State Consumer Disputes Redressal Commission
Dr.Loganathar,Dr.Ramanujam ... vs Murugan,Ambasamudram,Tirunelveli ... on 25 April, 2024
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IN THE CIRCUIT BENCH OF THE TAMILNADU STATE CONSUMER
DISPUTES REDRESSAL COMMISSION, MADURAI.
Date of appeal filed: 04.02.2016
Present.
THIRU.S.KARUPPIAH, PRESIDING JUDICIAL MEMBER
F.A.No.12/2016
THURSDAY, THE 25thDAY OF APRIL 2024
Dr.Loganathar,
Dr.Ramanujam Hospital,
College Main Road,
Amabasamudram, Ambasamudram Taluk,
Tirunelveli District. Appellant/1st Opposite Party
-Vs-
1. Murugan, (died),
S/o Late Paulraj,
11B, Middle Street, Mudappalam,
Ambasamudram, Ambasamudram Taluk,
Tirunelveli District. 1st Respondent/Complainant
2. Dr.A.Chidambaravadivu,
Dr.Ramanujam Hospital,
College Main Road, Amabasamudram,
Ambasamudram Taluk,
Tirunelveli District. 2nd Respondent/2nd Opposite Party
3. Mrs.Selvi,
W/o P.Murugan. 3rd Respondent/2nd Complainant
4. Esakkimuthu,
S/o P.Murugan, 4th Respondent/3rd Complainant
Rep.by Mrs.Selvi her mother
And natural guardian.
5. Esakkiammal,
D/o P.Murugan, 5th Respondent/4th Complainant
Rep.by Mrs.Selvi her mother
And natural guardian.
6. Pargavi,
D/o P.Murugan, 6th Respondent/5th Complainant
Rep.by Mrs.Selvi her mother
And natural guardian
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7. Vasantha,
Mother of P.Murugan, (Deceased). 7th Respondent/6th Complainant
All are residing at:
11B, Middle Street,
Mudappalam,
Ambasamudram,
Ambasamudram Taluk,
Tirunelveli District.
Counsel for Appellant/Opposite Party-1 : M/s S.Palanivelayutham, Advocate.
Counsel for Respondent-1/Complainant-1 : Died.
Counsel for Respondent-2/Opposite Party-2 : Given-up.
Counsel for Respondents-3to7/Complainants-2to6 : Mr.B.Dhanasekaran, Advocate.
Aggrieved with the award passed by the District Consumer Disputes Redressal
Commission, Tirunelveli, made in C.C.No.182/2013, dated 21.12.2015 the 1 st
opposite party/doctor filed this appeal. This appeal coming before me for final
hearing on 25.03.2024 and upon perusing the material records, this Commission
made the following:
ORDER
THIRU.S.KARUPPIAH,PRESIDING JUDICIAL MEMBER.
(Dictated in the Open Court)
1. The Facts: On 29.10.2011 at 7.30 A.M the complainant has experienced pain in his right leg and he approached the opposite party's hospital. At the time the opposite parties were not available in the hospital. Since the pain was severe, duty nurses rang up the opposite parties and on the advice of the opposite parties over phone, 15 injections were injected in both the hips. After administering the injections there was numbness and swelling in the right leg. Since the opposite 3 party's nurses injected wrong drug or expired drugs there was swelling in his leg. The opposite parties came at 9.00 A.M and they informed that the tissues in the hips had torn and advised to wear hip belt. Even after that the pain did not reduce. After giving wrong treatment the opposite parties collected a sum of Rs.7,500/- towards service charges, and asked him to go to the Tirunelveli Medical College Hospital and he was discharged on 31.10.2011. On the same date he was admitted as in-patient in Tirunelveli Medical College Hospital and the duty doctors informed that a wrong treatment was given by the opposite parties and casting was done. He was treated for for seven days as in-patient , even then it was not cured. Hence he was referred to Madurai Rajaji Hospital. On 10.11.2011 at Rajaji hospital, since the ailment would not be cured, his right leg below the knee was amputated and he was discharged on 03.12.2011. Again on 03.05.2012 he was admitted in Madurai Rajaji hospital and his another leg was also amputated on 16.05.2012 and he was discharged on 07.06.2012. His both legs were amputated because of the wrong treatment given by the opposite parties. On 31.08.2012 the complainant sent an advocate notice regarding the deficiency in service. On 01.09.2012 the 1 st opposite party received it. On 03.09.2012, the 2nd opposite party received the notice. On 18.09.2012, the 1st opposite party alone replied with false information. Hence for the deficiency in service he filed the consumer complaint to direct the opposite parties to pay totally Rs.20,00,000/- towards compensation for mental agony, loss of legs, financial loss, deficiency of service and medical expenses and also cost of the proceedings.
2. The opposite parties filed their written version stating that they have denied the complaint averments. For the past 10 years the 1st opposite party has been providing free medical service for poor and middle class people. The opposite party 4 is a very famous medical practitioner in that area. The complainant did not come to the opposite party clinic on 29.10.2011. Only on 30.10.2011 between 7.00 A.M to 7.30 A.M this complainant came to their hospital. The complainant was accompanied by his wife, mother and another person and the complainant walked with the support of the above said people and he found it very difficult to walk and got admitted into the opposite party hospital. On oral enquiry it was revealed by the complainant that because of the acute excruciating pain radiating from his back and hips down to his both legs and because of this complainant was not able to perform his basic morning activities of daily living especially toileting. The pain was unbearable. The complainant was literally rolling over the bed due to the nature of pain. Immediately the opposite party advised the nurses and to give analgesic injections. As the pain persisted steps were taken to find out the source of the pain. During history taking the complainant told that he had smoking habit for more than 30 years. Further he had the habit of drinking alcohol too. The opposite party suspected this is not a normal pain and realized that patients with chronic smoking habits, blocks might occur in the blood vessels known as peripheral vascular disease which result in ischemia induced pain. So with first aid treatment the 1 st opposite party has advised the complainant to undergo other investigations like blood test, X-ray, CT scan and MRI scan. Since this condition is treatable only by a specialist explained to the complainant, and reference letter was given to Tirunelveli Government Medical College Hospital. But he was taken to the Tirunelveli Medical College Hospital only on the next day of the recommendation. While being discharged from the opposite parties clinic, the complainant went stating that they would settle the hospital bills in two days but till now the complainant has not paid 5 the amount. The medical practitioner rendering professional service free of charges has no obligation under the Consumer Protection Act 1986. The 2 nd opposite party was not at all present in Ambasamudram at that time. The 1st opposite party did not provide any other treatment apart from first aid. So the 1 st opposite party is no way responsible for the current status of the complainant. The complainant solely being responsible for his final stage of the disease due to his carelessness. Further on enquiry by the opposite party in the Tirunelveli Medical College Hospital, it is reliably learnt that during the treatment at Tirunelveli Medical College Hospitals some wrong method of treatment was followed and the opposite parties are in no way negligence. Doctors who have treatment in the Tirunelveli Medical College Hospital are also necessary parties, since they have treated for seven days. Hence they prayed to dismiss the complaint.
3. The District Commission, received both sides proof affidavits, and documents Exhibits-A1 to A11, and Exhibit-B1, and on the side of complainant two more witnesses were examined and Ex.X1 was also marked. The District Commission allowed the complaint in-part, passed an award directing the first opposite party to pay Rs.5,00,000/- towards compensation for deficiency in service and mental agony suffered by the complainant and also to pay Rs.3000/- as costs to the complainant. The complaint was dismissed as against second opposite party.
4. Aggrieved with the above order, the appeal has been preferred by the first opposite party. In his written argument as well as in the grounds of appeal the learned counsel has submitted that the order of the District Commission is erroneous. The District Commission wrongly concluded the first opposite 6 party/doctor committed medical negligence. On the other hand the District Commission failed to note the doctors at Tirunelveli Medical College Hospital and Doctor at Government Rajaji Hospital, Madurai were not impleaded who had treated the patient subsequently and who had operated the patient. Moreover the patient's legs amputated and there is no pleading or proof filed by the complainant to prove any nexus between amputation and treatment of the first opposite party. The learned counsel further submitted as a General Medical practitioner the first opposite party treated and gave only first aid to the patient. Hence he prayed to allow the appeal.
5. On the other hand the respondents-3to7/complainants-2to6 reiterated what they have alleged in the complaint and proof affidavit.
6. This Commission perused both sides written arguments and their oral arguments.
7. Now the point for consideration is:
Whether the first opposite party/doctor committed any medical negligence?
8. Point: As stated earlier, originally one P.Murugan filed a consumer complaint alleging medical negligence against one doctor Loganathar/1st opposite party, and his wife Chidamabaravadivu/2nd opposite party. The District Commission allowed the complaint and awarded Rs.5,00,000/- only against first opposite party/doctor and dismissed the complaint as against second opposite party/doctor. The above dismissal of complaint against second opposite party become conclusive as there is no appeal preferred by the complainant. While the appeal filed by the first opposite 7 party is pending, the complainant/P.Murugan, died and his legal heirs were impleaded as respondents-3to7/complainants-2to6.
9. Coming back to the facts of the case the complainant/P.Murugan approached the first opposite party/hospital complaining severe back pain. It is his allegations that he went to hospital on 29.10.2011. On the other hand the opposite party contended that the patient approached them only on 30.10.2011. Whatever it may be at the time of the complainant/patient presented for treatment, the doctors were not present and the complainant was treated only by the nurses of the above hospital. Though this fact was denied by the opposite party in their written version but in his cross-examination, the doctor admitted he usually visited the hospital at 9.00 A.M. Admittedly the patient presented for treatment around 7.00 a.m. in the treatment slip Exhibit-B1 it has been clearly mentioned by the opposite party the patient was admitted at 7.00 a.m. on 30.10.2011. The doctor further admitted the nurses who were present treated the patient but under his guidance. So from 7.00 A.M. to 9 A.M. the patient suffered from severe acute pain in his back side was treated by non qualified medical personal. The patient was not seen by the opposite party/doctor. But without seeing the patient, the doctor diagnosed something and prescribed medicines to treat the patient through phone which amounted to medical negligence. The District Commission primarily found this fact as one of medical negligence and carelessness on the side of the first opposite party/doctorand this Commission concurred with it.
10. The subsequent allegations of the complainant that, the nurses administered some wrong medicines or contaminated and expired medicines, so that he 8 immediately felt numbness in his right leg. Though this fact was denied by the opposite party/doctor but the patient was kept for two days observations by the doctor in his hospital. The doctor admitted he treated for two days and referred the patient to Tirunelveli Medical College Hospital for further management, the above referral letter is marked as Ex.A2. In the above referral letter the doctor opined that the complainant suffered from disc prolapse and sciatica. So as per his diagnosis he suspected the patient was suffered either by disc prolapse or sciatica only. The above referral letter was dated 31.10.2011 and the referral letter was given either at the time of discharge or after discharge from the hospital.
11. Contrary to this referral letter diagnosis, in Ex.B1 apart from above diagnoses Disc prolapse, lumbar spondylosis disorder, Nerve compression syndrome and sciatica. In the same page as an afterthought the Doctor additionally noted as he suspected Peripheral vascular disease. This note was an inserted one, written in a different ink. This above additional note is highly important as it was not the original diagnosis of the doctor. Only to substantiate that subsequent amputation was only due to Peripheral vascular disease and not because of any of his deficient treatment he had added those notes.
12. Similarly the Doctor made another additional note in the same page as"leg lift test unable to do". On the other hand during his stay the hospital the patient was given Physiotherapy. The Physiotherapy made an endorsement "SLR Negative, Dorsal nerve root Compression, sciatica pain, foot drop". The above note has been in different ink and it has been introduced in between the gaps. In the entire written version or evidence the doctor did not say that the complainant was given 9 physiotherapeutical exercise and treatment. When there was no pleading about any treatment by physiotherapist then, the endorsement also become vital.
13. The doctor's initial doubt of Disc prolapsed lead the Tirunelveli Medical College Hospital to take some initial investigation, and also found L4, L5 ,S1 Disc prolapsed. So the initial diagnosis of the doctor and his observation that the complainant was unable to raise foot were correlated with the clinical finding in the District Headquarters Hospital. However the complainant subsequently suffered numbness in his right leg apart from his initial complaint is back pain. The above numbness was also noted in the Tirunelveli Medical College Hospital as "Patient developed radiating pain in right lower Limb for 10 days. Had treated nearby hospital. Patient suddenly developed weakness of right leg and foot annotated sensory loss". If the patient suffered from any disc prolapsed need not underwent such subsequent complaint of numbness and loss of sense. The complications of numbness and loss of sensory in right leg occurred to the patient only after treatment by the first opposite party/doctor. Later complications developed and gangrene was formed resulting amputation of his legs. To escape from any tortious liability the doctor created as if he too diagnosed the pain was due to peripheral vascular disease
14. This Commission wants to emphasize if the doctor initially doubt the patient was suffering from peripheral vascular disease then he must act swiftly to refer the patient for Doppler Study and further management. But without doing so he kept the patient for two days observations which is also amounted to negligence on his part. The Doctor did not plead that he advised Doppler scan, but contrary to this he noted that" Doppler scan advised but refused by the patient". Apart from that the 10 doctor tried to emphasize the complainant was a chronic smoker and alcoholic. Ofcourse he may be a smoker and there is every possibility for a smoking person to suffer from peripheral vascular disease., that is Thromboangiitis obliterans (TAO) is nonatherosclerotic inflammatory disease of the peripheral blood vessels, and TAO affects the small and medium sized vessels of the extremities. TAO is mainly seen in young males who smoke, and smoking is strongly associated with the disease course and progression. The doctor put much pain to establish that the patient had smoking habit for 20 years, 30 years etc. Infact no such years have been entered in the discharge summary. This over emphasize and effort proved he is trying harder to cover up his mistakes.
15. At the same time a study reveals, many complications may arise in the injection site including: cellulitis, abscess, infected pseudoaneurysm, and infected deep vein thrombosis. Infected femoral pseudoaneurysm occurs as a result of inadvertent intraarterial or periarterial injection of illicit drugs. Extravasations of blood and contamination of the subsequent hematoma causes break down and rupture of the vessel wall and formation of an infected pseudoaneurysm, associated with a risk of mortality and limb amputation. So this Commission too found wrong administration of injections lead to miseries of the patient. On perusal of the treatment particulars which is marked as Ex.B1 containing five sheets, they were not correlated to each other. For example in the first sheet numbers of injections though have been advised, all of them were not found in that Drug Chart. Particularly injection Dexa 8 mg, and injection Retty IM, were not at all prescribed by the doctor but they were found in the drug chart. These discrepancy additions, insertion proved that the records were not maintained properly and they were cooked up for the purpose of 11 this case. The Hon'ble National Consumer Disputes Redressal Commission in its Judgment Dr.K.Vasanthi & Anr. .Vs. Chalasani Satyanarayana on 9 January, 2023 has held.
Further, I can't ignore the non-maintenance of vital medical record by the OPs. It was the primary duty of treating doctor to maintain proper treatment record including anesthesia, Operative notes , the medication, details of recovery from anesthesia etc. It should be borne in mind that, though I & D was a minor surgical procedure, OP-1 performed it under General Anesthesia and post operatively the patient was in ICU for 6 hours. Proper documentation will help to prove the doctor's duty of care and to defend certain unavoidable and unforeseen complications. Therefore, the Petitioners (OP-1 & 2) are held liable for the deficiency in services
17. Medical records not only serve as necessary documents for apt management of a patient, they are also legal documents. These records contain useful evidence for diverse litigations including personal injury cases, criminal cases, workers' compensation, disability determinations, and medical negligence claims. It should be borne in mind that "Good Record is Good Defense" Poor Record is Poor Defense" and "No record is No Defense." Thus, accurate and complete medical documentation is vital for appropriate and efficient patient care".
So non maintaining of records is also one of the deficiency or negligence committed by the opposite party. The District Commission found there was negligent on the part of the doctor in maintaining the records and handing over the same to the 12 complainant. This Commission also concurred with the above finding on the basis of the above discussions.
16. At this juncture the finding of the District Commission is to be upheld as this Commission is also confirmed the first opposite party/doctor committed medical negligence in two or more ways. The compensation of awarded by the District Commission is very reasonable. Moreover the patient subsequently died during the pendency of the appeal, and considering all those facts the appeal is liable to be dismissed as per the above discussion. Hence the order of the District Commission is hereby confirmed and the appeal is dismissed with cost and answered the point accordingly.
17. In the result,
1. The appeal is dismissed.
2. The order passed by the District Commission, Tirunelveli, in C.C.No.182/2013, dated 21.12.2015 is hereby confirmed.
3. The appellant/1st opposite party is directed to pay further cost of Rs.10,000/- to the respondents-3to7/complainants-2to6 in this appeal.
Dictated and pronounced in the open court to the Steno-typist transcribed and typed by her corrected and pronounced by me on this the 25th April 2024.
Sd/-xxxxxxx S.KARUPPIAH, PRESIDING JUDICIAL MEMBER.
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