| None for the appellant. The appeal is old one. Dismissed in default. Counsel for the appellant appeared later on and at his request the appeal is restored to its original number. Dismissed. Reasons to follow. This appeal arises out of the judgement and order rendered by the A.P. State Consumer Disputes Redressal Commission, Hyderabad (in short he State Commission, in complaint bearing No. 44/2001. The appellants are the original opposite party nos. 1 & 2. By the impugned judgement, the complaint was partly allowed and the appellants were directed to pay compensation of Rs.2,50,000/- to the complainant (respondent no.1) along with cost of Rs.2,000/. 2. Briefly stated, the case of respondent no.1 (complainant) is that he was suffering from abdomen pain in the nigh of 14.8.1999 and had approached the appellants with such complaint. The appellants advised him to go through certain clinical tests. He was told that he was suffering from problem of appendicitis, which was needed to be removed. On 16.8.89 at about 6 p.m. the appellant no. 2 conducted emergency exploratory Laporatomy operation. It was noticed by the appellants that ileum of the complainant was suffering from gangrene. So, a part of ileum to the extent of 1 mtr. length was removed and patchy jejunum and side to side ilecolic anastomosis was done. He was being treated as indoor patient. On 6th day of operation, he again suffered from abdomen pains. The appellants noticed development of leakage and, therefore, conducted another exploratory Laporatomy operation. For the second time, yet, another part of gangrenous jejunum was removed and E/E Anastamoses was done. As an aftermath, of the second operation, the complainant developed Feal Fistula. He was further treated for Feal Fistula. He was discharged from the hospital of the appellant on 29.9.1999. 3. The complainant alleged that there was patent error in the first diagnosis. He further alleged that during the first operation itself the gangrenous part could be removed. He alleged that there was no expertise available to conduct the operations because no Gastroentrologist was called upon to treat him. He was neither a smoker, alcoholic or diabetic and, therefore, the complications, which occurred after the two operations, were due to medical negligence of the appellants. He, therefore, got discharged and went to Aparna Hospital. He was referred to Dr. D. Nageswara Reddy who examined him and gave opinion that he was suffering from tatus post small bowel resection endoscopy normal barium meal follow through shows entry of barium from jejunum to colon and into fistulas tract On 16.10.1999, he was discharged by Aparna Hospital as his general condition had improved to some extent. He went to the native place on 30.10.1999. He took further treatment from Dr. M.B.R. Sharma, Kakinada for postoperative diarrhea and gastric outlet obstruction. His condition was improved only on 14.3.2000 and he was declared to be fit to resume duties from 15.3.2000. He alleged that all along he suffered pains and agony due to negligence of the appellants. He alleged further that there were postoperative complications due to negligent treatment and error committed by the appellant no.2. Subsequently, he filed a complaint seeking compensation of Rs.10,00,000/-. 4. The appellants denied truth in the averments made in the complaint. According to them, the emergency exploratory Laporatomy operation was done on 16.8.1999 because the complainant was found in toxic condition and there was tenderness in the abdomen. They alleged that initially, a part of the gangrene afflicted ileum was removed after due assessment and ileo transverse colostomy was done. They alleged that the surgery and the prognosis was explained to the relatives and attendants. They also justified further treatment given to the complainant till the date of discharge. They submitted that much against their medical advice, the complainant got himself discharged on 30.9.1999. They submitted that Dr. Prabhakar was the Gastroenterologist and had duly attended the complainant. They denied that there was no Gastroenterologist in the hospital. They denied any medical negligence on their part. Hence, they sought dismissal of the complaint. 5. The State Commission held that the appellants were guilty of medical negligence and deficiency in the service qua the complainant. The State Commission also held that the complainant suffered pains and agony due to postoperative problems and because of the fact that anticoagulant injection was not administered well in time to avoid thrombosis. The State Commission, therefore, partly allowed the complaint and awarded the compensation as indicated earlier. 6. We have heard learned Counsel for the parties. The learned Counsel for the appellants would submit that there was no negligence committed by the appellants. He contended that the services of Gastroenterologist were available with the appellants. He further submitted that the use of Heparin injection was not advisable immediately after the operation. He argued that in the absence of evidence of any medical expert, the treatment given to the complainant could not be branded as improper and no negligence could be attributed to them. He pointed out that the complainant got himself discharged against the medical advice. It is argued, therefore, that the appeal deserves to be allowed. Per contra, learned counsel for the respondent no.1 (complainant) supported the impugned judgement. 7. It is true, the complainant did not adduce evidence of any expert in support of the averments made in the complaint. The question of medical negligence, however, may be decided even though, evidence of an expert is not adduced. In V. Kishan Rao Vs. Nikhil Super Speciality Hospital and Anr. (2010) 5 SCC 513, the Supreme Court held that in a given case it may not be necessary to obtain an expert opinion. It was a case for which a patient suffering from intermittent fever and chills, was wrongly treated for typhoid instead of malaria for four days, which resulted in her death. It was held by the Supreme Court that it was apparent case of medical negligence. It was noticed that the Widal Test for Typhoid was conducted on 5th day and was negative whereas test for malarial parasite was positive. Obviously, it will have to be said that whether opinion of an expert is necessary or not will depend on fact situation of each case. It goes without saying that even where an expert is not examined, the Consumer Commission is not helpless if there is a sufficient material to reach conclusion about existence of medical negligence. 8. Coming to the facts of the present case, it is explicit from the record that when the complainant was admitted in the hospital on 5.8.199, the initial diagnose was of .C. appendicitis He was not diagnosed as a patient of gangrene ileum with S.M.A. Thrombosis. The first surgery was conducted on 16.8.1999 at about 6 p.m. If the version of the appellants is accepted then the first surgery was xploratory Laparotomy operationIt is but natural that the appellants ought to have explored the area of gangrenous ileum and jejunum at the time of surgery itself. The appellants failed to demonstrate as to why only one mtr. ileum was removed in the first phase and why other part of the gangrenous ileum was left as it is. Ordinarily, there was no reason for internal leakage after the first operation. The second operation was done when the complications had developed due to internal leakage. It appears that after the second operation, the complainant suffered from eal Fistulaand was required to be continued under the medical treatment as indoor patient until he got discharged on 29.9.1999. 9. It was the case of the appellant that Dr. Prabhakar is an expert Gastroentrologist and was associated with the operative procedure. The appellants did not place on record affidavit of Dr. Prabhakar. No substantial reason has been shown as to why Dr. Prabhakar was not examined before the State Commission. On behalf of the appellants, affidavit of the appellant no. 2 Dr. B. Mahender Reddy was filed on record in support of the defence. He is not a Gastroentrologist. He was attached to the hospital of the appellant no.1 as the Chief Surgeon. His version shows that he gave treatment to the complainant during the relevant period. His affidavit does not show, however, that the complainant was treated by any expert Gastroentrologist prior to the diagnosis and before conducting the second operation. 10. Cross-examination of the appellant no. 2(RW1 Dr. B. Mahender Reddy) goes to show that anticoagulant drugs were not administered till 23.8.1999. It appears that RW1 Dr. B. Mahender Reddy stated that he had noticed thrombosis i.e. the blood clotting of the vessal. He admitted that the entire intestine of the complainant was found to be afflicted by Gangrene. The medical literature produced by him revealed that for 48 hours after the operation, anticoagulant were not advisable, but in such a case, at least prior to 48 hours i.e. on 18.8.1999, he ought to have started administration of the anticoagulant. The delay between 18.8.1999 till 23.8.1999 gave rise to the complications and, therefore, the complainant suffered further prognosis. 11. We are of the opinion that the initial diagnosis that the complainant was suffering from appendicitis was itself improper and incorrect. In fact, the complainant should have been operated for removal of the entire gangrene afflicted part of the intestine in the first phase itself. The cross-examination of RW 1 Dr. B. Mahender Reddy purports to show that there was negligence committed by the appellants at least on two counts. First, there was no proper diagnose at the initial stage and secondly, there was no removal of the entire intestine part afflicted by gangrene and moreover, there was negligence due to delay in administration of anticoagulant. The adverse effect of such medial negligence was that the complainant was required to undergo the second operation and further suffered from complications like Feal Fistula. The State Commission has duly appreciated the evidence adduced by the parties. We do not find any substantial error committed by the State Commission while holding the appellants guilty of medical negligence. We are of the opinion that the compensation awarded to the complainant is on lower side. We are of the opinion that the complainant was required to suffer pains and agony due to medical negligence of the appellants and had to take prolonged treatment which could be of shorter duration if proper diagnose had been done and operative care could have been taken by the appellant. We are in general agreement with the findings of the State Commission. 12. Taking overall view of the matter, we do not find any merit in the present appeal. Hence, the appeal is dismissed with cost of Rs.5,000/- | |
