State Consumer Disputes Redressal Commission
Dr.Lalitha Lab Rep. By Dr.Lalitha ... vs K.Bhaskar Sagar, Hyderabad-32 on 11 October, 2013
BEFORE THE A BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD. F.A.No.551/2011 against C.C.No.91/2006 District Forum, Ranga Reddy District. Between Dr.Lalithas Lab rep. by Dr.Lalitha W/o.Dr.T.Sarveswara Rao, Aged about 54 years, Occ:Medical Doctor R/o.4-92/1, Chandanagar, Hyderabad-50. Appellant/ Opp.party And K.Bhaskar Sagar, S/o.K.Satyanna, aged about 24 years, Occ:Student, D.No.43-136, R/o.Anjaiahnagar, Gachibowli Kothagudam Post, Mandal Seriliganpally, R.R.Distrct, Hyderabad-500 032. Respondent/ Complainant Counsel for the Appellant : M/s M.Nagendra Babu Counsel for the Respondent: M/s P.Rajasripathi Rao QUORUM: SMT.M.SHREESHA, HONBLE Incharge President AND SRI S.BHUJANGA RAO, HONBLE MEMBER.
FRIDAY, THE ELEVENTH DAY OF OCTOBER, TWO THOUSAND THIRTEEN Order (Per Smt.M.Shreesha, Honble Incharge President) *** Aggrieved by the order in C.C.No.91/2006 on the file of District Forum, Ranga Reddy District, the opposite party preferred this appeal.
The brief facts as set out in the complaint are that the complainant in the month of November, 2004 suffered from severe chest pain and consulted Dr.P.C.Reddy for treatment and the said doctor advised the complainant to undergo certain tests with Spandana Pathological Laboratory and the complainant underwent several tests like hematology, Biochemistry, ESR and Mantoux test on 10-11-2004, 22-2-2005 and 24-2-2005. Subsequently the doctor again referred the complainant to Tesla Diagnostics, Chandanagar, Hyderabad on 11-11-2004 for 22-2-2005 x-ray chest, P.A. view etc. and the complainant went to opposite party for the said tests and opposite party had conducted tests like Pleural Fluid for analysis and Pleural fluid for ADA levels on 23-2-2005 and 25-2-2005 and the reports of the opposite party suggested that pleural fluid showed the impression suggestive of Acute lymphatic leukemia and Pleural Fluid for ADA levels showed ADA:68.3 units per ltr. (Normal upto 30 units per ltr.) and therefore Dr.P.C.Reddy referred him to Yashoda hospital and the complainant consulted Dr.Bahatah M. at Yashoda hospital, Secunderabad who asked the complainant to undergo Plueral Fluid Analysis test once again and not being satisfied with the reports of the opposite party. The complainant submitted that he deposited a sum of Rs.1150/- for the said test but did not undergo the said test.
The complainant submitted that on advice of well wishers, the complainant consulted Dr.Sai Ram Reddy J. at Medinova Diagnostic Services, Hyderabad and Dr.Sai Ram Reddy.J. asked the complainant to undergo the previous tests conducted by the opposite party and arrived at a conclusion that the complainant was not suffering with Acute Lymphatic Leukaemia. The complainant submitted that Dr.Sai Ram Reddy.J further advised the complainant to go to Nizam Institute, Panjagutta for bone marrow test and thereby the complainant consulted Dr.Raghunatha Rao, Unit Head of NIMS and several tests and investigations on 08-3-2005, 10-3-2005 and the Haemo Pathology test report dated 10-3-2005 showed Peripheral blood and marrow cytological features are consistent with Normal Marrow with no involvement of Leukaemia or lymphoma.
The cyto pathology report dated 12-3-2005 showed: smear appears to be aspirate from lymphnode and no a preparation of pleural fluid, consisting of polymorphous lymphoid population of cells with few plasma cells eosinophils, No mesothelial cells seen and it shows that features are suggestive of Reactive Hyperplasia.
The complainant submitted that he was diagnosed in two different hospitals i.e. Medinova and NIMS, Hyderabad after the diagnosis of opposite party lab and because of the lab report of opposite party, the complainant had to visit the said two hospitals to evidence the results and they have disproved the report of the opposite party. The complainant submitted that his family had suffered mental agony and the complainant apart from losing studies has lost his paternal grandfather due to shock of the report of the opposite party. The complainant submitted that his father is a labour contractor and borrowed huge money from friends and spent Rs.60,000/- for the tests, treatment and medicines and the complainant suffered a lot of mental agony because of negligence and deficiency in service on the part of the opposite party. Hence the complainant filed the complaint for a direction to the opposite party to pay Rs.60,000/- being the expenses for the test and investigations, treatment and medicines, to pay Rs.5,00,000/- towards damages for mental agony together with Rs.80,000/- as loss of earning of his father and costs.
Opposite party filed counter resisting the complaint. Opposite party submitted that it received a sample of pleural fluid tapped from the complainant for pleural fluid analysis and estimation of ADA levels and the same was referred by Dr.C.N.Reddy, consultant physician at M/s.Archana Multispeciality hospital, Chandanagar, Hyderabad. Opposite party submitted that after subjecting the sample to certain required tests, the pathologist reported that the sample is suggestive of Acute Luympatic Leukemia. Opposite party further submitted that it never stated that the report is confirmatory and on the other hand stated only suggestive and possibility of a particular disease and further recommended to correlate the same with clinical picture. The same is due to certain factors such as nature of test on a particular given sample, the disease paradigm, limitation of diagnosis through the given sample and hence one cannot come to any firm conclusion about the definitive diagnosis with the existing clinical knowledge on the basis of given sample. Opposite party submitted that for the purpose of confirmation of the suggested diagnosis, the complainants physician ought to have suggested certain other appropriate investigations. Opposite party submitted that the entire endeavour of the diagnosis effort is to ensure mentioning of any possibility though it is just a possibility otherwise irreparable damage would be done to the patient if a serious condition were to exist and if the same was to be missed or not mentioned. It denied that the complainant and his family members suffered mental agony and the complainant losing studies due to the shock of the report and that the complainant lost his grandfather as a result of shock due to the alleged wrong report given by the opposite party.
Opposite party also denied the allegations that the complainants father borrowed huge amount of money from friends and spent the same for the treatment of the complainant and submits that he is not entitled for Rs.5 lakhs towards damages as there is no deficiency in service and prayed for dismissal of the complaint.
Based on the evidence adduced i.e. Exs.A1 to A20 and the pleadings put forward, the District Forum allowed the complaint in part directing the opposite parties to pay Rs.5000/- towards tests and examinations together with compensation of Rs.50,000/- and Rs.5,000/- towards costs.
Aggrieved by the said order, the opposite party preferred this appeal.
The learned counsel for the appellant filed written arguments.
FA.IA.No.460/2013 is filed to receive report of NIMS dated 12-3-2005 as additional evidence and the same is received subject to proof and relevancy and marked as Ex.A21.
The brief point that falls for consideration is whether there is any deficiency in service on behalf of the appellant/opposite party and if the complainant is entitled for the relief sought for in the complaint?
The learned counsel for the appellant/opposite party filed written arguments and submitted that only a sample of the pleural fluid was sent by the complainant for the limited purpose of analysis and admittedly the same was referred by one Dr.C.N.Reddy. Ex.A1 is the Haemotology report dated 10-11-2004 issued by Spandana Pathological laboratory in which the investigations were referred by Dr.P.C.Reddy together with Biochemisty report (Ex.A2) and chest x-ray (Ex.A3 &A4) together with ESR (ExA5 ) and Mantoux test (Ex.A6). Vide Ex.A4 dated 22-2-2005, Dr.P.C.Reddy had advised for pleural effusion investigation which was done by the opposite party lab evidenced under Ex.A7 and A8 dated 23-2-2005 and this report reads as follows:
Report Physical:Received about 30 ml of haemorrhagic fluid Biochemical:Glucose:76 mgs/dl Protiens:5.11 gm/dl Cell count: Total count:4550 cells/cumm Smear shown many immature cells of lympocytic series along with manymature lymphocytes. Many eosinophils and mesothelial cells also seen.
Degenerating cells seen in large numbers.
Impression:suggestive of Acute lymphatic leukemia PLEASE CORRELATE WITH CLINICAL PICTURE Overleaf Ex.A7 is the handwriting given by the doctor, Dr.G.Sriram Reddy, Surgical Oncologist requesting for the citology slides of the complainant herein.
It is the complainants case that as Ex.A7 showed an impression of suggestion of Acute lymphatic Leukaemia, he underwent lot of mental agony and took second opinion of Dr.J.Sriram Reddy of Medinova Diagnostic and repeated the tests at Medinova on 05-3-2005 and also at NIMS where bone marrow test was conducted and then it was concluded that the complainant did not suffer either Leukaemia or Lymphoma. Exs.A9, 10 and 11 are the test reports of Medinova Diagnostic services and NIMS with respect to CBC, Serum creatinine and Haemotologic data and Ex.A12 is dated 10-3-2005 wherein the report reads as follows:
CLINICAL DIAGNOSIS Gross Description:
RED BLOOD CELLS-Normocytic normochromic WHITE BLOOD CELLS: Mild Leucocytosis with myeloid left shift.
PLATELETS-Adequate, There are no blast seen DIAGNOSIS:
COMMENTS:
BONE MARROW ASPIRATE:
Aspirate is particulate with normal cellularity M.E. ratio 2:1 Erythropoiesis is normoblastic and micronormoblastic Myelopiesis is orderly and normal Megakaryocytes are normal Blasts constitute 2% mature lymphocytes 10% Trephine imprints show increased cellularity with similar features COMMENTS Peripheral blood and marrow cytological features are Consistent with NORMAL MARROW with no involvement By Leukemia or lymphoma.
Report on Tephine section to follow As the results in these two hospitals i.e. Medinova and NIMS showed that there was no suggestion of Leukaemia or Lymphoma, it is the complainants case that the test report in Ex.A7 has led to lot of mental agony and shock and he even contends that his grandfather died due to the shock. It is the case of the appellant/opposite party that Ex.A7 is only suggestive of Acute Lymphatic Leukaemia and the crucial point in the report which has been ignored is that the complainant has to correlate with the clinical picture.
The learned counsel for the appellant/opposite party also filed the medical literature with respect to Pleural Effusion and Hand book of Fine needle ASPIRATION BIOPSY CYTOLOGY, Second Edition by Tilde S.Kline, M.D. In the diagnostic accuracy, the learned counsel for the appellant submitted that this aspiration biopsy can never be a single standard substitution for clinical judgment or used to negate the indications for tissue biopsy. If it is so, then when the diagnostic lab is giving such a report, suggestive of Leukaemia, they should be a clear note stating that the report cannot be taken as conclusive of the said disease. Please co-relate with clinical picture has been stated at the bottom but in the instant case, co-relation with clinical picture will not give a true indication but only a further test with respect to bone marrow aspiration would be more conclusive. As Ex.A7 was suggestive of Leukaemia on 23-2-2005, the patient for three weeks suffered mental agony and only on 10-3-2005 underwent the bone marrow aspiration which showed there was no involvement of Leukaemia or Lymphoma. However the grandfathers death due to the shock got from the wrong result is without evidence and is unsustainable and though there is deficiency in service on behalf of the opposite party in giving a test report without a foot note, that it is not conclusive and further tests have to be undertaken to establish the same diagnosis, we are of the considered opinion that the amount of Rs.5000/- awarded towards tests and examination and Rs.5000/- towards costs can be confirmed whereas the amount of Rs.50,000/-awarded by the District Forum towards mental agony is on the higher side and we reduce the same to Rs.25,000/- to be paid by the appellant within four weeks from the date of receipt of order.
In the result this appeal is allowed in part modifying the order of the District Forum with respect to reducing the compensation from Rs.50,000/- to Rs.25,000/- while confirming the rest of the order of the District Forum. Time for compliance four weeks.
Sd/-INCHARGE PRESIDENT.
Sd/-MEMBER.
JM Dt.11-10-2013