State Consumer Disputes Redressal Commission
Prasad Kumar T. vs Shahjahan Yoosuf Sahib on 30 April, 2015
Daily Order KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION SISUVIHARLANE VAZHUTHACADU THIRUVANANTHAPURAM CC.NO.21/08 JUDGMENT DATED :30.04.2015 PRESENT SRI.K.CHANDRADAS NADAR : JUDICIAL MEMBER SMT.A.RADHA : MEMBER SMT.SANTHAMMA THOMAS : MEMBER COMPLAINANT Prasad Kumar.T Oumasseril House, S.H.Mount.P.O Nattassery, Kottayam (By Adv.Sri.Raju Joseph) Vs OPPOSITE PARTIES 1.Shajahan Yoosuf Sahib, Chairman & Managing Director, Al-Shifa Super Speciality Hospial for Piles, Rajaji Road, Near KSRTC Bus Stand, Kochi - 35 2.M/s.Al-Shifa Super Speciality Hospital for Piles, Rajaji Road, Near KSRTC Bus Stand, Kochi - 35 , represented by Chairman & Managing Director, Sri.Shajahan Yoosur Sahib (By Adv.Smt.Preetha John & Adv.Suraj Krishna.B.S ) JUDGMENT
SRI.K.CHANDRADAS NADAR : JUDICIAL MEMBER This is a complaint filed under section 17 of the Consumer Protection Act. The allegations in the complaint in brief are the following. Attracted by the several advertisements published by the second opposite party Alshifa Hospital, Kochi, the second opp.party and their assurances the complainant who had difficulty in passing motion approached the hospital on 27.04.2006 and registered his name in the hospital. He was referred to Dr.Sunitha Kumari, who was working in the hospital. On her advice scan was taken. There after Dr.Sunitha kumari told the complainant that his anus was blocked to the extent of 90% and he required immediate treatment. Regarding the treatment he was assured that the surgery would be minor, painless, involving no risk and that he could go home on the same day itself. The complainant went to the hospital on 01.05.2006 to undergo the operation. At the operation theatre he was given spinal injection and thereafter a sharp object was inserted into the anus causing severe pain. Though in the advertisements mention of most modern imported machine for conducting surgery was made nothing of that sort was found in the operation theatre. The pain continued even after surgery. The complainant was made to believe that the operation was done by the first opp.party. But since surgery was performed by persons in robs and covered with mask the complainant could not identify them. The complainant was discharged from the hospital on the next day with the assurance that pain would subside and he would be cured in few days. But the problems aggravated. Since attempts to contact the first opposite party over telephone failed, the complainant went to the hospital on 10.06.2006. On reaching the hospital the complainant was taken to the operation theatre and laser dilatation treatment was done. But the pain and sufferings of the complainant only increased. Laser dilatation treatment was given to the complainant at least four times.On two occasions he was given. Spinal anaesthesia. When attempt was made to give anaesthesia again the complainant objected and asked them to refer him to some other hospital. Then the first opp.party appeared for the first time and promised the complainant to set at right everything. On that assurance the complainant continued treatment for eight more days but without positive result. He was discharged from the hospital on 08.07.2007 with the assurance that normal health would be restored gradually. However the condition of the complainant worsened. Apart from other complaints he also experienced prolapse in the anal region while standing numbness in the groin region, lower limbs anal and perianal region along with impaired erection. Therefore he again reported in the hospital on 08.08.2006. Though some remedial action was taken, there was no improvement.
2. On 14.08.2006 the complainant went to the Medical College Hospital, Kottayam. He was prescribed antibiotics and told to report again in case there was no improvement. On 22.08.2006 the complainant again went to the second opp.party hospital and requested them to give the treatment summary and refer him to a higher centre. Dr.P.C.Joseph (Subsequently impleaded as OP3.) gave a brief treatment summary and referred him to a higher centre for expert management. Again the complainant went to the Medical College Hospital, Kottayam and got admitted there on 22.09.2006. After detailed examination the doctors told him that since the injury is too deep a hole should be provided through the stomach for the purpose of passing stool. After discharge from the Medical College Hospital, Kottayam complainant went to the Amrita Hospital, Ernakulam on 27.09.2007. He underwent corrective surgery there on 21.01.2008. After prolonged treatment the complainant has recovered slightly from limb numbness. However, the other complaints continue. Therefore another surgery is recommended for strengthening sphincter tone and to increase squeeze pressure. The said operation is expensive. The complainant is continuing his treatment even now and there is no scope that normal health could be regained. All the pain and sufferings resulted from the negligence and carelessness of the opposite parties in treating the complainant. He is a permanent employee of M/s.MRF, Kottayam and his salary is production linked. He is aged 38 years and could have continued in service up to 58 years. His last drawn monthly salary is Rs.15,000/-. Any amount of compensation would not be sufficient to compensate the sufferings caused to the complainant. Notice was issued through the lawyer of the complainant seeking compensation from the opposite parties. But the opposite parties disowned liability. Hence the complaint. The complainant has claimed compensation of Rs.60,000,00/- towards loss of salary and emoluments, Rs.5,00,000/- towards treatment expenses incurred Rs.5, 00,000/- towards future treatment expenses. Rs.10,00,000/- towards pain and suffering and Rs.5000/- towards legal expenses.
3. Opp.parties 1 &2 filed joint version and the additional third opp.party filed separate version. Opp.parties 1 & 2 have contended that there was no negligence or deficiency in service on their part. It is admitted that the complainant approached the second opp.party hospital on 28.04.2006 with complaints of pain PR and constipation for six months. He had history of haemorrhoidectomy done one year back. On examination it was diagnosed that he was having internal haemorrhoids and fissure. Protoscopy and digital rectal scan were done which confirmed internal haemorrhoids and fissure. As his anus was blocked to the extent of 90%, immediate treatment was advised. Detailed information regarding piles its associated conditions its treatment, the possible outcome and complications were explained to the complainant. Different modalities of treatment available with its advantages and disadvantages were also explained to him. He came to the hospital for treatment on 01.05.2006 and on knowing the details of the various options available for treatment, opted for laser treatment and gave written consent for the purpose. Pre operative investigations were done and thereafter anal dilatation and laser and radio frequency under spinal anaesthesia through L3-L4 space were carried out on the complainant with utmost care and caution by Dr.P.C.Joseph along with a team of doctors. After prescribing post operative medicines he was discharged on 02.05.2006. Dr.P.C.Joseph, who performed the laser treatment, is a necessary party to the proceedings (subsequently impleaded as third additional Opp.party). Subsequently, the complainant approached the hospital on 12.05.2006 with complaint of constipation for which laxatives were prescribed .On 10.06.2006 the complainant reported with complaints of bleeding while passing motion. Though bleeding point was not located on examination fissuring was visualized at the posterior aspect of anal canal for which symptomatic treatment was advised. Though the complainant was advised to under go sigmoidoscopy, he was not willing to do that. The complainant visited the hospital on 26.04.2006 with pain and bleeding and was managed well by the opposite parties. As his complaint persisted he was admitted in the hospital on 03.06.2006. Protoscopy revealed raw area for which he was taken to the theatre and given IRC to the bleeding points. Wound healing is dependent on various factors and differs from individual to individual. Since the wound healing was not complete, medicines were prescribed but his complaint persisted in spite of maximum efforts of the doctors of the second opp.party. Hence he was referred to a higher centre at his request.
4. All the procedures were carried out by the doctors of the second opp.party with utmost care and caution and as the situation warranted. The allegations in the complaint are exaggerated and are made with intention to lower the reputation of the opp.parties. Laser treatment is a modern internationally accepted from of treatment for haemorrhoids. The complainant was attended by Dr.P.C.Joseph, who is the medical superintendent of the second opp.party hospital and he is a well qualified surgeon with sufficient training in laser treatment from Lone Star Health Care Group, Bryan, Texas. The treatment procedures adopted by the doctors of the second opposite party are proper and were carried out with strict aseptic precaution and with utmost care and caution. The opp.parties happened to treat a patient who was having severe neurological problems which was detected by a neurosurgeon one and a half years after haemorrhoidectomy was done at the second opp.party hospital. The compensation claimed is exaggerated and without any basis. The neurological problems of the complainant have no nexus with the haemorrhoidectomy. The difficulties and non healing were caused due to his neurological problems and not because of any negligence of the opp.parties. The complaint is devoid of merit.
5. In the version filed by the additional third opp.party more or less the same contentions referred to are raised.
On the contentions raised the following points arise for determination.
1. Whether the opp.parties were negligent in treating the haemorrhoids of the complainant and have committed deficiency in service?
2. Whether the complainant is entitled to realize compensation ?
If so what is the quantum?
6. On the side of the complainant four witnesses including the complainant were examined and Exts.A1 to A30 were marked. On the side of opp.parties, three witnesses including the third opposite party were examined.Exts.B1 and B2 were marked on their side. Ext.X1 was also marked in evidence.
Arguments were heard.
Point No.1
7. Admittedly, the complainant approached the second opp.party hospital on 28.04.2006 with complaints of pain anal region and constipation for six months. He had history of haemorrhoidectomy done one year back. On examination in the second opp.party hospital it was diagnosed that the complaint was having internal haemorrids and fissure. Protoscopy and digital rectal scan also confirmed internal hemorrhoids and fissure. According to the opp.parties the anus of the complainant was blocked to the extent of 90%. Hence immediate treatment was advised. Details regarding piles its associated condition treatment, consequent results and complications etc were explained to him and as opted by the complainant he was given laser treatment with utmost care and caution. After the treatment on 01.05.2006 he was discharged on the next day. It appears from the version itself that related complaints persisted and the complainant visited the second opp.party several times and ultimately at the request of the complainant he was referred to a higher centre for management.
8. Documents such as Exts.A3, A5, A23 & A24 reveal that the complainant was treated in the Amrita Institute of Medical Sciences. He was admitted there with complaints of urinary retention and constipation allegedly noticed after under going surgery under spinal anaesthesia in the second opp.party hospital. It was also associated with numbness in the groin region, lower limbs anal and perinal region and impaired erection. His MRI revealed intradural extra medullary lesion involving L1- L2 region. Accordingly he underwent L1-L2 laminotomy and excision. Ext.A5 further reveals that post operatively he recovered well without fresh deficits. His lower limb numbness has improved post operatively. But continued to have perianal numbness and is continuing follow up treatment at Amrita Institute. After discharge from the second opp.party hospital the complainant had also consulted some other hospitals. The records produced are explained by expert witnesses examined as PW2. PW3, PW4, DW2 & DW3. There is also Ext.A25 (Original Ext.X1) report of the medical board which will be referred to later. These evidences will have to be analysed to see the truth of the allegations in the complaint and the contentions raised.
9. PW2 is a surgeon and neurologist. He has issued Ext.A26 (copy Ext.A30) after examining the complainant and perusing the available records. According to him it was a typical case of neurogenic bladder with anal sphincter incontinence following denervation. He has seen the records relating to treatment by the second opp.party hospital. He referred to the four grades of hemorrhoids and deposed that in grade 1 hemorrhoids only conservative treatment is given. According to him as per the protoscopic examination the hemorrhoid of the complainant appeared to be of grade 1. But page no.4 of the case sheet would indicate that it was of grade 2 hemorrhoids. There was an associated fissure also. But page 4 of the case sheet is only that of anesthetist. No operation note is seen included in the case sheet. According to PW2 ordinarily there would be such a note. In a laser surgery the type of equipments used watts of laser used and the type of laser will have to be mentioned. No such details are found in the case sheet. Further to use laser a doctor requires special training. Otherwise various complications like bleeding, sphincter injury, nerve and vascular injury can happen and if the wound is large it can lead to infection. From the case sheet it can not be seen that the anus was blocked up to 90% (this is a claim in the version of the opp.parties). But PW2 could not say that laser surgery was the sole reason for the complications observed, but it may be due to the laser surgery. PW2 further opined that sigmoidoscopy performed confirmed deep fissure which in turm indicated complication from laser surgery. PW2 affirmed that there would be mental trauma in such a case. PW2 further deposed that from the records it seemed that the person who performed laser surgery lacked expertise. During cross examination he narrated the advantages of laser treatment. To the question whether ulceration is a known complication, PW2 deposed that ulcer can occur but not to this extent. But he did not see that deep ulceration existed immediately after discharge from the opp.party hospital. Investigative procedures do not cause any ulceration. The problems exhibited by the patient can be due to neurological reasons. Ext.A3 shows that the patient underwent spinal surgery for the very same complaints and Ext.A5 shows that after spinal surgery the lower limb sensation has improved. The pressure excreted by massive lesion upon nerves if prolonged could cause irreversible damages. Ext.A4 shows that ulceration was three centimeters long and not 10 cms. According to PW2, the limbs in order to be affected requires a higher lesion. But the other two problems can be caused by lesion at L1-L2 level. To the question whether taking the symptoms experienced by the patient as a whole, it is more likely that it could be attributed to spinal lesion at a higher region than to a localized treatment, PW2 answered that it seems to be a combination of both because numbness improved after spinal surgery.
10. The complainant was treated by DW2, the Professor, Department of Neuro Surgery, Amrita Institute of Medical Sciences. He has issued Exts.A3 & A5. Exts.A23 & 24 are reports relating to the treatment of the complainant. DW2 deposed that the patient was referred to the neuro surgery department from the department of Urology. His complaints were lack of sensation during excretion erectile dysfunction and parasthesia of limbs. When MRI was taken a growth was found at the spinal cord of the patient at L1-L2 region. As the growth could be the reason for the symptoms, it was removed by surgery. After surgery the numbness of the limbs of the patient was cured. But the problems relating to excretion and erectile dysfunction did not improve. DW2 gave the opinion that the tumour mentioned is likely to have affected the above body functions of the complainant. During cross examination by the complainants counsel, DW2 explained that the tumour referred to was of moderate size and he had never seen such severe symptoms due to a tumour of moderate size. He could not definitely say whether the only complication due to the moderate size tumour was the numbness of the legs of the patient. DW2 also affirmed that in Ext.B1 anaesthetic records, nurses records and theatre records are not seen. Generally speaking if an unskilled doctor performs laser surgery damage to internal organs can happen. Similarly, if piles is treated by laser technology by an unskilled surgeon damage to sphincter muscles is likely and if such damage happened the symptoms seen in the patient can happen. From Ext.B1 it can be seen that spinal anaesthesia was given to the patient more than once. Theoretically it is possible that lesion can happen if spinal anaesthesia is applied at L1-L2 region repeatedly. DW2 knows that the patient is still having symptoms other than numbness of the legs.
11. The case of the patient was referred for medical opinion from the doctors of the medical college hospital, Thiruvananthapuram. The original report is Ext.X1. It is signed by PW4 and DW3. The opinion of the medical board as well as the evidence of PW4 & DW3 are also relevant. Ext.X1 mentions the fact that after reference to a higher centre the complainant was followed up at the gastroenterology Department, Medic al College Hospital, Kottayam. He was evaluated by the surgical gastroenteroglist at P.V.S Institute of Digestive Diseases on 10.12.2007 that is, one and a half year after the procedure. The evaluation revealed poor anal splinter tone, poor squeeze, anal pressure and a deep linear ulcer extending from the anal verge for 3 cms. He also had erythema all around the anorectum and anal verge scarring from 9 'o clock to 5'o clock position. The medical board opined that with the findings in the report it was clear that the patient had a complication as a result of the surgical procedure for piles. He sustained deep ulcers, mucosal reaction and scarring as a result of the operation. The ulcers and erosion were intractable and refused to heal even after one and a half year of treatment. The medical report further refers to the laminectomy and excision of the tumour done at the Amrita Institute of Medical Sciences, Kochi and observes that the complainant is symptomatically improving. Further it is mentioned that ulceration is a known complication of laser procedure for piles and the patient had this complication leading to prolonged suffering for last 1 1/2 years post procedure. The burns produced by laser procedure and the sensory blunting produced by his neurological condition led to the complication of poor healing, bleeding and prolapse. The committee felt that surgery for the anal condition could have been deferred until the correct cause for his anal condition was ascertained.
12. PW4 and DW3 are the two doctors who constituted the Medical Board. They have signed Ext.X1 report. PW4 was working as Assistant Professor in the Department of Surgical Gastroenterology, Medical College, Thiruvananthapuram. To a suggestion that symptoms like numbness of lower limb perianal pain difficulty in passing urine and stool and poor heeling of wounds could be attributed to the spinal tumor at L1-L2 level, PW4 answered that it could be. He admitted that the committee felt that the surgery for the condition could have been deferred until the correct cause for the anal condition of the patient was ascertained.
13. DW3 was the professor and head of the department of neurosurgery medical college hospital, Thiruvananthapuram. The suggestion put to him was that spinal tumour exhibits slow growth. Hence the patient would feel the neurological weakness belatedly. To this question he answered in the affirmative. At times due to a small size lesion at L1-L2 level the patient would feel no symptom at all. If the lesion becomes large, it is likely that the patient would develop numbness of limbs. He also admitted that in Ext.B1 anaesthetic records and nurses records are not seen.
14. From the expert evidence discussed above it is obvious that the complainant approached the opp.party hospital with symptoms due to haemorrhoids. He had history of haemorroidectomy done earlier. But the expert evidence as seen already is that the records of the opposite party itself would indicate that the piles was at the first stage of development or at the second stage. It is in the above background exhibit X1 report is made to the effect that the laser surgery could have been deferred till the actual cause for the complaints was ascertained. A lesion at L1-lL2 level can cause identical symptoms but not all the symptoms are caused by haemorrhoids. Numbness of limbs is one of such symptoms exclusively caused by lesion at L1-L2 level. It is an admitted fact that spinal anaesthesia at L1-L2 level was given at least twice and there is a chance of developing lesion due to that. Even if this chance is ruled out the fact remains that spinal tumour grows slowly and in order to exhibit the symptoms due to the spinal lesion it must attain minimum size. So the likelihood of symptoms both due to haemorrhoids and spinal lesion existing simultaneously can not be ruled out. This explains why only the numbness of the limbs disappeared after spinal surgery. It is in the above background also the observation is made in Ext.X1 that laser surgery for haemorrhoids could have been deferred till the correct cause for the complaints was ascertained. The expert evidence as referred to already is that some lack of expertise in doing laser surgery is evident which caused the deep fissure and affected the sphincter muscles and this condition is not likely to improve. So it cannot be said that the opp.parties exhibited the skill of a surgeon of reasonable standards while doing laser surgery for haemorrhoids and this is not withstanding the fact that such complications are known.
15. Another area where there was clear deficiency in service on the part of the opp.parties is that they failed to keep proper records and all the witnesses affirm that among the records produced by the opposite parties anaesthetic record nurses record and operation notes are missing. So obviously, the complainant is denied the opportunity to know the entire procedure that transpired during the laser surgery. At the same time it is a fact that not all the complications arose from the haemorrhoidectomy alone. The spinal lesion at L1-L2 level has also contributed to the symptoms of the complainant and laminectomy was performed elsewhere, but not without success. It follows that the complainant has succeeded in establishing deficiency in service on the part of the opposite parties Point No.2
16. It follows that the complainant is entitled to realize compensation from the opposite parties. The complainant has claimed an amount of Rupees Sixty Lakhs towards loss of salary and emoluments on the allegation that he is employed in a company which disburses the salary linked to production. But though the complainant sustained permanent damage to the sphincter muscle and suffered associated inconveniences there is no clear medical evidence to show the extent of damage. Not only that there is no evidence apart from the deposition of PW1, that he has sustained loss of salary and emoluments as a result of the deficiency in service on the part of the opposite parties. Regarding the treatment expenses already incurred, the complainant has produced medical bills around Rs.14,000/- only. An amount of Rs.5,00,000/- is claimed towards future treatment expenses. It is only possible to say that the complainant would require future management of the condition caused by the deficiency in service on the part of the opp.parites. At the risk of repetition it may be mentioned that the condition of the complainant was only partly caused by hemorrhoids. The mass lesion at L1-L2 level had also contributed to the symptoms and it is not clear whether after laminectomy, the condition due to mass lesion at L1-L2 level has fully disappeared. The main ground on which the complainant is entitled to claim compensation is on account of the unnecessary pain and suffering he is subjected to due to the early laser surgery and the consequent complications and the continued disability and inconveniences caused by the same. So considering all aspects compensation of Rs.7, 00,000/- would be reasonable for the sufferings and expenses incurred by him. The point is found accordingly.
In the result, the complaint is allowed in part as below. Opposite parties are directed to pay jointly and severally. Compensation of Rs.7, 00,000/- and cost of Rs.10, 000/- to the complainant for the deficiency in service committed by them. Payment shall be effected within one month from the date of receipt of copy of the order.
K.CHANDRADAS NADAR : JUDICIAL MEMBER
A.RADHA : MEMBER
SANTHAMMA THOMAS : MEMBER
Be/
APPENDIX
List of witnesses for the complainants
PW1 - Prasad kumar
PW2 - Dr.S.V.Krishna Reddy
PW3 - Rema.V.S
PW4 - Dr.P.Bonny Natesan
Exihibts for the complainant
Ext.A1 - True copy of discharge summary issued from
Al-Shifa Super Specialty Hospital, Kochi dated
22.08.2006
Ext.A2 - True copy of the medical certificate issued from Medical
College Hospital, Kottayam dated: 20.12.2006
Ext.A3 - A true copy of certificate issued from Amrita Institute of
Medical Science, Kochi dated 27.09.2007
Ext.A4 - A true copy of the certificate issued from Institute of
Digestive Diseases dated 10.12.2007
Ext.A5 - A true copy of the certificate issued from Amrita Hospital,
Kochi dated: 19.08.2008
Ext.A6 - Notice issued to the opp.parties dated 23.05.2008
Ext.A7 - Letter requesting time dated: 26.06.2008
Ext.A8 - Reply notice dated: 22.07.2008
Ext.A9 - Handbook produced by the complainant
Ext.A10 - Paper publication in Malayala Manorama Daily dated
24.10.2007
Ext.A11 - Paper publication in National Review of current affairs
Magazine
Ext.A12 - The brochure published by the second opp.party
Ext.A13 - Publication in Malayalam Magazine Vanitha dated 2005
December 1-14
Ext.A14 - Medical Prescription dated 01.05.2006
Ext.A15 -The laboratory bill dated 01.05.2006 from the second
opp.party
Ext.A16 - Medicine Purchase bill dated 01.05.2006
Ext.A17 - A prescription from second opp.party
Ext.A18 - Prescription from second opp.party dated 08.07.2006
Ext.A19 - Bill dated 02.05.2006 issued by the second opp.party
Ext.A20 - A discharge summary dated nil
Ext.A21 - The op ticket of Kottayam Medical College Hospital dated
14.08.2006
Ext.A22 - The requisition for ENMG/EP report of Amrita Institute of
Medical Sciences and Research Centre dated 08.08.2007
Ext.A23 - The ENMG/EP report of Amrita Institute of Medical
Sciences and Research Centre dated 08.08.2007
Ext.A24 - The Abirectal Manometry report of Amrita Institute of
Medical Sciences and Research Centre dated 29.08.2009
Ext.A25 - The Medical Board report examination report dated
08.02.2010
Ext.A26 - A certificate issued by Dr.S.V.Krishna Reddy, Vijaya
Hospital, Nellore
Ext.A27 - The second opp.party published their hospitals details in
the website and the print out of the hospital profile.
Ext.A28 - The information provided by the Public Information Officer,
Travancore Cochin Medical Councils, Tvpm dated
30.09.2009
Ext.A29 - The CMG test results issued by Lakshmi Hospital dated
26.08.2010
Ext.A30 - Medical certificate issued from Vijaya Hospital, Nellore
dated 25.10.2010.
List of witnesses for the opposite parties
DW1 - Dr.P.C.Joseph
DW2 - Dr.Sajesh K.Menon
DW3 - Dr.K.L.Sureshkumar
Exibits for the opposite party
Ext.B1 - The case sheet of the complainant
Ext.B2 - Culture and Sensitivity Request / Report
K.CHANDRADAS NADAR : JUDICIAL MEMBER
A.RADHA : MEMBER
SANTHAMMA THOMAS : MEMBER
Be/
KERALA STATE
CONSUMER DISPUTES
REDRESSAL COMMISSION
SISUVIHARLANE
VAZHUTHACADU
THIRUVANANTHAPURAM
CC.NO.21/08
JUDGMENT
DATED :30.04.2015
Be/