State Consumer Disputes Redressal Commission
Harinder Kaur Widow Of Late Shri Jarnail ... vs Shergill Multispecialty Hospital on 1 June, 2011
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB,
S.C.O. NO. 3009-10, SECTOR 22-D, CHANDIGARH.
Consumer Complaint No.29 of 2007
Date of institution : 18.6.2007
Date of decision : 01.6.2011
1. Harinder Kaur widow of late Shri Jarnail Singh, R/o V& P.O. Dhotian,
District Tarn Taran.
2. Jaswinder Singh son of late Shri Jarnail Singh, R/o V& P.O. Dhotian,
District Tarn Taran at present residing at H.No.80, Guru Har Rai Avenue,
Opposite Khalsa College, Amritsar.
3. Smt. Sukhjit Kaur daughter of Late Shri Jarnail Singh and wife of Late
Shri Hukam Singh, 130, Railway Link Road, Amritsar.
4. Smt. Rupinder Kaur daughter of Late Shri Jarnail Singh and wife of Shri
Jaswinder Singh s/o Sunder Singh R/o Mustfabad backside Power House,
Verka, Amritsar.
5. Smt. Jatinder Kaur daughter of Late Shri Jarnail Singh and wife of Shri
Bhupinder Singh R/o Aliwal Road, Batala, District Gurdaspur.
....Complainants
Versus
1. Shergill Multispecialty Hospital, Majitha Road, Opposite Canara Bank,
Gopal Nagar, Amritsar through Dr. Inderjit Singh Shergill.
2. Dr. Inderjit Singh Shergill, Shergill Multispecialty Hospital, Majitha
Road, Opposite Canara Bank, Gopal Nagar, Amritsar.
3. Dr. Om Parkash Sharma, M.D. (Medicine) 160, Golden Avenue, Main
Road, Amritsar (Deleted vide order dated 20.9.2007).
4. Dr. Amitabh Jairath, M.D., Gastro-Enterologist, Fortis Hospital, Ranjit
Avenue, Amritsar.
5. Dr. Arindam Ghosh, M.D., Gastro-Enterologist Surgeon, Satguru Partap
Singh, Apollo Hospital, Ludhiana.
6. Dr. Mona-M.D., Senior Resident, S.G.R.D. Institute of Medical Science &
Research, Deptt. Of Anaesthesia, S.G.R.D. Hospital, Amritsar
(Respondents No.4 to 6 are being impleaded as a proper parties).
......Respondents
Consumer Complaint under Section 17 of the
Consumer Protection Act, 1986.
Before :-
Hon'ble Mr. Justice S.N. Aggarwal President.
Mrs. Amarpreet Sharma, Member.
Present :-
For the complainants : Shri H.S. Giani, Advocate.
For respondents No.1&2 : Shri Munish Goel, Advocate.
For respondent No.3 : Deleted vide order dated 20.9.2007.
For respondent No.4 : Shri B.J. Singh, Advocate for
Shri Updip Singh, Advocate.
For respondent No.5 : Ex parte.
For respondent No.6 : None.
JUSTICE S.N. AGGARWAL, PRESIDENT:
The question to be determined in this complaint is whether respondents No.1 and 2 have committed medical negligence while medically treating Jarnail Consumer Complaint No.29 of 2007. 2 Singh (now deceased) (in short "the patient") husband of complainant no.1 and father of complainants No.2 to 5?
2. Dr. Inderjit Singh Shergill respondent No.2 (in short "Dr. Shergill") was running the Shergill Multispecialty Hospital, Amritsar respondent No.1 (in short "the respondent hospital").
Version of the complainants:
3. It was further pleaded by the complainants that on 15.8.2006 the patient suffered severe pain in upper abdomen area. The pain radiated in the back also. There was temperature with sweating and body weakness. He had also the feeling of nausea. The pain increased while walking and lying straight with abdomen upwards. It started on 15.8.2006 at about noon before taking mid day meal. It continued without any relief. Pain killer injections were administered by the local registered medical practitioner (RMP) but there was no relief. The patient was then brought to the respondent hospital. He was admitted on 15.8.2006. Dr. Shergill gave the medical treatment but the pain did not subside. The patient was admitted in the respondent hospital. He was operated by Dr. Shergill on 18.8.2006 for removal of gallbladder by laparoscopic surgery under spinal anaesthesia. The patient was discharged on 22.8.2006 prematurely.
4. It was further pleaded that Dr. Shergill was extremely negligent at every step starting from clinical diagnosis on admission, from admission to operation and post operation period during the patient's stay in the respondent hospital. Dr. Shergill also failed to follow the standards of medical and surgical care. He also failed to use the reasonable degree of skill, care, knowledge and prudence while treating the patient.
5. It was further pleaded that the patient in fact was suffering from acute pancreatitis. However he was wrongly diagnosed by Dr. Shergill as a patient of acute Cholecystitis with Cholelithiasis (acute inflammation of Gallbladder with Gallstones). Dr. Shergill had got done the following investigations:-
" (i) HB
Consumer Complaint No.29 of 2007. 3
(ii) BT
(iii) CT
(iv) TLC
(v) DLC
(vi) HIV
(vii) Blood Sugar
(viii) Blood Urea
(ix) Serum creatinine
(x) S. Cholesterol
(xi) S. triglyceride
(xii) HDL
(xiii) LDL
(xiv) Serum Bilirubin
(xv) SGOT
(xvi) SGPT
(xvii) S. Alkaline Phosphotase
(xviii) E.C.G.
(xix) Echo Cardiography
(xx) Ultrasound
(xxi) X-ray Chest."
However Dr. Shergill did not feel the necessity to confirm the final diagnosis by confirmatory tests and investigations. The bio-medical, radiological, imaging and scanning tests etc. were not got done through competent experts. These were necessary and essential to reach a final diagnosis before initiating the medical treatment or a surgical operation. The investigations from serial No.(i) to (xvii) were got done by Dr. Shergill from his own hospital. Investigations from serial No.(i) to (vi) were routine investigations and the other investigations only were for assessing the functioning of liver, kidney and metabolic disorders. E.C.G. and Echo Consumer Complaint No.29 of 2007. 4 Cardiography were got conducted for assessing the functioning of the heart. All these reports of investigations reveal normal range except TLC, DLC and blood sugar. Echo cardiography was got done by Dr. Shergill on 17.8.2006 at about 9.00 P.M. from Advanced Diagnostics, Kennedy Avenue Market, Amritsar (in short "Advanced Diagnostics").
6. It was further pleaded that ultrasound was done by Dr. Shergill in the respondent hospital on 16.8.2006. Dr. Shergill had pleaded that the ultrasound report revealed the presence of gallstones in the gallbladder. The said ultrasound report was never shown by Dr. Shergill either to the patient or to the complainants nor it was brought to their knowledge. Ultrasound study requires a skilled operator while Dr. Shergill himself did not possess any qualification in radio-diagnosis (M.D. Radiology). Dr. Shergill was only M.S. in general surgery and he was surgery specialist. The histopathology report of gallbladder showed no evidence of stones in the gallbladder. Therefore no reliance can be placed on the ultrasound report of Dr. Shergill which was false.
7. It was further pleaded that Dr. Shergill had also not got done serum amylase tests from 15.8.2006 to 22.8.2006 i.e. for the entire stay of the patient in the respondent hospital. The patient was referred to Advanced Diagnostics on 17.8.2006 for echo-cardiography. Dr. Shergill could also have advised to have ultrasound examination from an expert of Advanced Diagnostics on 17.8.2006. Had he done so the disease of the patient could have been diagnosed to be a case of acute pancreatitis in the early stage. However, Dr. Shergill depended upon his own ultrasound report and provisional diagnosis of acute cholecystitis with choleliathiasis which was a totally wrong diagnosis. Some more investigations were essential to reach a definite final diagnosis for acute pain upper abdomen and to distinguish between acute cholecystitis from acute pancreatitis. There were various factors which could be the cause of acute pancreatitis. Dr. Shergill did not get conducted any such investigation in confirmation of his own diagnosis which amounted to gross medical negligence.
Consumer Complaint No.29 of 2007. 5
8. It was further pleaded that after the removal of gallbladder by Dr. Shergill, it was sent to Nijjar Scan & Diagnostic Centre, Amritsar (in short "Nijjar Centre") for histopathological examination. Dr. Karamjit Singh Gill, Pathologist of Nijjar Centre examined the gallbladder and submitted his report dated 24.8.2006. As per this report the disease of the patient was chronic cholecystitis not acute cholecystitis with cholelithiasis as diagnosed by Dr. Shergill. The histopathological test was a confirmatory test of the disease and it always prevailed upon clinical diagnosis. Moreover the histopathological report did not reveal any evidence of gallstones. Though the patient was having a pre-existing disease of chronic cholecystitis but the disease of chronic cholecystitis was symptomless for many years. The chronic cholecystitis is a pathological entity rather than a clinical entity.
9. The presence of gallstones in the gallbladder did not remain without symptoms for years and does not need prophylactic removal. If the acute cholecystitis with choleliathiasis had been correct then all symptoms of pain in the upper abdomen would have disappeared after removal of the gallbladder but the patient continued having severe pain even after the removal of gallbladder on 18.8.2006. Rather the acute pain continued even upto the date of discharge on 22.8.2006 and even thereafter. There was no evidence of stone in the gallbladder. Chronic cholecystitis is generally painless but the patient was having pain continuously. Therefore the patient was not suffering from acute cholecystitis. In fact the patient was suffering from acute pancreatitis at the time of his admission on 15.8.2006 in the respondent hospital and his disease was wrongly diagnosed by Dr. Shergill.
10. After the discharge of the patient from the respondent hospital on 22.8.2006 the patient continued having pain. He continued taking treatment even thereafter and he did not have any food orally. He was only taking liquid or semi-liquid. There was loss of appetite and he was having nausea. The temperature was rising with sweating. The patient was again taken to the Consumer Complaint No.29 of 2007. 6 respondent hospital on 25.8.2006 with these complaints and for removal of stitches. The patient was again admitted by Dr. Shergill in his hospital on 25.8.2006. On the night of that day Dr. Shergill got conducted an ultrasound test along with some other medical tests from Advanced Diagnostics. The ultrasound study was done by Dr. Atul Kapoor who confirmed the disease of acute pancreatitis.
11. The serum amylase level was kept at 18 u/L on 25.8.2006. This level also revealed that the acute pancreatitis was not of recent origin. It had not developed after 22.8.2006. If the level of serum amylase had been high on 25.8.2006 then the possibility was that acute pancreatitis was developed after 22.8.2006. The relationship of serum amylase level was 04 duration. With the onset of the disease serum amylase level rise with 24 hours and remains so up to 1-3 days and then comes to normal within 3-5 days. This fact was highly suggestive and corroborative that the patient was actually suffering from acute pancreatitis on 15.8.2006 and not from acute cholecystitis with choleliathiasis.
12. It was further pleaded that if Dr. Shergill had got conducted the ultrasound examination from some other expert in the field of utrasonography and radio- diagnosis on 15.8.2006, the level of serum amylase had been estimated properly and the disease of acute pancreatitis had been diagnosed. Dr. Shergill himself was not an expert in the field of radio-diagnosis. Since he himself had conducted the ultrasound examination on 16.8.2006 in the respondent hospital, therefore, Dr. Shergill misdiagnosed the disease of the patient. Therefore he committed medical negligence.
13. It was further pleaded that even the disease of acute pancreatitis was curable by medical treatment. It was the ethical, professional and moral duty of Dr. Shergill to start the correct and rational treatment keeping in view the possibility of acute pancreatitis after the admission of the patient on 15.8.2006. The acute cholecystitis usually subside on conservative treatment and, therefore, Dr. Shergill was not supposed to conduct urgent surgery. The urgent surgery Consumer Complaint No.29 of 2007. 7 was mandatory only when there was evidence of gangrene of gallbladder or perforation of gallbladder. Dr. Shergill conduced the surgery i.e. removal of the gallbladder very hastily, quickly and hurriedly even without considering that the patient was diabetic. The sugar level of the patient was very high on 18.8.2006. It was 360.4 mg per cent. The patient was not in a fit condition to bear the threshold of major surgery. Moreover Dr. Shergill was not definite if the surgery was required at that stage or not.
14. It was further pleaded that Dr. Shergill performed the surgery by laparoscope for removal of gallbladder under spinal anaesthesia but in the discharge slip Dr. Shergill mentioned with mala fide intention that open cholecystectomy was done under general anaesthesia. The CT scan report clearly revealed that cholecystectomy clips were present in the abdomen of the patient which revealed that laparoscopic cholecystectomy was done and not open surgery. Moreover the sugar level of the patient was not controlled by Dr. Shergill before conducting the major surgery. The safe range of sugar level for operation is 120-180 mg. per cent and cholecystectomy was generally done under general anaesthesia. Moreover the surgery for cholecystectomy on the patient was possible after ruling out the disease of acute pancreatitis. The treatment of acute pancreatitis was non-operative and only medical treatment and not surgical. Abdomen was never opened in case of acute pancreatitis which was required only for the complications of acute pancreatitis, namely, pancreatic abscess, necrosis and pseudocyst. Rather abdominal surgery was one of main causes for acute pancreatitis which was called post operative acute pancreatitis. The mortality rate in such cases was more than 50% and even could be higher.
15. It was further pleaded that after the removal of gallbladder of the patient, a drainage pipe was inserted in the right side of the abdomen. It was kept in sito for 6 days upto 22.8.2006 i.e. upto the date of discharge. The blood strained fluid remained continuously coming out from the drainage pipe till then. Generally drainage pipe was kept for two days in laparoscopic choecystectomy Consumer Complaint No.29 of 2007. 8 and the patient was discharged two days thereafter but in the present case the drainage pipe remained inserted and the blood strained fluid remained flowing through the drainage pipe. It was also indicative of the fact that the patient was not suffering from acute cholecystitis but from acute pancreatitis.
16. It was further pleaded that the patient was medically insured with MedSave Healthcare Limited, New Delhi under the Sanjivni Scheme for the members of the cooperative society. Dr. Shergill had written to the Insurance Company that the patient was an alcoholic and his case was rejected by MedSave authorities for cashless facility on that ground. If after the ultrasound examination on 16.8.2006 Dr. Shergill had found gallstones in the gallbladder and he also knew that the patient was alcoholic and diabetic then there was no difficulty for him to conclude that the possibility was that the patient was suffering from acute pancreatitis. Dr. Shergill had not even used reasonable degree of skill to diagnose the disease. He operated the patient almost closing the chances of survival. This unwanted and undesired operation was the sole root-cause of the complications of the acute pancreatitis which became incurable in spite of the best available medical and surgical treatment. Therefore Dr. Shergill had committed medical negligence not only in diagnosing and operating the patient but even in the post operation care.
17. It was further pleaded that on 27.8.2006 the patient was referred by Dr. Shergill for CT scan examination from Nijjar Centre. As per the C.T. scan report submitted by Dr. Jatinderpal Singh, M.D. of Nijjar Centre, the disease of acute pancreatitis with early septic changes was confirmed. There was no adequate medical, paramedical or nursing staff in the respondent hospital and for that reason the patient was taken by his relatives to Fortis Hospital, Ranjit Avenue, Amritsar (in short "Fortis Hospital") after getting discharged from the respondent hospital on 27.8.2006. The patient remained admitted in Fortis Hospital from 27.8.2006 to 6.9.2006. He was given medical treatment by Dr. Amitabh Jairath respondent No.4. The medical tests were got done from SLR Ranbaxy, Satellite Consumer Complaint No.29 of 2007. 9 Laboratory, Ranjit Avenue, Amritsar from 28.8.2006 to 5.9.2006. The ultrasound examination was also got done by respondent No.4 from Nijjar Centre on 2.9.2006. It confirmed the disease of pancreatitis. On 5.9.2006 second C.T. scan was got conducted by Fortis Hospital from Nijjar Centre. It confirmed pancreatitis abscess. The patient was discharged from Fortis Hospital on 6.9.2006 and he was referred to Satguru Partap Singh Apollo Hospital, Ludhiana (in short "Apollo Hospital") for treatment of pancreatitis abscess. There was serious complication of acute pancreatitis. It was the result of misdiagnosis on 15/16.8.2006 by Dr. Shergill and unwanted operation conducted by him on the patient on 18.8.2006.
18. It was further pleaded that the patient was admitted in the Apollo Hospital on 6.9.2006. He was operated for removing the pancreatitis abscess by Dr. Arindam Ghosh respondent No.5. The patient was again operated on 13.9.2006 for emergency exploratory laporotmy as the condition of the patient had further deteriorated due to septicemia. He was given proper and effective medical treatment by respondent No.5 but the patient could not recover and he died in the Apollo Hospital on 14.9.2006.
19. It was further pleaded that the complainants are the consumers of Dr. Shergill who had operated the patient negligently for removal of gallbladder after misdiagnosing the disease and when no operation was needed. This medical negligence committed by Dr. Shergill not only led to the death of the patient, it also caused great mental tension, physical harassment, medical expenditure and financial loss to the complainants. The complainants had suffered the loss from agriculture to the tune of Rs.9,49,833/- per annum and Rs.1,89,600/- from dairy farming because of the death of the patient. They also sought compensation and the complaint for recovery of Rs.99,91,737/- was filed. Interest and costs were also prayed.
Version of respondents:
Consumer Complaint No.29 of 2007. 10
20. Respondents No.1 and 2 filed the written reply and the case was contested. It was pleaded that the complaint was totally vexatious and misconceived. It was groundless and baseless and, therefore, was not maintainable. It was the misuse of the process of law and it deserved to be dismissed with heavy costs.
21. On merits it was admitted that the patient was admitted in the respondent hospital in the late evening of 15.8.2006. All the necessary investigations were got done prudently with due care and caution. The pre-operative checkup was made by a physician. Aanesthesia was also administered diligently. The patient was operated for acute chronic cholecystitis with cholelithiasis by laparoscopic cholecystectomy on 18.8.2006 under general anaesthesia prudently and with due care and diligently. Complainant No.1 was also admitted on 20.8.2006 with the old history of gallbladder stone. She was operated on the same day by laparoscopic cholecystectomy under general anaesthesia. Complainant No.1 and the patient were eating and moving normally. Both husband and wife were discharged on 22.8.2006 on their verbal request as they were residing locally. Normally in the case of laparoscopic surgery, patients are discharged on the same day or at the most on the second day.
22. It was denied if the patient displayed symptoms of acute pancreatitis. The history of the patient was recorded by Dr. Shergill as was told to him by the patient. The patient had presented himself with pain in the upper abdomen, more so in the right hypochondrium. There was no radiation of the pain to the back, no sweating, no fever, no cyanosis, no shock and no jaundice. There was no bluish discolouration at the back or at the umbilicus. The patient's vital signs namely pulse, B.P., respiration etc. were normal. The patient was also in full senses and was passing urine normally. The picture presented by the complainants was totally false.
23. It was denied if Dr. Shergill was in a hurry to discharge the patient as the indoor admission was paid for by the Sanjivni Scheme for both the patients. The Consumer Complaint No.29 of 2007. 11 history of the patient was recorded as was told by him to Dr. Shergill. The patient and his wife were in good condition at the time of discharge. It was denied if Dr. Shergill had committed any medical negligence while treating Jarnail Singh patient in pre-operation stage or during operation or post operation stage. Dr. O.P. Sharma (Retd. Professor and Head of Medicine) was the best physician who was associated. It was also denied if the patient was provisionally diagnosed as a patient of acute cholecystitis with cholelithiasis with diabetes. The history given by the patient, signs and symptoms were more markedly indicated the disease of acute cholecystitis due to gall stone which was confirmed by ultrasound scan. The serum amylase was also normal on 17.8.2006 indicating the normal pancreatitis at that time. It was admitted that serum amylase has to rise by 4 times to be significant for acute pancreatitis and had to remain elevated for 7 days.
24. It was further pleaded that if the patient developed marked abdominal pain, fever or unexplained shock following abdominal surgery or if the patient presented with diabetic coma and shock or if the patient had clinical features suggesting myocardial infarction with abdominal distension or if the patient had vomiting persistent and frequent, then the acute pancreatitis could be suspected but the patient did not have any such signs or symptoms. Existence of abrupt onset of deep epigastric pain often with radiation to back, history of previous episodes often related to alcohol intake, nausea and vomiting, abdominal tenderness and distention and fever or if there is increase of leucocytosis, serum amylase and serum lipase or the history of alcohol intake, hypotension, shock, renal failure, cool clammy skin are also additional signs and symptoms for pancreatitis.
25. In the present case the patient had none of these signs or symptoms. Rather blood sugar was markedly increased which clearly ruled out acute pancreatitis nor the sequence of events which happen even retrospectively suggest acute pancreatitis. Microlithiasis is also present in majority of the Consumer Complaint No.29 of 2007. 12 patients apparently/idiopathic pancreatitis. Serum amylase is increased in many other conditions and therefore, it was never single diagnostic test. The x-ray chest did not disclose any air under diaphragm. It ruled out the possibility of perforated peptic ulcer. The diagnosis of acute MI was again ruled out due to normal ECG & Echocardiography. Hepatitis was also ruled out by biochemistry tests and there was no inter costal tenderness. Therefore the balance of signs, symptoms and logical reasoning leads to diagnosis was in favour of acute cholecystitis with cholelithiasis.
26. It was further pleaded that Dr. Shergill had got conducted all the relevant investigations as the patient was diabetic with uncontrolled sugar levels. Injection Insulin was also added to treat pre-existing diabetes. Ultrasonography of the patient was got done in the respondent hospital on 16.8.2006 which along with other reports were clearly shown to the patient. Dr. Shergill was also trained to conduct ultrasound examinations. These documents were attached with pre-authrization form which were duly signed by the patient and these were sent to Sanjivni Trust for sanction of finances for the operation. A repeat ultrasound was also got done from Dr. I.B.S. Gill, M.D., Radiology on 17.8.2006.
27. It was also pleaded that the test of ultrasonography was 95% specific for gallbladder stones and 40-60% specific for acute pancreatitis. It could be missed even by a very trained radiologist as the value was often limited by air and fluid filled loops of bowel overlying and obscuring the pancreas. Swollen pancreas may be distinguished on ultrasonography but the gland was poorly visualized in 25-50% of cases. Ultrasound was often not helpful in diagnosing acute pancreatitis.
28. It was further pleaded that Serum Amylase & LDH were got done on 17.8.2006. These were normal. The patient was referred to Advanced Diagnostics for echo. Since cardiac status was normal, the patient was advised to undergo surgery. His consent was taken. The disease of the patient was diagnosed as acute cholecystitis with cholelithiasis. It was correct. Serum Consumer Complaint No.29 of 2007. 13 Amylase was the pillar on which diagnosis rested, although it was not absolute evidence of the disease. The serum amylase level was normal before and after the operation. It was also normal on 25.8.2006 and 27.8.2006. It was denied if there was any medical negligence on the part of Dr. Shergill in diagnosing the disease. Rather acute cholecystitis with cholelithiasis stood confirmed from the history, examination and ultrasound examination.
29. It was further pleaded that the slit gallbladder and the stones were put in a container. These were handed over to the relatives of the patient for getting the histopathology report. It was got done from Nijjar Centre. The report was of chronic cholecystitis. The case of cholelithiasis with acute cholecystitis becomes a case of chronic cholecystitis with passage of time. Chronic cholecystitis and acute cholecystitis are part of same spectrum of disease and are related to inflammation of the gallbladder due to obstruction of cystic duct by stones. With the flaring up of infection or the blockage of the duct with small stones acute attack of Cholecystitis is precipitated.
30. It was further pleaded that Harinder Kaur complainant No.1 (wife of the patient) was also suffering from silent cholelithiasis. She was also admitted in the respondent hospital. Laparoscopic cholecystectomy was the treatment of choice. It was given to the patient and to complainant No.1 Harinder Kaur. The patient was discharged five days after the operation while complainant No.1 was discharged two days after the operation. The patient and complainant No.1 (husband and wife) had gone back to their house on the same day. The preparation and indications for cholecystectomy are the same whether it is performed by laparoscopic or by open techniques. The treatment of choice for patients with symptomatic gallstone is laparoscopic cholecystectomy. Early surgery for acute cholecystitis is the treatment of choice. The patient was relieved of pain after the operation and at the time of discharge the patient had walked out of the hospital. The false allegations have been made by the complainants with mala fide intention. The patient was chronic alcoholic for the Consumer Complaint No.29 of 2007. 14 last 35 years and the mortality rate of operation was 5-10% in elderly people. The patient was on semi-solid diet since 20.8.2006 (post-operatively). If the patient had not been well, he would not have been discharged on 22.8.2006.
31. It was further pleaded that the patient was again brought to the respondent hospital on 25.8.2006 for removal of stitches. Since the patient complained of pain in umbilical region, he was examined and a provisional diagnosis of acute pancreatitis was made. The patient was sent to the Advanced Diagnostics for ultra-sonography and serum amylase estimation. The report revealed acute pancreatitis with raised blood count and high blood sugar levels (310 mg%). Serum amylase was normal.
32. It was further pleaded that on 17.8.2006 the patient was examined by Dr. O.P. Sharma (Retd.), Professor & Head, Department of Medicine and Medical Superintendent, Government Medical College, Amritsar. Dr. Sharma was a renowned physician of Amritsar. Dr. OP Sharma had advised blood tests and echo cardiography for the patient. He also recorded it in his own hand in the patient's record that he was alcoholic and was taking large amount of alcohol for the last many years. It could be a cause of precipitation of acute pancreatitis at the time of second admission. Both stress and alcohol intake plus history of gallbladder disease could cause acute pancreatitis in 70-90% of cases. Ultrasonography was got done from a trained radiologist on 17.8.2006. Serum amylase level was also got done on the same day. Before operation these were normal. It was repeatedly asserted that the diagnosis of acute cholecystitis with cholelithiasis was correct.
33. It was further pleaded that if the diagnosis was in doubt, it could be confirmed by laparotomy. The gallbladder needs be removed as the micro calculi from gallbladder could cause acute pancreatitis. Correct treatment was given to the patient on 15.8.2006 as also on 25.8.2006 before the patient was sent for C.T. scan to Nijjar Centre from where the patient absconded and never returned to the respondent hospital. The patient was diabetic and his sugar level Consumer Complaint No.29 of 2007. 15 was controlled by injections. It was 144 mg% before operation. It was checked by Dr. Mona Bansal, Anaesthetist, respondent No.6 who had administered anaesthesia on the patient. The patient and his relatives were informed about the operation. The consent was taken for removal of gallbladder. Regular blood and urine sugar charts were maintained and insulin was given to the patient to the extent it was needed. The patient had undergone laparoscopic cholecystectomy under general anaesthesia administered by Dr. Mona Bansal, M.D., Associate Professor of Anaesthesia (respondent No.6). The patient was shifted out of the operation theatre only when he was fully conscious.
34. Since the fundus of the gallbladder was adherent, the incision was extended to deliver the gallbladder as a whole. The presence of clips in the abdomen confirmed that laparoscopic cholecystectomy was done. Conversion to an open procedure should be made if the inflammation prevents adequate visualization of important structures. Dr. Shergill had ruled out the possibility of acute pancreatitis and only thereafter cholecystectomy was performed. It was denied if surgical treatment was never given for acute pancreatitis. Surgery at times was indicated for the diagnosis and treatment of acute pancreatitis. When uncomplicated pancreatitis was found, the exploration should be complete and established by the diagnosis beyond question. If gallstones were present pancreatitis is mild. Definitive billiary surgery usually could be completed safely at this time. If pancreatitis appears mild and cholelithiasis was present, cholecystectomy or cholecystostomy was justified.
35. It was further pleaded that usually a vacuum drain was inserted in sub- hepatic space to drain any collection after operation on liver and gallbladder. Such a drain was removed after 2 days when the discharge ceased as a prophylaxis to prevent sub-hepatic collection. It was followed in the case of this patient also.
36. It was further pleaded that the patient was a chronic alcoholic as was recorded by Dr. OP Sharma. He was registered under the Sanjivni Scheme. The Consumer Complaint No.29 of 2007. 16 claim of the patient was rejected by the Sanjivni Trust as alcoholism was not covered under the policy. The rejection of the claim by the Sanjivni Trust was the basic cause for which the complaint has been filed by the complainants against the respondents. The patient with gallstones even if microlithiasis must undergo cholecystectomy to prevent acute pancreatitis. The operation does not influence the overall morbidity and mortality. It could be undertaken in doubtful cases. The danger of misdiagnosis with persistent conservative treatment is greater than that of a properly conducted laparatomy. In the present case the patient was having cholecystitis with cholelithiasis and surgery (laparoscopic) was undertaken to cure the patient of this disease. If this had not been done, it could be one of provocative causes of acute pancreatitis and the consequences would have been serious. The treatment was correctly given by Dr. Shergill. There was no medical negligence on his part. The patient started oral feeding on the second day of the operation. He passed flatus and stool. There was no vomiting. The operation was successful to the extent that acute pain and the signs/symptoms stood subsided.
37. It was further pleaded that on re-admission of the patient on 25.8.2006 for removal of stitches, the patient had complained of pain in the umbilical region and for this reason he was sent to Advanced Diagnostics for ultrasound scan and serum amylase estimation. The report revealed acute pancreatitis but serum amylase was normal. On 26.8.2006 the patient was examined by Dr. O.P. Sharma, Physician and he had prescribed certain medicines. However the patient had absconded on 27.8.2006.
38. It was further pleaded that the respondent hospital was well equipped hospital with adequate medical and paramedical staff. Since the patient was satisfied with the facilities available in the respondent hospital, complainant no.1 was admitted in this hospital for laparoscopic cholecystectomy on 20.8.2006 and she was relieved two days thereafter. Earlier Tejinder Kaur relative of the deceased had come from England to get her retroperitoneal cyst (tumour) Consumer Complaint No.29 of 2007. 17 removed on 24.4.2006. Her operation was also successful and she had fully recovered.
39. The treatment taken by the patient from Fortis Hospital was denied for want of knowledge. Dr. Shergill was a well qualified and an experienced surgeon. Abdominal surgery was required. If pancreas were inflamed and if the causative factor was gallbladder stone or CBD stone, even then cholecystectomy was indicative. If the pain was mild and cholelithiasis was present, cholecystectomy or cholecystotomy was justified. The patient was treated conservatively from 15.8.2006 to 18.8.2006. He was operated thereafter after explaining the whole procedure to the patient. The patient wanted laparoscopic cholecystectomy. The possible complications were explained to the patient in the consent form. The consent of the son of the patient was also recorded. After financial clearance from Sanjivni Trust for the operation, it was carried out. It was repeatedly denied if there was any medical negligence on the part of the respondents. Dismissal of the complaint was prayed.
40. The name of respondent No.3 was deleted vide order dated 20.9.2007 passed by this Commission.
41. Respondents No.4 and 5 were proceeded against ex parte.
42. Dr. Mona, M.D. respondent No.6 also filed the written reply. In answer to some of the paragraphs it was pleaded that these paragraphs related to respondents No.1 and 2. It was pleaded that the patient had taken pain killer injection from local R.M.P. doctors which was not permissible in law. In response to paras No.14 and 15 it was admitted that she had administered the appropriate anaesthesia to the patient as required for laparoscopic cholecystectomy keeping in view the blood sugar level. The patient was in a fit condition to bear the threshold of surgery as per pre-anaesthetic checkup. The operation was performed under general anaesthesia. The patient was brought out of the operation theatre in a conscious state of mind.
Consumer Complaint No.29 of 2007. 18
43. It was further pleaded that the basic purpose of anaesthesia was to facilitate the surgical process, pain free, and with minimum complications. Since the patient was brought out of the operation theatre in a conscious state of mind, therefore, it cannot be said if there was any medical negligence in administering the anaesthesia. It was repeatedly denied if the general anaesthesia was not given in the right form or manner. Some of the paragraphs of the complaint were denied for want of knowledge. Dismissal of the complaint was prayed.
Proceedings before this Commission:
44. Jaswinder Singh complainant No.2 filed his affidavit dated 9.6.2007. The complainants also proved documents Annexure C-1 to Annexure C-29. They also filed documents Annexure C-30 and Annexure C-31.
45. On the other hand, respondents No.1 and 2 filed documents Annexure R-1 to Annexure R-7. Some extracts from books were also placed on the file.
46. On the basis of these pleadings, affidavits/documents, the learned counsel for the complainants submitted that the patient had died due to medical negligence committed by respondents No.1 and 2 when the patient was under
their medical treatment. It was prayed that the complaint be accepted and adequate compensation be awarded to the complainants.
47. On the other hand, the submission of the learned counsel for respondents No.1 and 2 was that there was no merit in the present complaint and the same be dismissed.
48. The submission of learned counsel for respondent No.4 was also that there was no merit in the present complaint and the same be dismissed.
49. Record has been perused. Submissions have been considered. Discussion:
50. The admitted facts are that the patient was admitted in the respondent hospital on 15.8.2006 as he had pain in the abdomen. The ultrasound was conducted by Dr. Shergill himself on 16.8.2006. He was operated by Dr Shergill Consumer Complaint No.29 of 2007. 19 on 18.8.2006 under general anaesthesia by laparoscopic cholecystectomy. The patient was discharged on 22.8.2006.
51. It is also admitted that on 25.8.2006 the patient had come in the respondent hospital for removal of stitches. He was again admitted in the respondent hospital on the same day. He was sent for ultrasonography examination to Advanced Diagnostics which was got conducted by the attendants of the patient and the disease of the patient was diagnosed to be acute pancreatitis. Dr. Shergill had also got conducted certain other medical tests on 25.8.2006, 26.8.2006 and on 27.8.2006. The patient was again referred to NIjjar Centre on 27.8.2006 for CT scan examination and thereafter the patient had not come back to the respondent hospital.
52. It is also admitted between the parties that Harinder Kaur complainant No.1 was the wife of the patient. She was also admitted in the respondent hospital on 20.8.2006. She had the old history of gallbladder stone. She was operated by Dr. Shergill on 20.8.2006 by laparoscopic cholecystectomy under general anaesthesia and she was also discharged on 22.8.2006.
53. It was pleaded by the complainants that the patient was admitted in Fortis Hospital on 27.8.2006. He was medically treated in that hospital and was discharged on 6.9.2006. Then the patient was admitted in Apollo Hospital on 6.9.2006. He was operated on 7.9.2006. He was again operated on 13.9.2006 but his condition deteriorated and the patient had died in the Apollo Hospital on 14.9.2006. All these facts have been denied by Dr. Shergill for want of knowledge.
54. The medical negligence alleged by the complainants was that Dr. Shergill had not taken sufficient steps to diagnose the disease of the patient before he was operated on 18.8.2006.
55. It was also submitted by the learned counsel for the complainants that Dr. Shergill was not competent for conducting ultra-sound test. Instead of sending the patient to outside diagnostic centre and for obtaining the proper Consumer Complaint No.29 of 2007. 20 ultrasound/ultrasonography report, Dr. Shergill who himself was unqualified and un-experienced in this field, conducted the ultrasound/ultrasonography test himself on 16.8.2006 and wrongly diagnosed the disease of the patient.
56. However the submission of the learned counsel for respondents No.1 and 2 was that respondent No.2 was not only duly qualified but he had lot of experience. He had got a certificate to that effect. Reliance was placed by the learned counsel for respondents No.1 and 2 on the certificate of registration issued by Civil Surgeon, Amritsar on 19.7.2004 (Annexure R-2). It was submitted that vide this certificate Dr. Shergill in the respondent hospital was authorized to conduct the ultrasound examinations.
57. This submission has been considered and the duplicate certificate of registration dated 19.7.2004 (Annexure R-2) has also been perused.
58. This certificate reveals that it was issued by the Civil Surgeon, Amritsar in exercise of his powers conferred under Section 19(1) of the Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 for Dr. Shergill in the respondent hospital. It was valid upto 14.7.2009. It means, therefore, that it was valid on 15.8.2006, 16.8.2006 and on 17.8.2006.
59. What is surprising is that this certificate authorized Dr. Shergill for prenatal diagnostic procedures and not for any other disease/purpose. The word 'prenatal' has been defined at page 1533 of Dorland's Illustrated Medical Dictionary (31st Edition) as under:-
"Prenatal existing or occurring before birth, with reference to the fetus."
60. It means, therefore, that Dr. Shergill was authorized for conducting ultra- sound only in cases of prior to delivery. It does not authorize Dr. Shergill to conduct the ultrasound examination for all purposes. Therefore the certificate of registration Annexure R-2 did not authorize Dr. Shergill to conduct ultrasound tests in cases of abdomen pain in the males.
Consumer Complaint No.29 of 2007. 21
61. Dr. Shergill was M.S. (Gen. Surg.). He was Professor and Head in the Department of Surgery. However the ultrasound test requires different qualifications and different experience for which neither Dr. Shergill was qualified nor he had the experience. Therefore there is merit in the submission of the learned counsel for the complainants that Dr. Shergill conducted the ultrasound test himself even being unauthorized rather than referring the patient to a proper diagnostic centre for this purpose and thereby Dr. Shergill failed to diagnose the disease of the patient properly.
62. The discharge card of the patient has been produced by the complainants as Annexure C-1. It reveals that the patient was admitted in the respondent hospital on 15.8.2006 and he was discharged on 22.8.2006. The disease of the patient was diagnosed by Dr. Shergill as acute cholecystitis with cholelithiasis.
63. The word 'cholecystitis' has been defined in the aforesaid medical dictionary at page 354 as under:-
"cholecystitis inflammation of the gallbladder."
64. The word 'Cholelithiasis' has been defined in the aforesaid medical dictionary at page 355 as under:-
"cholelithiasis the presence or formation of gallstones; they may be either in the gallbladder (cholecysto-lithiasis) or in the common bile duct (choledocholithiasis). "
65. The word 'Cholecystectomy' has been defined in the aforesaid medical dictionary at page 354 as under:-
"cholecystectomy surgical removal of the gallbladder."
66. Now the question arises as to what was the basis on which Dr. Shergill had diagnosed the disease of the patient as acute cholecystitis with cholelithiasis?
67. Respondents No.1 & 2 have also produced the bed head ticket of the patient as Annexure R-3. On the date of admission itself Dr. Shergill had diagnosed the disease of the patient provisionally as cholecystitis with cholelithiasis with diabetes with hypertension and the admission of the patient Consumer Complaint No.29 of 2007. 22 was recommended by Dr. Shergill. It is so mentioned by Dr. Shergill on the first sheet of the bed head ticket Annexure R-3. No reason has been mentioned by Dr. Shergill on this sheet on the basis of which he formed the opinion about the disease of the patient as cholecystitis with cholelithiasis. On the third sheet also no basis has been discussed. On the backside of the third sheet, the general examination of the patient is mentioned, the symptomatic examination of the patient is mentioned and the provisional diagnosis was shown as (i) acute cholecystitis with cholelithiasis (ii) acute pancreatitis (iii) acute M.I. and (iv) hepatitis.
68. It means, therefore, that the disease of the patient could be anything out of these four named diseases and it was for Dr. Shergill to determine on the basis of sound material as to which out of these four apprehended diseases, was the disease from which the patient was suffering. All these things related to 15.8.2006.
69. On 16.8.2006 the investigation process and general observations were made as per the bed head record Annexure R3. On 17.8.2006 some observations were made and it was also stated that Dr. OP Sharma be asked to give his opinion. Dr. OP Sharma visited the respondent hospital and examined the patient on 17.8.2006 and he advised echo-cardiography.
70. Accordingly Dr. Shergill referred the patient to Advanced Diagnostics for echo-cardiography on 17.8.2006. Dr. Shergill has pleaded in para 13 of the written reply that ultrasonography of the patient was done in the respondent hospital on 16.8.2006. The report of ultrasonography as well as the scan of ultrasonography were shown and given to the patient. However Dr. Shergill has not produced a copy of his report of ultrasonography or the scan of ultrasonography conducted by him on the patient on 16.8.2006. Moreover when Dr. Shergill himself was not duly qualified for conducting ultrasonography on the patient, there was no need for Dr. Shergill to conduct the ultrasonography himself in the respondent hospital itself.
Consumer Complaint No.29 of 2007. 23
71. Moreover if the patient could be sent to Advanced Diagnostics (owned by Dr. Anil Khanna) for echo-cardiography on 17.8.2006, the patient could also be sent outside for ultrasonography on 16.8.2006 when it was necessary to diagnose the disease of the patient. It has already been discussed in the above paragraphs that the certificate issued by the Civil Surgeon, Amritsar in favour of Dr. Shergill to conduct the ultrasound examination was limited only for prenatal purposes and not for any other kind of patients.
72. The ultrasound report dated 16.8.2006 is a part of bed head ticket produced by Dr. Shergill as Annexure R-3. This report is signed by technical assistant. It is not disclosed by Dr. Shergill as to who was the technical assistant in the respondent hospital who had conducted the ultrasound test on the patient? What was the qualification of that technical assistant and what was the experience of that technical assistant? As per this report the disease of the patient was diagnosed as acute cholecystitis with cholelithiasis but the qualification and experience of the technical assistant who conducted the ultrasound test on the patient have not been mentioned anywhere on this report.
73. Although Dr. Shergill has taken the plea that a repeat ultrasound was done by Dr. I.B.S. Gill, M.D., Radiology on 17.8.2006 (para 13 of the written reply) but the ultrasound report dated 17.8.2006 which is a part of the medical record of the patient Annexure R-3 is prepared on the Shergill Scan and X-ray Centre which was the Scan and X-Ray Centre of Dr. Shergill (respondent No.2) himself. The ultrasound report dated 16.8.2006 is on the letter pad of Dr. Shergill and the ultrasound report dated 17.8.2006 is also on the letter pad of Dr. Shergill (respondent No.2). Only the date is different and the signatures/initials of the person who signed the reports are different but the conclusions are the same i.e. acute cholecystitis with cholelithiasis. Therefore the plea taken by Dr. Shergill that the repeat ultrasound was done by Dr. I.B.S. Gill, M.D. Radiology is not believable.
Consumer Complaint No.29 of 2007. 24
74. Dr. Shergill has filed the affidavit of Dr. Inder Bir Singh Gill, M.D. Radio-diagnosis, Gandhi Hospital, Nawanshahr dated 6.7.2009 as Annexure R-6. This doctor has deposed in his affidavit that he had conducted ultrasonography on the patient Jarnail Singh on 17.8.2006 and had reported the disease of the patient as acute cholecystitis with cholelithiasis. This affidavit is not believable for the simple reason that this affidavit is signed by Dr. Inder Bir Singh Gill with full signatures while the initials on the ultrasound report dated 17.8.2006 do not tally with his signatures on the affidavit Annexure R-6.
75. Moreover in the affidavit dated 6.7.2009 (Annexure R-6), Dr. Inderbir Singh Gill has nowhere deposed if the ultrasound report dated 17.8.2006 was signed by him. Thirdly, Dr. Inderbir Singh Gill was working in Gandhi Hospital, Nawanshahr as per the affidavit dated 6.7.2009 Annexure R-6 while the hospital of Dr. Shergill (respondent No.2) was located in Amritsar. Dr. Inderbir Singh Gill has nowhere stated in his affidavit Annexure R-6 if he had prepared his report on the letter pad of Dr. Shergill (respondent No.2) or if he was the visiting doctor in the respondent hospital. Therefore this affidavit of Dr. Inderbir Singh Gill appears to have been manipulated by Dr. Shergill.
76. The affidavit of Dr. Inderbir Singh Gill Annexure R-6 reveals that he was working in Gandhi Hospital, Nawanshahr on 17.8.2006. Therefore it was not possible for Dr. Inderbir Singh Gill to go from Nawanshahr to Amritsar to conduct the ultrasonography on the patient in the respondent hospital on 17.8.2006.
77. Even the films of ultrasound conducted by Dr. Shergill on 16.8.2006 and allegedly conducted by Dr. Inderbir Singh Gill on 17.8.2006 have not been produced on the file nor these were shown to any competent doctor to get the opinion if those ultrasound reports clearly made out to be a case of cholecystitis with cholelithiasis. As already held above, Dr. Shergill (respondent No.2) was not competent to conduct the ultrasound test himself while the report dated 17.8.2006 appears to have been manipulated by Dr. Shergill (respondent No.2). Consumer Complaint No.29 of 2007. 25 It is a matter of question as to why Dr. Shergill (respondent No.2) had not got conducted ultrasound examination from Advanced Diagnostics on 17.8.2006 where the patient was sent for echo-cardiography (Annexure C-2) on the advice of Dr. O.P. Sharma.
78. Dr. Shergill (Respondent No.2) himself has placed on file the medical record of Harinder Kaur complainant No.1 as Annexure R-4. It contains a document (ultrasound report) which reveals that Harinder Kaur complainant No.1 had come to the respondent hospital for medical checkup regarding her abdomen pain on 14.8.2006. Dr. Shergill had examined her medically and she was subjected to ultrasound examination and it was found that she was having stones in her gallbladder.
79. It appears that since the wife of the patient was suffering from stone problem, therefore, Dr. Shergill (respondent No.2) opined without applying his mind that the patient must also be suffering from gallbladder stone. However the case of Harinder Kaur complainant No.1 was different because she had the history of gallstone even as per the version of respondent No.2.
80. Moreover Dr. Shergill (respondent No.2) had conducted the ultrasound test on the patient on 16.8.2006. He had also got conducted the repeat ultrasonography test allegedly from Dr. Inderbir Singh Gill. It means, therefore, that ultrasound test was a must for diagnosing the disease of the patient. So far as the first ultrasound report on the basis of ultrasound examination conducted by Dr. Shergill is concerned, he was neither qualified nor he was authorized to conduct the ultrasound test. Therefore the report dated 16.8.2006 was not sufficient for diagnosing the disease of the patient. Similarly it has already been discussed that the ultrasound report dated 17.8.2006 appears to have been manipulated by Dr. Shergill (respondent No.2). Therefore in fact no such test had taken place. Dr. I.B.S. Gill was working at a distant place i.e. Nawanshahr but even no reference has been made in the bed head ticket of the patient if Dr. Consumer Complaint No.29 of 2007. 26 I.B.S. Gill had conducted the ultrasound test on the patient. Therefore this report also falls to the ground.
81. The net result, therefore, is that no ultrasound test of the patient was got done by Dr. Shergill (respondent No.2) from any competent person before diagnosing the disease of the patient. Therefore it also amounts to medical negligence.
82. Dr. Shergill has further pleaded in para 15 of the written reply that the slit gallbladder and stones were put in a container and had handed over to the relatives of the patient for getting the histopathology done. The histopathology was got done from Nijjar Centre. The report of the Nijjar Centre dated 24.8.2006 has been proved by the complainants as Annexure C-3. It reads as under:-
"Specimen : Gall bladder.
Gross : Specimen of gall bladder measuring 6.0 cm. in
length. Outer surface is unremarkable. Cut section
mucosa is velvety green.
P/E.
MICRO : Gall bladder mucosa shows infiltration by
lymphocytes, few plasma cells and eosinophils. The
wall shows fibrosis and congested blood vessels.
IMP :CHRONIC CHOLECYSTITIS."
83. Therefore even the histopathology report of Nijjar Centre Annexure C-3 does not reveal if any stone was found in the gallbladder of the patient. This also clearly proves that the diagnosis of Dr. Shergill was totally misplaced.
84. Dr. Shergill had admittedly conducted cholecystectomy on Harinder Kaur complainant no.1 as she was admittedly suffering from gall stones. Her extracted gallbladder was also sent by respondent No.2 to Nijjar Centre for histopathology. The report of Nijjar Centre dated 31.8.2006 relating to Harinder Kaur has been proved as Annexure C-30. It reads as under:-
"Specimen : Gall bladder.
Consumer Complaint No.29 of 2007. 27
Gross : Already cut open specimen of gall bladder measuring
5.0 cm. in length. Outer surface is unremarkable.
Cut section mucosa is velvety green. Lumen contains
stones.
P/E.
MICRO :Gall bladder mucosa shows infiltration by
lymphocytes, few plasma cells and eosinophils. The
wall shows fibrosis and congested blood vessels.
IMP :CHRONIC CHOLECYSTITIS WITH
CHOLELITHIASIS."
85. It specifically says that the lumen contained stones. 'Lumen' has been
defined in the Dorland's Illustrated Medical Dictionary (31st Edition) at page 1092 as under:-
"lumen 1. the cavity or channel within a tube or tubular organ. 2. The SI unit of luminous flux; it is the light emitted in a solid angle of 1 steradian by a uniform point source with luminous intensity of 1 candela. "
86. The patient was admittedly sent by Dr. Shergill to the Advanced Diagnostics on 17.8.2006 for echo-cardiology on the advice of Dr. OP Sharma. Therefore Dr. Shergill could have also got conducted the ultrasound examination of the patient from Advanced Diagnostics. Therefore it was a medical negligence on the part of Dr. Shergill (Respondent No.2) having not got conducted ultrasound/ultrasonography of the patient from Advanced Diagnostics.
87. It may also be noticed that after the patient was re-admitted by Dr. Shergill in the respondent hospital on 25.8.2006, he had sent the patient to Advanced Diagnostics for ultrasonography and Dr. Atul Kapoor had clearly reported in his report that the patient had 'acute edematous pancreatitis with mild surrounding fluid'. This report has been produced by Dr. Shergill along with the Consumer Complaint No.29 of 2007. 28 medical record of the patient dated 25.8.2006 (Annexure R-5). The word 'edematous' has been defined in the aforesaid medical dictionary at page 601 as under:-
"edematous pertaining to or affected by edema."
88. The word 'edema' has been defined in the aforesaid medical dictionary at page 600 as under:-
"edema the presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body, usually referring to subcutaneous tissues. It may be localized (such as from venous obstruction, lymphatic obstruction, or increased vascular permeability) or systemic (such as from heart failure or renal disease). Edema is sometimes designated according to the site:
ascites (peritoneal cavity), hydrothorax (pleural cavity), or hydropericardium (pericardial sac). Massive generalized edema is called anasarca. Called also dropsy and hydrops."
89. If the patient could be sent to Advanced Diagnostics by Dr. Shergill (respondent No.2) on 25.8.2006 for ultrasonography test, why the ultrasonography test could not be got conducted by Dr. Shergill from the same Diagnostics Centre on 17.8.2006 when the patient was sent on 17.8.2006 to same Diagnostic Centre for ultrasonography.
90. It means, therefore, that pancreatitis was diagnosed by the qualified doctor of Advanced Diagnostics on 25.8.2006 when it was in grievous form. The scan of 25.8.2006 has also been produced. The said ultrasonography dated 25.8.2006 has also been proved by the complainants as Annexure C-4.
91. The patient was again sent by Dr. Shergill to Nijjar Centre on 27.8.2006 for CECT upper abdomen with oral contrast. Dr. Jatinder Pal Singh of Nijjar Centre submitted his report dated 27.8.2006 (Annexure C-11) according to which Consumer Complaint No.29 of 2007. 29 the CT findings suggested pancreatitis with early septic changes. This report further corroborates that the disease of pancreatitis of the patient had assumed critical nature by that date.
92. If Dr. Shergill had adopted proper basis in diagnosing the disease of the patient on 15.8.2006 or at least before performing the laparoscopic surgery on 18.8.2006, the disease of the patient could have been properly diagnosed. Therefore it amounted to medical negligence on the part of Dr. Shergill (respondent No.2).
93. The patient had not gone back to the respondent hospital after 27.8.2006. Rather the patient was got admitted by the complainants in Fortis Hospital where the disease of the patient could not be brought under control. Therefore he was got admitted in Apollo Hospital on 6.9.2006 but the patient died on 14.9.2006 (Annexure C-27). The death summary of the patient given by Apollo Hospital dated 14.9.2006 (Annexure C-27) is reproduced below:-
"62 years old male Jarnail Singh known case of DM type-II on regular treatment came to the hospital with chief c/o pain epigastrium since 15-20 days. Patient was diagnosed as a case of cholelithiasis and was operated outside and laparoscopic cholecystectomy was done. Post operatively patient developed high grade fever and epigastric tenderness. Patient was admitted at Fortis Hospital, Amritsar and was diagnosed as a case of pancreatic abscess and referred to SPS Apollo Hospital for further management.
After admission and thorough investigations, Pancreatic necrosectomy with transverse colectomy with ileostomy for gangrene and perforated Transverse colon was performed on 7/9/2006.
Biopsy of the specimen showed copulent fungal Consumer Complaint No.29 of 2007. 30 hyphae. Post operative patient was performing well for 48 hrs but started developing septicemia and patient was taken up for emergency re exploratory laparotomy on 13.9.2006 suspecting bowel gangrene.
On exploration small bowel diffuse patchy gangrene was noted, right colon gangrenous with closed end of the sutures opened. Right hemicolectomy was performed. Post operative patient was put on mechanical ventilation and needed ionotropic support for maintaining BP. Patient was shifted to MICU.
On arrival to MICU, patient had persistent hypotension with ionotropic support dopamine and nor adrenaline on high doses.
On 14th September at 1:30 am patient had bradycardia turning into asystole, CPR was started and Inj. Atropine and Adrenaline were given. Despite all resuscitate measures, patient could not be revived and hence declared dead at 2:15 am."
94. The submission of the learned counsel for Dr. Shergill (respondent No.2) was that the patient was an alcoholic for more 35 years and was taking large amount of alcohol. Failure of abstinence from alcohol could be a precipitating factor for acute pancreatitis, which developed later on, after the patient was discharged on 22.8.2006. Hence it was submitted that there was no medical negligence on the part of Dr. Shergill.
95. This submission has been considered.
96. The medical record of the patient from 15.8.2006 to 22.8.2006 has been produced on the file by Dr. Shergill as Annexure R-3. It was for the first time that on 17.8.2006 Dr. O.P. Sharma had recorded in the medical history of the patient (Annexure R-3) that the patient was a diabetic and had been taking huge Consumer Complaint No.29 of 2007. 31 quantity of alcohol for the last 35 years. It was nowhere mentioned by Dr. Shergill (respondent No.2) himself that where he had recorded the history of the disease of the patient. It cannot be presumed from these observations of Dr. O.P. Sharma if the patient failed to follow abstinence from alcohol after he was discharged from the respondent hospital on 22.8.2006.
97. The submission of learned counsel for Dr. Shergill (respondent No.2) was that since the MedSave Health Care Limited failed to reimburse the medical expenditure of the patient to the complainants, therefore, the complainants have filed the false complaint against the respondents.
98. This submission has been considered.
99. The MedSave Health Care Limited vide their letter dated 29.8.2006 (Annexure C-6) had rejected the cashless facility for the patient as alcoholism was not covered under the policy. The non-payment of reimbursement by the MedSave Health Care Limited was one thing but the loss of life of the patient was a different thing. The loss of life cannot be attributed merely to the alcoholism of Jarnail Singh patient prior to his admission on 15.8.2006 in the respondent hospital.
100. Keeping in view the discussion held above, we reach the conclusion that Dr. Shergill (respondent No.2) had committed medical negligence in wrongly diagnosing the disease of the patient on 15.8.2006 and wrongly operating the patient on 18.8.2006 for the disease of cholecystitis with cholelithiasis. The real disease was not diagnosed nor treated at proper time. It led to the death of the patient.
101. Although the award of compensation is no substitute for the loss of life of a person nor the human life can be valued in terms of money. It is a small consolation. However the amount of compensation claimed by the complainants is on the extremely higher side.
Consumer Complaint No.29 of 2007. 32
101. So far as the amount of compensation is concerned, it was held by the Hon'ble National Commission in "Ashok Kumar Upadhyaya and another v. Dr.D.N.Mishra (Professor) and others, I (2011) CPJ 194 (NC)" as under : -
"50. The problem acquires added dimensions in case of a child, as observed by Hon'ble Supreme Court of India in New India Assurance Company Ltd. v. Satender and others, VIII (2006) SLT 368 = III (2007) ACC 46 (SC) = (2006) 12 SCC 60. The problem has been clearly spelt out in the following observations : -
'The determination of damages for loss of human life is an extremely difficult task and it becomes all the more baffling when the deceased is a child and/or a non-earning person. The future of a child is uncertain. Where the deceased was a child, he was earning nothing but had a prospect to earn. The question of assessment of compensation, therefore, becomes stiffer. The figure of compensation in such cases involves a good deal of guesswork. In cases of young children of tender age, in view of uncertainties abound, neither their income at the time of death nor the prospects of the future increase in their income nor chances of advancement of their career are capable of proper determination on estimated bases. The reason is that at such an early age, the uncertainties in regard to their academic pursuits, achievements in career and Consumer Complaint No.29 of 2007. 33 thereafter advancement in life are so many that nothing can be assumed with reasonable certainty. Therefore, neither the income of the deceased child is capable of assessment on estimated basis nor the financial loss suffered by the parents is capable of mathematical computation."
102. In the facts and circumstances of this case, this complaint is partly accepted with costs of Rs.20,000/- only against the respondent hospital and Dr. Shergill (respondent No.2) and the complainants are awarded a sum of Rs.5 lac as compensation. However the complaint against all other respondents is dismissed. The amount of compensation shall be divided equally among all the complainants.
103. Dr. Shergill (respondent No.2) shall pay the aforesaid amounts to the complainants within a period of two months after the date of receipt of a copy of this order failing which respondent No.2 shall be liable to pay interest on the amount of compensation at the rate of 6% per annum from today till the date of payment.
104. The arguments in this case were heard on 16.5.2011 and the order was reserved. Now, the order be communicated to the parties.
105. The complaint could not be decided within the statutory period due to heavy pendency of court cases.
(JUSTICE S.N. AGGARWAL) PRESIDENT (MRS. AMARPREET SHARMA) MEMBER June 01 , 2011 Bansal Consumer Complaint No.29 of 2007. 34