State Consumer Disputes Redressal Commission
Smt. Reena Devi Singh vs Ramkrishna Care Hospital Through Dr. ... on 17 May, 2023
Complaint No.: Smt. Reena Devi Singh Date of Pronouncement:
CC/19/55 Vs. 17/05/2023
Ramkrishna Care Hospital
AFR / NAFR
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION
PANDRI, RAIPUR
Date of Institution: 16/10/2019
Date of Final Hearing: 04/05/2023
Date of Pronouncement: 17/05/2023
COMPLAINT CASE No.- CC/2019/55
IN THE MATTER OF :
Smt. Reena Devi Singh,
W/o. Shri Rajesh Kumar Singh
R/o. "Girdhar Kunj", Near Ravi Godown, New Purena, Raipur City,
Tah. & Dist. RAIPUR (C.G.)
Through: Shri Horilal Chandrakar, Advocate
... Complainant.
Vs.
Ramkrishna Care Hospital,
Through: Dr. Sandeep Dave,
Aurobindo Enclave, Pachpedi Naka Dhamtari Road, Raipur City,
Tah. & Dist. RAIPUR (C.G.)
Through: Shri Rajkumar Shukla, Advocate
... Opposite Party.
CORAM: -
HON'BLE SHRI JUSTICE GAUTAM CHOURDIYA, PRESIDENT
HON'BLE SHRI GOPAL CHANDRA SHIL, MEMBER
HON'BLE SHRI PRAMOD KUMAR VARMA, MEMBER PRESENT: -
Shri Horilal Chandrakar, Advocate.
Shri Rajkumar Shukla & Shri Bhupendra Jain, Advocates for the opposite party.
J U DG E M E NT PER: - JUSTICE GAUTAM CHOURDIYA, PRESIDENT This complaint, under section 17 of the Consumer Protection Act, 1986 (hereinafter referred to as "the Act" for short) has been filed by the complainant alleging medical negligence during hernia operation of the complainant and seeking direction for the opposite party to pay the complainant compensation for medical negligence and incapability Rs.11,00,000/- (Eleven Lacs) and Rs.39,00,000/- (Thirty Nine Lacs) for treatment expenses, mental agony, physical pain and loss of contagion along with Rs.1,00,000/- (One Lac) as cost of litigation and any other relief which this Commission deems fit.
Dismissed Page 1 of 13 Complaint No.: Smt. Reena Devi Singh Date of Pronouncement:
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2. Brief facts necessary for disposal of this complaint, as per the complaint are that the complainant contacted the opposite party for her physical problems. As advised by the opposite party that she was suffering hernia problem and operation is the only treatment, she was admitted in the opposite party Hospital for proper treatment and expenses (package) of Rs.81,414/- for hernia operation was said by the opposite party. The complainant was admitted in the opposite party Hospital on 25.05.2018 for operation and after general surgery she was discharged on 31.05.2018 and the opposite party charged just double than the fixed amount Rs.1,79,217/- which was deposited. After operation, pain remained continued and due to infection pus was formed in the surgical site. The problem was informed to the opposite party, they advised for reoperation for which the complainant was admitted on 15.06.2018 second surgery was performed, then she was discharged on 20.06.2018. For the second surgery Rs.70,163/- was charged from the complainant. But even after second operation the problem remained with the complainant, which was shown to the opposite party repeatedly and they charged fee for the same but the complainant could not be benefitted.
Thereafter, the complainant went to Shri Balaji Super-specialty Hospital Raipur where on examination it was said that due to infection during operation the flesh has shrunk and lumped and advised to go Medanta Hospital Gurgaon. In the said examination Rs.25,000/- were spent.
3. It is further stated by the complainant that in the Medanta Hospital Gurgaon also on examination in was found that in the surgical site of the complainant due to surgery performed by the opposite party there was infection, shrank flesh and lump. The complainant remained admitted there from 10.09.2018 to 13.09.2018, the lump was removed after operation Dismissed Page 2 of 13 Complaint No.: Smt. Reena Devi Singh Date of Pronouncement:
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and for hernia operation the complainant was asked to come after 04-05 months. In the Medanta Hospital treatment expenses of Rs.2,00,000/- was incurred, whereas operation of pre-existing hernia has to be done yet and about Rs.5,00,000/- have been spent on food and other items so far. With the above averments, the complaint has been filed alleging that due to infection during operation the flesh shrank and lump was formed, opinion of expert was not taken pre and post operation, necessary tests were also not done before the operation and these all amounts to medical negligence, deficiency in service and unfair trade practice on the part of the opposite party and directions to the opposite party as aforesaid in paragraph No.1 are sought.
4. The opposite party in its written version denied all the allegations and has taken preliminary objection that the complaint is filed on exaggerated facts without any opinion of Medical Board or any documents which can prove that any negligence or deficiency in service was committed by the opposite party. The complaint is premature as the complainant was satisfied with the treatment given by the opposite party and that is why she used to come for routine check-up. The complication developed to her was due to uncontrolled diabetes and her own negligence. Before going to Shri Balaji Hospital or Medanta Hospital opinion of the opposite party was not obtained, hence the opposite party is not responsible. It is further averred that on examination the complainant was diagnosed as patient of incisional hernia in an unknown case of uncontrolled diabetes mellitus and after operation the complainant was advised to take proper care and to control sugar level and it was clearly said that if sugar level is not controlled there will be adverse effect at the place of surgery and to the other organs also. It is specifically denied Dismissed Page 3 of 13 Complaint No.: Smt. Reena Devi Singh Date of Pronouncement:
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that double than the fixed amount was collected. It has also been denied that after the surgery by the opposite party the pain remained to the complainant, on the contrary in the surgery area due to infection pus was formed. It has also been denied that pre and post operation tests were not conducted. It is further averred that after discharge from the opposite party Hospital the complainant never come to the opposite party, hence they are not aware of the fact that she went to Balaji Hospital or Medanta Hospital for treatment. In the additional statement it is stated that the complainant was brought to the opposite party Hospital on 25.05.2018 with the complaint of pain and swelling where medical history was noted and examinations were done and treatment for problems due to hernia was done as mentioned in discharge summary dated 31.05.2018. During examination it was found that the complainant / patient was fully affected from diabetes her sugar level was extremely high, whereas at the time of admission the complainant did not give information about her diabetes, which is mentioned in the discharge summary.
5. For such a diabetes patient extra precaution and care was needed which was duly informed to her and medicines were given but due to her own negligence infection developed for which the opposite party is not responsible. In support of these facts medical literature is also filed. Consent form for the procedure/surgery was also signed by the complainant Smt. Reena Singh on 25.05.2018 and she was informed and explained about all the complications, which clearly shows that all the necessary and proper procedure were followed by the opposite party in treatment of the complainant and by proforma regarding hernia, which is used to be given to all patients, Annexure-E, all the information regarding operation and hernia was given to the complainant and her husband. At Dismissed Page 4 of 13 Complaint No.: Smt. Reena Devi Singh Date of Pronouncement:
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the time of discharge, again tests were done, which are mentioned in the discharge summary. After discharge the sugar level HbA1c value of the complainant on 30.05.2018, as evident from the documents filed by the complainant herself, was 11.3 which show the uncontrolled situation. She was advised to take medicines properly but she did not, hence infection, pain and mesh of hernia was also possible as per medical standard. In case of mesh repair also infection was possible as per the medical standard. From the documents, medical reports and test reports submitted by the complainant herself, it is clear that she was patient of several critical diseases and underwent surgery also. She was having past medical and surgical history according to which DM/HTN, LSCS in 2003, hysterectomy in 2005 treatment was done. With all the above averments it is stated that the opposite party has not committed any negligence or deficiency in service. The complaint has no substance and is liable to be dismissed with cost.
6. In support of the complaint, the complainant has filed her affidavit and documents Annexure C-1 to C-55, whereas the opposite party in support of the written version has filed affidavit of Dr. Sandeep Dave and document Annexure-1 the consent form, Annexure-2 Discharge Summary and Annexure-A to Annexure-N.
7. We have heard arguments advanced by both parties and perused the affidavits and documents filed by both parties. We have also gone through the written arguments and case-laws submitted by the opposite parties.
Dismissed Page 5 of 13 Complaint No.: Smt. Reena Devi Singh Date of Pronouncement:
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8. Learned counsel for the complainant before us has repeated the facts stated in complaint and argued that due to negligence of the opposite party during hernia operation of the complainant due to infection flesh shrank and lumped and the complainant has to suffer many complications and is living a hellish life. The complainant has to incur lots of expenses yet in treatment in the opposite party hospital as well as in other Hospitals also, hence the complaint be allowed and the opposite party be directed to pay compensation as aforesaid in paragraph No.1.
9. Whereas the opposite party has vehemently argued that the opposite party is a renowned surgeon who has performed more than 10,000 hernia operations in his career. In the case of the complainant also he has performed his duties with due diligence and no negligence was committed in fact the complainant herself was negligent for her health. Learned counsel for the opposite party has reiterating the defence taken in the written version and argued that after the discharge from the opposite party Hospital, as per documents submitted by the complainant herself the HbA1c value of the complainant was 11.3, which is a situation of uncontrolled diabetes. As per medical literature Annexure-F to Annexure- N in case of mesh repair occurrence of infection and pain are known and possible complications as per medical standard and belief. The complainant has not filed any document to prove his case that any negligence was committed by the opposite party in her treatment. It is further argued that the opposite party has treated the complainant as per standard medical procedure with proper care and advice and no negligence or any error was committed by the opposite party in treatment of the complainant, hence the complaint being devoid of any merits be dismissed. Learned counsel for the opposite party has placed reliance Dismissed Page 6 of 13 Complaint No.: Smt. Reena Devi Singh Date of Pronouncement:
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upon judgement of Hon‟ble Supreme Court in the case of Bombay Hospital & Medical Research Centre Vs. Asha Jaiswal & Ors., 2021 (4) CPR 419 (SC) and judgement of Hon‟ble National Commission in the case of K. Dasharathamand Ors. Vs. Dr. Hema Raghu Chitneniand Ors., 2022 (1) CPR 214 (NC); Neera Arya & Ors. Vs. Batra Hospital & Medical Research Centre of Ch. Aishi Ram Batra Public Charitable Trust and Ors., 2022 (1) CPR 216 (NC) and argued that medical practitioner cannot be held liable for medical negligence simply because things went wrong.
10. We have heard arguments advanced by both parties and perused the record as well as the medical literatures submitted by the opposite party. From the treatment record, discharge summary, test reports and biochemistry report of the complainant dated 30.05.2018, Annexure C-7, it is abundantly clear that the complainant/ patient was a known case of uncontrolled diabetes. In the document Annexure C-7 the reference range of non-diabetic is mentioned as 4.0 - 6.0, whereas the HbA1c value of the complainant was 11.3. As per the Discharge Summary filed as Annexure-2 by the opposite party the reason for admission has been written as „Swelling over anterior abdomen wall, previously operated area‟. Diagnosis is written as "Primary Diagnosis: Incisional Hernia In an unknown case of uncontrolled Diabetes Mellitus" and as argued by learned counsel for the opposite party the complainant did not disclose at the time of admission that she was having uncontrolled diabetes mellitus. This fact proves that the complainant herself was negligent and ignorant in disclosing her health condition to the opposite party at the time of admission. The another important piece of document is the informed consent for surgery/ procedure filed as Annexure-1 filed by the opposite party. In this consent form the risks involved in the operation / Dismissed Page 7 of 13 Complaint No.: Smt. Reena Devi Singh Date of Pronouncement:
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procedure are mentioned as „pain, infection, bleeding‟ and this form was signed by the complainant herself and Dr. Nitin and witnesses husband of the complainant and one staff Vinita have also signed the form. Thus the risks involved in the procedure were very well explained to the complainant and her consent was obtained in presence of her husband.
11. The medical literatures filed by the opposite party as Annexure-I is the Review „Mesh-related infections after hernia repair surgery‟ by M.E. Falagas and S.K. Kasiakou. In this literature the conclusion has been mentioned as under : -
"CONCLUSIONS:
Clinicians should promptly consider the possibility of mesh infection in any patient who has undergone hernia repair surgery involving a mesh, and who has fever of unknown aetiology or symptoms and/or signs of infection of the abdominal wall. There is no adequate evidence in the literature concerning the specific risk factors for such infections. Whether the surgical technique used for the repair of a hernia or the precise type of implanted mesh influences the rate of development of a mesh-related infection remains to be clarified.
As yet, there are no published reports of comparative trials of different antimicrobial regimens for the management of mesh- related infections. Consequently, no definitive recommendations can be made concerning the preferred medical management strategy. However, given the known facts regarding the microbial aetiology of mesh-related infections, and the pathogenesis and characteristics of infections involving other types of prosthetic material, antimicrobial agents used for the treatment of mesh- related infection should at least include coverage for Staphylococcus spp."
The another medical literature is an article written by Karan Vir Singh Rana, Gurjit Singh, Niteen A. Deshpande, Viju K. Bharathan, Srihari Sridharan, Department of Surgery, Padmashree Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri Pune, India. This article is titled as „Postoperative complications of mesh hernioplasty for incisional hernia repair and factors affecting the Dismissed Page 8 of 13 Complaint No.: Smt. Reena Devi Singh Date of Pronouncement:
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occurrence of complications‟ and in this article results are mentioned as under : -
"Results Of the 54 patients included in the study, 25 were males and 29 were females. The average age of the patients was 55.03 years. The average age of males was 61.5 years and the average age of females was 47.5 years. There was no case of complicated hernia in the study. The most common predisposing risk factors were advanced age, diabetes mellitus, and postoperative wound infection [Table 1]. The incidence of incisional hernia was higher after emergency surgery. The most common emergency surgery leading to incisional hernia was emergency laparotomy (40.7%) and the most common elective surgery was total abdominal hysterectomy (14.8%). The most common incision was infraumbilical midline incision.
Table 1: Predisposing risk factors in patients with incisional hernia The postoperative complications have been explained as under : -
"-------. The postoperative complications include seroma and superficial surgical site infection [Table 2]. There were two cases of recurrence [Table 3]. The risk factors associated with recurrence were diabetes mellitus, obesity, smoking, postoperative straining, and advanced age [Table 4].
Table 2: Postoperative complications The above literatures clearly show that Predisposing risk factors in patients with incisional hernia for the patients above 50 years of age was Dismissed Page 9 of 13 Complaint No.: Smt. Reena Devi Singh Date of Pronouncement:
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68.5% and for patient suffering diabetes mellitus the percentage of risk was 51.8%. In the postoperative complications include superficial surgical site infection and its percentage was mentioned as 16.7% and percentage of Seroma was mentioned as 22.2%.
12. The opposite party has also filed a document, Annexure-E mentioning the complications of Ventral Hernia Operation and explained the Ventral Hernia, how it can be known, its causes, about the laparoscopic surgery its benefits and complications etc. are explained in detail on the basis of Ventral Hernia Repair Surgery Patient Information form, Annexure-F. The opposite party has contended in his affidavit that this proforma, Annexure-E, has all the information regarding operation and hernia, which was given to the complainant and her husband and this fact has not been contradicted by the complainant. It is mentioned in the document Annexure-F at the top that the „Content Provided by the Society of American Gastrointestinal and Endoscopic Surgeons‟ and Annexure-E appears to be prepared in conformation with the Annexure-F. In the said document, Annexure-E, the infection in the incision, formation of gas bubbles in abdomen, mesh infection is rare but possible complication which causes pus formation and fever and seroma / hematoma a kind of fluid or blood collected at the site of incision etc. are explained as known complications of ventral hernia repair surgery. From bare reading of above all the medical literatures/ articles it appears that the patients suffering diabetes mellitus and the age group of the complainant the percentage of risk of developing complications are more than 50% and superficial surgical site infection and its percentage was mentioned as 16.7% and percentage of Seroma was mentioned as 22.2%, whereas the percentage of patients developed at least one of the complications was Dismissed Page 10 of 13 Complaint No.: Smt. Reena Devi Singh Date of Pronouncement:
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more that 40%. In such a situation there remains no doubt that the
complications developed to the complainant was known complications of the surgical procedure which she underwent after giving her consent and understanding the risks including infection of surgical site.
13. It is pertinent to mention here that document Annexure-E and contention of the opposite party that it was supplied and risks and complications were explained to the complainant and to her husband has not been specifically contradicted by the complainant neither the consent form signed by the complainant is denied nor allegation of negligence of the complainant herself of following the advices given to her for postoperative care to control her sugar level have been denied. In such situation it cannot be held that any lapse or negligence looking to the situation of the complainant was committed by the opposite party. The complainant has also failed to state as to what kind of lapse or negligence was committed in her hernia operation by the opposite party and that also to point out the negligence on the part of the opposite party due to which pus was developed after the surgery.
14. In the Discharge Summary of Medanta Hospital Annexure C-49 also past medical history is mentioned as DM/HTN (i.e. diabetes mellitus / hypertension). Diagnosis & Co-morbidities is mentioned as „Status infected intraperitoneal mesh (H/o. Laparoscopic IPOM) and thereafter other details have been mentioned but it is nowhere mentioned that any error or negligence was committed in the previous surgical process by the opposite party. Nor there is any such opinion or finding of the Shri Balaji Super-specialty Hospital also. Thus in the whole record of the case we do not find any cogent evidence in support of the allegations leveled by the Dismissed Page 11 of 13 Complaint No.: Smt. Reena Devi Singh Date of Pronouncement:
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complainant, whereas the opposite party has placed on record various medical literatures and articles and has succeeded to proved that the problems which were suffered by the complainant was due to postoperative complications of the surgery performed by the opposite party.
15. Learned counsel for the opposite party has placed reliance upon the judgement of Hon‟ble Apex Court in the case of Bombay Hospital & Medical Research Centre (supra) in which discussing the principle laid down in its previous judgments in Kusum Sharma & Ors. Vs. Batra Hospital & Medical Research Centre & Ors., I (2010) CPJ 29 (SC) and Jacob Mathew Vs. State of Punjab & Anr. III (2005) CPJ 9 (SC) the Hon‟ble Apex Court in Para No.35 has held that : -
"35.--------. The doctors are expected to take reasonable care but none of the professionals can assure that the patient would overcome the surgical procedures".
Learned counsel for the opposite party has also placed reliance upon judgement of Hon‟ble National Commission in the case of K. Dasharathamand Ors. (supra), in which in paragraph No.11 it was held that : -
"11. We would like to rely upon the catena of judgments from Hon‟ble Supreme Court which held that the medical practitioner cannot be held liable for medical negligence simply because the things went wrong as long as the doctors performed their duties with ordinary degree of professional skill and competence.----".
This Commission is also of the same opinion in its catena of judgements following the above principle laid down by the Hon‟ble Apex Court and Hon‟ble National Commission and in recent judgement dated 15.05.2023 in Complaint Case No.CC/17/69 between Girdhar Kumar Vaishya Vs. Apollo Hospital Bilaspur also. Dismissed Page 12 of 13 Complaint No.: Smt. Reena Devi Singh Date of Pronouncement:
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16. Therefore, for the foregoing discussion we are of the considered opinion that the complainant has failed to substantiate his case and allegations of medical negligence by way of any cogent evidence or medical literature and failed to point out any specific error in the surgical procedure performed by the opposite party. Consequently, this complaint being devoid of any merits is dismissed with no order as to cost.
(Justice Gautam Chourdiya) (Gopal Chandra Shil) (Pramod Kumar Varma)
President Member Member
/05/2023 /05/2023 /05/2023
Pronounced On: 17th May 2023
Dismissed Page 13 of 13