BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD.
F.A.No. 176 OF 2008 AGAINST C.C.NO.293 OF 2006 DISTRICT CONSUMER FORUM-II HYDERABAD
Between
Smt Madhu Shylaja W/o N.Praveen Kumar
aged 28 years, Occ: Housewife
R/o 6-6-464/1, Gandhinagar
Secunderabad
Appellant/complainant
A N D
- Sudershan Maternity & General Hospital
rep. by its Director Smt P.D.Nagamani M.D.D.G.O.
Dayara Market, Musheerabad,Hyderabad-020 AP
- Dr.A.V.Rao, Surgeon of O.P. Hospital
1-7-578/30/7, Gemini Colony
Musheerabad, Hyderabad-500 048
or
Plot No.171, Doctors Colony,
Saroornagar, L.B.Nagar, Hyderabad-38
Respondents/opposite parties
Counsel for the Appellants Sri G.Ravichandran
Counsel for the Respondents No.1 & 2 Sri D.Jagadishwar Rao
QUORUM: SRI SYED ABDULLAH, HON’BLE MEMBER
&
SRI R.LAKSHMINARSIMHA RAO, HON’BLE MEMBER
THURSDAY THE EIGTH DAY OF JULY
TWO THOUSAND TEN
Oral Order ( As per R.Lakshminarsimha Rao, Member)
***
The unsuccessful complainant is the appellant.
The facts leading to filing of this appeal are as under:
The appellant is a postgraduate with Master’s Degree in Human Resource Management and her husband, an MBA has been working in a reputed company. Both the appellant and her husband had a good status in the society. Ever since the appellant was pregnant, she was visiting the respondent no.2 hospital from 27.6.2003. The appellant complained of lower abdominal pain during 9th month of her pregnancy in the first week of March 2004 whereupon she approached the respondent no.1 hospital whose director diagnosed the problem not to be labour pains and prescribed pain killers for relief. The Director of the respondent no.1 hospital reportedly had not properly examined the appellant. On 4.3.2004 the appellant had again visited the respondent no.1 hospital complaining unbearable pain. The Director of the respondent no.1 hospital entrusted the case to the respondent no.2 who diagnosed the pain was the result of perianal abscess. On the same day an operation was performed and drainage was done and thereafter the appellant started passing urine and stools normally. The director of the respondent no1 hospital, without waiting for the appellant develop labour pains, performed caesarian section on the appellant. A baby boy was delivered on 6.3.2004 and the appellant was discharged from the respondent no.1 hospital on 13.3.2004 with an advice to get dressing of the perennial wound on the alternate days at the respondent no.1 hospital.
Unqualified nurse stated to have attended the dressing of wound at the respondent no.1 hospital and some times the appellant was advised to get the dressing of the wound done by herself. The appellant used to get dressing of periannal wound herself by obtaining sterile pads from the respondent no.1 hospital and other hospital. The appellant’s son developed heart problem on the 20th day and was admitted to the Apollo Hospital, Hyderabad and on 21st March 2004 after undergoing open heart surgery, he was discharged on 16.4.2004 from the hospital. During the period of her son’s stay in Apollo Hospital, the appellant used to get dressing of the perianal wound herself by sterile pads from the Apollo Hospital and at that stage also the appellant was passing urine and stools normally.
The appellant got dressing of perianal wound at the respondent no.1 hospital by the nurses therein, after the discharge of her son from the Apollo Hospital. The respondent no.1 hospital had not looked into the cause and status of perianal abscess even after lapse of 4 ½ months and on insistence of the appellant the director of the respondent no.1 hospital got examined the perianal abscess wound of the appellant by the respondent no.2 on 16.7.2004. The respondent no.2 conducted minor operation for excision of peripheral tissue without applying general anesthesia. On 18.7.2004 the appellant was discharged from the respondent no.1 hospital with an advice to get her admitted to the respondent no.1 hospital after a couple of days for the purpose detailed excision of perianal tissue under general anesthesia. On 21.7.2004 the appellant was admitted in the respondent no.1 hospital and the Director of the respondent no.1 hospital along with her husband who is the physician-cum-anesthesiologist and the respondent no.2 conducted the excision of tissue of perianal wound assuring the appellant that after the operation she would need no further operation and she will be alright in a couple of days. The next day, the appellant realized that something had gone wrong with the operation. The appellant complained to the respondent no.1 hospital that the stools were passing through the perianal wound. The respondents no.1 and 2 assured the appellant that several stitches were made and powerful antibiotics were administered and as such the wound would heal whereby the stools would not pass through the perianal wound.
The appellant used to experience passage of stools continuously without any control from the perianal wound till 26.7.2004 on which date the respondent no1 informed the appellant that the respondent no.1 hospital was not in a position to treat the appellant any further and hurriedly discharged the appellant without demanding any fees and advised her to approach Osmania General Hospital immediately to undergo colostomy. Accordingly, the appellant was admitted to Osmania General Hospital where the doctors after examining the appellant informed her parents that anal sphincter of the appellant was badly damaged with no sphincter action and that the diversion of stools was to be made on the stomach by putting disposal bag for the collection of the stools. The procedure known as loop colostomy which the appellant was to bear for a period of 1 ½ years. Loop colostomy was done on the appellant on 29.7.2004 and she was discharged on 2.8.2004 from the Osmania General Hospital with an advice to get dressing of the colostomy part on the stomach and perianal wound regularly at any hospital convenient to the appellant.
The respondents deliberately performed the peri-anal operation twice, on 16.7.2004 and later by suppressing the fact which amounts to deliberate medical negligence and deficiency in service and lack of postoperative care on the part of the respondents. All the respondents are responsible for their deliberate act for the development three fold suffering of the appellant, 1) dressing of peripheral wound, 2) dressing of the part on the stomach of the appellant that was subjected to colostomy and 3) inability of the appellant to pay proper care to her five months old son who was operated upon at Apollo Hospital.
After the appellant was discharged from the Osmania Hospital, her father consulted the respondent no.1 hospital for the purpose of getting dressing of the perianal wound and the operated portion. The respondent no.1 informed him that it would be done by the respondent no.2 only on payment of doctor’s fees and usage charges after settlement of pending earlier bills dated 26,7.2004. The bills were settled, the fees and usage charges were paid by the appellant. The respondent no.2 attended the dressing of perianal wound and on alternative days commencing from 3.8.2004. However, the dressing was done subsequently in the respondent no. hospital. The director of the respondent no.1 hospital has not paid least attention to attend for the dressing of the wound of the appellant. Due to the forced colostomy the appellant’s movements were restricted for the apprehension of social stigma.
The husband of the appellant and her relatives deserted her during the period of her suffering resulting financial burden to the appellant’s parents. The appellant was kept on broad spectrum of antibiotics resulting loss of resistance to more than 17 antibiotics whereby her health was affected and during the nights, the appellant was not in a position to hold her son or sleep with him for the fear of dislocation of the bag meant for collection of feces. The appellant’s son had to stay away from her during the crucial period after he had undergone open heart surgery. After five months of continuous dressing also, the perianal wound was not healed. The doctor of the respondent no.1 hospital informed the appellant’s father that the damaged sphincter muscle was to repaired and reconstructed by a competent surgeon and suggested the name of Dr.N.R.Rao of Saint Theresa’s Hospital Sanathnagar, Hyderabad. The respondent no.1 hospital was not well equipped and did not have the service of competent doctor for treating the perianal wound of the appellant.
The father of the appellant consulted two surgeons, Dr.A.K.Chary and Dr.N.R.Rao. Dr.A.K.Chary opined that the surgery on the sphincter muscle twice led to considerable damage and complete chance of recovery in such case cannot be assured and in such event the appellant had to remained permanently on colostomy bag. Dr.N.R.Rao who examined the appellant stated that much loss was done to the sphincter and the repair and reconstruction of the sphincter may provide 50% of chance of recovery. On 15.12.2004 the appellant was admitted to Saint Thera’s Hospital for repair and reconstruction of the sphincter under general anesthesia which was on 24.12.2004. After the operation Dr.N.R.Rao requested the appellant not to get examined by any other doctor except to getting dressing done under his supervision at St.Theras is only. Within 10 days therefrom, the wound was completely healed and there was no need for any further dressing. After prolonged healing time, the appellant was again admitted to St.Thera’s Hospital on 8.8.2005 for closure of colostomy which was done on 9.8.2005 under general anesthesia by Dr.N.R.Rao and his team. The appellant was discharged on 15.8.2005 from St.Therasa’s hospital with an advice to avoid pregnancy for a period of four years in view of the prolonged healing process of the sphincter. It created another gap in the marital relations of the appellant. During the period of 1 ½ years the appellant has undergone six operations under general anesthesia. Even after closure of colostomy the appellant has not completely regained the original sphincter action. She cannot withstand long bowel pressure in passing stools and she has to rush to pass stools with little pressure of bowels. It is a partial disability for the complainant as she does not know how much time it will take to regain original sphincter action. On account of the negligence and lack of postoperative care on the part of the respondents the appellant suffered mental agony and physical suffering for more than 1 ½ years and lost the opportunity to exercise care on her five months old child. The appellant has got issued notice through her advocate on 10.1.2006 claiming an amount of Rs.20 lakh towards compensation and damages. The respondent no.1 in its reply dated 6.2.2006 denied the allegations made in the legal notice.
The Director of respondent no.1 hospital Dr.P.D.Nagamani has filed her affidavit which was treated as the counter. It was stated that the caesarian delivery was done basing on the health condition of the appellant. The damage to the anal sphincter muscle of the complainant was due to disease process. Whatever was done in the respondent no.1 hospital, it was done in the interest of the appellant’s health and as per the medical norms. She submits that she is a postgraduate in gynecology and obstetrics. During first week of March 2004 when she was 9th month pregnant, the appellant came to the respondent no.1 complaining of backache and pain in vaginal region. She had examined the appellant in detail with regard to her pregnancy and came to the conclusion that it was not labour pains and could be controlled by using pain killers. Pain killers were prescribed. On that day there was no sign of perianal abscess. The appellant has not reported of any such complaint in the past. Without finding any symptom of any other disease, the respondent no.1 could not do anything on that day, therefore she advised for the use of the pain killers. On 4.3.2004 the appellant came to the respondent no.1 hospital again complaining that she was unable to bear the pain in the vaginal and anal region.
The respondent no.1 had examined her and concluded that it was not labour pains but due to periannal abscess and the same was causing pain to the appellant. The appellant had not suffered from the same pain when she came to the respondent no.1 hospital earlier and the same was found externally on 4.3.2004. As it was a surgical problem the respondent no.1 advised the appellant to approach a surgeon who could treat the problem. On enquiry by the appellant and her father, the respondent no.1 replied that Dr.K.V.Rao, the opposite party no.2 is an eminent surgeon and retired professor of surgery department of Osmania Medical College would be visiting the respondent no.1 hospital apart from other nursing homes.
The appellant and her father consulted the respondent no.2 who on examination of the appellant confirmed that it was periannal abscess and the same was to be drained by conducting a minor operation. The general consideration for abscess as held in medical literature is “antibiotics given while allowing the abscess to mature are not helpful. Early surgical operative drainage is the best way to avoid the potentially disastrous complications of undrained periannal sepsis. When the abscess are drained either surgically or spontaneously, creating a fistula from the anus to the periannal skin (fistula – in – ano. A fistula-in-ano is not a surgical emergency). By the medical literature, It is clear that there are 50% chances of formation of fistula after drainage is done which has caused to the appellant. Therefore, the same is a disease process but not due to negligence on the part of the doctors. As per the medical literature, the complications of abscess or “unless drained, the infection may spread rapidly, and result in extensive tissue loss, sphincter injury and even death”. If the abscess is severe, it causes tissue loss. The high level fistula can be treated only by staged operations, often by the procedure of colostomy to prevent septic complications and to fasten healing time between the stages. The appellant was having the high level fistula. Therefore the treatment adopted was mandatory.
The cesarean operation was essential for two reasons, 1) periannal abscess – a huge collection of pus very close to the birth canal and 2) oligohydramnics (decrease in the quantity of fluid around the baby – which is not safe for normal delivery). The appellant and her family membes were explained the same and then cesarean section was adopted as it was essential. After a lapse of two years, the appellant cannot attribute any lapse on the part of the respondent no.1 hospital. The cesarean wound had healed completely. The periannal wound would take quite sometime to heal as the same would be kept open to drain away the complete infected material out. Only dressing is required to the wound. Therefore, the appellant was discharged on 13.3.2004. All the staff of the respondent no.1 hospital are qualified and well trained. Whenever the appellant came for dressing to the respondent no.1 hospital, the respondent no.2 used to do the dressing and in his absence, the director of the respondent no.1 hospital used to dress the wound of the appellant. The appellant herself dressed the wound to avoid coming to the respondent no.1 hospital to get the dressing done, the respondent no.1 cannot be held responsible. The respondent no.1 hospital had not advised the appellant to get the dressing done by herself.
The respondent no.1 cannot be held responsible for the dressing done by the appellant herself in the Apollo Hospital. Whenever the appellant approached the respondent no.1 hospital, they had properly examined her and accordingly treated her. The periannal abscess was very high in the appellant. It was not drained completely. The wound was not healed and it also converted into fistula by disease process itself. As the periannal abscess was high, the same could be treated only by way of staged operations and the same was informed to the appellant and her father on 16.7.2004. After understanding everyting in this regard, they preferred to get the operation done at the respondent no.1 hospital by the respondent no.2 on 16.7.2004 on which date it was noticed that the tissue was being damaged by process of disease due to high level fistula. Therefore, the appellant was advised to get admitted in the respondent no.1 hospital on 21.7.2004 for detail excision of periannal tissue under general anesthesia. As the tissue was being damaged, the appellant was passing stools normally. If the tissue gets damaged or there becomes a hole to the tissue by disease process, then part of the stools comes out from the wound and remaining from the anus. As the tissues have not damaged to that stage as on 16.7.2004 the appellant was passing stools from her anus. By 21.7.2004 the tissues have damaged to a greater extent and thus the stool started coming out from the wound.
The healing of the wound was taking time due to high level fistula and the same has caused the damage to the tissue. Therefore, the stools started coming from the wound and not because of the operation conducted by the respondent no.2 in the respondent no.1 hospital or due to lack of proper facilities in the hospital. The respondent no.2 advised the appellant to get the colostomy done. The father of the appellant informed them that he had spent huge amount of money for the operation of the appellant’s son and as such he cannot meet the expenditure for colostomy in the respondent no.1 hospital. He had informed them that he would take the appellant for treatment to a government hospital. Since the respondent no.2 is a professor and surgeon in Osmania General Hospital, he advised the appellant to go to Osmania General Hospital. On the advice of the respondent no.2 the appellant went to the Osmania General Hospital to get the colostomy done.
The appellant’s father requested the respondents not to insist further payment of fees due as his financial condition was bad due to which he offered to take the appellant to a government hospital. The respondent no.1 hospital had not expressed its inability to treat the appellant. The appellant’s father had taken four days time to shift her to Osmania General Hospital. The respondent no.1 hospital had not hurriedly discharged her. The doctors in Osmania General Hospital diagnosed the problem as high fistula in anus and done colostomy which was necessary for diversion of stools to keep the effected sphincter area dry so that further treatment such as repair of the sphincter could be done. The same line of treatment was advised by the respondent no.2. The father of the appellant expressed his view that he could not meet any expenditure and wanted to go to Government Hospital.
The disease process which had caused the problem to the appellant for which the respondents cannot be held responsible. The appellant was satisfied by the proper treatment administered in the respondent no.1 hospital. No patient would come to the same hospital where a damage was caused. The appellant consulted the respondent no.1 hospital for dressing of the wound after she had undergone colostomy in Osmania General Hospital. There was no complaint in regard to the service rendered by the respondent no.1 hospital. The respondent no.1 hospital had not demanded the appellant to clear the pending bills. The appellant’s father himself offered and cleared the bills. The dressing was done by the respondent no.2 in the absence of the Director of the respondent no.1 hospital.
The appellant coming to the respondent no.1 hospital again itself proves that she was much satisfied with the service rendered by the respondent no.1 hospital. Healing time of the wound will depend upon the level of fistula. Since the appellant was having high level fistula, it had taken five months to heal and unless the wound is healed no further treatment such as repair of the sphincter could be done. The respondent no.2 felt that there was severe damage to the sphincter and the same was to be repaired, it was required for the appellant to consult doctor N.R.Rao. The advice to take treatment with another doctor itself is not a deficiency in service nor can be said that the respondent no1 hospital is not well equipped with competent doctors in treating with periannal wound.
In view of severe damage of the sphincter due to disease process the appellant was advised to consult Dr.N.R.Rao. The operation done at the respondent hospital was to drain the abscess and remove the high level fistula which was to be done stage by stage and one such stage is the colostomy to keep the area dry. If the colostomy is not done, the area will not be dried at all and it helps in development of further complications till the area was not dried the sphincter repair cannot be done. As the area was totally dried due to the time gap, Dr.N.R.Rao could do the sphincter repair. The wound at the operation area had healed in 10 days which was normal by any means or method of treatment. The director of respondent no.1 hospital conducted a cesarean delivery to the appellant on 6.3.2004. The cesarean section is a major operation than those operations performed on 4.3.2004, 16.7.2004 and 21.7.2004 and the same had healed and as such the appellant was discharged on 13.3.2004 within seven days from the date of conducting cesarean section from the respondent no.1 hospital. A reply was issued to the respondents to the notice that was issued on behalf of the appellant. There was no deficiency in service on the part of the respondent no.1 hospital.
The respondent no.2 filed counter contending that he was unaware of improper examination of the cause of pain that the appellant suffered in the first week of March 2004. The appellant visited the respondent no.1 hospital on 4.3.2004 with a complaint of pain. On the request of the respondent no.1 hospital the respondent no.2 examined the appellant and diagnosed that the pain was due to periannal abscess and accordingly she was operated upon. The appellant admitted that subsequent to the operation she was passing urine and stools normally. After the completion of surgery the respondent no.2 advised the appellant to be in the hospital as in-patient for a couple of days to get the dressing done with a qualified surgeon since the post operation dressing is very essential for the periannal abscess. The appellant was suffering from highly infected periannal abscess with a threat of its burst into the anal canal and rectum on two places deeper being 10cm and 3cm inside the anal verge. While conducting the surgery the respondent no.2 observed highly foul smelling puss came out from the periannal abscess. Abscess cavity was very big and it was packed with a ribbon gauze of one yard length with due care the surgery was conducted. The respondent no.2 advised the respondent no.1 hospital and the appellant that at the earliest, the appellant should undergo cesarean operation for delivering the child to prevent any further infection due to periannal abscess. As a human gesture the respondent no.2 visited the respondent no.1 hospital and wanted to examine the appellant to know the progress of the wound. The attendance of the appellant prevented the respondent no.2 to examine her further citing the reason that the appellant is a lady. The respondent no.2 instructed the respondent no.1 hospital to take care of the patient and do the dressing. The respondent no.2 was not aware when the appellant was discharged from the respondent no.1 hospital.
It was highly impossible for the appellant to do dressing the wound herself. The appellant did not attend the dressing properly. The appellant’s son undergoing operation might be cause of her not attending the dressing in the respondent no.1 hospital. On 16.7.2004 the appellant informed the respondent o.2 that she was discharging some pus from the wound. The respondent no.2 examined the appellant and found that the rectum and anal canal of the appellant became weak and discharging feculent liquid with pus and developed fistulae. The respondent no.2 had sent the pus for sensitive test and after looking into the antibiogram the respondent no.2 prescribed certain medicines to control the pus. After a gap of 20 days the appellant again contacted the respondent no.2 complaining that she continues to have discharge from the wound. The respondent no.2 advised her to undergone fistula operation. The cause for discharge of pus was due to negligence of dressing after the operation of periannal abscess conducted on 4.3.2004 and the same was informed to the appellant and her father. The respondent no.2 conducted fistulae operation after assessing the fistula track by inserting wire probe and during the surgery he had observed that the lower branch of fistula track connected to the lower anus which is 3 inches from the anal verge and the lower track was cut open and exercised and upper track was gone up to the internal sphincter level at the distance of 6cms. Lot of infective material was accumulated around sphincter track which was excised.
It is common for the faecal matter contaminating the operative wound due to excision at the lower fistula track and it prevents the proper dressing of the wound. To prevent the faecal contamination of the wound, another surgery under general anesthesia was conducted. Inspite of the attempt of the respondent no.2 to close the source of faecal contamination, still some amount of faecal matter was coming into the main wound which obstructed the proper dressing of the main wound to prepare for second stage operation of high fistula and repair of anal canal. The respondent no.2 instructed the appellant to undergone colostomy operation for bypassing the faecal matter for which the appellant requested the respondent no.1 hospital to refer her to Osmania General Hospital to save the expenditure. After undergoing colostomy in the Osmanai General Hospital, the appellant again came to the respondent no.2 for dressing of the fistula of wound. The respondent no.2 attended the dressing regularly till the appellant had gone for further management of sphincter and repair of anal canal.
The appellant and her father cooperated with the respondent no.1 hospital and they were put to knowledge of the stage wise treatment. The sphincter muscle was not functioning due to negligence of the appellant in not properly dressing the wound by a qualified surgeon. The respondent no.2 suggested the name of Dr.N.R.Rao for the expert opinion. Dr.N.R.Rao is a renowned surgeon who practiced for several years in England and specialist in the field of colorectal repair. Dr.N.R.Rao stated that the occurrence of damage to the sphincter muscle is not due to the negligence of the doctor who earlier conducted the operation but due to the negligence of the follow up dressing by the appellant. The respondent no.2 was impleaded after concluding the trial with an intention to tarnish his image. In the notice dated 3.8.2007 the appellant objected for impleading the respondentno.2. At the behest of the District Forum the respondent no.2 was impleaded in the case. The appellant has no specific allegation against the respondent no.2 nor was there any negligence committed by the respondent no.2 while conducting surgery or giving post operation advice. The respondent no.2 has not received the legal notice said to have been issued by the appellant nor has he got the knowledge of the notice. Hence, prayed for dismissal of the complaint.
The complainant has filed her affidavit and got marked Exs.A1 to A18.
On behalf of the opposite parties, the director of the respondent no.1 hospital and the respondent no.2 have filed their affidavits. RWs No.1 and 2 were examined. No documents had been marked.
The point for consideration is whether the opposite parties no.1 and 2 had committed medical negligence while treating the complainant?
The appellant ever since became pregnant was under the treatment of the director of the respondent no.1 hospital from 27.6.2003. She complained of lower abdominal pain in the first week of March 2004 whereupon the director of the respondent no.1hospital examined her and informed her that it was not labour pains. Again on 4.3.2004 the appellant approached the respondent no.1 hospital stating that she experienced unbearable pain. The respondent no.2 at the instance of the respondent no1 hospital examined the appellant and diagnosed that the pain was due to periannal abscess. On the same day an operation to drain the abscess was performed by the respondent no.2.
The contention of the appellant is that without waiting for the appellant develop labour pains, the respondent no.1 had performed cesarean section on 6.3.2004 on the appellant to deliver a baby boy and thereafter she was discharged on 13.3.2004 from the respondent no1 hospital with an advice to get dressing of the periannal wound on alternate days at the respondent no.1 hospital. The respondent no.2 has stated that he advised for cesarean section. He has stated “while conducting surgery I observed highly foul smelling pus came out from the periannal abscess. Abscess cavity was so big and it was packed with a ribbon gauze of 1 yard length. However, with due care the surgery was conducted and accoardingly I specifically instructed the complainant to be in the hospital as in-patient for a couple of days and undergo periodical dressing with a qualified surgeon and I accordingly advised opposite party no.1 hospital and the complainant that at the earliest the complainant should undergo cesarean operation for delivering the child to prevent any further infection due to periannal abscess”.
The gravity of the periannal abscess and surgery thereto conducted by the respondent no.2 is not disputed. The advice of the respondent no.2 for the appellant to undergo cesarean section in order to prevent further infection due to periannal abscess cannot be disputed. The respondent no.2 having performed the surgery and with the knowledge of the status of the abscess advised the respondent no.1 hospital to proceed with cesarean section.
The director of the respondent no.1 has stated that cesarean section was required to be done for two reasons 1) periannal abscess and 2) oligohydramnios. She described periannal abscess as “a huge collection of pus very close to the birth canal” and “oligohydramnios as “decrease in the quantity of fluid around the baby which is not safe for normal delivery”. She has further stated that she has informed the condition of the patient in the back drop of periannal abscess and oligohydramnios to the appellant and her family members. In the circumstances the contention of the appellant that the respondent no.1 hurried to proceed with the cesarean section on the appellant is not tenable.
The appellant has contended that dressing of the periannal wound was not attended by a qualified doctor but by unqualified nurses in the respondent no.1 hospital. It was contended that the appellant, sometimes used to do the dressing of the wound herself by obtaining sterile pads from the respondent no1 hospital and the other hospitals particularly during the period of her son’s stay in Apollo Hospital from 21.3.2004 to 16.4.2004. The respondent no.2 has stated that the appellant’s attendant prevented him from examining the abscess of the appellant when she delivered a child in the respondent no.1 hospital citing the reason that the appellant is a lady whereupon he had instructed the staff of the respondent no.1 hospital to do the dressing. It is the contention of the respondent no.2 that he had performed the operation successfully and advised the appellant to undergo dressing regularly with qualified surgeon to avoid further complications.
The respondent no2 has stated that the infection had spread as the appellant neglected to attend the respondent no.1 hospital for getting the dressing done by him. Except the statement of the appellant and the respondents no.1 and 2, an oath against oath, there is no other evidence brought on record in this regard. The attending circumstances would speak the fact that the appellant had not regularly attended the respondent no.1 hospital regularly for the dressing of her abscess wound.
It is the contention of the learned counsel for the appellant that the respondents no.1 and 2 negligently conducted the operation for the treatment of abscess. For the first time in the first week of March 2004 the appellant visited the respondent no.1 hospital with the complaint of abdominal pain and after examination, the director of the respondent no.1 hospital came to the conclusion that it was not labour pains. Again on 4.3.2004 the appellant has consulted the director of the respondent no.1 hospital with unbearable pain in her abdomen. This time the director of the respondent no.1 called for the respondent no.2 to examine the problem. The respondent no.2 having examined the appellant opined that she was experiencing pain due to periannal abscess and on the same day a minor operation was performed by the respondent no.2.
The respondent no.1 has explained the phrase “minor operation” as “cutting the spot and making way for pus and other waste material which was accumulated inside to go out and that cut is called operation”. The respondent no.2 had performed the surgery successfully for the perianal abscess on 4.3.2004. The appellant has also admitted that the operation was uneventful and she was passing urine and stools normally. On 6.3.2004 cesarean section was conducted by the Director of the respondent no.1 and the appellant delivered a baby boy. According to the respondent no.2, the appellant complained of discharging pus from the wound on 16.7.2004. On examination of the appellant the respondent no.2 diagnosed that “her rectum and anal canal became weak” and discharging feculent liquid with pus and developed fistulae. I sent the pus for sensitive test”. Even after being kept on the medicine prescribed by the respondent no.2, the appellant complained of continuation of discharge from the wound. The respondent no.2 then advised the appellant to undergo fistula operation. The cause for discharge of the pus trouble according to the respondent no.2 was due to negligent dressing after the original operation. Operation of perianal abscess was conducted on 4.3.2004.
According to the opposite party no.1, the opposite party no.2 opined that the complainant was suffering from perianal abscess and the same was to be drained by conducting a minor operation and there was 50% chance of formation of fistula even after the drainage is done. The minor operation was performed by the opposite party no.2 after which dressing was required to be done to the wound . The perianal abscess was very high in the complainant which could be treated only by way of staged operations. On 16.7.2004 excision was done by the opposite party no.2 and the complainant was discharged on 18.7.2004. The complainant was readmitted in the opposite party no.1 hospital on 21.7.2004 for examination and repair of perianal tissue under general anesthesia. Because of high level fistula the tissues were further sloughened. The tissues were damaged to a large extent and thus the stool started to come out from the wound due to the disease process. According to the opposite party no.3 he performed operation on the complainant on 4.3.2004 in the opposite party no.1 hospital and at that time the complainant was in her ninth month pregnancy. The discharge of pus is due to negligent dressing of the wound. The opposite party no.2 performed fistulae operation under general anesthesia to close the wound and the faecal contamination. Despite that effort by the opposite party no.2, some amount of faecal matter was coming out into the main wound for which the opposite party no.2 advised the complainant to undergo colostomy.
The opposite party no.1 had issued certificate dated 26.7.2004 to the effect that the complainant was admitted in opposite party ho.1 for minior excision of tissue of perianal fistula wound and she was discharged on 18.7.2004. Further, it is stated in the certiaficate that the complainant was readmitted on 21.7.2004 for the same operation under general anesthesia and she was discharged on 26.7.2004 with an advice to undergo colostomy at Osmania General Hospital. Another certificate date 4.2.2004 issued by the opposite party no.1 reveals that the complainant was admitted in the opposite party no.1 hospital on 4.8.2004 and she was discharged on 8.8.2004 and she had undergone dressing of the wound at the opposite party no.1 hospital after she was discharged therefrom on 8.8.2004, from 10.8.2004 to 4.12.2004. Dr.N.R.Rao had issued report that the complainant was admitted to St.Theresa Hospital with the problem of feeble spinchter action and repair of anal sphincter muscle was required to be done. In his report Ex.A8 Dr.N.R.Rao referred to the history of previous illness as under:
“ Incision and drainage done for perianal abscess before delivery. Four months later again incision was done under general anesthesia causing considerable damage to anal sphincter muscle and the fecaes started coming through fistula wound leading to loop colostomy at Osmania General Hospital five months back. Repair of sphincter was done on 24.12.2004 under general anesthesia and the patient was discharged on 10.1.2005. Madhu Shailaja was again admitted at this hospital on 8.8.2005 for closure of colostomy. Closure of colostomy was done on 9.8.2005 under general anesthesia and the patient was discharged on 15.8.2005”. (emphasis supplied)
Dr.N.R.Rao was examined by the complainant as PW2. He stated that the opposite parties had not been negligent while treating the complainant in regard to the treatment administered for perianal abscess. During his cross examination he has stated as follows:
“Damage was done by the disease and thus a repair of sphincter was done. Sphincter muscles were not damaged but abscess extended and made a hole into the rectum. The septic operation can be done in any hospital. I cannot answer if there was any negligence on the part of the opposite party or surgeon.” After seeing the certificate the witness opined that the condition which has found is due to disease process and my opinion also that a surgeon cannot produce these causes.
Dr.A.K.Chary who who was examined as PW3 has also not supported the case of the complainant. Both the doctors particularly PW2 who treated the complainant and issued the report had not expressed any definite idea of any negligence on the part of the opposite parties in treating the abscess wound of the complainant. Dr.A.K.Chary has stated that there was a chance of recurrence of abscess and it spreading to the other parts of the body. He has stated that the tissues got damaged when the fistula crack was on high level and according to him proper treatment was given at the opposite party no.1 hospital and the opposite party no.1 hospital had taken care to refer the patient for further management at higher centre. Hence, both the witnesses had not supported the theory of negligence of the opposite parties no.1 and 2 nor their evidence is of any use to draw support for the contention of the complainant that the opposite parties were deficient in rendering their service while treating the complainant.
The complainant has submitted that due to the problem that were cropped up after the surgery performed by the opposite party no.2, she had to carry a disposal bag for collection of stools and undergo loop colostomy in Osmania General Hospital. She has also expressed her helplessness that she was deprived of attending on her newly born child stating that she could not sleep with him for fear of infection and the doctor who subsequently treated her advised her not to go for a second child for about four years and thus she was deprived of marital relations. We sympathesize with the complainant for the trouble she had undergone but in the absence of any evidence to indicate any negligence on the part of the opposite parties on account of their treating the abscess wound of the complainant, we are inclined to dismiss the appeal.
In the result, the appeal is dismissed confirming the order dated 11.12.2007 of the District Forum. In the circumstances of the case there shall be no order as to costs.
Sd/-
MEMBER
Sd/-
MEMBER
Dt.08.07.2010
KMK*
