State Consumer Disputes Redressal Commission
Pandu Veera Venkata Satyanarayana vs 1. Asian Institute Of Gastroenterology on 12 June, 2023
1
BEFORE THE TELANGANA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION :: HYDERABAD.
(ADDITION AL BENCH)
CC 37/2015
Between:
Mr.Pandu Veera Venkata Satyanarayana,
S/o.Late P.Venkata Reddy,
aged about : 49 years,
Indian, Occ: Advocate,
R/o.H.No.2-3-511/15,
Bapu Nagar, Amberpet,
Hyderabad - 500 013. .... Complainant
And
1.Asian Institute of Gastroenterology, D.No.6-3-661, Somajiguda, Hyderabad -082, Rep. by its Managing Director.
2. Dr.P.Manohar Reddy, Consultant Gastroenterologist, Asian Institute of Gastroenterology, D.No.6-3-661, Somajiguda, Hyderabad - 500 082. ...Opposite parties Counsel for the Complainant : M/s.Srinivas Rao Pachwa .
Counsel for the opposite parties : M/s.S.Subramanya Reddy QUORUM: HON'BLE, SRI V.V.SESHUBABU MEMBER - (J) & HON'BLE SMT R.S. RAJESHREE, M EMBER - (NJ) M ONDAY, THE TWELFTH DAY OF JUNE, TW O THOUSAND TWENTY THREE.
Order :(Per Hon'ble Sri V.V.Seshubabu, M ember-Judicial.) ****
01). The complaint is filed on 20.2.2015 u/s.17(1)(a)(i) of Consumer Protection Act,1986 seeking direction against opposite party to pay compensation of Rs.49 lakhs with costs of Rs.25,000/-.
02). The brief averments of the complaint are that Smt.V.Durga, aged 32 years is the wife of the complainant who died on 1.2.2014 (hereinafter will be called as deceased); that on 30.11.2012 the deceased went to C.C.Shrooff Memorial Hospital , Barkatpura , 2 Hyderabad as she was suffering from abdomen pain; that Dr.M.Ramana, Gastroenterologist advised her to undergo UGI Endoscopy and the report dt.1.12.2012 revealed normal study; that doctor diagnosed her as a patient suffering from GERD (Gastro Esophageal Regurgitation) Gastric problem and she went to the same hospital on 8.12.2012 and 19.12.2012; that on 19.12.2012 she was subjected Echo Cardiogram and it was found normal; that on 26.2.2013, the deceased went to opposite party no.1 hospital for expert treatment with the complaint of regurgitation and epi gastric burning with 6 months duration; that the opposite party no.2 examined the patient and perused the previous investigation reports and given medication for one month; that on 31.3.2013 she again went to opposite party no.2 as there was no improvement and this time the medication was repeated; that on 1.4.2013 she again went and same drugs repeated for two months; that she also went to the opposite party no.2 on 9.7.2013, 26.7.2013 and 29.8.2013 and almost the same medicines were prescribed; that due to no improvement and as her health condition was aggravating and as she lost weight from 65 to 61 kgs., approached the opposite party no.2 on 2.10.2013; that this time opposite party no.2 prescribed investigations like endoscopy test, biopsy test, CT Scan, Pet CT Scan etc.,; that the endoscopy report dt.5.10.2013 revealed "mild resistence at GE Junction" half esophagus; that the stomach revealed large ulceration friable growth just below GE junction, thickened fold in the body of stomach with ulceration and lack of distensobality; that the video endoscopy report gave an impression "? CA STOMACH"; that the biopsy report dt.5.10.2013 gave an impression that "features are not adeno carcinoma poorly differentiated - against a background chronic active gastritis. Negative for H pylori" that CT abdomen with contrast report dt.7.10.2013 shows that "wall thickening at GE junction and extending into fundus and proximal body with peri gastric fat stranding"; that all the reports reveal that the deceased was suffering carcinoma of stomach; that to rule out the same, she undergone FDG Pet CT Scan of whole body at Vijaya Diagnostic Centre and the report dt.10.10./2013 revealed that "increased FDG uptake in multiple enlarged peri gastric - predominantly in gastric bed and along the grature curvature and few small left parraortic 3 lymph nodes, as mentioned above - likely metastatic. Increased FDG uptake in a nodular lesion in lower lobe of left lung, along the major fissures - ? Metastatic"; that the opposite party no.2 taken her to Dr.Pradeep of the same hospital and both of them suggested the deceased to undergo surgical intervention, but as she lost confidence not chosen for the same; that on 11.10.2013 the deceased went to Sowmya Multi Specialty Hospital, Secunderabad and she was examined by Dr.S.Chandrasekhar who advised and conducted laparoscopy on 15.10.2013 and during the surgery, it was found that there was growth in the proximal body with serosal breach : multiple parietal peritoneal deposits noted over sub peritoneum and due to the same resection was abonded and discharged on 17.10.2013 with an advise to come for review after two weeks; that the deceased went to Sowmya Hospital on 9 different dates from 21.11.2013 to 10.1.2014 but as she lost valuable time in the hands of opposite parties due to their failure to diagnose the problem, succumbed on 1.2.2014 while taking treatment in the Christian Cancer Centre, Kakinada where she was admitted on 19.1.2014; that it all happened only due to the negligence of the opposite parties; hence, the complaint.
03). The brief averments of the 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 averments made in the complaint; that though the deceased came to the opposite parties on the dates as mentioned, but the first alarm symptoms such as weight loss, vomiting etc. were reported only in the month of October,2013; that immediately the opposite party no.2 prescribed several diagnostic tests and after consulting Dr.Pradeep, a surgeon taken up further treatment; that on 9.7.2013 when the deceased presented with symptomatic improvement and was doing well at that particular point of time, there were no fresh complaints; that on 26.7.2013 the deceased came with persistent symptom of gastro esophageal reflux and no history of weight loss; that she was treated as a case of refractory gastro esophageal disease with modification drugs; that on 29.8.2013, the deceased came with a new symptom of occasional vomiting, but there was no weight loss; that in view of the said symptom, she was advised ultra sonography of abdomen 4 on 29.8.2013 itself, but her husband had not done with the same for the reasons best known to him; that on 2.10.2013 when the deceased undergone investigations like endoscopy test, biopsy test, CT Scan etc., which re vealed that she was suffering with carcinoma, so, she was advised to undergo surgery after consultation with Dr.Pradeep; however, the patient and complainant left the hospital without opting for surgery; that the opposite parties have no knowledge about her treatment in the Sowmay hospital and in a hospital at Kakinada; that when the complainant failed to cause sonography test of abdomen on the deceased cannot contend any negligence or deficiency of service on the part of opposite parties; that the complaint is liable for dismissal with exemplary costs being vexatious and speculative in nature.
04). To prove the case, complainant filed evidence affidavit as PW.1 and got marked Exs.A1 to A7. Opposite party no.2 filed evidence affidavit as RW.1 on behalf of the opposite parties, but no document is marked on his behalf. However, he was subjected to cross examination before the Advocate Commissioner. Written arguments filed for the opposite parties. Heard the arguments of both sides.
05). Now the points for consideration are :
i). whether opposite parties are negligent for not prescribing appropriate investigations, specifically endoscopy examination, nearly for a period of 8 months, which amounts to deficiency in service?
ii). Whether the complainant is entitled for the compensation as claimed ?
iii). Relief?
06). Point no.(i) : Ex.A1 is the prescription given by Dr.M.Ramanna, MD.DM (Gastro) of C.C.Shrooff Memorial Hospital dt.30.11.2012. It shows that the patient came with post Laparoscopic myomectomy for fibroids. Except that, it is not mentioned from how long the patient was suffering from abdomen pain. She was subjected to UGI Endoscopy and the report shows normal. It is mentioned in the document that she is having GERD (gastro esophageal regurgitation) and noted as reflux symptoms and was given medicines for 10 days. On 5 8.12.2012 she again went to same doctor and he noted that she is having GERD and medication was given for one month. On 19.12.2012, she was subjected to echo cardiogram by Dr.S.Srinivasa Reddy, MD..DM., (Cardiology) and report reveals normal.
07). It is a fact that the deceased went to opposite party no.1 hospital and consulted opposite party no.2/RW.1 on 26.2.2013. The name of opposite party no.1 hospital itself shows that it is specialized in gastroenterology. Ex.A3 is the out patient record maintained by opposite party no.1 hospital on the deceased. In the OP record it is mentioned that the deceased is suffering with Epi Gastric burning and reflux symptoms for the last 6 months and her weight is noted as 65 kgs. Doctor prescribed medicines for one month and advised to come for re view after one month. On 2.4.2013, she again went to the RW.1 and this time he gave medicines for two months and advised to come for review after two months. On 9.7.2013, she again went to the opposite party no.2 who noted that she was doing well and her weight is noted as 64 kgs. and prescribed medicines for two months. However, on 26.7.2013 itself, she went to opposite party no.2 and this time it is noted as reflux +, sleep( ) and prescribed medicines for one month. On 29.8.2013, she again went and it is noted as occasional vomiting :- immediately advised to undergo ultra sonography of abdomen. This time her weight is noted as 65 kgs. and asked to come for review after one month. Admittedly, the deceased not undergone the ultra sonography test.
08). On 2.10.2013, the deceased went to opposite party no.2 and this time her weight is noted as 61 kgs. by showing a loss of 4 kgs. Admittedly, she was subjected to UGI Endoscopy, USG abdomen, TSH/FBS. The tests revealed that she is suffering with carcinoma. On 8.10.2013 and 12.10.2013 notings are there to the effect that she had to undergo surgical operation. It is mentioned in the complaint that as they have lost faith in the opposite parties including their line of treatment, not opted for surgery in the opposite party no.1 hospital. Subsequently, the deceased went to Sowmya Multi Specialty Hospital, took treatment for some time and then went to Kakinada there also she took treatment and died 6 on 1.2.2014 as per Ex.A7. The entire point boils down on a single aspect i.e. whether the opposite parties due to their negligence failed to prescribe the endoscopy examination on the deceased, when she was coming to the hospital with the same complaint for nearly 6 visits covering a period of 6 months? It is also their contention that due to the delay caused by the opposite parties the life span of the deceased was cut short and they have failed to provide appropriate treatment at the appropriate time.
09). It is the contention of opposite parties that as the endoscopy was done at the CC Shroff Hospital and as it shows normal , medicines were changed from time to time treating her as the patient with refractory gastro esophageal reflux disease and treatment was given as per the guidelines and only when she came in the month of August, 2013, with a complaint of occasional vomiting without weight loss , the ultra sonography of abdomen was prescribed and only when she came in the month of October,2013, the weight loss was observed and so, tests like endoscopy and others were ordered. So, it is their contention that never they have neglected, while treating the deceased and at the right time prescribed the right tests and in those circumstances more so without subjecting herself to the ultrasonography of abdomen test, harsh on the part of the complainant to blame them with negligence.
10). The cross examination done on RW.1 throws some light in deciding the negligence or no negligence. RW.1 stated that in his 11 years of service as Gastroenterologist treated 1000 cases of cancer related one and also used to deal with GI cancers, Hepatoviliary and pancreatic malignancies and having vast experience in dealing with cancer related cases. This evidence of RW.1 show that he is having very good experience in treating the patients affected with cancer. RW.1 stated that on 26.2.2013 the patient came with persistence of symptoms i.e. reflux and epigastric burning with a 6 months duration; that she was treated as gastroesophageal reflux disease; that she again came to him on 2.4.2013 and she prescribed same medicines as done on 26.2.2013 but added some more medicines like "betonin"
7multivitamin syrup, "placida" tablet, "Ivoral" tablet along with "Nexpro-RD"; that Ivoral is a dewarming agent and "Placida" is a anti anxiety agent, "Nexpro-RD" is a prokinetic proton pump inhibitor ; that the symptoms complained by the patient are more less similar on the dates 26.2.2013 and 2.4.2013 and he had not suggested any further evolution of the patient. It shows e ven though the patient has been suffering with the same problems since 6 months prior to 26.2.2013, the same medicines were continued even by 2.4.2013 and she was asked to come for re view after two months.
11). RW.1 stated that on 9.7.2013 she came to him and not complained of any symptoms and was apparently doing well and for that reason he advised her to continue the tablet Nexpro-RD and to stop other medicines because Nexpro - RD is the main medicine for her symptoms; that as patient was doing well no investigation was advised and she was asked to come for review after two months; that on 26.7.2013 she came to him within 17 days with a complaint of reflux, globus sensation (sense of heaviness in throat); that he advised medication of Tryptomer tablet ( amitryprylline) besides Ganaton tablet, but no evolution was done on the said day for the reason that the globus sensation could be part of symptom complex of GERD; that on 29.8.2013 patient came to him with a complaint of occasional vomiting immediately after food and so, suggested ultrasound abdomen and added "Lesurid" tablet; that patient again came to him on 2.10.2013 and this time he advised her to undergo endoscopy, ultrasound abdomen etc,.
12). RW.1 admitted that to identify upper GI cancers, endoscopy is the primary diagnostic tool but negatived the suggestion that ultrasound test cannot identify the upper GI cancer. RW.1 was questioned what was the time frame to develop Endeno Carcinoma in upper GI and he answered that depending upon the biological nature of the tumor and type of Endeno Carcinoma (differentiation of tumor) and went on to add that the time depends upon various factors including biological behavior of the tumor, pathological variant of the cancer, aggressive behavior of the malignant tumor, genetic predisposing factors and other 8 conditions . It means there cannot be a straight answer to the question putforth to him by the counsel for the complainant. RW.1 also stated to the question that, if he conducted endoscopy test earlier could have identified the cancer earlier? the answer is as he treated the patient with GERD and as she had symptoms to that effect, endoscopy was not advised earlier. It is also suggested to RW1 that by the date 8.10.2013 she was found to be diagnosed with carcinoma stomach was in the fourth stage? but he negatived the same by giving an explanation that as relevant investigation/workup for staging, have not been completed cannot be commented upon the stage of the disease, because laparoscopy was not performed. Barrage of suggestions were given to RW.1 that he was at negligence in not advising endoscopy test on the patient earlier, but he denied all of them.
13). It is important to note that patient on 9.7.2013 reported that she was doing well and for that reason, RW.1 advised her to discontinue all the medicines except nexpro -RD and it shows RW.1 earnestly believed that the treatment is on the right path. However, on 29.8.2013 when the patient came with a complaint of vomiting after food, advised to undergo sonography and for the reasons better known to the patient and the complainant, she was not subjected to such test. Only on 2.10.2013, she approached RW.1 with similar symptoms and there was also weight loss of 4 kgs. Till then there are no alarming symptoms to suspect any carcinoma of stomach. Therefore, we are of the view that not prescribing the endoscopy test from 26.2.2013 to 2.10.2013 cannot be considered as a negligent act done by RW.1, more so when he ordered ultrasound USG sonography 29.8.2013.
14). It is the contention of the complainant counsel that USG sonography is not a substitute for the endoscopy examination in detecting cancer. RW.1 clearly denied the same and stated that with USG Sonography, cancer can be detected. When we googled, it is observed that ultrasound scans use high frequency sound waves to create a picture of a part of a body and they can show up changes, including abnormal growths to diagnose a cancer or find out if it has spread. Doctors order an abdominal scan when they are concerned about symptoms such as belly pain, 9 repeated vomitings, abnormal liver or kidney function tests, or swollen belly. The test can show them the size of the abdominal organs and help them check for injuries to or diseases of the organs. So, the argument of complainant counsel is also not having much force to contend that only endoscopy test is the "be all and end all". Prescribing USG sonography by RW.1 shows he is vigilant in treating the patient. It is also not the contention of PW.1 that, as USG Abdomen was found to be inferior to Endoscopy, the test was not conducted on the deceased. Taking all these discussions into consideration, we are of the view that there is no negligence or deficiency of service on the part of opposite parties.
15). In the result, the complaint is dismissed without costs by holding that the complainant failed to prove any negligence or deficiency of service on the part of opposite parties in providing treatment to the patient/Smt.V.Durga.
( Typed to dictation on system, corrected and pronounced by us in the open Court on this 12 th day of June,2023).
MEMBER(J) M EMBER(NJ)
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Dated : 12.6.2023
APPENDIX OF EVIDENCE
W itnesses Examined
For the complainant For the opposite parties
Complainant filed Evidence Evidence Aff. of opp.party
Aff. as PW.1. no.2 filed as RW.1
Opposite party no.2 was cross examined and Advocate
Commissioner's report filed.
Exhibits marked on behalf of the complainant:
Ex.A1: Photostat copy of Medical prescription dt. 30.11.2012 and test report dt.1.12.2012 issued by C.C.Shroff Memorial Hospital on behalf of Mrs.V.Durga. Ex.A2: Photostat copy of Medical prescription dt. 8.12.2012 and test report dt.14.12.2012 issued by C.C.Shroff Memorial Hospital on behalf of Mrs.V.Durga. Ex.A3 : Photostat copy of Out Patient Record of Mrs.V.Durga issued by opposite party no.1.
Ex.A4 : Copies of Medical test reports of Mrs.V.Durga issued by opp.parties.
Ex.A5 : Photostat copies of Out-Patient Registration Cards issued 10 by Soumya Multi Specialty Hospital on behalf of Smt.V.Durga.
Ex.A6 : Photostat copies of receipts issued by Christian Cancer Centre and also the medical bills. Ex.A7 : Copy of Certificate of Death of Smt.V.Durga issued by Govt. of A.P., Kakinada Municipal Corpn.
Exhibits marked on behalf of the opposite parties: nil.
MEMBER(J) M EMBER(NJ)
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Dated : 12.6.2023