National Consumer Disputes Redressal
Bimla Devi (Deceased) vs Dr. Ajay Aggarwal & 10 Ors. on 13 December, 2017
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI FIRST APPEAL NO. 226 OF 2017 (Against the Order dated 14/12/2016 in Complaint No. 61/2014 of the State Commission Haryana) 1. BIMLA DEVI (DECEASED) W/O. SUBE SINGH, NOW DECEASED REPRESENTED THROUGH HER LEGAL REPRESENTATIVES:- R/O. VILLAGE GOKAL GARH, TEHSIL AND DISTRICT REWARI 2. SMT. SHASHI MEHTA D/O. SH. SUBE SINGH AND BIMLA DEVI, RESIDENT OF HOUSE NO. U-24/19, PINK TOWN HOUSE, DLF, PHASE-3, GURGAON- HARYANA ...........Appellant(s) Versus 1. DR. AJAY AGGARWAL & 10 ORS. DEEP HOSPITAL, OPPOSITE GOVERNEMNET GIRLS SCHOOL, CIRCULAR ROAD, REWARI, TEHSIL AND DISTRICT REWARI, HARYANA 2. DEEP HOSPITAL, OPPOSITE GOVERNEMNET GIRLS SCHOOL, CIRCULAR ROAD, REWARI, TEHSIL AND DISTRICT REWARI, HARYANA 3. DR. GAJENDRA YADAV, PATHLOGY LAB, GARHI BOLNI ROAD, REWARI, HARYANA 4. DR. GAJENDRA YADAV, PATHLOGY LAB, THROUGH ITS PROPRIETOR/PARTNER DR. GAJENDRA YADAV, GARHI BOLNI ROAD, REWARI, HARYANA 5. ORIENTAL INSURANCE COMPANY LIMITED, BRANCH OFFICE 134/135, SNEH NAGAR, 3RD FLOOR, SAHU PLAZA, NEAR AWADH HOSPITAL, ALAMBAG, LUCKNOW-226005 6. ALL INDIA INSTITUTE OF MEDICAL SCIENCE, DR. B.R. AMBEDKAR INSTITUTE ROTARY CANCER HOSPITAL, DEPARTMENT OF PATHOLOGY, THROUGH ITS MANAGING DIRECTOR/CONCERNED OFFICER, NEW DELHI 7. DR. RAJESH GOYAL, K. LAL UTRASOUND & IMAGING CLINIC, 21, BRASS MARKET, REWARI, HARYANA 8. DR. RAJESH GOYAL, K. LAL UTRASOUND & IMAGING CLINIC, 21, BRASS MARKET, REWARI, HARYANA 9. DR. D.P. DAS, MICRO PATH LABS, MICRO PATHOLOGY SERVICES PRIVATE LIMITED, SECTOR-4, & 7 CIRCLE, NEAR AIRTEL BILLING CENTRE, RAILWAY ROAD, GURGAON 10. DR. NOUSHUMI SURYAVANSHI DR. LAL PATH LABS, SECTOR-18, BLOCK-E, ROHINI, NEW DELHI 11. RAJIV GANDHI CANCER INSTITUTE AND RESEARCH CENTRE (UNIT OF INDRASTHA CANCER SOCIETY AND RESEARCH CENTRE,) SECTOR-V, ROHINI, DELHI 12. THE NEW INDIA ASSURANCE COMPNAY LIMITED 1652, D, KATH MANDI, ABOVE STATE BANK BIKANER AND JAIPUR, REWARI, HARYANA-123401 13. THE NEW INDIA ASSURANCE COMPNAY LIMITED 1652, D, KATH MANDI, ABOVE STATE BANK BIKANER AND JAIPUR, REWARI, HARYANA-123401 ...........Respondent(s)
BEFORE: HON'BLE MR. DR. B.C. GUPTA,PRESIDING MEMBER HON'BLE MR. DR. S.M. KANTIKAR,MEMBER For the Appellant : Mr. Pawan Kumar Ray, Advocate For the Respondent :
Dated : 13 Dec 2017 ORDER DR. S. M. KANTIKAR, MEMBER
1. This first appeal has been filed under Section 19 of the Consumer Protection Act, 1986 against the order dated 14.12.2016 passed in complaint case No. 61 of 2014 by Haryana State Consumer Disputes Redressal Commission, Panchkula (in short, 'the State Commission') whereby the complaint of the complainant was dismissed.
2. The brief facts are that Bimla Devi, (since deceased, herein after referred as 'the patient') initially consulted Dr. Kaushal Goyal of Rewari for swelling in her left breast. She was referred to Pathologist for Fine Needle Aspirations Cytology (FNAC). The FNAC was performed by Pathologist-Dr. Gajendra Yadav (OP-3) and reported it on 6.1.2012. It was diagnosed as cancer of the left breast. Thereafter, the complainant with her husband contacted Dr. Ajay Aggarwal, (OP-1), who without doing any further examination, suggested her to undergo operation for removal of left breast alongwith tumor. Accordingly, on 9.1.2012, OP 1 performed the surgery. OP-1 got done X-ray of chest and ultrasound after the operation and everything was found to be normal. It was alleged that OP-1 was trying to extract the money unnecessarily. OP-1 has sent the specimen for histopathological examination (HPE) from Micro Path Labs. The Micro Path Labs issued the report on 6.1.2012 (annexure C-10). It was negative for cancer with clear remarks made at the end of the report as "Adjacent margins negative for tumour cell infiltration". Thus, it was a negligence on the part of OPs 1 and 3, who performed unnecessary operation and created fear of cancer in the mind of the complainant and her family. It was unfair trade practice. The complainant thereafter being not satisfied went to AIIMS, New Delhi for confirmation of the report. Dr. Paras at AIIMS called for the specimen for further check-up and diagnosis but AIIMS started Chemotherapy to save the skin of OP-1. The patient was also subjected for bone scan and Cyto-pathological study, which revealed 'Negative for cancer' and the Chemotherapy was stopped. The patient was again taken to Rajiv Gandhi Cancer Institute of Research Centre (OP-1) wherein nothing significant was revealed.
3. Alleging medical negligence on the part of OPs for wrong diagnosis of cancer, the complainant filed a complaint against the OPs before the State Commission and prayed compensation of Rs. 30 lakhs.
4. The OPs filed written statement and denied the allegations of negligence. OPs 1 and 2 submitted that the patient was advised for FNAC. It was performed by Dr. Gajendra Yadav (OP-3) and reported as positive for cancer in the left breast. Thereafter, the breast lump was removed and sent for histopathological examination at Micro Path Lab which it confirmed "the diagnosis or Infiltrating duct carcinoma with lymph node metastasis". Accordingly, she was treated by Chemotherapy. It was further stated that even the Lal Path Lab report where the patient was referred by AIIMS, revealed " 7/7 Metastatic lymph nodes with no perinodal spread", thus, cancer was confirmed again. Therefore, the allegations of wrong FNAC were denied. OPs 3 and 4 also filed joint written version and denied that FNAC was reported erroneously. All the OPs have denied the allegation of negligence. OP 10/Rajiv Gandhi Cancer Institute and Research Centre did not file any reply. During the pendency of the complaint, the complainant, Bimla Devi, died and her legal representatives were brought on record.
5. On the basis of evidence, the State Commission dismissed the complaint as there was no negligence. Being aggrieved, the complainant filed this first appeal before this Commission.
6. At admission stage, heard the learned counsel for the appellants. Counsel vehemently argued that the patient had left breast lump which the OPs have wrongly diagnosed and treated for cancer. Thereafter, it turned out to be negative at AIIMS.
7. We have given our thoughtful consideration to the arguments advanced by learned counsel for the appellants and perused the entire medical record. OP-1 referred the patient to Dr. Gajendra Yadav/OP 3 for FNAC. The FNAC report ext. C-1 is reproduced as below:-
"DESCRIPTION OF THE SWELLING/FNAC SITE Left breast lump MICROSCOPIC EXAMINATION Smears reveal malignant cells in groups and dispersed singly alongwith few lymphocytes and necrosis in background. The neoplastic cells are large with high n:c ratio and prominent nucleoli.
DIAGNOSIS Picture is consistent with Duct Carcinoma/left breast"
8. Thus, the patient was suffering from Duct Carcinoma/left breast. Accordingly, OP-2, Dr. Ajay Aggarwal removed the lump and sent for HPE. The patient was also advised for USG and X-ray. The HPE report clearly revealed that it was 'Infiltrating duct carcinoma with lymph node metastasis'. However, sections taken from surgical margins were found negative for malignant cells. Thereafter, the patient approached AIIMS. There, again the HPE paraffin blocks and slides of the previous specimen, were reviewed from Lal Path Laboratory. It was reported as under:-
"Mastectomy (Blocks and slides for review)
1. Blocks received show normal breast tissue.
2. Slides received show unremarkable overlying skin and metastatic lymph nodes
3. 7/7 Metastatic lymph nodes with no perionodal spread.
4. No evidence of primary malignancy seen in blocks and slides examined"
8. Now, the main question that whether the patient had malignancy or not? The complainant alleged that the OP-1 performed operation on the basis of FNAC report received from Dr. Gajendra Yadav/OP 3. By other tests, OP-1 should have confirmed the diagnosis before the operation. The surgical specimen was sent by OP-1 for HPE study at Micro Path Labs, and it was reported as 'infiltrating duct carcinoma with lymph node metastasis' and the 'sections from the margins adjacent to tumor were negative'. In our view, the complainant was misconceived about the terminology as negative for malignancy at the tumor margins. Further, the patient was examined at AIIMS and referred the blocks to Lal Pathology Lab, which revealed "7/7 Metastatic lymph nodes with no perinodal spread."
9. In our view, Lal Pathology Lab had examined few slides from the lymph nodes and the margins of the tumor, therefore, it was reported as 'no evidence of primary malignancy seen in blocks and slides examined', meaning thereby few slides from the tumor mass were not received by Lal Path Lab, but the lymph nodes metastasis itself confirms that the patient had invasive duct carcinoma.
10. Based on the discussion above and relying upon the medical record i.e. HPE and FNAC report, the patient was suffering from malignancy of breast. There was no fault either from the pathologist (OP-3) or the treating surgeon (OP-1). The diagnosis was correct and treatment was also correct. We do not find any merit in the instant appeal. It is hereby dismissed in limini.
...................... DR. B.C. GUPTA PRESIDING MEMBER ...................... DR. S.M. KANTIKAR MEMBER