National Consumer Disputes Redressal
Dr. Harpreet Singh & Anr. vs Harkanwar Singh & Anr. on 1 June, 2022
Author: R.K. Agrawal
Bench: R.K. Agrawal
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 1354 OF 2017 (Against the Order dated 12/01/2017 in Appeal No. 626/2014 of the State Commission Punjab) 1. DR. HARPREET SINGH & ANR. ORTHONOVA HOSPITAL, ORTHONOVA JOINT & TARUMA HOSPITAL (P) LTD. NAKODAR ROAD, NEAR NARI NIKETAN JALANDHAR CITY PUNJAB 2. ORTHONOVA HOSPITAL, ORTHONOVA JOINT & TARUMA HOSPITAL (P)LTD. THROUGH ITS PRINCIPAL OFFICER DR. HARPREET SINGH, NEAR NARI NIKENTAN JALANDHAR CITY PUNJAB ...........Petitioner(s) Versus 1. HARKANWAR SINGH & ANR. THROUGH SPECIAL POWER OF ATTORNEY HOLDER AND FATHER S.NANAK SINGH S/O. S. TARLOK SINGH, R/O. 41, RAJA GARDEN BASTI BAWA KHEL JALANDHAR CITY PUNJAB 2. THE NEW INDIA ASSURANCE CO. LTD., BUILDING 87, MAHATMA GANDHI ROAD FORT MUMBAI MAHARASHTRA ...........Respondent(s)
BEFORE: HON'BLE MR. JUSTICE R.K. AGRAWAL,PRESIDENT HON'BLE DR. S.M. KANTIKAR,MEMBER HON'BLE MR. BINOY KUMAR,MEMBER
For the Petitioner : Appeared at the time of arguments
For the Petitioner: Mr. Sandeep Suri, Advocate
Ms. Geetika Kapur, Advocate For the Respondent : Appeared at the time of arguments
For the Respondent: Mr. Lokesh Bhola, Advocate &
Ms. Nirmala Singh, Advocate for R-1
Mr. Anshum Jain, Advocate for R-2/Ins. Co.
Dated : 01 Jun 2022 ORDER
Pronounced on: 1st June 2022
ORDER
DR. S. M. KANTIKAR, MEMBER Brief Facts :-
1. This Revision Petition has been filed by the Petitioners i.e. Dr. Harpreet Singh (hereinafter referred to as the "Opposite Party No. 1" and Orthonova Hospital at Jalandhar (hereinafter referred to as the "Opposite Party No. 2" against the Order dated 12.01.2017 passed by State Consumer Dispute Redressal Commission, Punjab (for short "the State Commission") in First Appeal No. 626/2014 wherein the Appeal was dismissed and the Order of the District Forum was confirmed.
2. Heard the arguments from the learned Counsel on both the sides.
3. The contention of the learned Counsel for the Complainant is that, in fact and as confirmed by MRI report, there was tear involving body of Lateral Meniscus (in short LM), whereas Anterior Cruciate Ligament (in short ACL) and both collateral ligaments were normal and further Articular cartilage was normal. Further as per MRI report, Patellar tendon/ligament & patellar retinaculum were normal, Muscles and tendons around knee joint were normal. He further contended that instead of treating Lateral Meniscus, Dr. Harpreet Singh (hereinafter referred to as the 'Opposite Party No. 1') treated wrongly and operated on ACL.
4. On the other hand, the learned Counsel for the Opposite Parties, the MRI report showed Complex Grade III tear involving body of Lateral Meniscus. It was not seen during arthroscopy, but the ACL was defective and it was to be reconstructed. It was a cartilage defect which was seen during Arthroscopy, but this defect was not mentioned in MRI report which would further require mosaic plasty which was not available in the opposite party hospital at that time. He contended that as per medical literature the MRI Report is not 100% correct. He contended that after doing necessary operation the patient was discharged in satisfactory condition and there was no negligence or deficiency in service on the part of the Opposite Parties Nos. 1 and 2.
5. We have perused medical literature, on ACL tears and its diagnostic accuracy is 90% by clinical and MRI examinations. The MRI Report (Ex. C3) no tear was found in ACL and only Complex Grade III tear, involving body of Lateral Meniscus was detected. The Complainant got one Radiological report (Ex. C10) in Australia. It was reported that a horizontal oblique tear through the body of the lateral meniscus and a radial tear through the free margin of the body and anterior horn of the meniscus, which corroborate with the MRI report (Ex.C3).
6. We have perused from the medical literature about the anatomy of knee joint and the ligaments (ACL & PCL) & meniscus (lateral & medial). The lateral meniscus (LM) and anterior cruciate ligament (ACL) are quite distinct one. In the MRI report (Ex.C-3) ACL and both collateral ligament were normal and only LM tear was seen. However, the OPs held that MRI report was incorrect and hence surgery was performed to repair the ACL.
7. The main question that whether MRI report (Ex.C-3) was accurate than the clinical examination & arthroscopy. As per medical literature, ACL injuries are more common in women than men. No doubt, MRI report is always not 100% correct. The diagnostic accuracy of MRI was 66.67% for medial meniscus and 90% for lateral meniscus grade II and IV with 88% in the case of ACL tears. Diagnostic accuracy for both clinical examination and MRI examination came out to be 90% conclusion. Diagnostic arthroscopy can avoid in patient with ACL and PCL injuries having equivocal clinical and MRI examination and go on for therapeutic modality. As per medical literature, in case of ACL tears, diagnostic accuracy for both clinical examinations and MRI examination came out to be 90%. So the report of MRI is fairly accurate.
8. In this case, in MRI report Ex.C-3, no tear was found in ACL and only complex grade III tear, involving body of lateral meniscus was detected. The complainant further relied upon the Radiological report (Ex.C-10) done in Australia. It was reported as a horizontal oblique tear through the body of the lateral meniscus and a radial tear through the free margin of the body and anterior horn of the meniscus.
9. We have carefully perused the Medical Record. In the first MRI, the lateral meniscus showed Complex Grade III tear with intrameniscal and multi septated parameniscal cyst formation. It was also mentioned that "Anterior Cruciate Ligament" (ACL) and both collateral ligaments are normal. The Complainant, who was employed in Australia and a soccer player, went to Australia. During follow-up on 19.04.2012, the MRI right knee revealed - "a horizontal oblique tear through the body of the lateral meniscus...". Therefore, the Complainant was under impression that the ACL reconstruction was unnecessarily performed by the Opposite Party No. 2, when there was injury to lateral meniscus. It is pertinent to note that Dr. Harpreet Singh was experienced one. The clinical and operative notes of the Opposite Party No. 1 clearly establish that he performed Arthroscopic medial meniscal excision and ACL (PTB). It should be borne in mind that the Radiological investigations are indirect evidence, whereas the clinical assessment and Arthroscopy are directly helpful to arrive proper diagnosis. The MRI reporting depends upon quality of film, the Radiologist and his experience. Moreover, if there was PCL injury, the Complainant would have shown residual findings and the symptoms accordingly. Thus, the patient had no PCL tear.
10. On careful perusal of the admission record of Orthonova Hospital, it revealed that the Opposite Party No. 2 examined the patient carefully and mentioned the following findings:
o/e - Knee: tenderness at medial joint line Click + ve at 120 degree flexion Drawer / laciness test +/- No say sign
Thus, the above clinical assessment [Drawer / laciness test +] clearly indicates that the Complainant suffered ACL injury and it was supported by Arthroscopic direct visualisation. Thus, the treatment (ACL reconstruction) performed by the Opposite Party No. 2 was the correct treatment in the instant patient.
11. Both the fora below have failed to appreciate such vital direct evidence. They relied merely on MRI findings, which are false positive if not seen during Arthroscopy. Arthroscopy is more specific and its sensitivity is more than MRI. False positive MRI results are common and many times not conclusive.
12. Based on the discussion above, no negligence is attributed to the Opposite Party No. 1 - the Orthopaedic Surgeon. The Orders of both the fora are hereby set aside and the Revision Petition is allowed. Consequently, the Complaint is dismissed.
There shall be no Order as to costs.
......................J R.K. AGRAWAL PRESIDENT ...................... DR. S.M. KANTIKAR MEMBER ...................... BINOY KUMAR MEMBER