BEFORE THE DISTRICT FORUM: KURNOOL

Present: Sri K.V.H.Prasad, B.A., LL.B.,  Honb’le President

And

Smt.C.Preethi,  M.A., L.L.B. Hon’ble Lady Member

Thursday the  15^th  day of February, 2007

C.C.No.146/2004

P.Moulali, S/o P.Allipera,

Minor, aged about 15 Years,

Minor represented by natural guardian

Mother P.Shikun Bee, W/o P.Allipera,

Resident of H.No.11-76-C,

Chowdeswari Nagar, Kallur Mandal,

Kurnool District.                                                            …Complainant

          -Vs-

1. Superintendent,

Government General Hospital,

Kurnool.

1. Dr.G.Ramanath,

M.S.IV, Government General Hospital,

Kurnool.

1. Dr.Dhanunjaya,

Anesthetist,

Department of Anesthesiology,

Government General Hospital,

Kurnool.                                                               …Opposite parties

          This complaint coming on this day for orders in the presence of Sri.P.Siva Sudarshan, Advocate, Kurnool for complainant, and  Smt.D.S.Saileela, Advocate for opposite party No.1 and Sri.T.Lakshmi Reddy,  Advocate for opposite party No.2 and  Sri.A.Siva Ramaiah, Advocate for opposite party No.3 and stood over for consideration till this day, the Forum made the following.

C.C.No.146/2004

As per Sri. K.V.H. Prasad, Honb’le President

1.           This case of the complainant through his guardian is filed seeking direction on the opposite parties to pay him Rs.2,00,000/- towards present and future medical and other expenses, Rs.2,00,000/- towards mental agony and costs of this case alleging his joining Govt. General Hospital Kurnool, on 06-06-2002 for treatment to the complaint of stomach-ache and the opposite party No.2 conducting appendicitis operation to him and the complainant going to unconscious condition and inspite of examination by neurology experts and treatment, the complainant not recovering to original condition as on coming to consciousness the complainant was found paralized of his hands legs and mouth and the said was found as arisen due to administration of excess dosage of anesthesia during to appendicitis operation and the complainant did not recover inspite of joining Viswabharati Private Nursing Home Kurnool and N.I.M.S Hyderabad further treatment and spending more than Rs.1,00,000/- and Rs.2,00,000/- in treatment and the negligent conduct of the opposite party No.2 in conducting operation caused the disability in ruining his further prospecting life and the opposite parties 1 to 3 pertaining to said General Hospital in the capacity of Superintendent of said hospital and doctor who conducted said operation and anesthesia respectively, are liable to pay jointly and severally to his claim.

1. In pursuance of the receipt of the notice of this forum as to this case of the complainant the opposite parties 1 and 2 caused there appearance through their counsel and contested the case denying their liability to the complainant’s claim. The opposite party No.3 who was brought on record vide order in I.A.No.58/2005 dated 15-04-2005 also caused his appearance through his counsel and contested the case denying his liability to the complainant’s claim.

1. The written version of the opposite party No.1, even though admits the admission of complainant on 06-06-2002 and performance of appendicitis of operation in the hospital, deny  the alleged fact of the complainant becoming unconscious in said operation and alleged development of complications due to administration of excess anesthesia and its alleged advising the complainant to Viswabharati Hospital, Kurnool and N.I.M.S. Hyderabad for better treatment and also the alleged want of care and caution in treatment of complainant. It alleges that the complainant was shifted to acute medical care in post operative with care, with hundred percent Oxygen support and continuation of necessary surgical treatment and the condition of the complainant as responding to oral commands being in semi conscious condition.  It alleges the abscondence of complainant from hospital from 7.pm. of  08-06-2002 i.e.,  from 2^nd  post operative day evening, and endeavour of the complainant is to blame for its unauthorized abscondence and consequences arisen thereon without treatment till 13-06-2002 i.e., the date of joining Viswabharati Nursing Home, Kurnool. The District Collector, Secretary to Government & Director Medical Education on the complaint of complainant after due enquiry dismissed the same for want of any substance in complainant’s grievances. It lastly submits as the services lent to the complainant being free of charge and no negligence of its doctors in rendering necessary medical services to the complainant and as a case of the complainant is barred by limitation, seeks the dismissal of the case with costs.

1. The written version of the opposite party No. 2 besides denying his conducting of appendicitis operation to the complainant and administration of any excess dosage of anesthesia during operation and it’s leading to complications, denies also the alleged advising of shifting of the complainant to Viswabharati Hospital Kurnool for better treatment. It submits that the said operation to complainant was done by Dr.Radhakrishna, Assistant Professor of Surgery unit-IV under spinal anesthesia administered by Dr.  Dhanunjaya-tutor in anesthesia department as observed in the report of committee constituted by opposite party No.1, and the unauthorised abscondence of the complainant from hospital on 08-06-2002, and in any enquiry on the complaint of the complainant the doctors who rendered medical service to the complainant were found fault with and so seeks dismissal of the complaint with costs.

1. The written version of the opposite party No.3 even though admits the complainant joining the Government General Hospital with complaint of  acute stomach-ache on 06-06-2002 and performance of appendicitis operation to the complainant on 07-06-2002, but denies of the complainant becoming unconscious and not recovering from it and said was on account of administration of excess dosage of anesthesia and of any advising to the complainant for shifting to Viswabharathi Hospital for any better treatment. It alleges successful treatment to the complaint of Brady Cardia  hypotension the developed during operation to the complainant and thereafter shifting the complainant to the acute medical care and affording there all necessary treatment and the complainant abscondence unauthorizedly on 08-06-2002 at 7-00 P.M. while the complainant was recovering and responding to oral commands and this endeavour of the complainant is to blame the opposite parties for his irresponsible conduct of abscondence and consequences of discontinuance of necessary treatment. It further submits that none of the enquiries held by the committee constituted by District Collector, Secretary to Government & Director of Medical Education any medical negligencies of the doctors in the treatment to the complainant was found. It lastly submits that as the services rendered to the complainant were free of charge and the claim of the complainant is barred by limitation seeks the dismissal of the complaint with costs.

1. In substantiation of the contentions while the complainants side has taken reliance on the documentary record in Ex.A1 to A8, Ex.X1 and X2 and evidence of Pw1 and 2 besides to the sworn affidavit of complainant’s mother and replies of the opposite parties to its interrogatories, the opposite parties has taken reliance on Ex.B1 to B4, evidence of Rw1 to 4 and sworn affidavit of opposite parties No.1 and 3 and reply of complainant side to its interrogatories.

1. Hence, the point for consideration is whether the complainant has made out any medical negligence’s of the opposite parties for his acquired  permanent disability on account of said operation and thereby a liability of opposite parties to his claim.

1. The Ex.A1 is the discharge summary card of inpatient No.52287 showing date of admission to 17-10-2002 and date of discharge to 21-10-2002 for diagnosed hypoxic ischemic brain damage mentioning the investigation done.  From the reverse page of it, pertains to neurology unit of Government General Hospital with neuro medical Number 5159/2002 with patient name P.Moulali. It also consists of another discharge summary card of said patient P.Moulali with I.P.No.47326 in the date of admission to 06-09-02 and discharge to 28-09-2002 and the medial treatment given. There being any complaint as to the treatment covered under above discharge cards they remains with little relevancy for their appreciation in this case.

1. The Ex.A7 -letter dated:10-03-2003 of Dr.K.Narsaram- says of the same complication as found in Ex.A1 to the complainant. The case sheet in Ex.X1 issued by Viswabharati Super Specialty Hospital, Kurnool also envisages of the same complaint to complainant as found in Ex.A1 and A7, while the Ex.A4 is mere prescriptions of Viswabharati Hospital Kurnool relating to complainant and the Ex.A2 is an advance payment receipt of Rs.5,000/- for the amount received from the complainant by said hospital issued on 20-06-2002 and Ex.A3 is list of amounts charged by said hospital from complainant to the tune of Rs.19,800/- after  adjustment of the amount covered in Ex.A2 and the Ex.A5 are two receipts issued by Government General Hospital Kurnool for receipt of Rs.40/- and Rs.15/- for X-ray and E.C.G of the complainant and the Ex.A6 is the  three out patient tickets standing in the name of the complainant. The Ex.A8 is the C.T. Scan examination of brain of complainant taken in Govt., General Hospital Kurnool on 28-07-2002 indicating the symptoms of atrophic changes-showing dilation of all ventricles and prominent suki.
2. As per the case sheet of the complainant in Ex.B2 6.45 P.M. of 8^th June, 2002 the patient (complainant is semi conscious, responding to painful stimulation’s and to verbal commands) and advised the continuance of same line of treatment. No where in Ex.B2 the complication to the complainant as mentioned in Ex.A1, Ex.A7 and Ex.x1.

1.  As the opposite parties alleged unauthorized abscondence of the patient on 08-06-2002 at about 7-00 P.M. discontinuing the treatment and as the Ex.x1 case sheet finds for the first time the complication noted in Ex.A1, and A7 the point remaining for consideration is whether the said complication to complainant has arisen on account of non continuance of the line of treatment at Govt., General Hospital Kurnool by his unauthorized abscondence till he joined Viswabharati Hospital.

1. There being no mention in Ex.x1 that the complainant joined Viswabharati Hospital on being referred by Government General Hospital Kurnool and the date of joining of complainant in viswabharati Hospital from Ex.x1 as appears to be 7-30p.m. of 08-06-2002 the non-availability of the complainant in Government General Hospital Kurnool appears to be true.

1. As the abscondence of the complainant is alleged to about 7-00 P.M. of 08-06-2002, in the absence of any cogent material or evidence that such a complaint as noted in Ex.x1 would develop to the complainant in the said short spell of time i.e., in between the alleged abscondence  from Government General Hospital and joining Viswabharati Hospital the said complaint to the complainant could be undoubtedly believed that even at the time of said unauthorized leaving of the complainant the Government General Hospital Kurnool, the complainant was with said complaint as found by the Viswabharati Hospital in Ex.x1 especially when the evidence of PW1 Dr.K.Narasaram-says of that fact and condition of complainant when brought as unconscious because of hypoxic encephalopthy-(decrease supply of oxygen to brain), which is also known as hypoxic ischemic brain damage. The PW1 says in his evidence that coma stage will arrive to patient in post operative stage if oxygen supply was not there for about half an hour. Even though the written version of the opposite parties says that the patient was given hundred percent oxygen in his post operative care on being shifted to acute medical care, and the entries of 6.45 P.M. of 08-06-2002 at page No.23 of Ex.B2 case sheet also takes mention of air way reflexes are in tact and good as the condition of said patient was noted as semi conscious it implies insufficient supply of oxygen and thereby the negligence in supply of sufficient oxygen the Government General Hospital Kurnool itself appears to have contributed to the complications of the complainant for which the complainant was constrained to take treatment in viswabharati Hospital in N.I.MS Hyderabad which also not cured him but on the other hand made him beyond recovery as opined in the evidence of PW1 and PW2.

1. The Ex.B1 is the enquiry report of the committee constituted by Collector and District Magistrate and Chairman Hospital Development Society, Kurnool and the office known put up by Superintendent Government General Hospital Kurnool, to the Collector Kurnool.

1. From the said enquiry report it appears that the said committee has given its opinion after going through the document provided by the office of the Superintendent Government General Hospital Kurnool, which from the tenor of the wordings of said report appears to be nothing but the very case sheet of the patient. It mentions patient by name Moulali admitted on 06-06-2002 in surgical unit-IV with acute abdomen pain diagnosed as acute appendicitis was operated on 07-06-2002 by Dr.Radhakrishna Assistant Professor Surgery Unit-IV under spinal anesthesia given by Dr.Dhanunjaya tutor in anesthesia department during surgery patient developed hypotention and Brady Cardia and it was immediately resuscitated with endotracheal intubtation and surgery was continued. After completion of surgery as the pluse rate of the patient was observed at 104 per minute and B.P. at 120/95 mm.Hg.patient was shifted to  acute medical care unit for ventilator support and condition of patient thereafter and line of treatment given till 6-45p.m. of 08-06-2002 as broadly mentioned in the case sheet.

1. Hence, the above contents of Ex.B1 report are nothing but the reproduction of the matters mentioned in Ex.B2 case sheet. As the said Ex.B1 report reads that after going through above available record it has arrived at the conclusions-the said committee appears to have arrived its conclusion on the basis of said case sheet only and not being driven by any other material enquiring with any body who can say in that regard. It appears so as the evidence of its constituent committee member Dr.W.Seetaram (RW1, Dr.K.Narasaam PW2 and  Dr. B.Ramachandra Reddy RW2) say any other enquiry made by it in that regard expect going to said Ex.B2 case sheet. The evidence of Dr.M.Umamaheshwar (RW3 is also not making the case any thing better as the evidence is also on the basis of the very case sheet. Neither there appears any material in evidence of the supra stated witnesses concerned to said Ex.B1enquiry  report nor in the evidence of Rw3 that there was any intelligible enquiry with concerned doctors who performed surgery and administered anesthesia to said patient in reference to the entries of the case sheet and the circumstances leading to the alleged complications to the complainant in reference to his condition at that time and in reference to the reasonable taken care and caution taken by said doctors in seeing the patient non being effected by possible complications either anticipated or unanticipated and the efforts they have made in that regard. Hence, in the absence of any cogent material all the endeavour of said committee concerned to said Ex.B1 enquiry report and the evidence of RW3 in reference to the case sheet in Ex.B2 appears to merely certify the entries of the Ex.B2 case sheet. Therefore the said Ex.B1 enquiry report carries any value worthy of appreciation in favour of the opposite parties as it is not remaining above the comment of an endeavour of the birds of same feather to save its alike.

1. The Ex.B1 enquiry report of the specially constituted doctors to hold enquiry as to the grievances pertaining to the treatment of the complainant, says the surgical operations of the complainant for acute appendicitis was conducted by Dr.Radhakrishna while anesthesia was administered by Dr.Dhanunjaya-tutor in anesthesia department. The entries of page No.16 of Ex.B2 case sheet of Govt., General Hospital Kurnool pertaining to the complainant says the operation of appedicectomy and spinal was done on 07-06-2002 from 7.40 A.M. to 8-15 a.m. by surgeon Dr.Radhakrishna Assistant by Dr.Chandrasekhar-P.G. and Dr.Naveen H.S (House Surgeon) and Dr.Dhanunjaya Anesthetist and Dr.Danam P.G. as Anesthetist. The entry at page No.3 of Ex.B2 merely mentions the care of patient under Ramnath M.S. No where the Ex.B2 says of any of his concern in the operation conducted to said patient Moulali. Hence, there remains any basis for complainant’s contentions that due to neglect attitude of the opposite party No.2 (Dr.Ramnath in conducting the operation the entire life of the complainant’s spoiled and so there appears any concern of opposite party No.2 either in said operation to the complainant or in its consequential effects on account of any subsequent negligent services in treatment to the complainant. Therefore, the opposite party No.2 to this case appears to be a mis-joinder and so the complainants case does not with stand as to opposite party No.2 and consequently the case of the complainant is dismissed against opposite party No.2.

1. The opposite party No.3 Dr.Dhanunjaya, Anesthetist was brought on record vide orders dated 15-04-2005 in I.A. No.58/2005 of C.D.No.146/2004 as his im-pleading was merely felt essential for just adjudication of the matters in controversy in this case. The Honorable Supreme Court in Ramalingam Chettiear V/s. P.K.Pattabhiramam and another reported, in A.I.R. 2001 S.C. page 185 says the limitation begins to run from the date of impleadment of party in the case when no order if passed under provision to section 21 limitation act that the impleading act newly added party shall take effect from the date of institution of the case. As there is no such contemplated order in order dated 15-04-2005/I.A.No.58/2005 of C.D.146/2004 the statutory limitation of two years for filing the case in the forum against the opposite party No.3 commences from the date of cause of action i.e., 07-06-2002 and hence the date of his impleadings being beyond two years to the cause of action the case against opposite party No.3 remains barred by limitation i.e., as opposite party No.3 was permitted to brought on record on 15-04-2005 and that being not within the statutory period of  prescribed limitation of two years to sue the opposite party No.3 for any of his medical negligence in administering the anesthesia to complainant for enabling the operation the case of the complainant against the opposite party No.3 remains time barred. Hence, the case against opposite party No.3 stands dismissed for want of limitation to complainant’s cause of action against the opposite party No.3.

1. The evidence of PW2 Dr.A.S.Keerthi Consultant Neuro physician Medicity Hospital,  Hyderabad to whom the complainant was referred on 29-03-2003 while he was doing doctorate in medicine in N.I.M.S. Hyderabad, during January 2003 to December 2005, besides saying of the observations he made on the complications with which the complainant was then-opines that the said complications to the complainant has arisen during the course of operation and the said condition of the patient not improved even at the time of his discharge from  N.I.M.S. on 01-04-2003 and the same condition was persisting with the said patient. The evidence of Pw1 K.Narasaram says the said patient cannot recover from said complaint inspite of any treatment and the medication given to said patient (complainant) by him was not curative but only protective from developing further damage.  The above material shows the gravity of damage occurred to the normality  of the patient condition at the irresponsible  conduct and care the Government General Hospital has displayed at the patient in not keeping a vigilant watch  as if the conduct of the  said Govt., General Hospital, Kurnool is otherwise it would have either prevented the so called abscondence of the patient who is alleged to be at recovering stage taking into account the welfare of the  patients or would have obtained the material in writing that the said leaving of the patient was voluntarily against advise and so any responsibility  of the hospital  for any ill-consequences that follow on said shifting from the line of treatment the said patient was undergoing at that time.

1. The evidence of RW2 Dr.Ramachandra Reddy says that the complainant would have recovered if not absconded. But it would have some weight if the complainant not continued his treatment any where thereafter. While the Ex.B2 shows the last treatment attended to said patient was at 6.45 P.M. of 08-06-2002 and not definite of actual time of his so called abscondece from Government General Hospital, Kurnool the Ex.x1 case sheet of viswabharati Super Specialty Hospital Kurnool pertaining to the complainant (patient) shows his admission for treatment from 7.30 p.m. of said 08-06-2002 itself. If nothing is abnormal in compliance to condition during his last treatment at Govt., General Hospital Kurnool and especially when the patients alleged recovering stage is true, the said patient would not have been found in Ex.x1 as at the stage of hypoxic ensepalopahty at the time of the admission of the complainant at viswabharati super specialty Hospital, Kurnool. If the patients condition was so warranting supply of continuous oxygen and any of its discontinuance for a little time even disrupts the patients brain the said hospital authorities (i.e., Government General Hospital Kurnool) should have kept a proper vigilance not only on said patients treatment but also his moments. The deficiencies of services said Government General Hospital Kurnool is remaining quite clear in not keeping a proper vigilance on the said patient who require continuous treatment with itself. A person who is having any abnormality of health except the complaint the alleged would enter the hospital for treatment to his complaint with a preponderance or fond of hope to get cured properly and leave hospital in a hormonious mood of the satisfaction of medical services he was rendered. Hence, a person without any abnormalities was seriously effected of health that to if acquired a permanent disability while under going treatment which cannot be cured of any treatment necessarily implies either the medical negligence’s in his treatment or deficiencies of services in said hospital at him in the process of treatment and recovery. The rendering of free service  will not be an excuse in such cases as service is service irrespective of the fact of  any charging for it or not . So in such cases the liability for patients suffering will be in equal to the hospital management with its doctors who must have rendered said negligent or defective services which left a disastrous effect on the patients health during treatment and consequent thereon.
2. The Honorable Supreme Court in Smt.Savitha garg V/s. Director National Heart Institute reported, in, 2004 C.T.J. page 1009, says if the hospital fails to discharge their duties through their doctors being employed on job basis or employed on contract basis, it is the hospital which has to justified and by not impleading a particular doctor will not obsolved the hospital of their responsibilities.

1. Hence, irrespective of the fact that the concerned doctors  were not being proceeded in this case either on account of non joinder or being barred by limitation the  liability of the opposite party No.1 i.e., Government General Hospital Kurnool headed by its superintendent doesn’t cease on the other hand lies for compensation at the negligent and  deficient acts of its employee doctors for the permanent disability suffered by the complaint due to appendicitis surgical operation and so to may good of compensation for the said suffering of complainant.

1. The complainant in this case is a tender aged person who is having more life to lead with said incurable permanent disability acquired due to said operation conducted in Government General Hospital Kurnool by its doctors under control of opposite party No.1. In the said circumstances of hardship remaining to the complainant for a major part of his life the compensation of Rs.2,00,000/- sought by the complainant for his suffering doesn’t appear to be either exorbitant or not justifiable.

1. The circumstances of the complainant making an unendle legal battle for justice through out making approaches to all other possible ways and means shows the gravity of mental agony he was put to in this regard. Hence, an amount of Rs.50,000/- appears to be justifiable to the entitleness of the complainant from the opposite party No.1 towards the mental agony.

1. As the complainant was driven by the opposite parties by its evading conduct to its vicarious liability at the acts of it subordinate doctors an amount of Rs.20,000/- as costs of this litigation to the entitleness of the complainant at the liability of the opposite party  No.1 appears to meet the ends of justice.

1. In the result, the case of the complainant is allowed against the opposite party No.1 only dismissing against the other opposite parties. Consequently the opposite party No.1 is directed to pay the above award to the complainant with in a month of the receipt of this order. In default the liability of the opposite party No.1 to pay the award amount with 9% interest commences from the date of said default till realization.

Dictated to the Stenographer, transcribed by him, corrected and pronounced in the Open bench this the 15^th day of February, 2007.

MEMBER                                                                                         PRESIDENT

APPENDIX OF EVIDENCE

Witnesses Examined

For the Complainant:- PW 1 and 2  For the Opposite Parties:- RW 1 to 4

List of Exhibits marked for the complainant:-

Ex.A1          Discharge Summary Card.

Ex.A2          Cash bill dated 20-06-20021 for Rs.5,000/- issued by Viswabharati Super Specialty Hospital, Kurnool.

Ex.A3          Bill dated 12-07-2002 issued by Viswabharati Super Specialty Hospital, Kurnool.

Ex.A4          A Bunch of 32 prescriptions issued by Viswabharati Super Specialty Hospital, Kurnool.

Ex.A5          Two payment receipts issued by Government General Hospital, Kurnool for Rs.40/-, and Rs.15/-.

Ex.A6          A Bunch of (3) O.P. to clients issued by Government General Hospital, Kurnool.

Ex.A7          Letter of Dr.K.Narasaram dated 10-03-2003 to Dr.A.B.Taley.

Ex.A8          C.T Scan Examination of Brain, dated 20-07-2002 by Government General Hospital, Kurnool.

Ex.X1          Case Sheet (Viswabharati Super specialty Hospital, Kurnool).

Ex.X3          Progress record of Nizam’s Institute of Medical Sciences dated

29-03-2003.

PW1            Deposition of PW1 (Dr.K.Narasaram) dated 05-09-2005.

PW2            Deposition of PW2 (Dr.A.S.Keerthi) dated 12-04-2006.

List of Exhibits marked for the opposite parties:-

Ex.B1          Enquiry Report.   

Ex.B2          Case Sheet (Pertaining to the petitioner named Moulali).

Ex.B3          Relevant endorsement on 08-06-2002 at Ex.B2.

RW1           Deposition of RW1 (opposite party No.3) (Dr.W.Seetharam)

dated 20-10-2005.

RW2           Deposition of RW2 (opposite party) (Dr.B.Ramachandra Reddy) dated 13-12-2005.

RW3           Deposition of RW3 (Dr.M.Uma Maheswar) dated 06-01-2006.

RW4           Deposition of RW4 (Dr.A.Lakshman Rao) dated 10-08-2006.

MEMBER                                                                                      PRESIDENT

Copy to:

1. Sri.P.Siva Sudarshan, Advocate, Kurnool.

2. Smt.D.S.Saileela, Advocate, Kurnool.

3. Sri.Lakshmi Reddy, Advocate, Kurnool.

4. Sri.A.Siva Ramaiah, advocate, Kurnool

Copy was made ready on:

Copy was dispatched on:

Copy was delivered to parties