BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, ERNAKULAM.

Dated this the 30^th day of August 2016

Filed on : 15-03-2013

PRESENT:

Shri. Cherian K. Kuriakose, President.

Shri. Sheen Jose, Member.

Smt. Beena Kumari V.K. Member.

CC.No.212/2013

Between

Rajeswary Ramakrishnan, : Complainant

W/o. Ramakrishnan, (By Adv. Premprakash, Abraham Thomas,

Palappuzha house,Kottappuram kara, Shery P.A., N. Paravur)

Alangadu Village, Paravur taluk,

Ernakulam-683 511.

And

1. Sree Narayana Institute of : Opposite parties

Medical Science (SNIMS) (By Adv. George Cherian Karippa-

Chalakka, Kunnukara, parambil, Associates, HB.48, Panam-

Ernakulam-683 594. pilly Nagar, Kochi-682 036)

2. Dr. George Joy, Managing Director,

Gynecologist, Sree Narayana

Institute of Medical Science

(SNIMS), Chalakka,

Kunnukara, Ernakulam.

O R D E R

Beena Kumari V.K., Member.

The case of the complainant is as follows:

This complaint is filed alleging medical negligence on the part of the opposite party during the treatment of the complainant at the 1^st opposite party SNIMS. The complainant was diagnosed with vaginal prolapse at a medical camp conducted as a joint venture at KEM High School on 29-04-2012 by the opposite party and Soumyam Residents association . Consequently the complainant got examined at the 1^st opposite party hospital on 02-05-2012 by 2^nd opposite party Doctor George Joy. Since the complainant was found highly diabetic as a temporary measure ring pessary was inserted, on 07-05-2012. The complainant contended that the ring was rejected on the same day. The complainant got admitted to the 1^st opposite party – SNIMS on 15-05-2012 and after various tests and after controlling the blood sugar of the complainant a surgery to remove uterus was conducted on 21-05-2012. The complainant took medicines prescribed by the 2^nd opposite party doctor to control abdominal pain but after one and half week the complainant felt something bulging out from the vagina. After examining the complainant on 06-06-2012, the 2^nd opposite party doctor informed the complainant that the urinary bladder and a part of intestine had bulged out and he placed a mesh to prevent bulging through vagina and on 13-07-2012. The complainant felt severe pain due to infection at the operation site and the complainant was referred to Sunrise Hospital by the 2^nd opposite party Doctor for better management. Since Dr. Hafeez Rehmani was o leave, the complainant could consult him only on 08-08-2012 and on 11-08-2012 a surgery was conducted at sunrise Hospital and she was discharged on 13-08-2012. The complainant alleged that the surgery conducted by the 2^nd opposite party – Doctor at SNM hospital was incorrect and the mesh used by him was of substandard quality. Hence this complaint is filed before this forum seeking orders of this Forum to the opposite parties to refund an amount of Rs. 1,60,000/- which was spent by her in view of the negligent and deficient services offered to the complainant, to pay Rs. 2,00,000/- towards compensation for the pain and mental agony suffered by the complainant, to pay Rs. 60,000/- for the loss of normal life to the complainant, to pay Rs. 50,000/- for the expenses incurred for engaging a servant to look after the complainant. Thus a total amount of Rs. 4,70,000/- was claimed by the complainant.

2. Notice was issued to the opposite parties and the opposite parties filed their common version resisting the averments in the complaint.

3.Version of the opposite parties

The opposite parties submitted that a medical camp was conducted by the opposite parties on 29-04-2012 at Kottappuram KEM High School consequent to the diagnosis of vaginal prolapse the complainant approached the 1^st opposite party – Hospital on 02-05-2012 and she had undergone a detailed physical examination. The complainant gave a history of mass per vaginum for one year, low back ache for 2 years, increased frequency of urination, noeturia (increased right frequency of urination) and stress urinary in continence (involuntary loss of urine) long standing diabetic not on treatment, dysmenorrhea (painful menstruation), heavy bleeding (passage of clots) and inter menstrual bleeding. The 2^nd opposite party Doctor after examination of the complainant diagnosed stage 4 uterine prolapse, and advised the complainant that in this condition proper management is surgical intervention. But an immediate surgical intervention was not possible/or advisable since the complainant was suffering from uncontrolled type-2 diabetics. Therefore vaginal ring pessary was inserted as a temporary correction of genital prolapse. There was right pelvic calyceal system dilation with 11 mm calculus in distal ureter which was noted in ultra sound scan. Therefore, the complainant was advised urology consultation on 02-05-2012. The complainant was advised to get admitted to the hospital for starting medication to control diabetic but the complainant was not willing. Again when the complainant approached the 2^nd opposite party in the out patient department, her blood sugar was 441 mg and she was advised to take insulin injection and drugs and as an out patient procedure vaginal ring pessary was inserted on 07-05-2012 as a temporary correction of genital prolapse, to reduce congestion and to prepare the patient for surgery till diabetics is controlled. On 14-05-2012 when the complainant consulted the 2^nd opposite party doctor he found expulsion of ring pessary and genital prolapse and the complainant was advised to get admitted for vaginal packing. Accordingly the complainant got admitted on 15-05-2012 and all standard pre-operative tests alone were conducted from 15-05-2012 to18-05-2012. On getting fitness certificate from anesthesiologist and on getting the consent from the complainant and her husband, vaginal hysterectomy, pelvic floor repair mesh repair of cystocele were done on 21-05-2012 and pre and post operative period were uneventful and the complainant was discharged on 29-05-2012. The expulsion of pessary on the same day of insertion on 0705-2012 was not reported by the complainant, it was reported only on 14-05-2012. The expulsion of pessary may be due to weak pelvic floor muscle, secondary to uterus prolapse and uncontrolled diabetics or may be due to over straining. The patient was a symptomatic on08-06-2012. Thereafter the patient did not come for any follow up for 35 days. On 13-07-2012 the complainant reported with symptom of vault prolapse further surgical intervention to correct vault prolapse by laproscopic colposuspension was advised but the patient again reported only on 23-07-2012 and the 2^nd opposite party doctor, on the request of the complainant, gave a reference letter to Dr. Hafees Rahman of Sunrise Hospital, Kakkanad for getting a 2^nd opinion in the matter. The averment of the complainant that the 2^nd opposite party had pushed back the prolapsed bladder and intestine is false and hence denied on 08-06-2012 the complainant was a symptomatic and thereafter the complainant attended the opposite party hospital only on 13-07-2012 and the contrary allegation are false and hence denied. Further the mesh used in the surgery was manufactured by M/s. Sutures India Pvt. Ltd., Bangalore an ISO 9001 & CE 1293 certification company and not a mesh of substandard quality as alleged by the complainant. The standard surgical procedure was followed in this case as detailed in the discharge summary and the expenses incurred was only Rs. 32,200/- not Rs. 60,000/- as alleged by the complainant. The averment of the complainant that Dr. Haneef Rehman had conducted posterior laproscopic procedure is also false. The opposite parties submitted that the complaint is bereft of any bonafides and the complainant has not proved any medical negligence on the part of the opposite parties. It is prayed that this complaint may be dismissed with compensatory costs to the opposite parties.

4. The issues to be decided in this case are as follows:

1. 1. 1. Whether the complainant has proved deficiency in service on the part of the opposite parties?

      2. Whether the complainant is entitled to get refund of Rs. 1,60,000/- spent by the complainant from the opposite parties?

      3. Whether the opposite parties are liable to pay compensation for the mental agony suffered and for the loss of normal life if any to the complainant along with costs?.

5. The evidence in this case consisted of the oral evidence adduced by the complainant as PW1 and the Exbts. A1 to A14. The opposite parties adduced oral evidence through witnesses DW1, DW2 and DW3. Hospital records were marked as Exbts X1 to X4.

6. Issue No. (I). The complainant approached the 1^st opposite party hospital and 2^nd opposite party doctor on 02-05-2015 consequent to the diagnosis of a vaginal prolapse in a medical camp held at Kottappuram, KEM High School. She was advised to undergo surgery. But due to High level of blood sugar (441 mg) vaginal ring pessary was inserted as a temporary measure on 07-05-2012 as an outpatient procedure. The complainant contended that the ring was rejected on the very same day. The said fact was not seen reported to the opposite parties. But the complainant approached the opposite parties only on 14-05-2012, which shows that the complainant had not taken proper care of her own health problems. The expulsion on pessary may be due to weak pelvic floor muscle of the patient which may occur secondary to uterus prolapse. She got admitted to the 1^st opposite party hospital on 15-05-2012, her sugar level was controlled ad after getting the certificate of fitness for surgery from the anesthesiologist, vaginal hysterectomy and pelvic floor repair and mesh repair of cystocle were performed on 21-05-2012 and the complainant was discharged on 29-05-2012 since the post operative period was uneventful and she was asked to come for review after two weeks as evidenced by Exbt. A10 discharge summary. The complainant alleged that various tests were done repeatedly. The allegation was resisted/denied by the opposite parties and it is submitted that the standard pre-operative tests alone were conducted by the opposite parties. It is prerogative of the doctor to decide what all tests to be done to confirm the real physical condition of the patient. The complainant as PW1 deposed before the Forum at page 3 that she took the medicine for diabetics for the first time only when such medicines were given by 2^nd opposite party doctor to her on 02-05-2012 and due to high level of blood sugar (441mg) it was not possible for the opposite parties to do vaginal hysterectomy and the 2^nd opposite party doctor had as a temporary measure inserted vaginal ring pessary on 07-05-2012 as an outpatient procedure. Thus due care was seen taken by the 2^nd opposite party doctor . The complainant contended that the ring pessary was rejected on07-05-2012. This was reported only on 14-05-2012. The allegation stands not proved. Another allegation raised by the complainant is that the mesh used for the surgery was of substandard quality. The opposite parties submitted that the mesh used was of M/s. Sutures India Pvt. Ltd., Bangalore which is an ISO 9001 as evidenced by Exbt. X2 certificate, issued by certification body of EVPU and Exbt. X4 is the license issued by Drugs Controller and Licensing Authority authorizing the sale by way of wholesale dealing and storage for sale for the period from 18-05-2012 to 17-05-2017. The sutures India Pvt. Ltd. is also CE 1293 certification company having license to manufacture surgical mesh as evidenced by Exbt. X3 certificate. Hence the allegation of use substandard mesh stands not proved by the complainant and in the discharge summary dated 29-05-2012, the surgical procedure followed by 2^nd opposite party doctor is clearly mentioned which is the standard procedure as per the standard text books in obstetrics and Gynecology and in the instant case mesh failure occurred since the complainant was suffering from uncontrolled type 2 diabetics and is a diabetic patient with muscular weakness due to non-treatment for prolonged period and the rejection of Mesh cannot be due to the deficient services of the opposite parties. It is deposed by the witness of opposite parties (DW3) at page 6 that vault prolapse after hysterectomy can happen due to inherent weakness of the tissues. Evidently the complainant is highly diabetic for a long period and vault prolapse happened not due to any deficient service offered by the opposite parties. More over after the mesh failure, the 2^nd opposite party fairly referred the complainant to sunrise Hospital for betteer management and the complainant was admitted to the sunrise Hospital on 11-08-2018 with complaints of mass descending per vaginum after the vaginal hysterectomy. The discharge summary of the 1^st opposite party in Exbt. A10 and that of the Sunrise Hospital in Exbt. A13 show that anterior/Posterior colpoperineoraphy was done and contrary averments of the complainant are found not true and against facts. The accepted standard surgical procedure was followed by the opposite parties. When ever the complainant approached the opposite parties at her will. The complainant had not cared to admit herself when the opposite party required her to do so. Hence we find no deficiency in service on the part of the opposite parties. Hence we find no deficiency in service on the part of the opposite parties. Thus the 1^st issue is decided against the complainant. The complainant failed to prove any deficiency in service on the part of the opposite parties.

7. Issue No. ii & iii. Having found the issue No. (i) against the complainant, we are not inclined to consider and decide issues Nos. ii & iii.

8. In the result, we find that this complaint is liable to be dismissed. Hence the complaint is dismissed.

Pronounced in the open Forum on this the 30^th day of August 2016

Sd/-

Beena Kumari V.K., Member.

Sd/-

Cherian K. Kuriakose, President. Sd/-

Sheen Jose, Member.

Forwarded/By Order,

Senior Superintendent.

Appendix

Complainant's Exhibits

Exbt. A1 : Histopathology report

A2 : Blood bank reports

A3 : Serology reports

A4 : Bio – Chemistry lab reports

A5 : Ultra Sound Scan reports

A6 : Urine Analysis

A7 : Clinical Bio-Chemistry report

A8 : Clinical Hae matology Report

A9 : Medical bills and Bill statements

A10 : Discharge summary

A11 : Lab test results from Sun rise

Hospital

A12 : Medical Bills and Bill statement

from sunrise hospital

A13 : Discharge summary from Sun rise

hospital

Opposite party's exhibits:

X1 : Hospital records

X2 : True copy of Certificate

X3 : True copy of Notified body

No. 1293

X4 : True copy of licence

Depositions

PW1 : Rajeswary

DW1 : Georgy Joy Eralil

DW2 : Vaiju Alexander

DW3 : Dr. (Prof) M.A. Kunjamma

Copy of order despatched on :

By Post: By Hand: