Order-106.
Date-14/09/2015.
This is an application u/s.12 of the C.P. Act, 1986.
Complainant by filing this complaint has submitted that wife of the complainant was admitted in the hospital of the OP1 with a complain of pain in abdomen along with vomiting and in this connection when the wife of the complainant for the first time experienced a pain in abdomen she was for the first time shown to Dr. Amitava Biswas and on the advice of the said Dr. Biswas to admit the patient to a Nursing Home the patient was admitted with to OP1 Nursing Home and as per advice of the said doctor Biswas the patient was admitted on the Nursing Home on 22-03-2007 and after admission OP1 gave a call to Dr. Saswata Chakraborty, OP4 and in this connection the name of a senior Surgeon in this field namely Dr. Kartick Saha was referred to the Nursing Home and the complainant sought to prefer Dr. Kartick saha instead of said Dr.Chakraborty but the said Nursing Home for the reason best known to them engaged the OP4 for the treatment of the patient. However, OP4 doctor examined the patient and advised for her operation for ‘Acute Appendicitis’. Dr. Chakraborty advised for certain blood tests prior to the operation but he did not prefer to have any USG report of lower abdomen and advised for the operation without any USG report. It will appear that the Nursing home charged Rs.7,805/- for the entire process and the OP4 charged Rs.4,000/- for carrying out the operation of the patient.
In the morning of 23-07-2003 it appeared that the patient had no pain in her abdomen and as the operation was not urgent for that day and OP5 could easily have taken recourse to a report of USG to ascertain as to whether the operation was at all necessary or not or to ascertain as to whether any further complications were there or not in as much as he was going to open the lower abdomen of the patient. However, despite information to the doctor regarding no pain in the lower abdomen of the patient the doctor proceeded with the operation of appendicitis on 23-07-2003 without USG report and it took almost two hours for the doctor to complete the operation. However, the appendicitis which was allegedly removed from the patient was sent to the Serum Analysis Centre (P) Ltd. for Histopathology Test and specimen was received by the said Centre on 25-07-2003 and the report of the same was delivered on 31-07-2003. However, without curing the patient fully the said OP1 released the patient on 30-07-2003 by issuing a discharge certificate and also after prescribing certain medicines and at the time of release OP4 advised the patient for further check up on 30-07-2003 with the Biopsy Report and soon after having the operation of Appendicitis the condition of the wife of the complainant started deteriorating and again the pain started in her lower abdomen i.e. exactly at the place for which she was treated in Nilima Matri Sadan and on seeing the situation complainant got utterly confused and he called a doctor namely Dr. Ayon Kumar Das who happened to be residential surgeon of Nilima Matri Sadan and that said doctor attended the wife of the complainant at his house from 02-08-2003 to 06-08-2003. In this connection Dr. S. Chakraborty, OP5 who conducted the operation was consulted by the complainant in the meantime regarding the situation of the patient but he did not bother even for courtesy sake to visit the patient or to check up as to what went wrong with the patient and instead he advised the complainant to consult the said doctor Ayon Kumar Das being the residential Surgeon of OP1 and the said Dr. Das after checking the patient from 02-08-2003 to 06-08-2003 advised the complainant to admit the patient i.e. the wife of the complainant further into State Government hospital or any Nursing Home for further management of the patient and while giving such advice to the complainant it is advised to the complainant not to admit the patient at OP1’s Nursing Home at least and being advised by Dr. Das the patient was further admitted to the Northland Nursing Home and she was kept under the treatment of Dr. D.R. Basu, OP3 and OP3 after initial check up of the patient advised for USG of the patient for the first time and the patient was referred to Dr. B.K. & Dr. P.K. Pal of “The Relief” for having USG report and such report was issued by The Relief on 09-08-2003. After receiving the report OP3 consulted with another doctor i.e. Dr. S. Pramanik being OP4 and in association with the said Dr. Pramanik, the OP3 conducted “Laporotomy Operation” of the patient on 10-08-2003 and by this operation a big lump of large intestine with surrounding mescolon weighing about 7.50 grams was cut out from the patient’s lower abdomen and Hamicolectomy (Rt) with ilco transvusal naestomosis was done and the specimen of the said cut out portion was sent for biopsy on 11-08-2003 to the clinical laboratory. After three days of the said operation leakages and facial matter started discharging from the cut out portion of the operation. Patient remained under the treatment of Dr. D.R. Basu and S. Pramanik from 07-08-2003 to 19-08-2003 at the Northland Nursing Home but it was found that condition of the patient was deteriorating day by day and the doctors failed to make any improvement of the patient.
In the meantime the report of the clinical laboratory being ‘Pathowynd’ became available and it showed that the disease was ‘Crohns’ and on perusal of the said report the OP3 called another 4 doctors being Dr. S, D, Mukherjee and others for consultation and even then the condition of the patient could not be improved and the was further deteriorating day by day and situation arose when the doctors specially Dr. Basu left everything upon God. In this connection complainant was informed by the doctors OP2,3 and 4 that the patient was administered even the 4th generation anti-biotic but the situation was not improved and in this situation as they were helpless they suggested the complainant to transfer the patient being the wife of the complainant for better treatment of the patient and instead they felt better to wait for the death of the patient by counting the number of days. Thereafter, when complainant found the condition of his wife was about ‘to die’ complainant forced the Nursing home to release the patient and admitted her to Calcutta Hospital and Medical Research Institute under the treatment of Dr. Prof. N.K. Pal and she remained under such treatment from 20-08-2003 to 23-09-2003. In this connection it is mentioned herein that the patient was released from the Nursing Home on risk bond which in itself is the ample proof of the facts that the Nursing Home was not able to give proper relief to the patient. Thereafter, the patient was cured with the proper treatment of Dr. N.K. Pal of CMRI from the situation of about to die and the patient ultimately survive and presently the patient is being guided by the medicines prescribed by the said Dr. N.K. Pal and the condition of the patient was improved and if he would be in the treatment of the OP1 his death was imminent. In fact during the treatment of his wife under the OPs he spent Rs.1,50,000/- and due to medical negligence and also their intention to give no proper relief complainant suffered much and his wife also suffered much and in the above circumstances, complainant has filed the complaint for negligent and deficient manner of service and also on the ground that there was no need of intervention of any surgery by making such a disease Chrons can be cured and that is the opinion of Dr. N.K. Pal. So, the negligence of the OPs are well proved for which complainant prayed for redressal.
On the other hand OP5 Dr. Saswata Chakraborty, by filing written statement submitted that the entire complaint is false and fabricated and truth is that treatment was done not against the will of the patient and as per record he treated the wife of the complainant and there was no such material to show that patient party preferred Dr. Saha instead of OP5.
He has also stated that at that instance after clinical observation he found that the patient was suffering from acute appendicitis and make it confirm and better management he suggested certain tests before operation which would be apparent from the record of OP1 and from the prescription of Dr. Amitabha Biswas vide Annexure-A it would found he also diagnosed similarly but at the time of admission the prescription of Dr. Amitabha Biswas were not produced before the OP1. OP5 has also submitted that appendicitis (acute) is essentially a clinical diagnosis, acute appendicitis if diagnosed clinically should not be delayed even if a normal appendix is found at operation. USG cannot visualize the retrocaecal position of appendix, being the commonest position, because of air in caecum and USG in case of patients with symptoms and signs of acute appendicitis is only indicated in patients with a suspect of a gynaecological pathology. So, USG is a selective investigation and should not be routinely performed in all cases and patient had a history of three months of amenorrhoea for which he asked for pregnancy test prior to operation and only after a negative test he preceded for operation. Further final outcome of the patient was anastomotic leakage due to Rt. Hemicolectomy and biopsy report suggested Crohn’s disease mimicks acute appendicitis and the two cannot be differentiated by ultrasound. Even if Crohn’s disease is suspected pre-operatively appendectomy can still be performed.
The treatment of acute appendicitis appendicetous. There is a perception that urgent operation is essential to prevent the increased morbidity and mortality of peritonitis. While there should be no unnecessazry delay, particularly, those patients most at risk of serious morbidity, benefit by a short period of intensive preoperative preparation, intravenous fluid, sufficient to establish adequate urine output and appropriate antibiotics should be given.
Patient was admitted on 22-07-2003 and operated on 23-07-2003 because her operation was very much essential to prevent the increased morbidity and mortality of peritonitis and preoperative antibiotics namely ceflriaxone and metronidazole (particularly for anaerobic coverage) administered into the patient and in support of the above medical observations he would refer the BHT of the patient in support of the entire fact. Fact remains this OP always took positive steps did as per medical norms with skill but patient’s husband forcibly released the patient and after that forcible discharge patient did not turn with biopsy report and in fact only for the purpose for harassing the OP5 this complaint is filed.
On the other hand OP1 Nilima Matrisadan has submitted that Ayon Kumar Das in his personal capacity treated the patient nor as his RMO capacity. Moreso, such an important doctor ought to have been made party in this case and allegation as made against this Nursing Home is completely false and fabricated and this Nursing Home authority gave services of several doctors and as per doctor’s advice everything was done and no unfair practice was practiced by the OP and fact remains this Nursing Home took reasonable charge from the patient party. Patient was not forced to admit under Saswata Chakraborty in the OP1’s Nursing Home but patient party admitted the patient in the OP Nursing Home as their own will and other allegation against Nursing Home is false and fabricated and they are denied the charges and they prayed for dismissal of the charges for negligence and deficiency on the part of the Nursing Home because Nursing Home is always guided by doctors’ advice and regarding doctors’ advice Nursing home has no control so the entire allegation of the complaint is false and fabricated for which the present complaint should be dismissed.
On the other hand, OP4 Dr. Saroj Pramanik by filing written version submitted that the entire complaint is false and fabricated. There is no negligence, deficiency on the part of the OP doctors and regarding admission of the complainant at Northland Nursing was at the instance of the complainant and in this regard OP has their no role.
The OP4 and other OPs rendered all positive medical aid and service during post and pre-operative stages properly and till discharge there is no allegation on the part of the OPs and no such allegation was made against the doctors or the nursing at any point of time. It is specifically submitted that after getting pathology report it is observed that it is Crohn’s disease of intestine and he also suggested the complainant that by regular dressing and observative treatment the leakage will be healed but it will take time and for that purpose Manoj Agarwal, Gastroenterologist who were also opined for conservative treatment but the patient party became impatient and removed the patient to Calcutta Hospital under Prof. N.K. Pal. But the entire treatment which was done in the hospital was quite correct and as per medical procedure and he prayed for dismissal of the case.
At the same time OP2 Dr. Debasish Dey by filing written statement submitted that first operation was taken place on 23-07-2003 under the OP1, and the 2nd operation was taken place under the OP2 on 10-08-2003. The patient was released on P.R.Bond on 20-08-2003, so, OP has no responsibility.
Truth is that appendicectomy was done n 23-07-2003 from Nilima Matri Sadan Nursing Home and on this basis Dr. D. Basu consulted Dr. S. Pramanik regarding her post-operative complications and it is found from the records that exploratory laparotomy was done on the wife of the complainant by Dr. S. Pramanik on 10-08-2003 but during her stay all positive medical treatment was given for her care but the allegations are completely false and fabricated and always during her treatment at OP’s hospital all the doctors take all positive steps, consulted for giving her proper relief but question of stay at Hospital cannot be controlled by the doctor unless and until the patient is found stable. So, practically OPs played their all medical skill and truth is that patient was improving but patient party were found impatience and discharged her on Bond and shifted her to CMRI and in the above circumstances, the compliant should be dismissed when negligence, deficiency on the part of the OP is not at all proved.
OP4 and other OPs rendered all positive medical aid and service during post operative and pre-operative stages properly and till discharge there is no allegation on the part of the OPs and for such allegation
Decision with Reasons
On critical study of the complaint including the written version and particularly all the evidences filed by both the parties including materials on record it is found that the main allegation of the complainant in this case is that without any USG OP5 held operation and OP5 and other doctors of the OP1 did not make any proper diagnose and hastily made operation without collecting lung report and further there is no opinion whether they had been confirmed for the opening of the lower abdomen and that is necessary.
From the complainant’s own complaint it is clear that their claim is that the appendicitis operation was not at all necessary and only their allegation is that without USG report appendicitis operation was done on 23-07-2003.
Considering the entire complaint we are very much satisfied that we must have to roam and to collect the materials to determine whether appendicitis operation as done by the OP on 23-07-2003 was a correct decision or nor and their assessment that is diagnosis was correct or not and whether USG was mandatory before any operation of appendicitis or not and except these there is no other allegation.
Anyhow after further assessment of the complaint it is found that the complainant was compelled to discharge his wife from the present nursing home on 30-07-2003. Anyhow, the complainant tried to say that release was made by the OP1 on their sweet-will, not as per pressure of the complainant. So, we shall have to consider whether discharge of the patient on 30-07-2003 was as per opinion of the doctor or the patient was forcibly released by the complainant or not and further we shall have to consider whether there is negligence or deficiency on the part of the OP.
On proper consideration of the Annexure D the discharge certificate issued by Nilima Matrisadan it is found that complainant’s wife Nutan Chakraborty was admitted on 22-07-2003 and was discharged on 30-07-2003 and diagnosis was Ac. Appendicitis and the lady was aged about 38 years. USG report dated 09-08-2003 reveals that gall bladder wall appear thickened with evidence of cholesterosis but no calculus is seen and collection of thick fluid and debris seen in Rt lumber and RIF and Rt side of Pelvis and from histopathology report dated 11-08-2003 it is clear total feature is consistent with Crohn’s disease but no malignancy was there.
In this context the matter was referred to Medical Board of Medical College and Hospital and Medical Board submitted a report wherefrom it is found that they have opined that diagnoses of acute appendicitis was made on clinical ground as done by Dr. Amitabha Biswas and ultrasonogram is always not necessary. At the same time hospital authority submitted that based on the USG finding Northland Nursing Home patient rightly done Hemicolectomy and the post operative complication of fecal fistula can occur in any such operation and subsequent management is necessary and from that report it is clear the appendicectomy was done by Dr. Saswata Chakraborty at Nilima Matrisadan was no doubt correct procedure and medical experts of the Medical College also confirmed that Rt Hemicolectomy and ileotransverse anastomosis was done by Dr. Pramanik is also correct procedure. Doctors of the Medical College also confirmed that after operation development of faecal fistula is generally caused and in that case general treatment is usually medication that is done by CMRI doctor Dr. N.R. Pal where the patient recovered. At the same time vide report of the Medical College Expert dated 27-03-2015 it is specifically mentioned that Hemicolectomy specimen total feature is consistent with Crohn’s disease. So, it is not possible for the doctors to make any expert comment on medical negligence when no material proof of negligence of doctor is produced. Considering the medical expert report it is found that without USG appendicitis operation as done by Dr. Saswata Chakraborty, is as per medical norm when USG was not required. Subsequent operation Hemicolectomy was rightly done because Hemicolectomy specimen the total feature in the present case is consistent with Crohn’s disease. So, the complainant’s allegation that OPs failed to search out that complainant has been suffering from Crohn’s disease which was detected by CMRI doctor is disapproved by the medical board. At the same time the process and procedure as adopted by the OPs for operation of appendicitis and Hemicolectomy was proper in nature.
Most interesting factor is that doctor of CMRI noted down it is Crohn’s disease. But invariably that doctor also considered the prescription issued by the OPs but after considering two operations as done by the OPs that is appendicectomy and Hemicolectomy but did not opined whether it is related to that operation or Crohn’s disease was caused due to such operation.
Truth is that medical science says Crohn’s disease is a type of Inflammatory Bowel Disease (IBD). It is nothing but a chronic inflammation which may harm the whole wall of the colon and it is nothing but ulcerative colitis. Crohn’s disease can involve any part of the digestive tract, including the lower end of the small intestine and Crohn’s disease patient can also develop various nutritional deficiencies due to less than optimal diet. loss of protein via the intestine or poor absorption (malabsorption) of nutrients. Other possible complications include arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gall stones or other diseases of the liver and bile system and as per opinion of doctors in their authoritative books(reference) Dr. Mark Sircus, Ac., OMD, DM(P), Director, International Medical Veritas Association, Doctor of Oriental and Pastoral Medicine and after studying that book and theorization it is proved that Crohn’s disease is not due to appendicitis or for any other operational effect which is further proved from the said opinion of the doctor that Crohn’s disease cannot be cured but it can be managed successfully and remain in remission for long period of time but nature of the disease tends to recur unpredictably. It is specifically opined by the doctor that treatment goals are to control inflammation, correct nutritional deficiencies and relieve symptoms and relative system but nature of treatment is nothing but conventional medicine relies on a variety of drugs, nutritional supplements and in extreme cases surgery.
As per said doctor’s authoritative view Crohn’s disease cannot be diagnosed by USG but it can be diagnosed specifically by routine blood test that blood test will reveal anemia, high numbers of white blood cells and indications of inflammation such as a high Sed Rate and increased levels of C-reactive protein.
Relying upon that authoritative view of the said doctor we are confirmed USG was not required at the time of operation of appendicitis or Hemicolectomy and it is also proved that Crohn’s disease was not caused due to such operation and it is not the after effect of the operation.
Further from the said doctor’s opinion which is accepted all over the world supports that when medication fails in case of treatment of Crohn’s disease surgery is needed for such complication as blockages, perforations, abscess or bleeding in the intestine and in that case removal of part of the intestine may help but would not prevent the disease from striking an adjacent area in the intestine and to control the same sometimes entire colon must be removed. Lastly relying upon the said authoritative book of Dr. Mark Sircus it is clear there was no nexus in between the Crohn’s disease with appendicitis operation and Hemicolectomy. If the doctor of CMRI after USG found that she was suffering from Crohn’s disease in that case that doctor ought to have written down in the prescription that the Crohn’s disease is not the after effect of operation of appendicitis or that Hemicolectomy. May be it was not written by the doctor of CMRI but most interesting factor is that doctor has not stated anywhere that Crohn’s disease was caused due to that operation not even he found any error in respect of such operation. Truth is that there is already such opinion of the Medical Board of Medical College that second operation Hemicolectomy is generally done in case of Crohn’s disease related factor that means OP1 also search out that the patient suffered from Crohn’s disease for which the said operation was done to give him such protection and subsequent management is nothing but medication that was being denied by the OPs. Similar medication was applied by the CMRI doctor so no new procedure was adopted by the CMRI doctor but same procedure had been followed by the OPs which is proved beyond any manner of doubt but relying upon the opinion of the medical board of Medical College and particularly the world-wide accepted theorization of Crohn’s disease and others as found from the book of Dr. Mark Sircus we find even after surgery Crohn’s disease cannot be controlled and it shall recur again and again for which time to time medication is required. But before concluding we want to mention that CMRI doctors are not aware of the fact what is the fate of such disease if that was within their knowledge then the doctors of CMRI ought to have noted down that Crohn’s disease is life long disease that occurs frequent period of remission and that is the conclusion of the experts of worldwide doctors. So, we are confirmed that complainant’s wife has not been cured from that disease till today but complainant is satisfied that his wife has been cured by the doctors of CMRI but in our opinion his wife shall suffer till his death. There is no doctor of CMRI who may cure her permanently because worldwide opinion is that the disease is lifelong and that can occur frequent period of remission. Then we find there was no deficiency on the part of the OPs, there is no negligence also in their treatment. They adopted correct procedure and process. Surgical step was also required and rightly Dr. Pramanik did it and the lady was under medication at the relevant time but she was removed by the complainant forcefully. In the particular case from medical report of both the hospitals it is found that lady is an anemic and in view of Dr. Mark Sircus an anemic person cannot be cured from such disease. So, she must be kept in continuous medication so that his/her haemoglobin percentage shall be always within such normal limit if haemoglobin percentage is decreased then and there she shall have to suffer from that disease and condition of the patient shall be complicated and that is the nature of the Crohn’s disease. At the same time the doctor has confirmed that stress and diet are suspected as of Crohn’s disease and same are the factor or part of aggravating the disease because it is already decided that Crohn’s disease is an inflammatory bile disease and Crohn’s symptom may affect any part of gastronial tract from mouth to anus and all over the world the gastroenterologist and general physician and other correlated doctors confirmed that stress, habit of food and imotional issues are directly translated into gastro upset and Crohn’s disease is caused by a combination of environmental, immune and bacterial factors and now-a-days junk food and other food habits are causing more such cases in the common people also.
On overall assessment of the above observations of the doctors opinion of the doctors of medical board of Medical College and also the line of treatment as adopted by the OPs, at the same time the pre-operative and post operative care and treatment as made by the OPs we are confirmed that there was no negligence, deficiency on the part of the OPs and in need of urgent operation of appendicitis USG is not required, but other factors should be decided and that has been decided by the Board of 3-4 doctors and thereafter, appendicitis operation was done. Subsequently operation as done by Dr. Pramanik that is Hemicolectomy which was done rightly to control Crohn’s related disease that was confirmed by the Medical Board of Calcutta Medical College.
In the light of the above observation we find that entire procedure as adopted by the OP’s doctor during treatment period of the wife of the complainant was at par worldwide doctors’ adopted procedure and also it is at par Dr. Mark Sircus’s authorization and European Countries continuously adopted that procedure and truth is that even operation will not cure such a patient but time to time medication is must. So, the complainant’s view as experts in the complaint that his wife after treatment by CMRI cured is completely a baseless authorization because this disease will again and again recur till death and only it can be controlled for certain period only by proper medication and applying medicine in her daily life to keep herself stable from such disease.
Most interesting factor is that this case is pending since 2004 and we have gathered that everyone passed their days not to take up this case in view of the fact no positive opinion can be collected by the Forum and the then President what would be the decision but now-a-days if anyone read daily the particular subject which is placed before the Forum for decision and if that chapter is collected from internet from different universities of different countries and authoritative books after studying Forum many come to a conclusion whether negligence or deficiency is there or not. Practically we have already collected the particular book on Crohn’s disease and that is written by a worldwide doctor Dr. Mark Sircus and he had so many publications which is being accepted by different medical institution of world including India also and after studying the authorization in this regard and also collecting basic materials we have collected necessary answer against 16 queries which are vital in respect of the present disputes and answers are collected from book of Dr. Mark Sircus and after studying that materials and applying the authorization with the present case we are confirmed that entire allegation of the complainant is baseless and without any medical foundation.
In the result, the case succeeds.
Hence,
Ordered
That the case be and the same is dismissed on contest but without any cost.
