::BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,

AT BIDAR::

                                                                                                                                                                  C.C.No. 120/2016

                                                                                                                                                        Date of filing : 05/12/2016

                                                                                                                                                        Date of disposal : 23/04/2018.

P R E S E N T:-                    (1) Shri. Jagannath Prasad Udgata,

                                                                                           B.A., LL.B.,

                                                                                                       President.

                                           (2) Shri. Shankrappa (Halipurgi),

                                                                                          B.A.LL.B.,

                                                                                                   Member.

COMPLAINANT/S:      Nazia Begum W/o Md.Moizuddin,                        

                                    Age: 26 years,  Occ: Household,

                                       R/o Kohir, Dist: Medak Telangana.                                                       

                                    (By Smt.Niroja P Kulkarni, Advocate)

                                                      VERSUS

OPPONENT/S   :-      1.    The director (DEAN) BRIMS

                                           (Govt. Hospital) Bidar                                         

                                    2.    The Superintendent,

                                           BRIMS (Govt.Hospital) Bidar.

                                    3.     Dr. Jaishree, Lady Medical Officer,

                                            BRIMS (Govt. Hospital) Bidar.

                                    4.     Dr. Shashidhar Anesthesia doctor,

                                             BRIMS (Govt. Hospital) BIdar.                                    

                             (O.P.No.1 and 2 By Shri. Vilas Rao M.More, Adv.)

                             (OP.3 By Shri. Nashi Chandrakanth, Adv)

                             (OP-4 Exparte).                                            

::   J UD G M E N T  : :

(DELAY CONDONED)

By Shri. Jagannath Prasad Udgata, President.

1.        The complainant is before this Forum alleging deficiency of service in the part of the O.Ps.1 to 4, by filing a complaint U/s.12 of the C.P. Act., 1986.

2.      The sum total of the case of the complainant is as hereunder:

            The complainant was carrying 09 months pregnancy during the month of May-2014.  She was admitted in the O.Ps’., hospital on 21.05.2014 vide IP No.119319/14 and accordingly the O.P.3 made check up and suggested to undergo several tests which were followed by the complainant.  All the reports were normal.  O.P.3 suggested the complainant to undergo caesarean operation and got completed all the necessary formalities.  Before conducting the caesarean (operation), O.P.4 Anesthesia Doctor had given injection in the back bone of complainant as required for operation and accordingly the complainant became unconscious and thereafter, O.P.3 and 4 had conducted operation and a female child was born to complainant on the same day.  During the course of treatment, as per the suggestion of O.P.3, the complainant tried to walk, but she was unable to walk and became handicapped. She immediately complained about her problem of inability to walk.  The O.P.3 did not give any response to such information and accordingly the complainant was got discharged from the hospital on 28.05.2014.  The doctors not properly attending complainant, told that, she would recover normal health within short period.  The complainant being unable to walk continued in taking necessary treatment, had again underwent treatment as outpatient in Owaisi hospital, Hyderabad on 09.10.2014 and accordingly MRI of lumbar spine was done in the said hospital on 09.10.2014 and the followings problems were found.

1. There were mild disc bulge at L4-L5 level causing indentation over the cal sac.
2. STIR, T2 hyper intense area in sacral and iliac sides of left sides of left SI Joint-suggestive of left sacroilitis.

               Owaisi hospital provided necessary treatment, but the complainant could not recover her original health and became permanently, disabled, lost her strength and walking or standing powers.  It is contended that, as per the instructions of the O.P.3, the O.P.4 being Anesthesia doctor had given injection in the back bone of complainant and while injecting, the O.P.4 was negligent and careless due to which the needle of said injection touched to some vital parts of the back bone due to which there were mild bulging of discs at L4-L5 level and STIR T2 hyper intense area in sacral and iliac sides of left S1 joint as opined by Radiologist of Owaisi hospital Hyderabad as per MRI of lumbar spine report dated 09.10.2014 which  is filed herewith.  Due to the wrong treatment the complainant is still unable to walk and had lost her walking powers and strength and became permanently disabled.  The said illness caused to the complainant due to gross negligence on the part of both the O.P.3 and 4  and hence they are liable to pay the compensation as claimed.  The complainant was quite hale, healthy and young women of 26years age and was attending all her household work and also doing some private work to maintain her family members and earning Rs.15,000/- p.m.  Due to this illness and also on becoming handicapped, she is unable either to attend household work or do any type of work and lost her present and future earning capacity and thus is legally entitled to claim lump sum compensation from the O.Ps.  This forum has got jurisdiction to entertain the complaint.  Hence the complaint is here, claiming for compensation as prayed in the complaint.

3.         The opponents entering into defence on receipt of Court notice, the O.P.1 and 3 have filed their versions.  O.P.4 did not appear, hence, he was placed exparte.  O.P.1 contended in its version that, from the records produced by the complainant herself, it is a fact that, she has taken treatment free of cost in the O.P.1 hospital that to only to the extent of a delivery of a female child. Therefore, legally no complaint can be filed against any of the O.Ps., since it was a free of cost process. IN view of free treatment given to the complainant, the complainant cannot come under the definition of consumer, therefore, the complaint filed by the complainant is not maintainable under the provisions of the consumer Protection Act.   The complainant was admitted in the hospital on 21.05.2014, delivery of the complainant done by caesarean operation and a female child was born to her.  It is submitted by O.P.1 that, the complainant was discharged on 28.05.2014 and as per the contention of complainant, she got herself admitted in the hospital at Hyderabad in the month of October-2014, which clearly goes to show that, the treatment which she had taken in the hospital at Hyderabad is not at all related to the delivery of the complainant.  The O.P.1 and 2 are not related to the diseases for which the complainant has taken treatment in the hospital at Hyderabad.  Therefore, the contention of the complainant is denied.  There is no negligency on the part of any of the Doctors of O.P.1 and  2 Institution who had treated the complainant and their role was to the extent of delivery and further treatment after the delivery till her discharge.  The complications alleged to have been raised by the complaint are nothing to do with the process of delivery and also the alleged complications are not due to any negligence during the process of delivery.  Since there is delay in filing the complaint, the complaint is not maintain able and on the ground of limitation, the compliant is liable to be rejected.  The complainant after 2 months of the delivery might have got some other complications, which are not related to the delivery.  The complainant in order to recover the expenses for the treatment at Hyderabad is falsely alleging they said disease and has filed the present compliant.  Hence, the O.P.1 and 2 pray to dismiss the complaint with cost.

4.            O.P.3 contended in her version that, the complainant is not a consumer, as such the present complaint is not maintainable and the same is liable to be dismissed.  The O.P.3 is not a necessary party to this proceedings, since O.P.3 is working under the O.P.1.  Hence, the complaint is liable to be dismissed against O.P.3.  The complainant got admitted and had taken treatment in the hospital under the O.P.3.  The complainant might have taken treatment in Owaisi Hsopital at Hyderabad.  O.P.3 was not negligent in giving the treatment to the complainant during her stay in the hospital.  The alleged complications have not arisen out of any negligence of the O.P.3.  the O.P.3 submits that, on perusal of entire allegations made in the complaint, nowhere it is alleged the manner in which the O.P.3 is negligent and what way exact negligence meted out to the complainant while giving the treatment in the hospital.  In the absence of specific allegations in  the complaint in proving negligence and the resultant deficiency in service, the compliant is not maintainable.  The complaint is not filed within time, hence the same is barred by limitation and liable to be dismissed.  The O.P.3 further stated that complainant got herself admitted in the hospital for delivery.  The O.P.3 on duty examined the complainant, suggested for relevant investigations and going through the investigation reports and clinical examination, the O.P.3 advised the complainant for LSCS after explaining the risk of procedure and anesthesia and after examining the anesthetist on duty after giving anesthesia LSCS was done and a live baby was extracted and surgery and postoperative period was uneventful till 26.05.2014.  Further, on 26.05.2014, the complainant explained of pain in the back and leg while walking and to rule out the anesthesia complications, O.P.3 called the anesthetist immediately and he suggested medication and review and further on 28.05.2014, when she was referred for orthopedic opinion to rule out ay orthopedic cause, the patient went out against the medical advice before orthopedician could examine her.  From the above facts it is very clear that, the O.P.3 is not at all negligent in giving the treatment to the complainant during her stay in BRIMS Bidar.  The alleged complication is not complications arising out of LSCS (Lower Segment Caesarean Section ) Casesarean/operation by O.P.3. and O.P.4 being an anesthetist and expert in his work had given the anesthesia required to be given before LSCS operation independently during the course of discharge of his duty.  In view of the above, there was no negligence on the part of the O.P.3 during the course of LSCS operation and further necessary treatment required from time to time was attended.  This fact is proved by the case sheet of the complainant maintained in BRIMS Bidar and as such the complaint is liable to be dismissed against O.P.3.  Hence, she prays to dismiss the complaint with cost.

5.             The complainant has filed documents, detailed at the end of this order, so also the complainant has filed evidence affidavit justifying her side.  On the other hand, the O.P.3 has filedevidence affidavit justifying her side.   Both the complainant and O.P. have filed their written arguments respectively.

6.            Considering the contention of the complainant, the following points arise for our considerations.

1. Whether the complainant has proved that  there is deficiency in service on the part of the O.P?
2. What order?

7.           Our answers to the points  stated above are as follows:-

1. In the negative.
2.  As per final orders owing to the following:-

:: REASONS ::

8.  Point No.1:-   Since serious questions of high medical complications were involved, we vide an order date: 29.07.2017, had directed the registry to transmit all the papers in the case file to  the Karnataka Medical Council to analyse the etiology of the case, course of treatments administered to the patient at BRIMS Hospital and to further analyze the same vis-a-vis the treatment records of Owaisi Hospital, Hyderabad and to convey the councils opinion regarding Medical negligence.

9.          Such report received from the Medical Council now forms part of the case record and at page 2 to 3 the council has opined as follows:-

The records of inpatient of the petitioner at Owaisi Hospital was also obtained and reviewed by the Council.  As per the records, patient was treated for acute lumbago and left sacro iliatis.  As per the Expert opinion taken internally by the Council and citations reviewed by the Council- Council is of the opinion that the present complaint of the petitioner is not related to spinal anesthesia or caesarean section which she has undergone.

                  Review of the literature.

1. Low back pain in pregnancy: Investigations, Management and Role of Neuraxial analgesia and Anaesthesia: A Systematic review: Herman Sehmbi, Rohan D’Souza, Anuj Bhatia: Gynecologic and Obstetric Investigation:

Low back pain (LBP) is commonly experienced during pregnancy, affecting approximately 50% of pregnant women.  It is associated with significant morbidity in pregnant and post partum patients with persistent pain lasting 2 years in a tenth of the patients.

2. Low back Pain and Pelvic Girdle Pain in Pregnancy: Journal of the American Academy of Orthopaedic Surgeons: Casagrande, Danielle MD, Gugala, Zbigniew MD, Phd; Clark, Shannon M.MD., Lindsey, Ronald W.MD:

PGP typically begins by the end of the first trimester, peaking between the 24^th and 36^th gestational weeks; this usually resolves spontaneously within 6 months postpartum; however, in 8% to 10% of women, the pain continues for 1year to 2 years postpartum.  The incidence of PGP in pregnancy ranges from 4% to 76%, depending on the definition used, which often includes LBP.  When defines as pain located from the level of the posterior iliac crest and the gluteal fold over the anterior and posterior elements of the bony pelvis, the prevalence has been reported as ranging from 16% to 25%.  However, the precise definition of PGP often overlaps with that of LBP, inherently making all frequency indices obligatory estimates in the literature.

3. The Second ASRA Practice Advisory on Neurologic Complications Associated with Regional Anesthesia and Pain Medicine: Executive Summary 2015:

Neal, Joseph M.MD; Barrington, Michael J.MBBS, fanzca, PhD; Brull, Richard MD; Hadzic, Admir MD; Hebl, James R.MDII; Horlocker, Terese T.MD; Huntoon, Marc A MD; Kopp, Sandra L.MD; Rathmell, James P.MD; Watson, James C.MD; Regional Anesthesia and Pain Medicine:

Our final conclusion is very similar to that made in 2008: Neurologic complications associated with regional anesthesia and pain medicine are rare- particularly those complications that do not involve hematoma or infection.  Understanding the pathophysiology and risk factors associated with neuraxial and peripheral nerve injury may allow anaesthesiologists to minimize the number of adverse neurologic outcomes.  Unfortunately, even with flawless care of otherwise health patients by well-trained physicians, these complications are neither completely predictable nor preventable.  This practice advisory offers a number of recommendations specific to common clinical scenarios encountered in everyday practice.

10.       The findings and Conclusions of the expert body clinches the whole issue, where in no fault has been attributed to the O.P.s.

11.       Additionally, we have before us a ratio decidendi of the Hon’ble National Commission, reported in:-

            2016(4) CPR-569(NC).

Garlapati Kameshwar Rao ad Another v/s Kinnera Superspeciolity Hospital were in it has been held as here under:-

            “Simply because a patient has not favourably respondent to a treatment given by a doctor or Surgery has failed, doctor cannot be held straightway liable for medical negligence- sometimes despite best efforts, treatment of doctor fails- That does not mean that, doctor or surgeon would be held liable for medical negligence”.

12.       The above ratio has been adopted by the Hon’ble Chhatisgarh State Commission in the case Aurn Mishra V/s Dr. Srikant Gini, reported in 2017 (1) CPR 38.

13.       Owing to the discussions aforesaid, we find no medical negligence or deficiency of service and answering thepoint in negatice, proceed to pass the following:                                               

                                                  ::ORDER::

1. The complaint is rejected,
2. There would be no order as to cost or otherwise.

(Typed to our dictation then corrected, signed by us and then pronounced in the open Forum on this 23^rd day of April-2018)

   Sri. Shankrappa H.                                             Sri. Jagannath Prasad                                  

Member.                                                                President.                                                                                          

Documents produced by the complainant

1. Ex.P.1- Acknowledged copy of representation to BRIMS
                  date: 19.05.2016.
2. Ex.P.2–  Office copy of legal notice dated- nil.
3. Ex.P.3–  Original final bill and ancillary documents (29 sheets) of
                  Owaisei Hospital and Research Centre, Hyderabad
                  date: 01.07.2014.

 Document produced by the Opponents.

–Nil-

Witness examined.

Complainant.

1. P.W.1-   Smt. Nazia Begum W/o Md. Moizuddin (complainant).

Opponent No.1

1. R.W.1- Dr.Jayashree W/o Ratikant, Asst.Professor BRIMS, 
                  Bidar.

Sri. Shankrappa H.                                             Sri. Jagannath Prasad                                  

       Member.                                                                      President.