National Consumer Disputes Redressal
Rohini Hospital And Anr. vs P. Shashikala And Ors. on 3 April, 2008
Equivalent citations: 3(2008)CPJ53(NC)
ORDER
B.K. Taimni, Member
1. Petitioners were the opposite parties before the District Forum, where the respondents/complainants had filed a complaint alleging medical negligence on the part of the petitioners.
2. Very briefly the facts of the case are that one Narender Reddy, husband of the respondent/complainant No. 1 and father of respondent Nos. 2 and 3, was got admitted in the petitioner Hospital after developing some pain in abdomen, whereupon he was operated. On the second day of the operation, when the deceased was suffering from severe pain, the respondents approached the petitioner, who assured them that the patient shall be all right but instead of improving, his situation got worse and in the meantime it was noticed that the second petitioner, who was the surgeon, could not be contacted as he was not available. It was the case of the complainants that for lack of attendance, post-operative care, the deceased was finally referred to Nizam's Institute of Medical Sciences (NIMS), Hyderabad, wherein he died after ten days on account of negligence on the part of the petitioners. It is in these circumstances, complainants filed a complaint before the District Forum. The matter was contested. Parties filed their evidence and expert evidence was also led. The District Forum after thorough examination of the material on record, allowed the complaint and directed the petitioners to pay Rs. 30,000 towards consultation charges, operation expenses, medicines, etc. and Rs. 3 lakh as compensation. This amount was to carry interest @ 15% p.a. from 9.4.1996 till the date of deposit. Aggrieved by this order, petitioners filed an appeal before the State Commission, who after hearing the parties and perusal of material on record, dismissed the appeal. Hence this revision petition before us.
3. We heard the learned Counsel for the parties at length and also gone through the material on record.
4. There is no dispute that the surgery was carried out by the second petitioner on the deceased on 10th July, 1995. As per material on record, there is no dispute that thereafter 'biliary leak' was noticed but no proper action was taken, resulting in septicaemia, upon which the patient was referred to NIMS on 20.7.1995 where the patient died on 31.7.1995.
5. We have carefully gone through the evidence on record especially the affidavit of expert Dr. R.A. Shastry, Professor and Head of the Department Surgery, NIMS, Hyderabad. In his examination-in-chief, he has clearly stated that 'there was a 'bile leak' reported by the treating doctors and I confirmed it from my examination'. And he goes on to add as follows:
Later radiological examinations done at NIMS showed that there was a bile leak from the common bile duct above the level of insertion of 'T' tube. Post-operatively after surgery when a significant bile leak develops the site of leakage is delineated by various radiological studies like 'T' tube cholangiogram, ERCP, etc. (Endoscopic Retrograde, Cholangio Pancreas-to-graphy) and treat the patient according to the findings. I have mentioned the plan and the treatment. Biliary leak is the cause of septicaemia. The patient died on 31.7.1995 and the cause of death was biliary perotinitis with septicaemia, stress ulceration, Multiorgan failure. The complications which occurred are known to occur after biliary surgery, are quite common.
When I saw him on 20.7.1995 I found that the patient was running high temperature 100 degree F. His blood pressure was low and was maintained with the support of drugs 90/60. He was conscious but in coherent he had obvious biliary leak from drain site in the abdominal wall, the 'T' was not draining. There was guarding and...tenderness over the abdomen. He had bleeding from the ryles tube.
6. We specifically put it to the learned Counsel for the petitioner as to how did the petitioner follow the plan and the treatment referred to by Dr. Shastry in his examinationin-chief. It is important to note that he has noted "Post operatively after surgery when a significant bile leak develops the site of leakage is delineated by various radiological studies like 'T tube cholangiogram, ERCP, etc. (Endoscopic Retrograde, Cholangio Pancreasto-graphy) and treat the patient according to the findings'. No material has been brought on record by the petitioner to show as to what was done in this case as has been observed by the expert witness. Having not done or having not followed the procedure expected from a Doctor of a normal experience, is a clear case of medical negligence.
7. Learned Counsel for the petitioner emphasized Dr. Shastry's statement, "Operation that was conducted in the Rohini Hospital was a standard operation". There is no dispute that the operation carried out was standard operation. What is in question is the postoperative care, especially after the biliary leak was noticed. Learned Counsel also wish to rely upon what is stated in cross-examination.
Now, I have perused the case sheet of the Rohini Hospital with regard to this patient. On a reading of the case sheet and I find that the patient was adequately monitored throughout. His vital records are maintained well and the complications as they occurred were detected promptly.
8. We see an inherent contradiction between what the expert witness stated in his examination-in-chief about the line of treatment in cases of biliary leakage, which obviously has not been followed, and yet the expert witness goes on to state in his cross-examination that the patient was adequately monitored. We are not on the question of monitoring, we are on the question of seeing that having noticed the biliary leak, what was done by the petitioner which should have been done as per medical practice as already outlined earlier as extracted from the examination-in-chief of the expert witness? This has not been done. We also see that it was only on 20.7.1995 that the patient was referred to NIMS, Hyderabad, whose record we reproduce in toto as follows:
Clinical Summary--Referred from Rohini Hospital as a case of postoperative Biliary perotinitis following cholecystectomy and CBD exploration. At the time of admission H/o; Diabetis. O/E: PR 100/mt: BP: 95/60 mm Hg; RR 38/mt; Temp 100 f.
P/A: examination started, tenderness all over the abdomen, mild rigidity bowel sounds absent. There was one T. Tube and another drain (P Intra peritoneal) in the right subcostal region. Initial impression was Biliary Perotinitis with cystic duct blow out with septicaemia. He is investigated and found to be uncontrolled diabetes CBD stricture proximal to T. Tube insertion. Initially there is prolonged PT and APTT with stress ulceration. Initially managed conservatively with Naso biliary drainage. ERCP stricture is proximal to T. Tube catheter insertion is not useful. Planned for emergency surgery but due to very poor general condition managed conservatively for some time. Since the time of admission there is intermittent attacks of upper GI bleed-managed with. On 11th day of admission patient developed respiratory and cardiac arrest revived but his general condition and vitals gradually deteriorated and expired on 31.7.1995 at 12.30 a.m. Cause of Death: Septicaemia Secondary To Biliary Perotinitis. Cardiopulmonar arrest.
Investigations at the time of admission Under Section abd: Mild IHBD with ascites fluid aspirated Bile; RBBS 100 - 200 mg fluctuating.
Hb 10.2 gm%, TLC; 42,800 P87 L10 E3; Blood group B -ve; RBS - 128 mg; Blood urea 40 mg; Section Creat 1.2 mg%; S.NA 12.7; S.K+ - 2.9 CUE: 6.0 Spgr. 1.015 Alb.1+ ; Sugar nil; Micro-10-11 RBC 9-10 pus cells.
[Emphasis supplied]
9. A bare perusal of this leaves us in no doubt that the patient had already developed septicaemia while in the petitioner Hospital, which was the cause of death as recorded by NIMS. The above record has remained unrebutted and unchallenged.
10. In view of above, if both the lower Fora have found the petitioner medically negligent, we cannot but agree with the findings returned by the District Forum and affirmed by the State Commission.
11. Coming to the quantum of relief given by the District Forum, we find that the deceased was about 42 years and was agriculturist by profession and the sole bread-winner, in view of which we find no ground to interfere with the compensation of Rs. 3 lakh awarded by the District Forum and affirmed by the State Commission "along with" Rs. 30,000, i.e., much less than the actual amount incurred by the complainant on the consultation fee, medicines, etc. However, we find that the rate of interest awarded by the District Forum, i.e., 15% p.a. is on the high side which we reduce to 12% p.a. from 9.4.1996 to 31.3.2001, where after it shall be 9% p.a. till the date of payment. It has been stated by the learned Counsel for the petitioner that Rs. 3 lakh has already been paid to the complainant. The rest of the amount shall be paid by the petitioners to the complainants within a period of 6 weeks.
12. As per material on record, the petitioners have an Insurance Policy. The petitioner shall be free to claim the amount from the Insurance Company as per the terms and conditions of the Insurance Policy obtained by the petitioner(s).
13. The Revision Petition stands disposed of in above terms.