DISTRICT CONSUMER DISPUTES REDRESSAL FORUM PALAKKAD
Dated this the 16th day of August 2017
Present : Smt.Shiny.P.R. President
: Smt.Suma.K.P. Member Date of filing: 06/06/2015
: Sri.V.P.Anantha Narayanan, Member
(C.C.No.79/2015)
Sivadasan,
S/o Ramakrishnan,
Kuppiyode, Marutharode,
Palakakd. - Complainant
(Adv.B.Sreeprakash)
V/s
1. The Chairman, - Opposite party
Palaana Hospital,
Kannadi, Plakkad.
2. Dr.Shibu Mathew,
Orthopedic Surgeon,
Palaana Hospital, Kannadi,
Palakkad.
(Adv.V.K.Venugopalan)
O R D E R
By Smt.Suma.K.P. Member
The case of the complainant is that on 09.01.2013 at about 6.30 pm near FCRI, Kanjikode, complainant met with road traffic accident, and sustained serious injuries. Immediately after the incident complainant was taken to District Hospital. After giving first aid he was referred to a higher centre and was taken to the 1st opposite party’s hospital for better treatment. He was treated by the Orthopedic Department of the 1st opposite party. There was lacerated wounds 2 in number on the right leg with suspected fracture, another deformity was noted on right lower thigh with suspected fractures. On 09.01.2013 to 23.01.2013 complainant was undergoing treatment for the injuries in the 1st opposite party hospital. Hospital authorities told that there is right Supracondylar Fracture Femor, right Tibia Left Radius and surgery was done. Wound debridement was done on 11.01.2013, ORIF right femer with locking plate and bone grafting was done and left radius ORIF was also done. Inter locking nailing of right tibia was done. Antibiotics were administered to the complainant. The complainant alleges that no proper and regular examinations of wounds or area of surgery were made by the opposite party’s. When complained about severe pain there was no serious response. Due to improper management of the wounds injury got infected. Nothing effective was done for preventing the wound being affected, or to control the infection. Ultimately when the infection was beyond control, they advised the complainant to approach a better centre. Hence complainant was taken to Ganga Hospital, Coimbatore on 23.01.2013 and admitted as inpatient. Complainant was treated as inpatient till 13.02.2013. At the time of admission is was brought to the notice that the wound was fully infected and pus was oozing. In spite of earnest effects, solely due to infection, no positive result were shown. Ultimately debridement of above knew amputated stump and secondary closure of the stump was also made. The right knee amputation was caused solely due to the infection developed during the treatment at the opposite party hospital. Complainant continue his treatment upto July 2013. The complainant alleges that he was under the treatment of opposite party and solely due to improper management of wounds, infection developed. The opposite party waited till the situation become so critical. Hence there is clear deficiency of service on the part of the opposite party’s and the complainant is entitled for compensation from the opposite party for their deficiency of service. Complainant is a business man doing distribution business and due to the amputation of knee, he is not in a position to do business and now he is constrained to stop the business. The complainant further submit that he had spend 10 lakhs for treatment and allied expenses. At the age of 62, he lost one leg below knee and he is disabled and depending others even for movement. Hence he had approached before the Forum seeking an order directing the opposite party’s to pay a compensation of Rs.15,00,000/- (Rupees fifteen lakhs only) along with cost of this petition.
Notice was issued to the opposite parties for appearance. Both opposite parties entered appearance and filed their respective versions.
2nd opposite party contended that the complaint is barred by limitation and hence not maintainable. The complainant was brought to the 1st opposite party hospital on 01.01.2013 after 1st aid treatment from District Hospital, Palakkad with history of sustaining injuries following a road traffic accident. As per clinical history he was a chronic smoker with poor lung infection and having Coronary Artery disease. On examination he had Poly Trauma and Multiple fractures, more particularly (1) type II open fracture right tibia (2) Comminuted Supra Condylar fracture right femur, (3) Fracture left radius and (4) Soft tissue contusion of right thigh and right leg. The tibial fracture was open and the complainant’s bystanders were informed about the nature of fracture and treatment by debridement and fracture reduction and complication involved. He was taken up for emergency debridement and wound were debrided and fractures immobilised with slabs under strict sterile condition and admitted to surgical ICU. Post operatively the complainant was started on IV Cefoperazone + Salbactum, Amikacin and Tindazole. Cardiology and Pulmanolgy evaluation was done and he was diagnosed to have Coronary Artery disease with old Anteroseptal MI changes and effort angina, chronic bronchitis and poor lung reserves and treated under the concerned speciality.
On 11.01.2013 the complainant was taken up for minimally invasive TAPRO fixation of Supracondylar Fracture of right femur after explaining the pros and cons of the surgical procedure and with written informed consent. The facture fixation was done with locking condylar plate with bone grafting and open reduction and internal fixation of left radius with DCP plate was also done under general anesthesia. As tribal soft tissue edema was present, tribal fracture fixation was deferred. Tribal wounds were cleaned and dressed. IV linezolid also started and shifted the patient back to surgical ICU and kept under intensive care and observation and continued chest nebulisation on 14.01.2013. The complainant underwent tribal wound debridement and interlocking nailing of tibia under general anaesthesia. Formal wound were cleaned and dressed and drains removed. The patient was continuously managed in the ICU with IV antibiotics as per standard protocol. On 16.01.2013 the complainant had cough and fall in oxygen saturation to 94% and he was attended by the Pulmonologist and diagnosed to have pneumonia and changed antibiotics to IV Piperseillin + Tazobactum and Levofloxacin. The complaint’s chest symptoms improved and on 19.01.2013 he was shifted to the room. On 21.01.2013 the patient had a doubt of breathlessness and shifted back to ICU blebs were seen on the leg below the knee and he was restarted on IV linesolid and metronidazole. On 21.01.2013 no fresh blebs were seen and he was started on IV Netilmycin. Since the patient had persistent of blood the same was discussed with the complainant and his relative regarding reference to higher centre and in discussion with the plastic surgeon at Ganga Hospital, Coimbatore the complainant was referred to plastic surgery department at Ganga Hospital, Coimbatore for further management.
In the 1st opposite party hospital, the complainant was attended and treated by specialised team of Doctors comprising Orthopedics, Cardiology, pulmonology and critical care. His fracture were surgically fixed in a specialised Orthopedic theatre with all sterility precaution including laminar air flow by a well experienced Orthopedic surgeon and treated with broad spectrum highly effective and potent IV antibiotic continuously during hospital stat as per standard protocol. The complainant had a diagnosed bad leg condition due to smoking habit and pneumonia is very common in such patients and the complainant was managed with chest nebulization and medication and responded well. The wounds were dressed in strict sterile condition by the Orthopedic Surgeon himself and right leg was immobilised to bring down the swelling due to severe contusion injury. The complainant had severe soft tissue contusion and under risk of infection in crushed soft tissues even if under broad spectrum antibiotics. The crushed soft tissue cannot be removed or opened up during the first 7 to 10 days, following injury as the same will expose the fractured bone. The complainant was referred for elective plastic surgery procedure for healing of soft tissue in view of persistence of blebs for soft tissue flap cover. The 2nd opposite party had treated the complainant in strict regard to accepted medical practice and there was no negligence or deficiency.
The 1st opposite party also filed version adopting the contentions of the 2nd opposite party.
Complainant filed chief affidavit. Opposite parties also filed their respective chief affidavits. 2nd opposite party filed application (IA 82/2016) seeking permission to cross examine complainant. Application was allowed. Complainant filed another application as IA 126/16 to direct opposite party 1 to produce the original records. Application was allowed. 1st opposite party produced the original case sheet of the complainant. Complainant was cross examined as PW1. Ext.A1 to A3 was marked. Complainant filed application as IA 299/2016 to appoint an Advocate Commissioner to examine the expert witness. Application was allowed and an Advocate Commissioner was appointed to examine the expert doctor Dr.S.Rajasabavathi. The witness was examined through commissioner and CR was filed. Complainant filed another application for examination of 2nd opposite party. Application was allowed and 2nd opposite party was cross examined as DW 1. Ext.B1 series was marked. Evidence was closed and matter was heard.
The following issues that arises for consideration are.
1.Whether there is any negligence on the part of opposite parties in treating the complainant ?
2.Whether there is any deficiency of service from the part of opposite parties ?
3.If so what are the relief and cost?
Issues No.1 , 2 & 3
We have perused the documents as well as affidavit filed from both
sides. According to the opposite party the complainant was referred to Ganga Hospital in discussion with the plastic surgeon at Ganga Hospital, Coimbatore for further management. The complainant had sustained severe soft tissue contusion and soft tissue injuries are associated with high risk of infection due to factors beyond the control of the treating doctor. The complainant was referred to higher centre at the initiative of the 2nd opposite party for considering flap surgery for extensive devitalized soft tissue excision and flap cover which can be done only after 7 to 10 days after surgery and only after fixing the fractures. In the management of the injuries caused to the complainant, the 2nd opposite party had exercised reasonable skill and care in skill strict regard to accepted medical practice and infection was not caused due to any act or omission on his part. According to the complainant the 2nd opposite party was negligent in detecting infection because during cross examination the DW1 (2nd opposite party) has stated that presence of any type of bacteria was not noticed by me, till the time of discharge. Poor lung infection has direct consequence with respect to the injury on the leg. There should be sufficient flow of blood and supply of oxygen so as to heal the wound. The eco test result of opposite party 1 hospital is silent about right sided heart pressure variation. The cardiologist has written that on 10.01.2013, there was no observation to the effect that the patient was unfit for surgery. The 2nd opposite party had also deposed that till 23.01.2013, examination of surgical site was going on. Discharge of the patient from my hospital on 23.01.2013 was around noon. Just before discharge, I did not notice any fresh bleb formation on the body. He had also stated that it will take approximately 48 hours to three months so as to turn a tissue in to pus (page 6 of the deposition first line). Ext.A1 is the discharge summary issued from Ganga Medical Centre and Hospital, Coimbatore, were in it is stated that on 23.01.2013 Under SA and under tourniquet control debridement of extensively infected right distal thigh, right knee and right leg was done. Skin of right leg and right knee was brackens and 200 ml of pus comes out from right knee and 200 ml of pus comes out from right leg. The DW1 had deposed to the effect that on 23.01.2013 when the complainant was discharged from his hospital there were no signs of any bacterial infection. He himself has deposed to the effect that pus formation will take approximately 48 hours to 3 months. Hence, it can be inferred that on the day of admission at Ganga Hospital (23.01.2013) there were about 200 ml of pus coming out from the right knee of the complainant, was due to the development of infection at the time of treatment at opposite party 1 hospital by 2nd opposite party. He himself had admitted that he had not noticed bacteria till the time of discharge. The right knee amputation was caused solely due to the infection developed during the treatment at the 1st opposite party hospital. 2nd opposite party waited till the situation become so critical and efforts whatsoever are taken either to manage the infection by themselves or to refer to a better centre. This amounts to gross negligence and deficiency of service on the part of 2nd opposite party. Issue no. 1 & 2 is answered accordingly. In view of the above discussion we are of the view that the complaint is to be allowed.
Hence the complaint is allowed and we direct the opposite parties jointly and severally to pay an amount of Rs.2,00,000/- (Rupees two lakhs only) to the complainant as compensation for the mental agony suffered by him due to the amputation of the knee. We also direct the opposite party to pay Rs.10,000/- (Rupees Ten thousand only) as cost of this proceedings. Since the complainant had filed a claim before the Motor Accidents Claims Tribunal, Palakkad no amount is awarded to him for further treatment.
The afore said amount shall be paid within one month from the date of receipts of this order failing which complainant will be entitled to realize interest at the rate of 9% p.a from the date of order till realization.
Pronounced in the open court on this the 16th day of August 2017.
Sd/-
Shiny.P.R.
President
Sd/-
Suma.K.P.
Member
Sd/-
V.P.Anantha Narayanan
Member
Appendix
Exhibits marked on the side of complainant
Ext.A1 - Photo copies of Discharge Summary of the complainant issued by Ganga
Medicare Centre & Hospital (P) Ltd, Coimbatore Dated. 13.02.2013
Ext.A2 – Photo Copy of reference letter dated. 23.01.2013 issued by Palana Hospital,
To Ganga Medical Centre
Ext.A3 – Discharge Certificate (Attested) issued by Palana Hospital, Palakkad to Sub
Inspector of Police, Kasaba Police Station, Palakkad
Exhibits marked on the side of Opposite parties
Ext. B1 Series – Case sheet of Shri.Sivadsasan issued by Palana Hospital, Palakkad
Witness examined on the side of complainant
Nil
Witness examined on the side of opposite party
Dr. Shibu Mathew
Cost :
Rs. 5000/-
