State Consumer Disputes Redressal Commission
Rajendra Prasad G.S. & Karthik.S vs M/S Rangadore Memorial Hospital Ltd. on 28 June, 2023
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cC/204i2trr.,
Date of filing: 25 08-20 ti,
Date ol Disposal:28-0()-2Li-li,
.".!i',1) }T.E 'I'II E I(ARN A'IAI<A STATE C OI{S UMER D
I
RtrDI?ES SAL MIIIS SION, BEN GALURU I PRIN CIPAL BE NCIi}
DATE:28 .06.2023
PRESENT
HOH,FLE ITIT, JUSTICE HULWADI G. RAMESH: PRESIDENT
lvlr. H I1ISrIIIAMURTHY B. SANGANNANAVAR: JUDICIAL,
MDL{BE :r
[{rs. DIWASHR.EE M: LADY MEMBER
COiJS {JT,IEN CO ]!IPLAI IiT N o.2O4l 2015 i. iii,jc-ndltr Prasad G.S & I(arthil<.S S/ l-; I.:ri,, Si;rr.r-an arayitna, l\lc,-l 5ti ye;rrs, r\l I\;o. 1 1 13, Car Street, I,, Cr-rrsr.;, tJlsoor, i.itrl qi,rlore-1560 0C8.
,i. iialihrl'..S ::i/r; Seshaclri, ,ig;r:, i 3i1 )'ciu s, liesidir,s a1 N-o. 1 I 13, Cx Street, 1", CLorsr:, U1:;oor, Eeinqrdorc-5(rO 008. ...Complainanu/s rr; Shr!/Slrt Ip lRajendra prasad G.S. & Karthik.S) i
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1. rvl/s llarigadorc Nlemolial Ilospital Lrcl, 1", Cross Road, Shankarpuram, ltit:j3Vi rI rg-Ll d i, IlclBiriulr.r- 5b0 004 ilcp ir,1, iLs Cirrtiimtn.
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2. Binod Rangadore, Chairman, S/o Late H.S. Rangadore, M/s Rangadore Memorial Hospital Ltd., (Also Executive Vice President, Infosys Technologies Ltd.,) 1"t Cross Road, Shankarapurarn, Basavanagudi, Bengaluru- 560 004.
3. Dr. R. Rajkumar, Managing Director, SSSPCT/RMH, Aged unknown, Father's name unknown, Rangadore Memorial Hospital, Shakarpuram, Basavanagudi, Bengaluru- 560 004.
4. Dr. K. Lakshman, General Surgeon, Aged Unknown, Father's name unknown, Ran gadore Memorial Hospital, Shankapuram, Basavanagudi, Bengaluru- 560 004.
5. Dr. N.K. Prashantha Kesari, Plastic Surgeon, Aged Unlmown, Father's name unknown, Rangadore Memorial Hospital, Shankarpuram, Basavanagudi, Bengaluru- 560 004.
6. Dr. Madhu Muddiah, Physician Diabetologist, Aged Unknown, Father's name unknown, Rangadore Memorial Hospital, Shankarpuram, Basavanagudi, Bengaluru- 560 004.
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7. Dr. K. N. Sridhar, Urologist, Aged Unknown, Father's name unknown, Rangadore Memorial Hospital, Shankarpuram, Basavanagudi, Bengaluru- 560 004.
8. Dr. Padmashree Roa, Duty Doctor, Aged Unknown, Father's name unknown, Rangadore Memorial Hospital, Shankarpuram, Basavanagudi, Bengaluru- 560 004.
9 Dr. Lakshmarr Guptha, Anaesthetist, Aged Unknown, Father's natne unknown, Rangadore Memorial Hospital, Shankarpuram, Basavanagudi, Bengaluru- 560 004.
10, Dr. Raveendra Reddy, Anaesthetist, Agecl Unknorvn, F'ather's name unknown, Rangadore Memorial Hospital, Shankarpuram, Basavanagudi, Bengaiuru- 560 004.
11. Dr.RaSpal Singh R.L., Cardiologist, Aged Unknown, Father's name unknown, Rangadore Memorial Hospital, Shankarpuram, Basai,ar-ragudi, Bengaluru- 560 004.
12. V.R. Ramesh, M anaging Dead/ Director, Sharada Rotary & Sharada Aushadalaya, SSSPCT, Shankarpuram, 4 ccl2.04/2016 Basavanagudi, Bengaluru- 560 004.
13. Ramamurthy, Ward Boy, C/o Crystal India Domestic Service No.71, NHCS Layout, 2"d Cross, 2"a Main, Near Manasa Hospital, 3no Stage, 4th Block, Basaveshwaranagar, Benagluru- 560 079.
14. Arun H.S. Proprietor, Crystal India Domestic Service No.71, NHCS Layout, 2nd Cross, 2nd Main, Near Manasa Hospital, 3RD Stage, 4th Block, Basaveshwarailagar, Benagluru- 560 079.
.....Opposite party/s //OBDEB4( BY MTs. M. DIVYASHREE: LADY MEMBER
1. This is complaint filed by the complainant under section Nos 17 read with 18 read with 12 of the Consumer Protection Act, 1986 against the Opposite parties (herein referred in short as OPs) alleging Medicai Negligence and prays for the following reliefs against the OPs.
a| To direct the opposite parties to reimburse the amount of Rs. 2,98,217 l- (Rupees TWo Lakhs Ninety-eight Thousand Two Hundred and Eleven Only) being the arnount towards admission, treatment and surgical costs of Mr. Rajendra Prasad paid by the complainant v' along with interest.
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b) To Award total compensation of Rs. 98,94,048 I - (Rupees Ninety-eight Lakhs, Ninety four Thousand anci forty-eight only) excluding interest and costs.
Sl No Pa rticu la rs Costs (in Rs)
- Total Costs associated with the Victim for Treatment 2,98,211.C U
in Rangadore Memorial Hos pital
l-
f__ Costs Paid For Treatment in other Ho psital 1,85,837.00
r--
11 l Total Treatment costs
Legalexpenses
4,84,048.00
1,00,000.00
l
Advocate/GPA fees
F-.-+ 1,00,000.00
Other lega I
10,000.00
expenses/c ourier/photoco pying/stationa ry __l 2 Total Pecu nia damages(1+2) 7,94,048.
PU N ITIVE/EXEMPLARY DAMAG ES Committing FRAUD and FORGERy with documents to 1,00,000. prolon litigation Damages for filing False Criminal cases of Non- 10,00,000.00 payment of Bills to Harass patient (without _sub_mitting Bills)__ Criminal Breach of Trust and Mis-representaions for 10,00,000.r,'0 operating for Stricutre Urethra (Caused by IATROGENIC BURNS Compensation for Defamation of patient by -l 10,00,000.u0 breaching patient confidentiatlity by organizing and releasing patient photographs (including private L__ pa rts) in press conference li I Compensation for disability caused to Urethra and 20,00,000.00 I Ano recta I re gion and Bu rns I SPECIAL DAMAGES L Emotional distress, pain and suffering for damages 25,00,000. r- 0 ca used to fami ly 4 Pain/suffering endured b y the victim durin g therapy 10,00,000.00
- '.,] Losses and future losses "u p to the date of trial"
t 5,00,000
r
I TOTA LN ON-PECUNIARY COSTS (3+4) 91,00,000.00
TOTAL COSTS 98,94,04 8
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2. The facts in brief as stated by the complainant is as under:-
It is submitted that the 1"t complainant was the patient',r,ho received treatment for Perianal abscess in Rangadore Memorial Hospital since 09th September 2Ol4 and onwards. The 2"d Complainant is the Son-in-law of the Victim who is rvell au,are of the facts of the Case. The Opposite parties have provided "SERVICE" WHICH IS DEFINED UNDER Section 2 (1) (o) of the ;rct, since the Complainants have paid the RDQUiSITE FEE-FOR- SERVICE in total amount of Rs. 2,98,2 i i /- from September 2014 onwards. The Compiainant therefore comes under the defrnition oI "CONSUMER" under Section 2 (1) (d) of the C P Act.
The First Opposlte party is the Hospital, headed by the OP No-O2 and OP No--O3 where Mr. Rajendra Prasad G S was receiving treatment under the OP Nos 1-14 from September 2014 to November 2014 for the original problem of Perianal Abscess.
3. It is specilically alleged by the complainant thal despite paying the Fee-for-service in fu1l, the patie nt was subjected to GROSS NEGLIGENCE AND RECI{LESSNESS, and the life of an ordinary person has been subject to iatrogenic complications of BRUNS, Stricture urethra and persistent fistula- in-ano problems. Hence, there is deficiency oi- service, which is directly related to the DEFICIENCY OF TREATMENT.
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4. The case of the complainants is that the OP Nos 1 to 14 have caused the GREVIOUS IATROGENIC INJURIES of lvlr. Rajendra Prasad G S on account of their gross medical negligence, unethical medical practices and rash and negliger.rr action s at the treatment stage .
5. It is submitted that 1"r complainant Mr. Rajendra prirs:Ltl G S is an indigent person of very modest means, and is suffcrinil fro n'r Disabilities in Urinary tract, Skin and Anorectal region.'l'lrc i -, coraplainanrs wife is suffering from Visua,l Disabilirie s. Enclosed herervitl-r and produced is ANNEXURE-1 which is Copy of B P L CARD -ldentity Card of Mr. Rajendra prasad G S,s u.ife Jzrvashree and Disability Certificates.
Flrrther it is submitted that the I"r complainant vrsitcrl Rangiidore Memoriai Hospital for Allopathic moder, screrrti|it:
treatment. The Hospital has Certificate ol Registration i,tr ALLOPATHIC SYSTEM only. Despite this, the hospital is having di.rt-y doctors who do not have Allopathic degrees, resultir-rg in un scien tific treatment.
Er-rclosed here',vith and produced is ANNEXURE - 2 whic:h is copv ol Certificate of Registration ol Rangadore Memorial Hospiral under KPI\4tr Act '.vhich is entitled for ALLOpATHIC SySTEM only,
6. It is further submitted that the 1"t complainant went to tlrc hospital lor treatment of PERIANAL ABSCESS, but was treate(l hastil-y, wrongly and in completely ror FISTULA-lN-ANO u,irhourL { 8 ccl2o4/201.6 proper evaluation. It is further alleged that, despite the patient being under the elfects Spinal Anaesthcsia, the patient uras. taken out of the bed and immediately forced to sit in BOILINC} HOT WATER (with Ayurvedic mixture) which resulted in severe IATROGENIC BURNS, STRICTURE URETHRA with ur-rbearabie pain and other vulnerable Disabilites.
Thereafter, it is alleged that the patient r,'",as subjected to unauthorized repair ol STRICTURE URETHRA by the Hospital, to covcr up the evidence of the BURNS caused. This arxounts [o Me dical Negligence and Deficiency of Services.
The distressed patient was shuttled to Jayadeva Hospital to rule out "Cardiac event" to shunt the patient away.
Enclosed herewith and produced is ANNEXURtr-3 r,vhich is Copy of Treatnrent & Discharge Sumrnary of Rajer-rc1ra Prasari (] S l'r onr Rangadore Memorial Hospital.
7. It is alleged that the 1", Complainant '!vas spurned au,ay by the Rangadore hospital and not given a detaileC Bill inrmediately at the time of discharge. The Final Bill w'as posted to the 2"d Complainant, foliowing which the 2n,t Complainant pairl lhc Entire HOSPITAL BILL amount in toto for the Medical tl'calrnent of his father-in-law. Hence, the requisite FEE-FOR- SERVICE has been paid in full.
Enclose herewith and produced is ANNEXURE-4 which is Copy of Finat Bill Summary and Receipt of Payment -Showing compliance with FEE-FOR-SERVICE.
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8. It is further alleged that the 1"t complainant wrrs immediately forced to sit in BOILING HOT WATER (rvirh Ayunedic mixture) which resulted in IATROGENIC BURNS ol' about l07o of Body Surface area including of Perianal regir-,n, perineum, scrotum and penis; anci other resultant Disabilitie s. This amounts to Medical Negligence and Deficiency of Sen,ice.
Enclosed herewith arrd produced is ANNEXURE-S which are Photographs of IATROGENIC BURNS caused to pENtS, PERINEUM & PERIANAL REGIONS Rajendra prasad G S t:y Rangadore Memorial Hospital.
9. It is specilically alleged by the 1.r complainart, that he u,rrs ir'nnrt-.diately lorced to sit in BOILING HOT WATER (rvirlr Ayrrn,eclic mixture) which resulted in IATROGENIC BURNS ot erbout 1O?b ol Body Surface area inclLlding ol penis (and Urerh,.r, inside); irnd other resultant Disabilities of STRICI'LJl.t1:. UltliTHRA. The procedure of attempting to Operate on il:t Stricture Urethra was done with a malafide intention of coverirrg Llp the Evidence, and was done unauthorized without the consc.,tr oi the patient; and was not successlul.
It is further alleged that unfortunately as the healrh condition ol the i't complainant dicl not recover, the Strictu rc Urethra is persistir-rg till date, and is an incurable reperctr s::ior.r , and is causing difficulties in passing urine to the patient da:ly. This amounts to Medicals Negligence and Deficiency of Service.
Enclosed herewith and produced is ANNEXURE-6 which is Copy of Report on Micturating C5r51s Urethrogram/Retrogracle 10 cc120412076 Urethrogram showing CHRONIC STRICTURE URETHRA caused to Rajendra Prasad G S by Rangadore Memorial Hospital.
1O. The Complainants submits that it is a settled principle of SURGICAL PRATICE, that a suspected Fistuia-in-ano has to be o,aluated by either a Fistulogram X-ray or by Endorectal Ultrasound.
A Surgery like Perianal abscess has to be operated on an Etnergency basis, and other co-existing chrorric pathologr has to be operated on a Elective basis at a later date.
The procedure of attempting to operate on a SUSPECTED FISTULA-IN-ANO on Emergency basis is unscientific, and ]ras not bcen successful. The Fistula-in-ano is persisting till date,and is incurable,and is causing difficulties in passing stoois trl thc lratient daily.'Iiris amounts to Medical Negligence and Dehciency of Service.
Enclosed herewith and produced is ANNEXURE-7 which is Copy of Sono{istulogram report on CHRONIC FISTULA -lN -ANO caused to Rajendra Prasad G S by Rangadore Memorial Hospital
11. The l"t Complainant submits that the Hospital has caused Grievous Hurt and IATROGENIC INJURIES OF BURNS, Chronic Stricture Urethra and Chronic Fistula-in-ano to the patient -which is causing disabilities and continuing medical issues to the patient .The patient is undergoing continuing rnedical treatment for the Incurable disease, for which the Y, 11 cc120412076 outcomes cannot be favorable, even if surgical correctiolr is attempted.
Enclosed herewith and produced is ANNEXURE-8 which is copy of Criminal Complaints related to MEDICAL NEGLIGENCE fiied in Shankarpura Police Station as Crime no.22/2016.
Copy of Complaint related to GROSS MEDICAL NEGLIGENCtr filed in Karnataka Medical Council as Complair-rr no.i(l\4ClENQ/58/14,is produced herein as ANNEXURE-9 arrcl copy of continuirrg expenses in various hospitals is produci'cl herein as Annexure- 10.
12. After admitting the complaint the notice u,ere orclered Lo be issued to the opponents 1to 14.Opponents Nos 1,3 to 8,10 and 12 to 14 have entered appearance through their Advocatc s;. l'he notice issued to opponent s 2,9& 1 1 was also se r.v,..:l .
Opponcnts 2,9&, 11 did not appear ancl the sen,ice was ir,.,irl sufl'icient they have been placed ex-partee.
Counsel lor opponents 1 and 3 files version of Ops 1,3 ro 7 and also version of OPs 12, 13 and 14. Also version filed bv Op - 10 is taken on record.
When the case \\/as set down for recording evidence thc, Cotnplainar-rt got marked Ex-C1 to C28. On the opponents si(lc counsel for OP Nos.3 to 7,10,13 and 14 files affidavit eviclencc an<l got marked Ex- OPI - 60.
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13. Opposrte party No.4 filed the version giving para wise replies in brief stating that OP No.4 is a General Surgeon at Memorial Hospital. Mr. Rajendra Prasad availed of the surgery lrom O.P. 4 Mr. Rajendra Prasad was admitted in the general i,r''ard of Rangadore Memorial Hospital, under his primary' care. O.P. 4 noted / diagnosed that the said patient had perianal abscess at 2 o clock position. After through examination and assessment O.P.4 advised him for drainage and Fistulectomy. The patient could not tolerate PR examination and was not cooperative to thesame and hence the surgery was suggested. 'lhe suggested surgery was not an emergency and hence it was lelt to the discretion of the patient and relatives. The parient ail d iris rvife were thoroughly explained the risks and ber-refits and also recuperative period in respect of the proposed surgery'. Upon undcrstanding the facts a,r-rd circumstances involvcd iir th e suggested surgery, the patient along with his wife gavc the rronsent and accordingly sigrred the consent fornt.
14. On 09.O9.2014 Mr. Rqfendra Prasad was admitted as an inpatient in the hospital and sample of blood was drawn ard then sent lor all the relevant laboratory investigation. An ECG and ECHO were also ordered. As his GRBS was 454 mg at 11:45 am, sliding scale insulin was also initated. Per anesthetic assessment and a thorough plan care of treatment done. Dr. Raveendra Reddy, Anesthetist opined that the patient was an ASA grade N risk.
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15. The complainants alleged against O.P.No.4 in particular as to his deficiency, while OP No 4 has categorically denied his cleficiency of service in treating Mr. Rajendra Prasad that it u'as not an emergency surgery, all relevant investigations were rlone, Based on the opinion of Dr. Madhu Muddaiah, Physician, Ivlr. Rajendra Prasad was taken up lor surgery at 11.4 anr on 10.09.2014. Belore he was shilted to the operation theatre lV fluids and necessary medications were given. It is false to state that O.P.No 4 had to go away at 12 pm to Shanti Hospital Tl-rr:
surgery was not hurried. It is reiterated that a proper consent lornr rvas signed by both Mr. Rajendra prasad and his wife after. the,y were explained about the procedure by O.p.No 4 ar-r anorectal ultrasound could not be done because of excruciating pain in the anal region and also, this is not a routinc investigation that will be done in such circumstances as per- t1rt, routine surgical guidelines and evidence based surgical prirctie r.. Fistlrlectomy is indicated because recurrence risk falls to 3,1,, after the procedure as against 30% if Fistulectomy is not dotre. After surgery, the patient was shifted to the recovery room ar l pm. Routine painkilier and antibiorics were given in recovcrv room. The patient was advised sitz bath after removal of dressilg.
It is specificaliy pleaded by O.p.4 admitting the facts thar lrc:
lvas informed on the evening of date of surgery that the parien r developed bleds around the buttocks and upper thighs. O.p. 4 had sr-rggested the application of silverex crea_m to the alfectecl area. O. P. ,l noticed scalds during rounds the next incoming. Standard emergency treatment was given from the time of scalding. The depth of scald is not possible to be determined wirh t4 ccl2o4/20l6 accuracy immediately after the event. Standard treatment of pain l<illers, antibiotics and ointments were given an opetl treatment of scald was advised.
16. It is OP.4 specific stand that the causing BURNS,SCALDS to the Buttocks, perianal region penis, Sctotum ,perineum and urethra was suffered not because of his treatment, medicine or the course adopted by him in rendering treatment to Mr.Rajendra Prasad. He states that he was fuliy in conformity with the established medical practice and professiona-l skill. Advice of sitz bath after Fistulectomy falls within the established line of treatment. OP No.04 further states that, It is not his primary responsibility to administer the sitz bath. Also he denied that the accusation leveled against him that he did not call the plastic surgeon early enough. He further states that any thermal injury takes 3-7 days to establish the degree and extent of burns. Appropriate emergency measures were immediately instituted. As soon as the depth of injury became evident, the plastic surgeon was involved.
17. OP. 4 further pleaded that the averments made in r.he cornplaint that OP 4 h.rsisted quick discharge from the hospital and that 1-re has casually dismissed the burns and further apologizes for the said statements, are false & frivoious. OP4 dt:nies that he insited on a discharge .
The say of the OP No.04 regarding caring of the complainant No.01 is that, the situation was clearly explained to the patient and his relatives and they were further assured that \{-
15 C0l204l20t6 the treatment required for the scald will be given. In a few days, it became clear that the patient had thickness of scald that needecl excision grafting. The patient was referred to a plastic surgeon at this juncture ,this was on 03.09.2014 .Eariier referral would herve made no impact on treatment of the scald. The patient was givcn enough analgesics at the appropriate time he encouraged ro mobilize to avoid DVT, bed sores etc.
18. Commission now to examine certain vital aspects wi-iich are colrre in the enquiry in the evidence filed by the meclical expert Dr. Savio Pereira. She states that the 1.' Complainernr Rajendra Prasad G S was the patient who received treatment lor Acute Perianal abscess in Rangadore Memorial Hospital sinr:t:
09'r' September 2014 and onwards. He r,,",as perfectly normal, arrcl harl no other pre-existing Chronic disease (i.e. Stricture Uretlri'.i or Fistual-in-ano) when he was cxamined on 07 l06 120).4. llc went to the Hospital for treatment of PERJANAL ABSCESS, b,.rr rvas treated wrongiy and incompletely for (CHRONIC) FISTUI.,\- IN-ANO q'ithout a proper evaluation by either Fistulogrant or F-n cl<-rrect a I lrlt rasound.
19. She furrther states that u,ithout a proper scien!:rie evallration, and rvithout proper explanation of treatrnent rislis, benefits and alternatives, he was subjected to Incision ancl Drainage of Perianal abscess (which \vas reasonable and justilicdJ + Fistulectomy (which was unreasonable and unjustified on lOth September 14. There was unnecessary delay of Emergencv Y-
16 cc/204/2076 Surgery for the I &D BY 1 DAY, thereby causing grave danger to the life ol the patient.
20. Dr. Sarvio perera in her affidavit, inter a1ia, mentioned that immediately after being shifted out ol the Operation theatre at around 03:30 p.m, while the patient was under the effects of spinal anaesthesia (u'hich includes loss of sensation below the levei of waist downu.ards), the doctor Dr Lakshn-ran wrote ORDERS for unexplained ancl IRRATIONAL Post-operative Orders directing the patient to be forced to SIT FOR SITZ BATH therapy. The ward boy RAMAMURTHY under the directions ol the Surgeon and Duty doctor Dr PADMASHREE ROA forced the patient to sit in a Trrb of BOILING HOT WATER - causing BURNS, SCALDS to the Buttocks, perianal region, penis, scrotum, perineun'r and Llrcl hra.
21. Evidence in so far as administerir-rg SITZ BATI-{ to the patient Mr.Rajendra Prasad is concerned, Dr. Savic Pereira has stated that Despite the patient being under the effects Spinal Anaesthesia, the patient was immediateiy forced to sit in BOILING HOT WATER which resulted in IATROGENIC BURNS (to perineum, scrotum, penis, urethra, and buttocks), :I'I'RICTURE URETHRA and other Disabiiities /disfigurernents ,/impairments.
22. She further states that the patient has developed STRICTURE URETHRA, PHIMOSIS, BURNS directly attributable to the BOILING HOT WATER SITZ BATH, which amounts to 17 Ccl204l20t6 GROSS MEDICAL NEGLIGENCE. The patient has not been given reasonable care and procedures have been conducted without tl-re proper wlitten inlormed consenr for IATROGENIC STRICTURtr URETHRA caused by the burns.
The 1$ Complainant was immediately forced to sit irr Boll,lNG HOT WATER (with Ayurvedic mixture) which is resurlterl in IATROGENIC BURNS OF ABOUT 1,O% of Body Surface a.rea including of penis (and Urethra inside); and other resultarlr Disabilities/irnpairments of STRIC'IURE URETHRA. Tlrt-. procednre of attempting to Operate on the Stricture Urethra u,irs done rvithout the consent of the patient; and was not successliLl. The Stricture Urethra is persisting till date, and is incurable, ancl is car-rsirtg dilTiculties in passing urine to the patient daily.
She fi-trther states that the Report on Micturating Cr..,.r:o Llrethrogram/ Retrograde Urethrogram showing CHRON tC STRICTURE URETHRA caused to Rajndra prasacl G S tlr, Rangadore Memorial Hospital -is persisting.
23. l'he alfidavit olthe Ops 1,3 and 4 is conrrary ro tlrc experr evidcrice of Dr. Savio Pereira and the evidence ol' tlrr compiainants. Tl.re OPs reply that the "The patient,s conditior.r oi ischiorectal abscess was conlirmed through Ciinicai Examination". This condition is a very painful condition; Simple internal examinatior.r with a firrger itseil is intolerable. Usir-rg larger enclorectal ultrasound probe u,ould be adding in:,_rlr r<r injun' to the patient. Also, the internal opening was obvious eur 18 ccl2o4/20r6 examination under anaesthesia. Under these circumstances, endorectal ultrasound is not warranted and was not done. The srune argument applies to a listulogram; this test is done only if there is doubt about the interna_l opening.
Fistulectomy along with ischiorectal abscess drainage is a standard procedure ',vith many surgeons. If or-rly abscess drainage is done, recurrence rate of fistula is 25-30%; if fistulectomy is done at the time of drainage, the recurrence rate is only 3% hence fistulectomy was done to help the patient.
Sitz bath was given to relieve pain after surgery; it was glven at the appropriate time. If it is overly delaved, the parient sr-rffers from pain for an unjustifiably long postoperative l-.,eriod. Nobcdl, leaves the sitz bath until the next day, it has been strggcsted because the patient will have a miserablv pain[r-11 night a il er the surgery. The spinal anaesthetic lasts 90 rnir-iutes rur d tiie patient's bottom area was sensitive a-fter that period.
24. Dr. Prashanth Kesari O.P No.5 has submitted his ailldavit evidence, that become part and parcel of the enquiry frle. OP No.05 deposed his evidence that the that, he is a Plastic :irrrgeon at Ralgadore Mernorial Hospital Bangalore. Mr.Ralendra Plasad -complainant No.1 rvas admitted to the Hospital on 09.09.14 with Ischiorecta,l abscess under the primary care of Dr; T-:rkshman K (General Surgeon). OP No.05 submit that he attended the Compiainant Mr.Rajcndra Prasad on 13.O9.2O14 as soon as reference was given for thermal injuries to the thrghs 19 CC/2O4120L6 and buttocks. By then first aid treatment was already done. Any thermal injury takes 3-7 days to establish the degree and exrent and hence Topical & parenteral treatment was started.
O.P No 5 Dr Prashanth Kesari, further states that, the patient, Mr Rajendra Prasad, was planned for debridement arrd skin graft, but during surgery, consent from famiiy member/s ior circumcision lr.as obtained as it was found that the Glans ancl Prepuce 'uvere stuck and further there was obstruction tn the urethra. This respondent was not aware of burns duc to allcgcrcl boiling hot water. I-Ie was called to look into the issue i'or assessment and treatment options. Further, he has no connection, $,hatsoever, with regard to alleged burn/ s.
25. The O.P No,5 has also replied to the interrogatori,;s str irmitted by the complainants, that belore the comrnerrcern(:ir r:
of the surgery, ttre patient /family members, after il rll uncierstanding ol the proposed procedures, have tendered vetli,l, rvritten, informed consent for debridement/skin grah irnrl circurrcision. They also gave valid co.sent for placing uri'.rry cnthere/ removal .
of urethra_l stricture during debridn.renr procedure. There are difficuities during surgery which neccl inten'entions with clinical judgment. If the patient or attendaurrs insist WRITTEN consent for catheterization, insertion of IV lines and other rourine surgical procedures, it is difficult to conduct any surgery .A general informed consent is taken in writing lbr procedures which allow a surgeoll to do such complementa,r, surgrcal procedures during normal and emergency situatior-r s irr 20 ccl2c4l20t6 the interest of the patient which cannot be labeled as an act of ncgligence or misconduct has to be accepted.
26. OP No.7 Uroiogist Dr.K.N Sridhar has deposed in his evidence and also he replied to the interrogatories submitted by Complainant ,that he was called during surgery so as to help OP No 5 to place the urinarv catlterer so as to avoid any damage to Ihc patient. It was an emergency procedu re which gave a lot of relicf to the patient. The urethra1 structtlre was remol'ed after giving needful explanation to the family members of the patiettt. This OP No 7 is totally unaware of alleged iatrogenic burns. According to medical statics, more than 30% of diabetic patients, like Mr.Rajendra Prasad, develop phemosis, Circumcision was drlne by Dr.K.N Sridhar, '"vho was just called for placing uritlar'r' r:alherer ailowing urologist to remove ure thral strlcturte ciuring riclrridment procedure is not an act of medicai ncgligel-rce i'ias to lrc a<;cepted.
27. Evidence deposed by OP No.6 Dr.Madhu Muddalal-r consultant physician at Rangaore Memorial Hospital, thnt Mr.Rajendra Prasad -the compiainant no. 1 was adrritted to their hospital on 09.09.2014 with ischiorectal abscess ttnder the plin-rary care of Dr.Lakshman K (General Surgeon) .The prin-rarll consultant requested him to examine Mr.Rajendra Prasad's rnedical condition and evaluate, he examined Complainant No.1 by after noon on the day of admission. He presented pain around his perineum.
21 CC120412076 He had histoly of 'Ilpe 2 Diabetes mellitus since 10 years. He u,as managed by local medical practitioner and was on Tab.Glycomet GPl (Meftormin 500mg and Glimperoide 1 mg) trvice a day .He did not furnish any old records. On examinati<.rn, his pulse rate was B0/min BP: 180/80 mm Hg and overweight. Cardiovascular , respiratory and per abdominal examination wilri remarkable.
Investigation of complaint No.1 showed high blood sup,:,rr 454 nrgs/dl. I requested further investigation which inch,rdr:cl ECG and Echocardiography. His blood pressure were persistenth/ high since admission and he started on Anti-Hypertensve ancl insulin. The dose of insulin was adjusted as per blood sugars.
On 10.09.2014, the Complainant No.i rvas rer,iewecl a,,tl irivestigations shorved poor glymic control in the pasr (HBA 1t)- 12-3).trCG n,as normal .Echocardiograptrv showed Norn.rtrl l, l'l ventrivcnlar function & concentric left ventricular hypcrtropir y His blood sugars and BP were brought to reasonable control. ltc was shilted lor the procedure as planned by the primary team.
Post operativell. Complainant No. 1 was monitored irr liit:
rvard. His blood sugars and blood pressure trends were obscn crl on dailv basis. His anti-Hypertensive and insulin were adjtisrt.rl accordingly. He had abnormal lipid prolile and receivecl lilirl lou,ering drugs. Throughout the stay in the hospital OP lJo.(rt.r visitecl patient daily and managed his blood sugars ancl { 22 cc/20112016 appropriately. As a physician, he managed his diabetes and hypertension to the best of his ability.
28. OP No.6 in his version stated that in light of the aforesaid facts, the allegation of Complainants that the 'investigations with regard to diabetes were not proper' does not hold any credibility .Further ,the very same facts detailed above render the allegations oI the complainant 'the opponent .o.6 had ,ot reviewed the treatlnent of the patie,t after admissio,, redundant. It is further contended by Op No.6 that ,as per i.r'estigations, Mr. Rajendra prasad had poor glymeic control i.
the past .Prior to drainage and fistulectomy, the blood sugars and the BP of Mr.Rajendra prasad were brought to reasrtnable control. Post-operatively also the diabetes and Bp were managed :rrd brought to reasonable b1'the opponent,o.6 .Tl.re case *irects ol the Hospital would also depict the same.
29. OP No 10 Dr. Raveendra Reddy Anesthetist, Rangaclore ivlenrorial Hospital, has srvorn to an affidavit and therei. he has gi'en his evidence stating that the facts in regard to his role i.r the treatment of the 1"r complainant, that he has never seerl, esarnined, not treatecl or had ar"ry inter.action rvith !h"
corriplainant. Further states that, it is evident lrorn the l...oi,]. produced by the complainant himself. The hospital bill does not show any consultation or other charges in his name nor does the compiaint make out any general or specific allegations against hirn and denied that the complainant is a consurner as in reration to this OP.No. 10.
\d' 23 ccl2o4l20t6 3O. OP.No.13 Ramamurthy, Ward boy, Rangadore Memonai Hospital, in his evidence has swom to an affidavit and therein hc iras given his eviclence stating that he is a ward boy at Rangaclore N4emorial Hospital, there has been no negligence on his par.t in performing his duties. He replied to the interrogatories raisecl lrv Mr.Karthik S complainant No.2. He as a ward boy, and since l-ris routine works are as simple as taking the patients to toilet, help thetn with their routine necessities, give sitz bath etc, He furth,:r. states that, had not failed in his duties nor has he causecl hoL water burns. Neirher he was negligent nor he was deliberate ur his dr-re discharge of duties. Admittedly , Op No 13 in his evidence has clearly stated that he was instructed to gi,,,c lnkeu,arm \ /ater to the buttocks region (sitz bath) in a contuuncr. He rool< t1-re patient, Mr. Rajendra Prasad, to the bathroom arcl rnade him to sit there and further recluested him to rvait for rr I-.r minutes till he nrade lukewarm water ready and went to fet,.:li cold water. By the time he came back with cold water, a nrlrse had noLiced the patient, Mr. Rajendra prasad, was comfortablv sitting irt thc container of hot water.
31. Arun.H.S Proprietor, M/S crystal India Services, tirc OP.No. 14, in his evidence has stated that he is nou,ht.,-t. connected [o the case built up by the complainants. .l.lre averments made in the complaint not even remotely connect his cornplicity in the above matter. Also he reply to t ht:
interrogatories raised by complainant No.2 that, as per his 24 ccl2o4lzot6 knowledge, his employee has not failed in his duties and has caused hot water burns.
32. Evidence Affidavit of Dr.Rajkumar O.p.No.3 l-rerein representing OP No. 1, M/s Rangadore Memoriai Hospital, states on Oath that he is functioning as Managing Direcror ol Op No. L namely, M/s. Rangadore Memorial Hospital and hence deposing on behalf of OP No.1 also. The hospital is rendering its senice in tlre allopathic system of medicine an cl surgery. Rangaclore N,lemorial Hospital has also adopted al1 nccessary, scientilic ald rc:cluisite methocis and systems in order to give all possible better qlrality of service to the people. Rangadore Memorial Hospital is :lr institution, serving the mankind with better standrrrd of 1r-catment in the allopathic system with the requrred-care, skill and infrastructure.
OP No.03 further states that, on 09.09.201.1 N{i'.Rajendra Prasad was admitted as an inpatient in the hospital and his blood sample was drawn and then sent for all the relerrernt lal)oratcry investigation. An ECG and ECHO rvas also ordt:rcci. As ]ris GRBS was 454 mg at 11:45 am, sliding scale insulin rvas also initiated. Pre anesthetic assessment and a through plan care of [r'catment clone. OP No 10 Dr.Raveendra Reddy, Anethetist oprned that the patient was ar ASA grade II risl<. As it'"r,'as not an emergency surgery, all relevant investigations were done. Based on the opinion of Dr OP No 6 Madhu Muddiah, Physician, Mr.Rajendra Prasad was taken up for sur€{ery. Before he was shifted to the operation theatre lV_fluids and necessary 2s cc120412016 medications were given. It is fatse to state that Dr. K. Lakshmrilr had to go a\.vay ar 12 pm to Shanthi Hospital. The surgerl' u,as not hurried. A proper content form was signed by both \ir-. Rajendra Prasad and his wife after they were explained about thr_. procedure by Dr. K. Lakshman. As already said, an anorccr:rl ultrasound could not be done because o[ excruciating paii-r in thc anal region and also this is not a routine investigation that rvill be done in such circumstances as per the routine sr.rrgical guicielir-res and evidence based surgical practice. After surgery, the patient was. shifted to the recovery room at I pm. Routirrc pain killers and antibiotics were given in recovery room. FIe r.l,as received in the ward by 3pm and IV fluids and other ltusL operative instructions were continuecl. Upon perusal of casc sheets and c.nquires made by him it is evident that he u,irs advised sitz bath at 4.45pm after the removal of the dressirrg. :cr the dressing was removed & the patient was able to ,"vall< to tirr, bathroom for sitz bath .The ward boy by that time had got \{ai(tr. in a container and asked Complainant No.1 to wait till he gets cold water. There after the nurse who rvalked into the bathr.oor.r'r sarr", Mr. Rajendra Prasad sitting comfortably in the sitz bath. Tirc staff nurse tested the temperature of water by her hancl and ther-r as she felt the temperature was hot, she immediately nrarlc Cor.nplainant No.1 to get up. By that time she could mal<c ourL that there r,r,ere reddened area ar.ound both the buttocks as u,r:ll as the upper thighs. Immediately thereafter patient was shifte cl Lo his bed and Silver X cream applied. The patient never complarnecl of any pain or discomfort. It is false to say that pitkari BhasnLir was added to the water for sitz bath. Rangadore Mernorial Hospitai does not practice Ay.urveda as Rangadore Meinorial 26 ccl2o4lzot6 Hospital is an Allopathic multispecialty hospital. It is false to say that Mr. Rajendra Prasad was forced to sit in the hot boiling water. The records show the patient complained pan and burning sensation only at around 9 p.m. As the patient had incurred scalds, the treatment as first aid was initiated immediately by 5:i5 pm. The plastic surgeon was summoned at the appropriate tirne for evaluation and required procedure. In fact Dr. Prashanth i(esari the plastic surgeon had seen the patient on 13th Sep 2014 at 6:40 pm and as per his advice the treatment was continued. OP.No.3 further states that Dr. Lakshman being prima4r consultant had taken necessa-ry care at all reievant times urhlle Lreating the Complainar-rt No. 1.
33. The OPs have denied all the allegations made in the complaint. The hospital, doctors, nurses and PRO etc all have taken up the contention that before the corrmencement of the surgery and after the surgery, There has been no coercion, undue influence or misrepresentation exercised by any person attached to the hospital on Mr.Rajendra Prasad or his relatives at any point of time. Utmost care and reasonable skill were adopted and exercised by the doctors and the nurses in the hospital while rendering treatment to Complainant No.l .There has not been either misconduct or negligence on the part of doctors or staff attached to the hospitai. Abundant compassion was also extended to Complainant No.1 as it was presented to the hospital that he hails from a poor economic background. There is no negligence on the part of the doctors as it was not hurried or an incomplete treatment. The patient was advised sitz bath he was 27 ccl204/20]-6 not forced into sitting in "Boiling water". The sitz bath is :ur explained routine medical procedure after Ischlorectal abscess drainir-rg. The hospital has ayrrrvedic doctors as physicieur Assistants and as such they do not treat patients and the.\. rvr.r-t:
never allowed to exercise their skill or discretions under any circulTtstances.
34. From the discharge summary for the period 9lgl2014 to 27 lIOl20l4 w-herein complainant No.1 was admitted to tjtc Rangrrdorr: memorial Hospital, it is mentioned as:
Presenting Complalnts: poln ln the pe onal reglon since 5-6 months, swelling in the perionol rcglon slnce 15 doys, poinful defecotion since 15 doys, and fever wlth chllls since 75 ddys. past Medlcat Hlstory: Known cose of Type 2 DM on OHA, on irregulor treotment, old records ore not avoilable. personol Hlstory:
Stopped consuming alcohol for post 20 yeors, Physlcdl exomlnotlon: aenerol condition: potient ts moderotely built on(l well nourished. He is afebrile. Vitol signs: pulse ls 72 per minute and regulor; blood pressurc is 180/100mmHg, resptrdtory rute ls 22 pe mlnute, dnd GRBS ls 4s4mq/dl.
Cardiovasculor: 51, 52 heord.
Respirotory: NVBS biloterdlly. Abdomen: Solt, bowet sounds +. Locol exominotion: Perional obscess ot 2 o'clock position, Hospitol course: This S7-yeor old gentlemdn, known diabetic slnce 70 yeors, on HA, with poor control in the past and his old records ore not ovoiloble. He got odmltted on 09/09/14 lor lncislon ond droinage of rectol obscess. pdtient wds lound to have high sugdrs (A14mg/dL dn(l HbAlc of 1.2.9) ontl high blood pressurc (t8O/lOOmmHg) since odmission. physician's reference wos given for monoqement ol dtdbetes ond hlgh blood pressure, Chest x-
roy ond 2D echo were normol, He was put on lnj lnsulin, OHA, ond ontihypertensives. He wds diagnosed as poorly controlled diobetes mellttus & hypertension with ischiorectal abscess ond wos posted for surgery fi&D and listulectomy) with mlld-to-moderqte rlsk on 1O/Og/14 under splnol onoesthesla, Post-procedure, he was received to the word dt 3:OO p,m. on the some ddy.
\d-
28 cclzo4l2ot6 Postoperutively, he wos monoged wlth lV ftuids, dndlgesics, ontibiotlcs, ond othet supportive medicdtions. He wos advised to tdke sitz both dt S:OO p.m. on 10/09/14 oltet removlng the pdck'os per surqeon,s orders, patient complained of burning sensotion over both the buttocks ond scrotol drco at g:l5 p,m. on 1O/Og/14. On exomlndtlon, he wos found to hove demdl scolds over both the buttocks ond sctotdl drco. Sllverex olntment was dpplied ond tnj tT O,SmL wos. glven, Potient wds reviewed by the surgeon ond physiclon. On lg/Og/14, plclstic surgeon,s opinion wos token dnd was advised Epitheliolate AH ond Metrcgyl ointment dpplicotion, lt was decided that. wound debridement with splitskin gruting will be done by the plostlc surgeon The pdtient Rongodore Moevpnt the saigdry on 24/09/14 oftet preonoesthetic cleoronce ond informed consent. During the procedure, when urinory cotheterizotion wos inltldted, he wos found to hove dnterlor urcthrol strlcture, Following thls the procedure wos postponed lor on hour, The potient's dttenddnt wos opprlsed ol his urctlrrul condition ond his consent wds taken seporately to rectily the urethrol stricturc. For the urethrdl stricture he underwent cystourethrotomy urith clrcumcisibn whlch wos done by the urologist, Post-procedure he wds trcdted with ontibiotics & analgesics. Wound dressing wos done twice doily under the guidance of plostic surgeon. Durinq his hospital stdy, the dosdge ol insulin dnd antihypertensives were optimi2ed/odiusted dccordingly. Suaict ond BP levels were maintoined ot redsonoble levels, patient and lomily members (wife) were expldined obout the need lor insulin, OHA, and antihypertelsives. Potient's wife was educoted regording lnsulin and diet control. potient improved symplomdticolly, Scrotol sutures were removed on 16/10/14. The Skin grdft hos tdken up completely (100%). Donor site has heoled well ond completely, Fistula hos heoled well. The potlent hos been mobillzed. patlent was revietved by the physicldn, surgeon, ond plostlc surgeon ond odvised to be lit lot dtschdrge with the loltowing advice. At the time of dischdrge, potient's Bp and sugat qre well under control, DIAGONOSES:
7, lschlorectol obsecess (1 to 4 o'clock position)
2. Poorly controlled type 2 Didbetes Mellitus.
3. Poorly controlled Hypertension {poorly Controlled Bp)
4. Dermol scalds over the buttocks ond scrotdl oreo.
Advice on dischdrae:
7. lnj lnsugeon 30/70 40-0.25 units.
29 ccl2o4l20tt,
2. Tab Blisto 2mg 7-0-0, i. Tab prondiol 0,3m9 7-1-0.
4. Tdb Cilohedrt lqmg 7-0-O.
5. Tob Telmikind 80mg 7-0-0.
6. Suprodyn ointment LA 7-7-7,
7. Aquosoft lotion LA 1-1-7.
8. Sofrodex ointment LA 1-1-7.
35, Upon perusal of the case sheets, enquiries arr(l discharge summary it is to be noted here that ,it is apparent en(l evider.rt frorn the discharge summary Ex OP-l1 ,wherein ir is mentionecl that patient complainalt No.1 was advised to tal<e sitz bath at 5.00 pm on lOlOg12014 after removing the pack as pc,:
Surgeons orders. Patient complained of burning sensation or.,-.r. borh the l.rlrttocks and Scrotal area at 8115 pm on 10/09/201-r on examination, Complainant No.1 was found to have clermal scalds over both the buttocks and scrotal area.
36. Bi:fore considering lvhether the op's in the present cii.;i,, could be l-reld to be negligent, it rvill be useful to see as tl u l,.l can be regardecl as negligen'ce on the part of a doctor. ''The te:lt rvith regard to the negligence of a doctor was laid down in Bolairr v. Irrame Hospital Management Committee (1957) 1 WLR 582 Ir was to the effect that a doctor is not guilty of negligencc rl irt:
actcd in accordance r,r,ith a practice accepted as proper lt1 ir responsible bod1, of medical men skilled in that particul;u- alr. This principle in Bolam's case has been accepted by th...r House of Lords in England as applicable to diagnosis and treatment. See Sidaway v. Board of Governors of Bethlerr, Royal Hospital (1985) A. C. 871 Dealing with the questiorr i.,t' negligence, the High Court of Australia in Rogers v. Whitaker (1993) 1O9 A.L.R. has held that the question is not wheth+r \ -,/ \,, 30 cc120412076 the doctor's conduct accords with the practice of a medical profession or some part of it, but whether it conforms to the standard of reasonable care demanded by the law. That is a question for the court to decide and the duty of deciding it cannot be delegated to tany profession or group in the community.
37. ln view of the rival contentions of the respective parties, commission held an enquiry of parties to the complaint. In this regard complainants have produced few documents to show the Li\TROGENIC BURNS i.e, to perineum, scrotum, penis, urethra and buttocks. Complainants got marked Ex-C1 to C28 commission examined these documents coupled with e','idence cf r:ornplainants and medical experts.
We examined the whole evidence of OPs, perused the docllments got marked Ex-OP No.01 to OP No.60. But the lacts i'ernained that the patient has dcveioped STRIC-'|LiRE URITTHRA,PIIIMOSIS,BURNS directly attributable to the BOILING llOT WATER SITZ BATH, which amottnts to GROSS \,1EDICAL NEGLIGENCE which has become clea.r lrom the documents and evidence produced by the complainants ar-r d elidence of OP.No. 13, also it is seen that even according to the clidence of all the OPs themselves.
38. On examining medicai experts, give rise to the commission to attribute deficiency of service on the part of OPs 1 to 4,8 and l3,since deficiency of service is a comparative term which has to be ascertained from f acts and circumstances of the case as a whole. If we examine the whole enquiry,OP Nos 1 to 4 .B and 13 are to be held negligent considering their own evidence 31 CC120412076 of Ops. It is pertinent to note that, Dr. Lakshman OP.No 4 has deposed in his evidence, that Mr. Rajendra Prasad was adrnittt:cl in the general ivard of Rangadore memorial hospital, uncler his primary care, he noted/diagnosed that the said patient hrr(i perinal adbcess at 2 o clock position, After examination an(l assessment OP.4 advised Complainar-rt No.1 for drarnage ar-r<l Fistulectomy. Further OP No.4, based on the opinion of OP No.(i Dr. Madhu Muddaiah, Physician, Mr. Rajendra Prasad was takt.rr up for surgery. After surgery, the patient was shifted to tht:
reco\/ery room. Routine painkiller and antibiotics were given rrr reco\/elr room. OP.No.4 advised sitz bath to the patient, ilfrer. removal of dressing.
It is noted here that, when complainant No.1 was admittt.rl to the Rangadore Memorial Hospital lor treatment, it is uncler tlrt. prirnary care of Dr. Lakshman OP.No.4 being primarl, consulrt.irlr. attenrled the complainant No. 1, such being the case i)r. Lal<shman should have tal<en necessary c.rre at all relevanr tit:;..'s tbr thc. trearment of Complaina:rt No. 1.
Relied on the decision reported in AIR 1989SCI57C in ttrc case of A.S Mitall V/s State of UP, wherein it was laid down that rvhen a doctor is consulted by a patient, the doctor owes to I.rrs patient certain duties u,hich are a)A duty ol care in deciclinii whether to undertalce to the case (b) A duty of care in decrclirrit what treatment to give (c) A duty of care in the administration cl' that treatment. Breach o[ any of the above duties rna]' givr. ir cease action for negligence and the patient may on that lta.lis recover damages from his doctor.
\/
32 Ccl204l20t6
39. Expert evidence in so far as administering SITZ BATH to the patient Mr. Rajendra Prasad is concerned ,Dr.Savio Pereira has stated that immediately after being shifted out of the Operation theatre at around 03:30 p.m, while the patient was under the effects of spinal anaesthesia (which includes loss of sensation below the level of waist downwards), the Dr Lakshman wrote ORDERS for unexplained and IRRATIONAL Post-operative Orders directing the patient to be forced to SIT FOR SITZ BATH tl-rerapy. It has come in the enquiry that the ward boy RAMAMURTHY under the directions of the Surgeon and Duty doctor Dr PADMASHREE ROA OP.No.8 forced the patient to sit in a Tub of BOILING HOT WATER - causing BURNS, SCALDS to the Buttocks, perianal region, penis, scrotum, perineum and urethra.
40. It is important to note that admittediy OP No.13 further, st:ltes that after surgery, the patient was shilted to the rcr:ovetY rcorn at 1:00 p.m. he was rt:ceived in the'uvarcl by 3:00p.r-n:rnd IV lluids and other post operative instructiot.ts u'ere cotttjnuecl. Around 5:00p.m or so dressing was removed & amp; the patient r,r,as able to walk to the bathroom for sitz bath. The oppolrent no. I 3 by the time had got hot water in a container and asked complaint no.l to wait ti11 he gets coid water. Thercafter, the nurse who walked into the bathroom saw Mr. Rajendra Prasad sitttng comfortably in tl're sitz bath. The staff nurse tested the temperature of water by her hand and then as she felt the temperature was hot, she immediately made Complainant No.1 to get up. By that time she could make out that there were ;-ecldened area around both the buttocks as well as the upper tf ighs.
33 ccl204l20l6 4L. On examining medical experts KpME-reports marked as Ex-C28, it reads as here under 0dojo:- dorfcJ,"od, edr$olc do6d &erodro dd6 de).drld eJrt.
o vuel.eo:- 1l drodo edoerl, deJdd erd_ rootred8rrJddd dd doefr: er.do.d.d/er.d / goo4I 2o:-z -18 6dood os_o2-2o18.
2l doold:d.&. o o.e / S L I 20 L4- 1 S 66rood Os-o2_20 1 8.
rJoeer.od &doro oorln uuet eard. doaroefucJod dorlci.odu erdu$ofi0_ pe.oodeogi €-o. d0.11/9, uoos UoeF, ode pree, de>do&, eJorJd.odo-ou erd0rl Oe6dld dild"rqb alr[ errJd doaloQduocJ $e.ores. ro6eeus dddl Oe6dld d,o0d Serodd ddde, 0qL/oe€fu d erQro0rlrad:
1) uroll d6ed:s, €eroo, do{doerf OorJoo$iroero6rlCo, rjodd.odl drrd €er.
o
2) o-0[ 6Jod)u-o o0.ore6., €eroo, do0Joozr demrm-oer-o6rldo, aforJd.odl drJd der.
3) 60ll d6ed, deroo QrqiD66 eleuo6rfCo, erorJC.odJ drJd de,.
(,
4) 6ou qododd*d.' d ddE 4J uo, dgdl, d.eocF.dldo er{rd, dorJd.adl drld €er.
., edd) 6uood t9-o4-2o18 dodl erdr$rl gfe03 &e6 d.oeot'oaduoE doa:oQfud o-oaleldddo* aS68eofuo-orl dodceJod elodrJt'o di dCdodo6d. ddO d.oehrl rCeBdrd e3*ddoJo a:rlo oerg etodrlCdo* dOAe0fu &rrodm-o dod{r dd6 edr$otl t'.&.oo.q., &.tu.A.onf.8.0J.
v €drur d$rldo dd6 gle0.!oJlO_ €*O dB&dluo-d. The inadvertent 34 ccl204l20l6 or careless sitz bath with high temperature water is the cause for scalds hot water burns on perineum scrotal skin & penile skin of Mr. Rajendra Prasad necessitating the patient to under go skin grafting and Cystourethrosto, that has caused physical, mental & financial suffering of this patient, The hospital staff has failed to exercise simple care oodr * eaQo3otldooarl d0au-o dodd &rioduro dd6o$&{ de)o,lld.
42. ln the case of Dr. Laxman Balkrishan Joshi V.Dr. Trimbak Bapu Godbole and Anr' MANU/SC/036211968:
[1969]1SCR2O6 .In that case the High Court had held that the death of the son of tJle claimant was due to the shock resulting from red,uction of the patient's fracture attempted by the doctor without taking the elementa4r caution of giving unaesthetic. In this context, with reference to the duties of the doctors to the patient, this court in appeal, observed as follows.
The duties which a doctor owes to his patient are clear a person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding whether treatment to give or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient' The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither tJre very highest nor a very low degree of care and competence judged in the light of 35 cc/2o4lzot6 the particular circumstances of each case is what the law requires.
43. If we examine the whole enquiry, we are of the opinion that, before conducting sitz bath which is an essential procedure, OPs should have attended t}le patient with due care, skill and diligence. Things have gone wrong, patient suffers a continuing ailment because of negligence of the OPs, the entire negligence made is vicious circle that is one follows the other and vice versa. As such it is combined effect to the continuing aliment to the complainant No.1.
44. In the case on hand as considered from their own evidence of OPs, that the ward boy, nurses, doctors in the hospital providing treatment to the patient were deficient or negligence in service. In this present case the facts speak more themselves that the Hospital has caused grievous hurt and IATROGENIC INJURIES of BURNS, structure urethra and Fistula-inano to the patient 1"t complainant- which is causing disabilities and continuing medical issues to the patient. The patient is undergoing continuing medical treatment for which the outcomes may not be favorable. As held in Laxman's case (supra) by this court a medical practitioner has various duties towards his patient and he must act with a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. This is the least which a patient experts from a doctor.
45. OPs should have taken atl precautions while performing treatment and also should have look after the patient with due reasonable required-care without negligence of any kind \/ 36 ccl2o4lzal6 whatsoever on their part. However it has come in the enquiry that, in so far as administering SITZ BATH to the patient Mr. Rajendra Prasad is concerned, after surgery the patient was shifted to the recovery room at 1:00 p.m he was received in the ward by 3:00 p.m. at around 03:30 p.m, whlle the patlent was under the effects of spinal anaesthesia (which includes loss of sensation below the level of waist downwards), the doctor Dr Lakshman wrote ORDERS for unexplained and IRRATIONAL Post-operative Orders directing the patient to be forced to SIT FOR SITZ BATH therapy. It has come in the enquiry that the ward boy RAMAMURTHY under the directions of the Surgeon and Dut5r doctor Dr PADMASHREE ROA OP.No.8 forced the patient to sit in a Tub of BOILING HOT WATER - causing BURNS, SCALDS to the Buttocks, perianal region, penis, scrotum, perineum and urethra. This critical condition of the patient was due to careless sitz bath with high temperature water is the cause for scalds hot water burns on perineum scrotal skin & penile skin of Mr. Rajendra Prasad necessitating the patient to under go skin grafting and Cystourethrosto, that has caused physical, mental & Iinancial suffering of this patient, The OPs have failed to exercise simple care with responsibility of monitoring and overseeing to give all possible better quality of service to the patient.
OP. No.3 deposed in his evidence that he is functioning as managing director of OP.No.1, being the manager will be involved in decision making and it is bounden duty of OP.No.3 manager to supervise with responsibility of monitoring, overseeing, focus more on the administration and execution of the treatment and to oversee the success of the entire treatment to the patient from Y-
37 CC(ZO4|2OL6 the hospital. As it is the duty of the OP.No.3 manager to assign work to employees of the hospital and keep them on track. The supervisory role of the manager Dr. Rajkumar OP.No.3 includes supervisory, should have a particular focus on achieving better outcomes for patient who use services and their cares.
46. lt the case on hand as considered from the evidence of the OPs, their relevant entry in the discharge summar5r, the documents on record and evidence produced by the complainants gives a clear case of medical negligence. OPs failed to take all precautions required to be taken as a prudent doctor, ward boy and nurses of Rangadore Memorial hospital failed to exercise simple care witJl responsibility. In the above such circumstances, the evidence placed on record by complainants, alleging deficiency of service on the part of OPs have to be held proved.
In this connection reference is made to a reported case in Savits Grag v/s The Director, National Heart Institution respondent of SC & National Commission Consumer Law Cases (1996-2005) where in it is held that the consumer Forum is primarily meant to provide better protection in the interest of the consumer and not to short circuit the matter or to defeat the claim on technical grounds. In view of the above conclusion and in consideration of Annexure-4 copy of linal bill summary and receipt of pa5rment showing in Ex-C18 and bills, costs associated with the complainant No.l for treatment in OP No.l hospital, as complainants have shown incurring medical expenditure supported by cogent materials at Rs 2,98,211/- has to be acceptable as they are placed on record.
{ 38 ccl2ml2oL6 4?. lt is the duty of the hospital and concerned doctor to take pre and post procedural care of the patient admitted. Ward boy, nurses and duty doctors in the hospital have to take care of the patient admitted in tJle hospital. Due to the pain and suffering which the complainant No.l suffered due to the negligent act of the OPs careless Sitz bath with high temperature water is the cause for scalds hot water burns on perineum scrotal skin,& penile skin of Mr. Rajendra Prasad necessitating the patient to undergo skin grafting and Cystourethrosto, that has caused physical, mental & financial suffering of this patient, The OPs have failed to exercise simple care. It is the bounden duty of the OPs I to 4,8, 13 and nurses of the hospital to lookafter the patient with required care.
48. We are of the opinion it is a fit case to dispute opposite parties who are responsible for the situation of the complainant. Under the circumstances, As to the amount of compensation is concerned considering the age of the complainant as 58 years at the time of surgery and the inconvenience that the problem he had undergone after surgery, the trauma which he has faced, cannot be explained in terms of any words, in other words with such continued struggle he has to curse for his fate for his no fault. In view of such discussions we are of the opinion that commission held, there is deliciency in service on the part of OPs, while treating and performing sitz bath on complainant and he is liable to CPA and its legal effect in so far as payment of compensation is concerned, an amount of Rs. 10,00,000/-.As compensation towards pain, mental suffering, physical suffering and emotional distress.
39 cclzo4l2ot6 Towards legal expenses and other miscellaneous Rs.50,000/- has to be awardable.
49. In view of such discussions, the complainant has to be held estabiished that only on account of deficiency on the part of OPs.No. t to 4, 8 and 13 complainant No.1 was subjected to such severe health disorders and disability i.e caused grievous jurt and IATROGENIC INJURIES of BRUNS. Commission cannot award adequate compensation, Since considering, also it is evident from the documents produced by both the parties to the complaint and considering tJ:e discharge summary Ex-OP1i it is noted that, scrotal sutures were removed on 16 llOl2OA. The skin graft has taken up completely (100%) Donor site has healed well and completely. Fistula has healed well. The patient has been mobilized. Patient was reviewed by the physician, surgeon, and plastic surgeon and advised to be fit for discharge. From written version it is made known to the commission that complainant No.1 was given due care and treatment for the negligence that had happened from OPs. We perused complaint, affidavit evidence of complainants, written version and examination-in-chief affidavit of OPs, heard the arguments, on perusal of the records before the commission it is clear and evident that complainant No.l was treated in OP-l Hospital for the negligence of the OPs, treatment for the things that have gone wrong from the Opposite parties. This fact is also not dined by complainant in his affidavit evidence.
50. It is therefore in such circumstances, in considering the due care and treatment given to complainant No. I by the w 40 cq2u4l2[t6 opposite parties for the fault and negligence on their part commission cannot consider awarding exemprary damages '*,;
the complainant is seeking for.
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Keeping in mind, the principles granting the damages/compensation of on different counts, and that it should not be a bonanza or a lottery or windfall to the complainant and at the same time, it shall not be a pittance and glving for gratis, and that it should be just, proper, reasonable and adequate.
51. Due care and treatment given to the complainant No. I by the Opposite parties for the fault and negligence on their part.
The Foll0wing reasonable sk,r were adapted and exercised by the doctors and the nurses in the hospital wh,e rendering treatment to Complainant No.l from l3_g_20t4 to 2T_tO_2Ot4.
a It has come in the enquiry thot, the records show the patient complained poin and burning sensation ot dtound g p.m post operotive ordets directing the pdtient to sit for S:TZ BAIH theropy _cousing burns, lound to hove dermol scolds over both the buttocks ond scrotol orea. As the potient hod incurred scalds, the trcotment os first oid wos initidted immediately by S:75 p.M, Dr Lakshmon being primory consuttont hdd token necessary core ot all relevont times while trcoting the comploinant No.7.
a The plostic surgeon wos summoned ot the appropriate time for elevotion ond required procedure ,!n foct Dr proshonth Kesari the plostic surgeon hod seen the patient on lgth Sep 2074 ot 5:40 pm ond os per his advice the treotment wos continued. Any thermol injury tokes 3_7 ddys to establish the degree and extent.
The patient as well os the lamily members were continuousty kept informed obout the condition of comploinant No.I ot every stage. tn foct ,the surgicol procedure wos olso plonned in consultotion with the potient os well os his relotives. :;r" *", continuous counseling ,r::,':::""
consultonts os well os the managements who gove him utmost emotional support. The nursing stolf is turn attended to him on on exclusive bosis reossuring him thot he would be bock on hls feet soon. All these octed os o morole boostet to Mr.Rojendtd Prasod, the Comploindnt No,7 As per the odvice of Dr.Proshonth kesori,o plonned debridement ol the wound with skin grafting wos done under epidurol/spinal onesthesia. A thtough debridement (tongentiol debridement ond lovoge dedbrodment ) wos done ond the wound 'would wos covered with split thickness qruft.
During the suryery, it was obserued thot the skin around the glons penis hos scarred. Dr Prashonth kesori the plostic surgeon took o decislon to do o circumcision as this would help the patient and incidentolly is the treotment ol choice for scarred glans penis.
Subsequently consent to do o circumcision wos token, This wos not done under Nurses ond the whole procedure wos explained to the potient's wile by the plastic surgeon Dr.Prashonth Kesori. After the skin graft procedure, the potient was wolking to the rcst room by himsell ond he wos nevet pressurized ot ony given point to walk forcibly.
Fufther it has also come in the enquiry thdt since the Comploinont No.7 wos prcsented as a person who hails from poor economic bockground, the hospitdt took o considerote view towords the Comploinant No,l, At the insistence Comploinant No.7 ond his relotives rcquest letter for monitory help to get funds lrom vorious NGOs wos typed ond given to him. The potient wos never issued ony wrong bills nor wos ony misinlomotion regording his condition ond process was given, Toking into occount the surgicol condition ol comploinont No.7, he wos shilted to the semi/speciol word to focilitate privocy. f here wos no rcquest lrom eithet the potient ot the relotives to shift him to semi/speciat ward .Word boys were ossigned 24 hrs to help him, The hospitat outhorities went out of the woy were ossigned to help Comploinant No.7 hove os comlortoble o stoy os possible under the given circumstonces. More than a routine standord core was odministered to \/ 42 cclzo4lzot6 him, ln loct he wos shifted to thls smaller ward where he was looked ofter on o 24*7 bosis by the nursing stoII os well ds the duty doctors.
Further it hos come in the enquiry thdt, on 4th Nov 2O74 oround 4 p.m the comploinant No.7 complalned ol severe breathless ond plopitotions. The BP recorded wos 780/700 mm og hg, his heart rote wos 7O2 pet minute.
An ECG wos taken which showed Sl chonges ond the ICU teom wos informed. A Ttopnin T test wos advised .At 4:75 pm the lClt teom exomined the patient who hod been complaining of restlessness ond persistent elevated BP of 180/10.The ECG showed sinus tochycordio, poor R wove progression with nonspecific ST-T chonges. By now the Troponin results hod come os positive.ocs drugs were instituted and as they do not hove on odvanced cordiac service the patient was shilted to loyodeva lnstitute of Cordiology by oround 6:15 pm. At this point ol time his Bp wos 190/100 ond pulse wos 704 pet minute. A this while the potient ond his fomily were contlnuously informed of the condition ol the patient ond in consultation with the family ond Mr.Karthik ,the comploinont No.Z Comploinant No,7 was shifted to loyodevo tnstitute to cardiology ,There wos no question of transJer letters under duress os the fomily members were kept informed of every development ot every stage.
The potient wos ot loyadevo tnstitute of cordiology lrom 4th to 6th Nov 2074 ond wos treoted .As his wounds hod comptetety healed, he wos given o discharge note ond o ttsnsfer to layodevo lnstitute oJ cordiology .The potient was wolking well ond he wos ottending his doily chores without any poin or disobility .His vitol signs were normal till he comploined of uneosy feeling ond tachycordia on the evening of 4th Nov 2074, Comploinnat No.7 wos fit for dischorge and advised regording the some by both Dr.Lokshmon os well os Dr. proshonth Kesori on 2O.lO.2Ol4 itself. lt wos on unforeseen development on the evening of 4th Nov 2074 ond we hod to dischorge potient and we shifted him in the hospitot amhulonce to toyddevo lnstitute or Cordiology with o medicat ottendont ond senior staff nurse.
{ 43 cclzo4l2o76 Thus, on exomining oll the evidence of OPs ond documents Ex- Op l-60, would establish obout providing trcotment lor the IATROGENTC BaJRNS to the soid potient, Upon perusol ol the discharge summdry. potient wos reviewed by the surgeon and physlcion. On 13/09/14, plostic surgeon's opinion was taken dnd was odvised Epitheliolate AH and Metrcgyl ointment opplicotion. lt was decided thot wound debridement with splitskin groting will be done by the plostic surgeon The potient Rangodore Moevent the saigdry on 24/09/74 olter preanoesthetic clearonce ond informed consent. During the procedure, when urinory cotheterizdtion wos initioted, he wos lound to have ontefiu urethrol stricture. Following thiq the procedure wos postponed lor on hour. The patient's ottendont wos apprised of his urethral condition ond his consent wos taken seporotely to rcctily the urethrol stricture. For the urethrol stricture he underuent cystourethtotomy with circumcisibn which was done by the urologist. Post-procedure he wos teoted with antihiotics & anolgesics. Wound dressing wos done twice doily under the guidonce of plostic surgeon. During his hospital stoy, the dosage of insulin ond antihypertensives were optimized/adjusted occordingly. Sugar ond BP levels were mdintdined at redsonable levels, Potient ond family members (wife) were exploined obout the need for insulin, OHA, and ontihypertensives. Potient's wife was educoted regording insulin and diet control. Potient improved symptomaticolly. Scrotol sutures were removed on 16/10/74. The Skin groft hos token up completely (700%). Donor site hds heoled well and completely. Fistulo has heoled well. The potient hos been mobilized, Potient was reviewed by the physicion, surgeon, ond plostic surgeon ond odvised to be fit for discharge with the following odvice. At the time of discharge, patient's BP ond sugar ore well under conttol.
52. The complainants have not sought compensation from any pa-rticular doctor or hospital staff. They have claimed the above compensation from all the above OPs. It is OP-4 Dr. K. 44 ccl2o4lzot6 Lakshman general surgeon, under his primary care and consultation attended the Complaint No.Ol, noted/ diagnosed and conducted surgery to Mr. Rajendra prasad. It is Op.4 wrote post-operative orders directing the patient to slr for SITZ BATH therapy. Along with ward boy RAMAMURTHY Op No.13 under the directions of the surgeon and duty d.octor Dr pADMASHREE RAo OP No.S forced the patient to sit in a Tub of BOILING HOT WATER -Causing BURNS, SCALDS to the BUTTOKS, perianal region and Urethra. And also the nurses who are posted for the particular treatment. oP No.1 M/s Rangadore Memorial Hospital, Binod Rangadore ,OP No.2 Chairman M/s Rangadore Memorial Hospital and Dr Rajkumar Op No.3 being the manager representing oP No.ol have the responsibility of monitoring, overseeing and it is their duty to focus more on the administration and execution of the treatment, but Op No,s 1,2 and 3 are found negligent to oversee the success of the entire treatment to the patient Complainant No. 1 from the hospital.
In view of this, we are of the opinion that Op No,s 1,2,3,4,g and 13 are to be held responsible for the said negligence and arso liable to pay the compensation. Since these persons ,*,ho are entrusted with the treatment are the employees of Op_ 1 and by applying the principles of ,Various Liability,, Op_ t has to pay the compensation on behalf of the said doctors and the nursing staff. In case oP- 1 feels to recover the same from the said persons it is at liberty to do so. The Complaint against other Ops i.e Op_ 5,6,7,9,10,11,12 and 14 arc hereby dismissed as there is no evidence against them to prove their negligence.
Y 45 cc/204l2oL6 ORDER
1. 'fhe complaint ls allowed in part with cost.
2. OP- 1,2,3,4,8 and 13 are directed to pay total costs of Rs.2,98,211l- associated wlth the Complainant for treatment in Rangadore Memorial Hospital.
3. Further OP-112,3,4,8 and 13 are jointly and severally hereby directed to pay Rs:1O,OO,OOO/- as compensation towards pain and suffering, emotional distress, damages for physical hardship, mental agony and financial suffering of Complainant and towards legal expenses of Rs.5O,OOO/- to be payable to the Complainant.
4. OP-Lr2r3r4,8 and 13 are directed to comply the above order within 60 days from the date of receipt of this order. On failure to comply this order within the above stipulated time, opposite parties shall pay interest at the rate of 60/o per annum on the above sum of Rs. 1O,OO,OOO/- from the date of complaint till the date of payment.
5. The complaint against OP-S to 7,9 to 12 and 14 are hereby dismissed.
6. Copy of thls Order as per statutory requlrements, be forwarded to all the parties free of cost.
I
M em u Member
LW
President
-BR-