DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD

Dated this the 9^th day of August, 2024

Present      :   Sri. Vinay Menon V., President

                    :   Smt. Vidya A., Member                        

                   :   Sri. Krishnankutty N.K., Member                                        Date of Filing: 29/07/2021    

                                      CC/116/2021

Chandran Kolangara,

S/o. Narayanan Nair,

Sreevalsam,

Near GUP School, Shanthi Nagar,

Cherpulassery (PO), Palakkad – 679 503                                                                  -             Complainant

(By Adv. M/s Shahir Showkathali & Farhan K.M)  

                                                                                                                                Vs

1. M/s. GEM Hospital,

45, Pankaja Mill Road,

Ramanthapuram, Coimbatore,

Tamilnadu – 641 045

Rep. by its Chairman.

2. Dr. C. Palanivelu,

Gastroenterologist & Laparoscopy,

Surgeon, Chairman & Managing Trustee,

M/s.GEM Hospital, 4, Pankaja Mill Road,

Ramanthapuram, Coimbatore – 641 045

3. Dr. Senthil Anand,

Surgeon & Consultant,

M/s. GEM Hospital, 45, Pankaja Mill Road,

Ramanthapuram, Coimbatore,

Tamilnadu – 641 045

4. Dr. Mohammed Juned Khan,

Surgeon & Consultant, Unit Head,

M/s. GEM Hospital, 45, Pankaja Mill Road,

Ramanthapuram, Coimbatore,

Tamilnadu – 641 045                                                                       -             Opposite parties

(OPs 1, 2 & 3  by Adv. M/s.  D. Senthil Kumar & M. Gomathi

O.P. 3 is Ex-parte)

O R D E R

By Sri. Vinay Menon V., President

1. 1^st opposite party is a specialty hospital of which the 2^nd OP is the Chairman. The 3^rd and 4^th OPs are doctors who treated the complainant.  

Complainant was diagnosed with pancreatitis in 2017 and was under treatment in EMS memorial Co-operative Hospital and Research Centre Ltd., Perinthalmanna, Malappuram.  During 2019, he approached the 1^st OP hospital and was admitted and discharged on and off. The OPs convinced the complainant to undergo ERCP and stenting procedure for permanent relief. Procedure was carried out on 23/8/2019. But the procedure was a failure. He had to undergo diagnostic laparoscopy with pancreatic fluid drainage. OPs informed that the procedure was successful but by next day the complainant started experiencing pain/discomfort and could not move / feel his left leg.  There was also discoloration. OPs informed that this was a normal procedure. It was only after 15 hours of informing the OP that a doppler ultra sound scan was taken and found that there was blood clot. Since there was no proper medical facilities and equipment to treat the complainant, they sought for discharge and was referred to G. Kuppuswamy Memorial Hospital and thereafter to Amrutha Hospital.  In G. Kuppuswamy Memorial Hospital he was diagnosed with chronic pancreatitis, acute limb ischemia and sepsis. Treatment rendered in GKM Hospital was unsatisfactory and he approached Amrutha Hospital where they carried out effective treatment and his life and limb could be saved.

Complainant is aggrieved by three alleged negligence and unfair trade practice.

1. The OPs deliberately did not try their best to place the stent in the complainant’s body.
2. OPs lied about the surgeries and its success.
3. They failed to take the discomfort of the complainant’s left leg seriously.  

Aggrieved by the aforesaid three grievance, complainant seeks cost, compensation and future expenses to a tune of 65 lakhs.

2. OPs filed detailed version. They contended that the complainant had a history of alcohol abuse and was suffering from pancreatitis from 2017 onwards. Chronic pancreatitis is not curable and can only be managed.  The OP hospital has provisions for treatment of pancreatitis. Stenting could not be carried out beyond head of pancreas due to edema and wire could not be inserted fully and stent could not be fixed. Failure of this procedure was informed to the patient and bystanders. Diagnostic laparoscopy with drainage of pancreatic ascites was carried out successfully and nearly 6 litres of ascetic fluid was removed. The critical limb ischemia is not a bi-product or result of the treatment carried out in O.P. hospital. Patient was referred to GKNM hospital for treatment of acute limb ischemia. Doctors in GKNM hospital did not treat for chronic pancreatitis. There is no negligence whatsoever on the part of OPs and they sought for dismissal of the complaint.

 3.        The following issues were framed for consideration:

1. Whether non-placement of stent, in the facts and circumstance of the case, constitute deficiency in service / unfair trade practice?
2. Whether there was inordinate delay in addressing the complainant’s conditions so as to constitute deficiency in service / unfair trade practice?
3. Whether OPs lack infrastructural / logistical / personnel capacity to address the condition suffered by the complainant?
4.  Whether there is any deficiency in service or unfair trade practice on the part of the OPs?
5. Whether the complainant is entitled to any of the reliefs sought for?
6. Any other reliefs?

  4.        (i)          Documentary evidence of complainant comprised of proof affidavit and Exhibits           

A1 to A15.   Marking of Exts.A1 to A10 are objected to on the ground that they are not from the source that they are purported to be issued. Beyond such a vague statement, the O.P. has no comments to substantiate their contention. Hence, objection is overruled. It is also relevant to note that the counsel for O.P.s rely on Ext. A8 itself to drive in his arguments at hearing stage.

2. Two expert doctors, Dr. Anoop K Koshy & Dr. Bilal Muhammed, who had treated the complainant, were examined as PW1 & 2 respectively.

(iii)        OPs filed proof affidavit and marked Exts.B1 to B4.   

Marking of Exts.B1 is objected to on the ground that is a photocopy. Marking Exts.B3 was objected to as they are print-outs from internet accompanied by Section 65B certificate.     Since this Commission is not bound by Indian Evidence Act and in the absence of a plea that the said document was either forged or fabricated, said objection is overruled. 

   Issue No.1

5.         Complainant, a known case of pancreatitis from 2017 onwards got himself admitted to OP1 hospital for ERCP and stenting. Said procedures were carried out on 23/8/2019. The OPs thereafter informed the complainant and bystanders that the procedure was a failure. It is one of the grievances of the complainant that the OPs failed to exercise their ability and expertise to treat the complainant.  

6.         OP filed version stating that they could not complete the procedure as the wire could not be advanced beyond head of pancreas due to edema and wire could not be inserted fully and so stent could not be fixed.

7.         Exts.A1 is the discharge summary issued by OP1.   Procedure done is seen at the bottom of Ext. A1 wherein they had stated wire could not be advanced beyond head of pancreas.  It is also stated that the stent was not placed. OPs submitted that this kind of surgery will not cure the complainant but only assists in management.  

8.         Additionally, in order to prove that stenting is a slippery procedure and that there is always chance that the stent can slip from its original location, OPs carried us through Ext. A8 which is the discharge summary issued from Amrutha Hospital.  Under the procedure carried out on 14/9/2019, it could be seen that pancreatic duct stenting was done. Thereafter, on 16/9/2019, it could be seen that there was pancreatic duct disruption / chronic pancreatitis. Thereafter, on 23/9/2019, ERCP was carried out again and re-stenting was carried out. On 26/9/2019 there was indication of pancreatic ductal leak.  On 28/9/2019 also, there was indication of pancreatic duct stenting. It was only on 28/9/2019 that the PD stent was found to be in-situ. 

 9.        Even though the complainant cross examined PW1 and PW2 doctors who had treated him, no questions were put forward to the effect whether such disruptions in stenting herein arose as a result of negligence on the part of O.P.s.

10.       This Commission cannot be blind to the fact that human body reacts in unpredictable ways and manners.  A bio-chemical phenomena like human body cannot be expected to function with mathematical precision in every occasion and we are also not blind to the fact that the medical science has not grown to the extent of being able to predict and anticipate each and every complication that might arise.  

11.       Therefore, in the facts and circumstances of the case we hold that there is no negligence / deficiency in service / unfair trade practice on the part of OPs in carrying out ERCP and stenting.

            Issue Nos.2 & 3

Whether there is in-ordinate delay in taking doppler scan

12.       The second issue pertains to the alleged 15 hours delay on the part of the OPs in resorting to doppler scan after the complainant had initially complained of pain in the leg.  

13.       Ext.B1 is the medical records pertaining to the treatment rendered to the complainant in OP 1 hospital. Sheet 38 of Ext.B8 contains the ‘Nurses’ Notes’ starting from 30/8/2019 at 6 pm. On its reverse is the ‘night duty’ reports. At about 9.45 PM, the complainant had mild leg pain. It was informed to Dr. Sriram. At 10 PM Dr. Sriram saw the patient and advised medication and USG doppler scan to be carried out the next day. Thereafter on 31/8/2019 at 8.30 am, the patient was shifted to scan room.  USG doppler was taken.   At 10 AM Dr. Nallakilli saw the patient and advised to refer the patient to GKNM Hospital.

                        The complainant has no case that Ext.B2 is a forged and fabricated document. Therefore, it is safe to go by the contents of the said documents. The patient had reported pain at 9.45 PM. At 10 PM he was seen by the treating doctor who advised scanning. He was provided medication in the meantime during night. At 8.30 AM the patient was shifted to scan room and doppler scan taken.  He was advised to be referred to GKNM hospital at 10 AM.

14.       We are of the opinion that from the first instance of pain, the doctor had attend the patient, medicated him and waited for results. But when the pain did not subside, he was adviced to undergo scan. When the results came, he was referred to specialist’s hospital that deals with the condition suffered b the complainant.  We hold that this is a reasonable time-frame and do not find any undue and unwarranted delay on the part of OPs in referring the complainant for acute limb ischemia.

            Whether absence of department to treat acute limb ischemia is a deficiency in service on the part of O.P.

15.       PW1, Dr. Anoop K. Koshy was one of the doctors in Amrutha Hospital who treated the complainant. The complainant, in his chief examination put to PW1 questions regarding development of acute limb ischemia. His deposition in lines 14 to 16 in page 4 and lines 1 to 19 in page 5 are as follows:

            “Acute limb ischemia do not develop as a result of failure of ERCP. A question have put forward by the counsel of the complainant in the question whether the acute limb ischemia is a sudden developing extent? Answer given by doctor is yes. The doctor volunteers that acute means it is a sudden extent.” (sic)

16.       Thus, the words of the doctor who treated the complainant would show that development of ischemia had nothing to do with a treatment that was carried out in OP hospital.  Further, the contents in Ext.B2, already discussed supra, proves that there is no inordinate delay on the part of OP in referring the complainant for treatment of acute limb ischemia.  

17.       Since OP 1 hospital admittedly is a hospital for treatment for   gastroenterology and acute ischemic limb does not arise as a result of ERCP, absence of a department the deals with ischemic limb is not fatal.

18.       Thus, Issues 2 & 3 are also found against the complainant.

            Issue Nos.4 , 5 & 6

19.       Pursuant to the findings based on discussions in Issue nos. 1 to 3, we hold that there is no negligence, deficiency in service or unfair trade practice on the part of OPs.

20.       Resultantly, complainant is not entitled to any of the reliefs sought for.

21.       In the facts and circumstances of the case, we direct the parties to bear their respective costs.

                         Pronounced in open court on this the 9^th   day of August, 2024.     

                             Sd/-                                                                                                                             

                                                                                                                                                  Vinay Menon V

                                                                                   President

                                                                                         Sd/-

                          Vidya.A

                                              Member        

                               Sd/-

                Krishnankutty N.K.

                                                                                                                                                   Member     

APPENDIX

Exhibits marked on the side of the complainant

Ext.A1   - Original discharge summary dated 31/8/2019   

Ext.A2  –  Copy of package bill dated 31/8/2019  

Ext.A3  - Original X-ray.

Ext.A4 – Original cover of X-ray

Ext.A5   - Original referral letter dated 31/8/2019

Ext.A6   - Copy of discharge summary dated 11/9/2019 from GKNM Hospital   

Ext.A7   - Original final bill dated 11/9/2019  

Ext.A8   - Copy of discharge summary dated 10/10/19 from AIMS

Ext.A9   - Original invoice dated 10/10/2019

Ext.A10   - Original discharge summary   dated 31/12/2019

Ext.A11   - Copy of tax invoice dated 12/12/2020   

Ext.A12   - Copy of lawyers notice dated 12/2/2021

Ext.A13  - Copy of lawyers notice dated 7/4/2021

Ext.A14   Original 4 postal acknowledgment

Ext.A15   - True copy of certificate of disability dated 31/12/2020.

Exhibits marked on the side of the opposite party:

Ext.B1 – Copy of discharge summary dated 31/8/19     

Ext.B2 – Copy of hospital records of complainant

Ext.B3 – Printout of medical literature titled Pancreatitis treatment for acute chronic & severe

               cases  

Ext.B4 -  Photocopy of medical literature pertaining to acute pancreatitis

 Court Exhibit:  Nil  

Third party documents:  Nil

 Witness examined on the side of the complainant:  

PW1 – Dr. Anoop K Koshy, AIMS (Expert)

PW2 – Dr. Bilal Muhammed, Lissie  Hospital (Expert)

Witness examined on the side of the opposite party:  Nil

Court Witness: Nil

NB : Parties are directed to take back all extra set of  documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.