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K Balan Pillai filed a consumer case on 20 Dec 2018 against The MD,Pushpagiri Medical College Hospital in the StateCommission Consumer Court. The case no is CC/12/3 and the judgment uploaded on 24 Dec 2018.
KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION
SISUVIHARLANE VAZHUTHACADU THIRUVANANTHAPURAM
CC.NO.03/12
JUDGMENT DATED : 20.12.2018
PRESENT
HON’BLE JUSTICE SRI.S.S.SATHEESACHANDRAN :PRESIDENT
SRI.T.S.P.MOOSATH :JUDICIAL MEMBER
SRI.RANJIT.R :MEMBER
COMPLAINANTS
Vadakkenada, Mavelikkara.P.O, Alappuzha District
(By Adv.Sri.Unniraja.T.L)
VS
OPPOSITE PARTIES
(By Adv.Sri.M.C.Suresh & Adv.Sri.Narayan.R)
SRI.T.S.P.MOOSATH : JUDICIAL MEMBER
Complaint filed under section 17 of the Consumer Protection Act.
2. The averments contained in the complaint are in brief as follows. The first complainant is the husband and the second and third complainants are the children of deceased Sreedevi who was 50 years old. The deceased Sreedevi went to the first opposite party hospital on 07.08.2009 due to irregular painful heavy bleeding through vagina. The second opposite party who was the gynaecologist with the first opposite party examined the deceased and advised for the removal of uterus. Accordingly, the deceased Sreedevi was admitted in the first opposite party hospital on 07.08.2009 and without carrying any independent investigation, surgery was performed on 13.08.2009 whereby uterus was removed or hysterectomy was conducted by the second opposite party. During surgery bleeding was more than normal from the beginning. While trying to control the bleeding from uterine artery, both ureters were injured. Ureteric splinting was done on the right uterine artery and ureteric anastomosis was done on the left ureteric artery. After surgery the uterus which was removed was sent for biopsy test and biopsy test confirmed cancer Adeno Carcinoma stage II. Even after that the deceased developed continuous leakage of urine through vagina. The second opposite party with the advice of other doctors advised for another major step to arrest the leakage of urine and she stated that the leakage can be arrested only by another operation. The deceased and her relatives were in panic to allow for another operation by same doctors. Since the deceased was not confident to undergo a second process at the hands of the second opposite party she was shifted to Lakeshore hospital and Research Centre, Cochin, on 24.08.2009. The doctors of the Lakeshore hospital treated the deceased and the deceased underwent cystoscopy and stenting and the leakage of urine was subsided. In that hospital the service of an Oncologist was sought and new medication was started and on her advice Chemo therapy was started. But since the detection of cancer was in a later stage, the medication for cancer was also delayed. The opposite parties failed to detect diagnose and cure the cancer affected to the deceased. Surgery could not have been conducted on the deceased who was suffering from cancer and the surgery should have been performed by a qualified Oncologist and not by a simple gynaecologist. The surgery resulted in spreading of cancer to larger areas resulting loss of life of the victim on 07.01.2010. There was negligenceon the part of the opposite parties in giving proper treatment to the victim. The second opposite party conducted the surgery in a negligent manner. Deceased Sreedevi expired on 07.01.2010 after having failed to withstand the chemo therapy, as she lost her strength to undergo the treatment due to the defective surgery performed by the second opposite party. Complainants have spent an amount of Rs 10,00,000/- towards treatment expenses. The first complainant who is a business man in Kerala could not conduct his business as usual and the business loss is more than Rs 10,00,000/-. The second complainant who was working as an engineer in a reputed concern abroad resigned his job to take care of his mother and he sustained loss of Rs 12,00,000/- for one year. The third complainant resigned her job as a software engineer in a reputed US company in Chennai to take care of her mother and has suffered an income loss of Rs 3,00,000/-. There is deficiency of service on the part of the opposite parties in treating the deceased which lead to the loss of her life. The complainants claimed Rs 47,00,000/-, Rs 10,00,000/- towards treatment expenses, Rs 25,00,000/- towards loss of income and Rs 12,00,000/- towards mental agony and suffering, from the opposite parties. The complainants also prayed for allowing Rs 25,000/- towards cost of the proceedings to be realized from the opposite parties.
3. Opposite parties 1 & 2 filed separate version raising more or less same contentions and the contentions raised by the opposite parties can be summarized as follows. The complaint is not maintainable. There is no negligence or deficiency in service on the part of the opposite parties as alleged by the complainants. The complaint is barred by limitation and hence liable to be dismissed. The first opposite party is a medical college hospital where all the latest facilities for treatment diagnosis and after care of the patients are available. The second opposite party is having qualification of MD in Obstetrics and Gynaecology and is practicing a consultant for the last 21 years. The allegation of the complainantsthat the opposite parties failed to detect, diagnosis and cure cancer affected to the deceased patient is not correct. The patient namelySreedevi came to the first opposite party hospital on 07.08.2009 to consult the second opposite party with complaints of irregular heavy bleeding through vagina since February 2009 with severe abdominal pain. She had a history of previous consultation with senior consultant gynaecologist and V.S.M.Hosital with same complaints and she had also produced two ultra sound scanning reports taken as per the advice of the doctor. The patient had also a history of Dilatation and Curettage (D & C) and biopsy cervix done on 26.06.2009 by senior gynaecologistDr.Narayanakurup and she has produced the biopsy report. Those reports did not reveal any evidence of malignancy or any indications for a gynaecologist to suspect any malignancy. The patient has also reported a history of undergoing hysteroscopy evaluation to rule out any intra –uterine pathology at Amrita Institute of Medical Sciences one year back and its result was normal, according to the patient. On the basis of the clinical findings and investigations the patient was advised to undergo hysterectomy and she got admitted in the hospital on 07.08.2009. The patient underwent all necessary preoperative investigations. On the basis of clinical examination findings and investigations the patient was diagnosed to have adenomyosis. The physician and anesthetist had examined the patient and found her fit for total abdominal hysterectomy and bilateral salpingo Oophorectomy. On13.08.09 the second opposite party conducted the total abdominal hysterectomy with bilateral salpingo Oophorectomy. There was heavy bleeding and all possible measures were taken by the second opposite party to arrest bleeding with the help of surgeons by ligating uterine artery and internal iliac artery. The second opposite party with the assistance of urologist repaired the ureteric injury found on the left side and right ureter was found entangled in a ligature and it was released and splinted. The specimen was sent for pathology examination. The report received on 18.08.2009 revealed adenocarcinoma involving cervix and lower part uterus in stage II, and biopsy finding was informed to the relatives and advised Oncology consultation and treatment. The general condition of the patient improved gradually and she did not have bleeding or any other complaints. On 20.08.2009 the patient developed leaking per vagina. The urologist examined the patient and advised cystoscopy percutaneous nephrostomy. He suspected vaginal fistula. But the patient’s relatives wanted to go to another hospital and insisted for discharge and on 24.08.2009 the patient was discharged on request. Clinical as well as investigations findings did not reveal any indication to suspect malignancy in the case of the deceased patients. Hence there was no reasonable ground for the second opposite party to suspect malignancy in the case of deceased patient. Occurrence of ureteric injuryis a reported known complication associated with any pelvic surgery. The second opposite party had exercised due care and caution in the surgical treatment of the patient. The allegation that the second opposite party performed the surgery in a defective manner is false. The second opposite party had treated the patient as per the accepted medical practice and the death of the patient due to advanced adenocarcinoma cannot be contributed to any negligence on the part of the second opposite party. The allegation of the complainants that the surgery resulted in spreading of cancer to larger areas resulting in loss of life of the deceased person on 07.01.2010 is not sustainable and hence denied. The allegation that the death was due to the failure to wit stand chemo therapy due to the defective surgery performed by the second party is without any basis. The patient died due to adenocarcinoma which was in stage II as evidenced from the pathology report dated on 18.08.2009. The opposite parties have no knowledge about the actual amount spent for treatment of the deceased patient. The death of the patient was not due to any negligence or deficiency in service on the part of the opposite parties. The amounts claimed by the complainants under various heads are without any basis. Since there was no negligence, carelessness or deficiency in service on the part of the opposite parties in the treatment of the deceased persons, they are not liable to pay any amount to the complainants by way of compensation of otherwise. The complainants are not entitled to realize any amount from the opposite parties. The complaint is to be dismissed.
4. The point that arise for consideration are :
5. The evidence in this case consists of the oral testimony of PW1 and Exts. A1 to A9 marked on the side of the complainant and the testimony of DW1 and DW2 and Exts.B1, B1(a), B2 and B3 on the side of the opposite parties.
Point No.1:-
6. The allegation of the complainants is that there was deficiency in service on the part of the opposite parties in giving proper treatment to deceased Sreedevi, wife of the first complainant and the mother of complainants 2 & 3. The allegation of medical negligence levelled by the complainants against the opposite parties is that they failed to detect, diagnose and give proper treatment to cure cancer of deceased Sreedevi.
7. The deceased Sreedevi aged 50 went to the first opposite party hospital on 07.08.2009 due to irregular, painful bleeding through vagina. The second opposite party working as gynaecologist of the first opposite party hospital examined her and advised removal of uterus or hysterectomy. The deceased Sreedevi was admitted in the hospital on 07.08.2009 and surgery was conducted on 13.08.2009 whereby uterus was removed or hysterectomy was conducted by the second opposite party. During surgery there was bleeding more than normal and there was bleeding ureteric injury and it was repaired. After the surgery the uterus was removed and specimen was sent for biopsy test by the second opposite party and biopsy test confirmed cancer Adeno Carcinoma Stage II. There was leak of urine through the vagina of the deceased. The second opposite party, with the advice of other doctors advised cystoscopy and percutaneous nephrostomy as they suspected vaginal fistula. The second opposite party advised consultation of Oncologist. Since the deceased and first complainant were not confident to undergo second process at the hands of the second opposite party got discharged from the first opposite party hospital,on 24.08.2009 and shifted to Lakeshore hospital and Research Centre, Cochin. In the Lakeshore hospital the deceased underwent cystoscopy and stenting by which the urine leak subsided. Oncologist examined the deceased and chemo therapy was started. But the patient died on 07.01.2010. There is not much dispute between the parties regarding these facts.
8. The main allegation of the complainants is that the second opposite party, without conducing any independent investigation, conducted surgery of the deceased and there was failure on the part of the second opposite party in detecting, diagnosing and giving proper treatment for cancer to the deceased Sreedevi. It is alleged by the complainants that since the diagnosis of cancer of the deceased was in a later stage the medication of cancer was also delayed. It is the case of the complainants that surgery could not have been conducted on a patient suffering from cancer and it can be conducted only after giving other various treatments to the patient. It is also alleged by the complainants that the second opposite party conducted surgery in a negligent manner and surgery should have been conducted by a qualified Oncologist. The first complainant was examined as PW1 and Exts.A1 to A9 series were marked on the side of the complainants to prove their case. Exts.A1 (a) is the copy of the biopsy report dated 18.08.2009 of the first opposite party hospital regarding the examination of the uterus with both tubes and ovaries of the deceased Sreedevi, by which, cancer, Adeno carcinoma involving cervix and lower parts of uterus of the deceased Sreedevi was detected. Ext.A2 is the discharge summary of Pushpagiri Medical College Hospital, Thiruvalla and Ext.A3 is the Discharge summary of the Lakeshore hospital and Research Centre, Cochin regarding treatment of the deceased Sreedevi in that hospital. Ext.A4 is the copy of the Death certificate issued from the Corporation of Cochin from which it can be seen that the deceased Sreedevi died on 07.01.2010. The opposite parties denied the allegation of the complainant that there was failure on the part of the second opposite party to detect diagnose and give proper treatment for cancer of the deceased
Sreedevi. They denied the allegation of the complainants that the second opposite party without conducting any independent investigation conducted the surgery. It is the case of the opposite parties that when deceased Sreedevi approached the second opposite party she had produced two Scanning reports and one Biopsy report taken by her as per the direction of the doctors. The patient stated that she had under gone hysteroscopy evaluation to rule out any intra-uterine pathology at Amrita Institute of Medical Science one year back and it was normal according to the patient. It is stated by the opposite parties that on going through the reports produced by the deceased and examining her,second opposite party advised removal of uterus, hysterectomy, and the surgery was conducted after conducing all pre-operative investigations, including blood, urine, profile liver functioning test etc. It is stated by the second opposite party that the reports produced by the deceased and her examination did not reveal any evidence of malignancy or any other indication to suspect any malignancy. It is stated by the second opposite party that there was heavy bleeding during the surgery and it was managed with the help of senior surgeons and there was ureteric injury and it was repaired and even though cystoscopy and percutaneous nephrostomy was advised the patient’s relatives want to go to a higher center. It is stated by the second opposite party that after getting the biopsy report she advised consultation of the deceased by an Oncologist but her relatives wanted to take her to another hospital and she was discharged from the hospital. The second opposite party was examined as DW1 and Exts.B1 to B3 were marked on the side of the opposite parties. Exts. B1 & B1(a) are the copies of the scanning reports produced by the deceased Sreedevi before the second opposite party on 07.08.2009. Ext.A1 is the copy of the biopsy report, admittedly produced by the deceased before the second opposite party at the time of her first consultation. Exts.B2 & B3 are the medical records regarding the treatment of the deceased Sreedevi at the first opposite party hospital. DW1 deposed that at the time of first consultation the deceased Sreedevi has produced Exts.B1, B1(a) and A1 and going through those reports and on physical examination, there was no reason for her to suspect any malignancy. Further the patient had reported of history to undergoing hysteroscopic evaluation to rule out any intra uterine pathology at Amrita Institute of Medical Science one year back and it result was normal, according to the patient. DW1 deposed that there was no negligence on her part in conducing the surgery and the ureteric injury is a reportedknown complication in hysterectomy due to the proximity of ureter to uterus. DW1 deposed that since there was no reasonable ground to suspect any malignancy. There was no need to avail the service of an Oncologist of hysterectomy operation. DW1 deposed that she had treated the patient as per the accepted medical practice and death of patient due to advanced Adeno Carcinoma cannot be contributed due to any negligence or carelessness on her part. The fractional curettage and cervical biopsy is the accepted diagnostic method to detect carcinoma of cervix which was negative in the case of the deceased person, as per Ext.A1, the Biopsy report dated 26.06.2009. Hence there was no laches on her part for proceeding with the hysterectomy. DW1 deposed that the allegation that the surgery resulted in spreading of cancer to larger areas resulting in loss of life of the deceased on 07.01.2010 is baseless. In Ext.A1 the nature of specimen are stated
9. The opposite parties had examined Dr.Jayaprakash.P.G. Who was then working as the head of the Radiation Oncology and managing Gynae and Uro Oncology Division, RCC, Thiruvananthapuram and he was examined as DW2. DW2 deposed that from 1977 onwards he was practicing in the field of Oncology and his qualificationsare MD, DMR, FICRO. Exts. A1, A1(a), A2, A3 and B1, B1(a), B2 and B3 were shown to the witness. On going through Exts.B1 and B1(a) DW2 deposed that as per the reports there was endometrial thickness and in order to rule out cancer further test has to be conducted. On going through Ext.A1, DW2 deposed that the said test was conducted after Exts.B1 & B1(a) and the report does not indicate any malignancy to the uterus of the patient. DW2 deposed that by conducting test covered by Ext.A1 the malignancy was ruled out. DW2 deposed that when a patient approach a gynaecologist with the complaint of irregular bleeding through vagina, the normal tests to be advised to the patient are the test covered by Ext.B1, B1(a) and Ext.A1 and since there was no circumstance to suspect any malignancy, no further tests such as CT, MRI are to be advised to be taken and the proper treatment to be provided to the patient is hysterectomy. DW2,on going through the records stated that in the case of the deceased it was seen that there was ureteric injury and it was properly managed and since there was suspicision of fistula the procedure to be done is percutaneous nephrostomy and as per Ext.B3 the patient was advised to undergo cytoscopy and PCN on 24.08.2009 it was not done in that hospital and the patient got discharged from the hospital. DW2 deposed that from Ext.A3 it is seen that cystoscopy was done to the patient at the Lakeshore Hospital. DW2 deposed that Ext.B3 shows that the patient underwent all necessary pre operative investigations. DW2 deposed that in the case of suspicion of any malignancy, the test to be conducted is the curettage test, conducted as per Ext.A1. DW2 deposed that in the case of the deceased since there was clinical finding as well as ultra sound scanning finding of fibroid uterus and bleeding and biopsy report of fractional curetting ruling out any malignancy. There was no impropriety to proceed with total abdominal hysterectomy. On going through the records DW2 deposed that the patient cannot be expected to survive beyond one year. DW2 deposed that as per Ext.B3 it can be seen that when there was heavy bleeding to the patient and there was in uteric injury, the gynaecologist (DW1) had managed it properly with the help of the Urologist and she had taken all reasonable care and caution in imparting the treatment.
10. There is no dispute to the fact that on 13.08.2008 hysterectomy was conducted on the deceased Sreedevi by the second opposite party and after that specimen was sent for biopsy and as per Ext.A1 (a) report dated 18.08.2009, cancer, Adeno Carcinoma Stage II was detected and second opposite party advised Oncology consultation and cystoscopy. But the relatives of the patient expressed their desire to go to another hospital and they got discharged from the first opposite party hospital and went to Lakeshore Hospital, Cochin. In that hospital Cystoscopy was conducted on the deceased Sreedevi and she had undergone Chemo therapy treatment for cancer and her death was due to cancer. The allegation of the complainants is that without conducting any independent investigation the second opposite party conducted the surgery. In other words, the allegation of the complainants is that before conducting the surgery the second opposite party should have conducted other tests to rule out the possibility of malignancy and that was not done by her. DW1 deposed that at the time of consultation with her the deceased Sreedevi brought Exts.B1, B1(a) and A1 and she had stated that she had undergone hysteroscopy evaluation at AIMS, one year back to rule out any intra uterine pathology and its result was normal. On going through the records she was satisfied that there was no reasonable ground to suspect any malignancy of the uterus of the deceased. DW1 deposed that after going through the records and conducting physical examination of the patient she had advised hysterectomy. The reports produced by the patient showed bulky uterus with fibroid ovarian cyst and endometritis and considering all these facts she had advised hysterectomy. Ext.B1 is dated 11.02.2009, Ext.B1 (a) is dated 20.04.2009 and Ext.A1 is dated 26.06.2009, the scanning reports and biopsy report taken by the deceased as per the direction of the doctors. Further the patient stated that she had undergone hysteroscopy evaluation at AIMS at one year back and the result was normal. DW1 deposed that since there was no circumstance to suspect any malignancy as a gynaecologist she could conduct the surgery and it was not necessary that the surgery should be conducted by an Oncologist. DW2 deposed that since there was no circumstance to suspect malignancy, surgery can be conducted by a gynaecologist, DW1. DW2, after going through Exts.B1, B1(a) and A1 deposed that there was no necessity for a gynaecologist to advise a patient who had brought those tests results, to undergo any further tests and the gynaecologist can proceed with the hysterectomy surgery. DW1 deposed that she had qualification in MD in Obstetrics and Gynaecology and had experience for more than 22 years. The complainants have not deputed the qualifications of OP2, but their case is that the surgery should have been conducted by an Oncologist. DW1 and DW2 deposed that since there was no circumstance to suspect any malignancy, it was not necessary that the surgery had to be conducted by an Oncologist.
11. Considering the evidence, facts and circumstances it can be seen that there is no basis for the allegation of the complainants that hysterectomy was conducted by the second opposite party without any independent investigations. From the records it can be seen that at the time of consultation the deceased Sreedevi has produced Exts.B1, B1(a), & A1 before DW1 and there was no reasonable ground to suspect any malignancy to direct the patient to undergo any further test for that. From the records it can be seen that the surgery was conducted after conducting all pre operative tests of deceased Sreedevi. Another allegation of the complainant is that the second opposite party conducted the surgery in a negligent manner and while trying to control bleeding uterus was injured. DW1 denied the allegation of the complainants that she had conducted the surgery in a negligent manner. DW1 deposed that due to unexpected bleeding surgical proceedure became difficult and it was managed with the help of senior surgeons. All possible measures were taken to arrest bleeding with the help of surgeons by ligating uterine artery and she suspected possibility of ureteric injury. With the assistance of Urologist it was managed and ureteric injury was found out and it was repaired. DW1 deposed that since she suspected vaginal fistula she advised cystoscopy and percutaneous nephrotomy, but the patient and her relatives wanted to go to another hospital and they got discharged from the hospital on 24.08.2009. DW1 deposed that ureteric injury is a reported complication associated with any pelvic surgery and the occurrence of ureteric injury leading to vaginal fistula cannot be taken as a pointer of negligence. DW2 deposed that intra operative heavy bleeding there is risk of ureter entangled ligation and the records show that DW1 has managed the same with the assistance of other doctors and since there was suspicion of vaginal fistula, Cystoscopy was advised but it was not done in that hospital. DW2 also deposed that ureteric injury is a reported complication associated with any pelvic surgery. DW2 deposed that DW1 had taken all reasonable care and caution, in treating the ureteric injury, which gynaecology is expected to take in such a situation. In these circumstances because of the fact that ureteric injury was caused to the deceased Sreedevi while conducting surgery by OP2, it cannot be concluded that she had conducted the surgery in a negligent manner. As stated by DW2 the records shows that it was properly managed by the second opposite party. Nobody has a case that the ureteric injury caused to the deceased Sreedevi has got any connection with the development of cancer to her. Admittedly the death of Sreedevi was due to cancer and the complainants have not adduced any evidence, by examining any witness from the medical field, in support of their allegation that the hysterectomy done by the second opposite party on the deceased Sreedevi caused spread of cancer. Further the records show that on the basis of Exts.A1 (a) the second opposite party advised the patient for Oncologist consultation but she got discharged from the hospital. DW, on a perusal of the records, stated that the patient cannot be expected to survive beyond one year.
12. In the case of medical practitioners, over and above the general principles applicable to determine negligence, an additional perspective is added through a test known as Bolam test. In the case of Bolam Vs Friern Hospital Management Committee (1957) 2 AII ER 118 it has been held that the doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by responsible medical men skilled in that particular art. The apex court in Jacob Mathew Vs State of Punjab AIR 2005 SC -3180 has held that the medical professional may be held liable for negligence when (a) he was not possessed of requisite skill which he professed to have possessed, and /or (b) he did not exercise, with reasonable competence in the given case, the skill, which he did possess. A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of the medical professional
13. In the light of the dictum laid down by the apex court and considering the evidence, facts and circumstances of the case it can be seen that there is no medical negligence on the part of the opposite parties 1 & 2 to detect, diagnose and provide proper treatment to cure the caner of deceased Sreedevi, as alleged by the complainants. Complainants have failed to prove that there was deficiency in service on the part of the opposite parties 1 & 2. Point found accordingly.
Point No.2
In the light of the finding on point no.1, complainants are not entitled to get any relief against the opposite parties.
In the result, the complaint is dismissed.
The parties are directed to suffer their respective costs.
JUSTICE SRI.S.S.SATHEESACHANDRAN : PRESIDENT
T.S.P.MOOSATH : JUDICIAL MEMBER
RANJIT.R : MEMBER
Witness for the complainant
Exhibits for the complainant
Hospital, Thiruvalla dated 14.08.2009.
Collge Hospital, Thiruvalla
and Research Centre, Kochi
Corporation of Cochin
Ext.A5 series-Medical Bills
complainant submitted before the income tax
Witness for opposite parties
DW1 - Dr.Susan Mathew
DW2 - Dr.Jayaprakash .P.G
Exhibits for opposite parties
Ext.B1 - Scan report dated 11.02.2009
Ext.B1(a) - Scan report dated 20.04.2009
Ext.B2 - Treatment records of the Pushpagiri Medical College
Hospital, Thiruvalla (Outpatient)
Ext.B3 - Treatment records of the Pushpagiri Medical College
Hospital, Thiruvalla (inpatient)
JUSTICE SRI.S.S.SATHEESACHANDRAN : PRESIDENT
T.S.P.MOOSATH : JUDICIAL MEMBER
BE/
KERALA STATE
CONSUMER DISPUTES
REDRESSAL COMMISSION
SISUVIHARLANE VAZHUTHACADU
THIRUVANANTHAPURAM
CC.NO.03/12
JUDGMENT DATED : 20.12.2018
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