State Consumer Disputes Redressal Commission
Amrit Hospital And Another vs Jagtar Singh And Another on 8 April, 2011
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB,
SCO NOS.3009-12, SECTOR 22-D, CHANDIGARH.
First Appeal No.836 of 2005
Date of institution: 09.06.2005
Date of decision : 08.04.2011
1. Amrit Hospital, Surgical & Laproscopic Centre, Court Road, Fazilka,
District Ferozepur through Dr.M.M.Singh.
2. National Insurance Company, Salemshah Bazar, Failka through its Branch
Manager.
.....Appellants
Versus
1. Jagtar Singh aged about 50 years son of Kartar Singh village Teja Ruhela
(Gatti No.3), P.O. Mauzam, Tehsil Fazilka, District Ferozepur.
2. Malkeet Singh aged about 20 years;
3. Swarna Bai, aged about 17 years, daughter;
4. Gurcharan Singh, aged about 13 years, son;
5. Reshma aged about 12 years, daughter;
6. Chhindo aged about 10 years daughter of Jagtar Singh son of Kartar;
All residents of village Tehsil Ruhela (Gatti No.3) (Respondents No.3 to 6
minors through their father Jagtar Singh respondent No.1)
.....Respondents
First Appeal against the order dated 23.03.2205
passed by the District Consumer Disputes
Redressal Forum, Ferozepur .
Before:-
Hon'ble Mr.Justice S.N.Aggarwal, President
Mrs.Amarpreet Sharma, Member
Mr.Baldev Singh Sekhon, Member Present:-
For appellant No.1 : Sh.G.S.Chauhan, Advocate for
Sh.A.R.Takkar, Advocate
For appellant No.2 : Sh.P.S.Saini, Advocate with
Sh.Parminder Singh, Advocate
For the respondents : Sh.A.K.Khungar, Advocate
JUSTICE S.N.AGGARWAL, PRESIDENT
Kashmira Bai (now deceased) (in short "the patient") was the wife of Jagtar Singh respondent and mother of respondents No.2 to 6 . On 25.5.2004 she First Appeal No.836 of 2005 2 complained of pain in her abdomen. She was taken to Dr. Pardeep Jasuja (in short "Dr. Jasuja"). He recommended ultra-sound test. The ultra-sound test of whole abdomen was done at Chandrawati Scan Centre, Fazilka on the same day by Dr. (Mrs.) Simmi Jasuja. After looking at the ultra-sound report she told the patient that there was stone in her gall bladder which was the cause of pain. She was prescribed some medicine by Dr. Jasuja. He also recommended surgery for proper relief. The medicine was taken for few days by the patient but there was no relief. She again went to Dr. Jasuja on 6.6.2004 who recommended Hb examination at Bajaj Diagnostic Centre, Fazilka. It was also got conducted on 6.6.2004.
2. It was further pleaded that the patient was taken to Amrit Hospital owned by Dr. M.M. Singh appellant No.1 (in short "the appellant") for consultation. After perusing the medical test reports, the appellant suggested immediate surgery. The patient was admitted in the appellant hospital on 6.6.2004. Necessary tests were got conducted from Girdhar Lab. and the medicines as prescribed by the appellant were also being taken by the patient.
3. It was further pleaded that the appellant again advised ultra-sound and chest x-ray on 18.6.2004 to be got conducted from Chandrawati Scan Centre and Madaan X-Ray Centre respectively. The patient subjected herself to ultra- sound and chest x-ray and these reports were also shown to the appellant. He told the patient that the reports were normal. Some medicines were prescribed. The patient was taking the medicine but the pain was still subsisting.
4. It was further pleaded that on 25.6.2004 the appellant told the patient and respondent No.1 (in short "the respondent") that he was to go out of station for 2/3 days and the patient was being discharged. He also demanded Rs.4,000/- as the balance medical fee. The respondent made this payment and the patient was discharged by the appellant from his hospital on 25.6.2004. The patient remained in her house for two days but there was no improvement.
First Appeal No.836 of 2005 3
5. It was further pleaded that on 28.6.2004 the patient was again taken to Civil Hospital, Fazilka where she was admitted for further treatment. She was again subjected to some medical tests including ultra-sound, ECG and she remained admitted in that hospital till 9.7.2004. The respondent was told by the doctors of Civil Hospital, Fazilka that uterus of the patient was removed when the patient was in the hospital of the appellant. The respondent was shocked to know about it. The condition of the patient was deteriorating every day due to unwanted surgery and consequential infection. The patient was brought in Government Medical College and Hospital, Faridkot on 12.7.2004. Again the patient was subjected to certain medical tests. The blood was also transfused in her body but in vain. The patient died on 17.7.2004 at 7.30 P.M. in that hospital.
6. It was further pleaded that the patient was admitted in the hospital of the appellant for removal of stone in the gall bladder and for relieving the patient from pain. The appellant removed her uterus without knowledge and consent of the patient or of the respondent. Even after doing so it was not disclosed to the patient or to the respondent by the appellant. The uterus was removed in a negligent way by the appellant which caused infection while pain in the abdomen of the patient still continued. Therefore the appellant had committed medical negligence while treating the patient when she was remained admitted in his hospital from 6.6.2004 to 25.6.2004. Hence the complaint for claiming compensation of Rs.9,55,500/- on various counts. Costs were also prayed.
7. The appellants filed the written reply. In the written reply filed by the appellant, it was pleaded that the respondents have concealed material facts, on the basis of which, the complaint should be dismissed. It was also pleaded that the appellant had taken the professional indemnity insurance policy from appellant No.2. The frivolous and vexatious allegations have been made in the complaint. Dismissal of the complaint was prayed.
8. On merits, it was pleaded that Dr.Pradeep Jasuja was not running any hospital in Fazilka (the correct name of Dr.Jasuja is Dr.Navdeep Jasuja). It First Appeal No.836 of 2005 4 was further pleaded that the patient was admitted in Sachdeva Hospital on 1.6.2004 with the chief complaint of COPD (breathlessness) and for bleeding per vaginal. The patient was examined by Dr.Shavinder Verma, Gynaecologist. She was discharged from Sachdeva Hospital on 4.6.2004. During her stay in Sachdeva Hospital, the condition of the patient had slightly improved but bleeding continued. Thereafter, she was referred to the Surgeon for emergency hysterectomy. Therefore, the respondents have concealed material facts regarding the admission of the patient in Sachdeva Hospital.
9. It was further pleaded that the patient had come to the hospital of the appellant on 6.6.2004 for OPD consultation with the history of bleeding per vaginal for the last 15 days, cough with expectoration for the last 12 days and fever for the last 5 days. The patient had also told the appellant that she was having such type of complaint (i.e. bleeding per vaginal) for the last 1½ years but in the first week of June, 2004, it was excessive and uncontrolled. The patient had also disclosed to the appellant that she had taken treatment for this ailment from Sachdeva Hospital.
10. It was further pleaded that the appellant had examined the patient clinically. She was having excessive bleeding per vaginal. There were clots of blood in the passage of vagina. The appellant had advised the patient to undergo all the investigations and medical tests. She was also advised for admission in the hospital of the appellant because the treatment without her admission in the hospital for stopping the bleeding per vaginal was not possible in OPD. The appellant had called Dr.Simmi Jasuja, Gynaecologist for obtaining her Gynaecological opinion and in order to know the cause of bleeding. Dr.Simmi Jasuja had examined the patient on 6.6.2004 and she opined that the patient was a case of Dysfunctional Uterine Bleeding (DUB). Dr.Simmi Jasuja also told that the patient needed hysterectomy urgently as a life saving measure.
11. It was further pleaded that after going through all the medical reports and after obtaining the gynaecological opinion, the appellant had come to the First Appeal No.836 of 2005 5 conclusion that the patient required urgent hysterectomy. The consent of the patient and of respondent No.1 was taken. On 7.6.2004, the blood was transfused in the patient and, thereafter, the surgery was done. After the surgery, the uterus specimen was sent to the Elite Pathological Diagnostic Centre, Abohar for Histopathology. As per the report, it was reported that "Features suggestive of dysfunctional uterine bleeding with chronic cervicities". The surgery was uneventful and the patient was shifted to a ward in a satisfactory and stable condition. Proper steps were taken for the management of the patient even after the operation. The sutures were removed. The wound was healthy and ultimately, the patient was discharged in good general condition on 25.6.2004.
12. It was further pleaded that the appellant had advised for emergency hysterectomy and not for surgery relating to gall bladder. It was denied if the respondents had made the payment of Rs.5000/- to the appellant for surgery or Rs.1000/- for Anaesthesia. In fact, the appellant had received only a sum of Rs.2500/- in aggregate as charges for all the services. It was admitted that the surgery was performed on the patient on 7.6.2004 but it was denied if the bleeding was uncontrolled. It was also denied if the patient had made any complaint that she was not getting any relief by the medicines prescribed by the appellant. On the other hand, there was no bleeding after the surgery. There was only slight spotting which was very common after the surgery.
13. It was admitted that certain medical tests were got conducted in Girdhar Lab.. She was taking medicines as prescribed by the appellant. It was denied if she was not relieved from pain. It was also denied if the appellant had told the patient on 25.6.2004 that he was going out of station for 2-3 days or had discharged the patient from the hospital for that reason or if he had received a sum of Rs.4,000/- from the patient or the respondent on the date of discharge.
14. It was denied for want of knowledge if the patient thereafter was brought to the Civil Hospital, Fazilka or if she was admitted in that hospital for further treatment. It was also denied if the uterus of the patient was removed First Appeal No.836 of 2005 6 without the consent of the patient or without the knowledge of the patient or of respondent No.1. Rather it was removed only with the consent of the patient and after the entire complications were told to the patient and respondent No.1. It was also denied if the condition of the patient was deteriorating from day to day after the surgery. It was denied for want of knowledge if the patient was taken to the Government Medical College, Faridkot or if she was admitted and treated medically in that hospital.
15. It was also denied if the patient was admitted in the hospital of the appellant for relieving her of her pain which was caused by the stone in the gall bladder. It was also denied if the surgery conducted by the appellant on the patient was unwanted and unnecessary or if the appellant has committed any medical negligence while treating the patient or if any act of the appellant has led to her death. It was repeatedly denied if the appellant committed any medical negligence while treating the patient.
16. Appellant No.2 also filed the written statement. It was not denied if appellant No.1 had taken the professional indemnity insurance policy from appellant No.2. but it was denied if the appellant has committed any medical negligence while treating the patient or if the appellant insurance company was liable to pay any compensation. Dismissal of the complaint was prayed.
17. Parties produced the affidavits/documents in support of their respective versions.
18. The matter was also referred by the learned District Forum to the Board of Doctors consisting of 3 doctors and the Board had submitted its medical opinion dated 18.2.2005.
19. After considering the pleadings of the parties and the affidavits/documents produced on file and after going through the report of the Medical Board, the complaint was partly accepted by the learned District Forum vide impugned order dated 23.3.2005 with costs of Rs.2000/-. The appellants were First Appeal No.836 of 2005 7 directed to make the payment of Rs.2,50,000/- with interest @ 12% p.a. from the date of institution of the complaint till realisation.
20. Hence, this appeal.
21. The submission of the learned counsel for appellant No.1 was that the appeal be accepted and the impugned judgment dated 23.3.2005 be set aside.
22. Similar submission was made by the learned counsel for appellant No.2 that the appeal be accepted and the impugned judgment dated 23.3.2005 be set aside.
23. On the other hand, the submission of the learned counsel for the respondents was that there was no merit in the present appeal and the same be dismissed.
24. Record has been perused. Submissions have been considered.
25. The admitted facts are that Kashmira Bai patient was the wife of the respondent and the mother of respondents No.2 to 6. On 25.5.2004, she had complained of pain in her abdomen. She was taken to Dr. Jasuja (the actual name was Dr.Navdeep Jasuja). It appears that this clerical error was committed by the respondents because the name of Dr.Pradeep Jasuja is mentioned on the ultrasound test report which is duly signed even by Dr.(Mrs.)Simmi Jasuja) in Chandravati Heart Centre, Fazilka. She was advised ultrasound. It was performed by Dr.(Mrs.)Simmi Jasuja and as per the ultrasound test report, there was a stone in the gall bladder of the patient. Some medicines were prescribed to her by Dr.Jasuja but there was no relief.
26. Although the respondents have not pleaded if the patient remained admitted in Sachdeva Hospital for the period from 1.6.2004 to 4.6.2004 but it is specifically pleaded by the appellant that the patient was admitted in Sachdeva Hospital on 1.6.2004 with chief complaint of COPD (breathlessness) and bleeding per vagina. She was examined by Dr. Shavinder Verma, Gynaecologist. The condition of the patient had slightly improved but the bleeding continued. She was discharged from Sachdeva Hospital on 4.6.2004 and was referred to the hospital of First Appeal No.836 of 2005 8 the appellant. The medical record of Sachdeva Hospital is also placed on file where it is mentioned that she was admitted for COPD with bleeding per vagina. Some medicines were prescribed to the patient. It was stated in the medical treatment chart of the patient in Sachdeva Hospital dated 4.6.2004 that inspite of medication, the bleeding per vagina did not stop and she was referred for further management ? Hysterectomy if the bleeding persist. After her discharge from Sachdeva Hospital, the patient had come to the hospital of the appellant where she was admitted on 6.6.2004.
27. The respondents had suggested that the appellant had demanded a sum of Rs.5000/- for the surgery and Rs.1000/- for payment to Anaesthetist who was none else than his own wife. She was on Government job. It is also pleaded in para 9 of the complaint that the patient was discharged by the appellant from his hospital on 25.6.2004 after receiving a sum of Rs.4000/- from the respondents. In reply, the appellant has denied if he had received Rs.5000/- for medical fee for surgery and Rs.1000/- for payment to Anaesthetist but it is pleaded by him that he had received only a sum of Rs.2500/- in aggregate as charges for all services. However, he has denied if he had charged a sum of Rs.4000/- from the respondents on 25.6.2004 when the patient was discharged from his hospital. The fact remains that the appellant had received an amount of Rs.2500/- as consideration for rendering medical services to the patient. Therefore, the respondents were the consumer qua the appellants.
28. It was further pleaded by the respondent that the appellant had got conducted various medical tests on the patient from Girdhar Laboratory. This fact was admitted by the appellant.
29. It was pleaded by the respondents that the appellant had operated the patient on the midnight of 7.6.2004. This fact was admitted by the appellant. The respondent had pleaded that neither the bleeding stopped nor the pain. It was also pleaded in para 9 that after the discharge of the patient from the hospital of the appellant on 25.6.2004, she was brought in the Civil Hospital, Fazilka on First Appeal No.836 of 2005 9 28.6.2004. On the advice of the doctor, the ultrasound test and ECG was got done on 9.7.2004 and then the respondents came to know that the appellant had even removed the Uterus of the patient for which neither the consent of the respondent nor of the patient was taken nor it was brought to their notice.
30. On the other hand, the version of the appellant was that since there was uncontrolled bleeding per vagina and since the patient was referred by Sachdeva Hospital for Hysterectomy which was a life saving procedure, therefore, the removal of uterus was essential and the patient and the respondent had consented for it.
31. The report of Sachdeva Hospital has been placed on the file which reveals that the bleeding per vagina had not stopped and, therefore, the patient was referred to the Surgeon for emergency Hysterectomy which was essential for saving the life of the patient. It was so done with the consent given by the patient and by respondent No.1. The consent form is a part of the treatment record produced by the appellant in the learned District Forum. Therefore, there is no merit in the submission of the learned counsel for the respondents that the Uterus of the patient was removed without the knowledge and consent of the respondents.
32. However, the fact remains that the patient was subjected to the ultrasound test on 25.5.2004 in Chandravati Scanning Centre and the report given by Dr.(Mrs.) Simmi Jasuja has been placed on the file. As per this test report, the gall bladder was distended. A 14.5 mm calculus was seen in lumen of the gall bladder. G.B. wall was not thickened. No calculus was seen in C.B.D. It means, therefore, that the calculus was present in the gall bladder of the patient as on 25.5.2004 which was the cause of pain to the patient. Merely because the patient remained admitted in Sachdeva Hospital and that hospital had stated in the treatment record of the patient that the bleeding per vagina had not stopped, it does not mean that the appellant was to pay attention only on the bleeding part or that he was justified in ignoring the presence calculus in the gall bladder of the patient, First Appeal No.836 of 2005 10 the presence of which was clearly indicated in the ultrasound report dated 25.5.2004.
33. The appellant has pleaded in the written statement that after the admission of the patient in his hospital on 6.6.2004, the patient was examined by Dr.(Mrs.) Simmi Jasuja, Gynaecologist and she had given the opinion that the patient was a case of Dysfunctional Uterine Bleeding (DUB) and that the patient needed Hysterectomy urgently as a life saving measure. The affidavit of Dr.(Mrs.)Simmi Jasuja dated 21.10.2004 has been placed on the file in which she has supported the version of the appellant but at the same time, the ultrasound was conducted on the patient by Dr.(Mrs.)Simmi Jasuja on 25.5.2004 and the ultrasound report was also duly signed by her in which she had noticed that there was a 14.5 mm calculus in the lumen of gall bladder. It is not possible, at all, to believe if the presence of calculus in the gall bladder was not in the notice of the appellant particularly when the patient was crying of pain. The surgery for stopping the bleeding per vaginal might be essential but to give relief to the patient from pain, the appellant was also required to plan the removal of calculus lying in her gall bladder. In his written reply, the appellant has pleaded in para 5 that he had advised for emergency hysterectomy and not for surgery relating to the gall bladder. It appears that since the doctor in Sachdeva Hospital had confined himself only to the bleeding per vaginal, therefore, the appellant had also confined himself to that aspect. Therefore, it was a clear cut case of medical negligence on the part of the appellant for not having paid any attention to the calculus present in the gall bladder of the patient as per the ultrasound test report dated 25.5.2004.
34. The learned counsel for the appellant has placed reliance on the judgment of the Hon'ble Madhya Pradesh State Consumer Disputes Redressal Commission, Bhopal reported as "Dr.Sanjay Sharma and another v. Ana Singh, IV (2006) CPJ 45" in which it was held as under : -
"True the deceased had developed infection and which ultimately resulted into his death. It is aptly observed in First Appeal No.836 of 2005 11 Davis-Charistopher Textbook kof Surgery "most operations are successful and patient progresses smoothly to complete convalescence and rehabilitation. In certain number of instances, however, complications develop. These may be minor and easily treated, so that recovery is not delayed, or they may be major, hospitalization may be prolonged, and death may ensue. Virtually any operation may be associated with both preventable and non-preventable complications".
In the instant case unfortunately the operations were associated with non-preventable complications which as already pointed out, are not unknown in medical science. Merely because some complications developed which led to the death of the patient by itself, is not sufficient to jump upon any conclusion regarding negligence on the part of appellants."
35. This judgment is not applicable to the facts of the present case because in the present case, the appellant had conducted total medical negligence for not treating the patient for the calculus which was lying in her gall bladder even to the knowledge of the appellant. Rather the appellant has taken the plea that the patient was referred for emergency hysterectomy. It appears that the hysterectomy was conducted by the appellant merely on the basis of the report of Dr.Sachdeva or on the opinion of Dr.Simmi Jasuja without applying his own mind.
36. Even after the patient was operated by the appellant on 7.6.2004, he had again advised the ultrasound and chest X-ray on 18.6.2004 to be got performed from Chandravati Scan Centre and Madan X-ray Centre. The patient had got conducted the ultrasound test from Dr.(Mrs.)Simmy Jasuja of Chandravati Scan Centre on 18.6.2004. On that day again, it was reported by Dr.(Mrs.)Simmy First Appeal No.836 of 2005 12 Jasuja that the gall bladder of the patient was distended. It was also reported that a 14.5 mm calculus was seen in lumen of gall bladder. G.B.Wall was not thickened. No calculus was seen in C.B.D. In other words, even after the emergency hysterectomy surgery was performed by the appellant on the patient, still the stone which was noticed in the gall bladder as per the ultrasound test report dated 18.6.2004 was left untouched. Admittedly, the patient was an indoor patient in the hospital of the appellant on 18.6.2004 also. The appellant had not taken any steps for the removal of the stone from the gall bladder of the patient to relieve her of pain.
37. If the appellant himself was not a specialist for the removal of the stone which was certainly causing pain to the patient, it was the duty of the appellant to have referred the patient to some other doctor as Dr.Vijay Sachdeva had done when he had found that he was unable to control the bleeding per vaginal on 4.6.2004.
38. Moreover, it was pleaded by the respondent in the complaint that on 25.6.2004, they were told by the appellant that he was to go out of station for 2-3 days and suggested that the patient should be discharged from his hospital on 25.6.2004 and accordingly, the patient was discharged from the hospital of the appellant on 25.6.2004. The appellant has denied in the written reply if he had told the respondent that he was to go out of station for 2-3 days but the fact remains that the patient was discharged from the hospital of the appellant on 25.6.2004. Since the pain did not stop, the patient was got admitted by the respondent in Civil Hospital, Fazilka on 28.6.2004. On the advice of the doctors of the Civil Hospital, Fazilka, the respondent got conducted the ultrasound test on 9.7.2004 on the patient.
39. The bed head ticket of the patient from the Civil Hospital, Fazilka has been placed on the file. It was reported in the treatment record of the patient of the Civil Hospital, Fazilka on 7.7.204 that when the patient was got operated for hysterectomy about one month back from the private practitioner, then she First Appeal No.836 of 2005 13 developed vomiting and loose stools for which she was admitted there (Civil Hospital, Fazilka). Now she was relieved of loose stools but the vomiting off and on was still persisting. Now the patient was complaining of (not legible) and of pain in chest off and on for the last 6 days. The bleeding per vaginal was still persisting. The patient was discharged from Civil Hospital, Fazilka on 9.7.2004.
40. Since the condition of the patient did not improve, she was taken to the Government Medical College, Faridkot where she was admitted on 12.7.2004 and ultimately, the patient died in that hospital on 17.7.2004 at 7.30 p.m. The medical record of Guru Gobind Singh Medical College and Hospital, Faridkot is also placed on the file showing the admission of the patient on 12.7.2004 and her death on 17.7.2004. The cause of death was shown as Septicaemia Post Hysterectomy. This report also reveals that the lumen of the gall bladder had shown calculus.
41. The documents produced on file by the parties clearly reveal that the patient was not attended for calculus in the gall bladder which was noticed in the ultrasound test report dated 25.5.2004 and 18.6.2004. Moreover, the bleeding had not stopped. Rather the patient had developed Septicaemia by which the patient died. The medical negligence on the part of the appellant is clearly proved.
42. Moreover, the Board of doctors in their opinion dated 18.2.2005 had reached the conclusion that Cholelithiasis itself cannot lead to the bleeding per vaginal. It means, therefore, that even the diagnosis of the appellant and the surgery performed by him were not the proper treatment given by the appellant.
43. The appellant has proved on the file the professional indemnity insurance policy taken by the appellant from appellant No.2 for the period from 13.8.2003 to 12.8.2004 for an amount of Rs.10 lacs.
44. Since the appellant has committed medical negligence, therefore, the award of compensation is justified. Although the award of compensation does not restore the patient to the respondents and the situation does not become the same as it was in her presence but the amount of compensation would be a small First Appeal No.836 of 2005 14 consolation for the respondents and it must go to them. Therefore, the amount of compensation awarded by the learned District Forum is upheld. Since, the appellant had taken the insurance policy from appellant No.2 for the period from 13.8.2003 to 12.8.2004, therefore, appellant No.2 will make the payment of the amount of compensation to the respondents to the extent permissible under the policy. The remaining amount, if any, shall be payable by appellant No.1.
45. In view of the above discussions, there is no merit in the present appeal and the same is dismissed with costs of Rs.10,000/- to be shared equally by both the appellants.
46. The appellants had deposited an amount of Rs.25,000/- with this Commission at the time of filing of the appeal on 9.6.2005. This amount of Rs.25,000/- with interest accrued thereon, if any, be remitted by the registry to the respondents by way of a crossed cheque/demand draft after the expiry of 45 days under intimation to the learned District Forum and to the appellants.
47. The interest on the amount of Rs.25,000/- shall stop running with effect from the date the appellants had deposited the same in this Commission. Interest on this amount of Rs.25,000/- shall be what has accrued on this amount when it remained deposited by this Commission in the Bank.
48. Remaining amount shall be paid by the appellants to the respondents immediately.
49. The arguments in this appeal were heard on 31.3.2011 and the order was reserved. Now the order be communicated to the parties.
50. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
(JUSTICE S.N.AGGARWAL) PRESIDENT (AMARPREET SHARMA) MEMBER (BALDEV SINGH SEKHON) April 08, 2011 MEMBER Bansal/Paritosh