State Consumer Disputes Redressal Commission
Sridhar Reddy Leekkala Son Of Late L. ... vs 1. Prime Hospitals, A Unit Of Sri ... on 3 April, 2024
1
BEFORE THE TELANGANA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION : HYDERABAD.
C.C.159/2014
Between :
Sridhar Reddy Leekkala,
S/o.Late L.Malla Reddy,
Aged about 40 years, NRI,
Occ: Software Engineer,
Presently R/o.2101,SWPINOAK,
Ave Bentonville, Arkansas, USA,
Rep. his mother & GPA Holder.
Smt.Karuna Lekkala, W/o.L.Malla Reddy,
Aged about 58 years, Indian, Occ: Housewife,
R/o.H.No.2-258 to 60, Ramanthapur,
Hyderabad - 500 013.
.....Complainant
And
1.Prime Hospitals, (A Unit of Sri Sainatha Multi Specialty Hospital Pvt.Ltd.) Plot No.4, behind Mythrivanam, Mythrivanam Building, Beside Blue Fox Hospital, Ameerpet, Hyderabad - 500 036, Rep. by its Managing Director.
2. Dr.B.S.V.Raju, MS, DNB (Ortho)MCH (Neuro) Consultant Neuro Surgeon & Spine Surgeon, Prime Hospitals, Plot No.4, Behind Mythrivanam, Mythrivanam Building, Beside Blue Fox Hospital, Ameerpet, Hyderabad 500 036.
.....Opposite Parties Counsel for the Complainant : M/s.V.Gowri Sankara Rao Counsel for the Opposite Parties: M/s.D.Devender Rao QUORUM:
HON'BLE SMT. MEENA RAMANATHAN, IN-CHARGE PRESIDENT & HON'BLE SRI V.V.SESHUBABU, MEMBER-JUDICIAL WEDNESDAY, THE THIRD DAY OF APRIL TWO THOUSAND TWENTY FOUR ******* Order : (Per Smt.Meena Ramanathan, Hon'ble In-charge President)
1. This is a complaint filed by the Complainant under Section 17(1)(a)(i) of the Consumer Protection Act, 1986 praying to direct the Opposite parties to pay Rs.2,22,847/- towards reimbursement of hospital bills, Rs.20,74,000/- towards reimbursement of BJ 2 Hospital medical bills, Rs.10 lakhs towards compensation and Rs.50,000/- towards costs. In total the complainant is claiming Rs.33,46,847/-.
2. The brief facts of the case as stated in the complaint are as follows:
The complainant is a software engineer working in USA. During January,2013 when he came to India, he visited Dr.G.Chandra Shekar Reddy with complaints of Headache of 6 weeks duration, enlargement of hands and feet since one year, increase in size of nose since 6 months and with the history of nasal obstruction and snoring. The said doctor advised the complainant to undergo MRI Scan of the brain, 2D Echo Doppler test and other routine investigations. After undergoing the said test, the complainant was diagnosed as suffering from Acromegaly, Pituitary Adenoma and Nasal Polyps and he was referred to opposite party No.2.
3. The complainant visited opposite party No.2 doctor in opposite party No.1 hospital. Opposite party No.2 Doctor informed the complainant that a pituitary tumour has grown in the pituitary gland adjacent to the brain and it was releasing more growth hormone and as such there was enlargement of his hands and feet and increase in the size of nose and suggested to undergo a surgery for the reversal of symptoms.
4. The complainant was admitted in opposite party No.1 hospital on 21.3.2013 and on 25.1.2013 surgery for endoscopic transsphenoidal excision of the tumour was conducted by opposite party No.2 and his team of doctors. The opposite party No.2 stopped further surgery stating that intra operatively the complainant developed profuse bleeding throughout the procedure. On 29.1.2013 the said doctors performed 2nd surgery and he was discharged on 30.1.2013. The opposite party No.2 stated that the surgery was successful. After reaching home there was bleeding from the nose of the complainant and he immediately rushed to opposite party No.1 hospital and he was treated for 4 to 5 hours.
3The complainant left India for USA on the assurance of opposite party No.2 that he can fly to USA without any problems. After reaching USA, the complainant was suffering from the same problems and there was no improvement in his health condition. The complainant consulted Dr.Valey and Dr.Joshi at USA and at last visited Barnes - Jewish Hospital, Washington University Medical Centre, St.Louis.
5. On the request of the doctors of the said hospital, Dr.Rajasekharam, ENT surgeon who participated in the surgery of the complainant along with opposite party No.2 gave a certificate narrating nature of the alleged operation stating that the complainant underwent Transphenoidal Pituitary Tumour Excision and during the surgery after opening the posterior wall of Sphenoid Bone, there was brisk bleeding after incising dura. He suggested the doctors in USA to evaluate the vascular supply to the tumour with CT Angiogram to rule out the ICI damage before any intervention. MRI Pituitary with and without contrast procedure was done on 1.3.2013 and the said report gave an impression that there was evidence of Pituitary Tumour. From the said report it can be concluded that the opposite parties have not removed any portion of Pituitary Tumour in the surgery done on 21.1.2013.
6. The complainant was admitted in Barnes - Jewish Hospital on 1.4.2013 and the surgery was conducted on the same day itself. The name of the operation was
i) Expanded endnasal approach, Transphenoidal to resection of Pituitary Macroadenoma,
ii) Bilateral Endoscopic Antrostomies and removal of tissue from Maxillary Antrum and
iii) Left partial anterior Ethmoidectomy.
7. The operative summary revealed that the estimated blood loss was less than 25 ml. and there was no brisk bleeding as stated in Discharge Summary issued by opposite partyNo.2. After the surgery on 1.4.2013, MRI Brain Test revealed that there were no findings to suggest residual tumour and CT Test report 4 dt.2.4.2013 revealed that there was no evidence of pulmonary embolism acrostic dissection.
8. The complainant in total paid out of his pocket $10,000 towards surgery, MRI and CT scans. The action of the opposite parties in not conducting the surgery properly and also reporting that they have removed the tumour and they encountered profuse bleeding intra operatively not only amounts to deficiency in service but also amounts to gross negligence and unfair trade practice. Hence the complaint.
9. The opposite parties filed written version denying the allegations made in the complaint and admitting that the opposite party No.2 along with team of doctors and also ENT Surgeon Dr.Rajasekaram conducted the surgery of Endoscopic Transphenoidal Excision of the Pituitary Tumour on 25.1.2013 for the complainant. The opposite parties submit that after dural incision and curettage of the tumour there was profuse bleeding. Because of the bleeding, the doctors could not take chance to re- enter the sella and as such biopsy and further tumour excision was abandoned.
10. The opposite parties never told the complainant or his relatives that the surgery was successful. Giving first priority to save the life, no further attempts at tumoural excision were done. In view of the bleeding during surgery only a small portion of the tumour was decompressed and hence he was suggested to have an opinion of Endocrinologist or Radiation Oncologist. The opposite parties submit that they never told that there will be no further problems after travelling to U.S.A.
11. The first priority of opposite party No.2 in presence of profuse bleeding is not to take risk, but to have safety of the patient which is foremost and primary objective and hence further attempts at tumoural excision were not done. It is submitted that bleeding, incomplete excision of tumour and risk to 5 life are possible consequences in surgery involving these pituitary tumours.
12. In these surgeries through the nose using endoscope, the surgeon enters base of the brain to remove pituitary tumours. Pituitary tumours carry chances of vascular injuries with fatal consequences and death. Many patients with pituitary tumour with acromegaly required reoperation or radiation or medical treatment which can be prolonged and very troublesome which is supported by medical literature accepted all over the world. The opposite parties submit that there is no negligence on their part in treating the complainant and prayed to dismiss the complaint with exemplary costs.
13. Evidence Affidavit of Smt Karuna Lekkala, mother and GPA holder of the complainant as PW1 filed. Evidence Affidavit of the complainant as PW2 filed. Exs.A1 to A14 are marked on behalf of the complainant. On behalf of the opposite parties, evidence affidavit of opposite party No.2 filed. No documents are marked on behalf of Opposite Parties. Written Arguments of the complainant filed.
14. We have heard the learned counsel for both the parties and have gone through the record. The questions which fall for our consideration are:-
(1) Whether the surgery conducted by the Opposite Party No.2 Doctor and his team was negligently performed at Opposite Party No.1 Hospital?
(2) If yes, is the Complainant entitled to the reliefs sought for?
15. Points 1 & 2:-
The facts not in dispute are that the Complainant aged about 40 years and working as a software engineer in USA, came to India during January, 2013 and consulted Dr.Chandrasekhar with complaints of headache. In his complaint he has pleaded that Dr.Chandrasekhar diagnosed his condition as Acromegaly, 6 Pituitary Adenoma and Nasal Polyps and referred him to Opposite Party No.2-Doctor. From the material placed before us, the prescription notes and tests advised and diagnosis and subsequent referral to Opposite Party No.2-Doctor are not marked as exhibits and the Complainant has chosen not to file the report of Dr.Chandrasekhar.
16. Ex.A3 is the MRI Brain report taken at Focus Diagnostics and referred by Dr.Chandrasekhar. Date of report is 21.01.2013. Impression recorded is as follows:
MR IMAGE MORPHOLOGY IS IN FAVOUR OF
- ENLARGED PITUITARY GLAND WITH ADENOMA ON RIGHT SIDE.
- NORMAL STUDY OF BRAIN.
This means that although they are benign as the pituitary adenomas grow, they can put pressure or damage nearby tissues and cause compressive symptoms which include headache and vision problem. The Complainant's condition as per Dr.Chandrasekhar was Acromegaly. This is a rare, but serious condition and affects the body's bones and tissues and causes them to grow in abnormal ways. Overtime, it can lead to enlarged hands, feet or head size and poorly defined features. Depending on the size and severity, the Complainant was advised by Opposite Party No.2-Doctor to undergo transphenoidal surgery to remove the pituitary adenoma.
17. A close perusal of Ex.A1 reveals that - CT Scan of brain was done on 15.01.2013 as well as 2D Echo Doppler and date of admission at Opposite Party No.1-Hospital is 23.01.2013.
18. It is interesting at this juncture to point out that the MRI taken is dated 21.01.2013 as advised by Dr.Chandrasekhar. The Complainant was obviously consulting two specialists at different centres but for reasons best known to him failed to submit the advice given by Dr.Chandrasekhar and chose to have the surgery at Opposite Party No.1-Hospital.
719. The operation conducted by Opposite Party No.2 and his team of doctors on 25.01.2013 was "Endoscopic ethmoidal polypectomy, transphenoidal endoscopic partial decompression of the tumour."
20. As per the literature we have studied, (since neither party has provided us the information) Endoscopic Pituitary Surgery is a safe type of surgery but all surgical procedures carry some risk. The risks and complications include severe bleeding. In the instant case, after dural opening and curettage of the tumour, the Opposite Party No.2-Doctor encountered profuse bleeding and in view of the extensive bleeding, further excision of tumour was deferred.
21. Damage to the internal carotid artery remains one of the most serious and potentially fatal complications of transphenoidal surgery. This is accepted by the Opposite Party No.2-Doctor and his team and we refer to Ex.A4 wherein Dr.Rajasekharam, one of the Doctors in the team has explained the reason for brisk bleeding and since the Opposite Party No.1-Hospital did not have the facilities of image guided surgery, the surgery was abandoned and the Complainant was discharged in a stable condition.
22. The Complainant returned to U.S. and underwent Endoscopic transphenoidal approach, Stealth frameless stereotaxy, resection of tumour with intraoperative magnetic resonance scan, as per Ex.A8. The endoscopic transphenoidal approach was conducted with magnetic resonance scan, which was not available at Opposite Party No.1-Hospital. The fact that the Complainant had issues with intraoperative bleeding was very much known to the Doctors in U.S. and they have not stated that it was negligently done. Even in the operative summary of Ex.A8, the indication, alternatives and risks of transphenoidal surgery were discussed with the Complainant/patient and his family.
23. On the basis of the Complainant's submissions and study of medical record, the fact that the surgery conducted by Opposite 8 Party No.2-Doctors at Opposite Party No.1-Hospital cannot be termed deficient and negligent. Every surgical procedure is fraught with risks and complications and the primary duty of the medical professional is to address the safety of his/her patient if there are any adverse reactions to the procedure. Since there was brisk bleeding, the Opposite Party No.2-Doctor decided to control the bleeding with packing and further procedure was abandoned. They have been frank and have accepted that there was a need to evaluate for carotid injury.
24. It is also imperative to reproduce the findings in Ex.A6 at BJH.
"The macroadenoma abuts the right carotid artery at the cavernous segment but does not encase the carotid artery."
The incidence of carotid artery injury is higher in transphenoidal pituitary surgery and the over whelming blood loss can place the patient's life at imminent risk and the Opposite Parties have taken the precaution to abandon the surgery and save the Complainant from further complications.
25. From the available material and cross examination of PW2 the following lines are reproduced:
"It is true in Ex.A8 of BJH Hospital USA, it is clearly mentioned that there were tissues with intraoperative bleeding, therefore resection of the tumour was not accomplished.
It is true in the hospital at USA also they have informed me of all the risk factors for this kind of surgery.
It is true Ex.A11 page 23 of the material papers issued by the BJH Hospital, USA, they have clearly mentioned the history of illness and also elaborately mentioned that "he underwent an attempt at a transphenoidal resection in Janauary 2013 and per chart review the patient had a lot of polyps that were resected from his nose and the surgery was complicated by bleeding. Therefore no 9 resection was achieved. However, Mr.Leekkala reports that his headaches did improve after the procedure."
26. In view of the detailed discussions, study of medical records and cross examination of PW2, we sympathize with the condition of the Complainant but fail to appreciate that Opposite Party No.2 along with his team of Doctors conducted the surgery deficiently or negligently. Hence, the complaint is devoid of merits and liable to be dismissed.
27. In the result, the complaint is dismissed. There is no order as to costs.
_______________________________
I/C PRESIDENT MEMBER-J
Dt: 03.04.2024
UC*
APPENDIX OF EVIDENCE
Witnesses examined
For the complainant For the opposite parties
Evidence Affidavit of Evidence Affidavit of Opposite
Smt.Karuna Lekkala, Party No.2 filed.
Mother and GPA holder of
Complainant filed.
Advocate Commissioner: Sri A.Naveen Kumar, Advocate Exhibits marked on behalf of the complainant:
Ex.A1 - Photostat copy of Discharge Summary of the complainant dt.30.1.2013 issued by opposite party No.1. Ex.A2 - Photostat copy of findings of MRI Brain with contrast Dt.21.1.2013 of the complainant issued by Focus Diagnostics.
Ex.A3 - Photostat copy of Inpatient Final Bill 30.1.2013 issued by Opposite party No.1 on behalf of the complainant. Ex.A4 - Certificate issued by Dr.Rajasekharam N with regard to Surgery of the complainant.
Ex.A4A - Photostat copy of results of MRI Pituitary W WO Contrast of the complainant dt.3.4.2013.
Ex.A5 - Copy of Head Computed Tomography (CT) Angiography report dt.14.3.2013 of the complainant issued by BJH.10
Ex.A6 - Copy of report of Brain Stem Magnetic Resonance (MR) of the complainant dt.27.3.2013.
Ex.A7 - Copy of Surgical Pathology Report of the complainant Dt.1.4.2013 issued by BJH.
Ex.A8 - Copy of Operative Summary dt.1.4.2013 with regard to surgery undergone by the complainant in BJH. Ex.A9 - Copy of Operative Summary dt.1.4.2013 with regard to surgery undergone by the complainant in BJH. Ex.A10 - Copy of findings of report of Brain,Brain Stem Magnetic Resonance (MR) Imaging dt.1.4.2013 issued by BJH. Ex.A11 - Copy of Endocrinology Consultation Report dt.1.4.2013 of the complainant issued by BJH.
Ex.A12 - Copy of findings of the report of Chest Computed Tomography (CT) with contrast of the complainant dt. 2.4.2013 issued by BJH.
Ex.A13 - Photostat copy of insurance details issued by Blue Advantage Administrators of Arkanasas in favour of the complainant.
Ex.A14 - Photostat copy of General Power of Attorney issued by the Complainant in favour of his mother Karuna Lekkala, Dt.17.1.2014.
Exhibits marked on behalf of the Opposite Parties:
- NIL -
Sd/- Sd/-
I/C PRESIDENT MEMBER-J
Dt: 03.04.2024
UC*