BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION :HYDERABAD
F.A.No.983/2007 against C.C.No.171/2006, Dist. Forum-I,Hyderabad.
Between:
Dr.Kodati Vijayalakshmi,W/o.Dr.Prasad Rao,
Aged about 53 years,
Occ:Medical Superintendent(Former)
Consultant Gynaecologist,
Andhra Mahila Sabha,Vidyanagar,
Hyderabad. …Appellant/
Opp.party no.2
And
1.Smt. Anitha , W/o.P.Sudhakar,
Aged about 35 years, Occ:Self Employed,
R/o.1-1-379/20/2, SRT-28,
Jawahar Nagar, Cikkadpalli, Hyderabad. … Respondent/
Complainant
2. Andhra Mahila Sabha,
Rep. by its Medical Officer,
Vidyanagar, Hyderabad. … Respondent/
Opp.party no.1
3. Dr. Sowjanya Bhyri,
Vasavi Hospitals,
Khairatabad, Hyderabad. … Respondent/
Opp.party no.3
Counsel for the Appellant : M/s. K.V.R.Chowdary
Counsel for the Respondents : M/s.P.Mahipal Reddy –R1
CORAM: THE HON’BLE JUSTICE SRI D.APPA RAO, PRESIDENT,
AND
SMT. M.SHREESHA, HON’BLE MEMBER
MONDAY, THE THIRTY FIRST DAY OF MAY,
TWO THOUSAND TEN.
Oral Order :(Per Smt. M.Shreesha, Hon’ble Member)
****
Aggrieved by the order in C.C.No.171/2006 on the file of District Forum-I, Hyderabad, opposite party no.2 preferred this appeal.
The brief facts as set out in the complaint are as follows:
The complainant underwent tubectomy operation at opposite party no.1 hospital on 12.12.1996 and the surgery was conducted by Dr.Kodati Vijayalakshmi, opposite party no.2 and a certificate was issued on 14.12.96. The complainant submits that seven years after the said surgery she noticed some physiological changes in her monthly periods and she approached Dr.Mangala, Gynaecologist who recommended for urine test (Pregnancy Test) and she approached Tapadia Diagnostic Centre at Saptagiri Theatre, RTC X Road for the said test on 16.12.2003 and on perusing the said test report Dr.Mangla reported that the test is positive and confirmed that the complainant is pregnant. The complainant approached Dr.Kodati Vijayalaxmi who had performed the tubectomy operation to her in the year 1996 and on 16.12.2003 the said doctor examined the complainant and prescribed Ultra Sound Scan of Pelvis. The complainant was subjected to the said test at Tapadia Diagnostic Center on 17.12.2003, but the report disclosed no evidence of gestation Sac (Pregnancy not visible) and on perusing the said report Dr.Vijayalakshmi further prescribed Tans Vaginal Pelvic Scan and made to believe that it would be the final test for the purpose of confirmation of pregnancy. The complainant was subjected to the said test and report was given by Dr.Soujanya Bhyre, opposite party no.3 and basing on the said report dt.20.12.2003, opposite party no.2 informed to the complainant that everything appears to be normal and prescribed Regestrone 5 mg. tablet twice a day for a period of seven days. The complainant suffered severe abdominal pain and giddiness on 26.12.2003 at about 9 a.m. due to which she became unconscious and was shifted to Sri Narmada Hospital at Gandhinagar in a critical condition. Dr.P.Mangala diagnosed Ectopic pregnancy and the complainant was subjected to surgery on 26.12.2003 and she was taken up for immediate laparotomy and administered 4 units of compatible blood and she was discharged on 3.1.2004. Complainant submits that in the month of August 2004 due to uneasiness and giddiness she approached Dr.Mangala and she was prescribed for blood test on 22.8.2004 and the report showed the sugar trace as positive. Again on 24.8.2004 the same doctor advised for RBS and the said test also proved positive and also found sugar in her blood on testing in the month of February,2005 and owing to the said disorder of diabetes she developed side effects like eye sight and cardiology problems. Complainant submits that in the month of September,2005 she was hospitalized due to severe chest and back pain and was kept under observation of Dr.Nitin Kumar Kabra ,Consultant Cardiolgist in ICU for 24 hours who opined LV Diastolic Dysfunction and prescribed Thrombrosprin 500 mg. once a day for ever. The complainant submits that due to the deficiency in service of the opposite parties she suffered the above said problems and she was away from her duties and incurred heavy loss monetarily, physically and mentally. Hence the complaint seeking direction to the opposite party to pay Rs.2 lakhs towards compensation, to pay Rs.25,000/- towards medicines & Miscellaneous, to pay Rs.47,000/- towards medical treatment expenses , to pay Rs.10,000/- towards transportation and to pay Rs.2 lakhs towards mental agony and to pay costs of Rs.10,000/-.
Opposite party no.1 filed counter which has been adopted by opposite party no.2. It is stated in the counter that the opposite party is not supposed to remove the entire length of tube or ovaries while performing tubectomy operations and the same has nothing to do with either I.S.C.S or tubectomy and in the said transaction there is no negligence of the doctors who performed the operation of tubectomy on the complainant and the concerned doctors are no way responsible for the complications as the incidents of ectopic pregnancy in tubectomised patients is more common i.e. 15% to 50%. Opposite party submits that in the absence of gestation sac in the ultra sound scan report more so by transvaginal approach which is a less error prone method, Regestrone tablets were prescribed to regularize her periods which were irregular and these tablets have no connection with the later developments of ruptured ectopic which was not seen in the transvaginal ultra sound scanning . Opposite party submits that there is no deficiency in service on their behalf and seek for dismissal of the complaint.
The District Forum based on the evidence adduced i.e. Exs.A1 to A27 and B1 and B2 allowed the complaint partly directing the opposite party no.2 to pay compensation of Rs.50,000/- to the complainant along with costs of Rs.2000/- within two months from the date of the order.
It is not in dispute that the complainant underwent Tubectomy operation at Andhra Mahila Sabha Hospital on 12.12.96 and appellant/opp.party no.2 conducted operation. Seven years thereafter in the month of December,2003 the complainant noticed some physiological changes in her monthly periods and she approached Dr.P.Mangala, MBBS, DNB, Gandhinagar who recommended urine test to be conducted for test for pregnancy. The complainant on 16.12.2003 went to Tapadia Diagnostic Centre and the urine test was proved to be positive. This is evidenced by Ex.A2 dt.16.12.2003 and the result is ‘Positive’ for pregnancy and it is certified by Dr.R.Tapadia,MD.,DCP., Pathologist. It is the case of the complainant that Dr.Mangala confirmed that the complainant was pregnant and therefore the complainant approached the appellant/opp.party no.2 who performed tubectomy operation in the year 1996 and the said doctor examined and prescribed Ultra Sound Scan of Pelvis which was done as evidenced under Ex.A3. This is dated 17.12.2003 which states that there is no evidence of Gestation Sac and only says that Impression :Thickened Endometrium . Thereafter prescribed Tansvaginal pelvic scan evidenced under Ex.A6 which states uterine county appears empty. Ex.A7 is the prescription dt.16.12.2003 when the patient first went to appellant/opposite party no.2 doctor wherein the appellant had clearly mentioned that tubectomy was done seven year ago and urine test was termed as ‘Positive’. She also recorded that there was ‘No gestational sac’ and both overies are normal. It is the case of the complainant that the appellant did not detect ectopic pregnancy and instead prescribed regestrone 5mg. tablets for a period of 7 days as a result the complainant had suffered severe abdominal pain and giddiness on 26.12.2003 and she became unconscious and shifted to Sri Narmada Hospital in a critical condition. Dr.P.Mangala diagnosed Ectopic Pregnancy and performed surgery on the complainant on 26.12.2003 and performed laparotomy and administered four units of blood. It is the complainant’s case that she was in a state of severe shock with un recordable pulse and blood pressure and after undergoing lot of mental agony she was discharged on 3.1.2004 and thereafter she was diagnosed with diabetes and also suffered from severe chest and back pain problems with LV Diastolic Dysfunction and suffered monetarily and physically .
The learned counsel for the appellant/opposite party no.2 contended that the complaint is barred by limitation because tubectomy was done in the year 1996 and prescription was given on 20.12.2003 and the case was filed on 26.12.2005. Merely because the prescription is dt.20.12.2003 the treatment underwent by the complainant thereafter which is evidenced under Ex.A9, which is the discharge summary of Sri Narmada Hospital, dt.3.1.2004, cannot be ignored. Hence we are of the considered view that this complaint is definitely not barred by limitation. The second contention of the learned counsel for the appellant/opposite party no.2 is that ectopic pregnancy was not detected in the tests conducted by opposite party no.2 and therefore she prescribed Regestrone tablets and this cannot be construed as deficiency in service. We find this contention also unsustainable in the light of the evidence filed by the complainant and also the deposition of Dr.Mangala recorded before this Commission. When the exhibits clearly evidence ‘positive’ urine result for pregnancy and Ex.A7 is a prescription given by appellant/opp.party no.2 dt.20.10.2003 in which she clearly stated that the urine test is ‘positive’ and has further advised ultra sound scan and thereafter Transvaginal Scan she ought to have diagnosed ectopic pregnancy since she herself in her counter stated in para 8 that incidence of ectopic pregnancy in tubectomised patients is 15% to 50% according to medical literature of Dr.D.C.Dutta page 192, the medical literature to that effect has also been filed. When there is 15% to 50% risk of tubectomy patients carrying the risk of ectopic pregnancy, and in the instant case Ex.A2 clearly reveals ‘Positive’ result, merely because scan did not show gestational sac the doctors ought not to have ruled out ectopic pregnancy when she herself conducted tubectomy operation on the patient on 12.12.96 and is admitted that tubectomised patients carry 15% to 50% risk of ectopic pregnancy instead of that she prescribed regestrone tablets and within one week the patient become severely critical and she was admitted in Sri Narmada Hospital as evidenced under Ex.A9. Ex.A8 is Emergency Admission Certificate dt.26.12.2003 issued by Dr.Mangala in which she stated that the patient was admitted in the hospital with ruptured ectopic pregnancy and was in critical condition. In her chief examination Dr.Mangala deposed before this Commission that considering the patient’s previous history and the present symptoms she diagnosed ruptured ectopic pregnancy and immediately conducted operation and found the right tube to be is ruptured and two liters of blood was clotted in the abdominal cavity and she drained the abdomen, repaired the site and closed the abdomen after stabilizing her condition by administering five units of blood iv fluids and antibiotics. 10 days prior to the operation namely 15th or 16th December,2003 when the patient visited her she got a urine test conducted and found her to be pregnant. The doctor was cross examined by the counsel for the opposite party and in her cross examination she stated that the purpose of administering regestrone tablet is to get withdrawal bleeding and there is also possibility of error in urine test and a test known as Serum Beta H.C.G. would prove 100% ectopic pregnancy and this test was not conducted by the appellant or herself. She submitted that the patient approached her in a critical condition. From this deposition it is quite clear that when the patient was in critical condition Dr.Mangala had immediately diagnosed the patient to be suffering from ectopic pregnancy and treated her and appellant/opp.party no.2 failed to diagnose the patient to be suffering from ectopic pregnancy and instead prescribed regestrone tablets for a week for withdrawal of bleeding and the patient tested positive for pregnancy after 7 years of tubectomy and carried 15% to 50% risk of ectopic pregnancy.
We rely on the judgement in Bolam v. Friern Hospital Management Committee, WLR at p.586 in which it is held as follows:
“Where you get a situation which involves the use of some special skill or competence, then the test as to whether there has been negligence or not is not the test of the man on the top of a Clapham omnibus, because he has not got this special skill. The test is the standard of the ordinary skilled man exercising and professing to have that special skill. A man need not possess the highest expert skill….It is well established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art”
We also rely on the judgement of Apex Court in Dr.Laxman Balkrishna Joshi v. Dr.Trimbak Bapu Godbole and Anr. reported in (1969) I SCR 2006. The Apex court court discussed the “duty of care” a doctor should undertake
a) A duty of care in deciding whether to undertake the case
b) A duty of care in deciding what treatment to be given
c) A duty of care in the administration of that treatment
Keeping in view the afore mentioned judgements we are of the considered view that the appellant/opposite party no.2 did not diagnose the patient properly as per the standards of medical parlance and failed in her duty of care and precaution which we construe to be as negligence .
In the result this appeal fails and is accordingly dismissed . Time for compliance four weeks.
PRESIDENT
MEMBER
Dt. 31.5.2010
Pm*
