DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

(CENTRAL) ISBT KASHMERE GATE DELHI

CC No. 116/2014

No. DF/ Central/                                                                      Date

Sh. Bijender Singh

S/o Sh. Dharampal Singh

R/o 134, Hakikat Nagar,

Near Mukerjee Nagar,

Delhi

                                                                                                   .....COMPLAINANT

                                                     VERSUS

1. SIR GANGA RAM HOSPITAL

    Through its Medical Superintendent

    Rajender Nagar, New Delhi - 110060

2. DR. SUDHIR KHANNA

    Department of Urology

    Unit – 2, Sir Ganga Ram Hospital,

      Rajender Nagar, New Delhi - 110060

   Also at :

   8/29, East Patel Nagar,

   New Delhi - 110008

                                                                                          …..OPPOSITE PARTY

Ms. Rekha Rani President

Sh. Vikram Kumar Dabas, Member                                                                      Mrs. Manju Bala Sharma, Member

 ORDER                        Date:      .     .2018

Sh. Vikram Kumar Dabas

           In October 2013 the complainant had approached the OPs as he was detected with a stone in his right kidney.  It is alleged that OP 2 had advised removal of the  stone for which the Hospital offered a package deal amounting to Rs. 24,000/- which will include all charges i.e. admission, test or any other procedure like surgery for getting the stone crushed by way of laser surgery.  On 01/11/2013 the complainant deposited a sum of Rs. 31,000/- with the Hospital but was assured that the package charges will be Rs. 24,000/- only.  On inquiry he was told that during the procedure of removal of the stone some extra test may be conducted for which he may have to pay Rs. 7000/- more.  It is alleged by the complainant that after admission in the Hospital a procedure was done on him and after regaining consciousness he was shocked and surprised to see a urine pipe / bag fixed on him.  On inquiry he was told that D - J stenting had been carried out.  On further inquiry as to why a D-J stenting has been carried out, OP 2, in a most rude manner told the complainant:

‘’I am the doctor and not you, so  I am the person who will decide what will be done & what will not be done.’’  The complainant was further told that he will have to take more sessions of ESWL after discharge.  A biopsy of the gall bladder was also conducted without informing him for which he was charged extra.  On 04/11/2013 ESWL sessions were undertaken and a sum of Rs. 19,400/- was further deposited by the complainant on the direction of the OPs.  Even after 07 sessions of ESWL, the stone remained intact.  It is alleged by the complainant that even though all tests had been got conducted, he was made to get the tests done again from a private Pathological Laboratory i.e. Dr. Lal’s Pathology Lab.  This was in violation of the package which he had taken from the OPs.  By now the complainant had spent more than Rs. 80,000/- where as the package charges were Rs. 24,000/- and yet the stone had remained intact and had not been crushed/removed. The complainant met the Medical Superintendent of OP 1 hospital and demanded an explanation as to why he was being charged extra inspite of taking the package deal offered by the Hospital.  The Medical Superintendent instead of explaining the treatment and the expenses incurred, referred the complainant to Dr. Vipin Tyagi another urologist and assured the complainant that whatever negligence has been done on account of non removal of the stone, no charge will be taken from him.  It is alleged by the complainant that Dr. Vipin Tyagi after going through the treatment record observed that there was no need of inserting the stent and going through 7 ESWL sessions.  He also told the complainant that the X Ray upon which his treatment was being conducted was an X Ray of a female patient and not his X Ray.  In the meanwhile the complainant was again made to pay a sum of Rs. 5540/- and Rs. 4991/- on 24/01/2014 and 30/01/2014 respectively.  On 30^th Jan 2014 the complainant was discharged with the assurance that the stone has been crushed and the same will be ousted through urine within 03 /04 days.  On 19/02/2014 the complainant got an Ultra Sound done which revealed that the stone of 4 mm size was still present in the right kidney.  The complainant has alleged that the OPs were negligent in their treatment as there was no need of D-J stenting.  He has alleged that there was further no need of 7 ESWL sessions which should have been limited to 3 sessions only.  He has alleged that he has been made to pay unnecessarily on account of D-J stenting and unnecessary ESWL sessions.  He has alleged that because of the negligence of the OPs, he remained confined to bed / home & therefore suffered financially.  He therefore, approached this Forum with following prayer :

(a)       Pass an award for a sum of Rs. 5,00,000/- in favour of the complainant and against the OPs on account of the expenses incurred by the complainant in his treatment, at the hands of the opposite parties, which includes the charges levied by the respondent No. 1 from the complainant, conveyance charges, special diet, medicines beside other consequential expenses, which had to be incurred by the complainant during the treatment. 

(b)      Award an amount of Rs. 5,00,000/- in favour of the complainant and against the opposite parties on account of compensation, due to loss suffered by the complainant at this work, mental pain, agony, loss of normal routine life, including financial loss at his work place, due to mental and physical harassment caused by the opposite parties to the complainant on account of their deficiency in service and negligent to discharge their obligation.

(c )      Award an interest on the said principle amount @ 18% p.a. w.e.f. date of receipt of the excess amount by the OPs form the complainant till its realization.

(d)      Award cost of the proceedings in favour of the complainant and against the OPs.

(e)       Pass any other or further order (s), which this Hon’ble Court deems just and proper in view of facts and circumstance of the case, in view of the detailed submission made herein above, to meet the ends of justice.  

           The OPs have contested the complaint and have filed a reply.  Preliminary objections have been taken that the complaint is devoid of any cause of action because the complainant had neither suffered any loss nor was there any deficiency of service on the part of the OPs.  It was also claimed that the complainant had deliberately concealed material facts and had not approached the forum with clean hands.  The complaint was contested on merits.  It was stated that on 20/10/13 the complainant had showed the medical reports to OP 2 who had advised him to report to the main Operation Theatre on 01/11/2013 at 9 AM for D-J stenting.  It was stated that the consolidated charges does not include tests but includes the charges for breaking the stones in the kidney.  It was stated that it was explained to the complainant that D-J stenting, if needed, will entail additional charges.  It was stated that on 25/10/13 it was decided that stenting would be done.  As such the complainant was advised certain tests with the purpose of knowing his fitness for anaesthesia.   It was stated that on 01/11/2013 right side D-J stenting was carried out.  Before the procedure an MRI was advised in view of the history of painless haematuria to rule out any other cause of haematuria.  It was stated that an informed consent was obtained from the patient.  The allegations made in para 9 of the complaint as regards demand of additional amount of Rs. 19,400/- on 04/11/2013 was denied.  It was howsoever, stated that charges were taken for breaking of stones by lithotripsy.  It was also stated that at the time of the admission it was explained to the complainant that depending upon the nature of the stone there was 70 – 90% chances of breakage of stone and further that it may take up to 3 months for broken stone fragments to pass and clear.  It was also stated that it was further explained to the complainant that other procedures like PCNL or URS may be required to be performed to achieve total clearance for which extra charges may be taken.  It was stated that no guarantee or promise was given by OP 1 for removal of the stone for which a consent form was also obtained before starting the procedure of ESWL.  It was stated that after every session the complainant was explained that the thickness of the stone was getting smaller gradually and after 5 sessions of ESWL he was told that further fragmentation of the stone was not required.  It was further stated that it was only on the insistance of the complainant to make the stone further small, two additional sessions of ESWL were given.

           It was also stated that on 21/01/2014 the complainant had made a complaint against OP 2 to the Chairman Board of Management and Deputy Medical Superintendent whereby he had requested that he may be provided treatment through another doctor and it was on his request that he was sent to doctor Vipin Tyagi for further treatment.  It was stated that Dr. Vipin Tyagi examined the history and previous treatment and advised NCCT KUB which showed right D - J stent with few fragmented ureteric stones.  It was stated that all the allegation leveled by the complainant with regard to the observations ascribed to doctor Vipin Tyagi were false.  It was denied that complainant had paid Rs. 5,540/- on 24/01/2014.  It was stated that on the request of the complainant CT – KUB test was done free of cost and on 30/01/2014 on the request of the complainant a concession of Rs. 43,049/- was given in the final bill and he was asked to pay a bill of Rs. 4,991/-.   It was stated that the size of stone in right kidney was only 3.1 mm and the complainant had deliberately and intentionally mentioned it as 4 mm.  It was stated that OP 1 had charged a consolidated bill for all ESWL sessions and therefore the allegations that more ESWL sessions than what were required in order to fleece the complainant was denied.  It was claimed that there was no negligence on the part of the OPs and that the complaint was liable to be dismissed.  It was prayed accordingly.

           Complainant has filed its evidence by way of affidavit and has reiterated the contents of the complaint.  On behalf of the OPs Doctor Sudhir Khanna Chairman and Senior Consultant urology filed his affidavit dated 09/02/2015 supporting the defence taken in the reply of the OPs.  Doctor Vipin Tyagi also filed an affidavit which is in line with the reply filed by the OPs.

           We have heard arguments advanced at the bar and have perused the records.  Two main questions arise for our consideration.  The complainant has alleged medical negligence on the part of the OPs.   However, there is no material on record to prove that there was any sort of negligence on the part of OPs in the treatment.  The treatment was on standard medical practices and therefore it can be safely held that there was no medical negligence in treatment of the complainant. 

           The second question however, has a serious concern.  The complainant has alleged unfair trade practices on part of OPs.  The complainant was diagnosed as having a stone in his right kidney.  He had approached the OPs for removal of the same.  The OPs had offered a package to the tune of Rs. 24000/- to which he had apparently agreed.   A copy of package was not placed on record by the OPs, however at a later stage counsel for OPs had placed a copy of the same on record.  The package was not got signed by the complainant.   For a layman not acquainted with medical procedure it would mean a procedure by which the stone in his kidney would be removed.  The package also included in it the tests required before carrying out the procedure.  In the case in hand the procedure used was lithotripsy.  Before the actual procedure another procedure i.e. D-J stenting was carried out for which the complainant was charged extra.  One of the questions which is raised is as to whether D-J stenting was at all required and if so whether it should not have been included in the package offered to the complainant.  D-J stenting was undertaken in order to aid the removal of the stone from the kidney.  It, therefore, essentially formed  part of the procedure undertaken for removal of the stone. It is our considered view that D-J stenting is undertaken normally in almost all cases where lithotripsy is the procedure adopted for the removal of the stone.   It is our considered view that D-J stenting is undertaken normally in almost all cases where lithotripsy is the procedure adopted for the removal of the stone.  In our wild guess if the record of the Hospital is accessed, it would show that D-J stenting is carried out in 80-90% of such cases.  We therefore, are of the firm opinion that D-J stenting cannot form an independent procedure and has to be included in the package for which no extra charge should have been taken from the complainant.

           The complainant has also alleged that he was subjected to 7 ESWL sessions.  This was done in order to fleece him and to rake up the bill of his treatment.  Even though the OPs have denied this allegation, they have admitted that not more than    3-5 ESWL sessions were required.  The OPs claim that 7 ESWL sessions were conducted on the insistence of the complainant.  We do not appreciate the stand taken by the OPs because if as per medical protocol only 3 – 5 ESWL sessions were required, the OPs ought not to have carried out more sessions than what was required only on the insistence of the complainant.  We tend to believe that this was done to rake up the bill for medical treatment.  The medical treatment record shows that bills amounting to Rs. 80,000/-  were raised on the complainant in respect of the treatment for removal of stones.  The package offered was only for sum of Rs. 24,000/- which means that bills for Rs. 56,000/- were additionally raised on the complainant.  If the complainant was required to pay the aforesaid amount, what was the occasion for offering a package deal.  Ideally, a package deal would mean that all expense relating to the procedure would be included in the same.  It will also include treatment of the patient for any complication for which he has to remain in the Hospital for a longer period than is normally required.  In the present case the complainant was a vigilant consumer and he undertook with the hospital authorities the question of additional payment which he was asked to pay.  The hospital authorities gave a concession of Rs. 43049/.  Still the complainant was made to pay much more than what he was promised.  In our considered opinion the OPs are guilty of unfair trade practice.  The Hospital might have given a concession in this case but what about the other numerous cases which occur in the Hospital on each day where no such concession is given.  It is high time that the authorities look into this aspect and regulate the amounts being charged by the Hospital on hapless patient.

We therefore direct OP 1 as under :

This amount shall be paid by the OP to the complainant within 30 days from the date of this order failing which OP shall be liable to pay interest on the entire awarded amount @ 10% per annum from the date of this order till the date of payment.Copy of the order be supplied to the parties as per rules.                                                        

File be consigned to record room.

Announced on this  ______   day of                 2018.