State Consumer Disputes Redressal Commission
Shamim Parveen & Ors. vs Dr. Lalit Shah & Ors. on 14 March, 2016
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION,
PANDRI, RAIPUR (C.G.)
Complaint Case No.CC/2014/33
Instituted on : 24.11.2014
01. Shamim Parvin, Age 23 years,
(Daughter of Deceased Smt. Shabnam Bano and
Special Power of Attorney Holder of Complainant
No.02, 03, 04, 05 and 06.
02. Wakilluddin, Age 50 years,
S/o Late Jahiruddin,
(Husband of Deceased Late Smt. Shabnam Bano)
03. Shama Parvin, Age 28 years,
W/o Fahimmuddin
(Daughter of deceased Late Smt. Shabnam Bano)
04. Heena Parvin, Age 24 years,
W/o Saiyyad Irfan Ali,
R/o Kelabadi, Durg
(Daughter of Late Smt. Shabnam Bano),
05. Nadimmuddin, Age 20 years,
S/o Wakilluddin,
(Son of deceased Late Smt. Shabnam Bano),
06. Azharuddin, Age 17 years,
S/o Wakilluddin,
(Son of deceased Late Smt. Shabnam Bano).
Complainant No.01, 02, 03, 05 & 06 are
Resident of : Ward No.36, Moudhapara,
Ward No.36, Moudhapara,
Raipur (C.G.) ... Complainants.
Vs.
1. Dr. Lalit Shah, (M.S.) (M.C.H.) Urologist,
Proprietor : Jagjivan Urology Centre,
B/04, Main Road, Samta Colony,
Raipur (C.G.)
// 2 //
02. Dr. Sandeep Dave, Laparologist, Director,
Ramkrishna Care Hospital,
(NABH Accredited Hospital),
Arbindo Enclave, Pachpedi Naka,
Dhamtari Road, N.H.43,
Raipur - 492001
03. Dr. Ajay Parashar,
Urologist,
Ramkrishna Care Hospital,
Raipur (C.G.)
04. Oriental Insurance Company Limited,
R.K. Plaza,
Pachpedi Naka, Ring Road No.1,
Raipur (C.G.)
05. Insurance Company United India Insurance Co. Ltd.
Corporate Cell - Ramalay Building 1-7-241/10,
S.D. Road,
Secunderabad ... Opposite Parties
PRESENT: -
HON'BLE SHRI JUSTICE R.S. SHARMA, PRESIDENT
HON'BLE MISS HEENA THAKKAR, MEMBER
HON'BLE SHRI D.K. PODDAR, MEMBER
HON'BLE SHRI NARENDRA GUPTA, MEMBER
COUNSEL FOR THE PARTIES:
Shri Amin Khan, for the complainants
Miss Pravin Arora, for O.P.No.1.
Shri Shishir Bhandarkar, for O.P.No.2 & O.P.No.3.
Shri Manoj Prasad, for O.P.No.4.
Shri P.K. Paul, for O.P. No.5.
ORDER
Dated : 14/03/2016 PER :- HON'BLE SHRI JUSTICE R.S. SHARMA, PRESIDENT. The complainants filed this consumer complaint under Section 17 of the Consumer Protection Act, 1986 against the OPs seeking reliefs as under :-
// 3 // (1) To direct the OPs to jointly and severally pay a sum of Rs.3,50,000/- (Rupees Three Lakhs Fifty Thousand Only), which was spent in treatment taken by the deceased at Yashoda Hospital, and also pay a sum of Rs.5,00,000/-
(Rupees Five Lakhs Only) which was incurred in respect of taking the patient to Hyderabad and other expenses. (2) To direct the OPs to jointly and severally to pay a sum of Rs.10,00,000/- (Rupees Ten Lakhs Only) to the complainant No.2, because due to negligence and wrong treatment given by the O.P.No.1 to O.P.No.3, the complainant No.2 was deprived from his companion and was to suffer pain of death of his wife.
(3) To direct the OPs to pay jointly and severally a sum of Rs.15,00,000/- (Rupees Fifteen Thousand Only) to the complainant No.1 because the deceased is mother of complainant No.1 and at present the O.P. No.1 is unmarried and is doing P.H.D. and due to sudden death of Smt. Shabnam Bano, she suffered severe mental shock due to which her future study was badly affected because after death of Smt. Shabnam Bano, the entire family liability comes in the shoulder of the complainant No.1 and due to sudden death of Smt. Shabnam Bano problem regarding marriage of complainant No.1 come because her mother Smt. // 4 // Shaban Bano was searching groom for complainant No.1, therefore, it is not possible to calculate the cost of above mental shock in money, even then she is demanding a sum of Rs.15,00,000/-.
(4) To direct the OPs to pay jointly and severally a sum of Rs.10,00,000/- (Rupees Ten Lakhs Only) to the complainant No.3 & 4, because the complainant No.3 & 4 are married daughter of the deceased who suffered mental shock due to death of their mother.
(5) To direct the OPs to jointly and severally pay a sum of Rs.10,00,000/- (Rupees Ten Lakhs Only) each to the Complainant No.5 and Complainant No.6 because the complainant No.5 and 6 are sons of the deceased, at present they are studying and due to sudden death of their mother their studies are badly affected and they are deprived from affection of their mother, Thus the complainants have demanded total amount of Rs.68,00,000/- (Rs. Sixty Eight Lakhs) from the OPs jointly and severally.
2. Brief facts of the complaint are that : the complainant No.1 is daughter of deceased Smt. Shabnam Bano and she has been appointed Special Power of Attorney by remaining complainants in the instant case. The complainant No.2, is husband of deceased, complainant // 5 // No.3 and complainant No.4 are daughters of the deceased, complainant No.5 and 6 are sons of the deceased. The O.P.No.1 Dr. Lalit Shah, is running a hospital namely Jagjivan Urology Centre. The O.P.No.2 Dr. Sandeep Dave, is running a hospital namely Ramkrishna Care Hospital and the O.P.No.3 Dr. Ajay Parashar is giving his services as Urologist to O.P.No.2. In the month of January, 2014, Smt. Shabnam Bano, suffered pain in right side of her abdomen, therefore, she contacted with the Doctors and some of them advised her for undergoing operation of stone. In the year 2006, the uterus of the deceased was removed and after removal of the uterus, the deceased was suffering from such problem, therefore, the complainant No.1 did not want to conduct operation of the deceased. On 21.03.2014, the complainant No.1 along with her mother (deceased) went to O.P.No.1 with entire reports and the O.P.No.1 had taken details regarding the health of the deceased. The complainant No.1 and deceased informed that since last two years, the deceased was suffering from pain in right side of her abdomen and was also suffering from vomiting and also suffering from phode phunsi and blister. The O.P.No.1 minutely perused the reports of the deceased and after taking all information regarding her health for last 10 years, he informed that the there was no stone in kidney of the deceased, but it appears that due to contraction in the kidney of the deceased she was suffering pain, therefore, operation is not required and laser surgery is required. The laser surgery can be conducted within 20 minutes and the patient will be discharged from // 6 // the hospital within 2-3 days. As the O.P.No.1 expressed that he will treat the deceased through laser procedure, therefore, the complainants were ready for treatment of the deceased through O.P.No.1. On the advice of the O.P.No.1, the patient was admitted on 22.03.2014. On 21.03.2014 and 22.03.2014, the patient herself without any help went to O;.P.No.1. On 22.03.2014 again the O.P.No.1 examined the previous report and after obtaining some test reports, the O.P. No.1 took the patient for laser operation and after about 1 hour the O.P.No.1 came out from the operation theatre and told that he is not understanding regarding treatment of laser, perhaps the laser are not reaching to the actual place therefore for by passing the contraction of the kidney, a stent has to be inserted for which an open surgery is required. The O.P. No.1 gave wrong advice to extract money, which comes in the category of the deficiency in service. The O.P.No.1 told that there was too much fat inside, therefore only open surgery is required procedure. The deceased was taken by the doctor to operation theatre, therefore, there was no option with the complainants, hence on believing on the version of the O.P.No.1 the complainants told the O.P.No.1 treat the patient as you deem fit. After 6 hours of the operation, the O.P.No.1 came outside and told that he inserted the stent in the abdomen of the deceased in which 22 stitches were used, but when the laser surgery done by the O.P. No.1 was unsuccessful, then prior to conducting open surgery, it was ensured through medical and pathology test actually in which place what is the problem and thereafter only operation should be // 7 // done, but the O.P.No.1 confined the patient (deceased) in the Hospital with an intention to increase the bill of the hospital and treat her wrongly and conducted unnecessary surgery. On 22.03.2014, the O.P.No.1 conducted open surgery of abdomen of the patient on the basis of Ultra Sonography of 11.01.2014 and 25.02.2014, whereas according to Sonography there was stone in ureter of the patient and there was swelling in kidney but O.P.No.1 without obtaining any test report told that there was uretral structure in the above part of the patient. The O.P.No.1 did not mention regarding this in the discharge summary and only on the basis of possibility the O.P.No.1 conducted open surgery of the patient and inserted stent in the kidney. The O.P.No.1 treated the patient in a very negligent manner, which itself is confirmed from the discharge summary prepared by the O.P.No.1. The O.P.No.1 obtained all information from the patient at the time of medical investigation that the uterus of the patient has been removed and it is mentioned in the ultrasonography that there is no uterus in the body of the patient and in these circumstances the O.P. No.1 was required to conduct necessary tests prior to conducting surgery of kidney which is near the uterus, but the O.P.No.1 did not treat the patient in right direction and did not make effort to conduct test. After discharge from the O.P.No.1 hospital, the patient was taken to home where swelling and pain in her right leg was increased, then the complainant No.1 again took the patient (deceased) to O.P.No.1 and after conducting sonography on 14.04.2014, it was told that there is // 8 // possibility of bone disease. Then the complainants shown the patient to Orthopaedics Dr. Roychaudhary, who advised for M.R.I. After conducting M.R.I. on 05.05.2014, the report was shown to Dr. Roychaudhary, who advised to show the said report to the doctor who conducted operation i.e. O.P.No.1. On the advice of Dr. Roychaudhary, the patient was again taken to O.P.No.1 and said report was shown to him. After seeing the said report, the O.P.No.1 told that there is possibility of D.V.T. disease and he referred the patient to O.P.No.2 whereas looking to the above M.R.I. report, there is no symptoms of D.V.T. disease on the basis of which the patient was referred to O.P.No.2. The O.P. No.1 has not properly appreciated the M.R.I. Report and also ignored the advice of Dr. A.D. Raje. Dr. A.D. Raje advised for M.R.I. /C.T. Scan of entire abdomen, but the O.P.No.1 did not get conduct the above test and did not tell regarding such test. After referring the patient by the O.P.No.1 to O.P.No.2, the entire record was shown to the O.P.No.2 and thereafter on 05.05.2014, the patient was admitted in O.P.No.2 hospital. During her admission in the Hospital, the O.P.No.2 and O.P.No.3 were giving Eophil Forte medicine to the deceased, which is given in filaria disease whereas prior to starting treatment of filaria, filaria test is done, which is done in mid night, but the O.P.No.2 and O.P.No.3 started to give medicine of filaria without conducting filaria test. Thus the O.P.No.2 and O.P.No.3 were giving treatment in respect of filaria without any test on the basis of possibility. After admission of the // 9 // patient in the hospital, her treatment was started and during treatment on 10.05.2014 the C.T. Scan of entire abdomen was conducted in which it is mentioned that big size lymphnodes were found in many places and the Doctor who conducted the C.T. Scan had written to diagnose after conducting clinical and histopathological test, but the O.P.No.2 and O.P.No.3 ignored the same and treated the patient in wrong direction due to which the disease of the patient was continuously increasing. During treatment, the O.P.No.2 and O.P.No.3 conducted D.V.T and other tests and sonography, in which according to the doctors of Ramkrishna Care Hospital, all reports are normal. The patient was being treated by the O.P.No.2 Dr. Sandeep Dave and O.P.No.3 Dr. Ajay Parashar, Urologist but they are not giving any rely in respect of disease of the patient and there is no improvement in the condition of the patient but the bill of the O.P.No.2 & O.P.No.3 was continuously increased due to which the complainants were distressed that what was is the actual disease to the patient. The O.P.No.2 & O.P.No.3 without ascertaining the disease of the patient, are treating the patient on possibility only for increasing the bill of the hospital, which comes in the category of deficiency in service. Therefore, the complainants are entitled to get compensation from the OPs, as mentioned in the prayer clause of the complaint.
3. The O.P.No.1 Dr. Lalit Shah filed his written statement and averred that the case of the complainants is not maintainable before this // 10 // Commission because O.P.No.1 has not done any medical negligence or deficiency in service. According to the judgment of the Hon'ble Supreme Court of India in case of Martin F. D'Souza Vs. Md. Isfaq reported in CPR 2009 (1) Page 231, the Hon'ble Commission will not register any case unless there is any report of medical board or any expert report that the concerned doctor is negligent. The complainant has not filed any report or evidence in this regard. Hence the case of the complainant is liable to be dismissed on this ground only as per the judgment of the Hon'ble Supreme Court of India. The case of the complainants is not maintainable because the complainants have not made the party to the Insurance Company from who Dr. Lalit Shah, has taken the Professional Indemnity and is covered under the Policy. The Policy is obtained from Oriental Insurance Company Limited, the policy No. is 191300/48/2014/2238, the period of insurance is from 17.01.2014 to 16.01.2015, hence the Oriental Insurance Company Limited is the necessary party. The complainants have not come to this Commission with clean hands, and have suppressed material facts before this Commission, and have twisted the facts to suit their own malafide purpose, and to harass and extort large amount form the OPs under the false ground. The complaint is false, frivolous, baseless and vexatious, hence the compliant requires to be dismissed. The fact of matter is that the deceased Smt. Shabnam Bano had right flank pain since about more than two months. The complainants have not come with the clean hands and are twisting the story in retrospect to their // 11 // malafide intentions. They have intentionally hidden the prescription / advice papers of other doctors from this Commission. The fact is that the attendants of the patient had been careless about the treatment of the patient, while the patient always wanted treatment and relief from pain. This fact is obvious again by the fact that she came to O.P.No.1 as outpatient on 21/03/2014, when seeing the condition of the patient and her right kidney, the O.P.No.1 had advised admission after explaining various options and plan of management, prognosis, various possibilities, possible complications and failure, but she was not admitted. She got herself admitted on 22.03.2014 in evening as emergency case as she was having severe right flank pain. The patient or attendants (most of the time only one daughter used to be with her as attendant) had never given the history of such pain since 2006. It is unbelievable that any patient can be operated without his / her willingness. They can refuge the procedure at various stages. They may not come to the doctor or nursing home/ hospital. They may refuge to sign the consent for surgical intervention etc. Hence the allegation of patient not wanting to get operated / treated is totally false and baseless. The patient was brought to O.P.No.1 on 21.03.2014 as outpatient with complaint of right flank pain since more than about two months. She never complained of mouth ulcers or so called phode- phunsi. This seems more like a cooked up imaginary story in retrospect. It is unbelievable that she complaints of something like mouth ulcers and phode-phunsi since about two months, which does not heal for // 12 // months altogether. The complainants themselves are mentioning that the O.P.No.1 had taken history , examined the patients and checked all available investigations meticulously and in details, which itself is the proof of O.P.No.1's carefulness, sincerity, skill, diligence, knowledge and experience. She gave history of hysterectomy 6-8 years ago. On asking for the record of the same, they told it is not available. On asking about histopathology report of the same, they told "we do not have any, sab theek tha." The O.P.No.1 had explained in details about the various possibilities of the situation. The O.P.No.1 had told them very clearly that it is case of obstructed right kidney, the damage to the right kidney is also significant, any further delay would jeopardize the possibility of saving the right kidney. Patient would get pain and suffer in addition. Even if the patient is not getting pain, her right kidney is in trouble and that needs attempts to save right kidney. It is also possible that inspite of all attempts to save the kidney, we may not be able to save kidney and we may have to resort to removal of right kidney, in case it has been damaged irreversibly. They were told that two sonographies are showing stone in the ureter. But there is something peculiar in sense that USG in January, 2014 is showing the stone in lower, third while USG in February, 2014 is showing the stone in middle third. This is unusual. Usually the stone moves down in natural course of events. Moreover USG reliability is not 100% . But the fact remains that right kidney is obstructed and there is hydonephrosis and hydroureter. There is significant damage to the // 13 // functioning of right kidney as per IVP done in January, 2014 which is showing very poor functioning or non-functioning right kidney. Obstruction has to be released at the earliest to give the possibility of saving the right kidney a chance , of course in addition to pain relief for the patient from obstructed kidney. Obstruction can be due to stone or stricture of ureter There was never any possibility of stone in the kidney. The stone was reported to be in ureter in two USG. They were told that retrograde pyelogram (RGP) and / or ureteroscopy (URS) would be done, depending the result of the same, further management would be done (Proceed sos). They were never told that she does not need surgery, that laser would be done in 20 minutes or that she would be discharged in two three days time. All these allegations are nothing, but bundle of lies. They were told very clearly and in details that everything would depend on the result of RGP/URS. RGS/URS are the investigations next in line in such clinical situation. There are multiple possibilities. Simplest and best for patient (as well as for the surgeon) would be that we find a stone in the ureter and are able to break the stone with lithotripsy. Laser was never ever discussed because O.P.No.1 do not have laser at all. The lithotripsy in such situation is pneumatic intracorporeal lithotripsy, where stone is fragmented in pieces by a probe through ureteroscope. That means procedure will be completed in one stage and endoscopically, without any need for open surgical produce. Many times one is not able to reach the stone and/or not able to complete the fragmentation in one // 14 // stage, but is successful in passing a stent. In such situation, the procedure is abandoned for the time being. The remaining job can be done as stage two after a variable period, usually after about 2-3 weeks or even after upto three months depending on the condition of the patient. The advantage of such protocol is that the patient is saved from open surgical procedure. Stent is a bypass procedure, hence the obstructed kidney is relieved of the obstruction, hence patient will become pain free, further kidney damage would be reduced and kidney will get the chance to recover the reversible part of damage. The third possibility is that nothing can be done endoscopically, not even the stenting, then the kidney has to be deobstructed by open surgical procedure and deal with the obstruction causing pathology (stone/structure ureter), if possible at the same stage, or may need management of the pathology in next date. At worst end removal of kidney, if the kidney has become irreversibly damaged. The aim of the procedure was made very clear to them. Deobstruct the kidney, so that patient becomes pain free from obstructed kidney pain. Try to save the kidney, if possible. To do the procedure, endoscopically as far as possible. To reduce the number of procedures / stages as far as possible. They were clearly told that no guarantee can be made that it will be done endoscopically for sure or that they would not require staged procedure or her right kidney would be definitely saved. They were told, if done endoscopically, usually patient can be discharged in 2-3 days time, depending on the condition of the patient, however, if // 15 // the open surgical procedure is done patient would be in hospital for about 7-10 days, depending on her condition. And she being obese, could take longer time as obese patient do take longer time. The patient can walking without support on 21.03.2014 and 22.03.2014. The patient got discharged on 01.04.2014 and went home walking without support. The complainants are careless about the date and timing of the procedure. The fact of the matter is that the patient was taken to operation theatre on 24.03.2014. The fact of the matter is that they were never told about any laser, as the O.P.No.1 has never any laser with him. The O.P.No.1 did not commit any deficiency in service, hence the complaint is liable to be dismissed.
4. The O.P.No.2 Dr. Sandeep Dave filed his written statement and averred that the case of the complainants is not maintainable before this Commission because O.P.No.2 has not done any medical negligence or deficiency in service. According to the judgment of the Hon'ble Supreme Court of India in case of Martin F. D'Souza Vs. Md. Isfaq reported in CPR 2009 (1) Page 231, the Hon'ble Commission will not register any case unless there is any report of medical board or any expert report that the concerned doctor is negligent. The complainants have not filed any report or evidence in this regard. Hence the case of the complainant is liable to be dismissed on this ground only as per the judgment of the Hon'ble Supreme Court of India. The case of the complainant is not maintainable because the complainant has not made // 16 // the party to the United India Insurance Company Limited from whom Ramkrishna Care Hospital has taken the profession indemnity. The O.P.No.2 works at the Ramkrishna Care Hospital, Raipur as Consultant hence, is covered under the policy. The policy is obtained from United India Insurance Company Limited, the Policy No. is 500500/46/13/39/00000232, the period of insurance is from 24.11.2013 to 23.11.2014, hence the Oriental Insurance Company Limited is the necessary party. The complainants have not come to this Commission with clean hands, have suppressed material facts before this Commission, and have twisted the facts to suit their own malafide purpose, and to harass and extort large amount from the O.P.No.2 under false ground. The complaint is false, frivolous, baseless and vexatious, hence the complaint requires to be dismissed. It is not true that patient was admitted on 05.05.2014 at Ramkrishna Care Hospital, the fact is that she was admitted on 06.05.2014 as a possible DVT in emergency. She was admitted as a case of swollen right leg for investigations. It is also not true that the patient had come to Dr. Sandeep Dave (O.P.No.2), but to Ramkirshna Care Hospital as a possible case of DVT, initially she was taken care of by Dr. Javed, Cardiologist specialist, who managed the patient for treatment and investigations, one DVT was ruled out by colour Doppler, she was being taken care by Dr. Ajay Parashar and Dr. Sandip Dave. The patient was taken care of, initially by Dr. Javed, Cardiologist specialist. Once DVT was ruled out, she was managed by Dr. Ajay Parashar and // 17 // Dr. Sandip Dave. She was given Eophil forte, a drug for treatment of filaria. This drug should not be started unless the test for filaria is positive by night sample blood. Very few even definite cases of filaria come positive. In India filaria is quite common specially in our region, many times only the clinical basis, trial of antifilarial treatment is given. Moreover it was not the only treatment given to the patient, it was an additional treatment for the patient, moreover it is not a dangerous drug, and nothing much is lost, if it is also added to treatment protocol. CT Scan abdomen was done on 10.05.2014. The patient was admitted for investigations for right leg swelling. The first and dangerous diagnosis (in immediate terms) is DVT, colour Doppler ruled out DVT. The cause of right leg evident, supportive treatment was being given. As she had pus in the kidney, the infective part was one of the possibilities, hence antibiotics were being given, to which she did respond partially, her swelling and pain reduced to certain extent (say about 15-20%), most probably it took care of the infective/inflammatory part of the swelling. Next step was to make lymphnode biopsy for the diagnosis. As she had no lymphnodes palpable in neck or any other superficial location, the biopsy had to be taken from abdominal nodes, which were deep in abdomen, more difficult in obese and inflammatory abdominal wall. They were told very clearly that the O.P.No.2 do not have CT guided biopsy facility, and for laparoscopic biopsy, it would be better, and less risky, if we wait for about five seven days. They were offered the choice to go to // 18 // higher, centre, where CT guided biopsy is available, they took the discharge from the hospital. They had been very clearly and daily being explained about the nature of the problem, prognosis, plan of management, possible outcomes in details. They had been asked about the histopathology of the uterus, which they said "sab theek the", and the records are not available. Suspecting the possibility of genital malignancy CA 125 was advised. Dr. Ajay Parashar had told them clearly that stent is the lifeline for right kidney. At present management of stent is not the priority, as it will not sort out the problem of swelling right leg and the lymphnodes. As the stent is working alright, draining right kidney, she is not having right kidney pain, her creatinine is normal, her right kidney is working alright (much better than before), management of stent can wait. Stent needs to be removed or changed in about three months. The present priority is establish/treat the possible cause of right leg swelling and enlarged lymphnodes. The allegations of holding the patient for increasing hospital bill and treating patient empirically is totally false and baseless. In a complicated case, where the diagnosis is not straight forward, it takes time for investigations to be done, reports to become available, and many times inspite of all final diagnosis may not be clear, as medicine is not a mathematical science. If the records of the Yashoda Hospital are seen, (inspite of the facts that they had baseline investigations report available to them), they had done the same set of investigations, i.e. colour doppler to rule out DVT, Sonography etc. // 19 // They also took time to reach to diagnostic conclusion. Unfortunately, the malignancy was such fast growing, that the oedema leg had become bilateral rather than right sided only, lymphnodes in neck had become palpable, when the patient reached Hyderabad. The patient was never diagnosed / treated as filaria. Dr. Ajay Parashar is a Urologist, his part was for the management of stent. When a patient has multiple problems, she needs management by a team of doctors of many specialists, that way he/she gets the best possible management and treatment. This is possible in multispeciality hospital like Ramakrishna Care Hospital. Dr. Javed took care for possible DVT, Dr. Ajay Parashar was taking care for stent management, Dr. Sandip Dave was looking after his lymphoedema problem. The allegations of only passing time to extract money is totally false and baseless. If the bill details of Ramakrishna care is studied in details, it would be clear that most of the bill is for investigations, doctors fee is only a very small part of the bill. If the records of Yashoda Hospital is checked, it will become evident, that there also they did the same set of investigations, which were done at Ramakrishna Care Hospital, and they also took time to reach to the diagnosis, meaning that here also we were thinking and moving in the same lines, which is logical and correct. They had the advantage of results of investigations done at Raipur, and due to further development of disease, the lymphnodes were palpable in neck also, which is superficial. The patient was admitted as a case of swelling right leg for investigations, at the time of discharge, she was a // 20 // case of right leg lymphoedema under investigations, as DVT had been ruled out. She was due for histopathological diagnosis. Each and everything had been explained to them in details many times. Always citing financial constraints, they were reluctant for our offer to take the patient to a centre, where CT guided biopsy facility is available. They took the discharge from the hospital on 14/05/2014. The fact is that in such fast growing cancer, by the time the patient reached Hyderabad, there were palpable lymphnode in neck, possibility of cancer is the first diagnosis. Possibility of cancer was discussed here at Raipur also with the attendants of the patient, they had been asked about histopathology of uterus, which was removed 6-8 years ago. They had been told about the possible cancer situation, hence was the discussion about taking the biopsy from the lymphnodes. As there were no palpable or superficial lymphnodes available at that point in time, they were given the option of taking the patient to a centre, where CT guided biopsy facility is available or wait for about five days to consider laparoscopic lymphnode biopsy, as she was a obese patient, with abdominal wall inflammation. The possible cancer situation was discussed with them, they were again enquired about the histopathology of uterus, removed 6-8 years ago. CA-125, a tumour marker was requested. There had been no medical negligence or deficiency in service from the O.P.No.2. O.P.No.2 had done his duty with utmost care and sincerity, using all his skill, knowledge and experience with human touch. On humanitarian ground, to help the // 21 // patient and attendant financially in their difficult time, (though no fault of O.p.No.2) the hospital charges were waived off. Name of surgeon and nursing home/hospital is not built in a day just like that. It is the result of sincere and careful treatment of patients at affordable cost with human touch for long period of time. All doctors, nursing homes and hospitals are always doing some charity work i.e. treatment without fee, even otherwise sometimes willingly, sometimes semi- willingly). Many of the patients are not in a position to pay the charges, and the fee is waived partially or fully on humanitarian ground, (or sometimes as a reasonable business practice). It definitely does not mean that fee waiver is done only when there is medical negligence, it is done for the patients, who become alright without treatment of O.p.No.2 For example Ramakrishna Care Hospital had treated all civilians brought to the hospital after Jheeram Ghati Naxalite attack. It definitely does not mean that the hospital treated them negligently. The same level or care and sincerity in treatment was given to them, as was given to another paying patient. Moreover, if the bills of Yashoda Hospital are seen carefully, one would notice the fee for Dr. Babu, Urologist in nil, that means that he waived off his fee, for consultation as well as for operation charges, while he had performed right PCN and left DJS during first admission. Does it means that he was medically negligent, hence waived off his fee ? No Sir, like us, he too might have waived off his fee on humanitarian grounds. Hence the allegations of the complainants that the fee waiver by the O.P.No.2 was // 22 // equivalent to medical negligence is totally wrong. There had been no medical negligence. Best possible management at each point in time was given to the patient. Management includes investigations, treatment, medical and/or surgical and periodic counseling. There is no wrong diagnosis and treatment. When the patient was seen first on 21.03.2014, she had pain on the right flank since about two months, she had two sonography showing right hydronephrosis, hydroureter and stone in the ureter, she had no mass seen in pelvis, she had history of hysterectomy 6-8 years, no medical record of histopathology was available, and according to them, "sab theek tha", there were no signs or symptoms suggesting any possibility of any cancer. Medical science is not a mathematical science. Patient is managed according to clinical history, clinical examination, signs and symptoms, results of investigations. What investigations are to be done at that point in time depends on history, findings of clinical examinations, signs and symptoms. Based on these, the treatment is started, which may not be the final diagnosis and treatment. Periodically investigations are repeated, new investigations are done depending on the new developing signs and symptoms, and response of the patient to the treatment. Many times even after exhaustive investigations treatment, the diagnosis is not clear. Many times over a period patient develops a second unrelated problem also, that does not mean that the second problem is because of first problem. Unfortunately, this patient started developing signs and symptoms after more than a month of surgical // 23 // intervention, these are two different entity altogether and she had fast growing cancer and she could not be saved. O.P.No.2's heartfelt sympathies are with the family members, and hope, wish and pray that God gives them courage to bear the loss. But it certainly is not due to our so called medical negligence. The lower limb swelling could be due to cancer which was suspected while she was admitted in Ramkrishna Care Hospital and investigations (C.T. Scan 10-5-2014) were done. Since patient was due for biopsy so plan of laparoscopic biopsy was discussed with them and a date was fixed for it. A C.T. guided biopsy option was also discussed. However, patient took discharge and went to Hyderabad to Yashoda Hospital where she was investigated and biopsied in exactly the same line with some more investigational facilities like PET SCAN. The difficulties in reaching to correct diagnosis is evident from the fact that they did biopsy two times. As biopsy from neck gland was done first and than biopsy from abdomen was taken. This is like continuation of same line of treatment what was planned at Raipur. Moreover when they suspected obstruction of left kidney a double J stent was put. So this further proves that there was no wrong treatment done. It is true that they paid fees, but it is also true that they did manage to get the refund on humanitarian grounds, with sort of emotional blackmail and dadagiri. There had been no medical negligence or deficiency in service from O.P.No.2's side. The O.P.No.2 done his duty with utmost care and sincerity, using all his knowledge, skill and experience, the way he // 24 // would have treated his own sister/mother. Cancer cannot be given or increased by any doctor. The complainants have not come with the clean hands to this Commission, had twisted many facts, and had made up the story in retrospect only to extract the money. They have hidden many facts and papers from this Commission, which are not suitable to their story. Hence they should not be allowed to submit more papers, as they may be afterthought. During patient's stay at Ramakrishna Care Hospital, they complainants have been explained about the nature of problem, plan of management, prognosis, various possibilities etc. many times. Two/three times it was a joint counseling by Dr. Sandeep Dave, Dr. Ajay Parashar and Dr. Lalit Shah in details. Most of the time only one daughter used to be available as attendant for communication. She was well educated, and gave the impression that she is understanding the medical intricacies, and that , and that O.P.No.2 is doing his best of her mother's treatment. After 14/05/2014, the daughter of the patient went into background, and the husband of the patient, and his brother became the front persons, they were getting more aggressive, more disrespectful and even threatening. They were not willing to listen or understand anything, they had only one point agenda of extracting money, they wanted O.P.No.2 to bear the expenses involved in the treatment. Even after the patient was taken to Hyderabad, they continued the same. It can be confirmed by the call details of mobile phone (09755918765) of husband of the patient. Their calls had become so threatening that ultimately Dr. Lalit Shah had to // 25 // lodge a police information for the same. They had done the same with Dr. Sandeep Dave also at Ramakrishna Care Hospital in his chamber and even at his home, more than once. There is multiple contradiction in the complaint lodged by the complainants. It is more so, because the complainants have cooked up the story, twisted the facts to suit their story, so as to extract money. These contradictions and unreliability of the facts puts a very big question mark on the trustworthiness of the facts presented before this Commission. These facts speak about their carelessness for themselves. They have hidden many acts before this Commission. They have not come with clean hands. In para 2 it is said that the patient was having pain since 6-8 years, since hysterectomy, while in para 3 they are saying that the right flank pain was since about two months. Even in record of Yashoda Hospital, it is mentioned that there was history of pain right flank since about two months. The complainants have mentioned the date of operation as 22/03/2014, while the fact is that the surgery was done on 24/03/2014. The complainants have hidden the prescription papers and advice of many Doctors. Dr. Bhagwat, (Urologist), Dr. J. Roychaudhary and Dr. Sushil Sharma (Both Ortho Surgeons). The patient was admitted in Ramakrishna Care Hospital on 06/05/2014 and not on 05.05.2014 as mentioned in the complaint. Even till date it is not clear that whether she was operated for hysterectomy in 2006 or 2008. They had no medical record. In our questioning they had told it was done 6-8 years ago. If Yashoda Hospital's record are examined, it speaks of // 26 // Hysterectomy in 2006 and USG in 2008 showing thick endometrium. It is unbelievable and not possible, if hysterectomy has been done in 2006, and the uterus has been removed, USG in 2008 cannot show thick endometrium (inner lining of the uterus). Carelessness is also shown by the fact that they had not saved the medical records of hysterectomy. Histopathology of the organ removed is an important aspect of patient management. They have not cared to save that. Moreover, it is also not clear that whether Histopathology was done or not. The O.P.No.2 did not commit any deficiency in service and the complaint is liable to be dismissed.
5. The O.P.No.3 Dr. Ajay Parashar filed his written statement and averred that the case of the complainants is not maintainable before this Commission because O.P.No.3 has not done any medical negligence or deficiency in service. According to the judgment of the Hon'ble Supreme Court of India in case of Martin F. D'Souza Vs. Md. Isfaq reported in CPR 2009 (1) Page 231, the Hon'ble Commission will not register any case unless there is any report of medical board or any expert report that the concerned doctor is negligent. The complainants have not filed any report or evidence in this regard. Hence the case of the complainant is liable to be dismissed on this ground only as per the judgment of the Hon'ble Supreme Court of India. The case of the complainant is not maintainable because the complainants have not made the party to the United India Insurance Company Limited from // 27 // whom Ramkrishna Care Hospital has taken the profession indemnity. The O.P.No.2 works at the Ramkrishna Care Hospital, Raipur as Consultant hence, is covered under the policy. The policy is obtained from United India Insurance Company Limited, the Policy No. is 500500/46/13/39/00000232, the period of insurance is from 24.11.2013 to 23.11.2014, hence the Oriental Insurance Company Limited is the necessary party. The complainants have not come to this Commission with clean hands, have suppressed material facts before this Commission, and have twisted the facts to suit their own malafide purpose, and to harass and extort large amount from the O.P.No.2 under false ground. The complaint is false, frivolous, baseless and vexatious, hence the complaint requires to be dismissed. The O.P.No.3 further averred that it is not true that patient was admitted on 05.05.2014 at Ramkrishna Care Hospital, the fact is that she was admitted on 06.05.2014 as a possible DVT in emergency. She was admitted as a case of swollen right leg for investigations. It is also not true that the patient had come to Dr. Sandeep Dave (O.P.No.2), but to Ramkirshna Care Hospital as a possible case of DVT, initially she was taken care of by Dr. Javed, Cardiologist specialist, who managed the patient for treatment and investigations, one DVT was ruled out by colour Doppler, she was being taken care by Dr. Ajay Parashar and Dr. Sandip Dave. The patient was taken care of, initially by Dr. Javed, Cardiologist specialist. Once DVT was ruled out, she was managed by Dr. Ajay Parashar and Dr. Sandip Dave. She was given Eophil forte, a // 28 // drug for treatment of filaria. This drug should not be started unless the test for filaria is positive by night sample blood. Very few even definite cases of filaria come positive. In India filaria is quite common specially in our region, many times only the clinical basis, trial of antifilarial treatment is given. Moreover it was not the only treatment given to the patient, it was an additional treatment for the patient, moreover it is not a dangerous drug, and nothing much is lost, if it is also added to treatment protocol. CT Scan abdomen was done on 10.05.2014. The patient was admitted for investigations for right leg swelling. The first and dangerous diagnosis (in immediate terms) is DVT, colour Doppler ruled out DVT. The cause of right leg evident, supportive treatment was being given. As she had pus in the kidney, the infective part was one of the possibilities, hence antibiotics were being given, to which she did respond partially, her swelling and pain reduced to certain extent (say about 15-20%), most probably it took care of the infective/inflammatory part of the swelling. Next step was to make lymphnode biopsy for the diagnosis. As she had no lymphnodes palpable in neck or any other superficial location, the biopsy had to be taken from abdominal nodes, which were deep in abdomen, more difficult in obese and inflammatory abdominal wall. They were told very clearly that the O.P.No.2 do not have CT guided biopsy facility, and for laparoscopic biopsy, it would be better, and less risky, if we wait for about five seven days. They were offered the choice to go to higher, centre, where CT guided biopsy is available, they took the // 29 // discharge from the hospital. They had been very clearly and daily being explained about the nature of the problem, prognosis, plan of management, possible outcomes in details. They had been asked about the histopathology of the uterus, which they said "sab theek the", and the records are not available. Suspecting the possibility of genital malignancy CA 125 was advised. Dr. Ajay Parashar had told them clearly that stent is the lifeline for right kidney. At present management of stent is not the priority, as it will not sort out the problem of swelling right leg and the lymphnodes. As the stent is working alright, draining right kidney, she is not having right kidney pain, her creatinine is normal, her right kidney is working alright (much better than before), management of stent can wait. Stent needs to be removed or changed in about three months. The present priority is establish/treat the possible cause of right leg swelling and enlarged lymphnodes. The allegations of holding the patient for increasing hospital bill and treating patient empirically is totally false and baseless. In a complicated case, where the diagnosis is not straight forward, it takes time for investigations to be done, reports to become available, and many times inspite of all final diagnosis may not be clear, as medicine is not a mathematical science. If the records of the Yashoda Hospital are seen, (inspite of the facts that they had baseline investigations report available to them), they had done the same set of investigations, i.e. colour doppler to rule out DVT, Sonography etc. They also took time to reach to diagnostic conclusion. Unfortunately, // 30 // the malignancy was such fast growing, that the oedema leg had become bilateral rather than right sided only, lymphnodes in neck had become palpable, when the patient reached Hyderabad. The patient was never diagnosed / treated as filaria. Dr. Ajay Parashar is a Urologist, his part was for the management of stent. When a patient has multiple problems, she needs management by a team of doctors of many specialists, that way he/she gets the best possible management and treatment. This is possible in multispeciality hospital like Ramakrishna Care Hospital. Dr. Javed took care for possible DVT, Dr. Ajay Parashar was taking care for stent management, Dr. Sandip Dave was looking after his lymphoedema problem. The allegations of only passing time to extract money is totally false and baseless. If the bill details of Ramakrishna care is studied in details, it would be clear that most of the bill is for investigations, doctors fee is only a very small part of the bill. If the records of Yadhoda Hospital is checked, it will become evident, that there also they did the same set of investigations, which were done at Ramakrishna Care Hospital, and they also took time to reach to the diagnosis, meaning that here also we were thinking and moving in the same lines, which is logical and correct. They had the advantage of results of investigations done at Raipur, and due to further development of disease, the lymphnodes were palpable in neck also, which is superficial. The patient was admitted as a case of swelling right leg for investigations, at the time of discharge, she was a case of right leg lymphoedema under investigations, as DVT had been // 31 // ruled out. She was due for histopathological diagnosis. Each and everything had been explained to them in details many times. Always citing financial constraints, they were reluctant for our offer to take the patient to a centre, where CT guided biopsy facility is available. They took the discharge from the hospital on 14/05/2014. In such fast growing cancer, by the time the patient reached Hyderabad, there were palpable lymphnode in neck, possibility of cancer is the first diagnosis. Possibility of cancer was discussed here at Raipur also with the attendants of the patient, they had been asked about histopathology of uterus, which was removed 6-8 years ago. They had been told about the possible cancer situation, hence was the discussion about taking the biopsy from the lymphnodes. As there were no palpable or superficial lymphnodes available at that point in time, they were given the option of taking the patient to a centre, where CT guided biopsy facility is available or wait for about five days to consider laparoscopic lymphnode biopsy, as she was a obese patient, with abdominal wall inflammation. The possible cancer situation was discussed with them, they were again enquired about the histopathology of uterus, removed 6-8 years ago. CA-125, a tumour marker was requested. There had been no medical negligence or deficiency in service from the O.P.No.3. O.P.No.3 had done his duty with utmost care and sincerity, using all his skill, knowledge and experience with human touch. On humanitarian ground, to help the patient and attendant financially in their difficult time, (though no fault // 32 // of O.P.No.3) the hospital charges were waived off. Name of surgeon and nursing home/hospital is not built in a day just like that. It is the result of sincere and careful treatment of patients at affordable cost with human touch for long period of time. All doctors, nursing homes and hospitals are always doing some charity work i.e. treatment without fee, even otherwise sometimes willingly, sometimes semi- willingly). Many of the patients are not in a position to pay the charges, and the fee is waived partially or fully on humanitarian ground, (or sometimes as a reasonable business practice). It definitely does not mean that fee waiver is done only when there is medical negligence, it is done for the patients, who become alright without treatment of O.P.No.2 For example Ramakrishna Care Hospital had treated all civilians brought to the hospital after Jheeram Ghati Naxalite attack. It definitely does not mean that the hospital treated them negligently. The same level or care and sincerity in treatment was given to them, as was given to another paying patient. Moreover, if the bills of Yashoda Hospital are seen carefully, one would notice the fee for Dr. Babu, Urologist in nil, that means that he waived off his fee, for consultation as well as for operation charges, while he had performed right PCN and left DJS during first admission. Does it means that he was medically negligent, hence waived off his fee ? No Sir, like us, he too might have waived off his fee on humanitarian grounds. Hence the allegations of the complainants that the fee waiver by the O.P.No.2 was equivalent to medical negligence is totally wrong. There had been no // 33 // medical negligence. Best possible management at each point in time was given to the patient. Management includes investigations, treatment, medical and/or surgical and periodic counseling. Medical science is not a mathematical science. Medical science is not a mathematical science. Patient is managed according to clinical history, clinical examination, signs and symptoms, results of investigations. What investigations are to be done at that point in time depends on history, findings of clinical examinations, signs and symptoms. Based on these, the treatment is started, which may not be the final diagnosis and treatment. Periodically investigations are repeated, new investigations are done depending on the new developing signs and symptoms, and response of the patient to the treatment. Many times even after exhaustive investigations treatment, the diagnosis is not clear. Many times over a period patient develops a second unrelated problem also, that does not mean that the second problem is because of first problem. Unfortunately, this patient started developing signs and symptoms after more than a month of surgical intervention, these are two different entity altogether and she had fast growing cancer and she could not be saved. O.P.No.3's heartfelt sympathies are with the family members, and hope, wish and pray that God gives them courage to bear the loss. But it certainly is not due to our so called medical negligence. The lower limb swelling could be due to cancer which was suspected while she was admitted in Ramkrishna Care Hospital and investigations (C.T. Scan 10-5-2014) were done. Since patient was due // 34 // for biopsy so plan of laparoscopic biopsy was discussed with them and a date was fixed for it. A C.T. guided biopsy option was also discussed. However, patient took discharge and went to Hyderabad to Yashoda Hospital where she was investigated and biopsied in exactly the same line with some more investigational facilities like PET SCAN. The difficulties in reaching to correct diagnosis is evident from the fact that they did biopsy two times. As biopsy from neck gland was done first and then biopsy from abdomen was taken. This is like continuation of same line of treatment what was planned at Raipur. Moreover when they suspected obstruction of left kidney a double J stent was put. So this further proves that there was no wrong treatment done. It is true that they paid fees, but it is also true that they did manage to get the refund on humanitarian grounds, with sort of emotional blackmail and dadagiri. There had been no medical negligence or deficiency in service from O.P.No.3's side. The O.P.No.3 done his duty with utmost care and sincerity, using all his knowledge, skill and experience, the way he would have treated his own sister/mother. Cancer cannot be given or increased by any doctor. The complainants have not come up with the clean hands to this Commission, had twisted many facts, and had made up the story in retrospect only to extract the money. They have hidden many facts and papers from this Commission, which are not suitable to their story. Hence they should not be allowed to submit more papers, as they may be afterthought. Most of the time only one daughter used to be available as attendant for communication. She was well educated // 35 // and gave the impression that she is understanding the medical intricacies, and that we are doing our best for her mother's treatment. After 14/05/2014, the daughter of the patient went into background, and the husband of the patient, and his brother became the front persons, they were getting more aggressive, more disrespectful and even threatening. They were not willing to listen or understand anything, they had only one point agenda of extracting money, they wanted O.P.No.3 to bear the expenses involved in the treatment. Even after the patient was taken to Hyderabad, they continued the same. It can be confirmed by the call details of mobile phone (09755918765) of husband of the patient. Their calls had become so threatening that ultimately Dr. Lalit Shah had to lodge a police information for the same. They had done the same with Dr. Sandeep Dave also at Ramakrishna Care Hospital in his chamber and even at his home, more than once. There is multiple contradiction in the complaint lodged by the complainants. It is more so, because the complainants have cooked up the story, twisted the facts to suit their story, so as to extract money. These contradictions and unreliability of the facts puts a very big question mark on the trustworthiness of the facts presented before this Commission. These facts speak about their carelessness for themselves. They have hidden many acts before this Commission. They have not come with clean hands. In para 2 it is said that the patient was having pain since 6-8 years, since hysterectomy, while in para 3 they are saying that the right flank pain was since about two months. Even in record of // 36 // Yashoda Hospital, it is mentioned that there was history of pain right flank since about two months. The complainants have mentioned the date of operation as 22/03/2014, while the fact is that the surgery was done on 24/03/2014. The complainants have hidden the prescription papers and advice of many Doctors. Dr. Bhagwat, (Urologist), Dr. J. Roychaudhary and Dr. Sushil Sharma (Both Ortho Surgeons). The patient was admitted in Ramakrishna Care Hospital on 06/05/2014 and not on 05.05.2014 as mentioned in the complaint. Even till date it is not clear that whether she was operated for hysterectomy in 2006 or 2008. They had no medical record. In our questioning they had told it was done 6-8 years ago. If Yashoda Hospital's record are examined, it speaks of Hysterectomy in 2006 and USG in 2008 showing thick endometrium. It is unbelievable and not possible, if hysterectomy has been done in 2006, and the uterus has been removed, USG in 2008 cannot show thick endometrium (inner lining of the uterus). Carelessness is also shown by the fact that they had not saved the medical records of hysterectomy. Histopathology of the organ removed is an important aspect of patient management. They have not cared to save that. Moreover, it is also not clear that whether Histopathology was done or not. The O.P.No.3 did not commit any deficiency in service and the complaint is liable to be dismissed.
6. The O.P.No.4 The Oriental Insurance Company Limited filed it's written and averred that this Commission has no jurisdiction to hear // 37 // the complaint of the complainants against the O.P.No.4. The complainants/deceased are not consumer of the O.P.No.4. There was no insurance contract between the complainants/deceased and O.P.No.4, therefore, the O.P.No.4 is not a necessary party in the complaint. The complainants filed complaint in respect of medical negligence, but it is not proved therefore, the complaint is liable to be dismissed with cost. None of the opposite parties or complainants have gave intimation to O.P.No.4 regarding alleged treatment and death of the patient. For the first the first time the O.P.No.4 received notice from this Commission. The complainants have no right to file complaint against the O.P.No.4. The complaint filed by the complainant against the O.P.No.4 is liable to be dismissed.
7. The O.P. No. 5 United India Insurance Company Limited and denied the allegations made by the complainants against it in the complaint. It has been averred that the deceased patient Smt. Shabnam Bano herself has not paid any premium to the O.P.No.5 and did not obtain insurance cover, therefore, there is no privity of contract between Smt. Shabnam Bano and the O.P.No.5, therefore, she is not consumer of the O.P.No.5 under Section 2(1)(d) of the Consumer Protection Act. The complaint filed by the complainants against the O.P.No.5, is not maintainable and is liable to be dismissed. The complainants have not mentioned in their complaint or proved that the O.P.No.5 has committed any deficiency in service. The // 38 // complainants or deceased Smt. Shabnam Bano did not submit any claim before the O.P.No.5 and no dispute has arisen between them, from which the complaint received basis. The O.P. No.5 has not accepted or rejected the claim of the complainants, therefore, no deficiency in service has been committed by the O.P.No.5, hence, the complaint against the O.P.No.5, is liable to be dismissed.
8. The complainants filed documents. Document No.1 is Special Power of Attorney, document No.2 is Ultrasonography Report dated 11.01.2014, document No.3 is Ultrasonography Report dated 25.02.2014, document No.4 is prescription dated 02/03/2014 of Jagjivan Urology Centre, Raipur (C.G.), document No.5 is X-ray Chest PA View, document No.6 is Colour Doppler Echo Study Report, document No.7 is Report issued by Agrawal Digital X-ray / 3-D Digital Colour Doppler, Sonography and Echo Cordiography, document no.8 is prescription of Jagjivan Urology Centre, Raipur, document No.9 is Ultrasonography Report, document No.10 is Certificate dated 14.05.2014 issued by Jagjivan Urology Centre, document No.11 and 12 is statement of Wakilluddin dated 19.05.2014, document No.13 is MRI Test Report, document No.14 is Both Lower Limb Arterial & Venous Doppler report, document No.15 is Sonography report, document no.16 and 17 is CT Scan Report, document No.18 to 20 is Discharge Summary, document No.21 and 22 is Urltrasonography report, document No.23 is Colour Doppler Arterial System Right Lower Limb // 39 // report, document No.24 is Venous Doppler Right Lower Limb, document No.25 to 28 is PET-CT Whole Body report, document No.29 to 38 is Discharge Summary of Yashoda Cancer Institute, document No.39 is bill receipt, document No.40 to 46 is bill No.RC 1400081933 dated 14.05.2014 of Ramkrishna Care Hospital, document No.47 is E ticket, document No.48 to 52 is In patient final bill of Yashoda Health Care Services Pvt. Ltd., Secunderabad, document No.53 is Deposit Voucher, document No.54 to 56 is In Patient Final Bill of Yashoda Hospital, document No.57 is Deposit Voucher, document No.588 is bill of Urvashi Residency, document No.59 is Receipt issued by Urvashi Residency, document No.60 to 62 is In Patient Final Bill of Yashoda Healthcare Services Pvt. Ltd., document No.63 is deposit voucher, document No.64 to 66 is In Patient Bill of Yashoda Healthcare Services Pvt. Ltd., document No.67 is deposit voucher, document No.68 is E ticket, document No.69 is air ticket, document No.70 and 71 is Provisional Bill, document No.72 is e ticket, document No.73 to 75 is In Patient Final Bill of Yashoda Healthcare Services Pvt. Ltd., document No.76 is Deposit Voucher, document No.77 is e ticket, document No.78 is Receipt of Ramkrishna Care Hospitals, document No.79 is deposit voucher,, document No.80 and 81 are receipts issued by Yashoda Hospital, document No.82 and 83 are deposit voucher, document No.84 and 85 are receipts issued by Yashoda Hospital, Secunderabad, document No.86 is deposit voucher, document No.87 is Ambulance Cash Receipt.
// 40 //
9. The O.P.No.1 has filed documents i.e. Indoor Patient Record of the patient from 22.03.2014 to 01.04.2014.
10. The O.P.No.2 and O.P.No.3 have filed documents of Ramkrishna Care Hospital in respect of treatment of patient Smt. Shabnam Bano. Document No.1 is In Patient Checkout Slip of Ramkrishna Care Hospital, document No.2 is MRD Checklist, document No.3 is Registration Data of Ramkrishna Care Hospital dated 06.05.2014, document No.4 is Checklist for In-Patient Admission, document No.5 is Registration Data of Ramkrishna Care Hospital, dated 05.05.2014, document No.6 is Authorization for treatment during hospitalization at care hospitals, document No.7 is Pravesh Paramarsh Prakriya, document No. 8 and 9 is Doctors Admission Notes, document No.10 to 17 are Doctors Progress Note, document No.18 is declaration made by husband of the patient, document No.19 to 20 is Department Nursing Assessment Sheet, document No.21 is Nursing Admission Assessment, document No.22 is Nursing Daily Assessment, document No.23 to 25 is Nursing Care Plan, document No.26 is Admission Note of Ramkrishna Care Hospital, document No.27 to 36 is Nurses Progress Notes, document No.37 is Pain Assessment Score Sheet, document No.38 is Periferal Vascular Catheter Checklist, document No.39 to 44 is Patient Care Flow Chart (Nurses Medication Card), document No.45 to 47 is reports of Ramkrishna Care Hospital, document No.48 is letter written by the daughter of the patient to The // 41 // Incharge, Kidney Department on 10.05.2014, document No.49 is Nutrition Assessment Form, document No.50 is Discharge Summary of Ramkrishna Care Hospital.
11. The O.P.No.4 has filed Annexure OP-1 i.e. Professional Indemnity - Doctors Policy Schedule issued by The Oriental Insurance Company Limited.
12. Shri Amin Khan, learned counsel for the complainants has argued that on 21.03.2014, the complainant No.1 along with her mother went to O.P.No.1 and they gave medical reports of the mother of the complainant No.1 and O.P.No.1 perused the reports of the patient and obtained information from the patient regarding her health. The O.P.No.1 expressed that the operation will be conducted through laser procedure and therefore, the complainants were agreed for treatment of the deceased. The O.P.No.1 without obtaining Sonography report and without conducting other tests, conducted operation in negligent manner. After 6 hours of the operation, the O.P.No.1 came outside and told that he inserted the stent in abdomen of patient in which near about 22 stitches were used. The laser surgery conducted by the O.P. No.1 was unsuccessful. On 22.03.2014, the O.P. No.1 conducted open surgery of abdomen of the patient on the basis of old Sonography report. It was essential for the O.P.No.1 that before conducting operation he should have obtained Sonography Report and to conduct other necessary tests, but without obtaining Ultrasonography Report // 42 // and without conducting other tests, he conducted operation of the patient and inserted stent in the kidney. The O.P.No.1 treated the patient in a very negligent manner, which itself is confirmed from the discharge summary prepared by the O.P.No.1. The O.P.No.1 obtained all information from the patient at the time of medical investigation that the uterus of the patient has been removed and it is mentioned in the Ultrasonography that there is no uterus in the body of the patient and in these circumstance, the O.P.No.1 was required to conduct necessary test prior to conducting surgery of kidney which is near the uterus, but the O.P.No.1 did not treat the patient in right direction and he did not make effort to conduct tests. The O.P. No.1 has not properly appreciated the M.R.I. Report and also ignored the advice of Dr. A.D. Raje. Dr. A.D. Raje advised for M.R.I. /C.T. Scan of entire abdomen, but the O.P.No.1 did not get conduct the above test and did not tell regarding such test. After admission of the patient in the hospital, her treatment was started and during treatment on 10.05.2014, the C.T. Scan of entire abdomen was conducted in which it is mentioned that big size lymphnodes were found in many places and the Doctor, who conducted C.T. Scan had written to diagnose after conducting clinical and histopathological test, but the O.P.No.2 & 3 ignored the same and treated the patient in wrong direction due to which the disease of the patient was continuously increasing. The O.P.No.1 to 3 have committed medical negligence, therefore, the complainants are entitled // 43 // to get compensation from the OPs, as mentioned in the prayer clause of the complaint.
13. Miss Pravin Arora, learned counsel appearing for the O.P.No.1 Dr. Lalit Shah has argued that the O.P.No.1 Dr. Lalit Shah is a qualified and senior Urologist and he has devoted more than twenty years of tough and difficult studies. The O.P.No.1 has obtained M.S. (General Surgery) and M.Ch (Urology) degree. The O.P.No.1 is having 30 years experience as Urologist. He was the first regular qualified Urologist to offer his services in Chhattisgarh since 1990. His experience of Urology in Chhattisgarh, is almost twenty five years. He personally counsel his patients and attendants about the nature of problem, disease, prognosis plan of management, various options available, possible complications and failures and possible outcomes of various options. At no stage he show then to rosy picture that in few minutes everything will be alright. The O.P.No.1 try his best to give them the balanced realistic picture of the clinical situation and possible outcome using all his knowledge and experience. Smt. Shabnam Bano had right flank pain since about two months, her sonography showed right hydronephrosis (enlarged and dilated kidney) and stone in right ureter. IVP showed very poor / non functioning right kidney. In such unilateral obstructed kidney, next logical investigation and management is retrograde pyelography/ureteroscopy and proceed sos. Proceed sos means further plan of treatment would depend on the // 44 // result of RGP/Ureteroscopy. Stone is the common cause of unilateral obstructed kidney. The O.P.No.1 Dr. Lalit Shah has done his duty with utmost care and sincerity, using all his skill, knowledge and experience and diligence. Medical Science is not a mathematical science. It is a science of possibilities. The patient was getting right flank pain since last two months. The USG reports, which were brought by the complainants were showing hydronephrosis and hydroureter along with stone. The patient's IVP was showing poor functioning right kidney. The next logical line of investigation is RGP/URS, and to proceed accordingly, the obstructed kidney has to be deobstructed earliest. It has been O.P.No.1's experience and a universal fact also that in most of the cases the kidney function improves, once the obstruction is taken care of and the same thing happened in the instant case. As operation, right ureteroscopy was attempted, but even a very small 6F ureteroscope could not be negotiated beyond 2-3 cms due to tortuousity of uterter. Even a glidewire through ureteroscope could not be negotiated. After giving a reasonable trial of passing a glidewire, by changing the glidewires etc., the endoscopic procedure was abandoned and the O.P.No.1 had to move to next step of right ureteric exploration by open surgical procedure. The patient's right ureter was hugely dilated, there were adhesions and inflammation, urine was purulent i.e. urine mixed with pus, ureter was dissected upto last about 3 cms, stone could not be felt and as antegrade glidewire could be negotiated across the obstruction, stenting was done on // 45 // glidewire and it was decided to stop the procedure at this stage. The time for spinal anaesthesia effect was coming near its end and any further extension of the procedure would have required full general anaesthesia, which in obsese patient with short neck could have been troublesome, moreover the primary aim of the procedure to deobstruct the kidney was already achieved. As the purulent urine gradually started clearing and cleaner urine started dripping signifying that most probably even the second aim i.e. saving the kidney also has been achieved. The management of cause, if stone can be taken care of in next stage endoscopically. The patient's kidney pain disappeared, her kidney function improved, her kidney was saved as a resulting of stenting. It was a more than satisfying result in the given circumstances. Stent was the life line at that point in time. In para 2 of the complaint, the complainants have themselves accepted that they had been advised by some doctors for surgery for stone, but came out with twisted story that the patient had been getting such problem since hysterectomy in 2006. In para 3 of the complaint, the complainants have accepted that the O.P.No.1 checked the reports in details and took health related information of last 10 years. Even in the instant case it proved that the final diagnosis has not been reached. Before taking patient for surgery, sufficient pre-operative investigations had been done, which were essential as per outpatient paper. Moreover Right RGPO/URS/proceed sos was planning. RGP/Ureteroscopy itself is the diagnostic investigation. Ureteroscopy is an effective interventional // 46 // and diagnostic modality. The surgery was done under spinal anaesthesia, the effect of spinal anaesthesia cannot last for six hours. Sonography (11/1/2014, 25/2/2014) was reported as ureteric stone and the stone is the common cause of obstructed kidney, hence stone is obviously the first possibility. As stone could not be found and felt at operation, the only other possibility is ureteric stricture. Till 21.04.2014, there was no swelling leg, operative wound had healed, hence was called for follow up review after 15 days. When the patient came to O.P.No.1 with MRI lumbosacral spine report, she had swelling right lower limb since about last 5 days or so clinical picture was more like DVT, moreover DVT being life threatening in immediately terms, needs to be established or ruled out by colour Doppler study. There had been no signs and symptoms of possible cancer at that point in time. The first suspicion of cancer even in retrospect, would arise when MRI lumbosacral spine is showing come lymph nodes. Before that there has been no sign or symptom to suspect cancer, as per detailed history, clinical examination, all investigation. Even sonography done on 14/04/2014 is not showing any pelvic mass or lymphnode. It appears that the patient developed lymphnodes between 14/4/2014 and 5/5/2014. Unfortunately this was part of very fast growing extrapulmonary small cell carcinoma, with bad prognosis. She placed reliance on Calcutta Medical Research Institute Vs. Bimalesh Chatterjee LAWS (NCD) 1998 - 12 - 11 NCDRC decided on 09.12.1998; Upasana Hospital and Anr. Vs. Farook, II (2007) CPJ 235 // 47 // (NC); Martin F. D'Souza Vs. Mohd. Ishfaq, CPR 2009 (1) Page 231, R.F. Lambay Vs. Shanti Nursing Home and another, Complaint Case No.CC/01/313 decided on 01.07.2015 by State Consumer Disputes Redressal Commission, Maharashtra, Mumbai; Kusum Sharma & Ors. Vs. Batra Hospital & Med. Research, decided on 10.02.2010 by Supreme Court.
14. Shri Shishir Bhandarkar, learned counsel appearing for the O.P.No.2 & O.P.No.3 has argued that management by O.P.No.2 Dr. Sandip Dave and O.P.No.3 Dr. Ajay Parashar in the given situation was in line with the standard protocol. Smt. Shabanam Bano was brought to Ramkrishna Care Hospital with history of right lower limb swelling since about last 5 days. She had undergone surgical treatment for right obstructed, poorly functioning hydronephrotic kidney about six weeks ago. MRI lumbosacral spine showing some lymphnodes. It looked more like DVT, it is important to establish or rule out DVT first, as it is more dangerous in immediate terms. Once DVT was ruled out by colour Doppler, next possibility was lymphedema. The cause of lymphedema and lymph nodes enlargement could be ineffective, as there was history of surgery with pus in kidney, cancer, filaria, as filaria, is common in Chhattisgarh, hence while the investigations were being done to reach the diagnosis, supportive treatment for infection and filaria were started. Response to treatment becomes sort of therapeutic trial. CT Scan abdomen was done, which showed multiple // 48 // mild to moderate voule retroperitoneal lymph nodes in paraaortic and aortocaval regions with pelvic lymph nodes along right iliac and adnexa, right inguinal lymph node, ill defined heterogenous enhancing lobulated soft tissue lesion at right adnexa / lymphnode mass / ovarian mass, with comment "needs clinical and histopathological correlation. There was history of hysterectomy in 2006 ? 2008, patient and attendants were not aware about histopathology report or even whether histopathology was done or not, and kept on saying "sab theek tha". Gynae check up was done, unfortunately patient did not cooperate for proper gynae check up. CA 125 was advised. She was due for biopsy, as CT guided biopsy is not available in Raipur, they were given the option of taking her to centre, where such facility is available, or wait for about a week for laparoscopic biopsy, so that she becomes fitter for general anaesthesia, which will be necessary for laparoscopic biopsy. They choose to get the patient discharged. The lower limb swelling could be due to cancer which was suspected while the patient was admitted in Ramkrishna Care Hospital and investigations (C.T. Scan 10.5.2014) were done. Since patient was due for biopsy so plan of laparoscopic biopsy was discussed with them and a date was fixed for it. A.C.T. guided biopsy option was also discussed. However, patient took discharge and went to Yashoda Hospital, Hyderabad, where she was investigated and biopsied in exactly the same line with some more investigational facilities like PET SCAB. The difficulties in reaching to correct diagnosis in evident from the fact that // 49 // they did biopsy two months. As biopsy from neck gland was done first and then biopsy from abdomen was taken. This is like continuation of same line of treatment what was planned at Raipur. Moreover, when they suspected obstruction of left kidney a double J. stent was put. He placed reliance on Calcutta Medical Research Institute Vs. Bimalesh Chatterjee LAW NCD) - 1998 0 12- 11 NCDRC decided on 09.12.1998; Upasana Hospital and Anr. Vs. Farook, II (2007) CPJ 235 (NC); Jacob Mathew Vs. State of Punjab & Anr. Appeal (Crl.) 144-145 of 2004 decided on 05.08.2005 by Supreme Court; Kusum Sharma & Ors. Vs. Batra Hospital & Med. Research decided on 10.02.2010 by Supreme Court.
15. Shri Manoj Prasad, learned counsel appearing for the O.P.No.4 has argued that this Commission, has no jurisdiction to hear the complaint of the complainants against the O.P.No.4. The complainants/deceased are not consumer of the O.P.No.4. There was no insurance contract between the complainants/deceased and O.P.No.4, therefore, the O.P.No.4 is not a necessary party in the complaint. The complainants filed complaint in respect of medical negligence, but it is not proved therefore, the complaint is liable to be dismissed with cost. None of the opposite parties or complainants have gave intimation to O.P.No.4 regarding alleged treatment and death of the patient. For the first the first time the O.P.No.4 received notice from this Commission. The complainants have no right to file // 50 // complaint against the O.P.No.4. The complaint filed by the complainant against the O.P.No.4 is liable to be dismissed.
16. Shri P.K. Paul, learned counsel appearing for the O.P.No.5 has argued that the deceased patient Smt. Shabna Bano herself has not paid any premium to the O.P.No.5 and did not obtain insurance cover, therefore, there is no privity of contract between Smt. Shabnam Bano (deceased) and the O.P.No.5, therefore, she is not consumer of the O.P.No.5 under Section 2(1)(d) of the Consumer Protection Act. The complaint filed by the complainants against the O.P.No.5 is not maintainable and is liable to be dismissed. The complainants have not mentioned in their complaint or proved that the O.P.No.5 has committed any deficiency in service. The complainants or deceased Smt. Shabnam Bano did not submit any claim before the O.P.No.5 and no dispute has arisen between them, from which the complaint received basis. The O.P. No.5 has not accepted or rejected the claim of the complainants, therefore, no deficiency in service has been committed by the O.P.No.5, hence, the complaint against the O.P.No.5, is liable to be dismissed.
17. We have heard learned counsel appearing for the parties and have perused the record.
18. According to the complainants, the deceased Smt. Shabnam Bano, was taken in the Hospital of O.P.No.1 and O.P.No.1 expressed // 51 // his opinion that operation will be conducted through laser procedure, therefore, the complainants were agreed for treatment of the deceased, but the O.P.No.1 without obtaining Sonography report and without conducting other necessary tests, conducted operation in negligent manner. The above facts narrated by the complainants, is not supported by any authentic evidence. From bare perusal of the documents and complaint, it appears that the Uterus of the deceased was already removed in the year 2006 and the complainants themselves pleaded that problem was remain present since the uterus was removed. The above facts were not disclosed to the O.P.No.1 Dr. Lalit Shah. According to the O.P.No.1, the deceased was brought before him with flank pain about more than last 2 months and she was brought on 21.03.2014 as outdoor patient and she made complaint about mouth ulcer complained about mouth ulcer and phode phunsi.
19. The O.P.No.1 specifically pleaded that he explained to the complainants and deceased in detail regarding surgery and obstruction in kidney and also explained that right kidney may be damaged and for saving kidney operation is required. The USG report was brought by the deceased and after perusal of the Sonography Report, it is found that the functioning of right kidney is very poor and in non- functioning condition and the obstruction was due to stone. Thereafter by obtaining consent from the complainants, the procedure was done and O.P.No.1 removed the obstruction through stent. The // 52 // complainants have not produced any evidence to show that Cancer was occurred to the deceased due to obstruction or due to side effect of the operation conducted by the O.P.No.1.
20. The O.P.No.1 specifically pleaded that the results & consequences of the operation has been properly explained to the complainants and deceased. There is significant damage to the functioning of right kidney as per IVP done in January, 2014 which is showing very poor functioning or non-functioning of right kidney, therefore, obstruction has to be released at the earliest to give the possibility of saving the right kidney.
21. O.P.No.1 Dr. Lalit Shah is M.S., M.C.H. Urologist and is possessing qualification for conducting operation for removing obstruction through open surgery, therefore, the O.P.no.1 did not commit any medical negligence. The amount which was received by the O.P.No.1 and O.P.No.2 was refunded by them to the complainants and the complainants themselves pleaded regarding above fact.
22. So far as the question of medical negligence committed by the O.P.No.2 and O.P.No.3 is concerned, the complainants pleaded that the deceased was suffering from swelling and pain in her right leg, then she again came to O.P.No.1 on 14.04.2014 and after obtaining sonography report, the O.P.No.1 advised to consult with Orthopaedics Dr. J. Roychaudhary then the complainants took the deceased to Dr. J.
// 53 // Roychaudhary, Orthopaedics, who advised for M.R.I. and M.R.I. was conducted on 05.05.2014. Dr. J. Roychaudhary advised to contact O.P.No.1 and O.P.No.1 referred the patient to Ramkrishna Care Hospital, Raipur for further treatment.
23. The deceased was admitted on 06.05.2014 at Ramkrishna Care Hospital as a case of swollen right leg for investigation and Dr. Javed, Cardiologist specialist gave treatment to the deceased and DVT was ruled out by colour Doppler. Thereafter patient was being taken care by Dr . Ajay Parashar (O.P.No.3) and Dr. Sandeep Dave (O.P. No.2) and Eophil forte given to the deceased which was not a dangerous drug. According to O.P.No.2 & O.P.No.3 the CT guided biopsy facility was not available in the Ramkrishna Care Hospital, therefore, the complainants were offered choice to go to higher centre, where CT guided biopsy is available
24. From bare perusal of the documents produced by the complainants, it appears that during the treatment the symptoms of cancer were not present in the deceased and it is also not proved that Cancer was occurred to the deceased due to giving medicine for filaria. According to the O.P.No.2 & O.P.No.3 the medicine for filaria was given to the deceased as supportive medicine and it was not dangerous to the life of the deceased.
// 54 //
25. The complainants have filed Ultrasonography Report dated 11.01.2014 of Mrs. Shabnam issued by Apollo Diagnostic Centre, which is placed at page 2 in the record in which it is mentioned thus :-
"IMPRESSION :- U.S. study shows features of -
1. Mild hydronephrotic RT kidney with lower ureteric stone.
2. Gall bladder stone."
26. The complainants have filed Ultrasonography Report dated 25.02.2014 of Mrs. Shabnam issued by Apollo Diagnostic Centre, which is placed at page 3 in the record, in which it is mentioned thus :-
"IMPRESSION :- U.S. study shows features of -
1. Mild hydronephrotic RT kidney with mid ureteric stone.
2. Chronic cholecystitis with cholelithiasis"
27. The complainants have filed MRI Report dated 05.05.2014 of Shabnam Bano, issued by MRI Diagnostics, Raipur, which is placed at page 13 in the record, in which it is mentioned thus :-
"IMPRESSIONS:
1) Paraspinal muscle spasm.
2) A hemangioma involving L1 vertebral body.
3) Degenerative arthroses of bilateral L3-L4, L4-L5 facet joints.
4) Diffuse annular bulgings of L3-L4, L4-L5 disks causing effacement of epidural fat.
5) Pre and bilateral paraortic severe lymphadenopathy.
6) Right sided pelvic severe lymphadenopathy.
7) Right sided hydronephrosis.
Advice :- MRI/CT Whole Abdomen."
// 55 //
28. The complainants have filed Sonography Report of the Abdomen dated 05.05.2014 of Mrs. Shabnam Bano issued by Ramkrishna Care Hospitals, Raipur, which is placed at page 15 in the record, in which it is mentioned thus :-
"IMPRESSION :-
1. Hepatomegaly.
2. Calculus Cholecystitis.
3. Right anterior lower abdominal wall collection."
29. The complainants have filed CT Scan Report of Shabnam Bano dated 10.05.2014 issued by Ramkrishna Care Hospitals, Raipur which is placed at page 16 in the record, in which it is mentioned thus :-
"- Enlarged right inguinal lymphnodes with largest 3.9 X 3.1 cm.
- Multiple mild to moderate volume retroperitoncal lymphnodes in paraaortic & aortocaval regions with pelvic lymphnodes along right iliac & adnexa with largest 50 X 40 mm.
- Mild subcutaneous edema noted in right ilio-lumbar abdominal wall.
IMPRESSION :-
1.......................
2.......................
3.......................
4......................
5. Multiple mild to moderate volume retroperitoneal lymphnodes in paraaortic & aortocaval regions with pelvic lymphnodes along right iliac & adnexa.
6. Mild subcutaneous edema noted in right ilio-lumbar abdominal wall.
7. Diffuse edematous bulky right ileo-psoas muscles.
8. Mesenterio-fat stranding in right ielo-lumbar region.
// 56 //
9. Minimal ascitis in pelvic cavity.
10. Enlarged right inguinal lymphnodes.
11. ....................
12 ......................."
Needs clinical & Histopathological correlation."
30. In Discharge Card dated 01.04.2014 of Jagjivan Urology Centre, Raipur (C.G.) filed by the complainants, it is mentioned thus :-
"Diagnosis : ® HN - HU Poor Functioning Kidney ? Ureteric Stone LS Gall Stone.
?? Ureteric structure Type IV."
31. In Ultrasonography of whole document dated 14.04.2014 of Agrawal Digital X-Ray, filed by the complainants, it is mentioned thus :-
"Inference : Fatty Infiltration of Liver Mild Hepatomegaly.
Multiple Tiny / Mobile Gall Stone with Chronic Cholecystitis with normal CBD.
Right Sided Mild - Moderate Hydronephrosis.
Mild Cystitis With Some Postvoid."
32. In Both Lower Limb Arterial & Venous Doppler Report dated 05.05.2014, filed by the complainants, it is mentioned thus :-
" ....
No evidence of deep vein thrombosis.
Diffuse expensive right lower limb subcutaneous oedema.
// 57 // Right inguinal lymphnodes are seen enlarged."
33. The complainants have filed Color Doppler Arterial System Right Lower Limb Report dated 18.05.2014 of Mrs. Shabnam Bano, issued by Yashoda Hospital, which is placed at page 23 in the record, in which it is mentioned thus :-
"Diffuse significant myofascial/subcutaneous edema noted along the right lower limb.
Impression : Negative study for critical stenosis."
34. The complainants have filed PET CT Report dated 20.05.2014 of Mrs. Shabnam Bano, issued by Yashoda Hospital, which is placed at page 25 in the record, in which it is mentioned thus :-
"NECK :
Small nodes seen in bilateral level II, III, IV and supraclavicular regions.
Nodes in left supraclavicular region are conglomerate & compressing the adjacent jugular vein.
The largest node measures 3.9 x 3.6 cm.
Rest of neck spaces are normal.
CHEST :
.........Largest node in subcarinal region measures 3.7 x 3.5 cm.
ABDOMEN :
...........This lesion measures 14.7 x 12.4 cm in maximium dimensions.
The lesion measures 10.0 x 7.9 cm in maxium dimensions at the level of renal hilum.
// 58 // D.J. stent seen in situ on right side.
Both adrenal roots are bulky measuring 9 mm in right adrenal and 14 mm in left adrenal.
...........Largest node in the right inguinal region measures 2.6 x 2.2 cm.
Irregular collection noted in the right paramedian location in subcutaneous places measures 6.8 x 6.7 cm & abutting the right anterior chest wall muscles.
PET FINDINGS :
* Intense heterogeneous tracer activity is noted in large ill defined mass lesion in right adnexa involving right parametrium and right lateral aspect of vaginal vault. The lesion is completely encasing right vesico-ureteric junction and distal right ureter. There is infiltration of presacral & pelvic floor muscles on right side. (SUV MAX : 17.8). Secondary hydronephrosis noted on right side -- ? Vault Mass / ?? Infiltrating Nodal Mass.
* Multiple large heterogeneously hypremetabolic similar density conglomaters masses are seen involving right inguinal, right external & internal iliac, bilateral common iliac and most of retroperitoeal nodal stations. Few lesions appear necrotic infiltrating adjacent soft issue (SUV MAX : 16.4) - Extensive Nodal Metastases.
* Few hypermetabolic enlarged discreet nodes seen in left external & internal iliac., left para -psoas region, subcarinal region of mediastinum and left supra-calvicular area (SUV MAX : 16.8 in subcarnal nodes.
* A well defined metabolically inert collection noted in right anterior abdominal wall in pelvic region -- ? Post Operative collection.
// 59 // * No significant metabolically active peritoneal lesion noted. No free fluid in abdomen seen.
* No abnormal tracer activity noted in liver parenchyma and bilateral adrenals.
* No abnormal tracer activity noted anywhere in the rest part of the scanned segnment of the body including brain parenchyma, bilateral lungs and visualized skeleton.
POSSIBLE DIFFERENTIALS ARE --
1) CERVICAL / ENDOMETRIAL MALIGNANCY.
2) RIGHT URETERIC PRIMARY
3) LYMPHOMA.
35. The complainants have filed Discharge Summary Discharge on Request dated 25.05.2014 of Mrs. Shabnam Bano issued by Yashoda Cancer Institute, which is placed at page 29 & 30, in which it is mentioned thus :-
"HISTORY OF PRESENT ILLNESS :
Mrs. Shabnam Bano, presented with above complaints. She was evaluated by Urologist at her hometown and an open procedure was done for right ureteric stenting for diagnosis of ureteric calculi. She continued to deteriorate and was brought in bedridden state to the emergency department.
PAST HISTORY :
Significant Menorrhagia in 2008 - USG was reported showing 20 mm endometrial thickness ? Carcinoma Endomertium. She underwent TAH - September 2006. However, HPE was not just done.
PERSONALHISTORY :
Education - 10th Standard.
Occupation - Housewife Residence - Raipur.
Husband - Scrap business.
// 60 // Issues - 2 Sons / 3 Daughters.
Has good family support.
No exposure to active / passive smoking.""
36. In Real Time Ultrasonogorphy of Abdomen and Pelvis Performed Report of Department of Radiology, Yashoda Hospital, Secunderabad, filed by the complainants, it is mentioned thus :
"Liver 18.5 cms, Enlarged in size with increased exhotexture. No focal lesions. No IHBR/CBD dilation. Portal vein is normal.
Gall Bladder shows multiple hyperechoic foci of varying sizes in lumen. Wall thickness is normal.
Spleen 10.8 cms, normal in size and exhotexture. No focal lesions seen.
Pancreas : Obscured.
Right kidney measures : 9.4 x 5.6 cms. Left Kidney measures:12.1 x 5.7 Cms.
Both kidneys are normal in size and exhotexture . Cortico- medullary differentiation is made out.
Dilated collecting system and ureter not bilaterally. No evidence of obvious calculi noted.
...............
Diffuse myofascial edema with suggestion of multiloculated collection in the right lower anterior abdominal wall.
Impression : US findings are suggestive of :
* Hepatomegaly with grade II fatty liver. * Cholelithiasis * Bilateral hydroureteronephrosis.
* Right inquinal lymph adenopathy.
* Diffuse myofascial edema with suggestion of multiloculated collection in the right lower anterior abdominal wall.
Suggested : CECT abdomen for better assessment."
// 61 //
37. In Venous Doppler Right Lower Limb Report of Yashoda Hospital, dated 18.05.2014, it is mentioned thus :-
"Multiple enlarged lymphnodes with SAD measuring 2 - 2.5 cms in the right inguinal region.
GSV is mildly prominent (4.5 mm) with competent SFJ. Impression : Negative study for DVT."
38. The O.P.No.1 has filed literature on Position Statement of the National Lymphedema Network in which it is mentioned thus :-
"Diagnosis of Lymphedema Since lymphedema is progressive and early diagnosis leads to more effective treatment, the diagnosis of lymph edema at the earliest possible stage is very important. Treatment of lymphedema is based on correct diagnosis. Many conditions that cause swelling (edema) are not lymphedema. True lymphedema is swelling caused by abnormality in lymphatic system. Lymphedema can also co-exist with other medical and swelling conditions. Correct diagnosis of lymphedema may require evaluation by a physician or other health-care provider with expertise in lymphedema who can, when needed, perform specialized diagnostic testing. Diagnostic tests for lymphedema come under the following categories :-
- History and physical examination.
- Soft tissue imaging.
- Lymph vessel and lymph node imaging.
- Measures of volume.
- Changes in electrical conductance.
- Changes in biomechanical properties.
- Genetic testing.
// 62 // Soft Tissue Imaging :
Magnetic resonance imaging (MRI), computed tomography (MRI), computed tomography (CT) and some types of ultrasound (US) are able to detect the presence of extra fluid in the issues. Fluid that is outside of cells (extracellular) and also outside of vessels (extravascular) is called tissue fluid or interstitial fluid. Lymphedema is one type of interstitial fluid build up that occurs when fluid is not being removed effectively by the lymph vessels. MRI, CT and US can show the presence of increased interstitial fluid but cannot tell the cause. These imaging techniques have to be put together with history, physical examination and sometimes other imaging tests. Other conditions such as heart failure or low proteins in the blood from liver disease or malnutrition can cause fluid to build up in the tissues. MRI, US and CT scans may be required to determine the cause of lymphedema, especially if there is a concern that the lymphedema might be the result of an untreated cancer."
39. The O.P.No.2 & O.P.No.3 have filed literature on Hydronephrosis in which it is mentioned thus :-
"Hydronephrosis :
Definition :-
Hydronephrosis is the swelling of the kidneys when urine flow is obstructed in any part of the urinary tract. Swelling of the ureter, which always accompanies hydronephrosis, is called hydroureter. Hydronephrosis implies that a ureter and the renal pelvis (the connection of the ureter to the kidney) are overfilled with urine.
Causes and Symptoms "
Causes are numerous. Various congenital deformities of the ureter may sooner or later produce back pressure. Kidney stones are a common cause. They form in the renal pelvis and become lodged in the kidney, usually at the ureterovesical junction. In older men, the // 63 // continued growth of the prostate gland leads commonly to restricted urine flow out of the bladder. Prostate cancer, and cancer anywhere else along with urine pathways, can obstruct flow. Pregnancy normally causes ureteral obstruction from pressure of the enlarged uterus (womb) on the ureters.
Symptoms relate to the passage of urine. Sometimes, urine may be difficult to pass, irregular or uncontrolled. Pain from distension of the structures is present. Blood in the urine may be visible, but it is usually microscopic. In all cases where bodily fluids cannot flow freely, infection is inevitable. Symptoms of urinary infection may include :-
- Painful, burning urine.
- Cloudy urine.
- Pain in the back, flank, or groin.
- Fever, sweats, chills and generalized discomfort. Patients often mistake a serious urinary infection for the flu.
Diagnosis :
If the bladder is significantly distended, it can be felt through the abdomen. An analysis of the urine may reveal blood (if there is a stone), infection or chemical changes suggesting kidney damage. Blood tests may also detect a decrease in kidney function.
All urinary obstructions will undergo imaging of some sort. Beginning with standard x rays to look for stones, radiologists, physicians specializing in the use of radiant energy for diagnostic purposes, will select from a wide array of tests. Ultrasound is simple, inexpensive, and very useful for these conditions. Standard x rays can be enhanced with contrast agents in several ways. If the kidneys are functioning, they will filter an x ray dye out of the blood and concentrate it in the urine, giving excellent pictures and also an assessment of kidney function. For better images of the lower urinary tract, contrast agents can be instilled from below. This is usually done with a cystoscope placed in the bladder. Through the cystoscope, a small tube can be threaded into the ureter through the ureterovesical valv, allowing dye to be injected all the way to put the kidney.. Treatment :
The obstruction must be relieved even if it is partial or functional, as in the case of reflux from the bladder. If not, the kidney will ultimately be damaged, infection will appear, or both. The task may be as simple as placing a catheter through a restricting prostate or as complicated as removing a cancerous bladder and rebuilding a new one with a piece of // 64 // bowel. In some cases, a badly damaged kidney may have to be removed.
40. The O.P.No.2 & O.P.No.3 have filed literature on Etiology, in which it is mentioned thus :-
"Etiology :
Anything that obstructs the ureter or bladder may cause hydronephrosis. Lodged kidney stones are a common cause of unilateral hydronephrosis : bilateral hydronephrosis often results from bladder outlet obstruction (e.g. in men who have hyperplasia of the prostate). Neurogenic bladder dysfunction, pregnancy, urogenital cancer, urinary tract inflammation, congenital malformations, ureteral strictures, and even parasites (schistosomiasis) may cause hydronephrosis. If urinary flow is not restored, the kidney tissues dilates and atrophies, and chronic renal failure may occur.
41. The O.P.No.2 & 3 have filed Journal of Pakistan Medical Association in which it is mentioned thus :-
"Ureteroscopy (URS) : an Effective Interventional and Diagnostic Modality Conclusion : Considering the result from this study we suggest that URS is an effective interventional and diagnostic modality for ureteric diseases with a low complication rate.
Discussion :
Ureteroscopy continues to be the effective means of removing ureteral calculi but its use in diagnosis has undergone wide expansion........These advancement and improvement in technique have caused an increase in overall diagnostic and therapeutic success from 86 to 96%5........The failures were due to inability to negotiate the ureter......... It could be concluded from the study that URS is an effective and safe interventional and diagnostic modality for ureteric diseases.""
// 65 //
42. The O.P.No.2 & 3 have filed literature on Ureteroscopy Treatment and Management, in which it is mentioned thus :
"Surgical Therapy :
Ureteroscopy can be divided into diagnostic endoscopy and therapeutic treatments.
Diagnostic ureteroscopy :
Atraumatic diagnostic endoscopy minimizes mucosal distortion, allowing for complete mapping of the upper urinary tract. Ureteroscopic access is obtained with a wireless technique, if possible. The ureteral orifice is visualized and intubated without the assistance of a guidewire. The intramural ureter is traversed employing a "no- touch" technique, and the more proximal ureter and renal collecting system are then mapped. In a recent prospective study of 460 consecutive upper-tract endoscopies, no-touch ureteroscopy was successfully performed in most patients without prior stenting or ureteral dilation. This wireless form of flexible ureteroscop eliminates the potential trauma, mucosal irritation, and inadvertent manipulation of stones or tumours caused by guidewires and is particularly helpful when the collecting system is evaluated for mucosal/intra-luminal lesions.
Fluid irrigation facilitates passages of the ureteroscope while simultaneously clearing the optical field. Sterile saline is the preferred irrigant. Although automatic pumps are available for this purpose, hand irrigation is preferred for its precise control of volume dispensed. When wireless flexibe ureteroscopy is not feasible, a small-diameter rigid ureteroscope can be employed first to inspect and map the ureter. A guidewire is then placed only to the area that already has been inspected, and then a flexible instrument is the passed over it in a monorail fashion, under fluoroscopic guidance, to complete the mapping. The flexible ureteroscope is directed from calyx to calyx and frequently dilute contrast material is injected through the working // 66 // channel of the endoscope to help ensure the entire collecting system is inspected as depicted below.
Therapeutic ureteroscopy:
Therapeutic ureteroscopy if used in varied applications, including in the treatment of stones, urothelial tumors, and stricture disease. Ureteroscopy is a safe and minimally invasive method of treating stone disease in the kidneys and ureter as shown below. ........ In addition ureteroscopy can be employed to treat ureteral stenosis/stricture and ureteropelvic junction obstruction......."
43. The O.P.No.2 & O.P.No.3 have filed literature on Anatomy & Cell Biology in which it is mentioned thus :-
"Unilateral ureteric stone associated with gross hydronephrosis and kidney shrinkage : a cadaveric report.
Abstract :
Ureteric stones are a common cause of obstruction of the urinary tract, usually presenting with characteristic signs and symptoms, such as acute ureteric colic and hematuria. Occasionally, stones may present with non-specific symptoms such as low back pain and remain unidentified, leading to stone growth, chronic ureteric obstruction and complications such as hydronephrosis and renal damage. Here we report a large ureteric stone in a cadaver with complete obstruction at the left ureterovesical junction, resulting in severe dilation of the left ureter and renal pelvis."
44. The O.P.No.2 & O.P.No.3 have filed literature on Diseases and Conditions Ureteral Obstruction, in which it is mentioned thus :-
"Treatment at Mayo Clinic :
The goal of ureteral obstruction treatment is to remove blockages, if possible, or bypass the blockage, which may help repair damage to the kidneys. Because of the complexity of the urinary system, you may need more than one type of treatment.
Drainage procedures:
// 67 // A ureteral obstruction that causes severe pain may require an immediate procedure to remove urine from your body and temporally relieve the problems caused by a blockage. Your doctor (urologist) may recommend :
- A ureteral stent, which involves inserting a hollow tube inside the ureter to keep it open.
- Percutaneous nephrostomy, which involves inserting a tube through your back to drain the kidney directly.
- A Catheter, which involves inserting a tube through the urethra to connect the bladder to an external drainage bag. This may be especially important if your bladder also plays a role in poor drainage of your kidneys.
Your doctor can tell you which procedure or combination of procedures is best for you. Drainage procedures may be temporary or permanent treatment options, depending on your condition.......
Endoscopic Surgery :
Endoscopic surgery, a minimally invasive procedure, involves passing a lighted scope through the urethra into the bladder and other parts of the urinary tract. The Surgeon makes a cut (incision) into the damaged or blocked part of the ureter to widen the area and then placed a hollow tube (stent) in the ureter to keep it open. This procedure may be done to both diagnose and treat a condition.
Other surgical procedures :
Surgical procedures to correct ureteral obstruction include :
- Ureterolysis. Ureteolysis (u-ree-tuur-OL-ih-sis) is a procedure that exposes the ureter and frees it from abnormal fibrous or scar tissues (adhesions).
- Pyeloplasty : During pyeloplasty (PIE=uh-low-plas-toe, the surgeon reopens or repairs the ureter and inserts a hollow tube (stent) to keep the ureter and inserts a hollow tube (stent) to keep the ureter open. The stent remains in place for up to six weeks and is removed during an office visit.
- Partial nephrectomy. During a partial nephrectomy, the surgon removes the damaged part of the kidney caused by the ureteral obstruction.
// 68 //
- Ureterectomy. In this procedure, the surgeon removes all or part of a ureter, then reconstructs the urinary tract by lowering the kidney and stretching the bladder up or replacing the ureter using other body tissue.
- Ureteral reimplantation. In this surgery, a poorly functioning section of the ureter is removed and the remaining healthy sections are reconnected and reattached to the bladder.
- Transureteroureterostomy.During Transureteroureterostomy (trans-u-ree-tur-oh-u-ree-tur-OS-tuh-me), the surgeon joins one ureter to the other, resulting in sustained improvement in long - term renal function. This procedure isn't recommended if you have stone diseases or cancer in the ureters.
These surgical procedures may be performed through any one of these surgical approaches :-
- Open Surgery, during which your surgeon makes an incision in your abdomen to perform the procedure.
- .........................
- .........................."
45. The O.P.No.2 & O.P.No.3 have filed Indian Journal of Surgery, Vol. 67 No.1, January - February, 2005 pp 21-28 in which it is mentioned thus :-
"Urinary obstruction is a common cause of acute and chronic renal failure. The symptoms and signs of an obstructed kidney may vary from asymptomatic to severe actue pain. The diagnosis and management of a hydronephrotic kidney is not very difficult with ultrasonography. The approach to manage such patients has been rationalized after the advent of diuretic renography. The obstructed kidney should be decompressed as early as possible because of progressive loss of renal function with prolonged obstruction. Nephrectomy may be required lot a non-functioning kidney. Further advancements are being made as the molecular mechanisms involved in the pathophysiology of the obstructed kidney become known to us. ....... Hence obstruction coexisting with infection should be considered a urological emergency.............
// 69 // Retrograde pyelogram does not interfere with renal function. However, this procedure requires anaesthesia and is associated with the risk of introducing infection in an obstructed system. It now has only an adjunctive role in the opening room during ureterorenoscopy or DJ Stenting.
The first crucial decision to be made is whether to remove the kidney or relieve the obstruction. Diuretic renography ultrasonography (cortical thickness) and possibly even CT may help the clinician in deciding this, but the experience of the surgeon in assessing a clinical situation and per-op findings is the first. At times laboratory data may seem to favour salvage whereas the experience of the urologist favours nephrectomy. On the other hand, there have been cases of return of renal function when the kidney was salvaged if cortical thickness was adequate even though pre-operative renography depicted poor renal function.
......
The definitive management with the decision to preserve the kidney, depends upon the particular cause of obstruction and may include watchful waiting, endourologic approach percutaneous minimally invasive technique, laparoscopic or conventional open surgery. Today the emphasis is an saving as much of the functioning renal tissue as is possible. When both kidneys require surgical correction, one cannot allow the time-honoured dictates to be followed. Although it is sound advice to operate on the symptomatic o or the better functioning kidney first, the opposite kidney cannot be allowed to deteriorate further. It is imperative that the function of the other kidney be sustained by insertion of a DJ stent or a PCN catheter just prior to the time when a definite operative intervention is planned for the symptomatic/better functioning kidney. More experienced surgeons have also repaired both sides at the same sitting in the past. But its routine application is questionable.
// 70 //
46. The O.P.No.2 & 3 have filed literature on Diseases and Conditions Cancer in which it is mentioned thus :-
"Myth : A needle biopsy can disturb cancer cells, causing them to travel to other parts of the body.
Truth : For most types of cancer, theirs is no conclusive evidence that needle biopsy - a procedure used to diagnose many types of cancer - causes cancer cells to spread.
There are exceptions, though, of which doctors and surgeons are aware. For instance, needle biopsy usually isn't used in diagnosing testicular cancer. Instead, if a doctor suspects testicular cancer, the testicle is removed.
Myth : Surgery causes cancer to spread.
Truth : Surgery cann't cause cancer to spread. Don't delay or refuse treatment because of this myth. Surgically removing cancer is often the first and most important treatment.
Some people may believe this myth because they feel worse during recovery than they did before surgery. And if your surgeon discovers during surgery that your cancer is more advanced than first thought, that you may believe the surgery caused more extensive cancer. But there is no evidence to support this.
The O.P.No.1 & O.P.No.2 have filed literature on Extrapulmonary Small-cell Carcinoma : a Single institution Experience :-
Abstract :
Background : Extrpulmonary small-cell carcinoma (EPSCC) has been recognized as a clinicopathological entity distinct from small- cell carcinoma (SCC) of the lung. This study aimed to review the clinical features, therapy and natural course of patients with EPSCC in Oriental single-institution series. ..............
Results : Twenty four patients with EPSCC were identified and primary sites were various : uterine cervix in seven (29%), urinary // 71 // bladder in five, colon or rectum in three, kidney in two and stomach, esophagus, pancreas, common bile duct, larynx, parotid gland, thymus in one each. Sixteen patients (66.7%) had limited disease (LD) and eight had extensive disease (ED). Patients with ED received mostly platinum - based chemotherapy, for which the response rate was 57%, but showed an aggressive natural history, with median overall survival (OS) of 9.2 months.......Patients with LD SCC of sites other than cervix had an aggressive course with a median OS of 9.6 months."
47. In literature Cancer Antigen 125 (CA 125) it is mentioned thus :-
"Conditions which may cause elevated cancer antigen 125 Malignant disease Ovarian cancer Uterine cancer Fallopian tube cancer Other intra-abdominal cancers (pancreas, stomach, colony, rectum) and metastases from other sites (eg. Breast, lung).
Investigation of female patients with symptoms suggestive of ovarian cancer.
CA 125 can be used in the assessment of patients presenting with a pelvic mass. It is, however, a nonspecific test, i.e. raised in other conditions, many of which are benign (see above). The National Institute for Health and Care Excellence (NICE) estimates only 1 in 100 women with a raised CA 125 or abnormal ultrasound will have ovarian cancer. So far every 100 women referred, 99 will not have cancer, which results in economic and psychological cost. Nevertheless, NIC advocates that CA 125 should be the first-line investigation for women (particularly over the age of 50) with symptoms suggestive of ovarian cancer.
Monitoring known patients with ovarian cancer for relapse A number of reviews have failed to identify survival advantage for the process of monitoring CA 125 in asymptomatic women after treatment. It has often traditionally been used to try to pick up relapse early but is currently not recommended.
// 72 // Screening for ovarian cancer The relatively low prevalence of ovarian cancer means that the positive predictive value of CA 125 as a screening test is extremely low. CA 125 is unreliable in differentiating benign from malignant ovarian masses in premenopausal women because of the increased rate of false positive and reducted specifically. This is because an elevated CA 125 level is also found in so many other conditions. When levels are elevated, serial monitoring can be helpful, as rapidly rising levels are more likely to be associated with malignancy than high levels which are static.
Large studies have evaluated CA 125 as a screening tool in combination with ultrasound scanning to detect ovarian cancer early but results so far have failed to demonstrate benefit. Therefore, it is not recommended outside research settings.
However, CA 125 is still being evaluated as a screening tool for patients at high risk of ovarian cancer, in combination with other tests. The UK Familial Ovarian Cancer Screening Study (UKFOCSS) recruited women over a number of years with strong family histories or mutations in BRCA1 or BRCA2, to be screened with transvaginal ultrasound scan of the ovaries combined with a CA 125 level regularly and continue to follow this up. A second study, the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) study reports encouraging early results but further follow-up is awaited before conclusions can be reached."
48. In the literature of CA 125 test it is mentioned thus :-
"A CA 125 test may be used to monitor certain cancers during and after treatment. In some causes, a CA 125 test may be used to look for early signs of ovarian cancer in women with a very high risk of the disease.
... Certain cancers may also cause an increased level of CA 125, including ovarian, endometrical, peritoneal and fallopian tube cancers.
Why it's done You may have a CA 125 test for several reasons :
To monitor cancer treatment : if you have ovarian, endometrial, peritoneal o fallopian tube cancer, your doctor may recommend // 73 // a CA 125 test on a regular basis to monitor your condition and treatment.
But such monitoring hasn't been shown to improve the outcome for women with ovarian cancer, and it might lead to additional and unnecessary rounds of chemotherapy or other treatments. To screen for ovarian cancer if you're at high risk : If you have a strong family history of ovarian cancer or you have the BRCA1 or BRCA2 gene mutation, your doctor may recommend a CA 125 test as one way to screen for ovarian cancer.
Some doctors may recommend CA 125 testing combined with transvaginal ultrasound every six months for women at very high risk.
However, some women with ovarian cancer may not have an increased CA 125 level. And no evidence shows that screen women with CA-125 decreases the chance of dying of ovarian cancer. An elevated level of CA 125 could prompt your doctor to put you through unnecessary and possibly harmful tests. To Check for cancer recurrence : If your doctor suspects your may have ovarian cancer or another type of cancer, he or she may recommend a biopsy to collect a sample of cells. Other tests that may be helpful in evaluating these cancers include a transvaginal or pelvic ultrasound and computerized tomography (CT).
49. In the literature Cancer Symptoms : Seven Warning Signs it is mentions thus :-
If you have any of these signs, see your doctor. These are potential cancer symptoms :-
1. Change in bowel or bladder habits.
2. Sore that does not heal.
3. Unusual bleeding or discharge.
4. Thickening or lump in the breast or elsewhere.
5. Indigestion or difficulty in swallowing.
6. Obvious change in a wart or mole.
7. Nagging cough or hoarseness."
// 74 //
50. In the literature Cancer Symptoms - Seven Warning Signs seven symptoms of the cancer have been given but none of these symptoms were found in the deceased, therefore, treatment of the cancer was not done by the O.P.No.2 & 3. The complainants have not been able to prove that the O.P.No.2 & O.P.No.3 committed medical negligence while treating the deceased. When the deceased was brought in Ramkrishna Care Hospital, Raipur she was having complaint of swelling in right lower limb and at that time clinical picture was more like DVT and there had been no sign and symptom for possible cancer at the time of treatment. There had been no sign or symptom to suspect cancer, as per detailed history, clinical examination. Even Sonogaphy report dated 14.04.2014 is not showing any pelvic mass or lymphnode. After perusal of the Sonography Report dated 14.04.2014 and Discharge Summary of Yashoda Hospital, it seems that the lymphnodes was developed between 14/04/2014 and 05/05/2014. On the basis of literature on Cancer, it appears that the lymphnode was part of very fast growing extrapulmonary small cell carcinoma with bad prognosis.
51. From bare perusal of documents and the complaint, it appears that the O.P.No.1 and O.P.No.2 waived their charges and refunded the same to the complainants on humanitarian ground. The complainants have not been able to prove that the O.P.No.1 to O.P.No.3 have treated the patient for extracting the money from the complainants. The // 75 // complainants have not filed any expert opinion to show that the O.P.No.1 to 3 done wrong treatment of the deceased or the treatment given by them to the deceased, are in wrong direction.
52. On the basis of above discussions, in the instant case we find that the complainants have not been able to prove that there was any medical negligence on the part of the O.P.No.1 Dr. Lalit Shah, O.P.No.2 Dr. Sandeep Dave and O.P.No.3 Dr. Ajay Parashar. As there is no negligence on the part of the O.P.No.1, O.P.No.2 & O.P.No.3 and they have not committed any negligence, therefore, the complainants are not entitled to get any compensation from them.
53. Therefore, the complaint filed by the complainants against OPs, is liable to be dismissed, hence the same is dismissed. Parties shall bear their own costs.
(Justice R.S. Sharma) (Ms. Heena Thakkar) (D.K. Poddar) (Narendra Gupta)
President Member Member Member
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