By Smt. Padmini Sudheesh, President:
On 4.7.04 the complainant consulted the 3rd respondent doctor at 1st respondent hospital with history of trauma. The 3rd respondent doctor has examined and prescribed for taking x-ray. The doctor told that there is no injury to bone and after dressing the injury he can leave the hospital. After exploration the 3rd respondent doctor told that there is fracture to bone and POP is necessary. So he was admitted in the hospital. While on discharge it was advised that the complainant should come on July 9 and 12 for dressing. On July 16th the stitch has been removed, POP was done and advised for bed rest for 4 weeks. The 2nd respondent has examined and certificate was issued. The complainant had suspicion about 3rd respondent doctor and so consulted on July 9th Dr. Manu, Ortho Surgeon working at Taluk Government Hospital, Kodungallur. He has prescribed for x-ray and after examination told that there was no fracture to bone or vein. The respondents-2 and 3 committed negligence and all the respondents are liable to compensate the complainant. Hence the complaint.
2. The counter of 1st respondent is that the hospital is a 100 beded super speciality hospital with well equipped to major operation theatres. The hospital has units of Cardiology, Neurology, Urology, Maxilo Facial unit etc. The hospital has also units of x-ray, U.S.G, Endoscope, Upper G.I. There are also having qualified nurses and experienced staff. The respondents-2 and 3 are well experienced Orthopaedic Surgeons. There was no deficiency in service on the part of respondents. Hence dismiss.
3. The counter of 2nd respondent is to the effect that the patient Mr. Rajeev.V.S. was seen in the Orthopaedic Department of hospital on 4.7.04 with complaints of pain and swelling of the left foot after a history of trauma on the same day. On examination, he had lacerated wound over the lateral aspect of left foot associated with swelling around this region. He was assessed both clinically and radiologically and he was explained about the necessity of exploration of the wound and suturing. After obtaining informed consent, the complainant was taken to the operation theatre and then the wound was thoroughly washed and explored. On exploration it was found that there was injury to the periosteal layer with contused margines of the underlying cuboid bone. The wound was sutured and he was admitted as an inpatient and the wound was taken care of by appropriate intravenous antibiotics, supportive treatment and POP slab. The wound was examined on 6.7.04 and drain was removed and he was discharged with the advice to come to OPD on 9.7.04. He was reviewed in the OPD periodically and alternate sutures were removed on 12.7.04 and complete sutures were removed on 16.7.04. He was reassessed clinically and as there was persistence of swelling over the contused bone with clinical diagnosis of unicortical injury of cuboid bone, the 2nd respondent advised a POP walking cast for 2 weeks more. Before putting this plaster on 16.7.04, the necessity for a POP walking cast for 2 weeks was well explained to the patient. The averment in the complaint that Dr. Rajagopal had told that there was no fracture and that the complainant could leave after dressing the wound is false and denied. The averment in the complaint that the wound was stitched and dressed and later the doctor returned and told that there was fracture and the complainant needed to be admitted and plaster applied are false and denied. There is no reason for any confusion about the extent of injury as he has seen it himself with the naked eye. The 2nd respondent again assessed the patient clinically and radiologically during his stay in the hospital and further visits in the OPD. The x-ray did not reveal any fracture. This was also discussed by the 2nd respondent with Dr. Rajagopal and the patient. But since there was an osteoperiosteal crack and also since there was persistence of pain and tenderness even after complete healing of the wound, the 2nd respondent and his team decided to immobilize the affected part with a POP walking cast. The averment that the complainant consulted Dr. Manu of Kodungallur Taluk hospital on 9.7.04 since he was suspicious of the behaviour and talk of Dr. Rajagopal is patently false and extremely unbelievable since the patient had continued treatment with the respondents even after this till 16.7.04. The averment that Dr. Manu assessed the x-ray and gave a comment that there is no evidence of bony fracture or tendon or nerve injuries is irrelevant because the 2nd respondent also told the complainant that the x-ray showed no fracture and the osteoperiosteal crack was detected during wound exploration by direct observation. It is important to note that no tendon or nerve injuries can be detected in x-ray. These are findings which can be assessed intra operatively and it was assessed by Dr. Rajagopal during the surgery. There is no negligence or deficiency in service on the part of these respondents. Hence dismiss.
4. The 3rd respondent filed counter adopting the counter of 2nd respondent.
5. The points for consideration are that:
(1) Whether there was any negligent act from the respondents?
(2) If so, reliefs and costs.
6. The evidence consists of Exts. P1 to P13, Ext. R1, oral testimonies of PW1 and RW1.
7. Points: The complaint is filed alleging negligence on the part of respondents. It is the case that the complainant on 4.7.04 consulted 3rd respondent doctor for an injury to his foot. According to the complainant there was no fracture to his bone but the 3rd respondent doctor told him that there was fracture to bone and plaster has been applied. It is his case that consequently he consulted Dr. Manu working at Kodungallur Taluk hospital and he told him after examining the x-ray that there was no fracture to foot or veins. So he stated that the respondent doctors are liable for compensating the complainant for wrong treatment done to him.
8. The respondents filed detailed counter and seriously contested the case. It is their case that PW1 the complainant was taken to the operation theatre and the wound was explored. On exploration it was found that there was injury to the periosteal layer with contused margines of the underlying cuboid bone. The procedure adopted by the doctors were specified in detail in the counter and in the chief affidavit filed by RW1. So according to the respondents the standard procedure has been adopted by them in the case of PW1.
9. The complainant is examined as PW1 and Exts. P1 to P13 documents were marked on his part. While examination he stated that he doesn’t know whether injury has been sustained to periosteal layer. He also deposed that he doesn’t know whether injury to cuboid bone. It is the case of respondents that on exploration it was found that there was injury to the periosteal layer with contused margins of the underlying cuboid bone. Ext. R1 is the case sheet from 1st respondent hospital in which it is stated in the first page itself after drawing a picture the injury to osteoperiosteal and over cuboid. So according to the respondents on 4.7.04 the first day of consultation itself these things were noted at the time of exploration and they have applied the standard procedure on complainant.
10. It is alleged by complainant that Dr. Manu from Taluk Hospital, Kodungallur has told him that there was no injury to his bone or vein. It is only a statement made by complainant and there is no evidence at all to show that Dr. Manu has told the same to complainant. Dr. Manu is not examined before the Forum. So the words alleged to be told by Dr. Manu are not at all relevant and is not admissible in evidence.
11. It is the case of complainant that the fracture alleged by respondents is not seen from the x-rays. The x-rays are produced and marked as Ext. P1 to P4. It is true that on perusal of x-rays there is no fracture. But it is the case of respondents that the x-ray did not reveal any fracture and fracture sustained to complainant can be assessed only clinically or intra operatively. According to them no tendon or nerve injuries can be detected in x-ray. More over an osteoperiosteal crack or a unicortical fracture can be seen in the ordinary x-ray. According to them these are findings which can be assessed intra operatively and it was assessed by 3rd respondent doctor during the surgery. There is no expert evidence adduced by complainant to disprove the facts stated by respondents and we believe the words of respondent doctors.
12. The 3rd respondent doctor is examined as RW1. He deposed that while exploration the break of bone noticed. He also stated that before exploration x-ray was taken and in which there can be seen no break to bone. A suggestive question has been put on RW1 “ (In Malayalam words)
x-ray (In Malayalam words) .” The answer was
(In Malayalam words) .” With regard to the application of POP also deposed by RW1. It is the case of complainant that the respondent doctors applied POP unnecessarily. But according to the doctors and as per deposition of RW1 the casting of POP was highly essential. There is no expert evidence to prove otherwise. The complainant is a layman and has no medical knowledge.
13. RW1 repeatedly stated that the break to bone stated in the counter cannot be seen through x-ray. He has noticed the same only on exploration. During re-examination he has stated that through CT scan and MRI scan break can be assessed. The complainant has also a case that the respondents did not prescribe for scanning. It is true that the respondents can very well prescribe for scanning. But the case of complainant is not based on the non-prescription of scanning. There is no evidence adduced by complainant to prove that negligent has been committed by respondents.
14. In the result the complaint stands dismissed.
Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the open Forum this the 21st day of November 2011.
