State Consumer Disputes Redressal Commission
Miss. Bhupinder Kaur vs Patel Hospital Private Limited, on 7 April, 2014
2nd Additional Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB
DAKSHIN MARG, SECTOR 37-A, CHANDIGARH
Consumer Complaint No. 13 of 2004
Date of institution: 12.7.2004
Date of Decision: 7.4.2014
Miss. Bhupinder Kaur D/o Sh. Jai Karan Singh, Permanent Resident of
Village & P.O. Shahpur Jajan, Tehsil Dera Baba Nanak, District Gurdaspur
(Punjab), Presently resident of C/o Master Harmeet Singh, H. No. 17, Guru
Ram Dass Nagar, Near S.D. School, Gilwali Gate, Amritsar.
.....Complainant
Versus
1. Patel Hospital Private Limited, Civil Lines, Jalandhar, Punjab,
through its Chairman/ Managing Director/ Director/ Medical
Superintendent.
2. Dr. S.K. Sharma, M.S. Surgical Specialist at Patel Hospital
Private Limited, Civil Lines, Jalandhar.
3. Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road,
New Delhi - 110 044, through its Chairman/ Managing Director/
Medical Superintendent.
4. Dr. Sameer Kaul, M.S. (Surgical Oncology), Indraprastha Apollo
Hospital, Sarita Vihar, Delhi-Mathura Road, New Delhi - 110 044
5. Dr. G.C. Vaishnava, Senior Consultant, Internal Medicine,
Indraprastha Apollo Hospital, Sarita Vihar, Delhi-Mathura Road,
New Delhi - 110 044
6. Dr. Sumaid Kaul, Pathologist, Indraprastha Apollo Hospital, Sarita
Vihar, Delhi-Mathura Road, New Delhi - 110 044
7. Dr. Uma Ravishankar, Senior Consultant, Nuclear Medicine,
Indraprastha Apollo Hospital, Sarita Vihar, Delhi-Mathura Road,
New Delhi - 110 044
8. Dr. Sanjiv Nand, M.S. Orthopaedics, Indraprastha Apollo
Hospital, Sarita Vihar, Delhi-Mathura Road, New Delhi
9. United India Ins. Co. Ltd., Industrial Area, Jalandhar
10. New India Assurance Company, 19, Community Centre, New
Friends Colony, New Delhi Office.
.....Respondents/Opposite Parties
Consumer Complaint under Section 17 of the
Consumer Protection Act.
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member
Shri Vinod Kumar Gupta, Member
Shri Harcharan Singh Guram, Member
Present:-
For the complainant : Sh. Updip Singh, Advocate
For opposite parties No.1&2: Sh. Rohit Sood, Advocate
For opposite parties No.3, 6&7:Sh. Arun Kumar Bakshi, Advocate
2
Consumer Complaint No. 13 of 2004
For opposite parties No. 4&10: Sh. R.C. Gupta, Advocate
For opposite parties No.5,8&9: Ex.-parte.
Gurcharan Singh Saran, Presiding Judicial Member
ORDER
The complaint has been filed by the complainant-Ms. Bhupinder Kaur (hereinafter referred to as 'the complainant') stating that she is a young lady of 26 years and has become bed ridden due to the gross negligence of the opposite parties. She was having Diploma in General Nursing. She was working as such and bright career as well as marriage prospectus.
2. It was alleged that respondent Nos. 1 & 3 are multi speciality hospitals. In the year 1998, the complainant when she was 20 years old had swelling in the neck for the past one year and had report of Thyroid Harmone dated 13.6.1998 and approached respondent No. 1 on 26.9.1998. The swelling had increased in size when no associated hoarseness of voice. On examination, the doctors found small nodular swelling left side of neck and was advised surgery for excision of nodule by Dr. S.K. Sharma- respondent No. 2. However, no pre-investigation was done to rule out malignancy by way of FNAC or scanning or whether it is cold or warm nodule. The complainant was admitted with respondent No. 1 on 6.7.1998 and was operated upon by respondent No. 2 on 7.7.1998 and thyroid was explored and the findings were noted. The mass involves isthimus. Excision of adenoma was done and left lobectomy was done. Thereafter Histopathology examination report of operative specimen revealed to be of Follicular Adenoma. Although report was 3 Consumer Complaint No. 13 of 2004 not given to the complainant and no follow up was advised to rule out malignancy. Since Follicular Adenoma is not fast growing and develop over a number of years and nodule is warm nodule on scantiscanning encapsulated form and involvement of isthmus and left lobe of thyroid happens. In case of Follicular Adenocarcinoma, which is a malignant tumour, therefore, there should have been sufficient signal to the treating doctor to go for further investigations to rule out or diagnose Malignancy and Pathologist should have advised further probe. At that stage with further investigation if malignancy would have been found and treated at the very early stage, had given complete cure preventing the present condition and status of the complainant. It was further stated that Follecular Adenomas if at in the age of 2nd or 3rd decade, regular follow up should have been advised. The complainant was discharged on 9.7.1998. Discharge card did not give proper operative details showing casual attitude of respondent No. 2. On 29.9.1999 after about more than 14 months of the previous surgery, the complainant again reported to respondent No. 1 with complaint of developing nodule, right lobe of thyroid. Without giving any further treatment, respondent No. 1 advised to the complainant to go for T3 T4 TSH and FNAC. In January, 2000, these were got done from Bharat Diagnostics, Amritsar. Puri Pathology Laboratory showed multiple swelling in thyroid "impression "Secondaries from Thyroid Carcinoma as well as Papilliary Thyroid Carcinoma" and he was referred to Mohan Devi Oswal Cancer Treatment & Research Foundation, Ludhiana for further management. After further investigation from that hospital as well as 4 Consumer Complaint No. 13 of 2004 PGI, Chandigarh, she visited the Apollo Hospital, New Delhi. On 7.4.2000 she was examined in Indraprastha Apollo Hospital, New Delhi (respondent No. 3) by respondent No. 5 Dr. G.C. Vaishnava, Senior Consultant Internal Medicine, who after thorough investigation including ultra sound referred her to Dr. Sameer Kaul respondent No. 4(Senior Consultant Surgical Oncology). Respondent No. 4, who examined her on 8.4.2000 diagnosed as having Hypothyroidism and she was advised immediate surgery. Total Thyroidectomy with Bilateral Nodule Dissection, 6 weeks later whole body iodine scan, radioiodine ablation and immediate CT Neck and Thorax. However, no pre-operative investigation like Scintigraph or MRI or Bone Scan to evaluate extent of Metastasis was done although Follecular Carcinoma of Thyroid is known to metastatise in bones. Pre-operative CT Scan was done on 10.4.2000, which was not of much significance. Total thyroidectomy with B/L Modified Neck Disection was done on 11.4.2000 by respondent No. 4. Post Operative routine investigation was also done. Surgical Histopathology Examination was done by respondent No. 6, who revealed (examined) as under:-
"-Papillary Carcinoma, Tall Cell Variant, of the Thyroid,
-Tumor Invading the Thyroid Capsule,
-All the 75 Neck and Mediastinal Lymphnodes Show Metastatic Deposits of the Tumor.
3. This HPE report had not made a mention of Follecular Carcinoma, which shows casual approach of respondent No. 6 and she was discharged on 17.4.2000. On follow up she was advised to go for whole body scan by respondent No. 4. Scintigraph was done on 22.5.2000 by Dr. Uma Ravishankar respondent No. 7, which was 5 Consumer Complaint No. 13 of 2004 not properly carried out as it showed residual thyroid tissue in the neck only but missed presence of distant metastasis. Radio Iodine Ablation was done on 27.5.2000 under hospitalization for residual thyroid tissue. However, no whole body bone scan pre-operative/ post operative MRI was not done to rule out metastasis in bones or other body parts. The dose of Radio Iodine was only given for ablation of residual thyroid tissue. Further Thyroglobulin estimation was advised to be done after six months. Whereas repeat scintigraph after one week with larger dose of radioiodine cold have ruled out functional metastasis of the bones. Then on 31.5.2000, the complainant was again admitted with respondent No. 3 with complaint of weakness both lower limbs with urinary retention resulting into complete paraplegia of lower parts of body upto chest.
On admission various investigations were conducted including MRI dorsal spine, which revealed as under:-
"Bony Metastasis involving D2 Vertebral Soft Tissue Component, The Spinal Cord is Focally Compressed at this level."
4. Posterior Decompression was tried by Ortho-Surgeon Dr. Sanjiv Nand, respondent No. 8, who ignored the site of compression i.e. anterior side, therefore, he was not successful as his approach was wrong. He also did not associate any Onco Surgeon or Neuro Surgeon. Had he involved those Surgeons then he would not have applied the posterior approach. Then anterior approach was advised by the Ortho Surgeon, which had a lot of complications and risk of mortality, therefore, the complainant and her relatives did not opt for anterior approach. Therefore, even the surgery could not improve the 6 Consumer Complaint No. 13 of 2004 paraplegic status of the patient and she was discharged from that hospital with advice of extensive physiotherapy, which was otherwise not possible in the presence of functional metastasis. Whereas on the other side, the doctors had wrongly mentioned the history of fall in the operation notes to save their own skin. Had proper investigations being done pre-operatively before first surgery at Apollo and Metastasis into vertebra detected, proper dose of Radioactive Iodine treatment, which could have prevented spinal cord at D2 Vertebra and she would have been saved from paraplegic condition.
5. Then the complainant approached Sanjivani Hospital, Amritsar from where she was referred to Muni Lal Chopra Memorial Hospital, Amritsar attended by Dr. Raj Kamal on 1.7.2000 and MRI whole body was taken as well as Scintigraph and MRI revealed as under:-
"Metastatic Collapse of D2 with anterior epidural infiltration & causing moderate compression of theca and cord", and bone scan revealed "metastatic deposits D2 and Mid Shaft of Right Femur".
6. On 2.7.2000, Dr. Raj Kamal operated upon the patient applying Posterolateral approach for the patient and removed D2 vertebral body alongwith greyish, soft, moderately vascular tissue, although intervertebral disc and Iliac bone graft was placed. After surgery sensation improved on left side of body. Surgical Biopsy was sent to Kahlon Diagnostics & Cancer Research Centre, Amritsar, which concluded as under:-
"In view of Atypical Cells and Patient being known case of Thyroid Malignancy, features appear consistent with M.R.I., Impression of secondary deposits".7
Consumer Complaint No. 13 of 2004
7. Same biopsy sample was sent to Tata Memorial Hospital, Mumbai, who gave the findings:-
"Metastatic Carcinoma"
Whereas the report of Dr. Sumaid Kaul sent to respondent No. 3 again gave the findings:-
"There is no evidence of Malignancy in the Sections Studies".
8. Post operatively Radiotherapy was given to the complainant for 4-5 days and it was stopped as she was admitted in Muni Lal Muni Lal Chopra Memorial Hospital, Amritsar from 6.8.2000 to 11.8.2000. Then whole body scan was conducted on 18.8.2000, which showed increased tracer uptake in D2 Vertebra.
9. In the year 2003, the complainant was again admitted in Muni Lal Chopra Memorial Hospital, Amritsar from 28.3.2003 to 10.4.2003 with further complications of the disease. Again in the year 2004, she was admitted in Muni Lal Chopra Memorial Hospital, Amritsar from 6.4.2004 to 7.4.2004 with further complications of the disease, therefore, it has been alleged that due to negligence on the part of the respondents, the Malignancy was not detected at the initial stage as a result of which Malignancy developed in other parts of body including D2 Vertebra, which resulted into paraplegic condition of the complainant. In case proper tests and proper diagnosis would have been done and proper treatment would have been given to the complainant saving from the spread of the disease, which spread on account of deficiency in services on the part of the respondents. She has spent more than Rs. 5 lacs on the treatment with respondent Nos. 3 to 8, Rs. 25,000/- with respondent Nos. 1 & 2 and sufficient 8 Consumer Complaint No. 13 of 2004 amount was spent for the purchase of medicines; her prospect of career and marriage had been spoiled and accordingly, compensation of Rs. 90 lacs has been demanded for harassment, mental agony, loss of career and matrimonial chances, Rs. 5,25,000/- cost of treatment and Rs. 10,000/- as litigation expenses.
10. Alongwith the complaint, an application under Section 24- A(2) of the Act was given by the complainant to condone the delay in filing the complaint.
11. The State Commission vide its order dated 11.10.2006 dismissed the application as well as complaint barred by limitation. Its appeal was filed before the Hon'ble National Commission, who vide their order dated 16.1.2007 dismissed the appeal. Its further appeal was filed with the Hon'ble Supreme Court of India, who vide its order dated 13.12.2011 allowed the application and the case was remanded back to the State Commission to decide the same on merits.
12. Notice was issued to the respondents. Respondents Nos. 3, 6 & 7 had appeared through Sh. Jai Singh Brar, Advocate but they did not file reply and further adjournment was declined to file reply vide order dated 21.11.2012. Application was filed to recall that order but the said application was also dismissed vide order dated 21.2.2013. Whereas none appeared on behalf of respondents No. 5, 8 & 9, therefore, they were proceeded ex-parte. However, written replies were filed by respondents No. 1 & 2 and 4 & 10.
13. Respondents No. 1 & 2 in their written reply had taken the preliminary objections that it is unfortunate that the complainant had 9 Consumer Complaint No. 13 of 2004 undergone tremendous trauma due to aggressive nature of the disease, which is cancerous in nature. The pleadings in the complaint are technical and ambiguous as no specific act of negligence has been alleged with regard to role of these respondents; the complainant has not arrayed Pathologists, who had given the histopathological report given the opinion "Follicular Adenoma" on the basis of excision biopsy, which is one of the best test to check the Malignancy. Although the complainant has taken the treatment from five institutions, however, she was selectively chosen only two institutions. There is a hidden agenda in the pleadings and accompanying documents as the complainant had completely alleviated the nature of the disease and consequence thereof and that the pleadings are not substantiated with any expert opinion. On merits, it has been stated that when the complainant had come to these respondents with a lump on the left side of neck, which was painless, mobile otherwise (while) non-toxic, it was examined by respondent No. 2, who opined that in order to accurately and expeditiously examine the nature of the lump and to localize the damage an excision biopsy was the most effective and accurate procedure, which could be adopted in order to thoroughly investigate the nature of the lump and it was sent to Pathologist and it was found to be benign. As per the report there was no evidence of any malignancy, therefore, she was advised for follow up after six months and after that she had reported to the Ops in September, 1999 with fixed lump in the right side of the neck. She was advised FNAC but she underwent that procedure in December, 1999. This inordinate 10 Consumer Complaint No. 13 of 2004 delay could have lost her valuable time in order to diagnose and control that situation and there were traces of metastasis of thyroid carcinoma. Being the seriousness of the emerging situation, the respondents immediately referred her to Mohan Dai Oswal Cancer Treatment and Research Centre, Ludhiana. Thereafter, the respondents neither considered nor at any time the complainant had come within the care and attention of these respondents. It was denied that the respondents did not undertake the certain tests i.e. Scintigraphy, FNAC. So far as Scintigraphy is concerned, it was in early 70's. However, over the flux of time and evolution of medical science, the same procedure could be categorized as underlining the functional status of a particular nodule. It could be hot as well as cold. If the result comes as 'cold' the probability of the same being malignant increases but even the 'Hot' nodule may be malignant. FNAC came in vogue in early 80's. It was seen as a material improvement over Scintigraphy in which without removing the tumor, certain cells are extracted and are examined for traces of carcinoma but the same tests is more like a random testing as some tests might be damaged and others not affective at all, therefore, the exact accuracy of this test is also suspected.
14. Excision Biopsy is benchmark test with regard to the diagnosis of any cancer at any stage in any organ, based upon the examination of the tumor so excised in order to determine the type of carcinoma. It is recognized as most highly effective and accurate, specific and sensitive test to determine the malignancy of a tumor and is accurate of nearly 100% but the cancer has disease which has 11 Consumer Complaint No. 13 of 2004 no cut and dry method of detection/cure and field is still evolving. Exercise of judgment with regard to adoption of either of the three procedures rest with the treating doctor, who is the best judge. It has been so observed in the Medical Book "Cancer Principles & Practice of Oncology" by Vinscent T. DeVita, Jr. et al. It has further been stated that respondent No. 2 is distinguished surgical specialist having experience of 42 years. Therefore, it was submitted that there is no negligence on the part of this respondent for treating the complainant. The complaint has been wrongly filed against these respondents on frivolous points, therefore, the complaint be dismissed qua these respondents.
15. OP Nos. 4 & 10 in their written reply have taken the preliminary objections that the complainant is not a 'consumer' as defined under Section 2(d) of the CP Act; the complainant has not come to this Commission with clean hands as she has concealed the material facts to grab easy money. Insurance is a matter of good faith and the complainant is not maintaining the good faith while pursuing the complaint; the matter involves disputed material facts, which needs elaborate evidence, which cannot be decided in summary proceedings, therefore, the matter be relegated to the Civil Court; before coming to OP No. 3 she was treated in OP No. 1 and when she was examined, she was diagnosed as Papillary and Follicular Carcinoma of Thyroid Gland. After taking pre-operative tests, surgery was conducted on 11.4.2000 and was discharged on 17.4.2000 without any prospective complications. As a standard procedure, OP No. 4 referred her and advised for whole body iodine scan, which was 12 Consumer Complaint No. 13 of 2004 got conducted around 5½ weeks later by OP No. 7. Ailment suffered by the complainant was found to be a typical case of aggressive thyroid cancer in a young individual, non responsive to the iodine ablative treatment and widely reported in world medical literature. As per the experience of OP No. 4, he was having 30 years experience in treating the patients being a Specialized Oncologist, Fellow from London and Sr. Consultant, such patients hardly survive, therefore, the whole complaint is made out by her is malicious and tantamount to fraudulent intent to make money by illegitimate means. Therefore, keeping in view the nature of the disease to which she was suffering survival was not guaranteed. However, in case the Commission holds the OP liable then he is insured with OP No. 10 New India Assurance Co. Ltd. Vide Doctors Professional Indemnity Policy No. 311900469902915 valid from 16.9.1999 to 15.9.2000.
16. On merits, it has been stated that the complainant was referred to OP No. 4 by OP No. 5 and accordingly, she had undertaken the treatment referred above. The complainant blames to the effect that had proper investigations been done pre-operatively before first surgery at Apollo and Metastasis verterba detected, proper dose of radioactive iodine treatment would have been deactivated metastasis on the bones, which would have prevented compression of spinal code at D2 Verterbra and would have saved the complainant from paraplegic condition. The complainant has made allegations without any cogent evidence or any expert evidence to prove the allegations against these respondents. The respondents are not responsible for the loss of career, higher education, lucrative 13 Consumer Complaint No. 13 of 2004 job or marriage prospectus, therefore, the complaint filed against these respondents is without any basis, just to extract the money and deserves dismissal. Additional plea has been taken that OP No. 4 is insured with OP No. 10 by Professional Indemnity Insurance (Doctor) Policy No. 311900469902915 valid from 19.9.1999 to 15.9.2000 and in case any liability fixed upon OP No. 4 then OP No. 10 is to pay the same being the insurer.
17. The parties were allowed by the learned District Forum to lead their evidence.
18. In support of his allegations, the complainant had tendered into evidence affidavit of Sandeep Kaur D/o Jai Karan Singh Ex.C-C, affidavit of Pinky Ex.C-D, alongwith documents i.e. copy of character certificate dated 7.5.1999 Ex.C-1, copy of experience certificate dated 9.11.1999 Ex.C-2, copy of report of T3T4TSH dated 13.6.1998 Ex.C-3, copy of discharge card of Patel Hospital dated 9.7.1998 Ex.C-4, copy of report of thyroid function test dated 4.1.2000 Ex.C-5, copy of FNAC report dated 5.1.2000 Ex.C-6, copy of history report of Patel Hospital dated nil Ex.C-7, copy of bio- chemistry report of Oswal Hospital dated 18.1.2000 Ex.C-8, copy of ECG report of Oswal Hospital dated 18.1.2000 Ex.C-9, copy of urine examination report of Oswal Hospital dated 18.1.2000 Ex.C-10, copy of blood test report dated 18.1.2000 Ex.C-11, copy of OPD card of PGI, Chandigarh dated 15.2.2000 Ex.C-12, copy of OPD Slip Apollo Hospital dated 7.4.2000 Ex.C-13, copy of bio-chemistry report Apollo Hospital dated 7.4.2000 Ex.C-14, copy of blood report Apollo Hospital dated 7.4.2000 Ex.C-15, copy of ultra sound report Apollo Hospital 14 Consumer Complaint No. 13 of 2004 dated 8.4.2000 Ex.C-16, copy of OPD slip Apollo Hospital dated 8.4.2000 Ex.C-17, copy of CT report Apollo Hospital dated 10.4.2000 Ex.C-18, copies of blood reports of different dates from Ex.C-19 to Ex.C-24, copy of X-ray report dated 15.4.2000 Ex.C-25, copies of blood reports dated 15.4.2000 and 17.4.2000 Ex.C-26 and C-27 respectively, copy of HPE report dated 17.4.2000 Ex.C-28, copy of discharge summary Apollo Hospital dated 17.4.2000 Ex.C-29, copy of OPD slip dated nil Ex.C-30, copy of Whole Body Scan Report dated 22.5.2000 Ex.C-31, copy of blood report dated 22.5.2000 Ex.C-32, copy of discharge summary dated 29.5.2000 Ex.C-33, copies of blood reports of different dates Ex.C-34 to C-38, copy of T3T4TSH report dated 3.6.2000 Ex.C-39, copy of MRI report dated 3.6.2000 Ex.C-40, copies of blood reports of different dates Ex.C-41 to C-44, copy of TSH report dated 22.6.2000 Ex.C-45, copy of blood report dated 22.6.2000 Ex.C-46, copy of urine report dated 22.6.2000 Ex.C- 47, copy of treatment history under signatures of Dr.Sanjiv Nand Ex.48, copy of discharge summary dated 25.6.2000 Ex.C-49, copy of scintigraphy report dated 6.2000 Ex.C-50, copy of MRI report dated 29.6.2000 Ex.C-51, copy of HPE report dated 8.7.2000 Ex.C-52, copy of biopsy report dated 25.7.2000 of Tata Memorial Hospital Ex.C-53, copy of HPE report of Apollo Hospital dated 8.8.2000 Ex.C-54, copy of discharge card dated 18.7.2000 Ex.C-55, copy of OPD Slip Guru Ram Dass Rotary Cancer Hospital, Amritsar dated 2.8.2000 Ex.C-56, copy of discharge card dated 11.8.2000 Ex.C-57, copy of Whole Body Scan Report dated 18.8.2000 Ex.C-58, copy of OPD Slip dated 17.5.2000 Ex.C-59, copy of OPD Slip 6.6.2002 Ex.C-60, copy of OPD 15 Consumer Complaint No. 13 of 2004 Slip dated 18.10.2002 Ex.C-61, copy of discharge card dated 10.4.2003 Ex.C-62, copy of MRI report dated 29.3.2003 Ex.C-63, copy of Whole Body Bone Scan report dated 31.3.2003 Ex.C-64, copy of discharge card dated 7.4.2004 Ex.C-65, copy of MRI report dated 6.4.2000 Ex.C-66, copy of ultrasound report dated 6.4.2004 Ex.67, photograph of complainant dated 9.7.2004 Ex.C-68, copy of death certificate of Sh.Jai Karan Singh dated 14.5.2009 Ex.C-69, copies of discharge cards of hospitalizations from 8.9.2004 to till date Ex.C-70 (colly.), copy of MRI Report dated 6.4.2009 Ex.C-71, copy of treatment record with Indian Spinal Injury Centre, New Delhi from 16.2.2012 to 8.3.2013 Ex.C-72 (colly.), copy of treatment at Hong Kong dated 19.7.2013 Ex.C-73, copy of detail of treatment expense from 9.7.1998 to 12.8.2013 and invoices/receipts of payments Ex.C- 74 (colly.), copy of disability certificate of complainant dated 23.5.2012 Ex.C-75. Respondents Nos. 3, 6 & 7 had tendered into evidence affidavit of Dr.Ritu Rawat Ex.OP-3A/1, affidavit of Dr.Sumaid Kaul as Ex.OP-6A/2 & affidavit of Dr.Uma Ravi Shankar as Ex-OP-7A/3 along with documents Ex.OP-7/4 (medical literature) & Ex.OP-7/5. Respondents No. 4 & 10 had tendered into evidence affidavit of Sh.K.B.Bindal, Manager, New India Assurance Company Ex.R-4/A, affidavit of Dr.Sameer Kaul Ex.R-10/A alongwith documents i.e. copy of policy of insurance with terms and conditions for the period of 16.9.1999 to 15.9.2000 Ex.R-4/1 and close the same on behalf of opposite parties No.4&10.
19. We have heard the learned counsel for the complainant Sh. Updip Singh, Advocate and learned counsel for 16 Consumer Complaint No. 13 of 2004 respondents/opposite parties No. 1 & 2 Sh. Rohit Sood, Advocate, learned counsel for respondents/OP Nos. 4 & 10 Sh. R.C. Gupta, Advocate and Sh. Arun Kumar Bakshi, Advocate learned counsel for respondents/OP Nos. 3,6 & 7 although their written reply and evidence was not taken on the record in view of the order stated above. We have also carefully gone through the pleadings and documents on the record.
20. The preliminary objection has been taken by the respondents that the complainant is not a consumer. The respondents have given the treatment and they have taken the fee for treatment, therefore, there is relationship of 'consumer' and 'service provider' and during the course of arguments, counsel for the respondents were unable to convince before this Commission, how the complainant does not fall within the definition of 'consumer'.
21. Another objection was taken that it involves complicated questions of facts and lengthy evidence, which may require cross- examination also, therefore, the matter should be referred to the Civil Court. In case this was the preposition then the application should be made at the initial stage. In case the evidence of the parties is complete then there is no reason to relegate the matter to the Civil Court. A reference can be made to the judgment of the Hon'ble Supreme Court in the case of "Dr. J.J. Merchant and others Vs. Shrinath Chaturvedi", 2002(6) SCC 635 that:-
'the State Commission and District Forum are headed by retired High Court Judges and officers of District Judge level and in our view, this is not such a case which cannot be decided by the 'Consumer Fora' after obtaining evidence and if need be after getting an expert opinion'.17
Consumer Complaint No. 13 of 2004
22. When the Presiding Officers of the Consumer Fora are experienced Judicial Officers and they have sufficient experience at their back, therefore, they are fully competent to decide these types of cases. It has been so fortified by the Hon'ble National Commission in "Shiv Kumar Agarwal versus Arun Tandon and another", 2007(2) CLT 287. In that case - plea that case involves complicated questions of act and law and will need expert evidence, which is not possible in the summary proceedings adopted by the Consumer Fora repelled - Consumer Forum which is headed by Senior Judicial Officers, are capable of dealing with even complex questions. When both the parties have complete their evidence then it is not proper to relegate the matter to the Civil Court and the District Forum should have decided the matter. As per the above judgments, we do not agree with the preposition raised by the counsel for respondents No. 4 to 10 that the matter should be referred to the Civil Court.
23. The counsel for the complainant stated that the complainant is a Nurse and her experience certificate from Hans Raj Memorial Hospital is Ex. C-2 and her character certificate is Ex. C-1. In the year 1998, when she was 20 years old, she had swelling in her neck and had report of Thyroid Harmone Study Ex. C-3 and she approached respondent No. 1 on 26.6.1998 and on examination it was found that she had small nodular swelling left side of neck and was advised surgery for excision of nodule by respondent No. 2. However, no investigation was done to rule out malignancy either by way FNAC or Scintigraphy whether it was cold or warm nodule. Surgery was conducted on 7.7.1998 and Histopathology examination 18 Consumer Complaint No. 13 of 2004 report of operative specimen revealed it to be of Follicular Adenoma and no further investigation was suggested to rule out the malignancy as follicular adenoma is not fast growing and developed over a number of years. That involvement of isthumus and left lobe of thyroid was there and this happens in case of Follicular Adenocarcinoma, which is malignant tumour and further Follecular Adenoma is also turn into Carcinoma in the age of 2nd or 3rd decade and she was again reported to this hospital on 29.9.1999 and she was advised to go for T3, T4, TSH and FNAC, which she had undergone in the month of January, 2000 and report is Ex. C-5. FNAC report is Ex. C-5 & C-6 and it was found that "Secondaries From Thyroid Carcinoma Biopsy Advised". Keeping in view the nature of the disease from which she was suffering, she was referred to Mohan Devi Oswal Cancer Treatment & Research Foundation, Ludhiana for further treatment.
24. Now the question for determination is whether the treatment given by respondents/OP Nos. 1 & 2 was proper or there was any negligence on the part of respondents/OP Nos. 1 & 2 in not conducting the proper tests/treatment.
25. In the written reply respondents No. 1 & 2 stated that there are different tests to check the malignancy i.e. Scintigraphy, which were prevalent in the year early 1970. Then in the Mid 1980's, FNAC come in vogue and Excision Biopsy is the latest diagnosis and is benchmark test of any cancer at any stage in any organ, based upon the examination of the tumor so excised in order to determine the type and extent of carcinoma. It is most highly effective and 19 Consumer Complaint No. 13 of 2004 accurate nearly 100%, therefore, OP No. 2 had opted for Excision Biopsy.
26. As per the allegations in the complaint and written synopsis, it has been stated that in the Histopathology Examination report although the same has not been proved on the record but the case summary Ex. C-7 is there wherein it has been mentioned that Follecular Adenoma and follow up on 10.7.1998 but after discharge she did not come for follow up and had reported to the hospital on 29.9.1999 after a gap of 14 months. At that time she was referred to go for T3, T4, TSH and FNAC, in January, 2000, which was got done from Bharat Diagnostics, Amritsar and "Secondaries from Thyroid Carcinoma" was detected, therefore, in case there was no report with regard to the Malignancy then OP Nos. 1 & 2 cannot be held responsible for the same.
For not giving the Histopathology report as per the guidelines issued by the Medical Council of India that the Professional Conduct, Etiquette and Ethics) Regulations, 2002, every physician shall maintain the medical records pertaining to his / her indoor patients for a period of three years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India (Section 1.3.1 and Appendix 3). If any request is made for medical records either by the patients / authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours (Section 1.3.2.) 20 Consumer Complaint No. 13 of 2004 Therefore, respondents No. 1 & 2 now could not produce the said record.
When Histopathology report found to be a case of Follecular Adenoma, which is not cancerous in nature and moreover, when biopsy was done then Scintigraphy FNAC, if not done, would be meaningless because the latest procedure to detect the malignancy was done in this case. In the Histopathology Examination, no melagnancy was found, therefore, immediately, no further action was required at that time and accordingly, she was advised for follow up after six months.
27. How the medical negligence is to be proved; has been held by the Hon'ble Supreme Court in the judgment "Kusum Sharma and others versus Batra Hospital & Medical Research Centre & Others", 2010(3) SCC 480 : 2010 (2) RCR (Civil) 161 that "negligence is the breach of a duty exercised by omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do.' Therefore, in case no malignancy was found in the biopsy and Histopathology examination then OP Nos. 1 & 2 were required to do anything at that time. What they can do, was to go for follow up, which was suggested to the complainant as per the case summary Ex. C-7.
28. Further in another judgment "Ms. Ins. Malhotra versus Dr. A. Kriplani & Ors.", 2009 (2) RCR (Civil) 791 wherein it was observed by the Hon'ble Supreme Court as under:-
21
Consumer Complaint No. 13 of 2004 "(1) So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course of method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed.
(2) It is not necessary for every professional to possess the highest level of expertise in that branch which he practices. Three things are pertinent to be noted. Firstly, the standard of care, when assessing the practice as adopted, is judged in the light of knowledge available at the time (of the incident), and not at the date of trial. Secondly, when the charge of negligence arises out of failure to use some particular equipment, the charge would fail if the equipment was not generally available at that point of time (that is, the time of the incident) on which it is suggested as should have been used - Thirdly when it comes to the failure of taking precautions, what has to be seen is whether those precautions were taken which the ordinary experience of men has found to be sufficient a failure to use special or extraordinary precautions which might have prevented the particular happening cannot be the standard for judging the alleged negligence."
29. It has been further contended by the counsel for the complainant that where there was involvement of isthmus and left lobe of thyroid, it happens to be a case of Follicular Adenocarcinoma. Counsel for the complainant has referred to "Harrison's Principles of Internal Medicine' wherein he has referred 'Carcinomas of Follicular Epithelium', which tend to be slow growing, account respectively for 70 and 15 percent of all thyroid cancers and it tends to occur in older individuals and differs from benign follicular adenoma. The presence of involved lymph nodded may be associated with a greater risk of recurrence but not, apparently, which increased mortality. Recent growth of a thyroid nodule or mass, especially if rapid and unaccompanied by tenderness and hoarseness, should prompt suspicion. There is no definite medical literature that in case there is 22 Consumer Complaint No. 13 of 2004 involvement of isthmus and left lobe of thyroid, it will involve Follicular Adenocarcinoma, therefore, what was to be done by respondents (OP) Nos. 1 & 2 to check the malignancy excision, biopsy was done and Histopathology was done and no malignancy was found and she was advised for follow up on 10.7.1998 whereas she reported to the hospital after a gap of 14 months and during that period Carcinoma had developed on the left side and for further management, she was referred to Mohan Dai Oswal Cancer Treatment and Research Centre, Ludhiana, therefore, apparently there has been no case of medical negligence on the part of respondents/OP Nos. 1 & 2. Carcinoma developed increased in the body of the complainant due to her own slagness as she did not go for follow up as suggested by respondents/OP Nos. 1 & 2. Even otherwise the Ops have acted in precaution, which was required from an ordinary and experienced man and in view of the judgments of the Hon'ble Supreme Court referred above, respondents No. 1 & 2 cannot be held liable for any medical negligence.
30. On 7.4.2000, the complainant reported respondent/OP No. 3 and she was checked by respondent No. 5 vide OPD Slip No. ID M0017063 Ex. C-13 and after routine investigations including Ultra Sound examination of whole abdomen Exs. C-14 to C-16 referred to respondents No. 4, who examined her on 8.4.2000 having history of already diagnosed case of Papilliary Carcinoma of Thyroid. She was diagnosed by him as Hypothyroidism and she was advised surgery. However, no requisite pre-operative investigation like Scintigraph or MRI or Bone Scan to evaluate extent of Metastasis was done 23 Consumer Complaint No. 13 of 2004 although Follecular Carcinoma of Thyroid is known to metastatise in bones. CT Scan was done on 10.4.2000 Ex. C-18) in which there was no obvious active lung disease or pleural effusion on either side. Total thyroidectomy with B/L Modified Neck Dissection was done on 11.4.2000 by respondent No. 4. Post Operative routine investigation was also done. Surgical Histopathology Examination was done by respondent No. 6, who in his report Ex. C-28 revealed as under:-
"-Papillary Carcinoma, Tall Cell Variant, of the Thyroid,
-Tumor Invading the Thyroid Capsule,
-All the 75 Neck and Mediastinal Lymphnodes Show Metastatic Deposits of the Tumor.
31. This report did not refer Follecular Carcinoma, which was referred by respondent No. 4 in his report Ex. C-17 and she was discharged on 17.4.2000 with satisfactory condition with further direction to come on Thursday and then she was advised to go for whole body scan i.e. Scintigraph was done on 22.5.2000 by Dr. Uma Ravishankar respondent No. 7 and it showed only tracer uptake in neck region and no evidence of distant metastasis was seen. Then Radio Iodine Ablation was done on 27.5.2000 under hospitalization for residual thyroid tissue and she was advised to come in to Nuclear Medicine Department for follow up RAI whole body scan & Thyroglobulin (Thymoglobulin) assay after 6 months after stopping Eltroxin for 6 weeks. Since whole body scan or pre-operative / post-
operative MRI was done to rule out or find functional metastasis in bones. Being there in case of Follecular Carcinoma of Thyroid, the dose of Radio Iodine was only given for ablation of residual thyroid tissue and further Thyroglulin Estimation was advised to be done 24 Consumer Complaint No. 13 of 2004 after six months. In case the advice to repeat Scintigraphy after one week with larger dose of Radio Iodine could have detect or rule out functional metastasis of the bones, which was already present by that time. On 31.5.2000, she was again admitted with Op No. 3 with complaint of weakness both lower limbs with urinary retention resulting into complete paraplegia of lower parts of body upto chest.
Then various investigations were done and vide MRI dorsal spine (Ex. C-40), it was revealed as under:-
"MR findings in this known case of Thyroid CA are suggestive of Bony Metastasis involving D2 Vertebral Soft Tissue Component, The Spinal Cord is Focally Compressed at this level."
32. Posterior Decompression was tried but it was not successful as respondent No. 8 not joined Onco Surgeon or Neuro Surgeon. Had they been joined, they would have suggested for Anteriorlateral approach instead of Posterolateral approach. They had suggested for Anteriorlater approach but that was not appropriate seeing the condition of the patient and she was prescribed extensive physiotherapy but on account of weakness in the bones that was also not practical. Then on 1.7.2000 again her MRI whole body as well as Scintigraphy was done and MRI reported as under:-
"Metastatic Collapse of D2 with anterior epidural infiltration & causing moderate compression of theca and cord", and bone scan revealed "metastatic deposits D2 and Mid Shaft of Right Femur".
and report of Scintigraphy gave conclusion as under:-
"Conclusion :- Appearances consistent with Metastatic Deposits D2 and Mid Shaft of RT Femur"
and on 2.7.2000 Dr. Raj Kamal operated upon the complainant applying Posterolateral approach for removal D2 vertebral body alongwith greyish, soft, moderately vascular tissue, although 25 Consumer Complaint No. 13 of 2004 intervertebral disc and Iliac bone graft was done and after surgery sensation had improved on left side of the body. Again Biopsy was sent to respondent No. 3, who gave the opinion that:-
"There is no evidence of Malignancy in the Sections Studies".
Whereas Tata Memorial Hospital, Mumbai, gave the findings:-
"Metastatic Carcinoma"
It was also sent to Kahlon Diagnostics Cancer Research Centre, Amritsar. They advised as under:-
"In view of Atypical Cells and Patient being known case of Thyroid Malignancy, features appear consistent with M.R.I., Impression of secondary deposits".
Therefore, this report of OP No. 3 was again wrong report. Therefore, it has been contended that no pre-operative investigation like Scintigraph or MRI or Bone Scan to evaluate extent of Metastasis was done as Follecular Carcinoma of Thyroid is metastatise in bones. HPE report dated 17.7.2000 is incomplete as it did not refer to Follecular Carcinoma, which was referred in Ex. C-17 shows casual approach of respondent No. 6 and she was discharged on 17.4.2000. Scintigraph dated 22.5.2000 was done by respondent No. 7 was not proper as it showed residual thyroid tissue in the neck only but missed presence of distant metastasis, which was already there. In case whole body bone scan or pre-operative/ post operative MRI was done to rule out or find functional metastases of the bones, which can be present in case of Follecular Carcinoma of Thyroid then dose of Radio Iodine Ablation of residual Thyroid Tissue could have been extended to that part of the body and the complainant could have been saved from spreading disease upto D2 Vertebra, which resulted into paraplegic condition of the complainant. Even after coming to 26 Consumer Complaint No. 13 of 2004 know about Metastasis Indo Edibra (Anterior) Posterior approach was adopted, which was unsuccessful as no Onco Surgeon or Neuro Surgeon was involved. In case they would have been involved then they will have suggested for Anteriorlateral approach and ultimately, the operation was conducted in Muni Lal Chopra Memorial Hospital, Amritsar and after that there was improvement in the sensation on the left side of the complainant. Accordingly, it has been argued by the counsel for the complainant that due to negligence and inaction on the part of respondents No. 3 to 8 the condition of the complainant has worsened. In case there would have been timely deactivation of Carcinoma by undergoing pre-operative / post-operative test then this condition would have been saved.
33. Here the judgment referred above to determine the medical negligence "Kusum Sharma and others versus Batra Hospital & Medical Research Centre & Others", 2010(3) SCC 480 : 2010 (2) RCR (Civil) 161 issued the guidelines that the following principles must be kept in mind while deciding whether the medical professional is guilty of medical negligence is relevant:-
"I. Negligence is the breach of a duty exercised by omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do. II. Negligence is an essential ingredient of the offence. The negligence to be established by the prosecution must be culpable or gross and not the negligence merely based upon an error of judgment. III. The medical professional is expected to bring a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires.27
Consumer Complaint No. 13 of 2004 IV. A medical practitioner would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field.
V. In the realm of diagnosis and treatment there is scope for genuine difference of opinion and one professional doctor is clearly not negligent merely because his conclusion differs from that of other professional doctor.
VI. The medical professional is often called upon to adopt a procedure which involves higher element of risk, but which he honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure. Just because a professional looking to the gravity of illness has taken higher element of risk to redeem the patient out of his/her suffering which did not yield the desired result may not amount to negligence.
VII. Negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession.
VIII. It would not be conducive to the efficiency of the medical profession if no Doctor could administer medicine without a halter round his neck. IX. It is our bounden duty and obligation of the civil society to ensure that the medical professionals are not unnecessary harassed or humiliated so that they can perform their professional duties without fear and apprehension.
X. The medical practitioners at times also have to be saved from such a class of complainants who use criminal process as a tool for pressurizing the medical professionals/hospitals particularly private hospitals or clinics for extracting uncalled for compensation. Such malicious proceedings deserve to be discarded against the medical practitioners.
XI. The medical professionals are entitled to get protection so long as they perform their duties with reasonable skill and competence and in the interest of the patients. The interest and welfare of the patients have to be paramount for the medical professionals."
34. When the complainant had reported to respondent No. 3 and from the test as observed by respondent No. 4 in Ex. C-17, she was diagnosed as case of Papillary Follicular Carcinoma of Thyroid 28 Consumer Complaint No. 13 of 2004 and he suggested for Portal Hypothyroidism (Hydroractan) with Bilateral Nodule (module) Section. But in the pre-operatively investigation Scintigraphy, MRI of whole body was done to evaluate extent of Metastasis because Follecular Carcinoma of Thyroid is known to metastatise in bones. After surgery Histopathology was done, which referred about Papillary Carcinoma and omitted Follicular Carcinoma, which was already FNAC. Then on 22.5.2000, respondent No. 7 carried out whole body scan and he referred residual thyroid tissue in the neck and no evidence of distant metastasis seen. But on 31.5.2000, when MRI dorsal spine was done after a gap of just one week it revealed "Bony Metastasis involving D2 Vertebral Soft Tissue Component", which showed that the whole body scan conducted by respondent No. 7 was not a correct body scan. Since the complainant was infected with Follicular Carcinoma, which is known to metastatise in bones, therefore, apart from Total Thyroidectomy, the Ops should have also suggested Scintigraphy MRI to rule out the extent of metastatise but it was not done; it was done only when the disease had spread to the bones and she was percolate and reported to respondent No. 3 on 31.5.2000. Therefore, certainly, it is lapse on the part of OP Nos. 3 to 8 for not conducting proper pre-operative / post operative tests, which were required to be done to rule out the metastasise in the bones, which ultimately, was detected at a later stage when the complainant was fully Parapleged (Paraplegia), although it was there and in case timely test would have been done then it could be checked with Radio Iodine Ablation. 29 Consumer Complaint No. 13 of 2004
35. So far as Posterior Decompression, which was tried by respondent No. 8, it was un-successful. Had he taken the attendants of Onco Surgeon or Neuro Surgeon, they would have advised Anterior approach but in case we see the record, lateron surgery was conducted by Muni Lal Chopra Memorial Hospital, Amritsar in July, 2000 and they have also followed Posterolateral approach, which was successful, therefore, it cannot be said that in case respondent No. 8 followed Posterolateral approach, it was a wrong approach. It is a different matter that his approach was not successful. Further the report of respondent No. 7-Dr. Sunil Kumar (Dr. Uma Ravishankar) when Biopsy was sent to respondent No. 3 in which he reported that there is no evidence of "there is no evidence of Malignancy in the Sections Studies" whereas when it was sent to Tata Memorial Hospital, Mumbai, it gave the findings "Metastatic Carcinoma" and similar report was received from Kahlon Diagnostics & Cancer Research Centre, Amritsar, therefore, this report was not a correct report, which further gave indications with regard to the casual approach, which was adopted by the Doctors of respondent No. 3 in treating the complainant. Whereas the counsel for respondent No. 4, who is contesting this complaint because the remaining are ex-parte or their written reply has not been taken on the record, being not filed within time, it has been stated that there is no expert evidence to say that the treatment given to the complainant was not proper treatment. Error of judgment is not a negligence, therefore, respondent No. 4 was not wrong in his approach. He is one of the known Oncologist of 30 Consumer Complaint No. 13 of 2004 India and without any expert report, no findings can be recorded against respondent No. 4.
36. No doubt if there is no clear evidence, the expert report may be helpful to arrive at a conclusion whether the treating Doctor is negligent or not but where from the documents, one can judge the lapses on the part of the Doctor then the absence of any expert report will not be material.
37. No doubt respondent No. 4 may be best Oncologist but it is no criteria to judge the negligence. Even the experienced Doctor can be negligent in case their approach is casual. Keeping in view the details of the treatment given to the complainant, who had come to respondent No. 3 on 7.4.2000, in case as referred above MRI, Whole Body Scan, Scintigraphy would have been done to know metastasis in the bones then the condition, which the complainant had developed could be saved because she was suffering from Follecular Carcinoma, which is known to metastasis in bones but no efforts were done by the Doctor of respondent No. 3 to go for these tests and in case tests were done, those were not correct tests because whole body scan was done on 22.5.2000 (Ex. C-31) and in that report no distant metastasis was seen. But when after a week i.e. 31.5.2000, the complainant was completely Paraplegic and her MRI was done that metastasis in bones involving D2 vertebral was found, which clearly shows that they have failed to do what the ordinary experienced Doctor should have done in this type of cases, therefore, it is clear cut case of medical negligence.
31Consumer Complaint No. 13 of 2004
38. The respondent No. 4, who was Surgical Oncologist was the main and was required to suggest these tests is responsible for the same. Alongwith him Dr. G.C. Vaishnava, Dr. Sumaid Kaul and Dr. Uma Ravishankar was involved in the examination of tests, they were also responsible for not giving the correct diagnoses, in this way, respondents/OP Nos. 3 to 7 are held medically negligent qua the complainant. So far as respondent/OP No. 8 is concerned as stated above his approach was not wrong, it is different matter that his operation was not successful, therefore, it cannot be said that there is any medical negligence on his part.
39. Now with regard to the quantum of compensation. It is not disputed that the complainant was having Diploma in Staff Nursing; she was working as such; she was young girl of 20 years at that time and when she reported to respondent No. 3, she was just 22 years of age. In case her disease would have been timely detected then she could be saved from the wrath of this dreaded disease of Cancer and she would have bright future. She was in the marriageable age and with this disease, now her marital prospectus have also been diminished, therefore, the compensation is to be fixed according to the suffering received by the complainant and the extent of negligence on the part of the respondents. There is no straightway formula to assess the compensation, it depends from case to case. Keeping in view the circumstances of this case and the amount so spent by her on the treatment, which ultimately was not successful at the hands of respondents No. 3 to 8 and further complicated disease of the complainant; we assess the lumpsum compensation of Rs. 20 32 Consumer Complaint No. 13 of 2004 lacs (Rs. 20,00,000/-), which will be paid by respondents (OP) Nos. 3 to 8 jointly and severally to the complainant.
40. Respondent No. 3, who is an institution and is vicariously liable for the same; will pay Rs. 8 lacs and similarly respondent No. 4, who was the main Doctor will pay Rs. 6 lacs and respondents No. 5, 6 & 7 will pay Rs. 2 lacs each. Since respondent No. 4 was insured and insurance was given by respondent No. 10, therefore, respondent No. 10 will indemnify the claim of respondent No. 4.
41. Respondents No. 3, 4 5, 6, & & 10 are directed to comply with the abovesaid directions within 45 days from the receipt of copy of the order, failing which then proceedings under Section 25 & 27 of the C.P. Act can be initiated against them.
42. The complaint is accepted in the above terms.
43. The arguments in this consumer complaint were heard on 25.3.2014 and the order was reserved. Now the order be communicated to the parties as per rules.
44. The consumer complaint could not be decided within the statutory period due to heavy pendency of Court cases.
(Gurcharan Singh Saran) Presiding Judicial Member (Vinod Kumar Gupta) Member April 7, 2014. (Harcharan Singh Guram) as Member Judgment referred to Reporter (Gurcharan Singh Saran) Presiding Judicial Member