State Consumer Disputes Redressal Commission
1. Smt.Kanneboina Seshamma And Others vs Kinnera Superspecialty Hospital, Wyra ... on 29 October, 2012
BEFORE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD F.A.No.268 OF 2011 AGAINST C.C.NO.456 OF 2007 DISTRICT FORUM KHAMMAM Between: 1. Smt.Kanneboina Seshamma, w/o.Venkateswarlu, age: 50 years, occu: Housewife, 2. Kanneboina Venkateswarlu, s/o.late Kotaiah, age: 53 years, occu: Agriculture, Both are R/o.H.No.5-2-246/B2/B, Mustafanagar, Khammam town, Khammam District. 3. Kanneboina Himabindu, w/o. late K.Rambabu, age: 25 years, occu: Housewife, C/o.Sadam Itam Raju, near Old Court building, Kodada post & Mandal, Nalgonda District, Appellants/complainants A N D 1. Kinnera Superspecialty Hospital, Wyra Road, Khammam, rep. by its Managing Director, Dr.Chigurupati Maheedar. 2. Dr.Chigurupati Maheedar, S/o.Seshagiri Rao, age: 40 years, occu: Managing Director, Kinnera Super specialty Hospital, Wyra Road, Khammam. 3. Dr.Boppanna Durga Suresh, S/o.Satyanarayana, age: 39 years, Occu: General Surgeon, Kinnera Super Specialty Hospital, Wyra Road, Khammam. 4. Dr.Racharal Arun Kumar, S/o. Narsaiah, age: 34 years, occu: Homeopathic Physician and Duty Doctor in Kinnera Super specialty Hospital, Wyra Road, Khammam Respondents/opposite parties Counsel for the Appellant M/s S.N.Sastry Counsel for the Respondent M/s G.L.Narasimha Rao QUORUM: SRI R.LAKSHMINARASIMHA RAO, HONBLE MEMBER
AND SRI THOTA ASHOK KUMAR, HONBLE MEMBER MONDAY THE TWENTY NINETH DAY OF OCTOBER TWO THOUSAND TWELVE Oral Order (As per Sri R.Lakshminarasimha Rao, Honble Member) ***
1. The unsuccessful complainants are the appellants. They filed complaint with the averments that the husband of first appellant was a technician, organ player and musician with M/s Anna Audio Lab Hyderabad and used to earn a sum of `20,000/- per month. He visited Khammam, his native place on 8.11.2004 and developed stomach-ache and he was taken to the respondent no.1 hospital where he was admitted and initially diagnosed with suffering from acute pancreatitis. The respondents advised for ultrasound scan of abdomen which indicated pancreatic outline. Serum analysis test was carried out on 8.11.2004 which revealed abnormal level. Initially, the fourth respondent had examined the first appellants husband.
2. The appellants have contended that the fourth respondent is not a qualified doctor and the third respondent failed to carry out required diagnostic tests and allowed the fourth respondent to monitor the condition of the patient and that they resorted to manipulate the medical records and fabricated two different case sheets. It is contended that the preserved part of pancreas was forwarded to Forensic Professor, Siddhartha Medical College, Vijayawada who opined that the death of the patient was caused by pancreatic shock and cardiac arrest.
3. It is contended that the appellants lodged complaint with the police, Khammam I Town against the respondents no.2 to 4 who were arrested and charge-sheet was filed against them in the court. It is submitted that the first respondent-hospital is ill-equipped and the respondents ought to have preferred the patient to a higher centre. The first respondents husband died at very young age of 24 years due to the negligence of the respondents.
4. The respondents resisted the case contending that the husband of the first appellant was admitted in causality of the respondent no.1 hospital by the respondent no.2 at 2.00 p.m. on 8.11.2004 and he was advised for tests such as blood test, ultrasound scanning which revealed serum amylase in abnormal level and the other tests like blood glucose, serum calcium, sodium, potassium tests, kidney function test and cardiac test were done because of acute pancreatitis.
5. The respondents found necessity to stop giving food by mouth and they stated that they had given fluids such as ringer lactate, DNS. The third respondent has treated the patient till the death of the patient at 7.45 a.m. on 10.11.2004. On 9.11.2004 the patient was shifted to normal room as the second appellant expressed their inability to afford the expenses towards room charges.
Pantoprozole was administered and pain killers were given and the patient was put on sedation. The patient went to bathroom and collapsed there and he was brought back to ICU. Immediate steps were taken and to prevent further deterioration of the patients health, all required treatment was administered to him. The patient died within 1 days from the date of his hospitalisation.
6. It is contended that the report of post-mortem examination, the report of FSL confirmed that the patient died due to acute pancreatitis. The original case sheet was taken by the police and the case sheet filed by the appellants would show that the third respondent and not the fourth respondent attended the patient. A political party motivated in denigrating the first respondent hospital and its doctor for its own reasons and the complaint was filed at behest of the leaders of the political party. The fourth respondent is a qualified homeo doctor and he has been attending to the duties assigned to him. The patient was a chronic alcoholic and he suffered from acute pancreatis. It is contended that there was no deficiency in service on the part of the respondents.
7. On behalf of the appellants the second appellant was examined as PW1 and Dr.Ajit Kumar, gastroenterologist was examined as PW2. Exs.A1 to A11 had been marked. On behalf of the respondents the third respondent was examined as RwW1 and got marked Exs.B1 and B2.
8. The District Forum has dismissed the complaint on the premise that the appellants failed to establish any deficiency in service in treating the patient who was suffering from acute pancreatitis.
9. Aggrieved by the order of the District Forum, the complainants have filed appeal contending that the respondents failed to provide treatment which was urgently requires and the treatment to save the life of the patient.
The District Forum ought to have drawn adverse inference against the respondents for not filing the case sheet.
10. The points for consideration are:
1.
Whether there was any deficiency in service on the part of the respondents in administering treatment to the appellant?
2. To what relief?
11. POINT No.1 The first appellants husband was taken to the first respondent hospital on 8.11.2004 with the complaint of severe stomach pain. The second respondent attended on him and advised for tests such as ultrasound scan of abdomen and CBP. Ultrasound scan revealed the impression that there were moderate fatty changes in the liver and pancreatic outline were not clearly visualised. Besides the blood test and ultrasound scan, other tests such as urine test, Liver Function Test were conducted on 8.11.2004 at the first respondent hospital. The clinical pathology report issued by the first respondents- hospital would show no abnormality in values. The second and third respondents on making clinical correlation of the test values of pathological tests of the patient, diagnosed him with suffering from acute pancreatitis.
12. The appellants contended that the respondents ought to have advised for CT Scan of the abdomen of the patient when the ultrasound scan had shown no definite outline of the pancreas. The respondents had submitted that they did not consider it necessary as they came to the conclusion even without going for CT Scan and the diagnoses made by them that the patient was suffering from acute pancreatitis is not rebutted nor proved contra by the appellants and that the cause of death of the patient as for the reports of the FSL, PM examination would support their contention that the patient suffered from acute pancreatitis.
13. The appellants examined Dr.Ajit Kumar, Gastroenterologist as PW2 and his evidence was relied upon by the appellants as also the respondents. The respondents submitted that PW2 has nowhere stated that their treatment of the patient fell short of standard prescribed by the protocol. PW2 has stated that he is working as Gastroenterologist with NIMS since 1991 and he had gone through the medical record of the patient. He has stated that the first respondent hospital has not maintained time and date and the medical record would show that the patient was diagnosed with suffering from acute pancreatitis. He has stated that:
the tests results available on record they suggest that the diagnosis of acute pancreatitis. The treatment for acute pancreatitis given was appropriate and patient was doing well till the morning of 10th November 2004. When he had sudden cardiac arrest and died at 7.45 a.m. on the same day despite the resuscitation provided to the patient. Since the previous ECG and other records do not suggest andy previous cardiac disease, so it is more likely that the patient had fatal cardiac arrest, which can occur in patients of acute pancreatitis.
14. The evidence of the doctor who was examined on the side of the appellant had not supported their case that the respondents no.2 to 4 were negligent and rendered deficient service while treating the husband of the first appellant who was suffering from acute pancreatitis. It is the consistent version of the appellants that the respondent no.1- hospital is ill-equipped and it ought to have referred the patient to higher centre as it was not having the sophisticated machinery for treating the patient who was in serious condition and fighting for life. The first respondent would state that the patient was admitted into acute medical care unit and all the required tests, blood glucose, WBC counter, differential counter, Serum calcium, sodium, potassium, Kidney Function Tests, Liver Function Test, Cardiac Tests were conducted.
15. The literature on pancreatitis would show that pancreatitis is inflammation of the pancreas. The diagnosis and treatment as also complications thereof are mentioned as under:
Diagnosis While asking about a persons medical history and conducting a thorough physical examination, the doctor will order a blood test to assist in the diagnosis. During acute pancreatitis, the blood contains at least three times the normal amount of amylase and lipase, digestive enzymes formed in the pancreas.
Changes may also occur in other body chemicals such a glucose, calcium magnesium, sodium, potassium and bicarbonate. After the persons condition improves, the levels usually return to normal.
Diagnosing acute pancreatitis is often difficult because of the deep location of the pancreas. The doctor will likely order one or more of the following tests:
Abdominal ultrasound.
Sound waves are sent to toward the pancreas through a handheld device that a technical glides over the abdomen.
The sound waves bounced off the pancreas, gallbladder, liver, and other organs, and their echoes make electrical impulses that create a picture called a sonogram on a video monitor.
If gallstones are causing inflammation, the sound waves will also bounced off them, showing their location.
Computerized tomography (CT) scan.
The CT scan is a noinvasive x ray that produces three-dimensional pictures of parts of the body. The person lies on a table that slides into a donut-shaped machine. The test may show gallstones and the extent of damage to the pancreas.
Endoscopic ultrasound (EUS). After spraying a solution to a numb the patients throat, the doctor inserts an endoscope-a thin, flexible, lighted tube-down the throat, through the stomach, and into the small intestine. The doctor turns on an ultrasound attachment to the scope that produces sound waves to create visual images of the pancreas and bile ducts.
Magnetic resonance cholangiopancreatography (MRCP). MRCP uses magnetic resonance imaging, a noninvasive test that produces cross-section images of parts of the body. After being lightly sedated, the patient lies in a cylinder-like tube for the test.
The technician injects dye into the patients veins that helps show the pancreas, gallbladder, and pancreatic and bile ducts.
Treatment Treatment for acute pancreatitis requires a few days stay in the hospital for intravenous (IV) fluids, antibiotics, and medication to relieve pain. The person cannot eat or drink so the pancreas can rest. If vomiting occurs, a tube may be placed through the nose and in the stomach to remove fluid and air.
Unless complications arise, acute pancreatitis usually resolves in a few days. In severe cases, the person may require nasogastric feeding-a special liquid given in a long, thin tube inserted through the nose and throat and into the stomach-for several weeks while the pancreas heals.
Before leaving the hospital, the person will be advised not to smoke, drink alcoholic beverages, or eat fatty meals. In some cases, the cause of he pancreatitis is clear, but in others, more tests are needed after the person is discharged and the pancreas is healed.
Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) for Acute and Chronic Pancreatitis.
ERCP is a specialised technique used to view the pancreas, gallbladder, and bile ducts and treat complications of acute and chronic pancreatitis-gallstones, narrowing or blockage of the pancreatic duct or bile ducts, leaks in the bile ducts, and pseudo cysts-accumulations of fluid and tissue debris.
Soon after a person is admitted to the hospital with suspected narrowing of the pancreatic duct or bile ducts, a physician with specialized training performs ERCP.
After lightly sedating the patient and giving medication to numb the throat, the doctor inserts an endoscope- a long, flexible, lighted tube with a camera-through the mouth, throat, and stomach into the small intestine. The endoscope is connected to computer and screen. The doctor guides the endoscope and injects a special dye into the pancreatic or bile ducts that helps the pancreas, gallbladder, and bile ducts appear on the screen while x rays are taken.
Complications:
Gallstones that cause acute pancreatitis require surgical removal of the stones and the gallbladder. If the pancreatitis is mild, gallbladder removal-called cholecystectomy-may proceed while the person is in the hospital. If the pancreatitis is severe, gallstones may be removed using therapeutic endoscopic retrograde cholangiopancreatography (ERCP)- a specialized technique used to view the pancreas, gallbladder, and bile ducts and treat complications of acute and chronic pancreatitis. Cholecystecomy is delayed for a month or more to allow for full recovery. For more information, see the Gallstones fact from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) If an infection develops, ERCP or surgery may be needed to drain the infected area, also called an abscess. Exploratory surgery may also be necessary to find the source of any bleeding, to rule out conditions that resemble pancreatitis, or to remove severely damaged pancreatic tissue.
Pseudo cysts-accumulations of fluid and tissue debris-that may develop in the pancreas can be drained using ERCP or EUS. If pseudo cysts were left untreated, enzymes and toxins can enter the bloodstream and affect the heart, lungs, kidneys or other organs.
Acute pancreatitis sometimes causes kidney failure. People with kidney failure need blood-cleansing treatments called dialysis or a kidney transplant.
In rare cases, acute pancreatitis can cause breathing problems. Hypoxia, a condition that occurs when body cells and tissues do not get enough oxygen, can develop. Doctors treat hypoxia by giving oxygen to the patient. Some people still experience lung failure-even with oxygen-and require a respirator for a while to help them breathe.
16. As aforementioned literature would suggest that pancreatitis is inflammation of pancreas and is the result of formation of gallstones in the pancreas and the treatment for acute pancreatitis requires a few days stay in the hospital. The literature would confirm the line of treatment adopted by the respondents.
The appellants have not established any negligence on the part of the respondents. It is essential to refer the decision of the Honble Supreme Court in In C.P.Sreekumar M.S (Ortho) vs S.Ramanujam in CIVIL APPEAL No.6168 OF 2008 decided on 1 May, 2009 It is also relevant that though the respondent had sought the opinion of Dr. Ajit Yadav of the Tamil Nadu Hospitals on 30th May 1992, he produced no evidence to off.set the appellant's evidence as to why he had chosen hemiarthroplasty over internal fixation. It is qually significant that the respondent had taken the advice of several renowned doctors including Dr. Mohan Das and Dr. Nand Kumar, but none of them in their treatment notes observed adversely about the choice of treatment nor any negligence in the actual operation. In the light of the fact that there is some divergence of opinion as to the proper procedure to be adopted, it cannot be said with certainty that the appellant, Dr. Sreekumar was grossly remiss in going in for hemiarthroplasty. In Jacob Mathew case (supra) it has observed as under:
(2) Negligence in the context of the medical profession necessarily calls for a treatment with a difference. To infer rashness or negligence on the part of a professional, in particular a doctor, additional considerations apply. A case of occupational negligence is different from one of professional negligence. A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of a medical professional. So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed;
21. It would, thus, be seen that the appellant's decision in choosing hemiarthroplasty with respect to a patient of 42 years of age was not so palpably erroneous or unacceptable as to dub it as a case of professional negligence
17. The Honble Supreme Court in Kusum Sharma Vs. Batra Hospital & Medical Research Centre reported in (2010) 3 SCC 480 after considering the entire case law on medical negligence observed :
Medical science has conferred great benefits on mankind, but these benefits are attended by considerable risks. Every surgical operation is attended by risks. We cannot take the benefits without taking risks. Every advancement in technique is also attended by risks.
18. In the aforementioned decision, the Apex Court framed the following principles while deciding whether the medical professional is guilty of medical negligence, I. Negligence is the breach of a duty exercised by omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do.
II. Negligence is an essential ingredient of the offence. The negligence to be established by the prosecution must be culpable or gross and not the negligence merely based upon an error of judgment.
III. The medical professional is expected to bring a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires.
IV. A medical practitioner would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field.
V. In the realm of diagnosis and treatment there is scope for genuine difference of opinion and one professional doctor is clearly not negligent merely because his conclusion differs from that of other professional doctor.
VI. The medical professional is often called upon to adopt a procedure which involves higher element of risk, but which he honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure. Just because a professional looking to the gravity of illness has taken higher element of risk to redeem the patient out of his/her suffering which did not yield the desired result may not amount to negligence.
VII. Negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession.
The respondents established that there was no deviation from the standard medical practice in choosing the administration of Pantoprozole and pain killers and also the other medicine to the patient. The appellants failed to establish any medical negligence on the part of the respondents. Though there has been no damage caused as a result of not properly mentioning the time and date in the medical record maintained by the first respondent hospital, the first respondent hospital is hereby advised to maintain accurate time and date in the medical records of the patients. The appeal as such is liable to be dismissed.
In the result the appeal is dismissed confirming the order of the District Forum.
There shall be no order as to costs.
MEMBER MEMBER Dt.29.10.2012 KMK*