National Consumer Disputes Redressal
N. Krishna Reddy vs Christian Medical College & Hospital on 23 April, 2007
NCDRC NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI ORIGINAL PETITION NO. 33 OF 1997 N. Krishna Reddy Complainant Son of Sri Konda Reddy No. 11-79-9, Nehru Street Piler, Chittor District Andhra Pradesh PIN : 517 214 Versus 1. Christian Medical College & Hospital Rep. By its Medical Superintendent Ida-Scudder Road Vellore TAMIL NADU PIN : 632 004 2. Dr. G.D. Sundara Raj Professor & Head of Department Department of Orthopaedic & Accident Surgery Unit-I The Christian Medical College & Hospital Ida Scudder Road Vellore TAMIL NADU PIN : 732 004 . Opposite Parites AND ORIGINAL PETITION NO. 34 OF 1997 N Krishna Reddy Complainant Son of Sri Konda Reddy No. 11-79-9, Nehru Street Piler, Chittor District Andhra Pradesh PIN : 517 214 Versus 1. The Manipal Hospital (A unit of the Medical Relief Society of South Kanara) Rep. by its Medical Superintendent No. 98, Rustom Bagh Airport Road BANGALORE 560 017 2. Dr. K.M.K. Varma Department of Orthopaedic Manipal Hospital No. 98, Rustom Bagh Airport Road BANGALORE 560 017. BEFORE : HONBLE MR. JUSTICE K.S. GUPTA, PRESIDING MEMBER HONBLE DR. P.D. SHENOY, MEMBER For the Complainant : Mr. P.B. Suresh, Advocate For the Opp.Parties: Mr. Krishna Srinivasan & In OP No. 33/97 Mr. P.K. Ram, Advocates For the Opp.parties : Mrs. Vimla Sinha, Advocate In OP No. 34/97 Dated the 23rd April, 2007. O R D E R
PER DR P D SHENOY, MEMBER OP No. 33 of 1997 and OP No. 34 of 1997 are connected matters wherein the complainant is the same. He has alleged medical negligence against the Christian Medical College and Hospital and Dr G D Sundar Raj Professor and HOD of the same hospital in OP No. 33 of 1997 and in OP No. 34 of 1997 the complaint is against Manipal Hospital and Dr K M K Varma of Orthopaedic Department of the same hospital.
OP No. 33 of 1997Case of the complainant :
Krishna Reddy, complainant who had a history of severe back ache was admitted for treatment in the Manipal Hospital at Bangalore from 5.11.1992 to 24.12.1992 wherein he was diagonised to have Kochs Spine. On 21.11.1992 he underwent surgery, viz., left thoracotomy anterior decompression and anterior spinal fusion. He was also put under anti Anti-Tuberculosis Treatment (ATT).
Severe backache recurred after some time in spite of the aforesaid treatment. Hence he was re-admitted there from 9.2.1996 to 12.2.1996 wherein he was told that the pain was due to minor joint/disc problem and was discharged after being prescribed some drugs. As the pain aggravated, he got himself re-admitted in the said hospital from15.3.1996 to 17.4.1996 but the pain did not subside.
Thereafter Mr Reddy, went to Christian Medical College at Vellore for further treatment wherein Dr. Sunder Raj, Professor and Head of Department of Orthopaedic & Accident Surgery, Unit-I examined him and conducted the relevant tests like biopsy, etc. According to his diagnosis, there was no evidence of Tuberculosis, hence ATT was stopped and on his advise he underwent surgery, viz., Debridement Anterior Stabilisation of L4 and L5 on 30.05.1996. He was discharged on 08.06.1996 and was directed to come back after six months for review. Despite following the course of drugs prescribed by the opposite parties, there was no improvement in his health and pain aggravated to unbearable levels.
When he approached the Hospital on 10.07.1996, the opposite parties inhumanly directed him to come back after six weeks without taking steps to reduce his agony.
The complainant was desperate and hence he approached the Apollo Hospital at Madras wherein he was admitted on 01.08.1996 and operated upon the left ribs and sternum and then discharged on 10.08.1996 after being mostly cured of his chronic malady. The complainant submits that though he is able to move about, he is unable to do professional work due to recurring pain and exhaustation at the least exertion resulting in his retiring from his legal profession. The complainant further submitted that both the opposite parties i.e. the C.M.C., Vellore and Dr. Sunder Raj (as well as Manipal Hospital, Bangalore) are jointly and severally liable for the permanent damage to his health.
Complainant claimed damages from the opposite parties, details of which are given below :-
a) Damages towards medical expenses : Rs. 80,000/-
like Hospitalisation, cost of drugs, surgery, etc.
b) Accommodation of the attendants and : Rs. 70,000/-
their transportation costs to and from Vellore
c) Mental agony and physical torture :
Rs. 9,50,000/-
d) Damages towards further loss of : Rs. 15,00,000/-
income and loss in profession
---------------------------
TOTAL Rs. 26,00,000/-
-------------------------
Case of the opposite parties:
CMC, Vellore is staffed by well qualified and competent medical, nursing and allied health professionals engaged in the work of treating the patients for the past 96 years.
The hospital has 1350 beds and treats about 5.5 lakhs out patients and over 40,000 in-patients, annually. Prof. G.D. Sundera Raj is a highly qualified surgeon in the field of Orthopaedics with a special training in the field of spinal surgery in several hospitals in the United Kingdom.
The complainant was admitted to the hospital i.e. on 22.05.1996. Though he was initially admitted to a private ward, he was shifted to general ward at his request on 29.5.1996.
Even then, he was attended by Prof. G.D. Sundera Raj himself.
The surgery undertaken was debridement of the lumbar 4th and 5th disc.
The specimens obtained at the time of the operation were sent for culture for routine as well as tuberculosis infection. The spine was stabilized using bone obtained from the complainants own hip bone. As there was no evidence of Tuberculosis, he was treated with antibiotics for non tuberculosis infection, pain relief tablets and was asked to be reviewed in the out-patient department 6 weeks from the date of discharge i.e. 8.6.1996. The complainant was seen for the last time on 10.9.1996 during which his clinical condition was discussed with Prof. G.D. Sundera Raj. The complainant was advised for a further review in six months for which the complainant did not report. As per the records of the opposite parties, the total hospitalization charges were in the region of Rs.18,431/- excluding the cost of drugs. According to the opposite parties, the complaint has been filed with a view to enriching by himself by preferring a claim of exorbitant amount by way of damages on untenable grounds.
Submissions of the learned Counsel for the complainant :
Learned Counsel submitted that stoppage of Anti Tubercular treatment (ATT) by the CMC Hospital was a gross mistake and medical negligence and because of this, the disease flared up and spread to sternum and rib necessitating a third surgery at this site in the Appollo Hospital, Chennai. He submitted that Dr N Krishnappa, MS (Orthopaedics) and former Professor and Head of Department of Orthopaedics of Bangalore Medical College has stated in para 5 of his report that anti tubercular treatment was stopped at Vellore Hospital which had aggravated his symptoms. Further in paras 6, 7 and 8 of his report he has stated that restarting of ATT by Appollo Hospital was the right choice and thereby stopping of ATT by CMC Hospital was a grave mistake. The relevant part of the report is reproduced below :
It is also submitted that multifocal nichrosis is not a diagnosis. The correct spelling is Necrosis which can be due to several causes including tuberculosis. Multifocal Necrosis by itself cannot be taken as clinical diagnosis. In fact, cause for the same has not been arrived at and that is why, there is a note of interrogation affixed after the word Multifocal Nichrosis. Thus it is indicative of the fact that cause is not clear to the attending doctors of Christian Medical College and Hospital, Vellore. The cause could be tuberculosis. It further appears that since anti-tuberculosis treatment was stopped by the Vellore Hospital, the disease flared up to present itself in the sternum and 7th and 8th ribs.
He quoted the medical literature by Shri S M Tuli wherein it is stated that :
It is known that tuberculosis can recur in a different site and tissue diagnosis may not be possible in 20% of cases particularly those already or those with chronic disease of long standing.
(Tuberculosis of the skeletal system by S M Tuli page No. 23, Jaypee Brothers Medical Publishers (P) Ltd.,, New Delhi (1991) He quoted the discharge summary of the Appollo Hospital, Chennai wherein the complainant was an in-patient from 01.08.1996 to 10.08.1996 and was operated on 03.08.1996 through an open biopsy procedure of the sternum and rib. Complainant was again put on ATT for six months which was stopped earlier by the CMC Hospital. The re-starting of ATT on the complainant is in tune with the consistent medical opinion that ATT ought not to have been stopped by the respondent hospital which resulted in the aggravation and spreading of the disease to the sternum and rib necessitating another surgery in the Appollo Hospital.
He referred to the affidavit of Dr K Venkataramaiah.
Dr K Venataramaiah a medical practitioner of 29 years of standing has stated in his affidavit as follows :
They ( CMC Hospital, Vellore) advised only non specific antibiotics and pain killers and asked him to review six weeks after discharge. They stopped ATT completely, which allowed the underlying disease to flare up. The sternum and left ribs were damaged.
Surgery is only to eradicate a localized problem where drugs do not reach. Surgery is only secondary treatment. Main stay and basic treatment is ATT.
In his affidavit Dr Khadar Basha, a medical practitioner of 32 years of standing has stated that :
No efforts were made by the CMC to relieve the compression of left S1 root in order to relieve the back pain and neurological deficit.
Accordingly, he submitted that the complaint may be allowed and compensation claimed may be awarded.
Submissions of the learned Counsel for the opposite party :
Learned Counsel for the CMC submitted that the complainant was fully cured by the treatment given by the CMC which is evident from the statement made by the complainant on 20.06.1996 to the Medical Supdt., of the Manipal Hospital wherein he has stated that :
Then I came back to my residence and decided to go to the Christian Medical College Hospital, Vellore, Tamil Nadu State on 22.05.1996. I went to Vellore CMC and admitted as inpatient. The doctors at CMC Hospital investigated into the problem and finalized that it is a multi focal Nichrosis and conducted surgery on 30.05.1996 on L4-L5 and recommended to take ciproflox-500 mg for six weeks and Brufen 400 mg and advised me to review after six weeks. I am following the medical advice. I am almost all recovered. (emphasis supplied) The medical record of the hospital indicates that microbiology test was conducted at CMC Hospital according to which :
Microbiology :
Pus Culture and Sensitivity report : No Growth.
PUS AFB - Smear Report Grams stain Many 2BCs, no pus cells or bacteria seen.
AFB Smear No AFB seen.
Dr G D Sundararaj in his deposition has stated that :
I submit that the material sent for culture and biopsy failed to show evidence of TB. Tablet Ciproflox was continued for six weeks. I submit that L4 and L5 being a major problem, it was decided to be tackled first. Non-intervention of this condition could make the patient paraplegic and permanently disabled or invalid.
The two doctors namely Dr K Venkataramaiah and Dr Khadar Basha examined by the complainant had concealed the fact that they are not the experts and they have not seen the patient.
Findings :
Complainant has filed affidavits of Dr K Venkataramaiah and Dr Khadar Basha. Neither of these doctors are Orthopaedic Surgeons nor are they experts in TB disease. In his cross examination Dr Khadar Basha has stated that he has given his affidavit with regard to CMC only on the basis of discharge summary certificate dated 08.06.1996. He has not perused the medical records of Krishna Reddy relating to the treatment given in CMC. He also stated that he was not aware that the patient is not suffering from TB. He was aware that antibiotic CIPRO FLOX 500 mg is an antibiotic used as a secondary line of treatment for Tuberculosis. Finally he stated that, he will take back the statement made in the last two paragraphs of his affidavit regarding negligence and deficiency in the treatment given by CMC, Vellore.
In his cross examination Dr K Venkataramaiah has stated that he based his opinion on the discharge summary of CMC Vellore and he has not seen the medical record of the CMC. He further stated that he has not treated any cases of multifocol Necrosis and he would not treat the cases of multifocol necrosis because he is not an expert in it. The discharge summary of CMC discloses that biopsy showed multifocol necrosis, no evidence of tuberculosis. In my opinion even if the biopsy report, is negative treatment is given for tuberculosis. CIPRO FLOX is a general antibiotic medicine. He further stated that CIPRO FLOX can be used as a second line of treatment for tuberculosis alongwith other drugs. Long term treatment of ATT would affect the kidney, liver and heart.
It is clear that neither of them have seen the patient nor perused the medical records except the discharge summary of the hospital. Therefore, the value of their evidence gets reduced drastically. As against this Dr Sundararaj has clearly stated in his report that there was no evidence of TB. Further the case of the respondent is fortified by the letter written (supra) by the complainant. The patient himself states that he was almost cured after he received treatment from the CMC Vellore which works as an estoppel against him. In fact evidence of any substantial nature has not been led by the complainant to support his claim.
Dr Vernon Lee in his affidavit has stated that the discharge summary of Apollo Hospital would reveal that the problem in the rib was a condition caused due to multifocal necrosis which is the cause for the new problem after the surgery at CMC. I submit that the patient was doing well after the surgery and was asked to come for evaluation after six weeks. The medical records filed reveals that the complainant had developed fresh lesion at the 1st surgical site which is the one which was said to be cured by Apollo Hospital. It is to be noted that multifocal necrosis patients are bound to develop certain other lesions at later occasions, which is why we at CMC recommend compulsory review after the surgery. I submit that the development of fresh lesions is a common occurrence which can be medically explained in the case of patients having multifocal necrosis.
He further submitted that the documents filed would reveal that the patient was surgically cured at the time he left CMC. I further submit that the court may consider the out patient record of the patient dated 22.05.1996 to 10.07.1996 which would reveal that the patient was diagnosed with multifocal necrosis and was treated with tablets/ medicines such as Ciprofloxacillin 500 mg and Brufen 400 mg being second line drugs of Tuberculosis so as to combat both multifocal necrosis, matted lymphnodes and tuberculosis if any. It was after the tissue culture taken during surgery that it was possible to confirm non-existence of Tuberculosis but the medicine was still continued because of the non-specific nature of the pathology report. He further submitted that the documents dated 22.05.196 to 08.06.1996 would reveal that the patient was doing well when he was discharged from CMC. In fact the history and consultation record dated nil would show that the history of the patient had been carefully considered before treatment was afforded to the patient. I submit that I also rely upon the outpatient cardiograph record dated 24.05.1996 and history and consultation record dated nil and laboratory reports dated 23.05.1996 for the correct course of treatment afforded to the complainant. I submit that the daily Nurses record, intake and output chart and the diabetic Chart would reveal the amount of care and exercise in treating the patient on day-to-day basis. I submit that the doctors order dated 22.05.1996 and progress record dated 22.05.1996 and graphic TPR Chart and bone scan report are all evidence which confirm that the treatment afforded in CMC is within the prescribed medical parameters. Dr Vernon Lee is a Professor of Department of Orthopaedics and Accident Surgery and Spinal Disorders Surgery, and he has not been cross examined.
Dr N Krishnappa, Consultant Orthopaedic Surgeon has submitted his report which was quoted by the learned Counsel for the complainant wherein he has stated that anti tubercular treatment was stopped at Vellore Hospital which had aggravated his symptoms. It is to be noted that though open Biopsy of the sternum and ribs performed at Apollo Hospital Chennai, did not show positive for tuberculosis, anti tubercular treatment was restarted by Apollo Hospital Chennai following the treatment pattern given at Manipal Hospital Bangalore. He has not filed any affidavit. Accordingly, no evidentiary value can be attached to his opinion.
In this connection, it is worthwhile to peruse the judgment of this Commission in Sethuraman Subramaniam Iyer vs Triveni Nursing Home and Anr 1998 CTJ 7 (CP) (NCDRC) wherein it is held that :
The complainant did not requisition the services of any expert to support his allegations. In the absence of any expert evidence on behalf of the complainant, the State Commission was right in relying upon the affidavits filed by four doctors on behalf of the respondents and in holding that there was no negligence on their part. The State Commission rightly analysed and appreciated the materials placed on record. It arrived at the finding after taking into consideration the totality of the circumstances. No case is made out by the appellant for interference with the order passed by the State Commission. The appeal is thus devoid of merit and is accordingly dismissed.
Further in Mrs Kiran Bala Rout vs Christian Medical College and Hospital and Ors 2003 (1) CPR 238 (NC) this Commission has held that :
Medical negligence must be established and not presumed. In the absence of expert evidence on behalf of the complainant, no negligence or deficiency in service could be found against affidavits filed by the doctors.
The citations quoted above are applicable to the case under consideration. In view of the above anlaysis we do not find any merit in this complaint. Accordingly, it is dismissed. No order as to costs.OP No. 34 of 1997
Submissions for the learned Counsel for the complainant :
The learned Counsel submitted that despite aggravation of the problems instead of conducting the second surgery the Manipal Hospital postponed it for one reason or the other by merely giving some medicines, thus resulting in complications. Accordingly, further surgeries had to be performed at CMC Vellore and Apollo Hospital. He quoted the affidavit filed on behalf of the complainant by Dr K Venkatramaiah, MBBS where in he has stated that again he had low back pain in February 1996 and C T Scan was done and found to significant pathology. He was advised rest and pain killers. Again he had severe low back pain in March 1996 and a fresh lesion was noticed lower to the previous lesion L4 L5. Anti T B Treatment and rest was advised. At this time patient was continuously complaining of pain over the left chest wall and the left side ribs. He again approached Manipal Hospital in April 1996 and complained the same thing. They took chest X-ray and no abnormality was detected. The discharge summary is silent about the pain on the chest. They ignored this complaint and they discharged the patient stating that the condition improved without surgery on the said two regions.
Submissions of the learned Counsel for the Manipal Hospital :
First surgery was performed in the year 1992 and there was no complaint at all from him. On 17.04.1996 the patient was asked to come back to the hospital for review. He came back on 17.05.1996 when the concerned surgeon was on leave and the doctors available examined and suggested certain required treatment. Again he was asked to come on 21.05.1996 for further treatment but he failed to turn up. Hence, his lethargy is a contributory factor for his suffering:
The learned Counsel submitted that, the complainant was attended to on every visit to opposite party No. 1. Even when the opposite party no. 2 was on leave from 16.05.1996 to 19.05.1996 he was examined by one Dr Ramanna, a Sr Orthopaedic surgeon who directed for X-ray. Since the x-ray did not show any improvement, he was advised to continue with the Anti T B medicine prescribed on 17.04.1996 and to see the opposite party No. 2 only after 34 days i.e. 21.05.1996 but the complainant pre-supposed that the opposite party No. 2 would not be available and therefore did not turn up as advised. In fact on 17.05.1996, the complainant was also examined by one Dr Ravi Raghvan, Consultant Physician to examine the cause of chest pain and other complaints made by the complainant. He also found pain and swelling at the lower end of sternum as possible tubercular etiology. In this view of the matter, the complainants allegations of negligence are absolutely baseless.
Dr K M K Verma, MS a highly qualified doctor had recommended at the time of discharge from the hospital that will review after one month.
In this case, it is clear that the complainant had not gone to Manipal Hospital for follow-up treatment on or after 21.05.1996, which was his own fault. The learned Counsel for the complainant had relied upon Dr Krishnappas statement while arguing the case against CMC Vellore wherein he has stated as follows :
I have gone through the documents pertaining to the above case in detail to arrive at following opinion.
The treatment received by Mr Krishna Reddy at Manipal Hospital during his admission from 15.11.1992 to 24.12.1992 was totally satisfactory and complete with respect to surgery and anti-tubercular treatment. This is confirmed by the fact that he was asymptomatic for over three years.
During his 2nd admission between 09.02.1996 and 12.02.1996 he was thoroughly investigated including a CT scan was taken to show that there was no fresh lesion.
While he was admitted on 25.03.1996 the lesion at L4 L5 was detected and prompt anti tubercular treatment was started which was the right treatment of choice. The concerned doctor also took second opinion from his senior colleague to continue conservative treatment for a month and had planned for surgry if conservative treatment had failed. This shows there has been no negligence or deficiency of service.
When patient reported to hospital OPD on 17.05.1996 even though the concerned doctor was unavailable, patient was seen by another senior Orthopaedic surgeon who examined him and took further x-rays and directed him to report back on 21.05.1996 so that the concerned doctor can treat the patient on his arrival back from leave. Patient did not obey his advice.
Anti tubercular treatment was stopped at Vellore Hospital which had aggravated his symptoms.
It is to be noted that despite open Biopsy of the sternum and ribs performed at Apollo Hospital Chennai, which did not show positive for tuberculosis, anti tubercular treatment was restarted by Apollo Hospital Chennai following the treatment pattern given at Manipal Hospital Bangalore. This shows that the treatment given at Manipal Hospital Bangalore was of supreme importance which only could have cured his ailment.
Further commenting on the affidavit filed by Dr K Venkataramaiah he stated that it clearly shows that restarting of anti tubercular treatment following the pattern of Manipal Hospital treatment alone has cured the disease.
Complainant cannot blow hot and cold at the same time. While arguing the case against CMC he wants to rely upon the report of Dr Krishnappa but not while arguing the case against Manipal Hospital.
Therefore, we are not persuaded to accept the submissions made by the learned Counsel for the complainant that there was medical negligence by the Manipal Hospital and Orthopaedic Surgeon Dr K M K Verma. Accordingly, this complaint - OP No. 34/97 is also dismissed. No order as to costs.
..J [ K S Gupta ] Presiding Member ..
[ P D Shenoy ] Member Satish