State Consumer Disputes Redressal Commission
Aakula Yelagonda vs 1.Malla Reddy Hospital, on 2 June, 2023
1
BEFORE THE TELANGANA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION :: HYDERABAD.
(ADDITION AL BENCH)
CC 172/2017
Between:
Aakula Yelagonda,
S/o.Sayanna,
Aged about 40 years,
Occ: Driver and Agriculture,
R/o.H.No.2-52/B, Pothanshetpally village,
Kolcharam Mandal,
Medak District. ....Complainant
And
1.Malla Reddy Hospital, Sy.No.138, Suraram Main Road, GHMC Quthbullapur, Hyderabad-55, Represented by its CEO Sri Dr.Sreedhar Reddy Suranasi
2. Dr.Shukla Renu Ramesh, D/o.Ramesh Shukla, Age : 36 years, Occ:Opthalmologist and Asst.Professor at Malla Reddy Hospital, Suraram, R/o.H.No.7-1-215/C/B/1/B, Dubey Nivas, Balkampet, SR Nagar, Hyderabad. ... Opposite parties Counsel for the Complainant : M/s.K.Subhash Chandra Goud.
. Mr.N.Janaiah.
Counsel for the Opposite Parties : M/s.K.Vishweshwar Reddy
-
QUORUM: HON'BLE, SRI V.V.SESHUBABU MEMBER - (J) & HON'BLE SMT R.S. RAJESHREE, M EMBER - (NJ) FRIDAY, THE SECOND DAY OF JUNE, TW O THOUSAND TWENTY THREE.
******* Order :(Per Hon'ble Sri V.V.Seshubabu, M ember-Judicial.)
01). The complaint is filed u/s.17(1)(a)(i) of the Consumer Protection Act on 24.7.2017 seeking direction against opposite parties 1 & 2, to pay compensation of Rs.20 lakhs for the loss of eye vision, to pay un-liquidated damages at Rs.20 lakhs and to pay interest on the entire Rs.40 lakhs with 18% p.a. from the date of complaint till the date of realization, besides costs.
202). The brief averments of the complaint are that opposite party no.1 is a hospital and opposite party no.2 is an Opthalmologist and working as Asst. Professor in the opposite party no.1 hospital; that the complainant is resident of Pothanshetpally of Kulcharam Mandal and on 19.4.2017 with a complaint of stomach ache went in a shuttle van to Narayana Hospital at Sooraram and as there was nobody to consult for stomach ache , was returning home and met opposite party no.2 on the way who advised him to get eyes checked up and thereafter, advised him go for cataract surgery on the left eye; that on 25.4.2017, as per the advise of opposite party no.2, he undergone blood test and sugar test and got admitted himself in the opposite party no.1 hospital on 26.4.2017; that the complainant paid Rs.5000/- as an advance and obtained receipt; that on 29.4.2017 cataract surgery was performed on his left eye, but vision was lost completely; that opposite party no.2 and other doctors advised the complainant to wait some more days for vision and discharged; that as there was no vision, he was referred to Win Vision Eye Hospital, Begumpet, Hyderabad by the opposite party no.2 recording the reasons; that Dr.Sri Hari Narayana tested the complainant's left eye and instructed to give samples and after collecting the same on 4.5.2017 went to GHR Micro Diagnostics which opined that complainant permanently lost the vision in the left eye and there are no chances to retrieve the same; that this all happened due to the negligence of opposite party no.2; that the complainant for second opinion went to L.V.Prasad Eye Institute at Hyderabad, where he was examined by Dr.Mukesh Taneja and Dr.Divya Balakrishna who stated that he lost inner and outer retinal, due to Toxic Retinopathy due to the negligence and careless operation conducted by opposite party no.2; that the complainant is suffering with severe headache and unable to do any job; that he was a driver working in Venkateswara Water Suppliers, Subash Nagar, Jeedimetla and earning Rs.15,000/- per month besides daily batta and also owner of a tractor purchased under finance to earn the money in agricultural season thereby was earning Rs.20,000/- per month; that due to loss of vision in the left eye, unable to attend the driver job; that he incurred Rs.1 lakh towards treatment, consultation and transportation; that opposite parties 1 & 2 are 3 jointly and severally liable to pay the compensation; hence, the complaint.
03). The brief averments of written version of opposite parties 1 & 2 are that the complaint is not maintainable either on facts or under law; that the complainant is put to strict proof of all the averments made in the complaint except those that are admitted; that the complaint is devoid of merits and it is vexatious in nature, filed mischievously to extract money; that as per the practice, when the complainant came to opposite party no.1 hospital he was randomly referred to opposite party no.2; that surgery that was performed on 28.4.2017 was uneventful; that first post operative day vision recorded at 6/12 - 6/9 which is good in all respects and so, was discharged; that opposite party no.2 not seen the patient on 2.5.2017 and he was seen by out patient doctor with a suspicion of endophthalmitis and so, was referred to retina specialist at Win Vision Hospital, due to the absence of retina consultant in the opposite party no.1 hospital; that Dr.Hari Narayana never mentioned that complainant permanently lost the vision and he had given intravitreal injections twice to the complainant and controlled the infection; that Dr.Hari Narayna never sent complainant to L.V.Prasad Eye Institute; that the complanant not went for follow up treatment to Dr.Hari Narayana and voluntarily went to L.V.Prasad Eye Institute; that there was no negligence on the part of opposite party no.2 at all; that complainant can do some job as the vision of left eye is 6/36 -6/24 which is not a blind eye at all; that toxic retinopathy can never be attributed to opposite party no.2; that the claim amount is excessive; that complainant shall prove his income; that as the pre-operative vision to the left eye is 3/60 and as per L.V.Prasad Eye Institute it was recorded at 6/24 P(20/100) which is not complete blindness and better than the earlier vision; that to consider a person as blind, the visual acuity must be 20/200. With this, requested to dismiss the complaint.
04). To prove the case, complainant filed evidence affidavit as PW.1 and got marked Exs.A1 to A11 and he was subjected to cross examination. Dr.Renu Shukla/opposite party no.2 filed evidence affidavit as RW.1 on behalf of the opposite parties 1 & 2 and got 4 marked Exs.B1 to B3 and she was subjected to cross examination. Both sides filed written arguments besides submitted oral arguments.
05). Now the points for determination are :
i. Whether there is deficiency in service on the part
of opposite parties 1 & 2 ?
ii. Whether complainant is entitled for the amounts
as claimed ?
iii. Relief?
06). Points i & ii : Ex.A1 is the Discharge Summary issued
by RW.1 and it shows cataract operation was performed to the left eye on 28.4.2017 when the date of admission was on 26.4.2017. Condition at the time of discharge was at 6/12 - 6/9, discharged on 29.4.2017 with an instruction to come for review on 5.5.2017. Treatment was given is mentioned as LE - Phacoends... Ex.A2 is the OP sheet dated 19.4.2017, lab tests like HIV, RBS, HBs Ag. Spot, HCV ELISA etc., were done on PW.1 and they are in normal range. PW.1 who went to the out-patient department of opposite party no.1 hospital on 2.5.2017 wherein her vision was recorded as 6/18 - C PH 6/9 Defective vision LE - POD -4 . On examination carnia noted raze; LE ? - Endophthalmitis - referred to VR Surgeon, Win Vision Hospitals . Ex.A3 are the bills showing the payments made by PW.1 in the opposite party no.1 hospital to the tune of Rs.5,550/- as an advance and purchased medicines worth Rs.63/-.
07). Ex.A4 goes to show that the doctor at Win Vision Hospital on 5.5.2017 noted that S/P 2 I/Vet injections - no hypopyed - cells - IOL insitu - Fibrin + refractive - fundus details seen- macula- ok. Prescribed medicines and come for review tomorrow at 4 p.m. On 6.5.2017, PW.1 again went there and doctor noted that the macula shows white deposits and made some notings. On 12.5.2017 and 5.6.2017, PW.1 went to Win Vision Hospital. On 12.5.2017 it is noted ischemic - macula - fundus photo- for documentation. On 5.6.2017 it is noted that Reteroscopy refraction and its readings are noted.
508). Ex.A7 to A9 shows that PW.1 went to L.V.Prasad Eye Institute. Ex.A8 is the report. It is noted therein that PW.1 underwent surgery of PHACO + PCIOL under LA in the left eye on 28.4.2017 at Mallareddy Hospital. Postoperative day vision not appreciated and treated with medication therapy. Post operative day 4th -Hyphema and Corneal Edema noted, diagnosed as post endopthalmitis and referred to higher centre for further management - CRx 1 Predfort Eye Drops 3 times in the left eye. It is further mentioned that on examination 1). OS marked foveal atrophy with decreased foveal thickness in OCT, 2). marked Arteriolar attenuation with hemorrhages above disc - 3). advised retina consult for the same, 4).OD visually significant cataract - to plan for cataract surgery subsequently, and 5).Condition explained and management discussed with the patient . It is also noted that OCTA shows inner and outer retinal loss S/O toxic retinopathy - unlikely to improve - GVP explained. Condition explained and management discussed with the patient. Nothing is mentioned by the L.V.Prasad Institute or Win Vision Eye Hospital that due to the mishandling of the cataract operation, the problems cropped up like Endophthalmitis .
09). Inspite of the cross examination of RW.1 nothing worth while elicited that she conducted the operation negligently. Except making suggestions that the operation was conducted negligently, it is not mentioned on what aspects the operation was done negligently. No expert is examined by complainant to establish that RW.1 conducted the operation negligently. PW.1 is only a driver and an agriculturist. Therefore, we cannot expect any medical knowledge to PW.1. After 2.5.2017, PW.1 never went to opposite party no.1 hospital and the same is admitted in the cross examination. Opposite party counsel filed medical literature under the head, Prevention, Diagnosis and Management of Acute Postoperative Bacterial Endophthalmitis. In the conclusion paragraph, it is noted that because of the potentially devastating complications of post surgical endophthalmitis, infection prophylaxis, diagnosis and treatment have been the subject of ongoing research and debate. Although it is fortunate that post surgical endophthalmitis is rare, the low incidence also makes it virtually impossible to perform enough prospective randomized 6 clinical trials to determine the most effective means of prophylaxis. Ophthalmologists must therefore exercise clinical judgment based on the best available published evidence. Basing on the above literature it is submitted that Endophthalmitis would occur only post operatively and mainly due to bacteria and also due to eye trauma or as a result of keratomycosis and it is usually exogenous in nature after eye surgery. For this RW.1 is not at all responsible and cannot made liable to pay any compensation.
10). The complainant counsel relied upon a case decided by the State Consumer Disputes Redressal Commission, Andaman and Nicobar Islands between Alagiri vs. Dr.Rohindra Lall dt.9.8.2017. We have minutely gone through the said case and we are of the view that it discussed several aspects relating to the cataract eye surgery including the preoperative, operative and post operative precautions for intraocular eye surgery. In the said case also after IOL to the left eye, the complainant suffered post operative endophthalmitis. It is observed that the doctor who was performing surgery should diagnose a). the type of cataract and surgical procedure to be performed; b)ocular examination of both eyes to rule out any septic foci and to give opinion regarding success of surgery; c). complete physical examination to be done to rule out systemic illness like diabetes, hypertension, cardiovascular complication, chronic obstructive pulmonary diseases and renal diseases; d) complete blood investigation including blood sugar, urine examination, blood pressure, ECG etc.; e). keratometry, biometry to calculate accurate IOL power. Many of the tests underlined as above by us are not performed on PW.1. Nowhere it is mentioned the details of the lens that planted/inserted in the eye was given besides its date of manufacture, date of expiry and the name of the company etc,. If the lens is not of good quality or suitable to the patient, there is a possibility to cause/occur Endophthalmitis .
11). Medical literature goes to show that to prevent Endophthalmitis in cataract surgeries, some of the following aspects to be observed: i) in addition to the use of povidone iodine 5% solution in the conjunctival sac, few minutes prior to surgery, proper construction of wound, injectable intraocular lenses, use of 7 prophylactic intra cameral antibiotics or prophylactic sub conjunctival antibiotic injection at the conclusion of cataract surgery are to be done. All these aspects are not mentioned in Ex.A1 and A2. Therefore, one cannot say that, RW.1 followed all the protocols to perform the PHACO + PCIOL under LA in the left eye on 28.4.2017. Therefore, we are of the view that the omissions and commissions on the part of RW.1 can be considered as deficiency in service.
12). Ex.A7 not given any conclusive proof that PW.1's left eye vision lost completely 100% . RW.1 categorically stated that PW.1 can attend his activities without support of anybody with the readings - 20/100 or 6/24 P (20/100) is not a total blindness. PW.1 not obtained any physical disability certificate from the Government authorities regarding the percentage of vision in the left eye. No Pattadar Passbook is filed; so also the Registration Certificate of Tractor is filed to show that, he owns lands and tractor, thereby earning money as alleged.
13). In the case on hand, the complainant said to have incurred Rs.1 lakh towards treatment, regular consultation, transportation and for loss of earnings during the period of treatment. Therefore, we are of the view that awarding Rs.1 lakh will meet the ends of justice besides compensation of Rs.3,00,000/-. So, points are answered accordingly.
14). In the result, complaint is partly allowed against opposite parties 1 & 2 with joint and several liability to pay altogether Rs.4 lakhs with interest at 9% p.a. from the date of complaint till the date of realization. Further the opposite parties are directed to pay costs of Rs.20,000/- Time for compliance is one month.
Typed to dictation on system, corrected and pronounced by us in the open Court on this 2nd day of June,2023.
MEMBER (M ) MEMBER (NJ)
-------------------------------------------------------
Dated : 2.6.2023 8 APPENDIX OF EVIDENCE W itnesses Examined For the complainant For the opposite parties Evidence aff. of the complainant Chief evidence aff. of filed as PW.1 opp.party no.2 filed as RW.1.
Complainant and opp.party no.2 were cross examined as PW.1 and RW.1 respectively and Advocate Commissioner's Reports filed.
Exhibits marked on behalf of the complainant:
Ex.A1 : Original Discharge Summary dt.29.4.2017 of Complainant issued by opposite parties. Ex.A2 : Original Medical Prescriptions dt.19.4.2017 & 2.5.2017 and Lab/Test Reports of complainant issued on behalf of complainant by opp.parties.
ExA3 : Photostat copies of Medical Bills issued by Opposite party on behalf of complainant.
Ex.A4 : Original medical prescriptions and medical bills issued by Win Vision Hospital on behalf of complainant.
Ex.A5 : Original medical bills issued by Win Vision Hospital on behalf of complainant.
Ex.A6 : Original bill dt.4.5.2917 issued by GHR Micro Diagnostics on behalf of the complainant along with payment details receipts.
Ex.A7 : Photostat copy of Bill cum Receipts dt.21.6.2017 issued by L.V.Prasad Eye Institute.
Ex.A8: Photostat copy of Medical Report dt.21.6.2017 issued by issued by L.V.Prasad Eye Institute on behalf of complainant.
Ex.A9 : Photostat copies of Ultra Sonography report of Complanant issued by issued by L.V.Prasad Eye Institute.
Ex.A10 : Photostat copy of Certificate issued by Venkateshwara Water Suppliers certifying that the complainant worked in their company. Ex.A11 : Photostat copy of Driving license of complainant Exhibits marked on behalf of opposite parties:
Ex.B1 : Medical literature with regard to Drug Induced Maculopathy Ex.B2 : Medical literature - {arson's diseases of the eye 22nd edition.
Ex.B3 : Medical literature - Prevention, diagnosis and management of acute postoperative bacterial endophthalmitis.
MEMBER (M ) MEMBER (NJ)
-------------------------------------------------------
Dated : 2.6.2023