State Consumer Disputes Redressal Commission
Dr Devendra Kumar vs Khushaboo Dixit on 20 February, 2023
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UP C-1 Vikrant Khand 1 (Near Shaheed Path), Gomti Nagar Lucknow-226010 First Appeal No. A/2014/367 ( Date of Filing : 20 Feb 2014 ) (Arisen out of Order Dated in Case No. of District State Commission) 1. Dr Devendra Kumar a ...........Appellant(s) Versus 1. Khushaboo Dixit a ...........Respondent(s) BEFORE: HON'BLE MR. Rajendra Singh PRESIDING MEMBER HON'BLE MR. Vikas Saxena JUDICIAL MEMBER PRESENT: Dated : 20 Feb 2023 Final Order / Judgement Reserved State Consumer Disputes Redressal Commission U.P. Lucknow. Appeal No 367 of 2014 1- Dr. Devendra Kumar, R/o Brij Chikitsa Sewa Sansthan, Daresi Road, Mathura. 2- Brij Chikitsa Sewa Sansthan, Daresi Road, Mathura through its Secretary. ...Appellants. Versus Km. Khushboo dixit d/o Sri Acharya Lalji Dixit, R/o Bairagpur, Mathura, Tehsil & Distt. Mathura ...Respondent. Present:- 1- Hon'ble Mr. Rajendra Singh, Presiding President. 2- Hon'ble Mr. Vikas Saxena, Member. Sri Naveen Kumar Tiwari, Advocate for appellants. Sri V.S. Bisaria, Advocate for respondent. Date : 1.3.2023 JUDGMENT
Per Mr. Rajendra Singh, Member: The present Appeal has been filed under section 15 of the Consumer Protection Act 1986, against the judgment and award dated 21.01.2014 passed in complaint case number 02 of 1997 Km. Khushboo Dixit Vs. Dr. Devendra Kumar & Anr. passed by learned District Consumer Forum, Mathura.
The brief facts of the appeal are that, that in surgical practice deciding on the right type of surgical access for a specific condition would be a skill of its own for a surgeon. The decision to select a specific incision would depend on the several aspects e.g. surgical site, related anatomical structures, easy access, fewer complications, quicker healing and minimum scar,. But all these options might not be fulfilled and the surgeons have to make a professional judgment as to decide on what is best for the patient's condition and act fast in order to save the life of the patient.
Due to Acute Appendicitis paramedian incision method was (2) preferred by the appellant. The finding of the learned DCF that the appellant should have adopted Grid- Iron method instead of paramedian incision method, is erroneous. The learned Forum has erred in holding appellant liable to pay compensation being deficient in providing service to the complainant/respondent, is erroneous being against the evidence on record. There was no expert opinion on record. The complainant has nowhere narrated even a single point that Methodist Hospital or its doctors have said anything wrong about the treatment given by the appellants.
The complainant herself ran from the appellant hospital in the morning of 30.09.96 at 07.30 am without paying the hospital charges. Due to this conduct of the complainant, discharge slip could not be issued. The complainant has deliberately not examined the doctors of the Methodist as it will prove that operation performed by the appellant was correct and there was no deficiency in service. The appellant no 1 is qualified doctor and has performed the operation of the complainant as per the norms and guidelines of the medical literature and the said operation was fully successful. Simply because has got admitted herself to some other hospital could not be sufficient to hold appellant liable for deficiency in service. Due care of the complainant after the operation was taken by the appellant and complainant has not been able to prove any negligence on the part of the appellants either in conducting the operation or in post-operative care. The learned DCF has erred in outrightly believing the version of the complainant and held the appellants liable, therefore this finding of the learned being erroneous is liable to be set aside. The learned is has erred in (3) avoiding interest at a very high rate of 9% and further erred in avoiding interest from the date of filing of complaint. Hence it is most humbly prayed that this Hon'ble commission may kindly be pleased to allow the appeal and set aside the impugned judgment and order dated 21.01.2014.
We have heard the learned counsel for the Appellant Mr. Naveen Kumar Tiwari and learned counsel for the respondent Mr. V.S. Bisaria. We have perused the pleadings and documents on record.
In the present case complainant Km. Khushboo aged about 13 years, got fever on 27.09.16 and started to omit. The complainant's father took her to the hospital of opposite party-2 where opposite party-1 Dr. Devendra Kumar examined Km. Khushboo and thereafter he admitted her in the hospital. She was advised to go x-ray and blood examination which was done and Dr. Devendra Kumar started the treatment. X-ray and examination of blood was done on 28.09.96 and she was given medicines but the condition did not improve. After getting the x-ray and blood report on 28.09.96, appendix was detected which has been ruptured. There is pus in the stomach which needed immediate operation. The complainant no 2 has asked the opposite party -1 to take consent from any other specialist for which he was ready to pay the fees. Dr. Devendra Kumar has said that operation should be done immediately otherwise the poison may spread in the body of Km. Khushboo and she may die. Thereafter operation was performed at 9:30 PM and long incision was made from naval to vagina and nine stitches were made. On query Dr. Devendra Kumar told the complainant-2 that the operation was not conducted from the (4) side because he wanted to know the reason of bursting of appendix. Due to carelessness of Dr. Devendra Kumar, unnecessarily a whole was made which scar cannot be deleted in future. She suffered a lot and the concerned Dr came to see her only once after the operation. On 30.09.16 swelling started to develop on the nose and mouth of the patient. When he tried to contact Dr. Devendra Kumar, he was not available at the hospital and no other doctor or resident doctor was available in the hospital except a class-IV employee who told the complainant-2 that the doctor is on leave. The complainant-2 wanted to discharge her daughter but the employee present on the spot said that without discharge he could not take her patient out of the hospital. Due to serious condition of the patient, the employee present asked to write something on paper and thereafter permitted to take the patient from the hospital.
The complainant took the patient to Methodist Hospital where he met Dr Thomas who asked for discharge slip, but as the discharge slip was not issued therefore he requested to start the treatment of her daughter at which she was admitted in the hospital and treatment was started. She was the man in the Methodist Hospital from 30.09.96 till 09.10.96. The complainant-2 spent Rs.5000/- in the Methodist Hospital for the treatment. There is clear deficiency in the service of the opposite party.
The respondent has stated that his hospital is a charitable hospital and no fee was taken from the complainant for the treatment. Dr. Devendra Kumar stated that the treatment of the patient was started under Dr Rakesh. At the time of admission the temperature was 104 degree and she (5) had stomache. She was diagnosed as a case of appendicitis. Her urine and blood was examined and stomach x-ray was done. When her condition was not improved on 28.09.96 she was referred to Dr Devendra Kumar. He examined the patient and found that the patient is suffering from peritonitis and appendicitis perfardis. Dr advised for immediate operation. After getting the consent of the attendant of the patient, she was operated. He treated the patient as per medical protocol.
He was on leave on 30.09.96 and the condition of the patient was satisfactory. As per his direction, Dr RMO/CMO was looking after the health of the patient but on 30.09.96 at about 6:30 AM, the father of the patient took her away from the hospital without the permission of the manager or the doctor. After operation, the patient usually take 15 days for total improvement. He did not show any carelessness on the part. He is MBBS, MS (GS).
First of all we perused the consent letter. It is on a printed form and not filled completely.Consent is a legal requirement of medical practice and not a procedural formality. Getting a mere signature on a form is no consent. If a patient is pressed into signing consent, without giving sufficient information, the consent may be invalid, despite the signature. Often medical professionals either ignore or are ignorant of the requirements of a valid consent and its legal implications. Instances where either consent was not taken or when an invalid consent was obtained have been a subject matter of judicial scrutiny in several medical malpractice cases. This article highlights the essential principles of consent and the Indian law related to it along with some citations, so that medical practitioners are not only able to (6) safeguard themselves against litigations and unnecessary harassment but can act rightfully.
INTRODUCTION Legally, two or more persons are said to consent when they agree upon the same thing in the same sense.[1] Consent must be obtained prior to conducting any medical procedure on a patient. It may be expressed or implied by patient's demeanour. A patient who comes to a doctor for treatment implies that he is agreeable to general physical (not intimate) examination.[2] Express consent (verbal/written) is specifically stated by the patient. Express verbal consent may be obtained for relatively minor examinations or procedures, in the presence of a witness.[3] Express written consent must be obtained for all major diagnostic, anaesthesia and surgical procedures as it is the most undisputable form of consent.
A doctor must take the consent of the patient before commencing a treatment/procedure except in emergencies, informed consent should be obtained sometime prior to the procedure so that the patient does not feel pressurised or rushed to sign. On the day of surgery, the patient may be under extreme mental stress or under influence of pre-medicant drugs which may hamper his decision-making ability. Consent remains valid for an indefinite period, provided there is no change in patient condition or proposed intervention.[4] It should be confirmed at the time of surgery.[4] Consent must be taken from the patient himself.
The doctor before performing any procedure must obtain patient's consent.[5] No one can consent on behalf of a competent adult. In Dr. Ramcharan Thiagarajan Facs versus (7) Medical Council of India case,[6] disciplinary action was awarded to the surgeon for not taking a proper informed consent for the entire procedure of kidney and pancreas transplant surgery from the patient. In some situations, beside patient consent, it is desirable to take additional consent of spouse. In sterilisation procedures, according to the Ministry of Health and Family Welfare, Government of India guidelines, consent of spouse is not required.[7] The Medical Council of India (clause 7.16) however states that in case an operation carries the risk of sterility, the consent of both husband and wife is needed.[8] It is advisable to take consent of spouse when the treatment or procedure may adversely affect or limit sex functions, or result in death of an unborn child.[9] In case of minor, consent of person with parental responsibility should be taken.[10] In an emergency, the person in charge of the child at that time can consent in absence of parents or guardians (loco parentis).[11] In a medical emergency, life-saving treatment can be given even in absence of consent.
Refusing treatment in life-threatening situations due to non-availability of consent may hold the doctor guilty, unless there is a documented refusal to treatment by the patient. In Dr. TT Thomas versus Smt. Elisa and Orscase,[12] the doctor was held guilty of negligence for not operating on a patient with life-threatening emergency condition, as there was no documented refusal to treatment.
The patient should have the capacity and competence to consent.
A person is competent to contract[13] if (i) he has attained the age of majority,[14] (ii) is of sound mind[15] and (8)
(iii) is not disqualified from contracting by any law to which he is subject. The legal age for giving a valid consent in India is 18 years.[14] A child >12 years can give a valid consent for physical/medical examination (Indian Penal Code, section 89).[3] Prior to performing any procedure on a child <18 years, it is advisable to take consent of a person with parental responsibility so that its validity is not questioned. If patient is incompetent, then consent can be taken from a surrogate/proxy decision maker who is the next of kin (spouse/adult child/parent/sibling/lawful guardian).[11] Consent is said to be free[16] when it is not caused by coercion,[17] undue influence,[18] fraud,[19] misrepresentation, [20] or mistake.[21,22,23] Consent should be on the basis of adequate information concerning the nature of the treatment procedure.[5] Consent should be informed and based on intelligent understanding. The doctor must disclose information regarding patient condition, prognosis, treatment benefits, adverse effects, available alternatives, risk of refusing treatment and the approximate treatment cost. He should encourage questions and answer all queries.[2] If the possibility of a risk, including the risk of death, due to performance of a procedure or its refusal is remote or only theoretical, it need not be explained.[5] Exceptions to physician's duty to disclose include[24] : (i) Patient refusal to be informed; this should be documented. (ii) If the doctor feels that providing information to a patient who is anxious or disturbed would not be processed rationally by him and is likely to psychologically harm him, the information may be withheld from him (therapeutic privilege); he should then (9) communicate with patient's close relative, family doctor or both.
The "adequate information" must be furnished by the doctor (or a member of his team) who treats the patient.[5] Information imparted should enable the patient to make a balanced judgment as to whether he should submit himself to the particular treatment or not.[5] Consent should be procedure specific.
Consent given only for a diagnostic procedure, cannot be considered as consent for the therapeutic treatment.[5] Consent given for a specific treatment procedure will not be valid for conducting some other procedure.[5] In Samira Kohli versus Dr. Prabha Manchanda and Anr case,[5] the doctor was held negligent for performing an additional procedure on the patient without taking her prior consent. An additional procedure may be performed without consent only if it is necessary to save the life or preserve the health of the patient and it would be unreasonable to delay, until patient regains consciousness and takes a decision.[5] A common consent for diagnostic and operative procedures may be taken where they are contemplated.[5] Consent obtained during the course of surgery is not acceptable.
In Dr. Janaki S. Kumar and Anr. versus Mrs. Sarafunnisa case, [25] in an allegation of performing sterilisation without consent, it was contended that consent was obtained during the course of surgery. The commission held that the patient under anaesthesia could neither understand the risk involved nor could she give a valid consent.
(10)When blood transfusion is anticipated, a specific written consent should be taken,[24] exception being an emergency situation where blood transfusion is needed to save life and consent cannot be attempted.[26] In M. Chinnaiyan versus Sri. Gokulam Hospital and Anrcase,[27] court awarded compensation as patient was transfused blood in the absence of specific consent for blood transfusion.
Consent for examining or observing a patient for educational purpose Prior to examining or observing patients for educational purpose, their consent must be taken.[28] Blanket consent is not valid.
Consent should be procedure specific. An all-encompassing consent to the effect 'I authorize so and so to carry out any test/procedure/surgery in the course of my treatment' is not valid.[29] Fresh consent should be taken for a repeat procedure.
A fresh written informed consent must be obtained prior to every surgical procedure that includes re-exploration procedure. In Dr. Shailesh Shah versus Aphraim Jayanand Rathod case,[30] the surgeon was found deficient in service and was liable for compensation as he had performed a re-exploration surgery without a written consent from the patient.
Surgical consent is not sufficient to cover anaesthesia care.
The surgeons are incapable to discuss the risks associated with anaesthesia. Informed consent for anaesthesia must be taken by the anaesthesia provider as only he can impart anaesthesia related necessary information and explain the risks involved. It may be documented by the (11) anaesthesiologist on the surgical consent form by a handwritten note, or on a separate anaesthesia consent form.[31] Competent patients have the legal and moral right to refuse treatment, even in life-threatening emergency situations.[31] In such cases informed refusal must be obtained and documented, over the patient's witnessed signature.[32] It may be advisable that two doctors document the reason for non-performance of life-saving surgery or treatment as express refusal by the patient or the authorised representative and inform the hospital administrator about the same.
To detain an adult patient against his will in a hospital is unlawful.[9] If a patient demands discharge from hospital against medical advice, this should be recorded, and his signature obtained.[9] Consent signed only by the patient and not by the doctor is not valid.[33] Witnessed consents are legally more dependable.
The role of a witness is even more important in instances when the patient is illiterate, and one needs to take his/her thumb impression.[34] Consent should be properly documented Video-recording of the informed consent process may also be done but with a prior consent for the same. This should be documented. It is commonly done for organ transplant procedures. If consent form is not signed by the patient or is amended without his signed authorisation, it can be claimed that the procedure was not consented to.[10] Patient is free to withdraw his consent anytime.
(12)When consent is withdrawn during the performance of a procedure, the procedure should be stopped. The doctor may address to patient's concerns and may continue the treatment only if the patient agrees. If stopping a procedure at that point puts patient's life in danger, the doctor may continue with the procedure till such a risk no longer exists.[10] There can be no valid consent for operations or procedures which are illegal.[24] Consent for an illegal act such as criminal abortion is invalid.[9] Consent is no defence in cases of professional negligence.[9] HOW TO OBTAIN A VALID CONSENT AND CONSENT FORMAT.
Always maintain good communication with your patient and provide adequate information to enable him make a rational decision.[35] It is preferable to take consent in patient's vernacular language. It may be better to make him write down his consent in the presence of a witness.[34] It is desirable to use short and simple sentences and non-medical terminology that is written/typed legibly.[36] Patient information sheets (PIS) depicting procedure related information, including pre-operative and post-operative pre-cautions in patient's understandable local language with pictorial representation may facilitate the informed consent process. These may help in providing consistently accurate information to the patients.[35] PIS should be handed over to the patients after explaining the contents. Even videos may be used as an aid in increasing patient understanding.[37] Though there is no standard consent format, it may include the following [e.g., Figure 1]:[38] (13) Figure 1 Anaesthesia informed consent form Date and time Patient related: Name, age and signature of the patient/proxy decision maker Doctor related: Name, registration number and signature of the doctor Witness: Name and signature of witness Disease-related: Diagnosis along with co-morbidities if any (14) Document the fact that patient and relatives were allowed to ask questions, and their queries were answered to their satisfaction.
Surgical procedure related: Type of surgery (elective/emergency), nature of surgery with antecedent risks and benefits, alternative treatment available, adverse consequences of refusing treatment Anaesthesia related: Type of anaesthesia (general and/or regional, local anaesthesia, sedation) including risks Blood transfusion: Requirement and related risks Special risks: Need for post-operative ventilation, intensive care, etc CONSENT IN RELATION TO PUBLICATION.
A registered medical practitioner is not permitted to publish photographs or case reports of his/her patients without their consent, in any medical or another journal in a manner by which their identity could be revealed. However, in case the identity is not disclosed, consent is not needed (clause 7.17).[8] CONSENT IN RELATION TO MEDICAL RESEARCH Consent taken from the patient for the drug trial or research should be as per the Indian Council of Medical Research guidelines[39]; otherwise it shall be construed as misconduct (clause 7.22).[8] COMMON FALLACIES IN THE CONSENT PROCESS.
The anaesthesiologist must ensure that consent is given maximum importance, and all the legal formalities are followed before agreeing to provide the services. Following are some frequent mistakes and omissions that can cost (15) him/her dearly in the event of a mishap: Procedure is considered trivial, and consent is not taken.
Consent of relative is taken instead of the patient, even when patient is a competent adult.
Consenting person is minor, intoxicated or of unsound mind Blanket consent is taken.
Alterations or additions are made in the consent form without patient's signed authorisation.
It is not procedure specific Consent for blood transfusion is not obtained.
Fresh consent is not taken for a repeat procedure Procedure related necessary information is not given Even if the information given, it is not documented Consent lacks the signature of the treating doctor Consent is not witnessed SUMMARY It is not only ethical to impart correct and necessary information to a patient prior to conducting any medical procedure, but it is also important legally. This communication should be documented. Even professional indemnity insurance may not cover for lapses in obtaining a valid consent, considering it to be an intentional assault.
ACKNOWLEDGMENTS We gratefully acknowledge the invaluable contribution and irreplaceable advice extended to us during the preparation of this article by Mr. M Wadhwani, Advocate.
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39. Ethical Guidelines for Biomedical Research on Human Participants. New Delhi: Published by: Director General Indian Council of Medical Research; 2006. [Accessed on 2014 Mar 3]. eral Ethical Issues; pp. 21-33. ] Now we discuss a little about consent form filed by the Appellant with his appeal. First there is no signature of the concerned Dr on this consent form. There is no separate consent form for anaesthesia. This pro forma is not in accordance with the pro forma prescribed for taking the consent. There is no separate consent to use the body for post-mortem examination for the purpose of study. There is nothing in this consent form which show that the doctor has specifically mentioned all the risks to the patient or his family members regarding operation or any other tests which may be performed. So this consent form is not a proper consent form as per the guidelines. It also shows deficiency and negligence on the part of the opposite parties.
Now let us see the oath taken be a doctor before entering the nobel profession of the Medical World. As per guidelines of MCI, Every member should get it framed in his or her office it should never be violated in its letter and spirit.
"I solemnly pledge myself to consecrate my life to service of humanity.
Even under threat, I will not use my medical knowledge contrary to the laws of Humanity.
I will maintain the utmost respect for human life from the time of conception.(22)
I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.
I will practice my profession with conscience and dignity.
The health of my patient will be my first consideration.
I will respect the secrets which are confined in me.
I will give to my teachers the respect and gratitude which is their due.
I will maintain by all means in my power, the honour and noble traditions of medical profession.
I will treat my colleagues with all respect and dignity.
I shall abide by the code of medical ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002.
I make these promises solemnly, freely and upon my honour."
The complexity of the human body and the uncertainty involved in the medical procedure are of such great magnitude that it is impossible for a Doctor to guarantee a successful result; and the only assurance that he can give, or can be understood to have given by implication is that he is possessed of requisite skill in that branch of profession which he is practising and while undertaking the performance of the task entrusted to him, he would be exercising his skills with reasonable competence. An ordinary physician or surgeon is not expected to be either a clodhopper or feckless practitioner of profession, as much as, he is not expected to be a paragon, combining qualities of polymath or prophet as in the realm of (23) diagnosis and treatment, there is ample scope for genuine difference of opinion; and a Doctor cannot be treated as negligent merely because his conclusion differs from that of other persons in the profession, or because he has displayed less skill or knowledge than others would have shown. The true test for establishing negligence in diagnosis or treatment on the part of a doctor is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would be guilty of, if acting with ordinary care. Furthermore, a golden principle of law has been laid down by the Hon'ble Apex Court in Jacob Mathew Vs. State of Punjab, (AIR 2005 SC 3180) that no sensible professional would intentionally commit an act or omission which would result in loss or injury to the patient as the professional reputation of the person is at stake. A single failure may cost him dear in his career. Even in civil jurisdiction, the rule of res ipsa loquitor is not an universal application and has to be applied with extreme care and caution to the cases of professional negligence and in particular that of the doctors, else it would be counter productive. Simply because a patient has not favourably responded to a treatment given by a physician or a surgery has failed, the doctor cannot be held liable per-se by applying the doctrine of res ipsa loquitor. Yet, another golden principle of law has been laid down by the Hon'ble Apex Court in Indian Medical Association Vs. V.P. Santha's III (1995) CPJ 1 (SC) at para 37 that "it is no doubt true that sometimes complicated questions requiring recording of evidence of experts may arise in a complaint about deficiency in service based on the ground of negligence in rendering medical services by a medical practitioner; but (24) this would not be so in all complaints about deficiency rendering services by a medical practitioner. There may be cases which do not raise such complicated questions and the deficiency in service may be due to obvious faults which can be easily established such as removal of the wrong limb or the performance of an operation on the wrong patient or giving injection of a drug to which the patient is allergic without looking into the out patient card containing the warning or use of wrong gas during the course of an anaesthetic or leaving inside the patient swabs or other items of operating equipment after surgery. Furthermore, it has been observed in Malay Kumar Ganguli's case (AIR 2010 SC 1162) that" charge of professional negligence on a medical person is a serious one as it affects his professional statusand reputation and as such, the burden of proof would be more onerous. A doctor cannot be held negligent only because something has gone wrong. He also cannot be held liable for mischance or misadventure or for an error in judgment in making a choice when two options are available. The mistake in diagnosis is not necessarily a negligent diagnosis." In the instant matter, thus a simple test, in the light of aforesaid observations, needs to be conducted in order to ascertain whether the Doctor is guilty of any tortious act of negligence/battery amounting to deficiency in conducting a surgery in the delivery of child and not properly attending the patient, the complainant and consequently, liable to pay damages for leaving cotton mass in the abdomen / stomach due to failure in surgery and deteriorating condition of the patient.
(25)Now, it is required to be seen whether an expert report is necessary in each and every case relating to medical negligence or not ? It has been observed by the Hon'ble Apex Court in Indian Medical Association Vs. V.P. Santha III (1995) CPJ 1 (SC) at para 37 that "it is no doubt true that sometimes complicated questions requiring recording of evidence of experts may arise in a complaint about deficiency in service based on the ground of negligence in rendering medical services by a medical practitioner; but this would not be so in all complaints about deficiency rendering services by a medical practitioner. There may be cases which do not raise such complicated questions and the deficiency in service may be due to obvious faults which can be easily established such as removal of the wrong limb or the performance of an operation on the wrong patient or giving injection of a drug to which the patient is allergic without looking into the out patient card containing the warning or use of wrong gas during the course of an anaesthetic or leaving inside the patient swabs or other items of operating equipment after surgery. Furthermore, in B. Krishna Rao Vs. Nikhil Super Speciality Hospital 2010 (V) SCC513 at para 40 the Hon'ble Apex Court was pleased to hold that it is not necessary to have opinion of the expert in each and every case of medical negligence. The Hon'ble Apex Court was pleased to further hold in Nizam Institute of Medical Sciences Vs. Prashant S. Dhananka and others 2009 (VI) SCC 1 that "in a case of medical negligence, once initial burden has been discharged by the complainant by making of a case of negligence on the part of the hospital or the doctor concerned, the owner then shifts on the hospital or to the (26) attending doctors and it is for the hospital to satisfy the court that there was no lack of care or diligence".
We have seen the case sheet is not very clear but date and time of discharge has been written as 30.09.96. There is one remark as LAMA on it. When the complainant -2 to her patient without the permission of the doctor or manager as stated by Appellant, how this case sheet has been prepared having remark of LAMA. It shows that it has been prepared later on. Now become to the procedure as adopted by Dr. Appendicitis can cause serious complications, such as: A ruptured appendix. A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity.Appendicular peritonitis is a complication of acute appendicitis characterized by the spread of the infectious process in the peritoneal cavity thus achieving wide spread or localized purulent peritonitis; it's a medico-surgical emergency. Our objectives are to determine the frequency, describe the clinical, therapeutic and prognostic aspects of peritonitis by appendicular perforations. Patients-Method: This was a 24-month retro, prospective, descriptive study from January 1, 2018 to December 31, 2019; conducted in the Bougouni Reference Health Center Surgery Unit. All patients of appendicular peritonitis at the Bougouni Reference Health Centre were included. Results: During the study period, 68 cases of generalized acute peritonitis including 30 appendicular peritonitis cases were collected. Appendicular peritonitis accounted for 44.1% of surgical procedures. Males accounted for 71.0% with a sex ratio of 1.2 at risk of men, the average age was 26.07 years. Abdominal pain and vomiting were the reasons for consultation in 86.7% and 76.7% of cases. Physical examination was used in most cases to make the diagnosis. X-ray of the abdomen without preparation, and (27) abdominal ultrasound were performed systematically. Surgical treatment consisted of an appendectomy with peritoneal toilet followed by drainage. The average length of hospitalization was 8.8 days with extremes of 1 - 44 days. Hospital mortality was 3.3%; morbidity and high mortality were related to delayed consultation. Conclusion: Appendicular generalized acute peritonitis is a medical-surgical emergency with a high mortality rate associated with delayed management.
The appellant has not stated about the diagnosis and has also not filed the various report regarding tests of the patient. Post-operative care is very important in the cases of operation. It is really surprising that after operation the doctor went on the. No name of any Dr or RMA/CMO has been disclosed. No attendant sister of doctors has been filed to show that how many persons and doctors were engaged during the operation. If any person found that his board is not being treated well in the hospital he has a right to move some other specialised centre to save the life of the world. Full papers of the treatment has not been produced or the bed head ticket of the patient has not been filed by the appellant. How the peritonitis has been treated, not disclosed by the Appellant.
Tests and procedures used to diagnose appendicitis include:
Physical exam to assess your pain. Your doctor may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed.
Your doctor may also look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding).
Your doctor may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of childbearing age may be given a pelvic exam to check for possible gynecological problems that could be causing the pain.
Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection.
Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn't causing your pain.(28)
Imaging tests. Your doctor may also recommend an abdominal X-ray, an abdominal ultrasound, computerized tomography (CT) scan or magnetic resonance imaging (MRI) to help confirm appendicitis or find other causes for your pain.
Treatment Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to treat infection.
Surgery to remove the appendix (appendectomy) Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10 centimeters) long (laparotomy). Or the surgery can be done through a few small abdominal incisions (laparoscopic surgery). During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix.
In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for older adults and people with obesity.
But laparoscopic surgery isn't appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity.
Expect to spend one or two days in the hospital after your appendectomy.
Draining an abscess before appendix surgery If your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin into the abscess. Appendectomy can be performed several weeks later after controlling the infection. The Appellant did not disclose the method of the reason for draining.
The standard treatment for appendicitis is an appendectomy, which is surgery to remove the inflamed appendix before it bursts.
If a doctor suspects that a person has a burst appendix, they may recommend immediate removalTrusted Source without conducting diagnostic testing.
Removing the appendix as soon as possible is the best prevention for a burst appendix. Early treatment is important to reduce the risk of complications, which can lead to death.
Surgeons can use one of two methods to remove the appendix:
Laparoscopic surgery : During laparoscopic surgery, the surgeon will make several small incisions and use special surgical tools to remove the appendix.
Laparotomy surgery : With laparotomy surgery, instead of several small incisions, the surgeon will make a single incision in the lower right area of the abdomen to remove the appendix.(29)
This may be necessary in the case of a burst appendix. The single incision allows the surgeon to clean the abdomen of pus and bacteria to prevent infection.
The complainant has stated that a long incision from naval to vagina reason has been made. In the operation of appendicitis two types of incisions are generally made.
Depending upon the circumstances of the individual patient, an appendectomy can be performed in one of two ways, through an open incision or with a laparoscope.
In the open technique, an incision is made in the lower right side of the abdomen, through the skin, muscle wall, and peritoneum. The appendix is located and then carefully freed from the surrounding structures and removed.
In the laparoscopic technique, several small incisions are made in the abdomen. In one incision a laparoscope is inserted. The laparoscope has a tiny lens to which a TV camera is attached. The appendectomy is performed by the surgeon while looking at the TV monitor. Small instruments are inserted in the other incisions and used to remove the appendix.
Which method has been used in this case has not been made clear by the Appellant. What was the need of such a long incision in which nine stitches were made. The learned Forum has said that why was the grid-iron incision was not used. There (30) is no satisfactory answer of it in the appeal the proper procedure for by the Appellant has not been disclosed. So it is clear that there is carelessness on the part of the doctor in the treatment. No post-operative care was taken in his hospital. The learned Forum has discussed very well the various aspects of the operation and thereafter passed the impugned judgment. There is clear deficiency on the part of the appellant and we are of the opinion that there is no need to interfere in the judgment of the learned District Forum. Hence this appeal is liable to be dismissed.
ORDER The appeal is dismissed with costs. The judgment and award dated 21.01.2014 passed in complaint case number 02 of 1997 Km Khushboo Dixit Vs Dr Devendra Kumar & Anr passed by learned District Consumer Forum ,Mathura is upheld.
The stenographer is requested to upload this order on the Website of this Commission today itself.
Certified copy of this judgment be provided to the parties as per rules.
(Vikas Saxena) (Rajendra Singh) Member Presiding Member Jafri, PA I Court 2 Judgment dated/typed signed by us and pronounced in the open court. Consign to record. (Vikas Saxena) (Rajendra Singh) Member Presiding Member JafRi, PA I Court 2 [HON'BLE MR. Rajendra Singh] PRESIDING MEMBER [HON'BLE MR. Vikas Saxena] JUDICIAL MEMBER