State Consumer Disputes Redressal Commission
Smt. G. Manikyamma Wife Of Late Sri B. ... vs 1.Dr. Ramayyas Urology And Nephrology ... on 28 December, 2023
1
BEFORE THE TELANGANA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION: HYDERABAD.
CC.NO.45 OF 2014
Between:
Mrs.G.Manikyamma,
W/o.Late Sri B.Krupakar Retd.Principal,
Aged about 69 years, Indian,
R/o.1/168, First Road,
Anantapuramu - 515 004.
..... Complainant
And
1.Dr.Ramayya's Urology & Nephrology Institute & Pramila Hospitals, 5-9-34/2/A, Adj. New M.L.A.Quarters, Basheerbagh, Hyderabad - 63.
2. Dr.Ramesh Ramayya, Urologist, Dr.Ramayya's Pramila Hospitals, Hyderabad.
3. Dr.Vamsikrishna, Consultant Doctor, Urologist, Dr.Ramayya's Pramila Hospitals, Hyderabad.
4. Dr.Naveenchandra Acharya, Consultant Doctor, Urologist, Dr.Ramayya's Pramila Hospitals, Hyderabad.
5. Dr. Madhusudan R. Jaju, Consultant Doctor Critical Care, MICU, Care Hospital, Nampally, Consultant Doctor, Pramila Hospital, Hyderabad.
..... Opposite Parties Counsel for the Complainant : M/s.G.Venkata Krishnaiah Counsel for the Opposite Parties : Mr. Omer Pasha- OP1 to OP5 QUORAM : SMT. MEENA RAMANATHAN, HON'BLE IN-CHARGE PRESIDENT & SRI K. RANGA RAO, HON'BLE MEMBER - JUDICIAL THURSDAY, THE TWENTY EIGHTH DAY OF DECEMBER TWO THOUSAND TWENTY THREE ********** Order : (Per Hon'ble Smt.Meena Ramanathan, I/c President) 2
1. This complaint is filed U/s.17(1)(u)(a) of the Consumer Protection, 1986 praying this Commission to direct the Opposite Parties:
(1) to pay compensation of Rs.25,00,000/- (2) to pay costs of Rs.50,000/-
2. The brief facts of the case are:
It is submitted that the Complainant's husband, a retired Principal of Government Degree College, Kalyandurg, Anantapur District was admitted to Opposite Party No.2 Hospital as he was diagnosed with prostate enlargement and advised surgery. He was admitted on 11.01.2012 and underwent all the pre-operative tests at ELBIT Medical Diagnostics Ltd., situated in the Opposite Party No.2 premises and was declared 'fit for surgery' by the Department of General Anesthesia.
3. On 12.01.2012, the laser prostate surgery was performed and stenting was done on the right side of the urinary bladder and the biopsy sample was sent to Apollo Hospital, Hyderabad for Pathological Report. The report revealed that it was "Malignant tumour in urinary bladder consistent with high grade urothelial carcinoma." The report was received on 16.01.2012 and he was convinced by the Opposite Party doctors to undergo another surgery for removal of Urinary Bladder (Radical cystectomy + illealconduit + uretrosigmodostomy done under general anesthesia).
4. The patient expressed his doubt about the consequences of undergoing another major surgery within a short span of having undergone the surgery to the prostate gland, but was assured by the Opposite Parties that all complications would be managed and he was re-admitted on 20.01.2012. After all the pre-operative tests were conducted and results found satisfactory, the patient underwent surgery to Urinary Bladder and colistomic bag in situ on 23.01.2012.
35. It is his submission that the surgery was not conducted under the supervision of a Surgical Oncologist and that it was conducted within a short span of ten days after having undergone surgery of prostectomy B.P.H. (Benign prostatic hyperplasia). He was kept in ICU after the surgery from 23.01.2012 to 30.01.2012 and shifted to Care Hospital, Nampally, Hyderabad on 31.01.2012 since the Opposite Party Hospital did not have the requisite infrastructure to deal with a medical emergency.
6. The patient was treated at MICU at Care Hospital, Nampally from 31.01.2012 to 06.02.2012 and shifted to Pramila Hospital against his wishes since Dr.Madhusudhan R. Jaju was a referral Doctor at Pramila Hospital and present at the time of surgery at the Opposite Party Hospital. From 06.02.2012 till 16.02.2012 he was at Opposite Party Hospital and he did not receive any treatment from a Specialist and he was discharged on 16.02.2012, although his condition was not good. He was advised to attend a review on 19.02.2012, but since Dr.Vamsikrishna and Dr.Naveenchandra Acharya were unavailable, he was asked to return on 20.02.2012.
7. On 20.02.2012, at about 3:00 A.M. he suffered a severe attack of asthma and was once against shifted to Care Hospital. His condition worsened and he passed away on 27.02.2012. The cause of death was diagnosed as "severe septic shock, Multi Organ Dysfunctional Syndrome (MODS) Malnourishment and severe Anemia, Diabitic Mellitus, Hypertension associated with BPH post Radial Cystectomy with ilealconduit."
8. The Complainant spent a total amount as follows:
Rs.5,12,142/- : paid to Pramila Hospital, Hyderabad Rs.2,14,502/- : paid to Care Hospital, Hyderabad.
_____________
Rs.7,26,644/- : Total amount paid.
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The agony and stress suffered due to lack of facilities in Pramila Hospital and lack of medical expertise and their gross deficiency 4 has caused the painful death of her husband-the patient herein. Hence, the present complaint is filed against the negligence and deficiency in service of the Opposite Parties thus seeking compensation and costs.
9. The Opposite Party No.1 filed their written version and is represented by its Managing Director, Dr.Ramesh Ramayya who is also Opposite Party No.2 and has filed the written version on behalf of all the Opposite Parties i.e., Opposite Parties 1 to 5:
The Complainant is a 72 year old man with the following complications "Diabetes, High Blood Pressure, Chronic Pulmonary disease, thyroid disease and history of spleen removal has underlying undetected risk factors associated with any surgery." The patient preferred to come to Opposite Party Hospital and his case was not an emergency and all possible precautions and pre- evaluative tests were conducted prior to surgery. It is because of their surgical expertise that a previously undiagnosed condition, bladder cancer was detected. Although the patient was admitted for a single procedure, a stent was placed to protect the right kidney. Since the diagnosis of a highly aggressive cancer was confirmed, he was advised to undergo the procedure of Radical Cystectomy and urinary diversion, as this is the first choice procedure in such a case.
10. The Opposite Party Hospital has carried out multiple such procedures since it commenced its services in the year 1970. Pre- operative evaluation were done by the required specialists and the patient was monitored during the entire time. They refer to the Apollo Hospital record dated 31.01.2012 that the bladder and tumor was completely removed. Prolonged hospitalization will cause nosocomial infection and on 31.01.2012, the patient suffered a severe attack of Asthma. He was shifted in a well- equipped ambulance to Care Hospital. Dr.Jaju (Opposite Party No.5) is the Chief of critical care at Care Hospital, Nampally and a visiting consultant at Opposite Party Hospital.
511. The patient and his family wanted to shift him to Opposite Party Hospital after the Bronchial Asthma attack. The patient suffered low grade fever due to cancer, surgical stress and apparent malnutrition because he was in a state of depression. The family did not give consent for aggressive therapy, which was withheld and documented in the progress notes.
12. The patient was elderly and had many pre-existing medical conditions and succumbed only because of his pre-existing problems. There has been no medical negligence on their part and they seek dismissal of the present complaint with exemplary costs.
13. The Complainant filed her evidence affidavit. Ex.A1 to A36 are marked on her behalf. The Opposite Parties filed their evidence affidavit and got marked Ex.B1 to B36.
14. The point that arises for consideration is - whether the patient Sri B.Krupakar, who underwent treatment at the Opposite Party hospital under the care of their doctors, succumbed only because of his pre-existing medical problems or because of the negligence of the treating doctors and lack of proper facilities at the Opposite Party No.1 Hospital?
15. Firstly the medical records and pleadings have to be carefully reconnoitered before addressing the main issue of medical negligence.
16. The patient, a retired Principal of Government Degree College, Kalyandurg, Ananthapur District, aged about 72 years was diagnosed with prostate enlargement (B.P.H. Benign prostatic hyperplasia) and advised surgery. The voluminous records have been carefully studied by us and the following details emerge which require our understanding and appreciation of the complaint.
17. Ex.B2 dated 30.11.2011 reveals that the patient was 73 years old and had consulted Dr.Y.Harinath Reddy at Ananthapur.
6He was diagnosed with BPH and advised medication. He visited Opposite Party Hospital only on 11.01.2012 and consulted Opposite Party No.2 Doctor who advised Laser Prostate (Level 9). The past medical and surgical history of the patient is recorded on page 19 of Ex.B2 and reads as follows:
Splenectomy - 54 years back Appendectomy - 54 years back Hemithyroidectomy - 1991 (partial) In her pleadings, the Complainant has been silent about these surgeries that took place and we need to understand these complications.
18. Splenectomy - The Spleen helps the body fight germs and infections and also helps filter blood. In the complaint, no reference is cited as to why the patient had to undergo Splenectomy at a very young age. A person can live without a Spleen but your risk of infection stays high for the rest of your life. The Spleen is important for the body's defense against germs.
19. Appendectomy - is a surgical operation in which the appendix is removed and as per the patient's history it took place around the same time as the Splenectomy.
20. Partial Hemithyroidectomy - This procedure, also referred to as a thyroid lobectomy or partial thyroidectomy, is performed to remove symptomic or cancerous modules. This procedure also lowers the levels of thyroid hormone and will need a thyroid hormone replacement.
21. In this back drop, the patient underwent the pre-operative tests as evidenced vide Ex.B3 which also included the X-Ray chest and 2D Echo/Doppler study at Hyderabad Nursing Home. After obtaining the cardiac clearance, he was admitted for BPH on 11.01.2012. The history of the present illness is recorded as follows:
Burning micturition Frequent micturition Poor flow of urine.7
The patient has been taking numerous medicines as recorded in the admission details for existing problems.
22. The ultrasound of the whole abdomen revealed the following impression vide Ex.B4.
Impression: Status Splenectomy Grade-II prostatomegaly with mild significant post void of 53 ml.
Mildly irregular wall of bladder.
-S/O Cystitis.
After obtaining Cardiac clearance, the Laser Prostate procedure was done on 12.01.2012. During the procedure it is submitted by the Opposite Party doctors that Bladder Neoplasm was detected. Therefore, in addition to the removal of the prostate, they also undertook for removal of bladder tumor.
23. It is the Complainant's submission that the patient was admitted for the removal of the prostate without conducting any PET Scan, MRI or Biopsy for investigation of Cancer and only pre- operative tests were conducted. Surgery helps if the enlarged prostate is causing serious problems. An enlarged prostate is >20CC and in the instant case, as per the Ultrasound Report- Ex.B4 it was more than >38 CC. If left untreated, the enlargement of the prostate glands leads to the Urethra becoming blocked and causes damage to the kidneys.
24. The Complainant's grievance is that the surgery was performed without advising him to undergo an MRI or a PET Scan. Common investigative tools to diagnose and stage the disease include clinical history, examination, PSA and TRUS with Biopsy of the Prostate. We find that incorporating Magnetic Resonance Imaging (MRI) and Positron emission tomography (PET) have promising results and were definitely ignored in the instant case, where the Opposite Parties most definitely needed to exercise more care and caution. These tools appear to have several advantages over the older imaging modalities.
825. At this juncture, we find it necessary to mention that the Opposite Parties did not ask for a PSA value. The PSA test is a blood test to help detect prostate cancer. The normal PSA value for a man 70-80 years could be 4.5-5.5. The Opposite Parties have by passed the newer more sensitive PSA tests on the horizon and that could have helped them more efficiently. The point that has not been addressed by the Opposite Parties is - was the prostate surgery imminent in this case without carrying out the mandatory tests?
26. Grade-2 Benign prostatic hyperplasia or BPH is a classification that can be treated through medication and surgery is the option if the enlarged prostate is causing serious problems. The Opposite Parties have not properly documented the symptoms before deciding whether to perform the surgery or not. The material prior to surgery does not support the fact that the patient was suffering serious problems warranting the surgery. Given the patient's medical history and previous complications, the Opposite Parties were careless in advising him to undergo the surgery at their facility when they cannot support the patient in an acute medical emergency. The patient has a complicated medical background and the Opposite Parties essentially failed to advise the important tests and rushed the patient into surgery without exercising their skill or knowledge which a medical practitioner ought to exercise.
27. A surgeon ought to exercise all the required precautions prior to surgery and after surgery, the post-operative care is of utmost importance. In the instant case, the following tests would have helped to decide to delay the surgery. Post-surgery they claim he was diagnosed with bladder cancer within 5 days of the prostate surgery and the Opposite Parties have submitted in their pleadings that this was never suspected when the pre-operative tests were carried out. They have also submitted that they are a highly qualified and skilled team of doctors and that the Opposite Party 9 Hospital has carried out multiple such procedures since it commenced in the year 1970.
28. Having sufficiently emphasized the fact that the Opposite Party doctors were experienced specialists, we find that they have failed miserably to follow the medical protocol as mandated when the patient was a 72 years old individual with Diabetes, High BP, Chronic Pulmonary disease, thyroid disease and history of spleen removal. In fact, in their evidence affidavit, the Opposite Parties have themselves specified that there was "underlying undetected risk factors associated with any surgery" and "the patient's case was not an emergency."
29. The two common tests are the Prostate-Specific Antigen (PSA) test and the DRE (Digital Rectal Exam). The Opposite Party doctors failed to evaluate the medical history and complications of the patient and failed to record the comprehensive examination along with diagnostic imaging studies. After the second surgery, which was indeed conducted within a very short span from the prostate surgery and the patient, a known case of Asthma and chronic pulmonary disease, suffered a setback, he had to be rushed to Care Hospital, Nampally since he required round the clock critical care. By their own admission, the Opposite Party No.1 hospital could not provide the 24x7 round the clock critical care for a patient with many pre-existing medical conditions.
30. The Hon'ble Supreme Court on the concept of Duty of Care clearly explained in the case of Dr.Laxman Balkrishna Joshi Vs. Dr.Trimbak Bapu Godbole and another, (2013) 15 SCC 4881 as below:
A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for that purpose.
i. He owes a duty of care in deciding whether to undertake the case.10
ii. He owes a duty of care in deciding what treatment to give and iii. He owes a duty of care in the administration of that treatment.
31. Failure to act in accordance with the medical standards in vogue and failure to exercise due care and diligence are generally deemed to constitute medical negligence. Adverting to the award of compensation, the patient was a 72 years old man and the guidelines for compensation have to be within certain broad lines and within certain broad parameters.
32. In view of our detailed discussions, we conclude that the complaint deserves to be allowed and award a compensation of Rs.10,00,000/- for the pain and suffering the patient has been forced to undergo.
33. In the result, the complaint is allowed with the following directions:
(1) The Opposite Parties 1 to 5 shall jointly and severally pay the Complainant a sum of Rs.10,00,000/- (Rupees ten lakhs only).
(2) The Opposite Parties 1 to 5 shall jointly and severally pay the Complainant a sum of Rs.20,000/- towards costs. (3) Time for compliance is eight weeks from the date of this order, failing which the said amount shall carry interest @ 7% p.a. till realization.
Sd/- Sd/-
I/C PRESIDENT MEMBER-J
Date: 28.12.2023
APPENDIX OF EVIDENCE
WITNESS EXAMINED
For the complainant For the opposite parties
Evidence affidavit Evidence affidavit of
Of Complainant Opposite Parties
11
EXHIBITS MARKED
For Complainants:
Ex.A1 - Admission details of Pramila Hospitals dated 11.01.2012 Ex.A2 - Sree Urology & Gynecology Report, Ananthapur, dated 30.11.2011.
Ex.A3 - Complete Blood Picture Report of Mr.Krupakar Bontha, dated 11.01.2012.
Ex.A4 - Ultrasound Whole Abdomen report of Mr.Krupakar, dated 05.01.2012.
Ex.A5 - Clinical notes dated 11.01.2012.
Ex.A6 - Report of Elbit Medical Diagnostics Ltd., from Department of Anatomical Pathology and Cytology, dated 16.01.2012.
Ex.A7 - Clinical notes dated 17.01.2012 of Pramila Hospitals Ex.A8 - Certificate-B Essentiality Certificate Ex.A9 - Admission/Discharge Summary of Pramila Hospitals Ex.A10 - Admission details of Pramila Hospitals dated 20.01.2012.
Ex.A11 - Clinical notes of Pramila Hospitals dated 20.01.2012 Ex.A12 - Clinical notes of Pramila Hospitals dated 23.01.2012 Ex.A13 - Clinical notes of Pramila Hospitals dated 24.01.2012 Ex.A14 - Clinical notes of Pramila Hospitals dated 30.01.2012 Ex.A15 - Clinical notes of Pramila Hospitals dated 31.01.2012 Ex.A16 - Report of Apollo hospitals from Department of Anatomical Pathology and Cytology dated 31.01.2012.
Ex.A17 - ECG report of the patient issued by Elbit Medical Diagnostics Ltd., Hyderabad.
Ex.A18 - Form of Application for Medical Claims Ex.A19 - Emergency Certificate dated 20.01.2012 Ex.A20 - Discharge Summary of Care Hospitals dated 06.02.2012 Ex.A21 - Registration Data dated 31.01.2012 Ex.A22 - Patient admission proforma, clinical examination, diagnosis etc., of Care Hospital.
Ex.A23 - Form of Application for Medical Claims Ex.A24 - Admission details of Pramila Hospitals dated 06.02.2012 12 Ex.A25 - Clinical notes of Pramila Hospitals dated 06.02.2012 Ex.A26 - Admission/Discharge Summary of patient Ex.A27 - Form of Application for Medical Claims Ex.A28 - Admission/Discharge Summary of patient issued by Pramila Hospitals dated 16.02.2012 Ex.A29 - Admission details of Pramila Hospitals dated 20.02.2012 Ex.A30 - Clinical notes of Pramila Hospitals dated 20.02.2012 Ex.A31 - Medication Delivery Chart Ex.A32 - Letter dated 21.02.2012 addressed to Dr.Madhusudhan Jaju, Care Hospital issued by Pramila Hospitals.
Ex.A33 - Registration Data/Admission Data of Care Hospital Ex.A34 - Progress Notes dated 21.02.2012 Ex.A35 - Death Summary by Department of Internal Medicine/Critical Care of Care Hospials.
Ex.A36 - Form of Application for Medical Claims For the Opposite Parties:
Ex.B1 - Admission details of Mr.B.Krupakar issued by Pramila Hospitals dated 11.01.2012.
Ex.B2 - Sree Urology & Gynecology Report, Ananthapur, dated 30.11.2011.
Ex.B3 - Complete Blood Picture (CBP) Report of patient issued by Elbit Medical Diagnostics Limited, dated 11.01.2012.
Ex.B4 - Ultrasound Whole Abdomen Report of Star Diagnostics dated 05.01.2012.
Ex.B5 - Clinical notes dated 11.01.2012.
Ex.B6 - Report of Elbit Medical Diagnostics Ltd., from Department of Anatomical Pathology and Cytology, dated 16.01.2012.
Ex.B7 - Clinical notes dated 17.01.2012 of Pramila Hospitals Ex.B8 - Form of Application For Medical Claims Ex.B9 - Admission/Discharge Summary of Pramila Hospitals Ex.B10 - Admission details of Pramila Hospitals dated 20.01.2012.
Ex.B11 - Clinical notes of Pramila Hospitals dated 20.01.2012 Ex.B12 - Clinical notes of Pramila Hospitals dated 23.01.2012 13 Ex.B13 - Clinical notes of Pramila Hospitals dated 24.01.2012 Ex.B14 - Clinical notes of Pramila Hospitals dated 30.01.2012 Ex.B15 - Clinical notes of Pramila Hospitals dated 31.01.2012 Ex.B16 - Report of Apollo hospitals from Department of Anatomical Pathology and Cytology dated 31.01.2012.
Ex.B17 - ECG report of the patient issued by Elbit Medical Diagnostics Ltd., Hyderabad.
Ex.B18 - Form of Application for Medical Claims Ex.B19 - Emergency Certificate dated 20.01.2012 Ex.B20 - Discharge Summary of Care Hospitals dated 06.02.2012 Ex.B21 - Registration Data dated 31.01.2012 Ex.B22 - Patient admission proforma, clinical examination, diagnosis etc., of Care Hospital.
Ex.B23 - Form of Application for Medical Claims Ex.B24 - Admission details of Pramila Hospitals dated 06.02.2012 Ex.B25 - Clinical notes of Pramila Hospitals dated 06.02.2012 Ex.B26 - Admission/Discharge Summary of patient Ex.B27 - Form of Application for Medical Claims Ex.B28 - Admission/Discharge Summary of patient issued by Pramila Hospitals dated 16.02.2012 Ex.B29 - Admission details of Pramila Hospitals dated 20.02.2012 Ex.B30 - Clinical notes of Pramila Hospitals dated 20.02.2012 Ex.B31 - Medication Delivery Chart Ex.B32 - Letter dated 21.02.2012 addressed to Dr.Madhusudhan Jaju, Care Hospital issued by Pramila Hospitals.
Ex.B33 - Registration Data/Admission Data of Care Hospital Ex.B34 - Progress Notes dated 21.02.2012 Ex.B35-Death Summary by Department of Internal Medicine/Critical Care of Care Hospials.
Ex.B36 - Form of Application for Medical Claims Sd/- Sd/-
I/C PRESIDENT MEMBER-J Date: 28.12.2023 UC