State Consumer Disputes Redressal Commission
Syed Monis Ahmad vs Appolo Hospital on 29 September, 2008
Complaint No IN THE STATE COMMISSION : DELHI (Constituted under Section 9 clause (b) of the Consumer Protection Act, 1986 ) Date of Decision: 29.09.2008 Complaint No.C-121/2000. Syed Monis Ahmad . Complainant. S/o Group Captian S.S. Ahmad, R/o M-27, Sector-25 NOIDA District Gautam Budh Nagar (U.P.) Versus 1. Appolo Hospital Sarita Vihar, Delhi Mathura Road, New Delhi Through its Director. 2. Dr. sugani, Sr. Consultant Neuro Surgery Appolo Hospital Sarita Vihar Delhi Mathura Road, New Delhi. 3. Dr. Lokesh Kumar, Plastic Surgeon Appolo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi. CORAM: Mr. Justice J.D.Kapoor . President Ms Rumnita Mittal . Member
1. Whether reporters of local newspapers be allowed to see the judgment?
2. To be referred to the Reporter or not?
Justice J.D.Kapoor (Oral)
1. On the allegation of medical negligence complainant has sought return of total expenditure of medical bills of Rs.1,22,922/- with interest @30% charged on cash,withdrawn on credit card,for the deficiency in service provided by doctors and employees of OP Hospital, Rs.5 lacs towards loss of services, Rs.5 lacs towards mental torture and agony, Rs. 4 lacs towards future treatment and Rs.25,000/- as towards cost of litigation.
2. Case of the complainant in brief is that he met with an accident on 18th December 1999 at 16.30 hrs behind Centaur Hotel near IGI Airport and sustained multiple injuries on head face and limbs and became unconscious. He was brought to Air Force hospital Hindan for treatment. The doctor on duty Dr. Wing Commander PS Singh attended the complainant. Since the complainants condition was deteriorating in form of sensorium and unexplained fever, Dr. P.S. Singh who is a physician contacted Dr. K.K. Sharma Neuro Surgeon Narendra Mohan Hospital, who examined the complainant and advised CT scan brain which was done at Ghaziabad and revealed ventricular Haemorrage. When the condition of the complainant deteriorated he was admitted to Appolo Hospital on 19 December 1999. The complainants father deposited advance money of Rs.50,000/- for the treatment of the complainant on 19th Dec.1999. The complainant was admitted on 19 Dec.1999 vide ID NO.99061772 and IP NO.99021229 under Dr. Sugani Senior Consultant Neurosurgery and Dr. Lokesh Kumar Plastic Surgeon. The complainant was examined by all possible super specialists during the period in ICU and till 23 Dec.1999 to be discharged on 24 Dec,1999. When Dr. Sugani came to prepare discharge, he noticed flattening on face at Lt. side and hanging jaw (lt) with inability to close the mouth to chew food and ordered X-ray of facial bones and skull followed by 3- dimensional CT scan of face on 24 Dec.1999 (after a lapse of 6 days of injuries). The X-ray and CT scan revealed as under:
(1) fracture mandible Lt, (2) fracture zygoma lt and (3) fracture anterior and posterior walls of maxillary sinus Lt.
3. That the complainant was referred to plastic surgeon Dr. Lokesh Kumar who advised surgical treatment elevation of zygomatic Arch Lt with internal with internal fixation of fracture mandible by open reduction (bringing displaced fragments together) and fixation by plating. The surgery was performed in OT under General anaesthesia on 27 Dec.199 and the fee charged for surgery was Rs.52,100/-. Dr. Lokesh Kr. Told the father of complainant that he has fixed the Mandible Fracture on Lt side by Arch Bar-Rubber Band Wiring with Gilles technique for fracture Zygoma (left) under GA. (inter-dental wiring and closing the month putting the upper and lower jaw together with rubber bands.
4. That nothing was done for fracture anterior and posterior wall of Maxillary sinus Lt. The complainant was put on heavy antibiotics and was on liquid diet and was advised following medication, tab epsolin 100 mg thrice a day repeat CT scan after 2 weeks bed rest for 3 months and review with DR. S.K. Sogani after one week. The complainant was regularly reviewed by Dr. Lokesh Kumar and repeated X-rays were done on 07. Jan.2000, 12 Jan,2000 25 Jan.2000 and 31 Jan, 2000, thereafter complainant had to undergo open reduction (operation for correction of deformity and fixation of two fragments). The father of complainant took the complainant to oral and Maxillo Facial surgeon Maj Suresh Menon at R&R hospital, Army Hospital Delhi Cantt on 03 Feb,2000 who after examining the latest X-rays done on 31 Jan 2000 opined that the fracture in fact had united with deformity (mal-united) and keeping the mouth closed with rubber bands and arch interdental wiring for such a long duration had pulled complainants all the teeth up/down and they had become loose. Keeping them in that condition for any longer would do irreparable damage to teeth gums, and oral cavity where complainant had already developed multiple ulcers. Dr. Suresh removed all rubber bands and interdental wiring and was shocked to see the unprofessional approach of Dr. Lokesh Kr. Dr. Lt. Col Suresh Memon informed that all such cases were always referred to oral and Maxillo-facial surgeons for treatment.
5. That treating such case by interdental wiring and rubber bands was wrong and only open reduction and plating should have been done in the first place. Tying both upper and lower jaw together with rubber band is done for maximum1-2 days during operation. Closing the mouth for 6 weeks (six weeks) was unheard of. Complainant made rapid recovery. All except one loosened tooth have returned to their normal place and the ulcerated and infected gums have also healed. The fracture mandible remains mal-united and face on Lt side is slightly flattened. On request of the father of complainant he was put on liquid/soft diet only on next day as the attending doctors has forgotten to prescribed soft diet/liquid diet earlier. Because of the above callous attitude and negligence of all doctors the fracture mandible got further displaced which still remains mal- united. The X-Ray of skull and face was delayed upto 24 Dec.1999. the delay in doing X-ray &CT scans of skull and face and institution of proper treatment for serious fractures of facial and skull bones cost the complainant/patient dearly and complainant developed permanent disfigurement (flattening of face on Lt side. The negligence on the part of opposite party leading to deficiency of service in respect of the inadequacy of diagnostic procedures gets firmly established.
6. In reply OP NO.1 absolved its liability by pleading that the consultant doctors of the answering OP hospital are not the employees of the hospital. The hospital only provides them with the facilities like equipments operation theatres etc. but the course of treatment to be undertaken is decided by the consultant doctors themselves and they themselves are responsible for their acts of commission or omission. Further, the doctors, have their own professional indemnity policies with the insurance companies.
7. On merit it has averred that the complainant is trying to mislead, he has given three different versions of the circumstances that caused injury to him. It is denied that there was any unusual or negligent delay in doing the X-ray of facial bones and the complainant was admitted in the Neurosurgical ICU of the answering OP. The course of action in such cases is to save the life first and then give attention to other associated non life threatening injuries later i.e. when the condition of the patient becomes stables and out of any risk. In the present case, as there was already a delay of more than 12 hours, the diagnosis of fractures of the facial bones in such cases is masked by swelling and these fractures become evident, once swelling subsidies.
8. Facial X-ray requires elaborate and accurate positioning which is not possible in an acute state as was in the present case. Since the complainant had critical head injuries which were life threatening, facial injuries which were not life threatening were treated when the condition of the complainant became stable. The course of treatment, which is required to be followed, depends upon the judgment of the treating doctors who are well qualified and experienced for taking such decisions. Difference of opinion of some other doctor does not imply that there was any negligence or deficiency in service on the part of the treating doctor or the hospital. In polytrauma patients (as in the present case where the complainant had also suffered from severe head injury), prioritization of treatment is essential to obtain a favourable outcome and such cases cannot be simply left on dental surgeons who are not competent to handle the same merely on the basis of the fact that one of the injury suffered by the patient is relating to fracture of jaw. It is denied that the fee charged by the answering OP hospital for surgery was Rs.52,100/-. In fact the complainant has wrongly stated that the fees for surgery as Rs.52,100/- only to mislead. The actual fee charged for surgery, as per the bills submitted by the complainant himself, is Rs.36,590/- (which is inclusive of the O.T charges, consumables & surgeons fee. The other incidental charges are as per the hospital tariff for the deluxe room that the complainant had chosen to stay in. the charges would have been lower had the complainant chosen a General or a semi-private ward for his stay. Standard treatment for facial injuries was followed, where attention is being given to patients teeth into proper dental occlusion. It is not necessary to fix individual fractures like anterior and posterior wall of sinus diagnosed on CT scan, which are actually part of the zygoma fracture and automatically get reduced when fracture zygoma is reduced. All over the world, Cranio-faciomaxillary injuries, particularly the ones which are complicated due to the presence of other life- threatening injuries as in the case of the complainant, are treated by plastic and reconstructive surgeons and not oral and maxilla facial surgeons, as alleged. Maxilla facial surgeons are basically dentist and are not trained to deal in all the complexities involved in polytrauma patients, as in the case of the complainant.
9. The OP denied that the complainant was forced to eat solid food. As a matter of fact, the complainants mouth was closed till 31st Jan. 2000 when he was last seen at the OP No.1 hospital, and all such patients whose mouth is kept closed for treatment of fracture of jaw are given liquid diet. Also it is not possible to feed solid food to any person whose mouth is closed by inter-dental wiring and putting the upper and lower jaw together with rubber bands. In patients with critical injuries like head injuries, only essential investigation like CT scans are done immediately. Accordingly, CT scan was done of the complainant. Further, facial x-ray requires elaborate and accurate positioning which is not possible in acute stage. The decision to take X-rays in serious patients who are in the ICU is not based on the patients request, nor they are done only to satisfy medico-legal requirements. The X-rays are done when the patient is fit enough to be sent to the X-ray department, which was not so in the present case. The complainant was brought to the answering OP hospital in a very critical state and to save life was of prime importance.
10. OP denied that there was any delay in providing treatment of facial fracture as alleged. The treatment to the facial injuries in the present case was well within the time frame prescribed by standard textbooks that is after the swelling comes down and the condition of the patient is stable. The fact that the complainants life was saved and he regained a near perfect appearance rather goes to show that the consultant surgeons at the OP hospital treated the complainant with utmost care and skill and were not negligent in any way. The surgery of jaw fracture as a matter of procedure was to be carried out later i.e. after the complications relating to head injury were taken care of as these were life threatening in nature. The fractured mandible of the complainant has united well and the complainant has not in any way been immobilized as alleged.
It is denied that the complainant is entitled to alleged compensation or any other compensation or relief.
11. OP No.2 stated that the complainant has set up three different stories one before Air Force hospital, Second Discharge Summary and Third the present complaint giving cause of injury of accident near Santoor Hotel behind IGI Airport. It is not disputed that he was examined by the answering OP and Dr. Lokesh Kr., Plastic Surgeon, on account of the fact that he was having multiple injuries on head, face, forearm and right knee. The complainant was examined by Dr. S.K. Sogani, the OP No.2 and Dr. Rakesh Aggarwal, Senior Neurologist of the Appolo Hospital on relations request in causality itself. He was seen by a General Surgeon. Dr. S.K. Jain and Sr. Eye Surgeon, Dr. L.R. Seth regularly due to his blunt abdominal injury and eye problem respectively and none of the four doctors after examining him in detail, advised an emergency facial CT scan and X-ray due to priority to save his life first rather than, small cosmetic problem and no way it could have delayed or changed the ultimate outcome of facial fractures. He was regularly daily seen by four different super-specialists every day and with consensus of opinion of all four senior specialists, it was decided to get CT scan face and facial bone x-rays and plastic and cosmetic surgeon reference when all four thought, he could be given general anesthesia and could undergo plastic surgery operation. Father of the complainant was a medical doctor who was allowed to stay with his son in hospital ICU and out of ICU after seeing the condition of the complainant the x-ray and CT scan revealed (1) fracture mandible Lt. And (3) anterior and posterior walls of maxillary sinus Lt. The complainant was referred to plastic surgeon Dr. Lokesh Kr. Who advised surgical treatment. Father of the complainant was always satisfied and grateful to Dr. S.K. Sogani to save his sons life as it was a serious case and refused to be treated in the Air Force Hospital due to serious head injuries and brain clot problem. The sole criteria was to save the life of the complainant. At first stage he was admitted in the Air Force Hospital rather than Appolo Hospital. Surgery was performed by Dr. Lokesh Kr. And not by the OP No.2. during this period he was under the treatment of Dr. Lokesh Kr. And he was advised to get the matter reviewed with Dr. S.K. Sogani after one week. During this period he was also examined by Dr. V.S. Madan, Sr. Ex. Army Neuro Surgeon presently working at Sir Ganga Ram Hospital to see the case in ICU and was fully satisfied with the progress of the case. The patient was not fit for general anaesthesia and maxillofacial surgery. To the best of knowledge of the OP No.2 there was no professional negligence of Dr. Lokesh Kumar or of the staff of Apollo Hospital as alleged in this para after going through the discharge history of the patient. It is denied that there was negligence of all the doctors. It is denied that the complainant had developed a permanent disfigurement on face on left side. It is denied that the doctors kept on giving wrong treatment inspite of seeing that the condition of the patient was deteriorating. Life of the patient was saved which was more important. Proper treatment was given at the first stage for saving the life of the patient. The OP No.2 had charged only Rs.2000/- for giving his services to the complainant.
12. As regards OP-3, the complainant had given 3 version of the circumstances in which the injury was received by him. The complainant had invoked jurisdiction of this Commission without appreciating the fact that a doctor could be asked to pay for compensation in gross negligence cases only and not for the case where the patient had not achieved the desired results. Error of judgment of a qualified doctor would not if-so-facto entitle the complainant for compensation. The patient himself and his attendants including his father, who is a doctor delayed the institution of treatment which could cost him his life. If it is correct that some accident took place near Centoure Hotel, the father of the complainant instead of taking him to R&R Hospital, Dhaula Kuan, (an apex hospital for army equipped with all modern neurosurgical unit).
Neuro-Surgery took him to Air for Hospital Hidon about 60 KMs away in an unconscious stage. In fact his condition deteriorated and the required surgery could not be performed in time because of delayed institution of the treatment. The patient (complainant) and his relatives had given different version of cause of injury at different times. The complainant was got removed from army hospital despite their entitlement to be there and was taken to Air Force Hospital, Hindon. The complainant was admitted with serious head injury (Ventricular bleed) in the Neuro-sudrgery, intensive care unit at Appolo Hospital on 19.12.2000. For a doctor in these cases, the preference is always to save life of the patient then to give attention to associated non-life threatening injuries which could be attended to later on.
13. That in cases of swelling the fracture and the surgery is done once the swelling subsides. In the normal course treatment of this facial fractures is undertaken only after about a week and that too after the patient has been declared to be out of danger by Neuro surgeon. The complainant has adverted to some hearsay advise which is not based on the facts and circumstances. The medical literature would show that treatment to these fractures are done only after 3-4 weeks of the injuries. The fracture on lower jaw was not treated by open reduction but by close reduction, which was considered ideal treatment for him in the given circumstances. The standard protocal for facial fracture was followed where the prime attention was given to bring patients teeth into proper dental occlusion. It is not necessary to fix individual fractures like anterior and posterior wall of sinus diagnosed on CT and scan which is actually part of zygoma fracture and automatically get reduced when zygoma is reduced. All possibilities of further course of action routinely explained to the patient in advance and as such possibilities of open reduction and fixation if the fracture does not unite and the same was done in his case, was also told to him. The complainant never came back to the OP for review after 31.01.2001. he went to another surgeon before even completion of 6 weeks, (which is a standard waiting period) for further treatment.
14. That all over the world Cranio-facio-maxmillary injuries particularly the ones complicated by the other life threatening injuries are treated by plastic and reconstruction surgeon and not by a dentist. The timing of treatment of facial fractures and mode of treatment is decided after taking into consideration the over all condition of the patient particularly when they are suffering from life threatening injuries to the other parts of body specially head injury, as in this case. Oral and Maxilla- facial surgeons, who are basically dentists are not trained to deal in all the complexity involved in polytrauma patients they are supposed to treat only those simple cases of fractures where no other bodily injuries are involved or they are working under skilled supervision of plastic surgeon as happens in one of the hospital in Delhi itself i.e. Safdarjang Hospital. As per the records supplied by the complainant prepared by the Dr. Menon, there is very little occlusion so where is the mal-union. The discrepancy can also be explained by the fact that interdental bone were opened by Dr. Menon in 5 weeks instead of minimum 6 weeks as prescribed by the answering OP as is the regular practice.
15. That the complainant was seen on 31.01.2001 last and his mouth was closed as on that date. It is a lie that he was forced to eat solid food. All the patient whose mouth are closed for treatment of fracture are given only liquid diet. The mouth was opend by Dr. Menon on 03.01.2002 and it is unimaginable that a patient was eating solid foods with closed mouth before that. The CT scan was one only after the arrival of the patient in ICU. The x-ray etc. are not taken as per the request of the patient but due to complications if the patient is fit enough to be send to the x-ray department. The treatment, which was administered was reasonable and adequate. The patient was not compelled for anything it was Bonafide medical decision to treat the fracture afterwards. It is denied that there was any negligence on the part of the OP on the treatment of the complainant. The complainant is not entitled for reimbursement of his expenditure bills with interest and also any other compensation.
16. As is apparent from the allegation of the complainant as far as the medical negligence on the part of the OP No.1 hospital and OP No.2 and 3, is concerned, the main controversy reveals around the preposition whether the complainant should have been treated by a maxillofacial surgeon or by a plastic surgeon. In view of the observations made by OP No.2 Dr. Sugani on 24.12.1999 who noticed flattening on face at left side of face and hanging left jaw with inability to close the month and in view of the report of the x-ray of facial bones and skull followed by three dimensional CT scan of face , revealed fracture mandible, fracture zygoma ltd. and fracture anterior and posterior walls of maxillary sinus .
17. There is no dispute that while dealing with the problem of the complainant, services of OP No.3 were availed by OP No.1 who happened to be a plastic surgeon. While justifying the treatment given by OP No.3, OP No.3 has come up with the following version:-
In cases of swelling masks the fracture and the surgery is done once the swelling subsides. In the normal course treatment of this facial fractures is undertaken only after about a week and that too after the patient has been declared to be out of danger by Neuro surgeon. The complainant has adverted to some hearsay advise which is not based on the facts and circumstances. The medical literature would show that treatment to these fractures are done only after 3-4 weeks of the injuries. The fracture on lower jaw was not treated by open reduction but by close reduction, which was considered ideal treatment for him in the given circumstances. The standard protocal for facial fracture was followed where the prime attention was given to bring patients teeth into proper dental occlusion. It is not necessary to fix individual fractures like anterior and posterior wall of sinus diagnosed on CT and scan which is actually part of zygoma fracture and automatically get reduced when zygoma is reduced.
18. OP No.3 has also contended that all possibilities of further course of action are routinely explained to the patient in advance and as such possibilities of open reduction and fixation if the fracture does not unite and the same was done in his case, was also told to him. The complainant never came back to the OP for review after 31.01.2001. he went to another surgeon before even completion of 6 weeks, (which is a standard waiting period) for further treatment.
19. At the same time OP No.3 has categorically stated that all over the world Cranio-facio-maxmillary injuries particularly the once complicated by the other life threatening injuries are treated by plastic and reconstruction surgeon and not by the dentist. The timing of treatment of facial fractures and mode of treatment is decided after taken into consideration the over all condition of the patient particularly when they are suffering from life threatening injuries to the other parts of body specially head injury, as in this case. Oral and Mxilla- facial surgeons, who are basically dentists are not trained to deal in all the complexity involved in polytrauma patient they are supposed to treat only those simple cases of fractures where no other body injuries are involved or they are working under skilled supervision of plastic surgeon as happens in one of the hospital in Delhi itself i.e. Safdarjang Hospital.
20. On the other hand the complainant has refuted the aforesaid opinion of OP No.3, with regard to nature of treatment and has tried to take advantage of observation of two doctors who are specialists in maxillofacial surgery. The first observation is by the doctor of Army Hospital R &R Delhi Cantt., which reads as under:
Pt. was managed by closed reduction & IMF for # mandible on 23/24th Dec.
O/E Step deject lower border of mandible IMF done.
Tenderness left mandibular region.
Check radiograph reveal inadequate reduction of #.
IMF removed.
Occlusion slight discrepancy is inter-cuspaltrilation mouth opening restricted.
Lower and upper anterior teeth grade 1 mobility Rygomatic complex # treated by indirect reductions.
21. Another observation is of the Safdarjung Hospital which are as under:-
H/o Old case of # maxilla positioned posteriorly.
Case of retrograded amnesia.
RTA on 18th Dec. 1999. Pt.
unconscious from 3 days.
C/o Inability to chew from left side.
Clicking Lt. TMJ during yawning Feeling of jelly type of teeth of left side.
Flattening of face lt. side Numbness left side of lip.
Cheek biting left side.
22. In support of this contention the counsel for OP No.1 has referred to and relied upon the medical literature :-
Because of their dental background, oral and maxillofacial surgeons are uniquely qualified to deal with any injury of the face, jaws, mouth or teeth. Cuts and lacerations anywhere on the face require meticulous attention. If stitches are needed, placement must be precise to ensure a proper cosmetic result. When facial bones are broken, the experience and training of the oral and maxillofacial surgeon are invaluable.
For a fractured jaw, metal braces may be attached to the teeth and wires or strong rubber bands used to hold the jaws in place and allow the bones to heal. Patients with few or no teeth may need dentures or special dental splints to align and fix the fractures. Severe fractures can require surgery to wire together broken bones or secure them with metal plates.
23. In nut shell the counsel for the complainant contends that there was considerable delay and negligence on the part of the OP No.1 in as much as that the patient was admitted on 19.12.1999 whereas the x-ray of facial bones and skull was conducted on 24.12.1999 and again the surgery was conducted on 27.12.1999. He was advised to bite and chew normal solid diet up to 29.12.1999 when he was operated by OP No.3 and mouth was closed by rubber bands. On the nature of operation and surgery conducted by OP No.3 again the contention of the complainant in brief was that the complainant was advised corrective surgery and orthodontic treatment by Dr. Dhirendra Srivastava, Maxillo-facial Surgeon at Safdarjung Hospital, New Delhi and also posterior displacement of maxilla causing anterior open bite and flattening of face cannot be corrected in India and further that the swelling on the face was so prominent because of the multiple fractures that it required the immediate attention and treatment along with the other injuries and therefore the doctor attending the complainant would have ordered x-ray of the facial bones to ascertain the extent of injuries on the face.
24. To ascertain the medical negligence, cumulative conclusions drawn from various decisions can be summed up in the form of following queries? Decision will depend upon the answers:-
a.
Whether the treating doctor had the ordinary skill and not the skill of the highest degree that he professed and exercised, as everybody is not supposed to possess the highest or perfect level of expertise or skills in the branch he practices?
b.
Whether the guilty doctor had done something or failed to do something which in the given facts and circumstances no medical professional would do when in ordinary senses and prudence?
c.
Whether the risk involved in the procedure or line of treatment was such that injury or death was imminent or risk involved was upto the percentage of failures?
d.
Whether there was error of judgment in adopting a particular line of treatment? If so what was the level of error? Was it so overboard that result could have been fatal or near fatal or at lowest mortality rate?
e.
Whether the negligence was so manifest and demonstrative that no professional or skilled person in his ordinary senses and prudence could have indulged in?
f.
Everything being in place, what was the main cause of injury or death. Whether the cause was the direct result of the deficiency in the treatment and medication?
g.
Whether the injury or death was the result of administrative deficiency or post-operative or condition environment-oriented deficiency?
25. We have accorded careful consideration to the medical literature as well as the explanation and the version given by OP No.3 coupled with the observations made by the doctors of Safdarjung Hospital as well as Army Hospital and find if at all there was any deficiency on the part of the OP No.1 it was only confined to the taking of x-ray of the facial bones to ascertain the injuries on the face, though it was a case of having suffered serious head injury and that was the top priority to save his life.
26. May be that there was a role of maxillofacial surgeon but it was at subsequent stage as the craniofacial injuries particularly once complicated with other life threatening injuries have to be treated by plastic and re-constructing surgeons at the first instance and not by the dentist.
27. The instant case was such where the timing of direction of the facial fracture and mode of treatment was to be decided after taking note of condition of the patient particularly in view of the life threatening injury to other parts of the body specially head injury. To say that service of oral and maxillofacial surgeon should have been availed at the first instance is not correct as these surgeons are basically dentists and not trained to deal with poly trauma patients who suffer head injury and multiple injuries may be involving injuries to the jaw or mouth or teeth.
28. There is no medical expert opinion produced by the complainant that may deal with any of complication or the problem faced subsequently by the complainant. There is also no expert opinion in the field of plastic surgery or other surgeries that in the given facts and circumstances of the case the first priority was to avail the service of maxillofacial surgeon and not plastic surgeon or other surgeon. Rather the medical literature on the subject as cited by the OP suggests Cranio-facio-maxmillary injuries particularly the ones complicated by the other life threatening injuries are treated by plastic and reconstruction surgeon and not by the dentist. The timing of treatment of facial fractures and mode of treatment is decided after taking into consideration the over all condition of the patient particularly when they are suffering from life threatening injuries to the other parts of body specially head injury
29. In our view subsequent complications could have been well avoided, had the OP taken the x-ray immediately and not waited for five days and again could have resorted to the surgery without waiting further period of four days but this is limited deficiency as the doctor attending to the complainant were highly qualified skilled persons and there is nothing on record suggesting that the line of treatment was wrong
30. In our view for the limited deficiency lump sum compensation amounting to Rs.50,000/- besides Rs.10,000/- towards cost of litigation shall meet the ends of justice.
31. In the result the complaint is allowed with the direction to OP No.1 to pay a sum of Rs.50,000/- as compensation and Rs.10,000/- as cost of litigation to the complainant within one month from the date of receipt of this order.
32. A copy of this order as per the statutory requirements be forwarded to the parties free of charge and also to the concerned District Forum and thereafter the file be consigned to Record Room.
Announced today on 29th day of September 2008.
(Justice J.D. Kapoor) President (Rumnita Mittal) Member Tri