IN THE CONSUMER DISPUTES REDRESSAL FORUM, PATHANAMTHITTA.

Dated this the 28^th day of April, 2010.

Present:- Sri. Jacob Stephen (President)

Smt. C. Lathika Bhai (Member)

Sri. N. Premkumar (Member)

C.C.No.39/06 (Filed on 21.02.2006)

Between:

K.N. Sivarajan, aged 58 years,

Kidangil Veedu,

Elavumthitta Muri,

Mezhuveli Village,

Kozhencherry Taluk,

Pathanamthitta Dist.

 (By Adv. Shilu Muralidharan)                                                      .....       Complainant

And:

1. Managing Director,

Mar Gregorios Memorial-

Muthoot Medical Centre,

Kozhencherry.

(By Adv. G.M. Idiculla)

Addl.2. ICICI Lombard General Insurance-

   Co. Ltd., Kochi.

(By Adv. Ajit Kumar Varma)                                                         .....       Opposite parties.

O R D E R

C. Lathika Bhai (Member):

                        The complainant has filed this complaint against the opposite parties for getting a relief from Forum.

                        2. The fact of the complaint is as follows:  On 18.2.05 the complainant was admitted in the 1^st opposite party hospital for the treatment of acute abdomen pain and dysuria.  His IP Number was 258669.  After taking the ultra sound scanning and further investigation diagnosed the disease as calculus in Left Ureter.  On 19.2.05 a major operation was done by the doctor in 1^st opposite party hospital to remove the calculas from Ureter and insert DJ stent to the complainant.  After the operation the doctor in 1^st opposite party hospital made to believe the complainant and his relatives that no further complications will not arise.  But after the operation the complainant had developed pneumonia fever, shivering and septicaemia and he was treated in ICU for 4 days.  But the complainant’s condition become worse, the relatives of the complainant requested the discharge of the complainant from 1^st opposite party hospital.  On 23.2.05 the complainant was discharged from the 1^st opposite party hospital and referred to Lakeshore Hospital and admitted on the same day.  The complainant was treated there for 16 days.  In Lakeshore Hospital the complainant’s disease was detected as enlargement of prostate gland and proper treatment was given to the complainant.  After that the complainant was completely cured from his disease.

                        3. The complainant’s allegation against the opposite party is that they have not conducted proper clinical test and has not taken KUB X-ray which is necessary for diagnosing the disease and for the treatment of the complainant.  In the reference letter they referred that all the clinical findings are normal, with the intention that the complainant will not get proper treatment from anywhere.  Due to the improper diagnosis and negligent treatment complainant had developed complications and he was referred to the Lakeshore Hospital.  For the treatment in Lakeshore Hospital he had expended more.  More over exorbitant treatment charges were collected from the complainant for the treatment in 1^st opposite party hospital.  All the acts of the 1^st opposite party amounts to a clear deficiency in service which caused much mental agony, financial loss and hardships to the complainant.  For that the opposite party is liable to compensate the same to the complainant.  Hence he filed this complaint against the opposite party for getting an order for allowing to realise the medical bill amount of Rs.89,000/- received by the 1^st opposite party from the complainant and for allowing to realise the medical bill amount of Rs.1,50,000/- paid by the complainant in Lakeshore Hospital and for realising compensation and cost from the opposite party.  The complainant prays for granting the relief.

                        4. The 1^st opposite party has filed a version stating the following contentions:  This opposite party admitted the admission of the complainant in this hospital on 18.2.05 for treating acute abdomen pain and dysuria.  All the preliminary and subsequent investigation and necessary follow up was done by Dr. Joseph Manak who is a competent surgeon in this field.  Lithotripsy (stone fragmentation) was done and a DJ Stent was to put to the complainant to facilitate drainage of Urine and for the easy passage of stone pieces, which was already fragmented.  This was the usually accepted procedure.  After following the endoscopic procedure the sign of Septicemia is an accepted complication of Urological endoscopy.  Hence all the necessary follow up treatment were started.  The patient was very much improved but he was discharged on request of him with the discharge summary including all the details of investigation and treatment.

                        5. Seven years back TUR (Prostate Operation) was done to the complainant by the same surgeon in the same hospital of 1^st opposite party.  After that the complainant was admitted twice in the 1^st opposite party hospital with left Ureteric stone and he was treated conservatively and Cystoscopy was also done.  He was also treated for Hepatitis ‘B’ in this hospital.  All these facts are purposefully suppressed by the complainant.  All the best treatments by competent doctors have been given to the complainant.  There is no deficiency in treatment provided to the complainant in this hospital.  This opposite party is insured with ICICI Lombard and the insurance is liable for any reward.  This complaint is fictitious and the complainant is trying to extract monetary benefit from the 1^st opposite party.  Hence the 1^st opposite party prayed for the dismissal of the complaint with compensatory cost.

                        6. 2^nd opposite party has filed a version stating the following contentions:  The 2^nd opposite party is admitting the insurance policy issued to the complainant.  All the averments in the complainant is not within the knowledge of this opposite party hence the same are denied by this opposite party.  The liability of this opposite party to indemnify the 1^st opposite party is strictly limited to the compliance of the terms and conditions, stipulations and procedures mentioned in the policy are subject to the exclusion clauses there in.  The claim of the complainant is beyond the scope of insurance cover provided by this opposite party hence this opposite party has no legal liability to indemnify the 1^st opposite party.  Hence this opposite party prays for the dismissal of this complaint.

                        7. On the basis of the pleadings the only point to be considered is whether the complaint can be allowed or not.

                        8. The evidence of complaint consists of the oral deposition of PW1 and 2 and Exts.A1 to A10.  For opposite parties no oral or documentary evidence adduced.

                        9. The complainant’s case is that the complainant was admitted in 1^st opposite party hospital on 18.2.05 for the treatment of acute abdomen pain and obstruction of urine.  On 19.2.05 a major operation was done to the complainant to remove the calculus from Ureter and DJ Stent inserted.  After the operation phenomena fever, shivering and septicemia was developed to the complainant.  On 12.2.05 on request of the complainant he was discharged and admitted in Lakeshore Hospital same day.  He was treated 16 days in that hospital and cured his disease completely.  The complainant’s allegation is that the 1^st opposite party has not provided proper treatment to him.  They have not conducted proper investigations and has not taken KUB X-ray necessary for the complainant’s treatment.  Further without proper medical reference and medical opinion the complainant was referred.  Therefore the complainant filed this complaint for getting reliefs as sought for in the complaint.

                        10. In order to prove the complainant’s case, complainant has adduced oral evidence as PW1 and Exts.A1 to A9 marked.  Ext.A1 is the bill dated 23.02.2005 for Rs.13,876/- issued by the first opposite party to the complainant.  Ext.A2 is the receipt for the payment of Ext.A1 bill.  Ext.A3 is the scanning report of the complainant from first opposite party.  Ext.A4 is the reference letter dated 23.02.2005.  Ext.A4(a) is the reference letter dated 21.02.2005 issued by the first opposite party to Lakeshore Hospital.  Ext.A5 series is the medical bills (23 Nos.) for Rs.6,337/- issued by the first opposite party.  Ext.A6 is the discharge summary (4 pages) dated 09.03.2005 issued from Lakeshore Hospital.  Ext.A7 and A7(a) are the medical test reports from Lakeshore Hospital.  Ext.A8 is the discharge bill for Rs.88,399/- issued from Lakeshore Hospital.  Ext.A9 is the Inpatient Settlement Report dated 09.03.2005 for Rs.2,712/-. 

                        11. One witness for the complainant, an expert from Lakeshore Hospital has been examined as PW2 and Ext.A10 was marked.  Ext.A10 is the reference letter issued from first opposite party hospital by Dr. Cherian Mathew for Joseph Manak on 23.02.2005 to Lakeshore Hospital.

                        12. The first opposite party’s contention is that there is no deficiency in treatment provided to the complainant in their hospital.  The complainant was previously treated several times in their hospital and the same doctor was already done TUR (Prostate Operation) to the complainant.  The complainant is a chronic hepatitis B patient and he was treated previously for the same in this hospital.  All the necessary tests to find out the disease and proper treatments were given to the complainant in their hospital.  In order to prove their contentions, there is no oral or documentary evidence from the part of the first opposite party.

                        13. Second opposite party contended that the liability of this opposite party to indemnify the first opposite party is strictly limited to the compliance of the terms and conditions, stipulations and procedures mentioned in the policy.  It is subject to the exclusion herein.  There is no oral or documentary evidence from the part of the second opposite party.

                        14. Ongoing through the evidences in this case, it is seen that the complainant was admitted in the first opposite party hospital for the complaint of uriteric calculus and calculus removal operation.  URS was done by the doctor in first opposite party hospital.  After the operation, the complainant was developed septicemia, phenomia and other complications.  On the request of the complainant he was referred to the Lekshore Hospital for further treatment.  The complainant’s allegation is that the treatment given by the first opposite party is not proper and the operation was done without proper investigations and did not take KUB X-ray for diagnosing the disease.  Further, in the reference letter, proper medical reference and opinion were not recorded by the doctor who referred the complaint.  At the time of cross-examination PW1 stated that he was already admitted in 1^st opposite party hospital for the treatment of dysuria, prostate operation and Hepatitis ‘B’ and Cystoscopy test was also done in 1^st opposite party hospital.  After that he admitted that “aq{XXS, prostate operation and Hepatitis ‘B’ F¶o tcmK§IgnªmWv Cu tIkn\v tlXphmb AkpJ¯n\v NnInv¡v t]mbXv“.  Further stated that now and then treatment for all these diseases and operations were conducted by Dr. Manak in the 1^st opposite party hospital.  The above said deposition of the complainant clearly proves that the Dr. Manak who treated the complaint is familiar with the complainant’s diseases and his treatment.  It is pertinent to note that there was no allegation of negligent in treatment before from the complainant against the opposite party’s doctor.

                        15. At the time of cross-examination of PW2, as an expert in Urology stated as follows:-  “Lithotripsy F¶ kdn BWv ap¯q Bip]{Xnbn sNbvXXv.  Stone Fragmentation F¶mWv Cu kdn¡v ]dbp¶Xv.  Cu kdnbpsS `mKambmWv stend CSp¶Xv.  Lithotripsy surgery well accepted procedure of treatment BWv.  Septicaemia F¶ complication C¯cw Hm¸tdj\pIfn A]q#198;ambn kw`hn¡mhp¶ accepted complication BWv.  Rm³ \S¯nbmepw CXpt]mse kw`hn¡mw“.  According to him, the proper line of treatment was followed by the 1^st opposite party hospital for treating the complainant.  After discharge only the further treatments were given in Lakeshore Hospital.  As per the opinion of medical expert there was no medical negligence from the part of 1^st opposite party. 

                        16. On a perusal of Ext.A10 reference letter it is seen that the complainant was referred to Lakeshore Hospital for further treatment.  It is also stated that the patient was developed Septicemia and septic shock and Broncho pneumonia after the URS operation and given proper treatment and now the patient is stable and comfortable.  The investigation reports were also recorded in Ext.A10.  In the circumstances, the allegation of the complainant that the complaint was referred without medical reference is not sustainable. 

                        17. On a perusal of materials on records and medical expert opinion in this case clearly reveals that the line of treatment followed by the 1^st opposite party hospital was as per the accepted principles of medical practice and was not contradicted by any material evidence.  In the circumstances, we could not find any negligence or deficiency in service for the treatment given by 1^st opposite party hospital to the complainant.  All the allegations raised by the complainant against the opposite party is stands unproved.  The complainant failed to prove his complaint hence the complaint is liable to be dismissed. 

                        18. In the result, this complaint is dismissed.  No cost.

                        Declared in the Open Forum on this the 28^th day of April, 2010.

                                                                                                                                 (Sd/-)

                                                                                                                        C. Lathika Bhai,

                                                                                                                             (Member)

Sri. Jacob Stephen (President)                    :           (Sd/-)

Sri. N. Premkumar (Member)                    :           (Sd/-)

Appendix:

Witness examined on the side of the complainant:

PW1    :  K.N. Sivarajan

PW2    :  Dr. George. P. Abraham

Exhibits marked on the side of the complainant:

A1       :   Receipt dated 23.2.05 for Rs.13,876/- issued by the first opposite party to the 

                complainant. 

A2       :  Bill dated 23.02.2005 for Rs.13,876/- issued by the first opposite party to the  

               complainant. 

A3       :  Scanning report of the complainant from first opposite party. 

A4       : Reference letter dated 23.02.2005 issued by the first opposite party to the   

              complainant.

A4(a)   :  Reference letter dated 21.02.2005 issued by the first opposite party to the 

               complainant.

A5 series : Medical bills (23 Nos.) for Rs.6,337/- issued by the first opposite party to the 

                   complainant. 

A6       :  Discharge summary (4 pages) dated 09.03.2005 issued by Lakeshore Hospital to 

               the complainant. 

A7       :  Scanning Report

A7(a)   :  Medical test reports dated 23.2.05 issued by Lakeshore Hospital to the 

               complainant. 

A8       :  Discharge bill for Rs.88,399/- issued by Lakeshore Hospital to the complainant.  A9     :  In-patient Settlement Receipt dated 09.03.2005 for Rs.2,712/- issued by 

               Lakeshore Hospital to the complainant. 

A10     :  Reference letter dated 23.2.05 issued by first opposite party hospital to the 

               Urologist,Lakeshore Hospital, Kochi.

Witness examined on the side of the opposite parties:  Nil

Exhibits marked on the side of the opposite parties:  Nil.

                                                                                                                        (By Order)

                                                                                                              Senior Superintendent.

Copy to:- (1) K.N. Sivarajan, Kidangil Veedu, Elavumthitta Muri,

                      Mezhuveli Village, Kozhencherry Taluk, Pathanamthitta Dist.

                (2) Managing Director, Mar Gregorios Memorial Muthoot Medical Centre,

          Kozhencherry.

(3)    ICICI Lombard General Insurance Co. Ltd., Kochi.

(4)    The Stock File.