 07.9.02 Dr. Harsh Mahajan, MBBS (MAMC), M.D., Radiologist(PGI, CHD) & Honorary Physician to the President of India conducted M.R.I. Scan of the complainant’s brain which revealed a lobulated mass lesion(tumour) measuring 2.1 cm(S1)X2(T.R.)X1.6 cm(AP) in the region of fourth ventricle. M.R.I. Scan(brain) was conducted by Dr. Sunil Suneja, M.D. consultant Radiologist which revealed altered signal mass lesion (tumour) measuring 2.0 (S.I)X1.8 (T.R.)X1.6 (A.P) cm in the same region of fourth ventricle. On comparison with previous M.R.I. scan dated 26.9.2002 there was mild reduction in size of mass and lesion indicating less enhancements. The above material facts on record give rise to a conclusion that the OP-2 conducted Micro Surgical Decompression of the tumour took out a piece of the same and closed the operation on 27.9.2002 without bothering for removal of the considerable size of the tumour.
- Because on 30.9.2002 Dr. Preeti Bala Vashthava, M.D. Consultant Radiologist conducted plain C.T.(head) of the complainant in the Apollo Millennium Hospitals Pusa Road, New Delhi which showed evidence of posterior Fossa even after the operation on 27.9.2002. The matter was brought to the notice of OP-2 on 09.11.02 who assured that the complainant will be cured by use of the medicines prescribed by him.
- Because on 24.12.02 OP-3 and OP-4 brought out a C.T. scan report indicating that no focal enhancing lesion was there in the brain of the complainant. On the basis of this report OP-2 had pointed out to the husband of the complainant that there was no tumour in the brain and the C.T. scan report of the Dr. Raju Gupta, Radiologist of Sri Sai Hospital Moradabad was wrong without conducting a through examination as to the actual situation of the tumour which caused a lot of physical suffering and mental agony.
- The finding of the Delhi Medical Council that the OP-2 cannot be attributed with medical negligence is not reasonably convincing as the same was intended to save OP-2. Further when a small part of tumour was left behind to save life of the complainant there was absolutely no necessity to suppress the same fact from disclosure to the husband of the complainant in the interest of her life. Further nothing was documented in the concerned discharge summary regarding left over tumour as admitted before the Delhi Medical Council. This shows that the operational notes were subsequently modified by way of inserting that a small part of the tumour was left over to save life of the complainant. The ground taken that the complainant developed episode of bradycardia during the operation is contrary to the results of clinical tests conducted prior to the alleged operation according to which the cardio vascular system of the complainant was functioning normally and she tolerated the operation well as documented in the discharge summary.
- Because the Delhi Medical Council has asserted on one hand that Dr. S.K. Sogani has left over a portion of tumour to save life of the complainant and on the other hand the Sai Council supports that Dr. S.K. Sogani relied on the scanning report dated 24.12.02 that there was no tumour which shows prima facie inconsistency in its reasoning purposefully to save the OP-1 and OP-2.
Complainant has claimed relief of Rs.42 lakhs which includes Rs.6 lakhs for expenses incurred, Rs.10 lakhs for physical and mental suffering of the complainant, Rs.5.5 lakhs for dependency of the complainant on others for her entire life time, Rs.5.5 lakhs for loss occurred to the husband of complainant i.e. loss of salary, accumulation of leave and loss of promotional avenues, Rs.10 lakhs for mental agony, Rs.5 lakhs for mental agony to the children.
The complaint was filed in the Hon’ble State Commission as beyond the pecuniary jurisdiction of this Forum however the same was transferred by Hon’ble State Commission to this Forum vide order dated 28.3.06 by observing that the amount of compensation would not exceed Rs.20 lakhs keeping in view the actual medical expenses incurred and the medical negligence.
OP-2 in the reply took the preliminary objection that there was no cause of action for filing the present complaint as complainant has already approached Medical Council of Delhi who after going through the entire medical records of the complainant held that there was no negligence on the part of either the hospital or the doctor concerned. Even otherwise the complaint is barred by limitation as complainant was admitted in the hospital on 27.9.02 for operation and present complaint has been filed on 26.4.06. It is stated that the Brain C.T. Scan of the complainant was done in the Sri Sai Hospital, Muradabad on 03.9.2002 indicating midline posterior fossa vemain Tumour. Tuberculoma/Ependymoma. Thereafter, the patient got her MRI Brain done on 07.9.2002 in the G.M.R. Institute of Imaging & Research, New Delhi which confirmed the lobulated mass tumour expending on 4th Ventricular. It is pertinent to submit that after reviewing the patient clinically with CT & MRI report. OP-2 Dr. S.K. Sogani advised urgent operation for the complainant and explained the complaint and her family members with all possible risk of surgery and dangerous location of the tumour.
It is stated that during the operation, the complainant had an episode of bradycardia while removing tumour completely hence to save her life, small part of tumour adjacent to brainstem was left behind. It is further stated that after surgery, complainant was shifted to Millennium Hospital for post operative recovery ad was discharged from there on 07.10.02 in a satisfactory condition without any complaint. Post recovery of the complaint was uneventful. It is further stated that even the decision given by the Delhi Medical Council that “no medical negligence can be attributed on the part of Dr. S.K. Sogani, treating doctor and the answering OP hospital in the treatment of the complainant” was upheld in by the Medical Council of India. It is stated that there was no negligence nor deficiency on the part of OP-1 or OP-2 hence the complaint be dismissed.
The identical stand was taken by OP-1 in its reply.
OP-3 and OP-4 were proceeded ex parte.
OP-5 i.e. Delhi Medical Council, in its reply stated that complainant is not a consumer qua OP-5. The complaint made by the husband of the complainant to Medical Council of India about medical negligence was transferred to Delhi Medical Council and order dated 10.10.05 displayed that complaint against OP-5 is liable to be dismissed.
OP-6 i.e. Medical Council of India took the plea that complainant is not a consumer qua OP-6. Medical Council of India considered the appeal submitted by the husband of the complainant against the order dated 10.10.05 of Delhi Medical Council and disposed of the same by order dated 27.10.06. It is prayed that the complaint be dismissed.
We have heard Ld. Counsel for the parties and carefully perused the record.
It is proved on record that brain scanning of the complainant was done on 03.09.2002 in the Sri Sai Hospital, Muradabad (Vide Annexure A) and on 07.09.2002 in the G.M.R. Institute of Imaging & Research, New Delhi (Vide Annexure N) which revealed lobulated mass tumor (lesion) measuring 2.1 Cm (S1)X2 (TR) X 1.6 Cm (AP) in the region of fourth ventricle (Vermain) of her brain. It is also proved on record that on 07.09.2002 she was taken to the Indra Prastha Apollo Hospital, Sarita Vihar, Mathura Road, New Delhi and after deposit of the consultation charges Dr. S.K. Sogani, Senior Consultant Surgical Neurology of the said Hospitals examined the complainant and diagnosed that the complaint was suffering from “Mid line Post Fossa Tumor” with the advice for its urgent operation.
It is submitted by Ld. Counsel for complainant that on 26.09.2002 complainant was admitted in the aforesaid hospital. On 27.9.2002 the complainant was taken to operation but instead of removing the tumor by surgical operation the area of the tumor was suppressed through micro surgical decompression and excision of the small portion of the size 0.1 CM (S.I)X0.2(T.R)X1.6CmX(A.P) as if the same was for biopsy test. After surgery the complainant was discharged on 29.9.09 vide discharge summary (annexure E) which provides as under:-
“Course in the hospital:-
After admission, patient was planned for surgery. Patient was fully investigated. Physician clearance taken from Dr. Alok Kumar Aggarwal and PAC was done. After informed consent, patient was taken for surgery on 27.9.2002. Midline posterior fossa craniectomy and excision if intra IV ventricular ependymoma. Patient tolerated the procedure well and is being discharged in a stable neurological and haemodynamic condition. Patient has come form Apollo Millennium hospital and is now being referred back to Apollo Millennium Hospital.”
It is nowhere mentioned in this discharge summary that the part of tumour on floor left on account of bradycardia. In the discharge summary it is rather stated that the patient tolerated the procedure well. In fact the operation notes exhibit R-1/C were created subsequently wherein it was mentioned that near total decompression done therein once “bradycardia so tumour on floor left”. So as per this report near total decompression was done and small portion was left on account of bradycarida which is contrary to the discharge summary as in the discharge summary it is nowhere stated that on account of bradycardia part of the tumour was left rather it is stated that the patient tolerated the procedure well. So there is no doubt that this surgical operation notes were prepared subsequently.
It is significant to note that the patient was sent to Apollo Millennium Hospital after surgery. On 30.09.2002 in Apollo Millennium hospital the CT scan was done vide Annexure P which shows that there is an evidence of mid line occipital craniectomy with underlying soft tissue defect seen beneath it. So even on 30.9.2002 the soft tissue defect was seen meaning thereby the tumour was there on that day also. C.E.C.T. Brain Scan of the patient was done by Dr. Raju Gupta, MBBS, MD, Radiologist of Sri Sari Hospital Moradabad on 23.11.2002 showing evidence of a small focal enhancing area measuring about 1.14X1.14 cm in the same midline posterior fossa and underlying soft tissue thereof.
Later on since the condition of the complaint did not improve she was again brought to Apollo Hospital and her CT scan was done on 24.12.2002 which shows no focal enhancing lesion in the brain. It is the contention of OP-2 itself that a part of tumour was left so at least that part should have been shown in this CT scan. The fact of the matter is that this CT scan was manipulated scan as the report dated 24.12.2002 of CT scan is not signed by Dr. Ajay Malhotra and Dr. Vimal Vohra who have alleged to have done CT scan rather it is signed on their behalf by someone else. It is not clear as to who has signed the same. It further shows that the operation notes were prepared subsequently as in the operation notes it is stated that the part of tumour was left. If it was so it would have come in report of CT scan dated 24.12.2002. It was not there. It shows that the report dated 24.12.2002 is manipulated one.
It is a fact that last CT scan was done on 16.7.2004 in N.M.C. Imaging the diagnostic centre VIMHANS, New Delhi (Vide Annexure O) which showed the tumour measuring 2.0(S.1)X1.8(T.R)X6(A.P) in her brain.
It is proved that on 20.08.2004 patient was taken to VIMHANS hospital Nehru Nagar and there the brain tumour of size 2.0 cm(S1)X1.8(T.R) and 1.6cmX(A.P) was found and she was operated by Gamma Knife Radio Surgery.
It is submitted by OP-1 and OP-2 that in fact the complainant made a complaint in Medical Council of India who referred the complaint to Delhi Medical Council and Delhi Medical Council submitted findings on 10.10.05. The relevant portion is produced as under:-
“Briefly stated that facts of the cases are that the said patient with a diagnosis of space occupying lesion posterior fossa underwent midline post fossa craniotomy and excision of Intra IVth Ventricular Ependymoma on 27.9.2002 at the said Hospital. The surgery was performed by OP-1. The patient was discharged on 29.9.2002. A CECT Brain done on 23.11.2002 at Sri Sai Hospital, Moradabad, gave the impression of residual/recurrence of tumour. However, CT Brain report dated 24.12.2002 of Indraprastha Apollo Hospital, done on advice of OP-1 ruled out any focal enhancing lesion in the brain. A subsequent MRI of Brain done on 16.7.2004 at VIMHANS, Nehru Nagar, New Delhi, raised the query of recurrent/residual mass and hence the patient underwent Gamma Knife treatment for fourth ventricle Choroids Plexus Papilloma on 20.8.2004 at VIMHANS.
It is the allegation of the complainant that OP-1 acted negligently whilst performing the surgery on 27.9.2002, as he did not completely remove the tumour form the brain of the patient.
The OP-1 in his reply has stated that he performed the surgery after obtaining written consent for craniotomy and tumour decompression and since during the operation, the patient had an episode of bradycardia while removing tumour completely, hence to save her life, small part of tumour adherent to brainstem was left behind. The same has been documented in the operation notes of the said Hospital.
The Delhi Medical Council is of the opinion that in view of the dangerous location of the tumour and the fact that the patient had an episode of transient bradycardia during the surgical procedure, it was within the realm of standard professional practice to leave the part of tumour, in order to save the life of the patient. Dr. S.K. Sogani cannot be faulted for the same.
It is however observed that the discharge summary dated 29.9.2002 of the Sai Hospital which was released to the complainant should have made mention of the fact that a part of the tumour was being left behind, as was noted by Dr. S.K. Sogani in his operation notes.”
The appeal preferred against the finding of DMC by the complainant was dismissed by Medical Council of India vide order dated….
It is clear cut case of deficiency in service on the part of OP-1 and OP-2.
We have gone through the report of Delhi Medical Council and Medical Council of India and perused the record carefully and. As already stated Delhi Medical Council has not referred to the discharge summary wherein it specifically stated that the patient tolerated the procedure well. It is nowhere stated that part of the tumour was left on account of bradycardia.
Delhi Medical Council missed the report of CT scan which was done at Apollo Millennium Hospital immediately after operation as well as that Dr. Raju Gupta of Sri Sai Hospital, Moradabad showing the presence of tumour.
We have no doubt that there was no episode of bradycardia in view of the discharge summary.
Even Delhi Medical Council has stated that in the discharge summary the fact that a part of the tumour being left behind should have been mentioned. We are also of the same view. It is a true that there is deficiency in service. If one looks at the discharge summary one will get an impression that the operation has been done and a tumour was removed. No mention that the part of tumour left on account of bradycardia or for another reason. Rather CT scan dated 24.12.2002 shows that there was no tumour left and this vey important aspect is missed by Delhi Medical Council that if there was no tumour left on 24.12.2002 where was the scope of the part of tumour left on account of bradycardia.
We have no hesitation in coming to the conclusion that it is a clear cut case of deficiency in service on the part of OP-1 and OP-2.
In fact the complainant suffered a lot constantly. She was under treatment. The tumour was very much in the brain. Ultimately she has to undergo Gamma Knife Radio Surgery in the VIMHANS Hospital. Under these circumstances, we are of the view that interest of justice will suffice if the compensation of Rs.10 lakhs is awarded to the complainant alongwith interest @ 9% p.a. from the date of filing of complaint plus litigation expense of Rs.50,000/-. 80% of the amount shall be paid by OP-1 and 20% by OP-2. The compensation will be distributed equally to the legal heirs of deceased complainant.
Let the order be complied with within one month of the receipt thereof. The complaint stands disposed of accordingly.
Copy of order be sent to the parties, free of cost, and thereafter file be consigned to record room.
(D.R. TAMTA) (A.S. YADAV)
MEMBER PRESIDENT
