State Consumer Disputes Redressal Commission
Dr. P.Madhusudhan Reddy, And 2 Others ... vs R.Bayapu Reddy Kadapa on 17 March, 2009
BEFORE THE A BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: HYDERABAD. F.A.No.1470/2006 against C.D.No. 186/2005, Dist. Forum, Kadapa. Between: 1. Dr. P.Madhusudhan Reddy, S/o.P.Venkata Subba Reddy, aged about 38 years, R/o.Ashrya Nursing Home, Pulivendula, Kadapa District. 2.Dr. V.Ashajyothi , W/o.Dr.P.Madhusudhan Reddy, Aged about 33 years, R./o. Ashrya Nursing Home, Pulivendula , Kadapa District. 3. Dr. Venkatesh Naik, S/o.Laxmi Naik, Aged about 34 years, Medical Officer, Primary Health Centre, Simhadripuram Mandal, Pulivendula Tq., Kadpaa District. Appellants / Opp.parties And R.Bayapu Reddy, S/o. Soora Reddy, Aged about 25 years, R/o.Agadur Village, Thondur Mandal Kadapa District. Respondent/ Complainant Counsel for the appellants : M/s. VRN.Prashanth Counsel for the respondent : Sri .V.R.Reddy Kovvuri CORAM : THE HONBLE JUSTICE SRI.D.APPA RAO , PRESIDENT, AND SRI SYED ABDULLAH, HONBLE MEMBER
TUESDAY, THE SEVENTEENTH DAY OF MARCH TWO THOUSAND NINE.
Oral Order : (Per Sri Syed Abdullah, Hon ble Member. ) *** The appellants 1 to 3 are the opposite parties in C.D.No.186 /2005, Dist. Forum , Kadapa against whom order was passed directing them to pay 3 lakhs with joint and several liability with interest there on at 9% from 12.5.2004 till the date of realization.
The impugned order is assailed contending that the District Forum failed to see that the appellants have done Laparotomy to close perforation caused to the small intestine and the appendix was not at all opened as alleged, if really appendix was operated it would have been mentioned in the discharge summary given by St. Johns Hospital , Bangalore i.e. Ex.A3 filed on behalf of the complainant which shows that the patient was admitted there for second operation.
Further it is contended that the laporatomy was performed by them was successful , it is too much to attribute with medical negligence and in the absence of expert evidence it cannot be said that the operation done by the opp.parties was totally wrong one.
In short the facts in case in C.D. No.186/2005 are that the complainant approached the opposite parties 1 and 2 on 14.4.2004 as he developed abdominal pain and after diagnosis he was advised to under go appendicitis operation . The opposite parties 1 to 3 conducted surgery for removal of appendix . Even after surgery there was no relief at all but complications developed by having blood motions. It is alleged that the opposite parties doctors after operating abdomen found that there was no need to do Appendicitis operation had closed the stomach . On account of their wrong diagnosis, the complications arose further they failed to apply stitches properly at the operated portion which lead to further complications. The complainant was rushed to St. Johns Hospital , Bangalore for further treatment . There they diagnosed as post illeostomy plus mucus fistula. Operation was done to rectify the problem where the complainant had to spend Rs. 2 lakhs which is on account of negligence of opposite parties.
The opposite parties in their versions while admitting that the complainant had approached the opp.parties 1 and 2 on 12.5.2004 have stated that he was having fever for the past 7 days and abdomen pain for the past 2 days and as per the complainants information he approached the RMP doctor for treatment and as first aid he took some treatment . The opposite parties have advised to have clinical examination and the reports showed the signs of perforation i.e. rigidity of abdomen , tenderness of abdomen and absence of bowel sounds.
After he was advised to undergo CBP , CUE, Chest X Ray including abdomen ultrasound (abdomen) smear for M.P. Widal test. Medicines were given to control the abdomen pain and fever till 13.5.2004. Reports reveal that the complainant was suffering from typhoid and development of tiny ulcer on the ileum , which in turn caused perforation over the small intestine , in view of the delayed treatment. The complainant was informed about need for treating the perforation of ileum (small intestine) by way of laparatomy and after explaining the risks involved in the surgery viz peritonitis burst abdomen , Fistula and after obtaining the consent, Laparatomy was done on 13.5.2004 . On opening abdomen by way midline incision, there was a perforation in the ileal region and greenish feacal matter and its deposit all over the abdominal cavity . Peritoneal lavage was done and ileal perforation was closed in layers and surgical drain was put to drain out the peritoneal fluid. The operation procedure was shown to the elder brother of the complainant and explained the post operative complications. After the surgery the complainant was administered with anti biotics and thereafter he was allowed to take fluids consequently he had normal stools. It is an indication that the perforation of ilium was successfully closed in the absence of which the complainant would not be in a position to pass stools. In view of peritonitis the abdominal wall wound did not heal. At that stage the complainant and his attendants insisted for discharge. On 19.5.2004 the complainant was discharged and he was referred to St. Johns hospital , Bangalore. Discharge summary dt. 12.6. 2004 given by the said hospital disclose that the complainant was treated for abdominal wound and the findings of the surgery done on 31.5.2004 reveal that the anastomosis was intact and further there was no leakage and he only underwent ileostomy for multiple bleeding ulcers and it revealed that the anastomosis was intact and further there was no leakage and this itself indicates that the surgery conducted by the opposite parties was successful. In case the opp.parties have diagnosed for appendicitis it would be found in the discharge summary by the said hospital. For appendicitis operation the incision will beat macburneys point but in the present case, mid line incision was made for the purpose of laparotomy False allegations are made in spite of the fact that the complainant was treated with utmost care and caution and in accordance with standard medical practice. There is no deficiency in service or negligence on the part of the opp.parties .
In order to prove medical negligence, the complainant filed his evidence affidavit as well Exs.A1 to A7 documents. The opp.parties neither filed any evidence affidavit nor any documents. After considering the evidence on record the District Forum arrived at the finding that the opposite parties have not filed any documents showing that the patient was discharged at his own instance . The complainant has relied on Ex.A3 discharge summary issued by St. Johns hospital in which it is noted that the patient was treated for abdominal wound and for anastomosis as in patient. There was no leakage and the complainant underwent only for ileostomy for multiple bleeding ulcer. An observation was made by the Dist. Forum that had the opposite parties conducted surgery carefully without any negligence there would not have been any necessity to go for second operation to St.Johns Hospital, Bangalore where he was kept for more than 15 days as in patient with post operative care. Thereby the District Forum awarded Rs.2 lakhs towards expenditure spent by the complainant and Rs.1 lakh towards compensation for mental agony along with interest @ 9% p.a. from 12.5.2004 till the date of realization.
On reappraisal of the factual aspects and evidence the following findings are arrived at:
The main grievance is that the complainant was asked to undergo Appendix operation and before that clinical diagnosis was done . Infact the operation was done on 14.4.2004 for removal of appendicitis . Even then there was no relief and on the other hand complications arose by having blood motions. Apart from it, due to improper stitching at the operated portion blood oozed from it which was on account of improper closure of abdomen. . In the said situation the patient had to be rushed to St. Johns hospital , Bangalore where it was diagnosed as post illeostomy plus mucus fistula.
The initial burden is on the complainant to prove the negligence by placing expert evidence or producing the medical literature in support of the allegations. . When ever negligence is attributed, it is to be proved but cannot be presumed . So it is also necessary to prove that the doctors failed to take reasonable care and performed operation wrongly and failed to take post operative care. There is no allegation against the hospital or doctors opposite parties 2 and 3 that they did not have requisite qualification skill competence to conduct the operation and that they failed to exercise reasonable care in discharge of duty . If a doctor had acted in accordance with the practice accepted as proper by reasonable body of medical men skilled in particular field , doctors cannot be attributed as negligent (Bolams Rule ).
For the reason that the patient had not responded to treatment or operation , doctor cannot be held guilty by applying the principles of Res.-ipsa-loquiter When and in what circumstances the doctor can be found negligent to arrive at the conclusion about the negligence has been well laid down in a decision of Honble Supreme Court in (unreported decision) in Martin F.DSouza vs. Mohd Ishfaq Civil appeal no. 3541 of 2002 decided on February 17,2009 . Keeping in mind the principles laid down in the above decision and the earlier precedents the evidence on record to be evaluated to arrive at the conclusion.
Besides evidence affidavit, the complainant has filed few documents which are Ex.A1 xerox copy of the patient card dt.
12.5.2004 . Ex.A2 the discharge summary dt. 31.8.2004 of St. Johns Medical College Hospital, Bangalore . Ex.A3 discharge summary dt. 22.5.2004 of the same hospital . Ex.A4 the legal notice issued to the opp.parties dt. 8.2.2005 by the complainant.
As regard Exs.A1 and A2 the opposite parties version is that St, Johns Hospital had not pointed out any negligence or that complications arose on account of the operation done by them or that they have operated wrongly . It is pointed out that the discharge summary dt. 12 6 2004 given by St.Johns Hospital show that the patient was given treatment for abdominal wound and the findings of the surgery done on 31.5.2004 disclose that anastomosis was intact without any leakage and the complainant underwent ileostomy for multiple bleeding ulcers. The said findings given by the hospital would support that the surgery was intact done by them without any leakage and the patient underwent ileostomy operation for multiple bleeding ulcers . These findings indicate that the surgery conducted by the opposite parties was successful . The diagnosis made by them as appendicitis was correct and there was no necessity to remove appendicitis at all. The very finding of St. John Hospital covered by E.A1 will falsify the allegation of medical negligence . The complainant has not examined any expert doctor in support of his version that the opposite parties 2 and 3 have not taken sufficient care and on account of their lack of skill the abdominal operation was a failure.
The District Forum had made an observation that had the opposite party doctors conducted surgery without any negligence the patient had no necessity to take further treatment in St.Johns Hospital , Bangalore, where he has been treated for a fortnight. This circumstance cannot be a basis to draw an inference that the opposite parties have not exercised any reasonable care in conducting operation. Ex.A3 itself will demolish and falsify the version of the complainant. As such the complaint is liable to be dismissed by setting aside the order of the District Forum In the result appeal is allowed by setting aside the order dt. 13.9.2006 in C.D.No.186/2005 on the file of Dist Forum, Kadapa. Consequently complaint is dismissed. . In the circumstances of the case each party to bear their own costs.
PRESIDENT MALE MEMBER Dt. 17.3.2009.