National Consumer Disputes Redressal
Bassi Hospital Pvt. Ltd. And Anr. vs Pankaj Gupta And Anr. on 10 September, 2007
Equivalent citations: IV(2007)CPJ239(NC)
ORDER
P.D. Shenoy, Member
1. Aggrieved arid dissatisfied by the order of the State Consumer Disputes Redressal Commission, Ptinjab, Chandigarh directing the opposite parties -Bassi Hospital, Ludhiana and Dr. Naresh Bassi of Bassi Hospital (hereinafter referred to as the Hospital) to pay a sum of Rs. 2,75,690 to the complainant as compensation and Rs. 10,000 as costs, Appeal No. 376 of 2003 has been filed by Dr. Naresh Bassi (hereinafter referred to as Dr. Bassi) and the Hospital. Similarly, the complainant has also filed First Appeal No. 702 of 2003 for enhancement of compensation.
As these two matters arise out of the same order of the State Commission we heard them together and proceed to pass a common order.
First Appeal No. 376 of 2003 Case of the complainant:
2. Case of the complainant-Pankaj Gupta is that, he developed an abscess with pain in the right inguinal region (groin Region). Dr Bassi-OP No. 2 before the State Commission advised that the treatment requires operation. On 3.1.2000 he was admitted as an indoor patient by Dr. Bassi at the Hospital for treatment. On 5.1.2000 while performing the surgery, Dr. Bassi cut a big hole in the femoral artery of the right leg and he was profusely bleeding and when the situation went out of control, Dr. Bassi referred the complainant to Christian Medical College and Hospital, Ludhiana (hereinafter be referred as CMC) for further treatment.
3. When the complainant was admitted to the CMC at 7.00 p.m. on 5.1.2000 it was found that his right Popliteal Artery and Dorsali's Pedis Artery were not palpable. During the treatment at CMC the complainant came to know that he had pseudo aneurysm femoral artery with abscess and that Dr. Bassi while operating the abscess, cut negligently a big hole in the under lying femoral artery resulting in huge loss of blood but also in cutting of blood supply of lower parts of the right leg causing permanent damage to the lower leg which developed into gangrene. In order to save his right leg below the knee, amputation was done on 15.1.2000 but gangrene could not be controlled. Hence, another above knee amputation was performed on 21.1.2000 and knee stump closure was performed on 7.2.2000. It is the say of the complainant that Dr. Bassi did not take due care and caution while performing the surgery. As a result of the amputation, complainant suffered unbearable pain and it took about 10 weeks for complete healing of the wound. He had to incur a lot of expenditure for nutritious diet, travel and going to Nevedac Prosthetic Centre at Chandigarh. Though better Prosthetic leg was available at Rs.1,86,000 the complainant could not afford to buy the same. Civil Surgeon, Ludhiana has certified that he has 80% permanent disability. Alleging medical negligence on the part of the opposite parties, he claimed Rs. 20 lakh as compensation with 18% interest along with Rs. 79,566 incurred for the treatment.
Case of the opposite parties:
4. The case was contested by the opposite parties, according to whom the complainant was a IV Drug addict and habitual of sexual contacts. Complainant had developed severe pain in the right inguinal region and swelling. Accordingly, Dr. Bassi had rightly advised him to undergo surgery for drainage of the abscess but no assurance for recovery was ever given by him. Abscess was confirmed P M surgery was performed by Dr. Bassi under the supervision of Dr. Katyal, Senior Anasthetist of the town. Senior Consultant Microvascular and Plastic Surgeon Dr. Ravinder Tah was called for advice and he has also confirmed the operation procedure and hemostasis and found the blood of the limb with good capillary filling of Rt Foot of the complainant and he was shifted to recovery in the good general condition. He was kept under observation and he was shifted to CMC. It was denied that femoral artery was negligently cut by Dr. Bassi but the pseudo aneurysm which developed because of drug addiction got burst itself which is to the credit of complainant itself, was controlled in the best possible manner.
5. Complainant was shifted to CMC in a stable condition and nothing was done at CMC till the next day as all parameters i.e. B P, Pulse, respiration remained stable and the complainant remained under observation as per CMC Record. Ligation of femoral artery was done on the next day of admission in CMC and gangrene of the limb developed 10 days after the admission in CMC and below knee amputation was done on 15.1.2000.
Submissions of the learned Counsel for the appellants:
6. Learned Counsel for the appellants submitted that there are several deficiencies in the order of the State Commission. It has been wrongly stated in the order of the State Commission that (a) opposite party has not been able to deny the allegations made by the complainant; (b) further, admittedly the femoral artery was cut during the operation of the abscess which resulted in non-flow of blood in the right leg for a long time and the complainant developed gangrene. He quoted an extract from the report published by the Indian Journal of Clinical Practice, Volume 12, No. 1, on "Surgery for Drug Addicts" written by C Lalhmingliana after studying some of the cases of drug addicts in the North East India including Mizoram which reads as under:
They inject into both the femoral vessels, since they are in no position to know which is which. The vessel walls slowly tears open and blood begins to leak out into the surrounding tissues. The bacteria also come into for their feast. The continuous overflow of blood and rapid pus formation start destroying the muscles. Soon the skin around the entry of the needles become necrosed and burst open, death being just a matter of minutes or hour unless the appropriate surgical intervention is done. Among 19 patients we had operated only in 1 patient the femoral artery was reparable. A 6 inch long incision was made from inguinal ligament down to mid thigh. While the assistant pressed down upon the vessels at the level of the inguinal ligament, the surgeon removed a mixture of blood clots, pus and necrosed tissue totaling roughly 2 litres. When the debris was finally cleared and the upper and of the femur including its neck fully exposed, the muscles and the femoral vessels were nowhere in sight. The stumps of femoral artery and vein were suture-ligated with No. 1 nylon at the level of the inguinal ligament. The cavity was irrigated with hydrogen peroxide and saline, packed with gauze soaked with betadine. He was given injection ciprofloxacin, daily dressing and a total of 18 units of blood. The cavity was slowly filled up by tissues.
7. Dr. S.M. Bose has given his expert evidence in the form of an affidavit without seeing the records of the Bassi Hospital and CMC Hospital. He was not cross-examined. In fact none of the witness were cross-examined.
8. Complainant is an IV drug addict with habitual of sexual contact and having multiple puncture wounds on his body. When the complainant was admitted in the Hospital he had severe pain in the inguinal region and swelling in the inguinal region which was tender without any pulsation and diagnosis of cellulites with developing abscess, which was confirmed by Fine Needle Aspiration Cytology (FNAC). He was advised Incision and Drainage (I & D) which is the standard treatment. The under lying pseudo aneurysm which got detected at the operation table after I and D gave way because of necrosis of its wall and bleeding started which was managed in the most efficient way by Dr. Bassi. Bursting with haemorrhage is a usual complication of pseudo aneurysm. The second opinion of Consultant Micro Vascular and Plastic Surgeon Dr. Ravinder Tah was taken in the operation theatre who confirmed good blood supply to the limb with good capillary filling in foot. Complainant was shifted to CMC in his best interest and for continuous observation under the care of Cardio Vascular Surgeon to carry out any by-pass surgery if thrombosis or any other complication develops and who can manage the known complication of pseudo aneurysm in a better way. Applying pressure on artery for a few moments to control bleeding and doing repair are usual parts of procedure and blood loss does not lead to gangrene of the limb. Amputation of the leg of the complainant is a direct result of habit of drug addiction with repeated injections which led to formation of pseudo aneurysm which is responsible for loss of blood supply to the limb which is a usual complication, and hence, Dr. Bassi was not negligent. In support of their case, apart from the affidavit of Dr. Bassi, the appellants have filed affidavits of Dr Sanjiv Uppal, MBBS, MS (Surgery) M Ch (Plastic and Re-constructive Surgery) specially trained in Microvascular Surgery and Dr. Waheguru Pal Singh, MBBS, MS (Surgery), M Ch (Plastic and Re-constructive Surgery) in response to the affidavit given by Dr. S.M. Bose in favour of the complainant.
Dr. S.M. Bose has falsely stated that:
(i) Surgeon of Bassi Hospital should have repaired the rent caused by his scalpel rather than ligation of the femoral artery;
(ii) The surgeon at Bassi Hospital ligated the femoral artery which was done above the origin of profunda femoral artery which is sure to cause gangrene of the limb;
(iii) The femoral artery should not be left occluded either by ligature or tourniquet for more than 90 minutes to 2 hours whereas the complainant was referred to CMC 6 hours after the operation;
(iv) It seems while making incision for drainage the abscess, the surgeon made a deep incision producing a rent (cut) in the femoral artery which is the main source of blood supply to the lower limb. Ligation was done at CMC and not at Bassi Hospital.
9. He further submitted that as per the case history of the appellant, it is clearly, stated in the operation notes that the rent was sutured. This means that rent was repaired and no ligation was done at Bassi Hospital. He further submitted that the ligation of the femoral artery was done at CMC Hospital on 6.1.2000 as is evident from the discharge card of CMC Hospital. The only time when the femoral artery was left occluded was within the permissible limit as suggested by Dr. S.M. Bose in his affidavit. In his affidavit Dr. Bose has stated that during operation, the surgeon should have control of the artery, both above and below the pseudo aneurysm and only then he should proceed. He further submitted that there are 11% incidents of amputation of limb in patients who suffer from pseudo aneurysm in the best centres of the world in spite of the best possible treatment.
10. He referred to the discharge summary of the CMC Hospital which mentions that he was admitted on 5.1.2000 and the patient was discharged on 14.2.2000. He was admitted for multiple puncture wounds all over the body. Treatment on 6.1.2000 was for (R) Femoral artery, exploration and ligation under general anaesthesia (GA). On 15.1.2000 through knee amputation under GA was done. On 21.1.2000 above knee amputation under GA and on 7.2.2000 STSG and knee stump closure under GA was done.
11. Consent form was obtained on 5.1.2000 whicn was signed by the patient and also the father of the patient. The extract of the printed consent form is given below:
Though utmost care is taken in every case still doctors do not undertake any guarantee or responsibility of any sort and no guarantee has been given as per to the final results of treatment. I have satisfied myself with the facilities available in the hospital. Anaesthesia Notes Anaesthesia Time 2.30 p.m. to 5.00 p.m. Surgery started with Pentazocine .30, Diazepam 10 and ketamine -- 100, pus drained out, pseudo aneurysm was seen which was found to be bleeding so repair of vessel was planned and patient was intubated and maintained on halothane, N20, 02, Pencuronium. BT was given, vitals were monitored maintained and patient was shifted to recovery in satisfactory condition. Operative Note:
Patients parts cleaned with Betadine, drapped with sterile sheets, stab over necrotic skin given. Frank foul smelling pus drained out cavity washed out, packed with Betadine roller gauge, sterile dressing applied just after the operation dressing was found to be soaked with blood. Pack removed and gush of blood came out from the wound, immediately pressure applied, patient redrapped, cavity exposed. It was found in the base of abscess cavity there was a rent from which fresh arterial blood was gushing out. Femoral artery dissected proximally and distally. Vascular clamps applied and rent sutured.
Surgeon -- Dr. Naresh Bassi He was also seen by Dr. R. Tah whose advice is as follows:
5.1.2000 Case seen by Dr. R. Tah I was called to examine and give opinion O/E Young Patient I & D Done Femoral Vessel Exposed A rent in femoral vessel just above profunda femoris Foot shows good capillary filling Adv * Assessment of vascularity of lower limb Rt side--
Angiography * Ligation * Vascular By-Pass Grafting or cross femoral graft to save limb if vascularity is deficient As all the above facilities exist in CMC patient may be Transferred to CMC Hospital, Ludhiana.
Submissions of the learned Counsel for the respondent:
12. By the time the patient was taken to CMC his right foot was dead. Three surgeries had to be performed at CMC. Patient cannot afford artificial leg which costs more than Rs. 1 lakh. Ms. Shobha showed us the photographs of the amputation also. The State Commission has awarded Rs. 2,75,619 as compensation to the complainant including the expenditure incurred along with cost of Rs. 10,000 which is thoroughly inadequate. Considering the fact that the patient has to use expensive artificial leg and considering the fact that his disability has been categorised at 80% which has reduced his earning capacity drastically and the same may be enhanced. The amount claimed by the complainant in the complaint is Rs. 20 lakh. Appellant No. 1 was insured for a total amount of Rs. 10 lakh and Rs. 2,50,000 per case for the period from 15.9.1999 to 14.9.2000 and the appellant No. 2 was insured for Rs. 10 lakh and Rs.51akhpercase for aperiodbetween31.8.1999 to 30.8.2000 with the Insurance Company.
13. Complainant was admitted to the CMC and it was found that "the right lower limb showed a sutured wound in the right inguinal region with no active bleeding. The right poplitial artery and Dorsali's pedis artery were not palpable and the pulsations were not heard on Doppler examination. The ankle and foot were cold and clammed. Movements were absent at the ankle. No sensation was present in the right lower limb. Left lower limb was normal". Right leg of the patient was dead when the patient was admitted to the hospital she added.
14. She quoted the treatment record of the CMC at the time of admission on 5.1.2000 at 7.15 p.m.:
Post operative effect of pseudo aneurysm (Rt) Femoral Artery O/E -- Conscious, in Severe Pain Pallor -- (Rt) Multiple IV Puncture wounds Chest Pulse--90/min BP--110/70 Afebrile (Pt) Poplitial, Dorsalis, Abscess (Pt)LL Cold, Clammy foot Absent movement at ankle Absent sensation of foot Capillary filling Operated site sutured from outside (Pt) Inguinal Region Admit for observation CBC BU/CT/E/BS Blood C/S HIV/HBSAg/HCV
15. She further submitted that two doctors have filed affidavits in support of Dr. Bassi. Dr. Sanjeev Uppal, and Dr. Waheguru Pal Singh, have filed their verbatim affidavits. It appears from their affidavits that if they have been drafted by their Advocates and signed by them without application of mind, hence they cannot be believed.
16. She further submitted that while treating the complainant who had abscess in the right inguinal region (groin region), Dr. Bassi negligently cut a big hole in the underlying femoral artery resulting into huge loss of blood which could not be controlled by the respondent and to stop the blood loss pressure was applied on the femoral artery and in that process the blood supply to lower part of the right leg remained cut of f for a considerable longer period resulting in permanent damage to the lower leg. Since there was blood loss and non-flow of the blood in the right leg for a long time, complainant developed gangrene which persisted and as result of which complainant's right leg was amputated through three surgeries. Complainant could have gone for prosthetic leg worth Rs. 1,87,000 and has compromised with a cheaper leg which is more than 6 kgs. in weight and due to its weight the complainant is not able to walk freely. The State Commission awarded only Rs. 2,75,169 compensation and cost which is disproportionately on the lower side. Hence prayed for enhancement to Rs. 20 lakh.
Submissions of the learned Counsel for the Insurance Company:
17. Mr. Nandawani adopted the arguments of the learned Counsel for the appellants.
Findings:
Treatment Records
18. It is necessary to go through the records of Bassi Hospital which reads as under:
Severe pain Rt Inguinal region x 5 days H/O swelling Rt Inguinal Region Past History of repeated injections of drug by himself in various veins of body (Drug addiction) in Delhi for six months. On examination injection mark are present on various part of body, inguinal region, both arms etc. Rt Inguinal region showed a swelling about 5 cm x 7 cm. Tender fluctuant and red, no pulsation B P120/80, P-88/ Min, Temp. 98 F Provisional Diagnosis--Rt Inguinal L N Cellulitis with abscess investigation. 3.1.2000 Hb 10gm% TLC 9200 P 71 L 27 E 1 B T 2"45"
CT 7--20"
BL Gp. B positive Urine -- Sugar-Nil Alb -- Traces Pus Cell -- Rare RBC -- NIL BL Urea 32 mg/dl S Cr. 1.04 mg/dl 5.1.2000 HIV Negative VDRL Negative He was also seen by Dr. R Tah whose advice is as follows:
5.1.2000 Case seen by Dr. R Tah I was called to examine and give opinion O/E Young Patient I & D Done Femoral Vessel Exposed A rent in femoral vessel just above profunda femoris Foot shows good capillary filling Assessment of vascularity of lower limb Rt side--
Angiography * Ligation *Vascular By-Pass Grafting or cross femoral graft to save limb if vascularity is deficient As all the above facilities exist in CMC patient may be Transferred to CMC Hospital.
Ludhiana.
19. It is clear from the records that the patient was a chronic drug addict and though habituated to sexual contacts he was HIV and VDRL Negative. During the operation it is mentioned that blood came out from the wound, immediately pressure was applied and it was found in the base of abscess cavity there was a rent from which fresh arterial blood was gushing out. Femoral artery dissected proximally and distally. Vascular clamps applied and rent sutured. The case was seen by Dr. Ravinder Tah who has stated in his report that femoral vessel exposed, rent in femoral vessel just above profunda femoris, foot shows good capillary filling. Advised patient to be transferred to CMC Ludhiana. Though this observation shows that foot shows good capillary filling, but when he was taken to CMC, the CMC record indicates that the patient's peripheral pulse dorsalis pedis felt feeble. Impression: Post operative femoral artery pseudo aneurysm with abscess. The patient was referred to Cardio-thoracic unit.
The records of the CMC reads as follows:
Post operative effect -- The patient was conscious, in severe pain Poplitial Dorsalis absent Right Lower leg -- Coid Clammy foot Absent movement at the ankle Absent sensation of foot Capillary filling --?
Operated site sutured from outside --Inguinal region The record further shows that the right lower limb at Inguinal region sutured from outside. No active bleed.
Poplitial artery /Dorsalis pedis -- not palpable.
Doppler -- poplitial/Dorsalis pedis absent, foot, ankle, cold, clammy, absent movement at the ankle.
No sensation at the right lower limb infected pseudo aneurysm (Rt) Femoral artery. This means that the patient was shifted to CMC, when they found that the patient's right leg has got no sensation and it has become cold and clammy. CMC also observed that thrombosis of femoral artery.
20. Though, Dr. Bassi of Bassi Hospital took the patient for treatment, when he found that he had cut the femoral artery which is the most important artery of the leg, in panic he summoned Dr. Ravinder Tah. Dr. Ravinder Tah is himself is a Microvascular and Plastic Surgeon. After having called Dr. Rah he could have used his services for treating the patient but he thought that the best course is to pass on the buck to CMC which he has done. Now let us see the evidence of Dr. Bassi.
Evidence:
21. Dr. S.M. Bose, M S in surgery from Post Graduate Institute of Medical Education and Research, Chandigarh has additional degrees/ fellowships of FRCS, FACS, FICS and FAMS. He retired as Professor and Head of Surgery from PGIMER. after 39 years of service. He has vast experience as a general surgeon and also had a long experience of teaching post-graduate students at the above premier institute. He has stated in his deposition is as follows:
I have pone through the case records of Shri Pankai Gupta, complainant and I have arrived at the following conclusions:
(a) This was a case of abscess in the inguinal region as is clear from his history of pain, appearance of fluctuations two days after his admission in Bassi Hospital and FNAC result.
(b) This was not a case of Pseudo Aneurysm because the surgeon had not noted any pulsations in the swelling and FNAC had also not revealed blood.
(c) It seems while making incision for draining the abscess, the surgeon made a deep incision producing a rent (cut) in the femoral artery which is the main source of blood supply to the lower limb. This resulted into profuse bleeding for which the surgeon just ligated the femoral artery above the rent. This rent was subsequently identified and noted by the surgeon in CMC.
(d) It has been alleged that the artery had been damaged by the patient himself by repeated injections and had resulted into Pseudo Aneurvsm and necrosis of the blood vessel, but the surgeon at CMC did not write about any evidence of sloughing or necrosis anywhere in the wall of the femoral artery, (e) The surgeon of Bassi Hospital should have repaired the rent caused by his scalpel rather than ligating the femoral artery, he had also ligated above the origin of profunda femoral artery. This is sure to cause gangrene of the limb. Whenever there is a suspicion of Pseudo Aneurysm, the patient should be investigated by Doppler or Angiograohy so as to establish the exact nature of the problem in the femoral artery. At operation, the surgeon should have control of the artery, both above and below the Pseudo Aneurvsm and only then he should proceed. The femoral artery should not be left occluded either by ligature or tourniquet for more than 90 minutes to 2 hours whereas the complainant was referred to CMC after 6 hours after the operation.
Dr. Naresh Bassi has been negligent in diagnosing the patient, investigating the patient in a proper way and also in conducting the operation as he did not take recommended steps as are required in Pseudo Aneurysm problems i.e. control of the vessel below and above the Aneurysm. Had he taken such steps, profuse bleeding would not . have taken place even as a result of the rent caused due to scalpel and the rent would have been repaired within a short time without any significant loss of blood.
Considering the qualifications and experience of Dr. S.M. Bose and considering the fact that he has not been cross-examined, his evidence goes unrebutted.
12. As against this evidence, the Hospital authorities have filed affidavit of Dr. Sanjeev Uppal:
The extracts of his affidavit is re-produced below:
I have gone through the case records of Pankaj Gupta, complainant. I lave studied the records of Dr. Naresh Bassi and also the records submitted by CMC Ludhiana. I have derived at the following conclusions: Parawise --
(a) It seems that Dr. S.M. Bose has not studied the file thoroughly. It has been written clearly in the reply on the page No. 3 that the patient was admitted with diagnosis cellulities with development abscess in Rt inguinal region with H/O repeated injection of Drug in various vessels of his body (Annexures R 1 and R 2) as evident by history given by patient himself and his father in Bassi Hospital as well as in CMC. The diagnosis was confirmed by FNAC (Annexure R3)
(b) It has already been written in the reply vide page No. 7, 5th line from above and page No. 10, 6th and 7th line from below that patient had been suffering from superficial abscess in groin and pseudo aneurysm of femoral artery underlying it, the diagnosis of which was confirmed at the operation table. This has been written clearly in ref. letter to CMC Annexure R-14. It is absolutely wrong to say that patient was not suffering from pseudo aneurysm. Pulsation were absent because it was lying below the superficial abscess.
(c) It has already been mentioned in the reply on page No. 5 and R 5 page 28 that after the operation of abscess, incision and drainage, the bleeding started which was due to rupture of the pseudo aneurysm lying below it, which is usual complication of disease as per literature from Text Books Annexure R 7. There is no question of making a cut in femoral artery. Dr Naresh Bassi is a Senior Surgeon with 18 years of surgical experience.
The bleeding which occurred at the operation table was immediately controlled. Only a unit of blood was given. The other unit of blood was supplied with the patient to CMC (Annexure R 13 page 59 of reply). The patient was shifted to CMC in best stable condition and nothing was done in CMC till the next day as all the parameters B P, Pulse, respiration remained stable and patient was kept under observation only, as mentioned on page No. 6 of reply as per CMC record Annexure No. R 13.
As per Annexure No. R 05 page No. 28 only Repair of Femoral Artery Pseudo aneurysm was done in Bassi Hospital and ligation of the femoral artery was done in CMC on the next day i.e. 6.1.2000, as per CMC record (R - 19 page 91). Only the repaired rent was recognised at the operation table in CMC and also the diagnosis of infected pseudo aneurysm was confirmed. (Annexure R- 19). The statement of Dr. S.M. Bose is absolutely wrong that femoral artery was ligated at Bassi Hospital.
(d) Patient has already been proved to be an addict with H/o repeated injections of Drugs into blood vessels as mentioned in Annexure Nos. R 1 and R - 2. The operatives notes of CMC. Annexure R-19 page 91 proved it to be infected pseudo aneurysm. There is no doubt about the diagnosis and treatment.
(e) The statement of Dr. S.M. Bose is absolutely wrong. The repair of the pseudo aneurysm was done at Bassi Hospital and not ligation as mentioned in Annexure R 5 page 28, control of the artery above and below was achieved by vascular clamps (Annexure R 5) and bleeding was controlled in the most efficient manner as evident by HB report at Bassi Hospital as 10 gm and at CMC as 10.2 gm. Annexures R12 and R 13 femoral artery had not been occluded by ligature or tourniquet. Doppler study or Angiography is usually not done in cases of abscess. As per Annexure No. R 5 operation was completed at 5.00 p.m. and 7.00 p.m. is the admission time in CMC, R -13 page 59.1 think, it is the earliest time and moreover nothing was done in CMC till the next day and the patient was kept under observation only.
(f) HIV test does not have any link with the treatment given,
(g) Doppler study was not felt necessary as already mentioned in the case of abscess and diagnosis of pseudo aneurysm was confirmed at the operation table.
So it is absolutely wrong to say that if any negligence has been done in the treatment of Mr. Pankaj Gupta at Bassi Hospital Pvt. Ltd., Ludhiana. Rather he had been lucky enough to be in one of the most advanced surgical centres of the town where his life could be saved in the most efficient manner. Loss of limb can be attributed to his habit Drug Addiction.
23. Dr. Waheguru Pal Singh has also filed affidavit in support of Dr. Naresh Bassi and Bassi Hospital, which is the verbatim reproduction of the affidavit of Dr. Sanjeev Uppal. As these two doctors i.e. Dr. S Uppal and Dr. Waheguru Pal Singh have not been cross-examined and in normal circumstances we would have accepted their affidavits as a valuable piece of evidence. However, considering the fact that in both the affidavits there is no variations including coma, full stop and they are verbatim reproductions it gives room for arriving at a conclusion that these might have been drafted by the lawyer or by some interested person and the doctors might have blindly appended their signatures without any application of their mind. Hence they lose much of their evidentiary value.
24. The extract of the report of Mr. C. Lalhmingliana, author, after studying the case of drug addicts in the North East India including Mizoram quoted by the learned Counsel for the appellant (supra), is not of any help to the appellant because as the case on hand relates to Punjab and the study does not cover this case and the facts are distinguishable. It is only a report and not an authorised medical text.
25. Considering the treatment record of the CMC Hospital which gives enough proof of negligence by the appellants which is duly supplemented by the affidavit of Dr. Bassi an expert in the field, we are not persuaded to interfere with the well reasoned order of the State Commission holding medical negligence on the part of the appellants.
26. Our view is fortified by the celebrated judgment of the Apex Court in Dr. Laxman Balkrishana joshi v. Dr. Trimbak Bapu Godbole , while dealing with the question of medical negligence and duties of a doctor, observed thus:
The duties which a doctor owes to his patient are clear. A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz. a duty of care in deciding whether to undertake the case a duty of care in deciding what treatment to give or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires: (cf. Halsbury's Laws of England, 3rd Ed. Vol. 26 P.17). The Doctor, no doubt has discretion in choosing treatment which he proposes to give to the patient and such discretion is relatively ampler in cases of emergency.
27. Accordingly, we do not see any merit in the First Appeal No. 376 of 2003 filed by M/s. Bassi Hospital Pvt. Ltd., and Dr. Naresh Bassi. Hence, it is dismissed.
First Appeal No. 702 of 200328. Learned Counsel for the appellant in First Appeal No. 702 of 2003 argued that the appellant is a young man of 24 years of age and was earning Rs. 10,000 per month from his business and because of the amputation of his leg his capacity has been reduced drastically. Even multiple of 30 years he would have earned Rs. 10,000 x 360 = Rs. 36,00,000 by way of earnings only, further a good quality prosthetic leg costs Rs. 1,86,000. At present he is using a leg, which weighs 6 kgs. and which is heavy and uncomfortable. Accordingly, the appellant claimed a compensation of Rs. 20 lakh. The Civil Surgeon, Ludhiana has given a certificate stating that the complainant is handicapped to the extent of 80%. Considering the reduction in capacity of earnings and also the cost of good quality prosthetic leg, we consider the ends of justice would be met by enhancing the compensation of Rs. 2,75,619 awarded by the State Commission to Rs. 5.00 lakh. This shall be paid jointly by Bassi Hospital and Dr. Naresh Bassi in equal proportion. It was brought to our notice during the hearing that appellant No. 1 was insured for a total amount of Rs.10 lakhs and Rs. 2,50,000 per case for the period from 15.9.1999 to 14.9.2000 and the appellant No. 2 was insured for Rs.10 lakh and Rs. 5 lakh per case for a period between 31.8.1999 to 30.8.2000 with the Insurance Company. Accordingly, this amount shall will be reimbursed by the United India Insurance Company Limited. Order of the State Commission while partly allowing the said appeal is modified to the extent noticed above. There shall be no order as to costs in either of the two appeals.