Tamil Nadu
North Chennai
177/2009
Mr.C.Jayaprakash, - Complainant(s)
Versus
M/s. Life Rigid Hospital, - Opp.Party(s)
PVs Giridhar associates
13 May 2016
ORDER
Complaint presented on : 22.04.2009
Order pronounced on : 13.05.2016
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)
2nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3
PRESENT: THIRU.K.JAYABALAN, B.Sc., B.L., : PRESIDENT
TMT.T.KALAIYARASI, B.A.B.L., : MEMBER II
FRIDAY THE 13th DAY OF MAY 2016
C.C.NO.177/2009
C.Jayaprakash,
S/O. Chakravarthi,
No.47/7, Kolapillai Street,
Radha Nagar Main Road,
Chromepet, Chennai – 600 044.
..... Complainant
..Vs..
1.M/S Life Line Rigid Hospitals, No.47/3, New Avadi Road, Kilpauk, Chennai – 600 010.
2.J.S.Rajkumar, General Surgeon, M/S. Life Line Rigid Hospitals, No.47/3, New Avadi Road, Kilpauk, Chennai – 600 010.
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...Opposite Parties |
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Date of complaint 14.05.2009
Counsel for Complainant : M/S. P.V.S.Giridhar & Sai Associates
Counsel for 1st & 2nd opposite parties : M/S. K.Thyagarajan & S.Magimairaj
O R D E R
BY PRESIDENT THIRU. K.JAYABALAN B.SC., B.L.,
This complaint is filed by the complainant u/s 12 of the Consumer Protection Act.1986.
1.THE COMPLAINT IN BRIEF:
The Complainant suffered with severe abdominal pain during November 2008 and he initially consulted Dr.R.M.N. Francis who diagnosed it as a case of Appendicitis. Dr.Francis offered to perform appendicitis surgery stating that the expenses would be around Rs.20,000/-. Under the persuasion of one of his relative, Mr.D.Ravi, son of Devadoss, and the Complainant visited the 1st Opposite Party hospital on 22.11.2008. After initial examination, he was advised to admit himself for a Laparoscopic surgery on 24.11.2008. He therefore got himself admitted in the 1st Opposite Party hospital on 24.11.2008. A colonoscopy was performed by the 2nd Opposite Party on 25.11.2008 indicating “Extraneous Mass Lesion – Proximal ASC – colon”. On 25.11.2008, a laparoscopy was performed by the 2nd Opposite Party on the Complainant which was converted to open Right Hemicolectomy. The Discharge Report dated 18.12.2008 indicates that Laparoscopic Surgery was found to be impossible due to dense adhesion, and open laparotomy was resorted to during which the following were found
i 50ml of purulent fluid found in the Retro caecal Area,
ii. Caecal wall was unhealthy,
iii. Appendicitis was inflamed and adherent of caecal wall it was indicated
that Right Hemicolectomy was done
in view of conditions ii and iii above.
The Complainant further states that this is quite surprising in view of the prevalence of purulent fluid (puss) as indicated in (i) above, as it is well known that there is a gross danger of high infection and a prudent surgeon would have done a simple drainage. Due to faulty surgical procedures there was a heavy loss of blood, necessitating 17 bottles of blood transfusion. Surgical pathology report dated 27.11.2008 diagnosed it as “Suggestive of Acute or Chronic non specific Colitis”. Strangely the report mentions the specimen as having been received on 24.11.2008, when the biopsy itself was taken only on 25.11.2008. It is well known that appendectomy needs hospitalization of 1 to 2 days, but in the case of the Complainant he was discharged from 1st Opposite Party’s hospital on 18.12.2008 due to post-operative complications, consequent upon gross negligence in the procedure undertaken and the manner of the execution of the surgery. The Discharge Report dated 18.12.2008 indicates that the Complainant developed “Pre-renal Uremia (Kidney failure) and Anemia”. He was under heavy medication. Following the surgery blood urea shoot up to 97.0mg/dl and serum creatine to 2.8mg/dl on 12.12.2008. Prior to surgery all the parameters were normal, although he has been under treatment for hypertension for several years. His kidneys were normal, except for the presence of calculi. Initially the Opposite Parties have indicated that the entire surgery and treatment may come to Rs.70,000/-.Thereafter the Opposite Parties gave an estimate of Rs.1,20,000/-. The Complainant with the financial help from his brother paid a total sum of Rs.1,48,500/-. At the time of discharge, the Opposite Parties demanded a further sum of Rs.1,04,000/- which was asked to be paid in two installments for which written statement was taken from the patient of which the First installment Rs.50,000/- was paid. The Complainant was admitted to Ramachandra Medical Centre, Porur at Chennai wherein the following diagnosis was made
-Splenomegaly,
-Hypertension,
-Acute Renal Failure,
-Hyperkalemia,
-Hyperuricemia,
He was also found to suffer from anemia and azotemia: he was on dialysis and gradually he began to recover. A CT scan performed in Ramachandra Medical Centre indicated bilateral Nephrolithiasis with mild hydro uretero nephrosis. He was discharged from the said hospital on 29.12.2008. He was again admitted on 06.01.2009 and discharged on 12.01.2009. He incurred an expenditure of Rs.1,50,000/- in the said hospitals. The Complainant continues to be under treatment. Much to his acute shock it has been recently diagnosed that he has developed Myelofibrosis which could be a terminal condition. The Complainant has been put to grave life – threatening hardship, pain, financial loss and mental agony on account of the Opposite Parties gross negligence and deficiency in their services. He is being forced to borrow huge sum at high rates of interest. It is just and necessary that the Opposite Parties should be directed to refund the entire sum paid to them towards fees and medical expenses, and pay compensation of Rs.12,00,000/- to the Complainant for professional negligence, unfair trade practice and Deficiency in Service resulting in physical pain and hardship, mental agony, and financial loss suffered in physical pain and hardship, mental agony, and financial loss suffered by the Complainant.
2. WRITTEN VERSION OF THE OPPOSITE PARTIES IN BRIEF:
The Complainant initially consulted Dr.R.M.N. Francis, which is evident from the records produced by him to the 2nd Opposite Party, which also included the scan reports from M/S. Saravana Scans and the report revealed what had been set out in the paragraph 1 of the Complaint. The CT scan conducted at the first Opposite Party hospital also confirmed the report given by M/S Saravana scans, on the advice of Dr.R.M.N.Francis. As per scan reports it is found that the Appendicitis or an Appendectomy had to be performed on the Complainant. All standard test and investigations like blood urea, serum creatine, haemoglobin, etc., were done to ascertain as to whether the Complainant was fit enough to undergo a surgical procedure. A surgical colonoscopy was also advised to the Complainant. The 2nd Opposite Party Dr.J.S.Rajkumar performed a colonoscopy on 25.1.2008 which indicated, “extraneous mass Lesion on Proximal ascending colon’. The CT scan on 25.11.2008 also confirmed the same status and accordingly on the basis of investigation reports, CT scan and the colonoscopy, it was advised that a surgical appendectomy through laparoscopic method could be done. Since the Investigation reports did not indicate any hematological diseases at that point of time and further the Complainant did not disclose any past history or complete hematological disease or renal calculi it was decided to go in for a laparoscopic surgery to remove the appendix. This is an infective condition of the appendix, where cure is removal of the appendix. The Opposite Parties submit that after the surgical procedure started in the presence of other operating surgeons namely Dr.Anton,M.S., Dr.MohanKumarM.S., Dr.KolandaisamyM.S.and Dr.Chandrasekhar, M.S.FRCS, the 2nd Opposite Party and the other doctors found that it was not possible to do a laparoscopic surgery on the Complainant because of the fact that there was a mass with purulent fluid, friable in nature and tumorous feel of caecum for which a Laparoscopic surgery was not advisable, since there was pus in the abdomen, a drainage procedure was done with hemicolectomy. Since it is an established protocol that is followed by many surgeons, it was decided to switch over to an open hemicolectomy and not a laparoscopic appendectomy. This decision was taken by all the 5 surgeons as it was in the best interest of the Complainant herein. The Complainant’s relatives as well as the Complainant were informed before the beginning of the procedure. The blood loss at the time of operation was approximately 250ml, as it is clear from the operative notes and the files. The laboratory test report as well as the biopsy reports were only after laparoscopic incisions were made, it revealed that only a open surgery could be performed and not a laparoscopic surgery as was initially planned. Post operative the Complainant was subject to further investigations, the result showed that his Hemoglobin content level was low. Low hemoglobin levels do not occur because of loss of blood during surgical procedures but only because of hematological problems. In the 1st week of his operation the Complainant was given only 6 units of blood. After the 1st week of operation further investigations revealed that the Hemoglobin levels of the Complainant had not improved and the consultant Doctors suspected that the cause to be there was a massive spleenomegaly and not loss of blood during surgery. On 27.11.2008 a day after the surgery, 6 units of blood were given to the Complainant. On 28.11.2008, 4 units of platelets were given, since there were low levels of platelets and also 4 units fresh frozen plasma were given on 27.11.2008 and on 02.12.2008, 2 units of blood were again transfused and later on 09.12.2008 yet another 2 units of blood was transfused. The Opposite Parties submits that it is not because of the inability of the Complainant’s body to produce RBC’s which had let to a situation where blood had to be transfused. In normal circumstances Appendicectomy definitely requires 1 to 2 days of hospitalization, but in the case of the Complainant, it was not merely appendicitis as originally diagnosed, but it was found that he had severe infections of, caecum, portions of large bowel and further had severe spleenomegaly and bilateral renal calculi which later proved that his condition was quite grave and requires further hospitalization. On 1st December 2008, kidney function test was carried out on the Complainant; the reports revealed that the test was within prescribed normal limits. Consulting Nephrologists Dr. Balraman on his 2nd visit also asked for the Hematologist’s opinion for Hematological problem and subsequently diagnosed it as Renal Failure in the Complainant, which was also treated. The kidney status of the Complainant could be revealed only from his kidney function test, abdominal scans. However the pre surgical procedures and tests did not reveal that he was suffering from renal failure. However after the surgery was performed, and since blood transfusion had to be resorted to and as the Complainant consistently failed to respond to the treatments, opinion of the consultant Nephrologists Dr. Balaraman was sought for and along with the opinion of the Hematologist, came to a conclusion that the kidney function was not normal. This fact was further confirmed by the clear admission of the Complainant in the lawyer’s notice dated 04.02.2009 issued on the Opposite Parties that the CT Scan performed to the Complainant at Ramachandra Medical Centre reveals bilateral Nephrolithiasis, with mild hydro uretero nephrosis. It was undiagnosed renal failure which has resulted in loss of platelets and RBC’s in the Complainant, further the CT Scan done did not show any obstructive features and therefore it was clear that it was only progressive impairment of the renal system and renal calculi could be the reasons for the mild obstructive features and there was no negligence at all that could even be alleged upon the Opposite Parties. The Complainant was also referred to a consultant Hematologist Dr.Margaret who suggested a bone marrow aspiration test to find out the reason for Severe Anemia, Thrombocytopenia and spleenomegaly. The Complainant however was insisting that he should be discharged from the hospital and hence he was discharged from the 1st Opposite Party hospital against medical advice further he was advised to come for review. However the Complainant failed to come for review to the nephrologists as regards the renal function test. Hematologist Dr.Margaret has advised repeat bone marrow aspiration, since the first bone marrow aspiration report revealed that the sample was inadequate for testing and for a report and hence the consultant had advised for a second bone marrow aspiration. However the Complainant refused to go through the same and wanted to get discharged. It is admitted in the Complainant’s notice dated 04.02.2009 in paragraph 7 that the Complainant was subsequently admitted to Ramachandra Medical Centre, Porur where he was diagnosed and suspected of the following:- (Spleenomegaly, Hypertension, Acute Renal Failure, Hyperkalemia and Hyperuricemia). In the Complaint it is stated that the Complainant was suffering from anemia and azotemia and he was suggested dialysis and gradually he began to recover. The initial estimate of laparoscopic Haemecolectomy which was later converted into an open Haemecolectomy was Rs.1.12 lakhs, however taking into account the condition that the Complainant was admitted for a very long time i.e. for nearly 26 days due to his hematological renal conditions and also that he was not producing sufficient RBC’s and Platelets. The 1st of the Opposite Party agreed for a concession and charged the Complainant only a sum of Rs.1,29,060/- as against the bill of Rs.1,54,060.00/- and giving the Complainant a concession of Rs.25,000/- and the Complainant had paid only Rs.90,000/- and he is still due and liable to pay the balance amount of charges. Later on the Complainant paid a further sum of Rs.50,000/- and as of now the Complainant is due and liable to pay a sum of Rs.54,829/- to the 1st Opposite Party. The Complainant was advised not to get discharged unless and until the diagnosis was complete, however the Complainant wanted to be compulsorily discharged and therefore he was discharged against the medical advice. The Opposite Parties denies the allegation made in the Complaint and they have not committed any Deficiency in Service and hence the Opposite Parties prayed to dismiss the Complaint with costs.
3. POINTS FOR CONSIDERATION:
1. Whether there is deficiency in service on the part of the opposite parties?
2. Whether the complainant is entitled to any relief? If so to what relief?
4. POINT NO :1
On behalf of Complainant Ex.A1 to Ex.A90 marked were and on behalf of the Opposite Parties Ex.B1 to Ex.B3 were marked on 19.03.2010 and again on behalf of the Opposite Parties 6 documents were filed and the same have been inadvertently marked as Ex.B1 to Ex.B6 instead of Ex.B4 to Ex.B9. Now in this order the said 6 documents are remarked as Ex.B4 to Ex.B9.
5. On behalf of the Complainant, Dr.P.Koli expert witness was examined as PW2 to prove the complainants case. However he was not cross examined. The Opposite Party’s filed C.M.P. No.29 & 30/16 for cross examination of the PW2. At the stage of filing counter, the counsel for the complainant made endorsement that he is not pressing the evidence of Dr.Koli (PW2) and based on such endorsement, the evidence of PW2 had been ordered as need not be referred for deciding the main C.C. In view of such circumstances there is no expert evidence is available on behalf of the Complainant.
6.The admitted facts are that the Complainant initially consulted with Agash Nursing Home on 01.11.2008 and the doctor who attended on him in that nursing home suspected that he was suffering from Appendicitis and prescribed certain medicines under Ex.A1 prescription and later he had consulted Dr.R.M.N Francis who diagnosed that he is suffering from appendicitis and thereafter he had undergone for CT scan and Ex.A3 CT Scan report was issued for him and Dr.Francis informed him that he has to undergo Appendicitis surgery and later he had visited the 1st Opposite Party hospital on 22.11.2008 and he was attended by the 2nd Opposite Party Dr.Mr.J.S.Rajkumar and several tests like blood urea, serum, creatinine and Hemoglobin for investigation on the Complainant.
7. The Complainant contended that he was admitted into the 1st Opposite Party hospital for the treatment of appendicitis and before his admission he undergone several tests and all the test report revealed that he was normal and the 2nd Opposite Party/Surgeon who conducted surgery on 25.11.2008 on the Complainant and after such surgery the 2nd Opposite Party stated that the Complainant suffered with anemia, kidney trouble and developed into Myelofibrosis and further for the simple surgery of appendicitis five doctors were present at the time of surgery is unusual and further the Complainant was discharged after 23 days of surgery on 18.12.2008 and therefore the development of anemic, kidney trouble and Myelofibrosis after surgery clearly establishes that the Opposite Parties have committed fault in the surgery or Deficiency in Service in the surgery and that is why those complication were arose after surgery and further the 2nd Opposite Party ought to have conducted surgery in conservative method instead of open surgery and further several units of blood were transfused after surgery and therefore the above facts clearly establishes that the Opposite Parties committed negligence in the surgery.
8. The Opposite Parties contended that they have conducted the surgery with due care to the Complainant and initially Dr.J.R.Shankaran referred the Complainant to the 2nd Opposite Party under Ex.A7 and after examination the 2nd Opposite Party conducted colonoscopy and through such test he found that the intestine was large, mass lesion was present in Right Iliac fossa posterior to ceacum and appendix not separately seen and the ascending colon was infected and further purulent (pus) was present in the appendicitis area and unable to see the appendicitis and hence instead of doing laparoscopy surgery, he converted the surgery into open surgery and after surgery the nephrologists was called and consulted and absolutely the Opposite Parties have not committed any Deficiency in Service while conducting the operation.
9. There is no expert evidence available to prove the case of the Complainant’s allegation that at the time of conducting surgery the Opposite Parties have committed Deficiency in Service. However, on behalf of the Opposite Party in pursuance of the order passed in CMP No.203/2013 in this case Dr.D.Kannan, qualified surgical Gastroenterologist, Madras Medical College, Chennai was examined as DW2 an expert witness and the said witness was duly cross examined by the Complainant.
10. Ex.A1 is the referral letter for the Complainant from Agash Nursing Home. Ex.A2 is the scan report dated 10.11.2008. In the said scan report the findings are that spleen appear enlarged in size and in Right Iliac fossa Caecal wall thickening seen in the Right Iliac fossa, minimum surrounding free fluid, seen appendicitis could not delineated from the caecal wall and impression given as spleenomegaly and suggestive of appendicular mass. Ex.A3 multi slice CT Scan of the abdomen dated 15.11.2008, the findings are that liver grossly enlarged, spleen massively enlarged, multiple bilateral renal calculi seen in kidney and there is evidence of large Right Iliac fossa region, heterogenous irregularly outlined lesion seen with surrounding facts standing and appendix not separately visualized and the impression report also confirms the above findings. Therefore prior to surgery of 15 days in advance as per Ex.A1 & Ex.A2 the mass lesion was present around the appendix area and hence appendix could not be seen and Right Iliac fossa was largely infected and spleen massively enlarged and with these conditions of health the Complainant approached the 2nd Opposite Party at the 1st Opposite Party hospital for treatment.
11. The 2nd Opposite Party Doctor who has done the surgery stated in his cross examination that they have seen puss at the sight of the appendix large intestine they decided to remove the entire diseased area of the large intestine, a portion of small intestine and the appendix and since they had a strong doubt about the tumorous nature of the caecum appendix and a portion of small intestine they have decided to remove it surgically in order to avoid further complications. Admittedly as per Ex.A4 report appendix was not separately seen due to puss was present and due to that the open surgery adopted by the Opposite Parties doctors is justifiable.
12. DW2, expert witness gone through the entire documents of the Complainant and filed his proof affidavit. He was also subjected to cross examination by the Complainant. During cross examination he deposed that normally in the case of this nature, normally there won’t be any kidney complication and occasionally this kind of complications could arise. He further stated that as per the operation notes during surgery there is no loss of blood. It was also suggested to the expert that the open surgery adopted by the doctor instead of conservative method of treatment is clear case of medical negligence and the same was denied by the expert doctor. Therefore the expert witness opined that the procedure committed by the doctors while conducting surgery on the Complainant is normal and acceptable in medical parlance and hence the expert evidence is fully accepted.
13. Even DW2 expert doctor also not faulted the open surgery. However both the DW1 (2nd Opposite Party) and the DW2 expert witness accepted that when two methods of treatment is available the conservative method has to be adopted in order to avoid surgery. In the case in hand the 2nd Opposite Party adopted open surgery in view of that puss was present and appendix was not visualized and therefore the conservative method was not followed and open surgery adopted cannot be deficiency in service in the circumstances of the case.
14. The next contention of the Complainant for a simple surgery of appendicitis the presence of five doctors is unusual and that itself proves the deficiency of the Opposite Parties. The 2nd Opposite Party surgeon who had headed the surgery has to choose the presence of doctors at the time of surgery and according to him it necessitated to have the other doctors with him and therefore the five doctors present at the time of surgery, no way and the same can be construed as Deficiency in Service.
15. The next contention of the Complainant that 17 bottles of blood was transfused to the Complainant is unheard of from the time of surgery and therefore deficiency committed by the Opposite Parties. DW2 expert witness answered in the cross examination that 6 units blood, 4 units platelets, 4 units plasma and 2 units blood were given on various dates. This evidence makes clear that 17 bottles of blood was not transfused and apart from blood platelets and plasma also administered to the Complainant and therefore in this regard the Opposite Parties have not committed any mistake.
16. The Complainant referred a judgment of the Supreme Court reported in 2005 (6) SC (1) (Jacop Mathew Vs. State of Punjab) to support the case of the Complainant. The Supreme Court held that professional negligence involves 3 constituents.
- a legal duty to exercise due care on the part of the party
complained of towards the party complaining the
former’s conduct within the scope of the duty,
2. breach of the said duty and
3. consequential damage.
In the case in hand the Opposite Parties have taken due care at the time of surgery and further for conducting open surgery, the 2nd Opposite Party deposed acceptable explanation in the cross examination and thereby the doctor has not breached any duty and caused any consequential damage and therefore the above referred judgment of the Supreme Court do not apply to the facts of the case in hand.
17. Therefore considering the evidence of the either parties on record, the Complainant has not proved his case with expert evidence that the Opposite Parties have committed Deficiency in Service and on the other hand the evidence of DW2 expert evidence supports the case of the Opposite Parties therefore, we hold that the Opposite Parties have not committed any Deficiency in Service.
18.POINT NO: 2
Since the Opposite Parties have not committed Deficiency in Service, the Complainant is not entitled for any relief to the Complaint and the Complaint is liable to be dismissed.
In the result the Complaint is dismissed. No costs.
Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 13th day of May 2016.
MEMBER – II PRESIDENT
LIST OF DOCUMENTS FILED BY THE COMPLAINANT:
Ex.A1 dated 01.11.2008 | Prescription for appendices issued by agash nursing home chromepet.
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Ex.A2 dated 10.11.20008 | Ultrasonography (Andomen) report for liver, Gallbladder, prostate, peritoneum, Aorthi and IV Complaint, Right Iliac fossa issued by India scan.
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Ex.A3 dated 15.11.2008 | Scan Report (Multi slice CT abdomen and pelvis) issued by Saravana Scan
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Ex.A4 dated 19.11.2008 | Hitech lab (Test Report) |
Ex.A5 dated 21.11.2008 | Letter issued by Dr.Kannan referring Mr.Purushothaman to Dr.Francis
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Ex.A6 dated 22.11.2008 | Discharge Prescription issued by Lifeline Rigid Hospital, Rep. by Dr.J.S.Rajkumar.
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Ex.A7 dated 22.11.2008 | Advice report issued by Lifeline Rigid Hospital, Rep.by Dr.J.R.Sankaran
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Ex.A8 dated 24.1.2008 | Bio-Chemistry report for blood sugar, blood urea, serum creatiniine and serum electorolytes issued by LLRH
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Ex.A9 dated 24.11.2008 | Immunology result report for serology issued by LLRH |
Ex.A10 dated 24.11.2008 | Haematology report for blood grouping, RH typing, BT,CT,PTT,APTT, issued by LLRH |
Ex.A11 dated 25.11.2008 | Colonoscopy report issued by Lifeline Rigid Hospital Rep.by Dr.J.S.Rajkumar/ chandran |
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Ex.A12 dated 25.11.2008 | 64 Slice – CT abdomen plain and contrast issued by LLRH
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Ex.A13 dated 26.11.2008 | Haematology report for HB, PCV issued by LLRH
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Ex.A14 dated 26.11.2008 | Haematology report for difference in HB & PVC issued by LLRH
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Ex.A15 dated 26.11.2008 | Bio-Chemistry report for blood sugar, blood urea, serum creatinine and serum electrolytes issued by LLRH
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Ex.A16 dated 27.11.2008 | Surgical Pathology report for specimen – Ascending colon Biopsy, gross and microscopic description, diagnosis issued by LLRH.
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Ex.A17 dated 27.11.2008 | Bio-Chemistry report for blood sugar, blood urea, serum creatiniine and serum electorolytes issued by LLRH
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Ex.A18 dated 27.11.2008 | Haematology report for HB,PCV,RBC,WBC-T.C., Platelet count, MCV,MCH,MCHC,ESR,WBC-differential count issued by, LLRH
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Ex.A19 dated 27.11.2008 | Haematology report for difference in HB,PVC & Platelet count issued by LLRH
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Ex.A20 dated 27.11.2008 | Haematology report for difference in HB,PVC & Platelet count issued by LLRH
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Ex.A21 dated 27.11.2008 | Haematology report for difference in HB,PVC & Platelet count issued by LLRH
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Ex.A22 dated 27.11.2008 | Micro Biology report for culture & sensitivity, Antibiogram issued by LLRH
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Ex.A23 dated 28.11.2008 | Haematology report for PTT, APTT issued by LLRH
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Ex.A24 dated 28.11.2008 | Bio-Chemistry report for blood sugar, blood urea, serum creatiniine and serum electorolytes issued by LLRH
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Ex.A25 dated 29.11.2008 | Bio-Chemistry report for blood sugar, blood urea, serum creatiniine Liver function tests, serum electorolytes issued by LLRH
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Ex.A26 dated 29.11.2008 | Haematology report for PTT, APTT Platelet count issued by LLRH
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Ex.A27 dated 30.11.2008 | Haematology report for HB, PCV, Platelet count, PTT, APTT. Issued by LLRH
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Ex.A28 dated 30.11.2008 | Micro Biology report for blood culture and sensitivity issued by LLRH
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Ex.A29 dated 01.12.2008 | Bio-Chemistry report for blood urea, serum electrolytes serum createnine serum albumin issued by LLRH
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Ex.A30 dated 01.12.2008 | Haematology report for HB, PCV,RBC,WBC-TC, Platelet count, MCV,MCH,MCHC,ESR,WBC differential count issued by LLRH
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Ex.A31 dated 02.12.2008 | Ultrasonogram of abdomen (Post Operative Screening) studyreport issued by LLRH
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Ex.A32 dated 02.12.2008 | Haematology report for HB,PVC, PTT,APTT. Issued by LLRH
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Ex.A33 dated 02.12.2008 | Urinalysis report issued by LLRH
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Ex.A34 dated 02.12.2008 | Bio chemistry report for blood urea, serum creatinine, liver function tests issued by LLRH
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Ex.A35 dated 03.12.2008 | Micro Biology report for culture and sensitivity (Nature of specimen – Urine) issued by LLRH
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Ex.A36 dated 03.12.2008 | Bio chemistry report for blood Urea, Serum Creatinine, serum albumin and serum electrolytes issued by LLRH
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Ex.A37 dated 03.12.2008 | Haematology report for HB,PVC, Platelet count issued by LLRH
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Ex.A38 dated 03.12.2008 | Surgical pathology report for specimen (1) limited resection – caecal, (2) (Appendix) gross & microscopic description), Diagnosis issued by LLRH
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Ex.A39 dated 04.12.2008 | Haematology report for ESR, WBC differential count, HB, PCV,RBC, WBC-T.C., Platelet count, MCV,MCH,MCHC issued by LLRH
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Ex.A40 dated 04.12.2008 | Bio chemistry report for blood urea serum creatinine, serum electrolytes, Liver function test issued by LLRH
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Ex.A41 dated 05.12.2008 | Haematology report for HB & PCV issued by LLRH
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Ex.A42 dated 05.12.2008 | Bio chemistry report for blood urea serum creatinine, serum electrolytes, issued by LLRH
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Ex.A43 dated 05.12.2008 | Urinalysis report issued by LLRH
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Ex.A44 dated 06.12.2008 | Multi slice CT abdomen report issued by LLRH
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Ex.A45 dated 06.12.2008 | Haematology report for peripheral smear study HB, PCV,RBC,WBC-T.C., Platelet count, MCV,MCH,MCHC ESR, WBC differential counts issued by LLRH
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Ex.A46 dated 06.12.2008 | Micro biology report for culure and sensitivity (Nature of specimen – pus), antibiogram issued by LLRH
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Ex.A47 dated 06.12.2008 | Bio chemistry report for blood urea serum creatinine, serum electrolytes, Liver function test issued by LLRH
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Ex.A48 dated 08.12.2008 | Multi slice CT Abdomen report issued by LLRH
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Ex.A49 dated 08.12.2008 | Bio chemistry report for LDH issued by LLRH
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Ex.A50 dated 08.12.2008 | Laboratory result for Haematology issued by LLRH
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Ex.A51 dated 09.12.2008 | Haematology report for PTT, APTT,BT (Bleeding Time), CT (Clotting Time), platelet count issued by LLRH
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Ex.A52 dated 09.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, Serum electrolytes, Liver function test issued by LLRH
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Ex.A53 dated 10.12.2008 | Haematology report for MCV issued by LLRH
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Ex.A54 dated 10.12.2008 | Micro Biology report for culture and sensitivity (Nature of specimen – stool) issued by LLRH
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Ex.A55 dated 10.12.2008 | Micro Biology report for culture and sensitivity (Nature of specimen – Urine) issued by LLRH
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Ex.A56 dated 10.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, Serum electrolytes, issued by LLRH
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Ex.A57 dated 11.12.2008 | Micro Biology report for culture and sensitivity issued by LLRH
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Ex.A58 dated 11.12.2008 | Haematology report for HB, PCV,RBC,WBC-T.C., Platelet count, MCV,MCH,MCHC issued by LLRH
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Ex.A59 dated 11.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, Serum electrolytes, Liver function test issued by LLRH
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Ex.A60 dated 12.12.2008 | Haematology report for HB, PCV, issued by LLRH |
Ex.A61 dated 12.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, Serum electrolytes, issued by LLRH
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Ex.A62 dated 13.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, LDH, Total protein, Serum albumin serum globulins A/G Ratio issued by LLRH
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Ex.A63 dated 13.12.2008 | Surgical pathology report for specimen-bone marrow biopsy, (Clinical Details, Gross & Microscopic description), diagnosis issued by LLRH
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Ex.A64 dated 13.12.2008 | Cytology report for specimen bone marrow aspirate, (Clinical details, gross & Microcopic description) diagnosis issued by LLRH
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Ex.A65 dated 13.12.2008 | Test description – coagulation (Fibrinogen (Nephelometry)) issued by LLRH
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Ex.A66 dated 13.12.2008 | Leter subject to the payment for underwent surgery issued by LLRH
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Ex.A67 dated 14.12.2008 | Haematology report for HB. PCV issued by LLRH
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Ex.A68 dated 14.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, issued by LLRH
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Ex.A69 dated 16.12.2008 | Haematology report for HB,PCV,RBC,WBC,T.C, platelet count, MCV, MCH, MCHC,ESR,WBC differential count issued by LLRH
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Ex.A70 dated 16.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, Serum electrolytes, Liver function test issued by LLRH
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Ex.A71 dated 18.12.2008 | Discharge prescription issued by LLRH
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Ex.A72 dated 18.12.2008 | Discharge summary issued by Life line Rigid Hospital Rep. by Dr.Anandan. |
Ex.A73 dated NIL | Picture of Gastro-Intestinal
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Ex.A74 dated 26.12.2008 | Opposite Party receipt of Jayaprakash issued by SRU clinics
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Ex.A75 dated 26.12.2008 | CT scan whole abdomen (Plain) report issued by SRI Ramachandra Medical Centre.
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Ex.A76 dated 29.12.2008 | Discharge summary issued by SRI Ramachandra Medical Centre
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Ex.A77 dated 01.01.2009 | SRI Sakthi Dianostic Laboratory report
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Ex.A78 dated 02.01.2009 | Doctor notes sheet of SRU PVT Clinics
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Ex.A79 dated 02.01.2009 | Payment receipt of SRU PVT Clinics
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Ex.A80 dated 02.01.2009 | Gastroscopy report issued by SRMC.
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Ex.A81 dated 03.01.2009 | Clinical progress notes and payment receipt issued by SRMC
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Ex.A82 dated 03.01.2009 | Portal venus system Doppler issued by SRMC
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Ex.A83 dated 04.01.2009 | SRMC test result on BIO chemistry and clinical pathology
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Ex.A84 dated 04.01.2009 | Payment receipt of SRMC
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Ex.A85 dated 05.01.2009 | SRU PVT clinics – receipt
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Ex.A86 dated 01.04.2009 | Blood Haemotology report
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Ex.A87 dated 22.01.2009 | Letter from ICRPC
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Ex.A88 dated NIL | Reply from 2nd Opposite Party
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Ex.A89 dated 04.02.2009 | Lawyer Notice
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Ex.A90 dated 06.05.2009 | Reply Notice |
LIST OF DOCUMENTS FILED BY THE OPPOSITE PARTIES:
Ex.B1 dated 25.11.2008 Operation notes and the files
Ex.B2 dated 25.11.2008 Receipt for procurement of blood
Ex.B3 dated 22.11.2008 Date of admission and diagnosis file
Ex. B4 dated 25.11.2008 Operation data and instruction
Ex.B5 dated 24.11.2008 Initial examination
Ex.B6 dated 22.11.2008 Doctors instruction and notes
18.12.2008
Ex.B7 dated 22.11.2008 Nurses notes
18.12.2008
Ex.B8 dated 22.11.2008 Clinical chart
18.12.2008
Ex.B9 dated 22.11.2008 Intake output – TTR/BP chart
MEMBER – II PRESIDENT
Complaint presented on : 22.04.2009
Order pronounced on : 13.05.2016
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)
2nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3
PRESENT: THIRU.K.JAYABALAN, B.Sc., B.L., : PRESIDENT
TMT.T.KALAIYARASI, B.A.B.L., : MEMBER II
FRIDAY THE 13th DAY OF MAY 2016
C.C.NO.177/2009
C.Jayaprakash,
S/O. Chakravarthi,
No.47/7, Kolapillai Street,
Radha Nagar Main Road,
Chromepet, Chennai – 600 044.
..... Complainant
..Vs..
1.M/S Life Line Rigid Hospitals, No.47/3, New Avadi Road, Kilpauk, Chennai – 600 010.
2.J.S.Rajkumar, General Surgeon, M/S. Life Line Rigid Hospitals, No.47/3, New Avadi Road, Kilpauk, Chennai – 600 010.
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...Opposite Parties |
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Date of complaint 14.05.2009
Counsel for Complainant : M/S. P.V.S.Giridhar & Sai Associates
Counsel for 1st & 2nd opposite parties : M/S. K.Thyagarajan & S.Magimairaj
O R D E R
BY PRESIDENT THIRU. K.JAYABALAN B.SC., B.L.,
This complaint is filed by the complainant u/s 12 of the Consumer Protection Act.1986.
1.THE COMPLAINT IN BRIEF:
The Complainant suffered with severe abdominal pain during November 2008 and he initially consulted Dr.R.M.N. Francis who diagnosed it as a case of Appendicitis. Dr.Francis offered to perform appendicitis surgery stating that the expenses would be around Rs.20,000/-. Under the persuasion of one of his relative, Mr.D.Ravi, son of Devadoss, and the Complainant visited the 1st Opposite Party hospital on 22.11.2008. After initial examination, he was advised to admit himself for a Laparoscopic surgery on 24.11.2008. He therefore got himself admitted in the 1st Opposite Party hospital on 24.11.2008. A colonoscopy was performed by the 2nd Opposite Party on 25.11.2008 indicating “Extraneous Mass Lesion – Proximal ASC – colon”. On 25.11.2008, a laparoscopy was performed by the 2nd Opposite Party on the Complainant which was converted to open Right Hemicolectomy. The Discharge Report dated 18.12.2008 indicates that Laparoscopic Surgery was found to be impossible due to dense adhesion, and open laparotomy was resorted to during which the following were found
i 50ml of purulent fluid found in the Retro caecal Area,
ii. Caecal wall was unhealthy,
iii. Appendicitis was inflamed and adherent of caecal wall it was indicated
that Right Hemicolectomy was done
in view of conditions ii and iii above.
The Complainant further states that this is quite surprising in view of the prevalence of purulent fluid (puss) as indicated in (i) above, as it is well known that there is a gross danger of high infection and a prudent surgeon would have done a simple drainage. Due to faulty surgical procedures there was a heavy loss of blood, necessitating 17 bottles of blood transfusion. Surgical pathology report dated 27.11.2008 diagnosed it as “Suggestive of Acute or Chronic non specific Colitis”. Strangely the report mentions the specimen as having been received on 24.11.2008, when the biopsy itself was taken only on 25.11.2008. It is well known that appendectomy needs hospitalization of 1 to 2 days, but in the case of the Complainant he was discharged from 1st Opposite Party’s hospital on 18.12.2008 due to post-operative complications, consequent upon gross negligence in the procedure undertaken and the manner of the execution of the surgery. The Discharge Report dated 18.12.2008 indicates that the Complainant developed “Pre-renal Uremia (Kidney failure) and Anemia”. He was under heavy medication. Following the surgery blood urea shoot up to 97.0mg/dl and serum creatine to 2.8mg/dl on 12.12.2008. Prior to surgery all the parameters were normal, although he has been under treatment for hypertension for several years. His kidneys were normal, except for the presence of calculi. Initially the Opposite Parties have indicated that the entire surgery and treatment may come to Rs.70,000/-.Thereafter the Opposite Parties gave an estimate of Rs.1,20,000/-. The Complainant with the financial help from his brother paid a total sum of Rs.1,48,500/-. At the time of discharge, the Opposite Parties demanded a further sum of Rs.1,04,000/- which was asked to be paid in two installments for which written statement was taken from the patient of which the First installment Rs.50,000/- was paid. The Complainant was admitted to Ramachandra Medical Centre, Porur at Chennai wherein the following diagnosis was made
-Splenomegaly,
-Hypertension,
-Acute Renal Failure,
-Hyperkalemia,
-Hyperuricemia,
He was also found to suffer from anemia and azotemia: he was on dialysis and gradually he began to recover. A CT scan performed in Ramachandra Medical Centre indicated bilateral Nephrolithiasis with mild hydro uretero nephrosis. He was discharged from the said hospital on 29.12.2008. He was again admitted on 06.01.2009 and discharged on 12.01.2009. He incurred an expenditure of Rs.1,50,000/- in the said hospitals. The Complainant continues to be under treatment. Much to his acute shock it has been recently diagnosed that he has developed Myelofibrosis which could be a terminal condition. The Complainant has been put to grave life – threatening hardship, pain, financial loss and mental agony on account of the Opposite Parties gross negligence and deficiency in their services. He is being forced to borrow huge sum at high rates of interest. It is just and necessary that the Opposite Parties should be directed to refund the entire sum paid to them towards fees and medical expenses, and pay compensation of Rs.12,00,000/- to the Complainant for professional negligence, unfair trade practice and Deficiency in Service resulting in physical pain and hardship, mental agony, and financial loss suffered in physical pain and hardship, mental agony, and financial loss suffered by the Complainant.
2. WRITTEN VERSION OF THE OPPOSITE PARTIES IN BRIEF:
The Complainant initially consulted Dr.R.M.N. Francis, which is evident from the records produced by him to the 2nd Opposite Party, which also included the scan reports from M/S. Saravana Scans and the report revealed what had been set out in the paragraph 1 of the Complaint. The CT scan conducted at the first Opposite Party hospital also confirmed the report given by M/S Saravana scans, on the advice of Dr.R.M.N.Francis. As per scan reports it is found that the Appendicitis or an Appendectomy had to be performed on the Complainant. All standard test and investigations like blood urea, serum creatine, haemoglobin, etc., were done to ascertain as to whether the Complainant was fit enough to undergo a surgical procedure. A surgical colonoscopy was also advised to the Complainant. The 2nd Opposite Party Dr.J.S.Rajkumar performed a colonoscopy on 25.1.2008 which indicated, “extraneous mass Lesion on Proximal ascending colon’. The CT scan on 25.11.2008 also confirmed the same status and accordingly on the basis of investigation reports, CT scan and the colonoscopy, it was advised that a surgical appendectomy through laparoscopic method could be done. Since the Investigation reports did not indicate any hematological diseases at that point of time and further the Complainant did not disclose any past history or complete hematological disease or renal calculi it was decided to go in for a laparoscopic surgery to remove the appendix. This is an infective condition of the appendix, where cure is removal of the appendix. The Opposite Parties submit that after the surgical procedure started in the presence of other operating surgeons namely Dr.Anton,M.S., Dr.MohanKumarM.S., Dr.KolandaisamyM.S.and Dr.Chandrasekhar, M.S.FRCS, the 2nd Opposite Party and the other doctors found that it was not possible to do a laparoscopic surgery on the Complainant because of the fact that there was a mass with purulent fluid, friable in nature and tumorous feel of caecum for which a Laparoscopic surgery was not advisable, since there was pus in the abdomen, a drainage procedure was done with hemicolectomy. Since it is an established protocol that is followed by many surgeons, it was decided to switch over to an open hemicolectomy and not a laparoscopic appendectomy. This decision was taken by all the 5 surgeons as it was in the best interest of the Complainant herein. The Complainant’s relatives as well as the Complainant were informed before the beginning of the procedure. The blood loss at the time of operation was approximately 250ml, as it is clear from the operative notes and the files. The laboratory test report as well as the biopsy reports were only after laparoscopic incisions were made, it revealed that only a open surgery could be performed and not a laparoscopic surgery as was initially planned. Post operative the Complainant was subject to further investigations, the result showed that his Hemoglobin content level was low. Low hemoglobin levels do not occur because of loss of blood during surgical procedures but only because of hematological problems. In the 1st week of his operation the Complainant was given only 6 units of blood. After the 1st week of operation further investigations revealed that the Hemoglobin levels of the Complainant had not improved and the consultant Doctors suspected that the cause to be there was a massive spleenomegaly and not loss of blood during surgery. On 27.11.2008 a day after the surgery, 6 units of blood were given to the Complainant. On 28.11.2008, 4 units of platelets were given, since there were low levels of platelets and also 4 units fresh frozen plasma were given on 27.11.2008 and on 02.12.2008, 2 units of blood were again transfused and later on 09.12.2008 yet another 2 units of blood was transfused. The Opposite Parties submits that it is not because of the inability of the Complainant’s body to produce RBC’s which had let to a situation where blood had to be transfused. In normal circumstances Appendicectomy definitely requires 1 to 2 days of hospitalization, but in the case of the Complainant, it was not merely appendicitis as originally diagnosed, but it was found that he had severe infections of, caecum, portions of large bowel and further had severe spleenomegaly and bilateral renal calculi which later proved that his condition was quite grave and requires further hospitalization. On 1st December 2008, kidney function test was carried out on the Complainant; the reports revealed that the test was within prescribed normal limits. Consulting Nephrologists Dr. Balraman on his 2nd visit also asked for the Hematologist’s opinion for Hematological problem and subsequently diagnosed it as Renal Failure in the Complainant, which was also treated. The kidney status of the Complainant could be revealed only from his kidney function test, abdominal scans. However the pre surgical procedures and tests did not reveal that he was suffering from renal failure. However after the surgery was performed, and since blood transfusion had to be resorted to and as the Complainant consistently failed to respond to the treatments, opinion of the consultant Nephrologists Dr. Balaraman was sought for and along with the opinion of the Hematologist, came to a conclusion that the kidney function was not normal. This fact was further confirmed by the clear admission of the Complainant in the lawyer’s notice dated 04.02.2009 issued on the Opposite Parties that the CT Scan performed to the Complainant at Ramachandra Medical Centre reveals bilateral Nephrolithiasis, with mild hydro uretero nephrosis. It was undiagnosed renal failure which has resulted in loss of platelets and RBC’s in the Complainant, further the CT Scan done did not show any obstructive features and therefore it was clear that it was only progressive impairment of the renal system and renal calculi could be the reasons for the mild obstructive features and there was no negligence at all that could even be alleged upon the Opposite Parties. The Complainant was also referred to a consultant Hematologist Dr.Margaret who suggested a bone marrow aspiration test to find out the reason for Severe Anemia, Thrombocytopenia and spleenomegaly. The Complainant however was insisting that he should be discharged from the hospital and hence he was discharged from the 1st Opposite Party hospital against medical advice further he was advised to come for review. However the Complainant failed to come for review to the nephrologists as regards the renal function test. Hematologist Dr.Margaret has advised repeat bone marrow aspiration, since the first bone marrow aspiration report revealed that the sample was inadequate for testing and for a report and hence the consultant had advised for a second bone marrow aspiration. However the Complainant refused to go through the same and wanted to get discharged. It is admitted in the Complainant’s notice dated 04.02.2009 in paragraph 7 that the Complainant was subsequently admitted to Ramachandra Medical Centre, Porur where he was diagnosed and suspected of the following:- (Spleenomegaly, Hypertension, Acute Renal Failure, Hyperkalemia and Hyperuricemia). In the Complaint it is stated that the Complainant was suffering from anemia and azotemia and he was suggested dialysis and gradually he began to recover. The initial estimate of laparoscopic Haemecolectomy which was later converted into an open Haemecolectomy was Rs.1.12 lakhs, however taking into account the condition that the Complainant was admitted for a very long time i.e. for nearly 26 days due to his hematological renal conditions and also that he was not producing sufficient RBC’s and Platelets. The 1st of the Opposite Party agreed for a concession and charged the Complainant only a sum of Rs.1,29,060/- as against the bill of Rs.1,54,060.00/- and giving the Complainant a concession of Rs.25,000/- and the Complainant had paid only Rs.90,000/- and he is still due and liable to pay the balance amount of charges. Later on the Complainant paid a further sum of Rs.50,000/- and as of now the Complainant is due and liable to pay a sum of Rs.54,829/- to the 1st Opposite Party. The Complainant was advised not to get discharged unless and until the diagnosis was complete, however the Complainant wanted to be compulsorily discharged and therefore he was discharged against the medical advice. The Opposite Parties denies the allegation made in the Complaint and they have not committed any Deficiency in Service and hence the Opposite Parties prayed to dismiss the Complaint with costs.
3. POINTS FOR CONSIDERATION:
1. Whether there is deficiency in service on the part of the opposite parties?
2. Whether the complainant is entitled to any relief? If so to what relief?
4. POINT NO :1
On behalf of Complainant Ex.A1 to Ex.A90 marked were and on behalf of the Opposite Parties Ex.B1 to Ex.B3 were marked on 19.03.2010 and again on behalf of the Opposite Parties 6 documents were filed and the same have been inadvertently marked as Ex.B1 to Ex.B6 instead of Ex.B4 to Ex.B9. Now in this order the said 6 documents are remarked as Ex.B4 to Ex.B9.
5. On behalf of the Complainant, Dr.P.Koli expert witness was examined as PW2 to prove the complainants case. However he was not cross examined. The Opposite Party’s filed C.M.P. No.29 & 30/16 for cross examination of the PW2. At the stage of filing counter, the counsel for the complainant made endorsement that he is not pressing the evidence of Dr.Koli (PW2) and based on such endorsement, the evidence of PW2 had been ordered as need not be referred for deciding the main C.C. In view of such circumstances there is no expert evidence is available on behalf of the Complainant.
6.The admitted facts are that the Complainant initially consulted with Agash Nursing Home on 01.11.2008 and the doctor who attended on him in that nursing home suspected that he was suffering from Appendicitis and prescribed certain medicines under Ex.A1 prescription and later he had consulted Dr.R.M.N Francis who diagnosed that he is suffering from appendicitis and thereafter he had undergone for CT scan and Ex.A3 CT Scan report was issued for him and Dr.Francis informed him that he has to undergo Appendicitis surgery and later he had visited the 1st Opposite Party hospital on 22.11.2008 and he was attended by the 2nd Opposite Party Dr.Mr.J.S.Rajkumar and several tests like blood urea, serum, creatinine and Hemoglobin for investigation on the Complainant.
7. The Complainant contended that he was admitted into the 1st Opposite Party hospital for the treatment of appendicitis and before his admission he undergone several tests and all the test report revealed that he was normal and the 2nd Opposite Party/Surgeon who conducted surgery on 25.11.2008 on the Complainant and after such surgery the 2nd Opposite Party stated that the Complainant suffered with anemia, kidney trouble and developed into Myelofibrosis and further for the simple surgery of appendicitis five doctors were present at the time of surgery is unusual and further the Complainant was discharged after 23 days of surgery on 18.12.2008 and therefore the development of anemic, kidney trouble and Myelofibrosis after surgery clearly establishes that the Opposite Parties have committed fault in the surgery or Deficiency in Service in the surgery and that is why those complication were arose after surgery and further the 2nd Opposite Party ought to have conducted surgery in conservative method instead of open surgery and further several units of blood were transfused after surgery and therefore the above facts clearly establishes that the Opposite Parties committed negligence in the surgery.
8. The Opposite Parties contended that they have conducted the surgery with due care to the Complainant and initially Dr.J.R.Shankaran referred the Complainant to the 2nd Opposite Party under Ex.A7 and after examination the 2nd Opposite Party conducted colonoscopy and through such test he found that the intestine was large, mass lesion was present in Right Iliac fossa posterior to ceacum and appendix not separately seen and the ascending colon was infected and further purulent (pus) was present in the appendicitis area and unable to see the appendicitis and hence instead of doing laparoscopy surgery, he converted the surgery into open surgery and after surgery the nephrologists was called and consulted and absolutely the Opposite Parties have not committed any Deficiency in Service while conducting the operation.
9. There is no expert evidence available to prove the case of the Complainant’s allegation that at the time of conducting surgery the Opposite Parties have committed Deficiency in Service. However, on behalf of the Opposite Party in pursuance of the order passed in CMP No.203/2013 in this case Dr.D.Kannan, qualified surgical Gastroenterologist, Madras Medical College, Chennai was examined as DW2 an expert witness and the said witness was duly cross examined by the Complainant.
10. Ex.A1 is the referral letter for the Complainant from Agash Nursing Home. Ex.A2 is the scan report dated 10.11.2008. In the said scan report the findings are that spleen appear enlarged in size and in Right Iliac fossa Caecal wall thickening seen in the Right Iliac fossa, minimum surrounding free fluid, seen appendicitis could not delineated from the caecal wall and impression given as spleenomegaly and suggestive of appendicular mass. Ex.A3 multi slice CT Scan of the abdomen dated 15.11.2008, the findings are that liver grossly enlarged, spleen massively enlarged, multiple bilateral renal calculi seen in kidney and there is evidence of large Right Iliac fossa region, heterogenous irregularly outlined lesion seen with surrounding facts standing and appendix not separately visualized and the impression report also confirms the above findings. Therefore prior to surgery of 15 days in advance as per Ex.A1 & Ex.A2 the mass lesion was present around the appendix area and hence appendix could not be seen and Right Iliac fossa was largely infected and spleen massively enlarged and with these conditions of health the Complainant approached the 2nd Opposite Party at the 1st Opposite Party hospital for treatment.
11. The 2nd Opposite Party Doctor who has done the surgery stated in his cross examination that they have seen puss at the sight of the appendix large intestine they decided to remove the entire diseased area of the large intestine, a portion of small intestine and the appendix and since they had a strong doubt about the tumorous nature of the caecum appendix and a portion of small intestine they have decided to remove it surgically in order to avoid further complications. Admittedly as per Ex.A4 report appendix was not separately seen due to puss was present and due to that the open surgery adopted by the Opposite Parties doctors is justifiable.
12. DW2, expert witness gone through the entire documents of the Complainant and filed his proof affidavit. He was also subjected to cross examination by the Complainant. During cross examination he deposed that normally in the case of this nature, normally there won’t be any kidney complication and occasionally this kind of complications could arise. He further stated that as per the operation notes during surgery there is no loss of blood. It was also suggested to the expert that the open surgery adopted by the doctor instead of conservative method of treatment is clear case of medical negligence and the same was denied by the expert doctor. Therefore the expert witness opined that the procedure committed by the doctors while conducting surgery on the Complainant is normal and acceptable in medical parlance and hence the expert evidence is fully accepted.
13. Even DW2 expert doctor also not faulted the open surgery. However both the DW1 (2nd Opposite Party) and the DW2 expert witness accepted that when two methods of treatment is available the conservative method has to be adopted in order to avoid surgery. In the case in hand the 2nd Opposite Party adopted open surgery in view of that puss was present and appendix was not visualized and therefore the conservative method was not followed and open surgery adopted cannot be deficiency in service in the circumstances of the case.
14. The next contention of the Complainant for a simple surgery of appendicitis the presence of five doctors is unusual and that itself proves the deficiency of the Opposite Parties. The 2nd Opposite Party surgeon who had headed the surgery has to choose the presence of doctors at the time of surgery and according to him it necessitated to have the other doctors with him and therefore the five doctors present at the time of surgery, no way and the same can be construed as Deficiency in Service.
15. The next contention of the Complainant that 17 bottles of blood was transfused to the Complainant is unheard of from the time of surgery and therefore deficiency committed by the Opposite Parties. DW2 expert witness answered in the cross examination that 6 units blood, 4 units platelets, 4 units plasma and 2 units blood were given on various dates. This evidence makes clear that 17 bottles of blood was not transfused and apart from blood platelets and plasma also administered to the Complainant and therefore in this regard the Opposite Parties have not committed any mistake.
16. The Complainant referred a judgment of the Supreme Court reported in 2005 (6) SC (1) (Jacop Mathew Vs. State of Punjab) to support the case of the Complainant. The Supreme Court held that professional negligence involves 3 constituents.
- a legal duty to exercise due care on the part of the party
complained of towards the party complaining the
former’s conduct within the scope of the duty,
2. breach of the said duty and
3. consequential damage.
In the case in hand the Opposite Parties have taken due care at the time of surgery and further for conducting open surgery, the 2nd Opposite Party deposed acceptable explanation in the cross examination and thereby the doctor has not breached any duty and caused any consequential damage and therefore the above referred judgment of the Supreme Court do not apply to the facts of the case in hand.
17. Therefore considering the evidence of the either parties on record, the Complainant has not proved his case with expert evidence that the Opposite Parties have committed Deficiency in Service and on the other hand the evidence of DW2 expert evidence supports the case of the Opposite Parties therefore, we hold that the Opposite Parties have not committed any Deficiency in Service.
18.POINT NO: 2
Since the Opposite Parties have not committed Deficiency in Service, the Complainant is not entitled for any relief to the Complaint and the Complaint is liable to be dismissed.
In the result the Complaint is dismissed. No costs.
Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 13th day of May 2016.
MEMBER – II PRESIDENT
LIST OF DOCUMENTS FILED BY THE COMPLAINANT:
Ex.A1 dated 01.11.2008 | Prescription for appendices issued by agash nursing home chromepet.
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Ex.A2 dated 10.11.20008 | Ultrasonography (Andomen) report for liver, Gallbladder, prostate, peritoneum, Aorthi and IV Complaint, Right Iliac fossa issued by India scan.
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Ex.A3 dated 15.11.2008 | Scan Report (Multi slice CT abdomen and pelvis) issued by Saravana Scan
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Ex.A4 dated 19.11.2008 | Hitech lab (Test Report) |
Ex.A5 dated 21.11.2008 | Letter issued by Dr.Kannan referring Mr.Purushothaman to Dr.Francis
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Ex.A6 dated 22.11.2008 | Discharge Prescription issued by Lifeline Rigid Hospital, Rep. by Dr.J.S.Rajkumar.
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Ex.A7 dated 22.11.2008 | Advice report issued by Lifeline Rigid Hospital, Rep.by Dr.J.R.Sankaran
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Ex.A8 dated 24.1.2008 | Bio-Chemistry report for blood sugar, blood urea, serum creatiniine and serum electorolytes issued by LLRH
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Ex.A9 dated 24.11.2008 | Immunology result report for serology issued by LLRH |
Ex.A10 dated 24.11.2008 | Haematology report for blood grouping, RH typing, BT,CT,PTT,APTT, issued by LLRH |
Ex.A11 dated 25.11.2008 | Colonoscopy report issued by Lifeline Rigid Hospital Rep.by Dr.J.S.Rajkumar/ chandran |
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Ex.A12 dated 25.11.2008 | 64 Slice – CT abdomen plain and contrast issued by LLRH
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Ex.A13 dated 26.11.2008 | Haematology report for HB, PCV issued by LLRH
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Ex.A14 dated 26.11.2008 | Haematology report for difference in HB & PVC issued by LLRH
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Ex.A15 dated 26.11.2008 | Bio-Chemistry report for blood sugar, blood urea, serum creatinine and serum electrolytes issued by LLRH
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Ex.A16 dated 27.11.2008 | Surgical Pathology report for specimen – Ascending colon Biopsy, gross and microscopic description, diagnosis issued by LLRH.
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Ex.A17 dated 27.11.2008 | Bio-Chemistry report for blood sugar, blood urea, serum creatiniine and serum electorolytes issued by LLRH
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Ex.A18 dated 27.11.2008 | Haematology report for HB,PCV,RBC,WBC-T.C., Platelet count, MCV,MCH,MCHC,ESR,WBC-differential count issued by, LLRH
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Ex.A19 dated 27.11.2008 | Haematology report for difference in HB,PVC & Platelet count issued by LLRH
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Ex.A20 dated 27.11.2008 | Haematology report for difference in HB,PVC & Platelet count issued by LLRH
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Ex.A21 dated 27.11.2008 | Haematology report for difference in HB,PVC & Platelet count issued by LLRH
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Ex.A22 dated 27.11.2008 | Micro Biology report for culture & sensitivity, Antibiogram issued by LLRH
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Ex.A23 dated 28.11.2008 | Haematology report for PTT, APTT issued by LLRH
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Ex.A24 dated 28.11.2008 | Bio-Chemistry report for blood sugar, blood urea, serum creatiniine and serum electorolytes issued by LLRH
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Ex.A25 dated 29.11.2008 | Bio-Chemistry report for blood sugar, blood urea, serum creatiniine Liver function tests, serum electorolytes issued by LLRH
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Ex.A26 dated 29.11.2008 | Haematology report for PTT, APTT Platelet count issued by LLRH
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Ex.A27 dated 30.11.2008 | Haematology report for HB, PCV, Platelet count, PTT, APTT. Issued by LLRH
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Ex.A28 dated 30.11.2008 | Micro Biology report for blood culture and sensitivity issued by LLRH
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Ex.A29 dated 01.12.2008 | Bio-Chemistry report for blood urea, serum electrolytes serum createnine serum albumin issued by LLRH
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Ex.A30 dated 01.12.2008 | Haematology report for HB, PCV,RBC,WBC-TC, Platelet count, MCV,MCH,MCHC,ESR,WBC differential count issued by LLRH
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Ex.A31 dated 02.12.2008 | Ultrasonogram of abdomen (Post Operative Screening) studyreport issued by LLRH
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Ex.A32 dated 02.12.2008 | Haematology report for HB,PVC, PTT,APTT. Issued by LLRH
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Ex.A33 dated 02.12.2008 | Urinalysis report issued by LLRH
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Ex.A34 dated 02.12.2008 | Bio chemistry report for blood urea, serum creatinine, liver function tests issued by LLRH
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Ex.A35 dated 03.12.2008 | Micro Biology report for culture and sensitivity (Nature of specimen – Urine) issued by LLRH
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Ex.A36 dated 03.12.2008 | Bio chemistry report for blood Urea, Serum Creatinine, serum albumin and serum electrolytes issued by LLRH
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Ex.A37 dated 03.12.2008 | Haematology report for HB,PVC, Platelet count issued by LLRH
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Ex.A38 dated 03.12.2008 | Surgical pathology report for specimen (1) limited resection – caecal, (2) (Appendix) gross & microscopic description), Diagnosis issued by LLRH
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Ex.A39 dated 04.12.2008 | Haematology report for ESR, WBC differential count, HB, PCV,RBC, WBC-T.C., Platelet count, MCV,MCH,MCHC issued by LLRH
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Ex.A40 dated 04.12.2008 | Bio chemistry report for blood urea serum creatinine, serum electrolytes, Liver function test issued by LLRH
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Ex.A41 dated 05.12.2008 | Haematology report for HB & PCV issued by LLRH
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Ex.A42 dated 05.12.2008 | Bio chemistry report for blood urea serum creatinine, serum electrolytes, issued by LLRH
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Ex.A43 dated 05.12.2008 | Urinalysis report issued by LLRH
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Ex.A44 dated 06.12.2008 | Multi slice CT abdomen report issued by LLRH
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Ex.A45 dated 06.12.2008 | Haematology report for peripheral smear study HB, PCV,RBC,WBC-T.C., Platelet count, MCV,MCH,MCHC ESR, WBC differential counts issued by LLRH
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Ex.A46 dated 06.12.2008 | Micro biology report for culure and sensitivity (Nature of specimen – pus), antibiogram issued by LLRH
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Ex.A47 dated 06.12.2008 | Bio chemistry report for blood urea serum creatinine, serum electrolytes, Liver function test issued by LLRH
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Ex.A48 dated 08.12.2008 | Multi slice CT Abdomen report issued by LLRH
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Ex.A49 dated 08.12.2008 | Bio chemistry report for LDH issued by LLRH
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Ex.A50 dated 08.12.2008 | Laboratory result for Haematology issued by LLRH
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Ex.A51 dated 09.12.2008 | Haematology report for PTT, APTT,BT (Bleeding Time), CT (Clotting Time), platelet count issued by LLRH
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Ex.A52 dated 09.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, Serum electrolytes, Liver function test issued by LLRH
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Ex.A53 dated 10.12.2008 | Haematology report for MCV issued by LLRH
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Ex.A54 dated 10.12.2008 | Micro Biology report for culture and sensitivity (Nature of specimen – stool) issued by LLRH
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Ex.A55 dated 10.12.2008 | Micro Biology report for culture and sensitivity (Nature of specimen – Urine) issued by LLRH
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Ex.A56 dated 10.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, Serum electrolytes, issued by LLRH
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Ex.A57 dated 11.12.2008 | Micro Biology report for culture and sensitivity issued by LLRH
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Ex.A58 dated 11.12.2008 | Haematology report for HB, PCV,RBC,WBC-T.C., Platelet count, MCV,MCH,MCHC issued by LLRH
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Ex.A59 dated 11.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, Serum electrolytes, Liver function test issued by LLRH
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Ex.A60 dated 12.12.2008 | Haematology report for HB, PCV, issued by LLRH |
Ex.A61 dated 12.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, Serum electrolytes, issued by LLRH
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Ex.A62 dated 13.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, LDH, Total protein, Serum albumin serum globulins A/G Ratio issued by LLRH
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Ex.A63 dated 13.12.2008 | Surgical pathology report for specimen-bone marrow biopsy, (Clinical Details, Gross & Microscopic description), diagnosis issued by LLRH
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Ex.A64 dated 13.12.2008 | Cytology report for specimen bone marrow aspirate, (Clinical details, gross & Microcopic description) diagnosis issued by LLRH
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Ex.A65 dated 13.12.2008 | Test description – coagulation (Fibrinogen (Nephelometry)) issued by LLRH
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Ex.A66 dated 13.12.2008 | Leter subject to the payment for underwent surgery issued by LLRH
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Ex.A67 dated 14.12.2008 | Haematology report for HB. PCV issued by LLRH
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Ex.A68 dated 14.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, issued by LLRH
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Ex.A69 dated 16.12.2008 | Haematology report for HB,PCV,RBC,WBC,T.C, platelet count, MCV, MCH, MCHC,ESR,WBC differential count issued by LLRH
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Ex.A70 dated 16.12.2008 | Bio chemistry report for blood Urea, Serum creatinine, Serum electrolytes, Liver function test issued by LLRH
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Ex.A71 dated 18.12.2008 | Discharge prescription issued by LLRH
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Ex.A72 dated 18.12.2008 | Discharge summary issued by Life line Rigid Hospital Rep. by Dr.Anandan. |
Ex.A73 dated NIL | Picture of Gastro-Intestinal
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Ex.A74 dated 26.12.2008 | Opposite Party receipt of Jayaprakash issued by SRU clinics
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Ex.A75 dated 26.12.2008 | CT scan whole abdomen (Plain) report issued by SRI Ramachandra Medical Centre.
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Ex.A76 dated 29.12.2008 | Discharge summary issued by SRI Ramachandra Medical Centre
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Ex.A77 dated 01.01.2009 | SRI Sakthi Dianostic Laboratory report
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Ex.A78 dated 02.01.2009 | Doctor notes sheet of SRU PVT Clinics
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Ex.A79 dated 02.01.2009 | Payment receipt of SRU PVT Clinics
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Ex.A80 dated 02.01.2009 | Gastroscopy report issued by SRMC.
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Ex.A81 dated 03.01.2009 | Clinical progress notes and payment receipt issued by SRMC
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Ex.A82 dated 03.01.2009 | Portal venus system Doppler issued by SRMC
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Ex.A83 dated 04.01.2009 | SRMC test result on BIO chemistry and clinical pathology
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Ex.A84 dated 04.01.2009 | Payment receipt of SRMC
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Ex.A85 dated 05.01.2009 | SRU PVT clinics – receipt
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Ex.A86 dated 01.04.2009 | Blood Haemotology report
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Ex.A87 dated 22.01.2009 | Letter from ICRPC
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Ex.A88 dated NIL | Reply from 2nd Opposite Party
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Ex.A89 dated 04.02.2009 | Lawyer Notice
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Ex.A90 dated 06.05.2009 | Reply Notice |
LIST OF DOCUMENTS FILED BY THE OPPOSITE PARTIES:
Ex.B1 dated 25.11.2008 Operation notes and the files
Ex.B2 dated 25.11.2008 Receipt for procurement of blood
Ex.B3 dated 22.11.2008 Date of admission and diagnosis file
Ex. B4 dated 25.11.2008 Operation data and instruction
Ex.B5 dated 24.11.2008 Initial examination
Ex.B6 dated 22.11.2008 Doctors instruction and notes
18.12.2008
Ex.B7 dated 22.11.2008 Nurses notes
18.12.2008
Ex.B8 dated 22.11.2008 Clinical chart
18.12.2008
Ex.B9 dated 22.11.2008 Intake output – TTR/BP chart
MEMBER – II PRESIDENT
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