Tamil Nadu

StateCommission

FA/314/2013

RAMA DEVI - Complainant(s)

Versus

THE STATE OF TAMILNADU, SECRETARY TO GOVERNMENT - Opp.Party(s)

M. SHIVARAMAN

04 Sep 2019

ORDER

Heading1
Heading2
 
First Appeal No. FA/314/2013
( Date of Filing : 22 Apr 2013 )
(Arisen out of Order Dated in Case No. of District )
 
1. RAMA DEVI
NO. 9, C JAGAN NAGAR, MINJUR-601 203
...........Appellant(s)
Versus
1. THE STATE OF TAMILNADU, SECRETARY TO GOVERNMENT
HEALTH DEPARTMENT, FORT ST. GEORGE, CHENNAI-600 009
2. GOVERNMENT STANELY HOSPITAL, THE DEAN
CHENNAI
CHENNAI
TAMILNADU
3. DR. T. RATNAM
GOVERNMENT STANELY HOSPITAL, CHENNAI
CHENNAI
TAMILNADU
...........Respondent(s)
 
BEFORE: 
 HON'BLE MR. K BASKARAN PRESIDING MEMBER
 HON'BLE MRS. TMT.Dr.S.M.LATHA MAHESHWARI MEMBER
 
For the Appellant:
For the Respondent:
Dated : 04 Sep 2019
Final Order / Judgement

IN THE TAMILNADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI.

 

Present:    THIRU.K. BASKARAN,                      PRESIDING JUDICIAL MEMBER

        TMT.Dr.S.M.LATHA MAHESWARI    MEMBER

 

 

F.A.No.314/2013

[Against the order passed in C.C.No.41/2006, dated 28.01.2013 on the file of the District Forum, Chennai (North)]

 

WEDNESDAY, THE 4th DAY OF SEPTEMBER, 2019.

 

Rama Devi,

W/o.N.Ravindran,

No.9, C Jagan Nagar,

Minjur – 601 203.                                ::   Appellant / Complainant.

 

Vs.

 

  1. The State of Tamil Nadu,

Rep. by its Secretary to Government,

Health Department,

Fort St. George, Chennai – 600 009.

 

  1. The Dean,

Government Stanely Hospital,

Chennai.

 

  1. Dr.T.Ratnam, M.S., D.L.O.,

Government Stanely  Hospital,

Chennai.                                               ::   Respondents/opposite parties.

 

        

For Appellant / complainant                            :  M/s.M.Shivaraman.

For Respondents 1 & 2/     opposite parties      :  M/s.T.Ravikumar.

For 3rd Respondent/ opposite party                  :   B.Soundarapandiyan.

 

This appeal coming before us for final hearing on 07.08.2019 and on hearing the arguments of both sides and upon perusing the material records, this Commission made the following:- 

ORDER

THIRU.K. BASKARAN, PRESIDING JUDICIAL MEMBER

 

  1. This appeal has been preferred by the appellant /complainant under section 15 read with section 17 (1) (a) (ii) of the Consumer Protection Act 1986, against the order in C.C.No.41/2006, dated 28.01.2013 passed by the learned District Consumer Disputes Redresssal Forum, Chennai (North).    
  2. The unsuccessful complainant whose complaint was dismissed by the learned District Consumer Disputes Redressal Forum, Chennai (North) [in short the District Forum] has filed this appeal. 

3.        For the sake of convenience and brevity, the parties are referred to here as they stood arrayed in the District Forum.

4.       The factual matrix culminating in this appeal:-

     That the complainant had filed this complaint claiming a total compensation of Rs.12 lakhs under various heads and Rs.10,000/- as litigation expenditure attributing medical negligence on the opposite parties alleging interalia, that she had developed some pain in left ear during December 1997 and on 16.01.1998 was admitted in the 2nd opposite party Hospital and the 3rd opposite party Doctor had negligently conducted surgery  on her on 17.01.1998, under general anaesthesia and she was discharged on 30.01.1998; that after discharge she developed some loss of sensation in the face at the        surgical site and she was unable to close her left eye and hence she had consulted with the doctors from other hospitals like Vijiya Health Centre, Madras Neuro Diagnosis Research Centre, Dr.Agarwal Eye Hospital and Apollo Hospital, Chennai, but could not recover, from the subsequently developed complications namely loss of vision and loss of hearing and she was certified to be suffering from permanent disability by the competent authority and hence she had undergone mental agony and other hardships due to medical negligence on the part of the 3rd opposite party doctor and hence the 2nd opposite party hospital and the 1st opposite party Government of Tamil Nadu are jointly and severally liable to pay compensation to the complainant as claimed, along with the 3rd opposite party.

          That the complainant was resisted by the opposite parties by taking a defence that the complainant was suffering from chronic Suppuerative Otitis Media and to correct the condition a procedure called Mastoidectomy was conducted and during the post operative period she had developed some facial weakness on the 2nd post operative day for which the treatment was given for 7 days and that when she was discharged on 13.01.1998, the surgical wound was found to have healed well; that after discharge the complainant had not reported before the 3rd opposite party doctor for review and follow up and instead the complainant had, on her own, consulted several other hospitals; that the treatment given to the complainant by the 3rd opposite party doctor was a recognized and standard medical procedure and in surgery like Mastoidectomy there would be 0.5% to 11% risk  of facial paralysis complication and hence the complainant is not entitled to any relief whatsoever.

          On the pleadings of the parties the learned District Forum had framed 3 points for consideration and by way of answering those points held that the complaint was barred by limitation and that there was no deficiency in service on the part of the opposite parties and finally dismissed the complaint and hence the complainant is before us in this appeal.

5.       Points for Consideration in this Appeal are as follows:-

          1)       Whether the complaint was barred by limitation as held by the learned District Forum?

          2)       Was there any deficiency in service on the part of the 3rd opposite party Doctor?

          3)       What relief the complainant is entitled to and from which of the opposite parties?

6.       Before the learned District Forum, the complainant had filed the proof affidavit and exhibits Ex.A1 to Ex.A19 were marked. On the side of the opposite parties, the proof affidavit of opposite parties was filed and Ex.B1 was marked.

7.       Point No.2 :-        The complainant would content that during December 1997 she was suffering from pain in her left ear and hence she was admitted in the ENT Department Unit II of the 2nd opposite party which is a Government run Teaching Institution and the 3rd opposite party was a doctor in the ENT Unit II of the 2nd opposite party hospital; the 3rd opposite party doctor diagnosed it as Chronic Suppuerative Otitis Media and conducted a surgery called Mastoidectomy on the complainant on 07.01.1998 under general anaesthesia and that she was discharged on 13.01.1998 and after discharge the complainant developed facial palsy and inability to close her left eye and when the complainant had brought it to the notice of the doctor in the 2nd opposite party hospital during review she was advised that during course of time she would become normal; that as the complainant did not recover from the said condition she had consulted with the doctors from various hospitals such as Vijiya Health Centre, Madras Neuro Diagnosis Research Centre, Dr.Agarwal Eye Hospital and Apollo Hospital; that she had even consulted Doctors in Government hospital, Chennai on 19.12.1998 But inspite of all these treatments she could not recover from the post operative complications developed in her which was due to medical negligence on the part of the 3rd opposite party in conducting the surgery on her on 07.01.1998.

8.       Per contra, the defence of the opposite parties is total denial and that there was no medical negligence on the part of the 3rd opposite party doctor in conducting the surgery and that at the time of the discharge from the 2nd opposite party hospital the complainant did not complain of any facial paralysis or inability to close the left eye etc., and that she never reported to the 2nd opposite party hospital for review after she was discharged on 13.01.1998 and hence what were the treatments given to her by what Doctor was not known to the opposite parties and that in a procedure like mastoidectomy development of facial paralysis is a known complication and that even prior to the surgery on 07.01.1998 for correcting some defect in her ear, she was suffering from conductive loss of hearing.

9.       On a perusal of the entire District Forum records, we are shocked to note that the 3rd opposite party doctor against whom primary medical negligence was attributed had not filed any written version followed by any proof affidavit to rebut the allegations of medical negligence against him. Hence the learned District Forum and this Commission would have easily held that the allegations contained in the complaint constituting medical negligence went un-rebutted by the 3rd opposite party and hence the complainant allegations stood proved and as such there was deficiency in service on the part of the 3rd opposite party doctor and other two opposite parties are also vicariously liable for the consequences of the medical negligence exhibited by the 3rd opposite party. But unfortunately for the complainant the counsel for the complainant had filed a petition in CMP No.135/2008 seeking permission to cross examine the 3rd opposite party doctor and the same was allowed and Dr.T.Rathinam was cross examined by the complainant before the learned District Forum on 29.03.2011. It is surprising to note how the learned District Forum had allowed this petition when the Dr.Rathinam had not at all filed any proof affidavit. Under the guise of cross examining the 3rd opposite party Dr.T.Rathinam the complainant had filled up of the lacunae in the defence of the opposite parties.  But for this cross examination of the 3rd opposite party doctor and the answers given by the 3rd opposite party doctor during such cross examination there is no other legal evidence to support the defence of the opposite parties and especially the 3rd opposite party and had there been no cross examination of 3rd opposite party doctor, the District Forum and for that matter this commission would be left no other option except to hold that the opposite parties had not re-butted the allegations contained in the complaint.

10.     In fact, the written version filed by the 2nd opposite party who was the Dean, Government Stanley Hospital, Chennai for himself and on behalf other opposite parties cannot rebut the complaint allegations in as much the Dean did not take part in the surgery conducted on the complainant nor he was present along with the 3rd opposite party doctor when post operative treatment was given to the complainant and as such the 2nd opposite party is not competent to rebut the complaint allegations. The only defence that could be raised by the opposite parties 1 & 2 is that there was no medical negligence on their part in as much all facilities were there in their hospital and they had extended all such facilities to the complainant in the treatment and that they were not vicariously liable for the alleged negligence committed by the 3rd opposite party doctor.

11.     By way of unnecessarily subjecting the 3rd opposite party doctor to cross examination the complainant had established what the 3rd opposite party had failed to establish. The 3rd opposite party doctor in his cross examination would say:

          “I am a master degree holder in ENT Surgery as I am possessing with MS., DLO degree. At the time of surgery to the complainant I was working at Govt. Stanley hospital, Chennai – 3. When I was working at Stanley hospital the first time the complainant approached me on 27.12.1997 for pain left ear with discharge and hard of hearing. After diagnosis I suggested for surgical treatment which was an elective one. According to my advice the complainant got himself admitted at Govt. Stanley Medical College Hospital on 06.01.1998 and she underwent the surgical treatment on 07.01.1998. Prior to surgery the complainant was subjected to audiometric test. As per Ex.B1 case sheet of the complainant and as per the audiometric test, she was suffering from moderate conductive hearing loss in low frequencies and severe hearing loss in high frequencies of the left ear. The complication of the surgery and post operative complications were clearly explained to the complainant on the early morning of 7.1.1998 and the complainant had also signed the consent form for surgery on 7.1.1998 as it is available at 1st page of case sheet (Ex.B1). If it is put to me that the 1st page of Ex.B1 is the form of consent as would have been obtained from every patient. I would say that getting the signature in that form, each patient would have been clearly explained about the problems of surgery and only then the signature of the complainant was obtained in Ex.B1. It is not correct to say that the consent as obtained in Ex.B1 is not an informed consent. This is the way by which we explained to the patient and obtained the consent of the patient. In 1st page of Ex.B1 it has not been stated that proper explanation of the surgery was given to the complainant. It is being stated in 1st page of Ex.B1 that the complainant had consented for administration of anaesthesia and for surgical treatment. The complainant was not suffering from diabetic or hypertension disorder. Subsequent to my transfer from Stanley hospital to Govt. General hospital, Chennai, the complainant had not approached me for any further consultation. It is not correct to say that I had treated the complainant at Govt. General hospital Chennai as outpatient. At the time when I examined the complainant at Stanley medical college hospital I had not been given with any information by the complainant with regard to any previous surgery. On my physical examination of the complainant I could not infer any such earlier complications or earlier surgical treatment in that regard. At the time of my examination I found discharge in the ear, hole in the airdrum and infection in the mastoid bone. The infection in the mastoid bone and cholesteatoma are inter related. Cholesteatoma means an infective tissue which is having the effect of erosion or any bone and would aggravate the infection. After surgery I have advised for post operative review for the complainant. Subsequent to the surgery the complainant was discharged on 13.01.1998 after that she did not meet me at any time. I had been transferred from Stanley Govt. hospital to Govt. General Hospital, Chennai during the month of July 1998. Facial paralysis is one among the post operative complications of ear mastoid surgery. Ex.A5 is the OP chit of the complainant for his examination at Govt. General Hospital, Chennai. It is not correct to say that the complainant approached me for post operative care at Govt. General Hospital, Chennai. But on 9.12.1998 the complainant attended the outpatient ward at Govt. General Hospital, Chennai. I have not written anything on Ex.A5. But as per the wording in Ex.A5 there seemed to have been facial weakness on the left side of the complainant following mastoid surgery in January 1998.

     The complainant was surgically treated by me at Stanley hospital in mastoid cavity, ear canal and tympatinic membrane. If it is put to me that if the surgical treatment was properly done to the complainant he would not have had the facial paralysis, I deny the same. When we do mastoidectomy operation we have to remove the entire choloestoma tissue in order to prevent any intra cranial complications so as to avoid the infection to spread to brain. Such precaution was also adopted in the case of the complainant. During surgery the facial nerve of the complainant was anatomically intact. If it is put to me that all the mastoidal bone operation would lead to facial paralysis, I would say that not all such surgery would lead to facial paralysis but internationally 11% of such patients would have facial paralysis complications after mastoidal some surgery. If it is put to me that the risk is less than 1% if the operation was properly done by skilled otologist. I deny the same. I gave the earlier answer by referring to international statistics. During the post operative examination of the complainant I did not observe that the complainant went to total deafness of left ear from partial deafness. The complainant had not gone out of the hospital against medical advice. There is no facial nerve injury during the surgical treatment. The facial paralysis alleged to have been suffered by the complainant was neither due to local anesthesia administration to the complainant for the surgery. Due to facial paralysis eyelid movement to be restricted on the affected side. We would not educate patients the complainant every time by anticipating drooping eyelids. If is put to me that only due to the defect in the primary surgery done to the complainant the patient complainant had to undergo two more surgeries, one at Apollo hospital to correct the facial paralysis and the second at Rajan eye care hospital to correct the dropping of eyelid, I deny the same and the Stanley medical college hospital Chennai is having all that specialty treatment especially the plastic and cosmetic surgery. If it is put to me that due to lack of utmost surgical skill and high level surgical applications the complainant was made to suffer from facial paralysis, I deny the same. It is correct to say that the eyelid muscles are involuntary muscies and reflective action were affected to the complainant only due to the negligence of my surgery I deny the same. In order to ascertain the post operative complication in a surgery like this we have to wait and watch. The complication of facial paralysis cannot be inferred immediately after surgery since the patient was not having such complications either at the operation table or on the subsequent day of the surgery. If any injury was caused to the facial nerve     

12.  At this juncture if we peruse the case sheet issued by the 2nd opposite party hospital in respect of the treatment given to the complainant under Ex.A1 it can be seen that the patient was diagnosed having Supperative Otitis Media with cholestreatoma and for treating this condition a procedure called Mastoidectomy was done by the 3rd opposite party doctor on the complainant on 07.01.1998 under general aneasthesia.  Likewisely, perusal of Ex.B1 shows that an audiometric test done on 20.12.1997 at the 2nd opposite party revealed that there was mild conductive hearing loss in the right ear and moderate conductive hearing loss and severe mixed loss in higher frequency in the left ear. From this it can be seen that even before the surgery was done by the 3rd opposite party for the above stated condition the complainant was suffering from some hearing impairment in both her ears.

13.     At this juncture, if we refer the medical literature (AIIMS) site, we can know about the Chronic Suppurative Otitis Media.

Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity.

The tympanic membrane is perforated in CSOM.

Unsafe CSOM involves Cholesteatoma

Mastoiditis is acute inflammation of the mastoid periosteum and air cells occurring when AOM infection spreads out from the middle ear.

Cholesteatoma occurs when keratinising squamous epithelium (skin) is present in the middle ear as a result of tympanic membrane retraction. 

 
 
[HON'BLE MR. K BASKARAN]
PRESIDING MEMBER
 
 
[HON'BLE MRS. TMT.Dr.S.M.LATHA MAHESHWARI]
MEMBER
 

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