National Consumer Disputes Redressal
Dr. R.G.V. Reddy vs Shaik Anjaman on 14 May, 2013
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 3006 OF 2012 (From order dated 23.02.2012 in First Appeal No. 1195 of 2010 of the State Consumer Disputes Redressal Commission, Andhra Pradesh, Hyderabad) Dr. R.G.V. Reddy S/o Mr.V.R. Ganesan, O/o Bharati Hospital, Yerramukkapalli Circle, R.S. Road, Kadapa District, A.P. Appellants Versus 1. Shaik Anjaman W/o Late /Mohd. Rafi, R/o D.No.8/47-S, Sainagar, Rajampeta Town, Kadapa District, A.P. 2. Dr. D.B. Sasidhar Reddy, Super Speciality Hospital, T-S 82, Sai Ram Street, Near Bhavani Nagar, Tirupathy, Chittoor Dist., A.P. 3. Christian Medical College, Rep. By Its Managing Direrctor, Vellore City, Tamil Nadu Respondents BEFORE: HONBLE MR.JUSTICE J.M.MALIK, PRESIDING MEMBER HONBLE DR.S.M.KANTIKAR, MEMBER For the Petitioner : Mr. Chandan Mishra, Adv. Pronounced on 14th May, 2013 ORDER
PER DR. S.M. KANTIKAR
1. The brief facts of the case are that in April 2009 the Complainant/Respondents husband by name Shaik Mohammad Rafi aged 45 years who was having abdominal problem approached the Respondent/Petitioner herein for treatment. The petitioner prescribed some medicines and advised him for Ultrasound Scan. He prescribed some medicines again after seeing the scan Report. But, there was no relief to the patient, therefore the petitioner suggested surgical treatment. On 05.05.2009 the Laparoscopic Cholecystectomy was done with the help of senior Chief Surgeon and the senior anesthetist from RIMS who attended at the time of surgery. On 06.05.2009, the patient complained of difficulty in breathing and therefore he suggested the patient to go for a higher management center to Tirupati. Therefore, on 07.05.2009 as per the advice of petitioner for better treatment Complainants husband went to Tirupati in OP No. 2 Hospital, but from there she was advised shift her husband (patient) immediately to CMC, Vellore and he was shifted to CMC (OP No. 3) on 08.05.2009 at 4.30 a.m. .After resuscitation the patient was shifted to Surgical Intensive Care Unit, injection Dopamine was given to bring up the blood pressure and intravenous fluids. Three operations were conducted by at CMC Hospital on 08.05.2009, 09.05.2009 and 04.06.2009 and the abdomen was washed. In the CMC Hospital, the patient underwent re-laperotomy on 09.05.2009 and perforation was reclosed with falcifarum ligament and once again abdominal cavity was washed with saline and multiple drains placed and the patient continued to be in a state of sepsis, developed seizures and continued to have sero-purulent discharge from his wound and all supports were given to maintain his B.P. Another laperotomy was conducted on 04/06/2009 which showed pus collection in the Pelvis and right Paro-colic Gutter, but despite of best treatment the patient died on 06.06.2009.
The Complainant/Respondent who is wife of the patient filed a complaint before the District Forum, Kadapa contending that initial damage was done by the petitioner as surgery performed by the petitioner caused damage to the gall bladder and the bile was oozing from the abdomen. If the petitioner performed the surgery carefully on the deceased, there would not be any need or necessity for her to approach the OP No. 2 and 3;thereafter, OP-2 & 3 could not rectify the defect caused by the petitioner and could not save her husbands life.
All the respondents denied the allegations made by complainant and contended that the patients condition after treatment was known complications of surgery and denied there is any deficiency of service while treating the patient.
2. The complainant filed a complaint No.128/2009 before District Forum, Kadapa for negligence of the Respondent / Doctors and severe mental agony and prayed for compensation of Rs.14, 63,167/- including medical expenses and mental agony.
3. The District forum considering the oral and documentary evidence and by referring several authorities held OP1 and OP3 for negligence and directed the OP No 1 to pay Rs.56,000/- towards operation and other expenses and Rs.4 lakhs towards compensation for loss of dependency and Rs.5,000/- towards costs totaling to Rs.4,61,000/-. Further opposite party no.3 is directed to pay and amount of Rs.6,56,965/- towards operation, medicines and other expenditure. Case against opposite party no.2 is dismissed without costs.
4. Aggrieved by the said order of District Forum, Kadapa, Three appeals were filed before the A. P. State Consumer Disputes Redressal Commission, Hyderabad (in short State Commission) namely F.A.No.1044/2011 is preferred by the complainant for enhancement of compensation. F.A.No.1195/2010 is preferred by OP-1 and FA No 972/2010 by OP No.3. The State Commission disposed of those three appeals by common order.
The State Commission relying upon the material on record made following observations;
The OP-1 during his cross examination deposed before District forum that, The doctor deposed that there was no chance of perforation of duodenum and there were no injuries to the common bile duct and that there was no chance of septicemia before the surgery. He also denies the entire stones in the gall bladder were not removed during the surgery. Exfacie it is contradictory to the DISCUSSION in Ex. A6, which is the Death Summary of opposite party no.3 in which they clearly stated there were multiple stones spilled within the subhepatic , it is also stated in Ex. A6 Death Summary report that there was Injury to CBD. We also observe from the record that opposite party no.1 did not file the informed consent given by the patient.
Exfacie we find that the observation of the District Forum with respect to difference in writing of opposite party no.1 in his prescription which is almost illegible with that of his Case Sheet Ex.B3, does not warrant any interference. Ex.A6 clearly evidences that there was common bile duct injury with perforation in the first part of the duodenum. Therefore, the contention of opposite party no.1 that there was no injury in CBD is unsustainable. The Expert has also confirmed this opinion. The contention of opposite party no.1 that there was a delay in subsequent treatment which resulted in multi organ failure is also unsustainable as the patient was already in high risk condition by the end of the operation on 06.05.2009 and within a gap of one day joined opposite party no.3 hospital on 08.05.2009. the documentary evidence read together with expert opinion clearly evidences that the injury to CBD was done together with perforation in opposite party no.1 hospital which led to all the subsequent complications. There is also contradiction in the contention of appellant/opposite party no.1 When he states that the sugar levels were normal at the time of operation which is also evidenced in diagnostic test performed prior to the operation (Ex. A1record) but the same opposite party no.1 in his deposition contends that it was only because of hyper tension and diabetes that the patient did not recover. We are unable to agree with this contention on account of the afore mentioned reasons and we find that first opposite party doctor is negligent in performing the operation and consequent injury to the common bile duct which led to post-operative complications like multi organ failure and septicemia.
Therefore, the state commission after the going through the evidence in detail and referring several judgments of Honble Apex Court and National commission held OP-1 alone liable for negligence and OP 2 & 3 were exempted from liability. The state Commission by common judgment; dismissed appeal FA 1195/2010 filed by OP-1; an appeal FA 972/2010 filed by CMC, Vellore (OP-3) was allowed and appeal FA 1044/2011 filed by complainant for enhancement was dismissed. State Commission modified the District Forum order as directing OP-1 alone to pay Rs.56,000/- towards operation and other expenses and Rs.4 lakhs towards compensation together with costs of Rs.5000/-
5. Being aggrieved by impugned order of State Commission petitioner herein filed this revision petition on 14/8/2012.
6. We have heard the learned counsel for both the sides and perused the evidence on record before district forum and state commission.
On careful observation of affidavit evidence of both the parties cleared the dust on many issues.
The opponent-1 has operated the patient for Laparoscopic Cholecystectomy on 05.05.2009. During the post-operative period the patient had sudden chest pain and difficulty in breathing on 06.05.2009 therefore; pulmonary embolism was suspected by OP-1 who advised the relative of patient to shift the patient to the higher center immediately. The OP-1 contended that as the patient was diabetic who was prone for post-operative infections therefore he was given antibiotics and some higher drugs to control the infection. OP-1 reiterated three expected complications of diabetics; Peripheral neuropathy, Diabetic nephropathy (degeneration of kidney) and Diabetic retinopathy. The OP-1 also contended that the uncontrolled hypertension leads to over load of heart, which leads to difficulty in breathing, and long term diabetes, which leads to hypertension and multiple organ problems which deteriorates the patients health. The opposite party took the cardiologists opinion and complete blood examination was done with chest X-ray, ECG, Echo Ultra Sound of abdomen and also took help of senior Chief Surgeon and anesthetist RIMS hospital and took all possible care. OP-1 reiterated that the patient had multiple organ problems and any stone in Gall bladder may lead to infection like septicemia to a diabetic patient. The patient was monitored closely and was referred to a higher center for better care and he died in CMC hospital for which OP-1 cannot be held liable. The Doctor reiterated in his counter that the patient had chronic diabetes, gallstone peptic ulcer, untreated peptic ulcer, which led to perforation of duodenum and therefore led to complications. There was no injury in CBD and no injury in the Gallbladder and therefore OP-1 cannot be made liable for negligence and therefore seek dismissal of the complaint with costs.
7. The OP-2 in evidence reiterated that no treatment was given to the patient who was in-turn referred to higher tertiary care center i.e CMC, Vellore on same day and patient went there on 8.5.2009 to OP-3 and thereafter further course of treatment carried out by doctors at OP-3.
8. The OP-3 also stated in written version that, the patient was brought on 08.05.2009 at 01.30 a.m. in a state of shock with a tube in throat for artificial breathing. As per the Glasgow Coma Scale 2T and abdominal examination show evidence of bile leak through the drain. He was also having acute renal failure and serum creatinine levels being 4.9 mg% and he was also in coagulopathy. The patient had severe acidosis with respiratory complaints. The patient was shifted to Surgical Intensive Care Unit after resuscitation with injection Dopomine to bring up the BP and intravenous fluids on 08.05.2009 at 05.45 a.m. the patient also required ventilator support for his breathing. The OP-3 in their affidavit submitted that the patient underwent an emergency operation which showed large volume of bile contamination in the whole abdominal cavity. The operation was converted to laperotomy where there was a 1 c.m. perforation (hole) in the first part of the duodenum and multiple gallstones spilled within the subhepatic space and 5 litres of bile. The abdominal cavity was washed with saline and omentum was used to close the perforation. Multiple drains were placed in the abdominal cavity for drainage. The operation was converted into a laparotomy. There was 1 cm perforation (hole) in the first part of the Duodenum and multiple Gall stones. The perforation was closed and the abdominal cavity was washed and the multiple drains were placed in the abdominal cavity for drainage. He was then transferred back to surgical intensive care unit. The patient continued to have bile in the drain and he underwent re laparotomy on 09.05.2009. This time perforation was closed again with falciform ligament. He continued to be monitored in surgical intensive care unit and continued to be in sepsis. He also suffered from ventilator associated pneumonia and developed seizures. The patient continued to be in a state of sepsis, developed seizures and continued to have Seropurulent discharge from his wound and all supports were given to maintain his B.P. He underwent CT Scan and was treated with high doses of antibiotics and underwent another Laparotomy on 4/6/2009 was conducted which showed pus collection in the Pelvis and Parocolic Gutter.
It was the contention of OP-3 that in-spite of their best efforts the patient died on 06.06.2009.
9. We find herein that the respondent/Complainants husband (a patient) was diagnosed as Cholelithiasis (Multiple Galls stones) and operated on for laparoscopic cholecystectomy and subsequently on next day developed breathlessness and referred to higher centre at Rama Devi Super Specialty Hospital, Tirupati (OP-2) who in turn further referred the same case to tertiary care centre i.e. CMC, Vellore (OP-3) where the patient undergone three operations and subsequently died. Hence, it is absolutely clear that the patient was at high risk and in a state of shock, was unable to breath; there was bile leak, renal failure, coagulopathy, and severe metabolic and respiratory acidosis. In such serious condition patient was brought and admitted at OP-3 on 08.05.2209 and three emergency operations were performed on 08.05.2009, 09.05.2009 and 04.06.2009. The patient was continuously monitored which has been confirmed by the entries in the case sheets. Therefore complainant failed to establish deficiency in service and carelessness on the part of OP-3 in treatment and lack of standard skill and knowledge in the line of treatment followed by OP-3. We rely on the judgment of this Commission in Shantaben Muljibhai Patel Vs. Breach Candy Hospital reported in 1(2005) CPJ 10 NC held that if the patient is a high risk patient and the hospital has done its best and followed all standards of normal medical parlance and still the patient dies, it cannot be held liable for negligence merely because the patient dies.
As contended by the petitioner we have perused the evidence Dr. T. Reddaiah who was MBBS only and retired from Government hospital. He was not a specialist or super specialist like a surgeon or a gastroenterologist to be considered as an expert.
10. It is pertinent to note that, the patient deteriorated after 1 st surgery performed by OP-1 who was in serious condition of shock referred to CMC, Vellore.
OP-3 is highly reputed institute in India and a known for best referral and tertiary care centre. On exploration of abdomen by the team of doctors at OP-3 found that huge collection of bile in the abdomen (about 5 liters) and spillage of multiple gallstones and perforation of duodenum. Hence, its Res Ipsa Loquitor i.e. the things speak on its own. Such consequences are only due to negligence of OP-1 in performing laparoscopic cholecystectomy. The petitioner defends himself by correlating such happening to the complications of diabetes or hypertension. The petitioner was aware that the patient was diabetic and petitioner who anticipated the complications should have very careful during laparoscopy. The statements of OP-1 appear that OP was trying to shift his negligence and cause of death on OP-2 and OP-3.
11. Therefore, we find after considering entire evidence of both parties that OP-2 has not given any treatment to the patient but only referred to CMC Vellore (OP-3); hence there was no negligence by OP-2. Also we do not find any negligence by OP-3 in treatment of the patient who they followed highest degree of skill and standards of medical practice. OP-3 has taken proper care as they had team of doctors and are experts in the respective fields. .
12. Therefore, to conclude, we uphold the order of State Commission that the Petitioner /OP-1 is guilty of medical negligence and ultimately the patient lost his life. Therefore we pass an ORDER -
The revision petition is dismissed. The petitioner (OP-1) alone is directed to pay Rs.56000/- towards operation and other expenses and Rs.4 lacs towards compensation together with cost of Rs.5000/- within 45 days failing which it will carry interest @ 9% till recovery.
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(J.M. MALIK J.) PRESIDING MEMBER .
(S.M. KANTIKAR) MEMBER Mss