National Consumer Disputes Redressal
R. K. Tripathi vs Dr. Ashok Pachori & Anr . Ltd on 3 January, 2018
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI APPEAL NO. 83 OF 2008 (Against the Order dated 01/09/2008 in Complaint No. 88/2002 of the State Commission Uttar Pradesh) 1. DR. ASHOK PACHORI SON OF LATE G.D.PACHORI RESIDENT OF 215, MANAS NAGAR, SHAHGANJ AGRA ...........Appellant(s) Versus 1. R.K. TRIPATHI RESIDENT OF 660/552, KARANAN GANJ, ALLAHABAD ...........Respondent(s) FIRST APPEAL NO. 295 OF 2008 (Against the Order dated 09/01/2008 in Complaint No. 88/sc/2002 of the State Commission Uttar Pradesh) 1. R. K. TRIPATHI Resident of 660/552, Karnal Ganj Allahabad Uttar Pradesh ...........Appellant(s) Versus 1. DR. ASHOK PACHORI & ANR . LTD M/s. Laser Sight (India) Pvt. Ltd. Laser Sight Centre, 215, Manas Nagar, Shahganj Agra Uttar Pradesh 2. DR. NISHI PACHORI, MSDO, MS. DIRECTOR /s. Laser Sight (India) Pvt. Ltd. Laser Sight Centre, 215, Manas Nagar, Shahganj Agra Uttar Pradesh ...........Respondent(s)
BEFORE: HON'BLE MR. DR. S.M. KANTIKAR,PRESIDING MEMBER
For the Appellant : In FA/83/2008
For the Appellant : Mr. Devendra Vajpayee, Advocate
For the Respondent : Mr. Anant Agarwal, Advocate with
Mr. Asheesh Chandra, Advocate and
Ms. Charanjeet Kaur Bhatia, Advocate For the Respondent : In FA/295/2008
For the Appellant : Mr. Anant Agarwal, Advocate with
Mr. Asheesh Chandra, Advocate and
Ms. Charanjeet Kaur Bhatia, Advocate
For the Respondents
: Mr. Devendra Vajpayee, Advocate
Dated : 03 Jan 2018 ORDER
1. The complainant, Mr. R. K. Tripathi, Sub Inspector, in the month of October, 1999 suffered injury of his right eye due to blunt trauma by bamboo stick. He approached M/s. Laser Sight India Pvt. Ltd. run by Dr. Dr. Ashok Pachori (OP1). After examination he was diagnosed as a case of dislocated lens. The patient was called on 19-12-1999 and, thereafter, he was operated by OP1 on 21-12-1999. Next day the bandage was removed but patient had persistent pain in his right eye. The OP1 advised him to come for further follow up on 25-12-1999. The patient initially got treatment of his right eye at B. S. Mehta Eye Hospital, Allahabad from 11-01-1999 to 22-01-1999 where he was thoroughly checked and was told that due to injury in his right eye the lens of his right eye was dislocated and advised to get the lens of his right eye be removed and new lens be placed after operation. Thereafter, he took treatment at Balrampur Hospital at Lucknow from 07-06-1999 to 21-06-1999 by Dr. O. P. Shukla who again suggested that eye has to be operated and injured lens has to be removed. Again on 10-07-1999, he got checked his right eye in Mansarovar Hospital, Lucknow and the doctors there advised the same. On 22-09-1999, he consulted, Dr. Shyama Prasad Mukherji Hospital, Lucknow who also suggested to replace the dislocated lens. Finally on 19-12-1999 he got his right eye tested by OP1 at their clinic in Agra wherein it was told that the operation of right eye is needed immediately. The patient was advised for routine laboratory tests. The OP assured that the patient's right eye will be completely well and fine after the surgery and new lens will be replaced. Accordingly, he was operated on 21-12-1999. On the next day, the bandage was removed but the operated eye shown swelling and pain. The patient was called on 25-12-1999 but in the meantime the condition of right eye drastically deteriorated and severe pain developed. The complainant with his wife approached OP clinic on 25-12-1999. The OP assured that nothing will happen. Everything will be settled and prescribed some medicines but there was no improvement and his right eye became completely blind. On 28-12-1999, the OP2 assured that the dislocated lens has already been removed by them and advised to take regular medicines for three weeks. The OP called the patient for further checkup to his clinic at Kanpur but due to non-improvement of the condition of the right eye on 31-12-1999 the patient went to Kanpur for checkup. Thereafter on 10-01-2000 the complainant consulted Dr. R. N. Mishra at Hari Netralaya Clinic, Allahabad who informed the complainant that without removing injury dislocated lens the OP1 implanted a new lens. Therefore, the implantation of IOL was not at appropriate place and there is retinal detachment also. The doctor also referred him to Sankara Nethralaya, Chennai. The patient consulted Kshetriya Netra Vigyan Sansthan, Netra Chikitsalya at Sitapur from 31-01-2000 to 01-02-2000 wherein the Chief Medical Officer verbally opined that patient's retina was torn and patient may develop neurological problem. On 23-03-2000 the complainant went to Sankara Netralaya at Chennai for checkup of his right eye where the doctors expressed to get operated without delay. Accordingly, after preliminary test he got admitted at Sankara Netralaya on 03-03-2000 and operated on next day. He was discharged from hospital on 05-03-2000.
2. Being aggrieved by the sufferings the complainant alleged medical negligence committed by the OP, Dr. Ashok Pachori as implanted ACIOL without removing his injured lens resulting into damage to the retina of his right eye, filed a complaint before the Uttar Pradesh State Consumer Disputes Redressal Commission (in short, "the State Commission")
3. The OP resisted the complaint by filing written version and submitted that he examined the complainant and found that there was a posterior sub luxation of lens in the right eye due to blunt trauma. The lens was dislocated laterally and inferiority, also there was vitreous herniating in anterior chamber. Hence, OP had planned for Intra Capsular Cataract Extraction (ICCE) on 21-12-1999 with A.C. Intra Occular Lens (IOL). The OP denied any negligence on the part of treatment of the blunt injury. The OP further submitted that he has tried to remove overlying vitreous with cellulose spunge, but it was not possible. Also anterior vitrectomy was done removing it by doing all these lens dipped into vitreous, as Zonules were very weak. However, papillary area was clear. He has performed to remove vitreous from anterior chamber and to ensure clear and better vision ACIOL was implanted. The same was informed to the complainant and was asked to come for regular follow up, but complainant never came after 22-12-1999 for follow up treatment or checkup.
4. The State Commission going through the pleadings and evidence allowed the complaint and directed OP No.1 to pay Rs.4,00,000/- to the complainant. Being aggrieved by the impugned order, both the parties filed appeals before this Commission. The appeal, FA No.83 of 2008 was filed by the OP No.1 for dismissal of complaint whereas the complainant filed FA No.295 of 2008 for enhancement of the compensation.
5. I have heard the learned counsel for the parties. Counsel for the appellant doctor vehemently argued that the doctor adopted the standard of ophthalmic practice. There was no deficiency or medical negligence whereas the learned counsel for the complainant submitted that it was the clear case of medical negligence and principle of res ipsa loquitor is clearly applicable. The counsel further submitted that the complainant suffered the injury by a balli (bamboo) in his right eye and started swelling. He had consulted immediately to Dr. B. S. Mehta Eye Hospital, Allahabad. He was informed that due to infection in the right eye, the lens of the right eye was dislocated and he was also advised to get the lens of his right eye removed and place a new lens after operation.
6. Learned counsel for the complainant placed reliance upon literature on cataract surgery and the textbook of Opthalmology which has discussed about aphakia. The absence of the lens from its normal position is quite aphakia. Therefore, surgical removal of cataractous lens is by far the commonest cause of aphakia. Under such circumstances, the management is discussed as below:
"The management of dislocation of lens requires meticulous evaluation of an individual case. If the subluxated lens is clear and does not cause any symptom, spectacle correction is advised; an aphakic correction gives better visual acuity than the phakie. The dislocated lens in the anterior chamber should be removed as early as possible to prevent PAS formation. In the posterior dislocation of the lens, an aphakic correction is prescribed. No attempt should be made to fish out the lens from the vitreous cavity as it ends up in gross vitreous loss and poor vision. The accompanied iridocyelitis is treated with atropine, antibiotic and steroids. The subluxated cataractous lens can be dealt with pars plana lensectomy with good visual prognosis."
7. I have perused the medical record on the file. The OP as per the medical record from OP hospital, it has mentioned that the complainant had blunt injury to the eye, but the complainant approached Medical Research Foundation of Sankara Nethralaya at Chennai wherein he underwent Lens Removal + Fluid Gas Exchange. The counsel for the appellant doctor relied upon the Principles and Practice of Opthalmology. The counsel for respondent/OP submitted the removal of luxated or subluxated lens, the following situations may arise:
(i) severe impairment of visual acuity; (ii) lens dislocation into the interior chamber; and (iii) phacolytic glaucoma; (iv) phacoantigenic ubeitis, etc..
8. Therefore, under these circumstances, the OP took a decision of surgery for implanting the artificial lens inside the eye post operatively 20% mannintol intravenously to reduce vitreous volume. But, the doing all these things, the lens moved further in the vitreous and it was not safe to remove the same at that point of time. Thus, the OP doctor had only two options, either to close the case without putting the lens or putting the lens in A.C. to have good vision so that complications should not occur and remove the soft cataractous lens later on with pars plana technique.
9. I have perused the medical record and the relevant medical text, the research papers on the ocular injuries and given thoughtful consideration to the arguments advanced by the learned counsel for both the parties. It is an admitted fact that there was a blunt trauma to the right eye of the complainant and it was the case of posterior subluxation of the lens in the vitreous chamber. It is clear from the multiple prescriptions that before consulting OP1 the complainant consulted several doctors in Kanpur, Allahabad, Lucknow, etc.. Everyone has advised that the injured lens be removed and further treatment to be taken by implantation of IOL. As per medical record and submissions made by OP, it is clear it was posteriorly dislocated cataract lens in the right eye and it was admitted fact that OP had made his conscious efforts to take out the lens from vitreous but it was failed. The OP had tried to extract the lens by means of cryoprop, but it was not freezing the upper pole of lens but overlying vitreous starting freezing. But despite all these procedures the lens dipped into vitreous as zonules were very weak. Therefore, the OP performed anterior vitrectomy and removed the vitreous from anterior chamber and, thereafter, ACIOL was implanted.
10. It is pertinent to note that as per medical literature without extraction of subluxated lens the IOL implantation is contraindicated. At that instance OP would have sent the patient to the higher centre or any retina specialist for further management but OP failed to refer the patient. Therefore, in my view it was the deficiency in service and negligence on the part of the OP.
11. With respect to the FA No.295 of 2008 filed by the complainant for enhancement of compensation, in my view the State Commission has awarded just and proper compensation after observing that complainant had suffered agony due to visits to number of doctors at different places in Uttar Pradesh and Chennai. I do not find any reason for the enhancement of compensation.
12. Based on the foregoing discussion, I do not find any merit in both the appeals and the same are ordered to be dismissed.
There shall be no order as to costs.
...................... DR. S.M. KANTIKAR PRESIDING MEMBER