CONSUMER DISPUTES REDRESSAL FORUM

Palakkad, Kerala

Dated this the 21^st  day of July 2014

PRESENT : SMT. SEENA. H, PRESIDENT                         Date of filing: 23/08/2013

                : SMT. SHINY.P.R ,MEMBER

      : SMT.SUMA K.P, MEMBER

CC/139/2013

Sheeja.K

D/o. Krishnankutty. K,

Kundulil Veedu,

Perumudiyur Post,

Pattambi 679 303                                                              : Complainant

( By Adv. K.K. Prasanth)                                                           

Vs

1.The Managing Director,

Valluvanad Hospital,

Ottapalam 679 104.

2.Dr. Sarala Ramachandran,

W/o. Dr. Ramachandran,

Palat Road, Ottapalam.                                                       : Opposite parties

( By Adv. V.K.Venugopalan)

                                                               O R D E R

By Smt. Suma. K.P, Member,

Brief case of the complaint :-

The case of the complainant  is that she went to consult the 2^nd  opposite party in the outpatient department  at the 1^st  opposite party hospital on 30/01/2012 with complaints of  menorrhagia ( excessive bleeding during periods) and severe dysmenorrhoea  ( painful periods) of two years duration. On examination the 2^nd opposite party  opined that there are fibroid growths in the uterus and the uterus to be removed completely .  According to the advice of 2^nd opposite party on 2.2.2012, she got admitted in the 1^st opposite party hospital and on 3.2.2012 operation was conducted.  After the operation urinary catheter was put for draining urine.  She felt unbearable  pain after the surgery and urine was drained without any control.  She informed the fact to the 2^nd opposite party but 2^nd opposite party only prescribed tablets for 7 days.  When the incontinence continued  she approach the 1^st opposite party hospital so as to consult the 2^nd opposite party .  But 2^nd opposite party was not available at station and the hospital authorities  advised her to contact Dr.Chithra.  Dr.Chithra directed her to consulted  urologist, Dr. Manoj in the same hospital and Dr. Manoj expressed his inability to treat her in the hospital.

 She went to Sevana hospital, Patttambi and then consulted Dr. Velayudhan.  As per his direction she went to Saroja Nursing Home, Thrissur for endoscopy.  Dr. Velayudhan opined that due to negligence in the  surgery conducted by 2^nd  opposite party  the complainant  has sustained three holes in the urinary bladder. Operation was conducted and the defect was rectified.  The complainant alleges  that, the  injuries was caused  to the bladder and in  the urinary track  due to the negligence on the part of 2^nd opposite party .  Since the complainant  was an RD agent she states that  she could not attend her job due to illness.  She had spent around Rs. Two lakhs for her treatment at various hospitals.  She claims a compensation of Rs. 18,20,000/- in total from the opposite parties.

Notice was issued to opposite parties  for appearance. Opposite party entered appearance through counsel and filed version stating the following contentions.  The 2^nd  opposite party admits that the complainant came to consult in the outpatient department of 1^st opposite party hospital on 30.1.2012 with complaints of menorrhagia( excessive bleeding during periods) and severe dysmenorrheoa( painful periods) of 2 years duration.  Her last menstrual period was on 11.01.2012 .  She was anaemic and as per investigation results haemoglobin level  was 7.1 gm% urine and other lab tests were within normal limits .  As per vaginal examination uterus was found enlarged with multiple fibroids.

Based on clinical findings as per examination, the 2^nd opposite party advised Ultra Sonographic examination of pelvis which confirmed the diagnosis  of multiple fibroids of uterus. 2^nd opposite party advised the complainant to undergo abdominal hysterectomy  which is the accepted surgical procedure for the diagnosed disease  condition and posted for surgery on 03/2/2012. 

The complainant got admitted to the 1^st opposite party hospital on 02/02/2012 and she underwent necessary   pre-operative investigations anaesthetic check up and found fit for surgery.

The 2^nd opposite party had explained the pros and cons of abdominal hysterectomy including the complications to the complainant  and her relatives and they voluntarily gave written  informed consent.  Under all aseptic care and precautions the 2^nd opposite party proceeded with total abdominal hysterectomy with bilateral salpingo oopherectomy on   03/02/2012 and urinary catheter was inserted pre-operatively.

Intra operatively uterus was found enlarged with 18 to 20 weeks size and having multiple fibroid tumours.  Adhesions present between uterus and rectum posteriorily which was released and total abdominal hysterectomy with bilateral salpingo oopherectomy was uneventfully completed.  2 pints of blood transfused and clear urine was draining through catheter.  She was kept under close observation and she did not have hematuria or any other complications post operatively.  Catheter was removed on 05/02/2012 and sutures on 08/02/2012 and the complainant was discharged without any complaints on 08/02/2012 .

The complainant came up for follow up review on 15/03/2012 with histopathology report and the report confirmed the diagnosis of fibroid uterus.  She had complained of painful micturition and urinary frequency.  Clinical examination showed healthy healing of wound and vaginal vault.  She did not show clinical symptoms to suspect urinary involvement and there was no smell of urine also.  The 2^nd  opposite party advised plenty of oral fluids and prescribed antibiotics.

The next review of the complainant was on 16/04/2012 but the 2^nd opposite party was on leave on medical reasons on that day.  Another gynecologist in the same department, namely Dr. Chithra had attended the complainant and the patient had complaints of burning sensation on micturition. On examination wound was healthy and abdomen was soft and per vaginal examination did not reveal any abnormality.  The complainant was advised urine culture and sensitivity and prescribed medicines.

On 27/04/2012 the complainant reported with complaints of recent urinary frequency and urgency and she was referred to the Urologist.  The Urologist examined the patient and conducted USG examination and since there was nothing abnormal she was given symptomatic treatment . The complainant again reported to the Urologist on 04/05/2012 and  she was advised same line of management through medication for two weeks.  Thereafter the complainant did not turn up for review and lost further follow up.

The diagnosis of fibroid uterus and its surgical treatment by total abdominal hysterectomy with bilateral salpingo oopherectomy conducted by the 2^nd opposite party was apt and proper procedure and it was done with due care and expertise.  The complainant’s case that she had been suffering from urinary incontinence since the surgery is quite improbable as during the course of post  operative  management.  She never reported urinary incontinence as a specific symptom. As per the records, the complainant went to Saroja Nursing Home two months after her last review in the 1^st opposite party hospital with complaints of urinary incontinence.  Hence it is obvious from the clinical manifestation  that the complainant developed Vesico Vaginal Fistula (V V F) as a complication with belated presentation.

The presence of adhesions with history of previous pelvic surgeries and inherent  weakness of the  bladder wall can increase the chance of infection and fistula formation in natural course after abdominal hysterectomy.  The occurrence of V V F following any pelvic surgery is a reported complication even if the medical practitioner exercises maximum care and expertise.

          1^st opposite party adopted the contentions raised by the 2^nd opposite party and denied negligence or deficiency in service on the part of the hospital. The absence of  specific pleadings as to the negligence on the part of the hospital,  in the complaint was also highlighted. The opposite parties prays for dismissal of the complaint.

          Complainant as well as opposite parties  filed their respective chief affidavits  Ext. A1 to A3  was marked from the side of complainant.  Ext. B1 was marked on the side of opposite parties . No oral evidence was adduced by the complainant or any expert was examine to substantiate her allegations  contented in the complaint.  Evidence was closed and matter heard.

The following issues are to be considered.

1. Whether there was any negligence on the side of opposite parties?
2. Whether the allegations in the complaint was due to the negligence of the opposite parties?
3. Whether there is any deficiency in service from the part of opposite parties?
4. If so, what is the relief and cost?        

ISSUES 1 & 2

All the points can be considered together in the set of circumstances -  It is revealed from Ext. A1 and A2 that complainant was  treated at the 1^st opposite party hospital as hysterectomy was done to her.  From Ext.  A3 it can be seen that she was treated at Saroja Nursing Home by one Dr.  A.C Velayudhan as inpatient for 10 days  and surgery was conducted  for V V F repair.  Opposite party had produced Ext. B1 which was case sheet with respect to the complainant .  There is no complaint of incontinence or leakage seen  recorded in  the case sheet.  After two months the complainant went to Saroja Nursing Home with complaints of  urinary incontinence. From the clinical manifestation it is seen that the complainant had developed Vesicovaginal Fistula (V V F) as a complication with belated presentation.  According to the opposite parties the presence of adhesions  with history of previous pelvic  surgeries and inherent weakness of the bladder wall can increase  the chance of infection and fistula formation after abdominal hysterectomy.

          There is absolutely no evidence on record beyond the affidavit of complainant herself to show that she developed V V F due to the negligence on the part of 2^nd opposite party and V V F developed as a result of negligence  during hysterectomy. Complainant has not produced any expert evidence and medical literature to support her plea.

The above materials available on records coupled with  the documents relied on by both sides and for details of  discussions held  in the complaint as well as  in the version, there is no other option but to conclude that complainant had failed to prove the issue No.1 and it is  assured  in the negative.  Since point No.1 is against the complainant, she is not entitled to claim any compensation in this case.

 In view  of the above discussion we are of the view that complainant  miserably failed to prove the allegations in the complaint. Hence the complaint is dismissed without cost.

           Pronounced in the open court on this the 21^st  day of July 2014.

                                                                                              Sd/-

                                                                                           Smt. Seena. H

                         President

                              Sd/-

                      Smt. Shiny. P.R

                          Member

                           Sd/-

                     Smt. Suma. K.P

                           Member

APPENDIX

Exhibits marked on the side of the complainant

Ext.A1 -   Original  Discharge card issued by Valluvanad Hospital Op.No. 1112/49377       

Ext.A2-  Original Discharge card issued by Saroja  Nursing Home O.P. No. 16017       

Ext.A3 -  Letter sent by complainant to  1^st opposite party dated 25/03/2012

Exhibits marked on the side of the opposite parties

Ext.B1- Inpatient Record (Case sheet) Hosp. No. 1112/49377 dated 2/02/2012         

Witness examined on the side of complainant

Nil

 Witness examined on the side of opposite parties

Nil 

Cost allowed

Nil