State Consumer Disputes Redressal Commission
Sanjiv Kumar vs Dr. Anjana Singh, Central Diagnostics on 25 April, 2011
Daily Order
STATE CONSUMER DISPUTES REDRESSAL COMMISSION BIHAR, PATNA Complaint Case No. CC/34/2000 1. Sanjiv Kumar Patna BEFORE: HONABLE MR. JUSTICE SUBHASH CHANDRA JHA PRESIDENT HONABLE MRS. RENU SINHA MEMBER PRESENT: ORDER
Date of order: 25-04-2011 S.C. JHA, PRESIDENT
Heard the learned counsel of both the parties, who have already filed their respective written notes of argument.
2. The brief fact of the case is that the complainant was suffering from liver problem and was being treated by Dr. B.K. Agrawal, M.D. (Medicine), F.I.C.P.,D.M.(Gastroenterology) but he was not feeling better. He was further advised many tests including blood test. The complainant was advised to give his blood sample to the laboratory of the Opposite Party and the complainant had given sample for laboratory examination and after examination a report was given to the complainant on 18-06-1999 showing anti HCV-positive meaning thereby the complainant was suffering from Hepatitis-C, which is a malingment stage of Hepatitis and not completely curable. The complainant further consulted Dr. Agarwal with the aforesaid report and relying on the aforesaid report of the Opposite Party, he referred the case for specialized treatment in AIIMS at New Delhi on 27-07-1999. The complainant proceeded for AIIMS, New Delhi and was advised to get his blood examined in the Department of Laboratory Medicine for clinical examination of his blood chemistry. Several times samples of blood was taken from the vein of the complainant and after clinical examination, the doctor has not found anti HCV positive.
3. It is alleged that the Opposite Party has given incorrect clinical examination report of bio-chemical test of the blood and wrongly reported that anti-HCV positive has been found in his blood.
4. It is also alleged that the complainant and his entire family members have been put in acute mental agony and financial distress by the aforesaid incorrect clinical examination report made by the Opposite Party. The complainant has been put under serious mental shock for a period of about four months, and for which the Opposite Party was responsible and for her irresponsible act, the complainant has not recovered his normal mental condition and consequently he has not appeared in any competitive examination. Accordingly, the complainant claimed in all a sum of Rs. five lacs as compensation for mental agony and harassment.
5. The Opposite Party appeared and filed her written statement contending interalia that the Opposite Party took all precautions and with due care, the report was given as positive result, which shows that the complainant had anti hepatitis C-virus. The complainant was advised by Dr. B.K. Agarwal to consult specialized treatment in AIIMS, New Delhi with clinical report of Opposite Party. The complainant was advised for blood examination again at AIIMS for starting proper treatment, which found that the patient was not suffering from anti HCV positive.
6. It was further contended that the Opposite Party uses all quality reagents and international standards are followed for minimization of errors and is ceaselessly working on quality Central Programmed to minimize the laboratory errors and the Opposite Party has been able to achieve automation and quality control. The method of blood text was ELISA and ELISA method detects the presence of anti bodies to HCV antigen in human plasma or serum. The ELISA method is used as screening test because the said method has got its own limitation due to cross reactivity with other antibodies and presence of interfering substances with ELISA test has generally to be confirmed by more sensitive test as PCR (Polymer-age Chain Reaction) and western blood test. The test results positive by ELISA test does not confirm the diagnosis rather it just points out towards the probability of having the antibody, which is to be further confirmed by more specific test and in the case of the complainant HCV should have been confirmed by PCR method.
7. It was further contended that all diagnostic tests have their limitations, which have been recognized by various diagnostic centre all over the world and definitive clinical diagnosis should not be made basis on the result of a single test. The Opposite party by way of evidence has annexed photocopy of medical literature of ELISA method detection of anti HCV test with SP-Nanbase C-96 kit for the detection of antibody to Hepatitis-C virus (anti-HCV) in human serum or plasma. At its clause No. (4.10) it deals with limitation and interference and at its sub-clause No. (4.10.4) it says that the anti-HCV negative result does not preclude the possibility of infection with HCV, the sub-clause (4.10.5) says that 'Non-repeatable table positive result may occur due to non-specific binding of the simple and conjugate to the wall of the well (s). In Paragraph No. (11), it is clear that the ELISA test for detecting anti bodies to HCV antigen in human plasma is not a full proof method of confirmation rather there are limitation of the test whereby it may result in not precluding the possibility of infection with HCV as the ELISA test may give false result. Thus, the ELISA test is only screening test and not a confirmation test.
8. We have gone through the pathological report, which have been filed on behalf of the complainant as also the documents, which have been filed on behalf of the O.P.-Dr. Anjana Singh. From the report (Annexure-2), which has been filed by the O.P.-Dr. Anjana Singh, Central Diagnostics, Shantipriya Apartment, Opp.IBP Petrol Pump, Boring Road, Patna, it is indicated that anti HCV has been found positive on 18-06-1999. The report can be reproduced here:-
Test Result Date run 1. HBs Ag 2. Anti HBs 3. Anti HB core (Total) Negative 4. Anti HB core (1gM) Negative 5. HBe Ag 6. Anti HBe 7. Anti HCV Positive 18/06/99 8. Anti HE (1gM) 9. Anti HD Comment: Method: ELISA
On the other hand, Annexure-4, which has been filed as documentary evidence on affidavit on behalf of the complainant dated 19-08-1999 of AIIMS, back page it is indicated that anti HCV has been reported negative.
9. Reading to all these annexures of pathological examination report, it is clear that reports of AIIMS, New Delhi is based on more sophisticated scientific reading and calculation. Other related investigation reports vide Annexure-5 & 6 also supports such report of the AIIMS, New Delhi. Annexure-7 is a laboratory report of SRL, Ranbaxy, which also goes to show that hepatitis C ABS,IGG EIA not detected. HCV IgG antibody is used for differential diagnosis of acute hepatitis and to screen blood units for transfusion safety. So reading together all these reports would clearly indicate that report of the O.P. vide Annexure-2 indicating HCV positive dated 18-06-1999 has been contradicted.
10. It was the contention of the complainant that for such wrongly furnishing of reports, he had to suffer mental agony and harassment and had to run from pillar to post and got himself treated and had to undergo rigorous test in AIIMS. According to the complainant, had O.P. been sincere in submission of report in right perspective by applying due caution and care, there would not have been repetition of such test. Even the O.P. insisted, on being informed, on her previous stand by writing a letter (Annexure-6). The O.P. has nowhere indicated the actual reading and findings of pathological test. In such circumstance, there is clear possibility that this report might have been submitted by some unexperienced or unqualified persons under the tenure of present O.P. and report has thus been signed and transmitted.
11. In such situation, having considered the entire aspect, we do not find that there was deliberate negligence on the part of the O.P., which may be branded as insufficient service to the patient. In such situation, there was requirement that such pathological reports should have been confirmed by some more sophisticated test with due care and caution as pathological examination of different constituents of the blood, as such, same has been done in AIIMS, New Delhi, which is equipped with costly and sophisticated instruments.
12. In the result, we do find plausible and convincing defence furnished by the O.P. so as to hold that the report of AIIMS contradicting such report may be correct. Of course, the report submitted by O.P. was incorrect but for that it can not be said that it was submitted as a negligent institution.
13. It is an important factor to be noted here that no medical expert has been examined on behalf of the complainant so as to infer that the O.P. was negligent in performing her duty.
14. It is but natural that Lab. in AIIMS, New Delhi and Tata Memorial Hospital, Mumbai are supposed to be more sophisticated and worth several times in value of the equipment available at Patna in a private Lab. So for that purpose in such, cases of detection of cancer, there is every likelihood of advice for confirmation of such result by sophisticated Lab. As such, efforts were taken for confirmation in AIIMS, New Delhi and the result ultimately was in favour of the complainant but which was a pleasant surprise and for that the O.P. cannot be solely held negligent and deficient in performing her duty.
15. In the circumstance, taking everything into entirety, we do not find it a fit case of negligence rather it is but natural that there may be variation in the result, if something is tested clinically in two Labs and for that the Lab. submitting wrong report cannot be solely blamed as it depends upon several factors, viz., place, kind of equipment etc. The Lab. in AIIMS, New Delhi is definitely can be supposed to be at par with sophisticated lab of International standard and so the efficiency and performance of that such Lab. cannot be equated with that of pathological and clinical lab. in Patna. In the circumstance, we do not find it a case of negligence and deficiency in providing service and so we are unable to arrive at this conclusion that O.P. were deficient in providing service and for that they cannot be solely blamed.
16. In the result, we do not find merit in this complaint and as such, it is dismissed. However, there shall not be any order of cost. [HONABLE MR. JUSTICE SUBHASH CHANDRA JHA] PRESIDENT [HONABLE MRS. RENU SINHA] MEMBER