DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BATHINDA<br /> CC.No.199 of 18-08-2009<br /> Decided on 30-07-2010<br /> <br /> Manjeet Kaur wife of Malkit Singh, resident of Sangat Road, Talwandi Sabo, District Bathinda.<br /> ........Complainant<br /> Versus<br /> 1. Life Line Hospital, (Kidney & Dialysis Centre), Power House Road, opposite Church, Bathinda, through its Proprietor Dr. J.J.Singh,<br /> 2. Dr. J.J.Singh, proprietor, Life Line Hospital, (Kidney & Dialysis Centre), Power House Road, opposite Church, Bathinda.<br /> 3. United India Insurance Co. Ltd., through its Divisional Manager, 54, Janpath, Connaught Place, New Delhi.<br /> .......Opposite parties<br /> <br /> Complaint under Section 12 of the Consumer Protection Act, 1986.<br /> <br /> QUORUM<br /> <br /> Smt. Vikramjit Kaur Soni, President.<br /> Dr. Phulinder Preet, Member.<br /> Sh. Amarjeet Paul, Member.<br /> <br /> Present:-<br /> For the Complainant : Sh.S.S.Gill, counsel for the complainant.<br /> For Opposite parties : Sh.Lalit Garg, counsel for opposite parties.<br /> <br /> ORDER<br /> <br /> VIKRAMJIT KAUR SONI, PRESIDENT:-<br /> <br /> 1. In brief, the facts of the complaint are that the complainant has been suffering from Symptomatic GSD of 6mth for which she visited the hospital of opposite party No.2 and the opposite party No.2 assured her that she needs to undergo open Cholecystectomy at the opposite party No.1 i.e. hospital after which she will be cured of the disease. The complainant underwent open cholecystectomy in opposite party No.1 as conducted by opposite party No.2 on 08.11.2008 and after four days, the complainant was discharged from the hospital. After 15 days, the complainant started developing progressively increasing distension of abdomen together with yellowish discolouration of eyes and face, associated with on-off vomiting, projectile, bilious, containing recently ingested food, occurring just after taking food. She had pale coloured stool and had intermittent fever, mild to moderate grade. Then the opposite party Nos.1&2 referred her to Dr. R.S.Sidhu of Delhi Heart Institute, Bathinda where she remained admitted for 8 days but there was no improvement in her condition. Thereafter the complainant referred to PGI, Chandigarh for specialist management and their doctors diagnosed her as “Post open cholecystectomy (outside) benign biliary stricture type 3”. She was admitted in PGI, Chandigarh on 07.12.2008 and discharged on 17.12.2008. She was again admitted to PGI, Chandigarh on 18.04.2009 and discharged on 29.04.2009. During this period, she underwent minor and major operations at PGI, Chandigarh. The complainant alleged that the opposite parties did not operate her properly taking all the precautions needed for complete recovery as required in such type operations and they operated her negligently thereby endangering her life, after due to timely medical treatment in a higher medical institution the life of the complainant was saved but she had to spend a huge amount on her medical treatment. <br /> 2. The opposite party Nos.1&2 on the other hand have pleaded that no medical expert opinion has been submitted by the complainant. The opposite party Nos.1&2 further pleaded that the diagnosis of disease and further its treatment and the complications subsequent to that are always a matter of fact and not of speculations and if the benefits of treatment have to go to the patient/complainant, it's complications, untoward effects and unwarranted results will also go to the patient, and these untoward results can not be garbed as negligence where it is a fact that the opposite party Nos.1&2 being the treating doctor, has tried his level best and used his highest degree of skill, care, knowledge, infrastructures, efforts and precautions and also tried to avoid all complications. It is further pleaded that a treating doctor cannot avoid any inherent complication which are basic ingredients either or disease pathology itself or treatment procedure about which the complainant/patient was well informed and was well in knowledge also. Only precautionary steps can be taken/advised by the opposite party Nos.1&2 as any other prudent qualified doctor/consultant who is engaged in treatment of the complainant/patient would do. Until & unless the complainant is able to prove that “the treating doctors have deviated from the normal/prescribed line of treatment applicable to the particular case/disease conditions, to label that as negligence”. The opposite party Nos.1&2 is a well qualified and reputed doctor with a practicing experience of more than 16 years. The opposite party Nos.1&2 have done and obtained their degree of MBBS, MD from Government Medical College, Punjabi University, Patiala. The opposite party No.2 has also taken additional qualification of D.N.B.(Nephrology) and is duly registered with Punjab Medical Council vide its Registration No.27602. The opposite party Nos.1&2 further pleaded that the treatment given to the complainant in good faith after explaining the diagnosis, treatment, prognosis, benefits, losses and known complications. The opposite party Nos.1&2 further pleaded that the complainant was admitted in hospital of opposite party No.1 on 08.11.2008 under the supervision of opposite party Nos.1&2 and underwent open cholecystectomy under spinal anesthesia in opposite party No.1 hospital. The surgery was performed by Dr. Mohinder Singh,(MS, Surgeon), with the help of Dr. Sarbjit Kaur, (DGO) and Dr. Jagat Jit Singh (MD). The process of operation took around two hours which is little larger time than usual due to distorted anatomy. During operation, the patient/ complainant was found to have a bad gallbladder due to lot of adhesions and anatomical distortions (look like Mirizzi Syndrome). Around about three weeks post-operative, she reported to the opposite party Nos.1&2 for abdominal discomfort and distention. On examination she was found to have Ascites and diagnostic tap done on 03.12.2008 revealed biliary nature of the fluid. She was referred to Dr.R.S.Sidhu, DM (Gastro) who had sent her to PGI, Chandigarh for better management and personally accompanied her to get admitted there and the treatment was started at the earliest on his recommendation. The opposite party Nos.1&2 further pleaded that the complainant had taken treatment from her family Dr. Paramjit Singh who is not a qualified doctor but an RMP only. She was suffering from Symptomatic GSD of 6mths. for which she took treatment from Sh. Paramjit Singh. The opposite party Nos.1&2 further pleaded that at PGI, Chandigarh, ERCP was attempted to stent the CBD but failed (another example of bad anatomy). The complainant was then referred to under surgical treatment, where drains were put in abdomen to relieve the pressure. The complainant underwent only 2 surgical procedures at PGI, Chandigarh as against 6 as mentioned in the complainant.<br /> 3. The opposite party No.3 filed its separate statement which is Insurance Company who has issued Professional Indemnity to Dr.J.J.Singh opposite party No.2 under the title of United India Insurance Co. Ltd.<br /> 4. The complainant has also served the legal notices to the opposite party Nos.1&2 vide Ex.C-2. The complainant has placed on file the prescription slip Ex.C-5 and slip Ex.C-3 through which she was referred to R.S.Sidhu of Delhi Heart Institute.<br /> 5. Parties have led their evidence in support of their respective pleadings.<br /> 6. Arguments heard. Record alongwith written submission submitted by the parties perused.<br /> 7. The complainant was admitted in the hospital of opposite party No.1 as she was suffering from Symptomatic GSD of 6 months. There, she underwent open cholecystectomy in October, 2008 and was discharged after 4 days. Thereafter, she complained problems within 15 days of post operative period and was referred to Dr. R.S.Sidhu, (DM Gestro) by the opposite party Nos.1&2. After getting treatment from Dr. R.S.sidhu for 8 days as no progress was shown in her condition, from where she was referred to PGI, Chandigarh and was treated there. In the discharge summary at PGI, Chandigarh Ex.C-69, history of the patient is reproduced as under:-<br /> “.......H/o symptomatic GSD of 6mth, for which she underwent open cholecystectomy in Oct.2008 in Bhatinda operation lasted 45 mins, and discharged after 4 days (no BT given, no drain). On pod20 she developed abdomen distention, jaundice and vomiting, intermittent fever. She presented to Esopd in Dec.08.<br /> ESOPD-2 flank drains placed and she underwent El and Drainage for diagnosis of billiary peritonitis. Intra op 3 drains were left and they were removed in P/U over 2 mths. the 3rd drain slipped and pigtail was placed in GB fossa and Subsequently removed in March............” <br /> The Medical History shows that no BT was given and no drain was put. A perusal of Ex.C-69 shows that the complainant underwent open cholecystectomy on 18.11.2008 and after 4 days the complainant was discharged from the hospital and After 15 days, instead of recovering from the operation, the complainant started developing progressively increasing distension of abdomen together with yellowish discolouration of eyes and face, associated with on-off vomiting, projectile, bilious, containing recently ingested food, occurring just after taking food. She had pale coloured stool and had intermittent fever, mild to moderate grade. She was referred to Dr.R.S.Sidhu where she remained for 8 days but no improvement was shown in her health. Then she was referred to PGI, Chandigarh for specialist management and there doctors diagnosed her as “Post open cholecystectomy (outside) benign biliary stricture type 3” where she remained from 07.12.2008 to 17.12.2008. The complainant underwent minor and major operation at PGI, Chandigarh. The complainant alleged that she was operated negligently by opposite party Nos.1&2 and her life saved due to timely treatment in a higher medical institution. Ex.C-70 page 3 to 5 which is again history of the patient, prepared at PGI, Chandigarh. Page 3 para No.3 onwards are reproduced as under:-<br /> “........However as from POD20, she started developing progressively increasing distension abdomen, together with yellowish discolouration of eyes, face. It was associated with vomiting on-off, projectile, bilous, containing recently ingested food, occurring just after taking food. Also, there is H/o pale coloured stool. There was also H/o intermittent fever, mild to moderate grade, unrecovered and Not associated with chills and rigors. It all lasted to 2 mths. till she presented to ESOPD in Dec.,2008, There is no H/o printies.<br /> Once admitted in ESOPD, 2 Flunt drains were placed and pt was prepared. For the diagnosis and biliary peritonitis she underwent EL drainage. IN all, 3 drains were left. The drains were removed during OPD follow-up at 2 weeks, interval. The third drain stipped and for complaint of pigtail hillnesand nomitiny she underwent USG and pigtail was thereafter placed in GB Fossa collection. The pigtail was removed in March.<br /> Since then, pt is asymptomatic, taking orally, good appetite plus tolerating well. <br /> No H/o UGI/LGI bleed........” which shows that the post operative care was not given by the opposite party No.2.<br /> 8. The opposite party Nos.1&2 have placed affidavit of Dr.J.J.Singh who has deposed in his affidavit Ex.R-1 that no any expert view of subject specialist or any scientific literature in this regard has been produced by the complainant. The patient was properly examined, investigated, diagnosed and treated by the opposite party Nos.1&2 as per prescribed norms of general practice. No experimentation has been made by the opposite party Nos.1&2 in this case rather they have used their reasonable skill. The opposite party No.2 is a well qualified and reputed doctor with a practicing experience of more than 16 years. They have treated the complainant in good faith after explaining the diagnosis, treatment, prognosis, benefits, losses and known complications. The complainant alleged that the doctors have operated her negligently but after perusal of record placed on file, it is very much clear that in all the cases BT is not given and drain is not put. The complainant had developed the complications after 15 days of the operation. As the operating doctors of opposite party Nos.1&2 were not Gestro doctors. They referred the patient to the Dr. R.S.Sidhu of Delhi Heart Institute, Bathinda who after observing the condition of the patient, personally accompanied her to admit at PGI, Chandigarh. At PGI, Chandigarh, ERCP was attempted to stent the CBD but failed (another example of bad anatomy). She was then her referred to under surgical treatment where drains were put in abdomen to relieve the pressure. This is a standard protocol of managing biliary peritonitis. Thereafter with the definite treatment of hepatojejenostomy, the patient was cured. The patient underwent only 2 surgical procedures at PGI, Chandigarh. <br /> Dr. T.D.Yadav who is treating doctor of the complainant, department of PGI, Chandigarh was summoned repeatedly avoided to come to the court under one or other pretext. Despite sending notices to the Dr. T.D.Yadav, he did not attend the Forum. Then the letter sent to the Civil Surgeon, Bathinda to constitute medical board to give opinion as to whether the treatment given to patient as per the norms and practice. The reminder was again sent to Civil Surgeon, Bathinda as per order dated 23.04.2010 to send the Medical report to this Forum on or before 14.05.2010. Till 23.06.2010 no report has been received from the Medical Board rather they sent letter dated 04.06.2010, in which they mentioned that they have not received the documents as the complainant has filed this complaint on 18.08.2009 and no option had been left to adjudicate the case without medical report. For this the support can be law laid down by Hon'ble Supreme Court in case titled V.Kishan Rao Versus Nikhil Super Speciality Hospital & Another Civil Appeal No.2641 of 2010 (Arising out of SLP (C) No.15084/2009) D/d 08.03.2010 RCR (2) 2010 where in it is held:-<br /> “(A) Consumer Protection Act, 1986, Sections 23and 3 – Medical negligence – Claim of petitioners cannot be rejected only on the ground that expert negligence of Doctor – It is not required to have expert evidence in all cases of Medical negligence.<br /> (H)(i) An expert witness in a given case normally discharges two functions – The first duty of the expert is to explain the technical issues as clearly as possible so that it can be understood by a common man – The other function is to assist the Fora is deciding whether the acts or omissions of the medical practitioners or the hospital constitute negligence.<br /> (H)(ii) In most of the cases the question whether a medical practitioner or the hospital is negligent or not is a mixed question of fact and law and the Fora is not bound in every case to accept the opinion of the expert witness. (1988) 2 SCC 602,(1990) 3 SCC 682 relied”<br /> The doctors who conducted operation on the complainant are well qualified and experienced doctor and expert in their field. They have operated the patient efficiently but they failed to give the patient post-operative treatment. The support can be sought by the precedent laid down by Hon'ble Punjab State Consumer Disputes Redressal Commission, Chandigarh in case titled Patel Hospital private Limited Versus Pawan Kumar & Ors. 2009 CPJ (iii) 401 wherein it is held:-<br /> “Consumer Protection Act, 1986 – Sections 2(1)(g) and 14 (1) (d) – Medical Negligence – Post-operative care – Stones diagnosed in gallbladder – Patient operated – Clips fixed – Pain and vomiting reported – No proper attention paid by treating doctors – Patient taken to another hospital – Two litres of bile in peritoneal cavity found, clip also found lying in peritoneal capacity – Huge quantity of bile could not have been collected in one/two days – Bile started Patient needed medical attention – Required attention not paid – Condition of patient deteriorated day by day, proved fatal within 4/5 days after operation – Compensation granted – Insurer of O.P. Hospital held liable to pay awarded amount”<br /> 9. In the light of what has been discussed above, there is deficiency in service on the part of the opposite parties as the patient started developing progressively increasing distension of abdomen together with yellowish discolouration of eyes and face, associated with on-off vomiting, projectile, bilious, containing recently ingested food, occurring just after taking food after within few days of post operative period. If the treating doctors of opposite party Nos.1&2 would have super-specialist or skilled doctors to withhold the complications arising after the post operative period, the patient must have not suffered for approximately four months. If they would have put EL plus drains earlier and in time, the patient would not have undergone 2 surgeries extra after undergoing one surgery at opposite party Nos.1&2. Hence this complaint is accepted with Rs.50,000/- as compensation for mental harassment, agony and medical expenses incurred on her treatment and Rs.5,000/- as cost. In case of failure in paying the amount of Rs.50,000/- within a stipulated period the interest @ 9% P.A. will yield. <br /> 10. The opposite party Nos. 1&2 are professionally indemnified with opposite party No.3 and the policy effective 23.11.2007 to 22.11.2008. Hence the opposite parties are jointly and severally directed to pay the amount of compensation and cost within 45 days from the of receipt of copy of this order.<br /> 11. A copy of this order be sent to the parties concerned free of cost and file be consigned for record. '<br /> <br /> <br /> Pronounced (Vikramjit Kaur Soni)<br /> 30.07.2010 President <br /> <br /> (Dr. Phulinder Preet)<br /> Member<br /> <br /> (Amarjeet Paul)<br /> Member