BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, ERNAKULAM.
Dated this the 17th day of October 2018
Filed on : 02-08-2014
PRESENT:
Shri. Cherian K. Kuriakose, President.
Shri. Sheen Jose, Member.
Smt. Beena Kumari V.K. Member.
CC.No.587/2014
Between
Malini Regunath, : Complainant
W/o. Raghunathan Nair, ( By Adv. R. Padmaraj, M/s. KNB Nair
Nettayikodath road, Associates,2nd Floor, Morning Star
Palarivattom P.O., Building, Kacheripady, Ernakulam,
Cochin-682 025. Cochin-682 018)
And
1. Medical Trust Hospital, : Opposite parties
Rep. by its Managing Director/ (1st O.P. By Adv. R.S. Kalkura,
Chairman, Medical Trust Hospital, “Srivathsa” 61/335, Judges Avenue,
MG. Road, Pallimukku, Kaloor, Kochi-17)
Cochin-682 016.
2. Dr. Girija Gurudas, (2nd and 3rd o.ps. by Adv. George
Gynecologist, Medical Trust Cherian, Karippaparambil Associates,
Hospital, MG Road, HB. 48, Panampilly Nagar, Kochi-
Pallimukku, Cochin-682 016. 682 036)
3. Dr. Jayakrishnan, Urologist,
Medical Trust Hospital,
M.G. Road, Pallimukku,
Cochin-682 016.
O R D E R
Beena Kumari V.K. Member
A brief statement of the facts of the case is as follows:
The complainant Smt. Malini Reghunath consulted Dr. Sasikala V Prabhu ;of Akshya Hospital, Kadavanthara, Ernakulam on 28-11-2012 due to uterus related problems and Dr. Sasikala diagnosed fibroid in uterus and advised surgery and directed the complainant to obtain a second opinion in the matter, the complainant consulted to the 1st opposite party-medical Trust Hospital and she was admitted to the 1st opposite party medical trust Hospital on 28-12-2012 and on 29-12-2012 she had undergone a surgery to remove the fibroid, followed with removal of the uterus. On the same night the complainant felt severe bleeding and on 30-12-2012 the 3rd opposite party Dr. Jayakrishnan, who is an urologist conducted yet another major surgery to rectify the urinary bladder which was causing bleeding and the complainant was also forced to sign certain Forms and papers while she was in a semi conscious state. After the surgery the complainant was put in ventilator and on 01-01-2013 the complainant-patient was shifted to the room from the ventilator. Thereafter the patient suffered severe abdominal pain and uncontrolled urination. Without conducting proper investigation the patient was discharged on 10-01-2013 and at the time of discharge from the hospital the patient was suffering from abdominal and back pain and there was uncontrolled urination also. On 13-01-2013 due to severe and uncontrollable pain and urinary issues the complainant had to be admitted again to the 1st opposite party ;hospital and the doctors administered antibiotics as well but the symptoms remain unchanged . It is submitted that the severe pain and controlled urination occurred due to the negligence in the conduct of the surgeries. On taking CT scan it was confirmed that urine got collected in the abdomen and the above situation occurred due to the negligent act of the doctors who had performed the surgeries . Dr. Kishore, another urologist who attended the patient wanted some time to study the case and Dr. Kishore had put the stent to rectify the cut occurred on the urinary tract. Thereafter the pain got reduced and the patient felt comfortable. The stent was removed on 02-04-2013. It is submitted that the full charges for the entire treatment and medical helps were collected from the complainant by the 1st opposite party – Hospital and the complainant was charged heavily for the rectification procedures done. It is submitted that the complaint is entitled to get compensation for the pain and other inconveniences suffered on account of the sheer negligence on the part of the hospital and the concerned doctors in conducting the surgeries. It is pertinent that a patient who was admitted on the gynecological complaints had been operated by urologist which could only be the outcome of failure in the 1st surgery performed by the gynecologist. It is submitted that the cut in the urinary tract had occurred due to the negligence of the doctor and the hospital and non-issuance of the correct medical records by the 1st opposite party also amounted to neglience on the part of the doctors and the opposite party hospital. It is submitted that during the course of surgery in relation to uterus, severing or cutting the urinary tract was an extreme deficient service. The damage caused to the urinary tract was not properly detected, consequently urine collected in the stomach leading to severe pain and agony to the complainant for several days and it was after assertive demand by the complainant and her family members, the deficiency had been diagnosed and remedial measures had been taken, that the complainant was under bed rest for months together and even now the complainant is under medical treatment and observation, therefore she could not render requisite support to her children and to her husband who was partially disabled due to a paralytic stroke happened in the past. In view of the above facts and circumstances, the complainant filed this complaint alleging deficiency in service and seeking orders of this Forum to the opposite parties to pay an amount of Rs. 20,00,000/- (Rupees twenty lakhs) towards compensation for pain, sufferings for shortening expectation of life, for loss of amenities and for the continuous medical follow up for the rest of the life of the complainant, along with interest @ 12% p.a. from the date of filing this complaint till the date of realization.
- Notice was issued to the opposite parties and the opposite parties filed their versions.
- Version of the 1st opposite party.
The 1st opposite party – Medical Trust hospital contended that this complaint is not maintainable that the opposite parties 2 and 3 are no longer in the service of the 1st opposite party, in the event of complainant not taking appropriate steps to have notice served on 2nd and 3rd opposite parties this complaint ought to be dismissed as barred for non-joinder of necessary parties. It is submitted that the complainant came to the out patient department of the medical trust hospital on 17-12-2012 with an ultra sound report of fibroid uterus, she was examined by the2nd opposite party Doctor Girija Gurudas and at the time of examination the complainant ;informed that she was having profuse bleeding for the past one year, thereafter she was directed to undergo various investigative tests viz. Blood, urine , x-ray chest, ECG etc. the investigative tests revealed that the complainant was suffering from a huge fibroid of the size of 32 weeks pregnant uterus and the complainant was informed that the huge fibroid along with uterus has to be removed by surgery immediately to avoid break down of health and damage to vital parts. The nature treatment to b e rendered was convincingly explained to the husband of the complainant and as well as to the complainant . She was admitted to the hospital on 28-12-2012. After getting informed consent, the surgery for the removal of fibroid was carried out on 29-12-2012 by the 2nd opposite party, Doctor. The removal of tumour (Myomectomy) was 1st carried out to reduce the bulk of the uterus, followed by the removal of uterus (hysterectomy). Thereafter the patient was closely observed in the post-operative intensive care unit, since there was a drop in the blood pressure the patient was given 6 pints of packed cells and all vital signs were monitored without break, ultra sound scan was carried out to identify the cause of the blood pressure fall. The ultrasound scan showed 400 ml of fluid in the peritoneal cavity which was a known complication of removal of a huge fibroid coupled in the hysterectomy which is known as reactionary hemorrhage. Laparotomy was carried out at the mid night on 29-12-2012/30-12-2012 which revealed the presence of 600 ml of blood in the peritoneal cavity. The blood was removed. There was no bleeding from the stumps of the hysterectomy but there was oozing from the deep bladder base. Immediately the 3rd opposite party – Doctor urologist examined the patient and couterised all the oozing points from the bladder base and ligated the same. A cystoscopy was carried out to visualize the inside of the bladder and to heal any injury stenting was attempted as a precautionary measure and it could not be passed. The ureter was abdominally explored and found intact and the post operative management was carried out in the ICU in consultation with the urologist. The patient as well as the bystander was convincingly informed of the complications and consequences of the myomectomy of the possibility of damage to vital organs, of the possibility of excess bleeding and informed consent was obtained before carrying out the surgery. Post operatively the patient was managed in the best manner possible and the patient was discharged on 09-01-2013 asymptomatic in a stable condition. Consequent to severe abdominal pain on 13-01-2013 (Sunday) the patient was examined in the causality by the 2nd opposite party Gynecologist and later by the 3rd opposite party – urologist and the ultrasound scan indicated that the patient was suffering from right hydro ureteronephrosis with intra abdominal collection. A CT-urogram indicated that there was ureteric leak and urinoma formation and ascites which a known complication of bladder related surgery. The ureteric leak and urinoma formation was on a/c of necrosis of the ureter. The subsequent investigation by the urology department indicated that there was obliteration of distal ureter and in order to set right the flow of urine, a guide wire was negotiated and stenting was also carried out by the urologist Dr. Kishore on 16-01-2013 and hydronephrosis and intra abdominal collection reduced significantly and the patient was discharged on 21-01-2013 in a stable condition. The stint which was retained for 3 months, was removed on 02-04-2013. Follow up review done on 13-07-2013 at urology Department. The patient was given best treatment and that the allegation of the patent rectification action done due to the negligence on the part of the opposite parties and that the patient was charged heavily are false and the intra abdominal blood collection is a known complication of myomectomy of the removal of fibroid in the uterusmeasuring about 18 cms in diameter. The allegation of the patient that the gynecological complaints were rectified by an operation done by an Urologist can not lead to any inference of negligence and by removal of fibroid Uterous also cannot lead to an inference of negligence on the part of the doctors who conducted the operations . It is contended that all the allegations in paragraphs 12 to 23 are either invented by the complainant for the purpose of this complaint or as a result of comprehensions of the nature of surgeries carried out on the patient. The medical records indicates that the patient was given the best treatment possible and there was no negligence on the part of the treating doctor. The contention of the complainant that the hardships and inconvenience, pain etc. occurred and the subsequent to sufferings patient had shortened the healthy, long life of the patient is without any basis. On the other hand the life span of the complainant has increased on account of the surgeries carried out. By the doctors of the 1st opposite party hospital. It is further submitted that best possible treatment was offered to the patient, due care was given to the patient the procedures were carried out by skilled doctors after obtaining informed consent hence there was no deviation from the normal professional practice or standard protocol. The patient had not suffered any mental agony or monetary loss as alleged and the complaint is ill motivated and filed with the intention of making illegal gains on non-existing, fanciful and imaginative grievance. Therefore the patient is not entitled to any compensation or any other reliefs as claimed in the complaint. 1st opposite party sought for the dismissal of the complaint with costs to the opposite party.
4) Version of the 2nd and 3rd opposite parties.
The version filed by the 1st opposite party was adopted by both 2nd and 3rd opposite parties.
5). Issues to be decided in this case
i. Whether the complainant has proved deficiency in service or unfair trade practice on the part of the opposite parties?
ii. If so the opposite parties are liable to pay compensation of Rs. 20 lakhs to the complainant along with costs of this proceeding.
6). The evidence in this case consists of the oral evidence adduced by the complainant as lPW1 and the documentary evidence furnished by the complainant which were marked as Exbts. A1 to A13. Opposite parties furnished documentary evidence which were marked B1 to B1)a)and the medical records are marked as Exbts. X1.
7. Issue No.i The 1st opposite party made a preliminary objection that the complaint is not maintainable if in the event of the complainant does not take appropriate steps to serve the notices on opposite parties 2 and 3. In this case both the opposite parties 2 and 3 were served with notice and they have filed their versions before this Forum. The aforesaid objection does not now exists.
The complainant Mrs. Malini Reghunath approached the 1st opposite party hospital with an ultra sound report of Fibroid Uterus. Considering the urgency in the matter she was immediately admitted to the opposite party hospital on 28-12-12 and the complainant patient was subjected to two surgeries on 29-12-2012 by the 2nd opposite party Gynecologist. The opposite parties contended that myomectomy (removal of tumor) was carried out first and thereafter removal of uterus (hysterectomy) was////////////////// carried out. After the aforesaid surgery the vital signs of the patient were monitored without brake and it was identified that the blood pressure was falling. On taking ultra sound scan it was revealed that 400 ml of fluid was collected in the peritoneal cavity. According to the opposite party it is a known complication after the removal of a huge fibroid coupled with hysterectomy. It is known as reactionary hemorrhage . Therefore laparotomy was done at Midnight on – 29-12-2012 -30-12-2012 600 ml of blood was removed from the peritoneal cavity. It is submitted that there was no bleeding from the stumps of the hysterectomy and it was noticed that oozing of blood was from the deep bladder base. A systoscopy of carried out and the inside of the bladder was visualized and Oozing points were ligated. The ureter was explored abdominally and found intact. The Stint was attempted as a precautionary measure to heal any injury. The patient was managed post operatively from 30-12-2012 to 09-01-2013. During which period it is noted that the temperature normal, urine output normal, wound healthy and healed and the patient was discharge in a stable condition. We are not inclined to accept the above averments fully, we find there is negligence especially when the fibroid was measuring 18. c.ms. in dia meter and 16c.mts in length and the services of a Urologist was not made available to the complain;ant patient. The doctors were very well aware that the procedure of miotectomy coupled with hysterectomy was a complicated one and there is chance for further complication hydrouteronephrosis and the service of the Urologist was made available only at midnight and the urologist on the very same day miotectomy coupled with hysterctomy was done . The Urologist could not insert the stint for reason best known to him and it was later by another urologist who succeed to insert stint to prevent bleeding from the cut occurred to the ureter. Thus it is evident that injury caused to the Ureter causing ureteric leak and urinoma formation and as cites which is according to the opposite party is a non-complication of bladder related surgery. But in the instant case the surgery conducted was not bladder related. It is a surgery made to the Uterus thereby the fibroid was removed first followed by hysterectomy.
In fact the complainant patient approached the 1st opposite party with uterus related problems i.e. with a large fibroid in the uterus. The opposite parties contended that the injury occurred to the complainant patient is a known complication. The opposite parties produced no expert opinion or medical literature to prove the above contention. The 3rd opposite party doctor could not place the stint as a curative measure when the 2nd surgery was done in the midnight of 29-12-2012,/30-12-2012 and the complainant patient was put in the ventilator up to 01-01-2013 and shifted to the room on 01-01-2013 and the complainant patient informed the opposite parties of severe abdominal pain and uncontrolled urination. There is no indication that the complainant patient was discharged on 10-01-2013 after curing or after finding root cause of pain and uncontrolled urination. There is no indication that the complainant patient was discharged on 10-01-2013 after curing or after finding root cause of pain and uncontrolled urination. Therefore the complainant-patient had compelled to get herself admitted to the 1st opposite party hospital again on 13-01-2013 and even after giving antibiotics the above symptoms remain unchanged. There was negligence and dereliction of duty on the part of the opposite parties in not identifying or detecting he root cause of the pain and uncontrolled urination after under going the above said surgeries. There was considerable delay in detecting the real cause of the pain and uncontrolled urination. On the 4th day after discharge on 10-01-2013, the complainant patient was examined on 13-01-2013, the complainant patient was examined on 13-01-2013 at the casualty 2nd opposite party and there by the 3rd opposite party and the ultrasound scan indicates that the complainant patient was suffering from hydro uretero Nephrosis with intra abdominal collection urinoma formation and stinting was carried out on 16-01-2013 by another urologist Dr. Kishore and symptoms of hydro Nephrosis, abdominal collection were significantly reduced and the stint was removed on 01-04-2013. the above facts show that a major operation of myomectomy coupled with hysterectomy was done by the 2nd opposite party gynecologist without the assistance of an urologist. Thus due precaution was not seen taken in giving the services of an urologist in the major operation held on 29-12-2012. It is true that post operatively a better management was given in consultation with the urologist after the complainant was readmitted on 13-01-2013 and the complainant – patient was actually discharged in a stable condition only on 21-01-2013. The medical records reveal that there was better management . The above said facts reveal that the complainant has during the period from 13-01-2013 to21-01-2013 has succeeded in proving deficiency in service in conducting the major surgery on 29-12-2012 o the part of the opposite parties. The 1st issue is thus decided in favour of the complainant.
Issue No. ii. The facts stated I the foregoing paragraphs reveal that the complainant-patient had suffered a lot of pain, inconvenience only due to the cut occurred to the ureter negligently during the surgery of myomectomy coupled with hysterectomy on 29-12-2012. The patient was suffering from severe pain in the abdomen and uncontrolled urination post operatively until stinting was done on 16-01-2013 for which the opposite parties are jointly and severally liable to compensate the complainant. Considering the deficient service offered on the date of surgery done o 29-12-2012 and considering the better post-operative management from 13-01-2013 to 21-01-2013 . We moderately fix the compensation amount at Rs. 2,00,000/- as against Rs. 20,00,000/- (Rupees Twenty lakhs) claimed by the complainant , along with interest thereon.
The complainant has spent her valuable time and money to contest this case before this Forum. Therefore we find that the complainant is entitled to get costs of this proceedings from the opposite parties. We fix the costs at Rs. 20,000/-.
In the result, we allow this complaint in part and direct as follows:
i. The opposite parties shall pay to the complainant Rs. 2,00,000/- (Rupees two lakhs only) along with interest at the rate of 12% p.a. from 02-08-2014 the date of filing this complaint till the date of realization of the above amount.
ii. The opposite parties shall also pay Rs. 20,000/- towards costs to the complainant.
iii. The liability of the opposite parties shall be joint & several
The above orders shall be complied with, within 30 days from the date of receipt of a copy of this order, failing which the compensation amount except costs, shall carry18% interest p.a. from the 31st day of receipt of this order.
Pronounced in the open Forum on this the 17th day of October 2018
Sd/-
Beena Kumari V.K., Member.
Sd/-
Cherian K. Kuriakose, President.
Sd/-
Sheen Jose, Member.
Forwarded/By Order,
Senior Superintendent
Appendix
Complainant's Exhibits
Exbt. A1 : Prescription dt. 15-07-2014
A2 : True copy of histo pathology
report
Opposite party's exhibits: : Nil
