State Consumer Disputes Redressal Commission
Dr. (Mrs.) A. Indumathi, ] W/O ... vs Kovai Medical Centre & Hospital Ltd, ] ... on 28 January, 2014
BEFORE THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI BEFORE THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI Hon'ble Justice Thiru R. Regupathi PRESIDENT Thiru J. Jayaram, JUDICIAL MEMBER
C.C. No. 63 / 2007 Dated this the 28th day of JANUARY, 2014 Dr. (Mrs.) A. Indumathi, ] W/o Madhivendan, ] No.15-B, C.S. Kowndar Layout, ] Saibaba Colony, ] Complainant Coimbatore - 11 ] Vs
1. Kovai Medical Centre & Hospital Ltd, ] Represented by its ] Chairman & Managing Director, ] Dr. Nalla Palanisamy, ] P.B. No.3290, Avinashi Road, ] Coimbatore 641 014 ] ]
2. Dr. P. Velayutham, ] Consultant Endocrinologist, ] Kovai Medical Centre & Hospital Ltd, ] P.B. No.3290, Avinashi Road, ] Coimbatore 641 014 ] ]
3. Dr. John AC Thanakumar, ] Consultant Laparoscopic Surgery, ] Kovai Medical Centre & Hospital Ltd, ] Opposite Parties P.B. No.3290, Avinashi Road, ] Coimbatore 641 014 ] This case coming before us for final hearing on 29.10.2013 and on hearing the arguments of both sides and upon perusing the material records, this Commission made the following Order:
Counsel for Complainant: Ms. Nandiniram Counsel for Respondent:
M/s Iyer & Thomas R1 to R3 J. JAYARAM, JUDICIAL MEMBER The complaint is filed under Sec. 17 of the Consumer Protection Act.
1. The case of the complainant is as follows:
The complainant is a qualified Ophthalmologist. The 1st opposite party is a public limited company incorporated under the provisions of the Indian Companies Act; and the 2nd opposite party is a Consultant Endocrinologist; and the 3rd opposite party is a Consultant Laparoscopic Surgeon under the 1st opposite party.
2. Sometime during May 2006, she felt some changes in her body, such as rapid increase in weight, Pigmentation and acne in the face, puffiness of face, fatigue, hypertension, joint pain, etc. she herself being a doctor, did few normal tests to rule out any endocrine disorder. The tests revealed that her Serum Cortisol level was high. Hence, she went to the 1st opposite party hospital where the 2nd opposite party is Consultant Endocrinologist and the 3rd opposite party is Consultant, Laparoscopic Surgeon. She was subjected to several tests at the 1st opposite party hospital as directed by the 2nd opposite party and on the basis of the said tests and after studying the CT Scan report, the 2nd opposite party diagnosed the problem as ACTH INDEPENDENT CUSHINGS SYNDROME due to ADENOMA IN LEFT ADRENAL GLAND and advised her to undergo Adrenelectomy (excision of the left Adrenal gland). The Radiologist and Surgeon of the 1st respondent hospital also confirmed the same. As per the advice of the 2nd opposite party, the complainant got admitted in the 1st opposite partys hospital on 16th Sept. 2006, and operation (excision of Left Adrenal Gland) was performed on 18th Sept. 2006 by the 2nd and 3rd opposite parties and she was discharged on 21-9-2006.
3. However, after the surgery, the clinical symptoms and complaints of the complainant increased instead of subsiding. She gained 4 kg. weight after the surgery and her acne in the face persisted and the pigmentation increased. Hence, she once again approached the 2nd opposite party and he convinced her that it would take some time to get relief, so she waited for nearly three months but there was no improvement but it still worsened. At this juncture, the 2nd opposite party even advised the complainant to get removed the right adrenal gland also as he was of the opinion that the problem might be due to Micro Adenoma in the right gland; but she was hesitant and not willing to take any risk of further operation and insisted on him to diagnose her problem correctly. The 2nd opposite party, therefore, advised her to go to the Christian Medical College Hospital (CMC), Vellore, for second opinion.
4. Accordingly, she went to Christian Medical College Hospital, Vellore, and the team of Doctors at CMC Hospital, under the head of Dr. Seshadri, Department of Endocrinology, examined her. She was in the hospital as inpatient from 14-12-2006 to 21-12-2006 and after conducting several tests, the doctors diagnosed the complainants problem as ACTH DEPENDANT CUSHINGS DISEASE DUE TO PITUITARY ADENOMA WITH BENIGN ADRENAL HYPERPLASIA and they further informed her that what was diagnosed and treated earlier at the 1st opposite party hospital was totally wrong and advised to undergo Pituitary Micro Adenoma at the earliest. She and her family members were terribly shocked to hear the same.
5. On the advice of the doctors of CMC Hospital, Vellore, she once again got herself admitted in the CMC Hospital, Vellore on 13th Jan 2007, and Transphenoidal Radical excision of Pituitary Microadenoma was done on 23-1-2007, and she was discharged on 3rd Feb 2007. Subsequent to the above operation, within 3 months she recovered soon, and the pigment in her face disappeared, relieved of muscle pain, etc. and now she is quite normal. The Review Medical Report dated 12-7-2007 of CMC Hospital, Vellore will clearly prove that bilateral adrenalectomy was done inadvertently by the opposite parties.
6. Thus the 2nd and 3rd opposite parties have wrongly diagnosed her problem and negligently performed a wrong surgery on her and removed a valuable part of the body. The Pathology Department of the 1st opposite party hospital also acted in a negligent manner by giving a wrong report. Because of the wrong surgery done by the opposite parties, she may develop deficiency of electrolytes, minerals and so many hormones in her body; gradually, which may even go to the extent of losing her life. Hence she has to keep on doing blood investigation to know the blood levels periodically throughout her life. She was also put to immense physical and mental stress and agony. She has not only incurred expenditure of nearly Rs. 5 Lac towards medical bills, travelling etc;
but she also had to abandon her medical practice for nearly 6 months. Her family was also in total disarray. The opposite parties 1 to 3 alone are totally responsible for all the above said loss, hardships and sufferings she had undergone and she estimates the loss caused to her by the negligent act of the opposite parties 1 to 3 at Rs.35,00,000/- which they are jointly and severally liable to pay to her.
7. She had already sent a letter dated 8-1-2007 to the opposite parties 1 and 2 asking for a detailed explanation but there was no response. Hence the complaint praying for direction to the opposite parties 1 to 3 to pay to her jointly and severally a sum of Rs.35,00,000/- as compensation for negligence and deficiency in service and for mental agony, and to pay costs.
8. The 1st opposite party filed version which was adopted by the opposite parties 2 and 3 stating as follows: The complaint suffers non-joinder of proper and necessary parties The complainant ought to have impleaded M/s Ramakrishna Centre for Imaging Sciences, M/s SRL Ranbaxy, Clinical Reference Laboratories and also Christian Medical College Hospital (CMCH), Vellore as parties in the complaint for a complete adjudication of the case. The complainant having failed to do so, the complaint ought to be dismissed.
9. The complainant has filed the instant complaint with the sole intention of harassing the opposite parties. There is no merit or substance in the complaint. The facts pertaining to the admission and treatment of the complainant at Kovai Medical Center and Hospital Limited, is as under:
a) The complainant was referred by Sri Ramakrishna Institute of Oncology and Research, Ramakrishna Hospital, Coimbatore to the 2nd opposite party with features of Cushings syndrome. She came to the Hospital on 28-8-2006.
b) The complainant had taken a CT Scan of the abdomen only on 26-8-2006 at Sri Ramakrishna Hospital. The results of the Scan revealed an enlarged left adrenal gland. The referral letter of Sri Ramakrishna Institute of Oncology and Research also stated that she had features of Cushings syndrome. The complainant had also undergone CT Scan of the Brain at Sri Ramakrishna Hospital which revealed a normal study.
c) The history and physical examination sheet dated 28-8-2006 of the hospital shows that she presented with conditions such as weight gain for the last two months, puffiness of face, fatigue, irregular menstrual cycle, hypertensive, obesity, presence of facial hair and acne. She also stated that she was the mother of one child and had an ovulation induction done. She also had progressive myopia.
Her BP was 130/80, she had no goiter.
d) Investigations including Complete Haemogram, PT, PTT were done and based on her clinical evaluation, it was diagnosed that the complainant had what was called Cushings syndrome. Cushings syndrome is a multi system disorder that results from sustained exposure of the body to gluco-corticoids.
e) Cushings syndrome can be of two types Exogenous or Endogenous. In exogenous Cushings syndrome, ACTH secretion is suppressed (ACTH independent) while in the cases of endogenous Cushings syndrome excess cortisol secretion may be ACTH dependant or ACTH independent. Once the diagnosis of endogenous Cushings syndrome is made, a determination of whether the patient has primary adrenal disease or an ACTH secreting tumor should be made. ACTH dependent Cushings syndrome accounts for about 85% of endogenous cases. 80 % of ACTH dependent Cushings is caused by Pituitary secretion. ACTH independent Cushings syndrome accounts for 15% of endogenous cases and is most often caused by benign cortisol secreting adrenal adenomas.
f) With this diagnosis, it had to be determined whether in the case of the complainant the problem lay in the adrenal gland or the pituitary gland (ACTH Dependent or ACTH Independent). In the diagnosis as to whether the Cushings / elevated levels of cortisol is due to a hyperactive adrenal gland or Pituitary gland, it is necessary to carry out what is called as an ACTH testing. ACTH is Adrenocorticotropic Hormone. Testing of ACTH is not a facility is available at the laboratory of the 1st opposite party hospital.
g) In the circumstances, the plasma of the complainant was sent to SRL Ranbaxy, Clinical Reference Laboratories, Mumbai for testing and report thereon. The report dated 1-9-2006 of SRL Ranbaxy showed that the ACTH level was <10 (less than 10) pg/ml. The report also clearly states that ACTH determinations can also help to identify the cause of Cortisol hypersecretion in Cushings syndrome. ACTH levels are typically low when this is due to lesions or hyperplasia of the Adrenal cortex and high when it is due to ectopic ACTH production or hypersecretion of ACTH by the Pituitary.
h) It can therefore be seen from the report of Ranbaxy which is considered among the world leaders in clinical reference and laboratory analysis that an ACTH level <10 is indicative of hyperplasia of the adrenal gland or the presence of a small tumour in the adrenal gland which can produce high levels of cortisone leading to Cushings syndrome.
i) The complainant was also subjected to MRI of the adrenal which showed a well defined nodule in the left adrenal. However, since no payment was received for the MRI (the complainant being a doctor), the film was not printed and a note of the report / finding alone was made in the progress sheet. This was another test to show that it was involvement of adrenal gland in the case of the complainant and not of the pituitary gland.
j) For further confirmation, the complainant was also put on an overnight dexamethasone suppression test (OND). The cortisol level at 8.00 a.m after the OND was 24.85 mcg/dl. The one mg overnight dexamethasone suppression test is a simple tool for Cushings syndrome with a reported sensitivity of 95 to 98% and specificity of 87%. Dexa has to be administered at night because the secretion rhythm of ACTH reaches its peak at this time. So in patients with hyper cortisolism, morning cortisol levels will be suppressed <5 mg / dL in 98% cases) in contrast to those with hyper cortisolism with a dose > 5 mg/dL. However, the results of the complainant showed non-suppression of cortisol levels suggesting endogenous Cushings syndrome.
k) Therefore, the complainant was also administered low dosage dexamethasone 0.5 mg every 6 hourly for 48 hours. The results of LDD showed 22.33 mg/dl confirming Cushings syndrome. In the circumstances it was not considered necessary to do high dose dexamethasone suppression test (HDD).
l) The second O.P. discussed the CT abdomen and the findings in the MRI Abdomen with the Radiologist and came to the diagnosis that it was an adrenocortical adenoma of the left adrenal and advised that the complainant required an adrenalectomy. In the case of unilateral or bilateral benign tumors of the adrenals, the adrenals should be surgically resected. Laparoscopic adrenalectomy is the procedure of choice.
m) The complainant being a doctor, was thoroughly and well explained with all the test results and she consented to undergo an adrenalectomy. Cardiologists opinion was obtained. Requisite consent for surgical and medical procedures was also obtained and on 18-9-2006 under general anaesthesia, the left adrenal was excised by the 3rd opposite party and the excised adrenal was duly sent for biopsy. The post operative period was uneventful and the complainant was discharged on 21-9-2006 with advice to come for review after a week.
n) The report of the pathologist of the hospital dated 23-9-2006 clearly established a 0.6 cm small nodule with no evidence of malignancy and the impression was Adrenal gland with cortical adenoma left adrenal gland.
o) When the complainant came as advised for her review on 27-9-2006 her histopathological report was discussed. The complainant also had a discussion with the pathologist. Subsequent review on 4-10-2006 showed however that symptoms of Cushings persisted and there was an increase in weight. On 13-11-2006 during subsequent review, her cortisol level was non-suppressed (14 mg/dcl after OND) and in these circumstances, it was suggested that a reassessment of the complainant is to be done to rule out bilateral nodular adrenal disease. However, the complainant did not return for further assessment, investigations or treatment.
10. Points for consideration are:
1. Whether there is negligence or deficiency in service on the part of the opposite parties as alleged in the complaint;
2. To what relief the complainant is entitled.
11. Point No.1:
The complainant filed her proof affidavit and 8 documents were filed and marked as Ex.A1 to A8 on her side. The 1st opposite party filed proof affidavit, adopted by opposite parties 2 and 3; and 10 documents were filed and marked as Ex.B1 to B10 on their side.
The Exhibits filed on Complainants side are as follows:
Ex.A1 is the Discharge Summary dated 21-9-2006 issued by the 1st opposite party Hospital Ex.A2 is the Discharge Summary dated 21-12-2006 issued by CMC Hospital, Vellore Ex.A3 is the Discharge Summary dated 03-02-2007 issued by CMC Hospital, Vellore Ex.A4 is the Review Summary dated 12-07-2007 issued by CMC Hospital, Vellore Ex.A5 is the Letter dated 08-01-2007 sent by the complainant to the opposite parties 1 & 2.
Ex.A6 is the Postal Acknowledgement Cards dated Nil.
Ex.A7 is the Medical bills dated NIL from Kovai Medical Centre Ex.A8 is the Medical bills dated NIL from CMC Hospital, Vellore The Exhibits filed on Opposite Parties side are as follows:
Ex.B1 is the copy of Referral letter dated NIL of Sri Ramakrishna Institute of Oncology and Research, referring the complainant for further management Ex.B2 is the Copy of History & Physical Examination sheet of the complainant issued by KMCH Dated 28-08-2006 Ex.B3 is the Copy of test reports of the complainant maintained by the 1st opposite party - Dated 28-08-2006 & 29-08-2006 Ex.B4 is the copy of Laboratory Test Report of SRL Ranbaxy, Mumbai addressed to the 1st opposite party Dt. 1-9-2006 Ex.B5 is the copy of Progress Record dated NIL of the complainant maintained by the 1st opposite party Ex.B6 is the copy of consent for surgical and medical procedures signed by the complainant - dated NIL Ex.B7 is the copy of the operation sheet dated NIL of the complainant.
Ex.B8 is the copy of Pathologist report dated 23-09-2006 of 1st opposite party hospital Ex.B9 is the copy of report dated 22-09-2006 specifying that the cortisol level was non-suppressed for the complainant.
Ex.B10 is the copy of Discharge summary dated 21-09-2006 of the complainant.
12. The complainant has filed the complaint against the opposite parties claiming compensation from the opposite parties for the medical negligence and deficiency in service on their part in diagnosing and treating the complainant in their hospital resulting in unwarranted excision of her left adrenal gland.
13. The opposite parties first contention is that the complaint is bad for non-joinder of proper and necessary parties and the complaint is liable to be dismissed on this ground. According to the opposite parties, the complainant ought to have impleaded M/s Ramakrishna Centre for Imaging Sciences, M/s SRL Ranbaxy Clinical Laboratories and the Christian Medical College Hospital, (CMCH) Vellore for proper and complete adjudication of the case.
14. It is pertinent to note that the complainant has been referred to the opposite party hospital by the Ramakrishna Centre for Imaging Sciences. The Plasma of the complainant was sent to SRL Ranbaxy Clinical Reference Laboratories, Mumbai for testing and report. The complainant approached the Christian Medical Centre Hospital for second opinion and further treatment and she has been successfully treated in that hospital.
15. It is relevant to note that the complaint is filed against the opposite parties attributing negligence and deficiency in service on their part in wrong diagnosis and wrong treatment in consequence of which the left Adrenal gland was unnecessarily removed by surgery by the opposite parties. In the backdrop of events, Shri Ramakrishna Centre for Medical Sciences has only referred the complainant to the opposite parties and the SRL Ranbaxy tested her Plasma and sent the Plasma report and in the Christian Medical College Hospital the complainant had her subsequent proper treatment; and all of them are not at all necessary parties for proper adjudication against the opposite parties; and therefore the contention of the opposite party that the complainant is liable to be dismissed on the ground of non-joinder of proper and necessary proposed parties, is untenable and we hold that the complaint is sustainable without impleading or bringing the above proposed parties on record.
16. It is significant to note that it is admitted in the version of the opposite parties that, the subsequent review on 4-10-2006 showed that symptoms of Cushings persisted and there was increase in weight; and on 13-11-2006 during the subsequent review, her cortisole level was non-suppressed and in these circumstances, it was suggested that reassessment of the complainants problem has to be done to rule out bilateral nodular Adrenal disease; but the complainant did not return for further assessment, investigation and treatment. This would go to show that the problem of the complainant was wrongly diagnosed and wrong treatment was given to her and in that process her left Adrenal gland was unnecessarily removed surgically.
17. It is further relevant to note that at least after the wrong diagnosis and wrong surgery, the opposite parties ought to have been more diligent and more careful in reassessing the problem; but instead of that the opposite parties have suggested removal of the right Adrenal gland also and the complainant had providential escape by not consenting to the second surgery and she rushed to CMC, Vellore for further treatment where her problem was correctly diagnosed and proper treatment was given and she got relieved of her medical problems..
18. It is further pertinent to note that there is no medical experts evidence or opinion on record to establish the contention of the complaint that there was negligence and deficiency in service on the part of the opposite parties in wrong diagnosis and faulty removal of her left Adrenal gland; and further advice the complainant to undergo further surgery to remove the right Adrenal gland also. Therefore, we have to decide the issues considering the available evidence on record.
19. Admittedly, there is no experts evidence or opinion placed before us to decide the issue but we feel that in the instant case, there is no need for an experts opinion and we need not go in search of experts evidence when it is patently evident that there has been negligence and deficiency in service on the part of the opposite parties in diagnosing and treating the complainant based on the doctrine of res ipsa loquitur. relying on the following decisions of Honble Supreme Court in the case of:
V. Krishna Rao v. Nikhil Super Speciality Hospital & Anr. III-(2010)-CPJ-I-(SC) In the opinion of this Court, before forming an opinion that expert evidence is necessary, the Fora under the Act must come to a conclusion that the case is complicated enough to require the opinion of an expert or that the facts of the case are such that it cannot be resolved by the members of the Fora without the assistance of expert opinion. This Court makes it clear that in these matters no mechanical approach can be followed by these Fora. Each case has to be judged on its own facts. If a decision is taken that in all cases medical negligence has to be proved on the basis of expert evidence, in that event the efficacy of the remedy provided under this Act will be unnecessarily burdened and in many cases such remedy would be illusory. ( Para
13) In a case where negligence is evident, the principle of res ipsa loquitur operates and the complainant does not have to prove anything as the thing (res) proves itself. In such a case it is for the respondent to prove that he has taken care and done his duty to repel the charge of negligence. ( Para 47) Jacob Mathew v. State of Punjab & anr.
2005 (6) Supreme Court cases.
Res ipsa Loquitur is a rule of evidence which in reality belongs to the Law of Tort. Inference as to negligence may be drawn from proved circumstances by applying the rule.
(Page 22) Res Ipsa loquitur is a rule of evidence and operates in the domain of civil law, especially in cases of torts and helps in determining the onus of proof in actions relating to negligence.
(Page 34)
20. It is well settled law that when the complainant has established her case, the onus shifts to the opposite party to rebut it and prove that there was no negligence on their part; but no rebuttal evidence is adduced by the opposite parties in this regard. We place reliance on the following decision of the Honble Supreme Court where it is ruled as follows: (at Para No.32) Nizam Institute of Medical Sciences vs. Prasanth S. Dhananka and Others reported in 2009-INDLAW-SC 1047 In a case involving medical negligence, once the initial burden has been discharged by the complainant by making out a case of negligence on the part of the hospital or the doctor concerned, the onus then shifts on to the hospital or to the attending doctors and it is for the hospital to satisfy the Court that there was no lack of care or diligence.
21. We have to note that the complainants problem has been wrongly diagnosed as Cushings syndrome instead of Cushings disease. On perusal of the discharge certificate and allied records, we find that the complainant had been suffering from Cushings disease and not Cushings syndrome, but the opposite parties have wrongly diagnosed as Cushings syndrome and have given wrong treatment and performed an unwanted surgery viz. surgical excision of left adrenal gland and again she was wrongly advised to get ready for further surgery for removal of right adrenal gland also.
22. We have to note that the complainants case has been properly and correctly diagnosed at CMCH Vellore as Cushings disease and not Cushings syndrome and proper treatment has been given and the complainants physical problems were resolved and she got proper relief.
23. The very fact that her problem was wrongly diagnosed as Cushings syndrome instead of Cushings disease which led to the unnecessary surgery and the resultant unfortunate loss of a vital part of the body viz. left Adrenal gland, goes to establish the gross negligence and deficiency in service on the part of the opposite parties.
24. The following facts contribute to further negligence and deficiency in service on the part of the opposite parties.
1. In the referral letter of Shri Ramakrishna Hospital, Ex.B1 addressed to the 2nd opposite party, it is clearly stated that it is a case of Cushings disease as follows:
Herewith referring Dr. Indumathi, 31 years, with features of Cushings disease.
2. In Ex.B3, the history and physical examination of the 1st opposite party (KMCH) of the patient / complainant it is noted as Cushings syndrome in the provisional diagnosis. Therefore it is evident that the 2nd opposite party has made up his mind as Cushings syndrome right from the beginning, totally ignoring the referral letter at the initial stage of provisional diagnosis itself.
3. We have to further note that in Ex.B4 report of the SRL Ranbaxy Clinical Laboratory Report, the sex of the patient is noted as male whereas the patient is a lady, and so the credibility of the report is at stake.
4. It is quite significant to note that in the operation sheet Ex.B7, of the 1st opposite party hospital (KMCH), against the column operation performed it is noted as Laparascopic adrenalectomy for Cushings disease but as seen from records, the operation was performed for Cushings syndrome. Therefore, the entry in the operation report Laparascopic adrenalectomy for Cushings disease is misleading, inconsistent and lacking clarity.
5. In the discharge summary, Ex.B10, the diagnosis is noted as: ACTH INDEPENDENT CUSHINGS SYNDROME ADEROMA LEFT ADRENAL GLAND.
6. In the Discharge Summary, Ex.A3 of CMC-Vellore, the discussion is as follows: Dr. Indumathi was admitted with clinical and biochemical features suggesting of Cushings disease. She had been diagnosed elsewhere to have Cushings syndrome and had undergone Laparoscopy left Adrenalectomy on 18th Sep 2006. As there was no improvement in her clinical condition, she was evaluated and was diagnosed to have Pituitary micro Adenoma. She underwent Transsphenoidal Radical excision of Pituitary micro Adenoma under general anesthesia on 23-1-2007.
7. Further in Ex.A4, which is the medical report of CMC, Vellore in the history column, it is mentioned as follows: Dr. Indumathi reviewed in Endocrinology OPD on 12-7-2007 with Cushings disease inadvertently, had adrenalectomy at Coimbatore, was found to have Pituitary ACTH secreting micro Adenoma at CMC, Vellore and underwent TSS on 23-1-2007.
25. The Chief Consultant who has signed the medical report Ex.A4, is found from records, to be a highly qualified person in medical field and an expert in Endocrinology, possessing M.D., Ph.D. (Endo), F.R.C.P. (Edin.) degrees and he is the Professor and Head of the Department of Endocrinology, Diabetes & Metabolism, CMC, Vellore and his findings and observations in Ex.A4 deserve due regard and Ex.A4 is worthy of due consideration.
26. The complainant cited the following decisions of Honble National Commission dwelling on Medical Opinion / medical evidence, the doctrine of res ipsa loquitur; etc.
1) i. M/s Nanjappa Hospital ii. Dr. Vani Kori vs. Smt. P.S. Shylaja (R.P. No.2940/2006 / National Commission, dt. 5-7-2011)
2) Dr. Kapildas Singh v. Sagina Khatoon.
R.P. No.3330 / 2008 National Commission, dt. 6-7-2011)
27. The opposite parties have submitted the following decision of Honble National Commission elaborately dwelling on Medical Negligence and Criminal Negligence Kusum Sharma v. Batra Hospital (2010) 3 Supreme Court cases - 480
28. Considering all these, we find that the wrong diagnosis of the Complainants complaint as Cushings syndrome instead of Cushings disease which is the correct one, is the root cause of all the problems and in the facts and circumstances of the case, and from the process of diagnosis, treatment, surgery and review, it is quite evident and well established that, had the opposite parties been more diligent and acted with reasonable care, caution and seriousness expected of skilled doctors, they could have certainly diagnosed the case correctly as Cushings disease and could not have resorted to unwarranted surgery adrenalectomy, surgically removing a precious, healthy organ of the body left adrenal gland which is a wrong procedure and an unnecessary and faulty one and again faulting in the review of the case and again negligently deciding that the further course of treatment would be excision of the remaining right adrenal gland and could have avoided the various erroneous and negligent commissions and omissions as stated supra. The opposite parties have been remiss in rendering service to the complainant and the complainants allegation that there is negligence and deficiency in service on the part of the opposite parties, is well substantiated.
29. For the aforesaid reasons, we hold that there is negligence and deficiency in service on the part of the opposite parties 1 to 3 and the point is answered accordingly.
30. Point No.2:
As regards the quantum of compensation, we have to consider the factors that the complainant is a lady Doctor / Ophthalmologist, aged
31 years, who has lost her normal and healthy Adrenal Gland due to the negligence of the opposite parties and that she has to suffer the consequences and the after-effects of loss of the organs functions throughout her life, loss of professional income, monetary loss, mental agony and psychological afflictions and she is entitled to proper, adequate and reasonable compensation; and the point is answered accordingly.
31. The complainant has claimed a sum of Rs.35 Lac as total compensation. We feel that the compensation claimed is very much on the higher side. The complainant has produced medical bills and hospital receipts for nearly Rs.2,94,000/- and she has stated that she had incurred expenses to the tune of nearly Rs.5 Lac towards medical bills, and travelling expenses.
32. Having regard to all the relevant factors as stated supra, we feel that a sum of Rs.4 Lac towards medical and travelling expenses; and a sum of Rs.1 Lac towards loss of professional income and monetary loss; and a sum of Rs.10 Lac for lifelong mental agony. Thus the total amount of Rs.15 Lac would be the just, appropriate and reasonable compensation.
33. In the result, the complaint is allowed in part directing the opposite parties 1 to 3 jointly and severally to pay a sum of Rs.15 Lac (Rupee Fifteen Lac only) to the complainant as total compensation. The opposite parties shall pay costs of Rs.10,000/- (Rupees Ten Thousand only) to the complainant. Time for compliance:
two months from the date of receipt of copy of this order.
(J. JAYARAM) (R. REGUPATHI) JUDICIAL MEMBER PRESIDENT Exhibits filed on Complainants side:
Ex.A1 21-09-2006 Discharge Summary issued by the 1st opposite party Hospital Ex.A2 21-12-2006 Discharge Summary issued by CMC Hospital, Vellore Ex.A3 03-02-2007 Discharge Summary issued by CMC Hospital, Vellore Ex.A4 12-07-2007 Review Summary issued by CMC Hospital, Vellore Ex.A5 08-01-2007 Letter sent by the complainant to the opposite parties 1 & 2.
Ex.A6 Postal Acknowledgement Cards dated Nil.
Ex.A7 Medical bills dated NIL from Kovai Medical Centre Ex.A8 Medical bills dated NIL from CMC Hospital, Vellore Exhibits filed on Opposite Parties side:
Ex.B1 Copy of Referral letter of Sri Ramakrishna Institute of Oncology and Research, referring the complainant for further management Ex.B2 28-08-2006 Copy of History & Physical Examination sheet of the complainant issued by KMCH Ex.B3 28-08-2006 Copy of test reports of the complainant maintained &29-08-2006 by the 1st opposite party Ex.B4 01-09-2006 Copy of Laboratory Test Report of SRL Ranbaxy, Mumbai addressed to the 1st opposite party Ex.B5 copy of Progress Record of the complainant maintained by the 1st opposite party Ex.B6 Copy of consent for surgical and medical procedures signed by the complainant Ex.B7 Copy of the operation sheet of the complainant.
Ex.B8 23-09-2006 Copy of Pathologist report of 1st opposite party hospital Ex.B9 22-09-2006 Copy of report specifying that the cortisol level was non-suppressed for the complainant.
Ex.B10 21-09-2006 Copy of Discharge summary of the complainant.
(J. JAYARAM) (R. REGUPATHI) JUDICIAL MEMBER PRESIDENT