National Consumer Disputes Redressal
Jagdishwar Singh vs Jaslok Hospital And Research Centre And ... on 13 September, 2004
Equivalent citations: I(2005)CPJ60(NC)
ORDER
M.B. Shah, J. (President)
1. It is the say of the complainant that in the month of October 1996, he was posted as Civil Judge (Senior Division) in Kanpur Nagar, Uttar Pradesh. In the beginning of October 1996, he was suffering from routine cold and cough. On advice of doctors, he had gone for chest X-ray at Parakh Diagnostic Centre, Kanpur Nagar. As per the report dated 5.10.1996 of the said Centre, the complainant was having "homogeneous oval opacity of 2.5 c.m. diameter at left apex. Hilar shadows are prominent. Bronhovascular markings are prominent.
The Centre had impression of:
1. Bronchitis?
2. Tuberculoma?
3. Malignancy?
4. Heematoma?"
2. Thereafter, the complainant has undergone CT Scan of Thorex at Prayag Medical Diagnostic Services Ltd., Kanpur Nagar. They reported that:
"Lt. Lung Fields : There is small well defined enhancing lesion measuring about 1.8 cms. in size, situated in left upper zone. No calcification seen."
"Small, well defined increased attenuating lesion in left upper zone: CT image morphology is in favour of vascular aneurysm or mal-formation-
Adv. (1) M.R.I. (2) This lesion kept in close observation for at least two years to see any further development"
3. Because of the aforesaid reports, the complainant went to Gandhi Memorial and Associates Hospital, Lucknow, for further check-up. On 26.10.1996, he was referred to Tata Memorial Hospital, Mumbai for further investigation and treatment.
4. Thereafter, he was examined at Mumbai and there is Histopathology Report dated 26.12.1996 by Jaslok Hospital and Research Centre, Mumbai, wherein it has been stated as under:
"Specimen: C.T. guided FNAC from
nodule in upper lobe of left
lung.
(2.5 cm solid nodule of
heterogeneous density)
Gross : Four smears 1 ml reddish
fluid and small brownish bit
in formalin are submitted.
Microscopic : Three smears show mainly
blood and few clusters of
abnormal cells. The 4th
smear has a large population
of monomorphic columner
cells in compact groups,
sheets and singles. The
nuclei are oval
hyperchromatic and of
variable sizes. The cells often
tend to form an acinous.
Comment : The cytomorphological
features are suggestive of an
adenocarcinoma.
5. Further on 29.10.1996 CT chest was done in King Edward Memorial Hospital, Mumbai. As per the Radiological Report, Pathologist found following inflation:
"There is a 2.5 cm diameter solitary pulmonary nodule in the apico-posterior segment of the (L) upper lobe. The lesion shows minimal enhancement. There is a small vessel abutting the lesion. No areas of calcification noted within the lesion. Remainder of the lung fields are clear. No enlarged lymph nodes noted. The retrocaval lesion represents an enlarged vessel. Heart and great vessel WNLs. Pleaura is (N).
Impression : The (L) upper lobe lung lesion could represent a neoplasm.
Suggest FNAC/ Follow up."
6. It is the say of the complainant that because of the report dated 30.12.1996 given by Dr. A run R. Chitale, petitioner was shocked and became extremely nervous and left hopes of life. He, therefore, went to Tata Memorial Hospital and consulted Dr. R.K. Deshpande who advised for immediate surgery keeping in view the Biopsy report of Dr. Chitale.
7. On 2.1.1997. Dr. R.K. Deshpande of Tata Memorial Hospital (R-4) operated the petitioner relying upon the report dated 30.12.1996 of Dr. Chitale. After opening the lung, Dr. Deshpande examined the said lesion and since the same was not looking like Adenocarcinoma, therefore, during the course of operation he took a small piece from the lesion and got its microscopic examination through Frozen Section of Tata Memorial Hospital. On such microscopic examination it was found that it was simply 'Chondroid Haematoma' of lung and it was not 'Adonocarcinoma'. That report is quoted above and that is the basis of this complaint.
8. Finally, on 9.1.1997 specimen of nodular lesion left upper be was sent for Surgical Pathology Report to Tata Memorial Hospital. The said report reads thus:
"Received specimen labelled as "nodular lesion, left upper lobelung. It consists of multiple reddish white firm to hard bits aggregating 4x2x1 cm. Submitted entirely.
Also received separately a single unlabelled black soft tissue bit (?node) measuring 1x0. 5x0.3 cm. Submitted entirely.
MICROSCOPIC EXAMINATIONS [ 222/ BL] Frozen Section : Histology is that of haematoma. Adjacent lung tissue shows dense lymphocytic infiltration.
Impression : Chondroid Haematoma of lung.
One reactive node is identified."
9. It is contended that respondent No. 2 Dr. Arun R. Chitale, Pathologist in Jaslok Hospital, examined the petitioner and reported 'Adenocarcinoma' which is highly malignant type of tumor and the said report was patently false and was the result of utter negligence committed by him during the course of pathological investigation. Because of this, complainant was unnecessarily operated. Therefore, opponent No. 1-Jaslok Hospital and opposite party No. 2-Dr. Chitale, are liable to pay the compensation, as claimed by the complainant.
10. In our view, there is no substance in this complaint. Undisputedly the Chest report dated 5.10.1996 given by Parakh Diagnostic Centre, Kanpur Nagar, indicates that there was Haematoma and the complainant was advised for further investigation. Next, on the advice of Dr. Nirmal Kheria, CT Scan was taken and as per the report dated 6.10.1996, there was a 'well-defined enhancing lesion measuring about 1.8 cm in size situated in left upper lobe. No calcification was seen. The advice was that lesion should be kept in close observation for at least 2 years to see any further development'. Again on 19.12.1996, Parakh Diagnostic Centre opined that there was Pulmonary Mass Lesion and on comparing with old X-rays it was found that Mass was not increasing in size and density. 'May be benign in nature'.
11. It has to be stated that in Histopathological Report dated 26.12.1996, it was mentioned that, it was suggestive of 'Adenocarcinoma' that was based on FNAC (Fine Needle Aspiration Cytology) - Nodule in upper lobe of left lung. This is pointed out to be a preliminary diagnosis procedure taken recourse prior to Biopsy and is not a final diagnostic procedure like Biopsy. It has been pointed out that on the basis of the report, the complainant was asked to take independent opinion from Tata Memorial Hospital. Tata Memorial Hospital also reported on 30.12.1996 as under:
"Haemorrhagic aspirate with numerous columnar cells. Some in clusters, very scanty suspicious cells noted. Please Devaluate at TMH."
12. From these reports it cannot be said that there was apparent deficiency on the part of Dr. Chitale. Dr. Chitale saw that it is again tested at Tata Memorial Hospital. As stated above, the report indicated that it was suggestive of Very Scanty Suspicious Cells and in such set of circumstances operation and removal of lesion cannot be said to be in any way unjustified one, as it was suspected that such lesion may develop in malignancy.
13. Further, on the Fine Needle Biopsy (FNAC) of haematoma of the lung, learned Counsel for the respondent has relied, upon the Medical Journal wherein it has been observed that:
"Hamartomes are unexpectedly detected in asymptomatic patients, in mass surveys, general health examinations, and chest radiographs for other reasons. They often present a difficult problem both for the radiologist and the referring clinician, as their differentiation from lung carcinoma or a metastasis may be impossible by radiography. Although the , typical radiographic appearance of a well circumscribed, solitary, lobulated nodule smaller than 4 cm .in diameter with popcorn calcification permits confident recognition, most haematomas present as non-characteristic nodules. Some authors, therefore, recommend thorncotomy for a definitive diagnosis."
Further, "Tonkata C, Islmuata K, Pukai S. A case report of a malignant haematoma of the lung observed in a 36-year-old housewife was presented. The haeihatoma was non-chondromatous (fibromyomatous), located beneath the pleura of the left upper lobe. The malignant lesion corresponded to anaplastic carcinoma of the lung. A review of the literatures on the malignant haematoma of the lung revealed rare incidences of the tumor, but haematoma and haematomatous lesions of the lung should, be regarded as one of the histopathological backgrounds where pulmonary carcinoma may arise."
14. The aforesaid medical literature reveal that haematomes present a difficult problem both for the radiologist and the referring clinician, as their differentiation from lung carcinoma or a metastasis may be impossible by radiography. In such haematomes lesion of the lung to be regarded as one of the histopalhological backgrounds where pulmonary carcinoma may arise. In this view of the matter, it would be difficult to arrive at the conclusion that there was deficiency in service by the opposite party No. 2.
15. With regard to the medical care, law on the subject is settled and the Apex Court, in Poonam Verma v. Ashwin Patel and Ors., (1996) 4 SCC 332, has observed that so far as persons engaged in the medical profession are concerned, it may be stated that every person who enters into the profession, undertakes to bring to the exercise of it, a reasonable degree of care and skill. It is true that a doctor or a surgeon does not undertake that he will positively cure a patient nor docs he undertake to use the highest possible degree of skill, as there may be persons more learned and skilled than himself, but he definitely undertakes to use a fair, reasonable and competent degree of skill. A reasonable degree of care and skill is expected from Doctors, This reasonable degree of care and skill covers the liability of a doctor in respect to his liability to warn the patients of the risk inherent in the treatment and his liability in respect of the treatment.
16. From the record, as stated above, it is apparent that lesion was admittedly found. To find out whether lesion was malignant or not, FNAC test was carried out, wherein it was found that it was suspected adenocarcinoma. The statement that it was suspected adcnocarcinoma would indicate that it was not a definite opinion. It is also not in dispute that such lesion may develop malignancy. Fine Needle Biopsy Report may not give 100% correct result. Hence, it is not necessary to refer to other literature on the Fine Needle Biopsy. Prom the various reports, as stated above, it is difficult to hold that opposite party Nos. 1 and 2 have not taken reasonable care and caution in giving their opinion.
17. In the result, this complaint is dismissed. There shall be no order as to costs.