State Consumer Disputes Redressal Commission
Smt. G. Ramadevi, Wife Of Sri G. ... vs 1. Dr.V. Srinivas on 11 April, 2022
BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL
COMMISSION:HYDERABAD
C.C.34/2014
Between:
1.Smt.G.Ramadevi, (Died)
Wife of Sri G.Lakshmaiah,
Aged 68 years, Resident of
Plot No.363/Phase II,
Saket Colony, Saket Road,
Kapra, ECIL P.O.,
Hyderabad 500 062.
2.Shri G.Lakshmaiah , Aged 80 years,
Occ:Pensioner, Husband of Late G.Ramadevi.
3. Shri Gopi Sridhar, Aged 46 yrs., Occ:Service
4. Shri Gopi Srikanth, Aged 45 yrs., Occ: Service,
5. Shri Gopi Srinath, Aged 44 yrs., Occ: Service
(SI.Nos.3 to 5 are sons of late G.Ramadevi)
6. Smt Gopi Sailaja, Aged 43 Yrs., Occ:House Wife
(Daughter of Late G.Ramadevi),
All Residents of Plot No.363/Phase I1, Saket
Colony, Kapra, Hyderabad 500 103. .. Complainants.
(Impleaded as per orders in I.A.No.1296/2018)
And
1.Dr.V.Srinivas,
C/o.Vasavi Hospital,
6-1-91, Beside Vasavi Seva Kendram,
Lakdi-Ka-Pool, Hyderabad 500 004.
2. Vasavi Hospital,
6-1-91, Beside Vasavi Seva Kendram,
Lakdi-ka-pool, Hyderabad 500 004. Opposite parties
Counsel for the Complainants Mr.V.P.Ramanath
of M/s.Ramanath & Associates.
Counsel for the opposite parties M/s.A.Alavender Goud-O.P.No. 1.
Mr.T.Sajad-0.P.No.2.
CORAM: Hon'ble Sri Justice M.S.K. Jaiswal, President.
And
Hon'ble Smt. Meena Ramanathan, Lady Member
MONDAY, THE ELEVENTH DAY OF APRIL, TWO THoUSAND TwENTY Two.
2Order:
1. This is a complaint filed by the Complainants under Section 17(1)ta}/) ofthe Consumer Protection Act, 1986 praying to direct the Opposite parties:
i). to pay compensation of Rs.40 lakhs for the botched up surgery conducted by opp. party no. 1 in opp.party no.2 hospital which increased risk to the life of complainant;
ii). to pay further compensation of Rs.7,50,000/- towards mental agony suffered by complainant no.1 and her kith and kin;
i). to pay compensation of Rs. 1,50,000/-as conveyance charges and other miscellaneous expenses for making various visits to Vasavi Hospital and Omega Hospital for undergoing 3 chemotherapy treatments and 31 radiation treatments and other miscellaneous expenses incurred by them ; and
iv).to pay Rs.1 lakh towards legal expenses etc..
2. The brief facts of the case are as follows:
Initially the present complaint was filed by the complainant no.1 and during the course of the proceedings, she passed away and her legal heirs have come on record. However, for the sake of convenience, the submissions of the deceased have been considered in our discussion.
The complainant aged 68 years sutfered acute pain in the abdomen followed by heavy bleeding and she approached opposite party no.1, Endoscopic Surgeon and after preliminary examinations he opined that she was suffering from Fibroid Polyp Uterus, Diabetes Mellitus lI and Grade I l Haemorrhoids and recommended immediate surgery at opposite party no.2 hospital. On 18.3.2013 the complainant was admitted as in patient in opposite party no.2 hospital and opposite party no.l conducted "LAVH + P.F.R. and Haemorrhoidectomy Surgery". The complainant paid a total sum of Rs.1,04,000/- in cash to opposite party no.2 towards the medical treatment. After the operation, two samples were collected and sent to M/s.Path Care Labs Pvt. Hyderabad viz Uterus and Haemorrhoids. Biopsy Report of Path Care Labs Ltd. dt.25.3.2013 revealed the following startling facts:
Cervix No Significant Changes. Endometrium- Suggestive of Endometrioid Carcinoma, Poorly Differentiated. Tumor1 Infiltratred uptil inner 1/3rd of Myometrium'. As per the biopsy report, though it was clearly revealed that the complainant was suflering from Malignancy that arose from the endometrium the opposite party no.1 had assured her that the biopsy report was absolutely normal As the complainant continued to have severe abdomen pain and Dr.Mohana Cancer Specialist associated bleeding, she consulted Vamsy, a with Omega Hospitals, Hyderabad and after conducting a series of tests, she was advised to undergo further surgery. Since the investigation under GA Laparoscopy showed tumor in left ovary and adnexa adherent to sigmoid mesentery, the procedure was converted to laparotomy and the complainant underwent the following surgeries on 30.4.2013 at Omega Hospital, Hyd.:
a). Bilateral Salpingo Ooprectomy
b). Bilateral Pelvic Node Biopsy
c). Bilateral Peritoneal Biopsy.
d). Omental Biopsy.
The complainant subsequently underwent three chemotherapy treatments and 31 radiation treatments as follow-up post operative treatment.
The complainant states that if both opposite parties 1 & 2 have followed the correct therapeutic approach and correct procedures in the first instance, the malignancy could have been detected and arrested and thus prevented the spread of the dreaded disease further during the interim period which they failed to and neglected. The complainant alleges that there is medical negligence and deficiency in service on the part of the opposite parties and hence approached this Commission for reliefs as stated supra in para no.1.
3. Opposite party no.1 filed written version stating that after thorough investigations, standard pre-diagnosis tests and considering the complainant's condition they advised her to undergo the surgery. The complainant being 67 years old was also obese and diabetic. Initially Dr.Anupama was consulted, but since there was a high risk of uterine perforation and uncontrolled bleeding this opposite party planned for laparoscopic total hysterectomy with bilateral Salpingo oopherectomy.
The fact that the complainant had a large degenerating uterus with severe pelvic infection was informed tu her and her attendants. Two samples were sent for biopsy as mentioned i.e. i). uterus and ii). Haemorrhoids. The was not collected by the attendants and the complainant was biopsy report discharged after four days of surgery. They were advised clearly on the discharge summary to collect biopsy report and attend the review.
The report dt.25.3.2013 clearly indicates that the complainant had endometrial carcinoma and this opposite party never advised or informed them that the report is normal. They consulted Dr.N.Madhavi in Omega Hospital on 30.3.2013 but did not follow her advise. They later consulted Dr.Mohana Vamsi on 25.4.2013. The delay is purely the complainant's negligence and against medical advise. This opposite party advised the complainant to come for review after obtaining the biopsy report, but their intentions are malafide and the allegations are baseless and made only to harass this opposite party it is further submitted that the Case Sheet and Discharge Summary would be self explanatory supporting his competence as a medical practitioner. With the afore mentioned submissions he prays that the Commission may dismiss the present complaint with exemplary costs.
Opposite party no.2 filed their written version contending that they are unaware of what transpired between opposite party no.1 and the complainant for the medical treatment. The complainant never approachcd this opposite party earlier for any treatment or consultation much less for the surgical procedure she underwent for her present ailment. She was admitted as inpatient with the opposite party no.2 hospital upon the recommendation of opposite party no.I and they only provided the operation theatre facility and support of efficient medical and para medical staf.
Admittedly, there is no specific allegation in the complaint against this opposite party no.2 hospital and the case sheet enclosed discloses the efficient care taken by their skilled, professional staf. The complainant chose to claim the exaggerated figure of Rs.40 lakhs without indicating the basis of arriving at the said figure. This opposite party is not liable to pay compensation or any other amount claimed and the complaint is devoid of merits.
Complainant no.1 filed her Evidence Affidavit. Exs.Al to Al5 are marked on behalf of the complainants. Opposite party no. 1 filed his evidence affidavit. Mr.G.Rajamouli Gupta, Chairman of Vasavi Hospital (opp.party no.2) filed evidence affidavic. Exs. B1 & B2 are marked on behalf of the opposite party no.2.
6. The points that arise for consideration are:
i) whether there is any deficiency in service on the part of the opposite parties and whether the complainants are entitled for the reliefs as prayed for ?
ii). To what relief ? 7. In the present case, the complainant submits that she is 68 years old and had menopause about 17 years ago. She complained about post menopausal bleeding and approached opposite party no.l for preliminary
examination and he recommended immediate surgery at opposite party no.2 Hospital. She underwent 'LAVH + P.F.R and Haemorrhoidectomy surgery'on 18.3.2013 and her sutures were not removed till 28.3.2013 causing her much inconvenience and discomfort.
Post surgery two samples were collected and the biopsy report was submitted to opposite party no.2 dated 25.3.2013. Although the report revealed that the complainant was suffering from malignancy, opposite party no.I doctor, she claims assured her that the report was 'normal.
The complainant continued to suffer from severe abdominal pain and consulted Dr.Mohana Vamsy at Omega Hospital and underwent further surgeries, chemotherapy and radiation treatment. She has filed the complaint against the negligence and mercenary procedure adopted by the opposite parties 1 & 2. It is her case that irrespective of age, the doctor should have advised an ultra sound of abdomen and pelvis followed by MRI Scan of abdomen. This would have revealed the endometrial carcinoma, ovarian pathology and any abnormal pelvic lyaph nodes.
8. It is seen from the version of the opposite party no.1 that the complainant and her son approached him on 17.3.2013 and that Dr.Anupama, Professor of Obstetrics and Gynaecology had referred them for Laparoscopic Hysterectomy. However, no referral note by her, with her observations is placed before us.
9. Admittedly the complainant aged about 68 years complained of post menopausal bleeding. We refer to the opinion submitted by Tata Memorial Centre. The Commission had requested them to study the case , evaluate and submit their opinion with regard to the methodology and protocol adopted by the opposite parties in the treatment of Endometrial Cancer suffered by the complainant.
"an elderly lady coming with complaints of post menopausal bleeding, would be subjected to Ultrasonographic (USG) examination and if the endometrium is found to be thickened ( more than 4 mm), biopsy is attempted to rule out malignancy".
No copy of the USG report is filed and although opposite party no.l stated in his written version that he had consulted Dr.Anupama and she did not do the Endometrial Biopsy neither her opinion or referral is filed.
10. The main issue that requires to be addressed is was the opposite party no.1 deficient and negligent in planning and conducting the surgery on the complainant without biopsy?
The opinion submitted by the Committee constituted by the Director, Tata Memorial Hospital is reproduced below:
"10.0: Overall, it lies within the domain of a skilful surgeon to adopt the methodology for surgery with due diligence adopting appropriate procedures and standards and taking into account the available diagnostic information available of the patients and their general health condition."
To this we add our reasoning after thoroughly examining the records to further understand and resolve the dilemma. Generally hysterectomies are done by a Gynaecologist, however a general surgeon with experience in this matter would be competent to perform laparoscopic assisted hysterectomy. The most common complication is uterine perforation and the risk is highest in post menopausal women. Patients with endometrial cancer also have a higher rate of uterine perioration.
Risk factors for uterine perforation include:
1) Nulli parity.
ii) Menopause.
ii Markedly Retroverted Uterus.
iv) Undue Force.
As per Ex.A6 the final diagnosis is Fibroid Polyp/DM/Haemorrhoids and her chief complaint is of pain in lower abdomen and post menopause bleeding. Opposite party no.l performed LAVH and Haemorrhoidectomy on 18.3.2013.
LAVH means Laparoscopy assisted vaginal hysterectomy - where a thin viewing tube is used to visualise st1uctures within the abdomen. Certain women would be best served by having this procedure because it allows the to becarefully inspected during surgery. Examples of use of upper abdomen would be for early Endometrial Cancer or if Oopherectomy is laparoscope planned. In this regard the procedure and protocol adopted by opposite party no.1 doctor cannot be faulted with.
The opposite party no.l doctor has detected, Fibroid and Polyps in the
11. complainant's uterus, which can only be confirmed by a trans vaginal/pelvic or abdominal ultra sound or MRI. In his evidence he has stated that the ultra sound of the abdomen showed, "large uterus with degeneration and necrosis".
He has consulted Dr.Anupama who was reluctant to do the D&C/Endometrial biopsy The complainant in her evidence has clearly admitted that she had consulted Dr.Anupama of Gandhi Medical College who recommended her to approach opposite party no.1. The complainant has failed to provide the referral letter or advise of Dr.Anupama. Opposite party no.l in his evidence advise and her hesitation to do a D & has also referred to Dr.Anupama's Neither party has chosen to cross examine C/Endometrial biopsy.
in her Dr.Anupama. We further emphasise the submission of the complainant 1 evidence affidavit - "Dr.V.Srinivas, since he was an Endoscopic Surgeon, and aiter doing some preliminary examination, he came to the conclusion that 1 was suffering from Fibroid Polyp Uterus, Diabetes Mellitus II and Grade l1 Haemorrhoids". By her own admission certain examinations were conducted and the opposite party no.1 doctor has insisted that the ultra sound of the abdomen showed "large uterus with degeneration and necrosis" The fact that the complainant was suffering from Fibroid Polyp Uterus could not have been visualised by opposite party no.1 doctor without an ultra sound test.
12. Both parties admit to the consultation and recommendation of Dr.Anupama. The fact that her advise to the complainant was to approach opposite party no. 1 doctor is adverted to by the complainant in her evidence and we wish to emphasise this yet again. Examination and Referral Letter is not submitted to the Commission and the opposite party no.1 Doctor could not have come to a conclusion that the complainant is suffering from Fibroid Polyp Uterus, DM I, Grade II Haemorrhoids' without any investigations.
The complainant has wantonly not revealed the advise given to her by Dr.Anupama. Implicating opposite party no.1 Doctor for the absence of tests supposedly not conducted cannot be viewed as deficiency or medical negligence. There is contributory negligence on the part of the complainant in not producing any evidence in this regard. We find that the records submitted are incomplete and this does not evidence medical negligence whatsoever. In the opinion submitted by the multi disciplinary committee constituted by the Director, Tata Memorial Hospital particular mention is made to the fact that the complainant and her son had approached Dr.Anupama, Professor of Obstetrics and Gynaecology. They have further added that no referral note by her with her observations is seen in the papers sent to Tata Memorial Hospital, to know her clinical opinion. The absence of certain vital documents/test not prove that the professional skilled surgeon has been careless, reports does or negligent. We find the complaint is unreasonable and mercenary unsubstantiated and with the aforementioned discussion devoid of merits.
In the result, complaint is dismissed. No costs.
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