Kerala

StateCommission

A/12/637

Bhumiraj Kandal - Complainant(s)

Versus

The MD,Ernakulam Medical Centre - Opp.Party(s)

Vivek Varghese P J

25 Apr 2016

ORDER

KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION SISUVIHARLANE VAZHUTHACADU THIRUVANANTHAPURAM

 

APPEAL NO.637/2012

JUDGMENT DATED:25/04/2016

(Appeal filed against the order in CC.No.333/2007 on the file of CDRF, Ernakulam, order dated : 30.04.2011)

 

PRESENT

 

SHRI.K.CHANDRADAS NADAR  : JUDICIAL MEMBER

 

SMT. A. RADHA                             : MEMBER

 

APPELLANTS

 

1. Bhumiraj Kandal,

          S/o. Leeladhar Kandal,

          TCC Colony, Udyogamandal,

          Kalamassery.

 

2. Meenu Kandal,

          D/o. Bhumiraj Kandal,

          TCC Colony, Udyogamandal,

          Kalamassery.

 

3. Subash Kandal,

          S/o. Bhumiraj Kandal,

          TCC Colony, Udyogamandal,

          Kalamassery.

 

          (BY Adv: Sri. M. Nizamudeen)

 

                                      Vs.

 

RESPONDENTS

 

1. Ernakulam Medical Centre (P) Ltd.,

          NH Byepass, Palarivattom,

          Cochin – 682028,

          R/by its Managing Director.

 

2.      Dr. P.S. Binu,

          Ernakulam Medical Centre (P) Ltd.,

          NH Byepass, Palarivattom,

          Cochin – 682028.

                  

3. Dr. Deepak R Nair,

          Ernakulam Medical Centre (P) Ltd.,

          NH Byepass, Palarivattom,

          Cochin – 682028.

 

          (By Adv: Sri. T.C. Krishna)

 

JUDGMENT

 

SHRI.K. CHANDRADAS NADAR : JUDICIAL MEMBER

          Appellants are the complainants in CC No.333/2007 in the CDRF, Ernakulam.  They are the husband and children of Pavithra Kandal who died on 26.10.2006 while she was undergoing treatment at the 1^st opposite party hospital.  The 2^nd opposite party was the surgeon and the 3^rd opposite party was the anaesthetist working in the 1^st opposite party hospital at that time.   The allegations in the complaint were that in 2006 Pavithra was diagnosed with lump in her left breast.  She consulted  

Dr. Sobhana Lakshmi, Medical Officer, Travancore Cochin Chemicals Ltd.  As per the direction of the medical officer, she underwent mammogram of both breasts at Amritha Institute of Medical Sciences, Kochi in September, 2006.  After considering the report Dr. Sobhana directed Pavithra to approach the 1^st opposite party hospital.  Accordingly Smt. Pavithra consulted the 2^nd opposite party on 4.10.2006, 9.10.2006 and 16.10.2006.  On 26.10.2006 Pavithra underwent excision biopsy of left breast lump under general anaesthesia.  At about 5.45 PM, the hospital authorities informed the 1^st complainant that Pavithra died in the operation theatre.  As per the post mortem report Pavithra died of pheochromocytoma and its complication precipitated by anaesthetic administration and surgical stress.  According to the complainants negligence on the part of the opposite parties and improper administration of anaesthesia are the causes of death of Pavithra.  The opposite parties are guilty of negligent diagnosis and failed to take proper care of the disease.  Hence they approached the consumer forum for  compensation of Rs.5 lakhs.

          2.      Opposite parties 1 and 3 filed joint version and the 2^nd opposite party filed separate version.  According to opposite parties 1 and 3 Smt. Pavithra consulted the 2^nd opposite party on 4.10.06 with complaints of pain and swelling of her left breast.   Initially she was given a course of antibiotics and she continued to improve.  Since the swelling persisted she was admitted in the hospital and on 26.10.06 the breast lump was removed under general anaesthesia without any complication.  After the procedure the patient continued to have tachycardia and raised blood pressure and developed severe acute left ventricular failure with pulmonary oedema despite receiving positive pressure ventilator.  She was given supportive treatment by mechanical ventilation, CPR, IV medications, intra cardiac injection etc.  Despite best collective efforts the patient died by 5.45 PM.  pheochromocytoma is a rare tumour which is asymptomatic .  Hence cannot be detected by routine standard pre operative investigations.  She died due to cardiac failure precipitated by high levels of catecholamines secreted by the tumour during surgical procedure.  There was no negligence or deficiency in service on the part of the opposite parties.

          3.      According to the 2^nd opposite party Smt. Pavithra gave history of having investigated at Amritha Institute of Medical Sciences Kochi where FNAC (Fine needle aspiration cytology) and mammography were done.  Since the lump appeared suspicious they advised biopsy of the lump.  On 26.12.2006 the surgery was completed without any complication.  During the procedure she developed persistent tachycardia and hyper tension which did not settle with medication or termination of general anaesthesia.  She suddenly developed pulmonary oedema and severe congestive cardiac failure.  She did not respond  to treatment.   The post mortem revealed the presence of undetected asymptomatic pheochromocytoma of the adrenal gland which was responsible for the lethal outcome following a minor surgical procedure.  The presence of pheochromocytoma could not be detected pre operatively as the patient did not have any symptom of the disease.

          4.      Before the consumer forum the 1^st complainant was examined as PW1and Ext. A1 to A13 were marked of the side of the complainant.  2^nd and 3^rd opposite parties were examined as DWs 1 and 2.  Exts. B1 and B2 were marked on the side of the opposite parties.  The consumer forum considered the evidence adduced by the parties, the medical literature and decisions presented before the forum and held that the complainants failed to prove any negligence on the part of the opposite parties.  The complainants question the correctness of the decision of the consumer forum.

          5.      Admittedly Smt. Pavithra Kandal the wife of the 1^st complainant consulted the 2^nd opposite party on 4.12.2006 with complaints of pain and swelling in her left breast.  She had earlier consulted Dr. Sobhana Lakshmi and on her instruction done mammogram of both breasts at Amritha Insitute of Medical Sciences, Kochi.  The 2^nd opposite party found the lump in the left breast of Pavithra suspicious and hence advised excision biopsy under general anaesthesia.  The procedure was done on 26.10.2006.  She died after the procedure was completed at 5.45 pm.  Ext. A11 post mortem certificate clearly shows that Smt. Pavithra died of pheochromocytoma and its complications precipitated by anaesthetic administration and surgical stress.  The post mortem findings are based on histopathological report of the tissue parts preserved during post mortem examination which showed pheochromocytoma of the right adrenal, fibrocystic disease of breast pulmonary oedema and a small laiomyoma of uterus.

          6.      According to the opposite parties pheochromocytoma is a rare disease.  In this regard the relevant medical literature placed before the consumer forum were placed before us also.  Without elaborating, it is sufficient to say that the medical literature shows that pheochromocytoma is a rare disease and in a large number of cases would remain asymptomatic and would express on surgical intervention or administration of anaesthesia.  According to PW1 the husband of the deceased also there was no symptom of this disease in Pavithra.  Her complaints earlier to other doctors were also pain and swelling in the left breast which was investigated.  So the opposite parties unsuspectingly went ahead with treatment of the lump in the left breast.   If specifically investigated tests are available to see whether a patient had pheochromocytoma but because of the rarity of the disease and its asymptomatic nature, no surgeon of reasonable prudence would suggest the patient to undergo test to diagnose pheochromocytoma.   That was the occasion for the unsuspected developments ending in the death of Smt. Pavithra. 

          It is not every error in judgment on the part of a doctor that can be termed as medical negligence.  The question is whether the doctor has adopted a procedure which a doctor of reasonable standards would not have adopted in similar circumstances and whether he had exhibited that degree of skill and professional standards of a doctor reasonable competence.  In this regard even the allegations in the complaint or evidence of PW1 do not establish any carelessness or negligence on the part of the opposite parties.  There is no independent expert evidence available in this case.  The only expert evidence is that of opposite parties 1 and 2 themselves.  On the given circumstances even a doctor of exceptional standards and skill would have done the same thing and the result was beyond his control as precipitated by the rare disease.  In short, the consumer forum rightly came to the conclusion that there was no medical negligence or deficiency in service on the part of the opposite parties.  Therefore the appeal is devoid of merit and is accordingly dismissed but without costs.

 

K. CHANDRADAS NADAR  : JUDICIAL MEMBER

 

1. RADHA               : MEMBER

 

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KERALA STATE CONSUMER

 DISPUTES REDRESSAL COMMISSION

SISUVIHARLANE VAZHUTHACADU

THIRUVANANTHAPURAM

 

APPEAL NO.637/2012

JUDGMENT DATED:25/04/2016

 

 

 

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