CC Filed on 18.02.2010

         Disposed on 17.12.2011

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KOLAR.

Dated: 17^th  day of December 2011

PRESENT:

                        HONORABLE T. RAJASHEKHARAIAH,  President.

  HONORABLE T.NAGARAJA,  Member.

       HONORABLE K.G.SHANTALA,  Member.

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Consumer Complaint No. 20/2010

Between:

ORDER

This is a complaint filed under section 12 of the Consumer Protection Act, 1986 by the L.Rs of deceased Lalithashree alleging medical negligence against the Opposite Party No.4 to 8 and Opposite Party No.9 separately, Opposite Party No.1 to 3 being formal parties.   The complainant has sought for direction against the Opposite Parties to pay a sum of Rs.20,00,000/- (twenty lakhs) as compensation due to their medical negligence and deficiency in service together within interest at the rate of 18% p.a. from the date of complaint till the date of realization and grant of such other alternate relief/reliefs that may be found fit. 

2. The complaint averments are that the ‘patient’ (deceased Lalithashree) had visited Opposite Party No.4 hospital on 05.11.2008 to undergo bilateral abdomen tubectomy and she was advised to undergo several tests and at Opposite Party No.4 hospital and the operation was fixed to be held on 05.11.2008.    After the operation the patient was shifted to the ward, suddenly she started suffering from vomiting, diarrhea, fever and cough, though her condition was informed to the attending nurse, no duty doctor was available, her condition did not come to normal but went on deteriorating as everybody seemed to be shirking the responsibility from their shoulder and having no other option, the patient was shifted to Opposite Party No.9 hospital on 08.11.2008.     The complainant’s allegation is that at the time of admission the patient had no complaint of pain in the abdomen and loose stool coupled with blood, that only upon the operation conducted by Opposite Party No.5 to 8.      The patient developed these problems as the tubectomy operation was not successful and had damaged the patients internal parts.    The complainant has further alleged that Opposite Party No.9 diagnosed the problem as ‘sepsis’ and recto sigmoid inflammatory structure and other related problem and when the Doctors of Opposite Party No.9 were asked by the attendants of patient about the reason for sudden complication of the patient’s condition, it was explained to them that while conducting the tubectomy, the internal parts of the patient have been damaged/cut/perforated which has resulted in seepage of toxic materials and resultant infection in some parts of the digestive system and surrounding organs of the abdomen which consequently lead to sepsis.    That there was similar lack of care and caution from the Doctor at Opposite Party No.9 hospital though the patient was under treatment with Opposite Party No.9 from 08.11.2008 to 04.12.2008 during which period the complainants have spent huge amount of money and except false assurances of recovery of the patient by the nurses and doctors, her actual condition did not improve.   The patient was subjected to various tests though their outcome was not explained to the complainant/attendant/relatives of the patient and though the doctors failed to come to any conclusion as to the actual problem of the patient, she was discharged from Opposite Party No.9 hospital on 04.12.2008.   None of the Specialist Doctors was present at the time of discharge to give proper advise on future cause of treatment to be taken.    The patient was discharged without ascertaining whether she was in a condition to be discharged.  

The patient was readmitted to Opposite Party No.9 hospital on 04.03.2009 and remained in the hospital till 09.03.2009 on which date she was declared to be dead by the Opposite Party No.9.     That the whole approach by the Opposite Party No.4 to 7 was casual and contrary to what a normal Specialist would have advised for the said symptoms and neither the complainant No.1 nor his (deceased) wife were informed or made aware of the medical complication and risk of injury.      The complainants have spent Rs.2,85,394.71 ps.  both at Opposite Party No.4 and Opposite Party No.9 hospitals.     The complainant got issued legal notice to Opposite Party No.1 to 9 which were duly served on all the Opposite Parties.  The complainants then filed the above complaint.

3. In the common version filed by the Opposite Party No.4 to 8, it is stated that the investigations was done on the OPD bases and the opinion of the Physician and Anestheist was taken as per procedure.     The patient was taken for conducting tubectomy operation, at that time it was found that the patient’s abdomen was having collection of fluid in the abdominal cavity, hence the Surgeon was called to give opinion and the Surgeon went through the whole procedure and the collection was cleared and completely drained and collection of fluid was handed over to the relatives for histo patholic examination.    As there was no further any fresh collection, urine catheterization was cleared and the procedure was completed.     Again the Surgeon was consulted and he advised ultra sonograph i.e. scanning and ultra sonograph was done and the report showed that there was no collection of fluid in the abdominal cavity.    Even though the same treatment was continued, the condition of the patient did not improve and the patient was advised to take treatment at higher medical centre.    The deceased was admitted on 05.11.2008 for Bilateral Abdomen Tubectomy.    As per the procedure and advise of physician was carried out (Inj. Dexonal CC and derphylline 1 cc i/v) and with all premedication, with i/v sedation patient underwent the procedure, but during surgery patient had collection of fluids in the abdominal cavity, therefore surgeon was called to give opinion, recovery was uneventful, postoperative status was satisfactory.  

4. Opposite Party No.9 has filed the version and contended that this Forum has no jurisdiction to entertain the complaint against this Opposite Party as no part of the cause of action arouse within the jurisdiction of this Forum.    It is stated that on 07.11.2008 the patient Smt. Lalithashree was admitted at the M.S. Ramaiah Teaching Hospital and then she was shifted to ICU under condition was critical.   On examination she was found dehydrated, abdomen was tender and guarding was present with decreased bowel sounds.    The necessary treatment for dehydration was started.   It was decided to conservatively manage the patient for the diagnosis of post-tubectomy sepsis with intestinal obstruction.    The opinion of the Gastroenterology was also taken and Dr. Umesh Jalihal examined the patient and suggested colonoscopy examination and it was done on 29.11.2008 and it was suggestive of recto sigmoid inflammatory stricture.     It is stated that differential diagnosis tuberculosis Vs Crohn’s disease was considered and blood investigation, CT scan and later colonic biopsy was done.     The result suggested of inflammatory granuloma to support diagnosis.    The patient was started on AKT and the patient made remarkable recovery and there was no need for hospitalization and she was discharged on 04.12.2008.    Again on 14.12.2008 the patient was readmitted with similar complaint of diarrhea and pain abdomen and her general condition was poor, she was reviewed by gastroenterologist and she underwent colonoscopy balloon dilatation of recto sigmoid stricture.    The colonoscopy appearance of proximal colon showed multiple apthoid ulcers favoring diagnosis of crohn’s disease.    She was treated with I.V. fluid, antibiotics, continued empirically started AKT.    As there was improvement she was discharged on 09.01.2009.    Again on 04.03.2009 the patient was brought to the hospital in critical state with multi organ dysfunction and she had pain abdomen.   On evaluation it was found she was having pleural crohin’s disease and pelvic abscess which may be part of or complication of fistulous chrohn’s disease.   Though she started on appropriate medications and meticulous ICU care, she succumbed to septicemia with multi dysfunction of 09.03.2009.    It is stated that there was no negligence or delay in giving proper treatment and all the treatment as per established and accepted method was given by expert Doctors in the field.    Hence there was no negligence and the complaint is liable to be dismissed.

5. The Opposite Parties on notices being served, appeared through Counsels and filed version.    From the averments made in the complaint, versions filed by the Opposite Parties, affidavits of the parties and documents produced on both side, the points that arise for consideration are that:

Point No.1:  Whether the complainant has proved the alleged

                       negligence/deficiency in service by the OP

                       No.4 to 8 and OP No.9?

Point No.2: Whether this Forum has jurisdiction to try the

                        dispute against OP No.9?

Point No.3:   If so, to which reliefs the complainant is entitled to?

Point No.4:  To what order?

            6.  Our findings to these points are as hereunder:

1.      Negative

2.      Affirmative

3.      Negative

4.      As per final order.

R E A S O N S

7. Point No.1: From the chronology of events contained in the written arguments of the complainant, it is seen the condition of the patient was stable after tubectomy operation and she was shifted to ward and there were no complaints.    On 06.11.2008 no loose stools till 10.30 p.m. later on 06.11.2008 Doctor writes to Surgeon that patient is suffering from abdomen pain and loose stools and requests for necessary action.    On 07.11.2008 Doctors attended patient at 9.30 a.m., 1 p.m., 3.30 p.m. patient is having loose stools with blood, same is not controlled and referred to head quarter hospital for further investigation and treatment.    Discharge summary of Opposite Party No.3 hospital discloses that as the patient was not responding to treatment for loose motion and pain abdomen was referred to Viotoia/Bowring Hospital Bangalore for further investigation and management.     On 07.11.2008 patient admitted to Opposite Party No.9 hospital at 11.45 p.m.    On 08.11.2008 patient shifted to NITU for further management with initial diagnosis ‘sepsis’.    On admission at Opposite Party No.9 hospital impression loose stricture at the lower end of the descending colon with thickening of the sigmoid colon and rectum with surround inflammatory changes were found. 

The contentions taken by the Opposite Party No.5 to 9 and the medical reports relating to the procedure done at the time goes to show that at the time of conducting the operation for tubectomy it was found that there was collection of fluid in the abdominal cavity and because of it Surgeon was called the fluid was drained and by doing ultra sound it was ascertained there was no further fresh collection of fluid and because of it the procedure was continued.    This thing clearly goes to show that even before she was admitted for doing tubectomy operation there was problem of collection of fluid in the abdominal cavity and after noticing it necessary steps was taken to drain the same and steps was taken to check, from time to time, about further collection of such fluid and after being satisfied that it has been properly maintained, the Doctors have continued with the tubectomy operation.    This clearly goes to show that collection of fluid in the abdominal cavity was not the result of any defect in doing the tubectomy operation.   The complainant has alleged that while conducting tubectomy, the internal parts of the patient’s have been damaged which is the result in seepage of toxic materials and resultant infection in some parts of digestive system and surrounding organs of the abdomen which consequently lead to ‘sepsis’.    In our opinion there is no material on record to substantiate this contention of the complainant.       Only the complainant alleges that the Opposite Party No.9 hospital had informed the patient’s attendants about it, but when we see the version of Opposite Party No.9,   this contention of the complainant is not having any basis and it is not acceptable.   On the other hand the material on record shows that at the inception it was found that there was collection of the fluid in the abdominal cavity.    Hence the contention that due to any damage that was caused to internal organs at the time of conducting tubectomy, such complications arose is not probable.    Hence the allegations against the Opposite Party No.4 to 8 that due to their negligence such complications started is not acceptable.  

About the alleged negligence about Opposite Party No.9 there was no specific allegation about how there was negligence, except stating that the patient was not properly treated or the patient was pre-maturely discharged from the hospital without curing the disease.    But when the version of the Opposite Party No.9 and the medical records produced by the Opposite Party No.9 are considered, it goes to show that it was diagnosed that the patient was suffering from crohn’s disease.    For coming to that conclusion the necessary investigations were done with the advise of gastroenterologist and he suggests colonoscopy and the treatment was also started for treating the disease by giving I.V. fluid, antibiotics and AKT.     At the first and second stage of her hospitalization there was improvement in the condition of the patient and because of it she was discharged.    After continued treatment, she went on to live for about 03 months and finally on 04.03.2009 she was admitted with serious complications and ultimately she died on 09.03.2009.  This thing clearly goes to show that Opposite Party No.9 has taken necessary precaution for diagnosing the disease and also has given the treatment.    The fact that for 03 months after she was discharged from the hospital, she did not have further serious complication goes to show that to some extent the treatment had succeeded, but some how she did not get the complete relief.     When all these things are considered it is not proper to conclude that there was negligence on the part of Opposite Party No.9 in treating the patient. 

The complainant has not placed on record any document or evidence to prove that chrohn’s disease had set in during the patient’s stay at Opposite Party No.4 hospital.   All the tests mentioned are routine and mandatory tests and ill-motive cannot be attributed for prescription of the same by Opposite Party No.9 hospital.    They were prescribed for arriving at a proper diagnosis to determine further line of treatment.  The patient’s condition did not permit the Doctors at Opposite Party No.9 hospital to conduct immediate surgery.  On 19.12.2008 surgery option set at stand by, by the Surgeon at Opposite Party No.9-Hospial.  Similarly on readmission to Opposite Party No.9 hospital, her condition improved slightly and she was advised follow up.    The third time she was admitted to Opposite Party No.9 hospital after her condition was critical and death was inevitable.      The complainant has failed to prove deficiency in service by the Opposite Parties.   The complainant has not examined any medical expert to prove the allegations of negligence against the Opposite Parties.       Opposite Party No.9 relied on the decision reported in 1 (2003) CPJ 239 (N.C.) in which it has been held that no relief be granted in the absence of expert evidence to show there is lapse on the part of Doctors concerned.   Hence this point is held against the complainant.

8. Point No.2:   The Opposite Party No.9 has contended that Opposite Party No.9 is a hospital situated at Bangalore, this Forum has no jurisdiction.    This contention is not acceptable for the following reasons.     When there are more than one Opposite Parties relating to the same dispute, then the case should be filed within the jurisdiction of any one of the Forums.   Hence in this case some of the Opposite Parties are residing within the jurisdiction of this Forum and only Opposite Party No.9 is situated outside the jurisdiction of this Forum.    Hence the complaint can be filed either in the Forum at Kolar or at the Forum at Bangalore.   Separate complaint cannot be filed for the same dispute both at Kolar and also at Bangalore.    It will be proper to file the complaint in any one of the Forum having jurisdiction.    Hence there is no defect in jurisdiction as alleged.     Hence this point is held against Opposite Party No.9.    

9. Point No. 3:   Since point No.1is held in negative, the point No.3 does not arise for consideration.

10. Point No. 4:    Hence we pass the following:

O R D E R

The complaint is dismissed.    No costs.

            Dictated to the Stenographer, corrected and pronounced in open Forum this the 17^th day of December 2011.

T. NAGARAJA                        K.G.SHANTALA           T. RAJASHEKHARAIAH  

   MEMBER                                   MEMBER                             PRESIDENT