State Consumer Disputes Redressal Commission
Sivam Tyagi vs Dr. Ankur Jain on 13 March, 2023
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UP C-1 Vikrant Khand 1 (Near Shaheed Path), Gomti Nagar Lucknow-226010 Complaint Case No. CC/5/2018 ( Date of Filing : 02 Jan 2018 ) 1. Sivam Tyagi Meerut ...........Complainant(s) Versus 1. Dr. Ankur Jain Meerut ............Opp.Party(s) BEFORE: HON'BLE MR. Rajendra Singh PRESIDING MEMBER HON'BLE MR. SUSHIL KUMAR JUDICIAL MEMBER PRESENT: Dated : 13 Mar 2023 Final Order / Judgement Reserved State Consumer Disputes Redressal Commission U.P. Lucknow. Complaint Case No.5 of 2018 Mr. Shivam Tyagi, aged about 19 years, S/o ........., R/o Julehda, Police Station, Sardhana, District, Meerut. ...Complainant. Versus 1- Dr. Ankur Jain, 279, Mangal Pandey Nagar, Near Mimhans Hospital, Opp. Apex Tower, Meerut-250001 2- Om Trauma And Neuro Hospital, C-8-9/5, Jagriti Vihar, Garh Road, Meerut. ...Opposite parties. Present:- 1- Hon'ble Sri Rajendra Singh, Member. 2- Hon'ble Sri Sushil Kumar, Member. Sri Asif Anees, Advocate for complainant. Sri Imran Asim, Advocate for OPs. Date : 17.04.2022 JUDGMENT
Per Sri Rajendra Singh, Member- This complaint has been filed by the complainant under section 17 of the Consumer Protection Act, 1986 for following reliefs:-
Opposite party to pay the amount of Rs.22,20,125.00 to complainant.
Opposite party to pay interest @ 18% p.a. on deposited amount details of which are given in para 29 & 30 of complaint.
Opposite party to pay Rs.2,00,000.00 for mental pain and suffering.
Opposite party to pay Rs.1,00,000.00 for cost of the case.
And any other relief as deemed fit and proper in the circumstances of the case may also be granted to the complainant.
The brief facts of the complainant's case are that, that in July, 2016, the complainant while going to his native place, slipped and fell due to which he experienced severe pain in his lower back. Consequently, he consulted Dr. Ankur Jain, opposite party no.1, who upon examination of the complainant and after perusal of the medical investigation reports, diagnosed him with Prolapse Disc L4 L5 S1 also know as slipped disc. The opposite party no.1 started the treatment of the complainant after the diagnosis. However instead of any relief the complainant's pain worsened, due to which the complainant, who had enrolled in a diploma course in 2016, had to stop his studies midway. On seeking no improvement in his condition, the complainant again went to the opposite party no.1 who in turn, advised the complainant to undergo a surgical procedure called Necleoplasty , and gave an assurance that it was a safe procedure, after which the complainant would be absolutely fine and healthy. Under the impression that the opposite party no.1 namely Dr. Ankur Jain, MD, PDCC (pain) is well qualified doctor and would conduct the surgery with due care, the complainant adhered to his advice and got himself admitted at Om Trauma and Neuro Hospital, opposite party no.2 on 7.11.2016 under the supervision of the opposite party no.1. It is also pertinent to mention here that the opposite party no.1 is a consultant doctor at the aforementioned hospital.
The opposite party no.1 very negligently and carelessly conducted the surgery ( Neucloplasty clubbed with Annuloplasty ) on the date of his admission itself i.e. 7.11.2016 at the aforementioned hospital by using sub-standard and infected/non-sterilized needle and not even the operation theater was in a proper condition to conduct the operation. The complainant was callously discharged on the very next day i.e. 8.11.2016 without being kept under observation and proper post surgery treatment.
It is pertinent to mention here that due to this careless handling of the complainant during as well as post operation by the opposite party no.1and the staff and management of the opposite party no.2, the complainant received infection.
After getting discharged, the complainant did not get relief from pain, however, he developed other ailments as well due to improper and irresponsible conduct of the opposite parties. The complainant was taken to the clinic of the opposite party no.1 who again advised the complainant to get admitted in Om Trauma and Neuro Hospital, opposite party no.2, consequently the complainant was again admitted as advised. To utter dismay, the complainant was discharged from the opposite party no.2 hospital on the very next day, with an advice of rest and a visit after 7 days for follow up treatment.
It is pertinent to mention here that the complainant was discharged from the hospital opposite party no.2 without properly enquiring about the reason of continuous pain and providing treatment, even though he was in severe pain. When the condition of the complainant worsened, the father of the complainant informed the same to the opposite party no.1 however, he was advised to continue the medication and take rest on assurance of relief, but the pain and sufferings of the complainant continued even thereafter. The condition of the complainant deteriorated as the effect of the infection increased and it started showing its symptoms. The OP no.1 was kept informed of the condition of the complainant however, he did not diagnose the exact cause of it.
Meanwhile, the complainant suffered from fever due to increasing impact of the infection and on repeated requests, the OP no.1 again advised the complainant to be admitted to the OP no.2 under his supervision on 16.11.2016. However, escaping from the responsibilities, the opposite parties again discharged the complainant just after two days on 18.11.2016 after prescribing the medicines. Since there was no improvement in the complainant's health even after the prolonged treatment provided by OP no.1, the father of the complainant took him to Our Lady Grace Hospital, Sardhana where it was diagnosed that the complainant is suffering from bacterial sepsis which could have only occurred at the time of the surgery performed by the OP no.1. That in the tests conducted it was found that the complainant was suffering from Sepsis and the consequent pain and high fever was a result of the same. That the action of the opposite parties in not treating the complainant with due care was uncalled for an unwarranted.
Nothing pertaining to the condition of the complainant improved and when the sufferings seemed increasing in addition to the callous behavior of the opposite parties, the complainant was taken to Dr. Sandeep Rana, on whose advice the complainant was admitted to Our Lady Grace Hospital on 21.11.2016 and was subsequently discharged on 26.11.2016 due to non-availability of higher facility for treatment. However, on further medical examinations it was confirmed that the complainant was suffering from sepsis. After being discharged from Our Lady Grace Hospital, the complainant was admitted to Yatharth Hospital, Noida for better treatment on 28.11.2016 and when no improvement was seen, the complainant was again discharged on 6.12.2016. After undergoing various medical examination tests, the complainant was subjected to bone biopsy, the report of which further confirmed the infection on lower spine of the complainant.
After several spells of medication when the misery did not end, the complainant underwent Trasforaminal Lumber Interbody Fusion (TLIF), a surgical procedure, on the advice of the doctors at the Jaypee Hospital, for stabilizing the spinal vertebrae and discs. Thereafter, the complainant was again admitted in the Jaypee Hospital on 20.12.2016 and was subjected to debridement and subsequently, discharged on 25.12.2016.
The complainant was again admitted for the third time on 12.1.2017 at Jaypee Hospital for follow up treatment and was subsequently discharged on 14.1.2017 with advice of further medication in consultation of the doctors of Jaypee Hospital. It is pertinent to mention here that the complainant is still under regular consultation with the doctors at Jaypee Hospital and is following the treatment as he has not been cured completely till date. The deliberated negligence and gross misconduct of the opposite parties have caused great distress and permanent physical ailments as well as mental agony to the complainant.
The complainant had also sent legal notice to the opposite parties no.1 and 2 dated 23.8.2017 demanding appropriate compensation for the lapse committed at their end. The opposite party no.1 replied to the above stated notice dated 30.8.2017 wherein it has been categorically accepted that the needle and kit used in the surgery was bought by the opposite party no.1 itself. This is more over a reason that the onus to justify the cause of bacterial sepsis is depended on the opposite parties as all the actions related to the surgery were taken by them and it was due to the lapse committed by them that the complainant has suffered from such a problem.
The complainant has spent an amount of Rs.22,20,125.00 on the treatment which the opposite parties are jointly and severally liable to pay to the complainant . The chain of the diagnosis done at various hospitals clearly reveals that the complainant was suffering from bacterial sepsis subsequent to the surgery performed by the opposite party no.1 which was not there prior to the surgery.
The opposite parties no.1 & 2 have filed their written statement in which it is stated that it is evident from the contents of the complaint itself that the complainant was facing due hardship & severe pain in complainant's back since 2016. The complainant was facing pain since 1½ years as per the discharge request issued by Yatharth Super Speciality Hospital dated 6.12.2016. The OP no.1 is a well experienced and a reputed doctor who has an experience of 9 years in dealing with such cases and has also dealt with similar cases successfully previously and has therefore, prescribed the correct medicine to the complainant which cures the alleged problem. It is also pertinent to mention here that the complainant first approached the OP no.1 on 20.9.2016 wherein the OP no.1 has prescribed the complainant to take the prescribed medicines in time and further advised the complainant to get the MRI done and asked the complainant to re-visit after 7 days for the check up but the complainant failed to follow the instructions of the OP no.1and the complainant re-visited the OP no.1 on 7.10.2016 with the same problem wherein the OP no.1 prescribed certain medicines after duly examining the complainant and also suggested on 7.10.2016 that the complainant should be admitted in Om Hospital which is clearly evident from the diagnosis prescription issued by the OP no.1 .
The complainant again failed to follow the instructions given on 7.10.2016 by the OP no.1 that the complainant should admit himself in OP no.2 but the complaint got himself admitted in OP no.2 on 7.11.2016 which is evident from the discharge summary and advice as annexed as annexure no.2 in the complaint by the complainant. Thus, it is clearly evident that the complainant has been negligent and has been continuously ignoring all the prescription and instructions given by the OP no.1 and therefore, the complainant can not shift the burden of his own negligence and wrongdoing onto the OP no.2, therefore, the complaint filed by the complainant is false, frivolous and vexatious and hence, it is liable to be dismissed at the very outset as far as the opposite parties are concerned. In the matter at hand the opposite parties has maliciously been made a party to the complaint. The complainant has filed the complaint with the sole intension of causing unnecessary duress and harm to the reputation and goodwill of the opposite parties and can make wrongful gain for himself and can cause wrongful loss to the opposite parties.
The complainant again failed to follow the instructions given on 7.10.2016 by the OP no.1 that the complainant should admit himself in OP no.2 but the complainant got himself admitted in OP no.2 on 7.11.2016 which is evident from discharge summary & advice. The OP no.1 duly informed the complainant and the complainant's father about the Necleoplasty with Annuloplasty and also advised the complaint to take proper care and precaution after the surgery further, the OP no.1 informed the complainant and the complainant's father that after the said surgery the complainant will get 80% relief and the pain and rest 20% is not assured that the complainant will get relief in the pain and the complainant and the complainant's father was also informed about the post operative effect of the surgery which was duly agreed by the complainant and the complainant's father which is clearly evident from the consent for surgery undertaking which was duly signed by the complainant's father. The OP no.1 is a well experienced and a reputed doctor who has an experience of 9 years in dealing with such surgeries, further it is pertinent to mention here that the complainant failed to follow the advice of the OP no.1 as the OP no.1 on 7.10.2016 suggested the complainant to admit himself in Om Hospital, OP no.2 which is clearly evident from the diagnosis prescription issued by the OP no.1. The complainant failed to follow the instruction/advice given on 7.10.2016 by the OP no.1 that the complainant should admit himself in OP no.2 but the complainant got himself admitted in OP no.2 on 7.11.2016 which is evident from the discharged summary and advice.
The OP no.1 is a well qualified, experienced and reputed doctor and has conducted the surgery with proper due diligence and precaution. It is pertinent to mention here that the special kit (Bipolar Flexible Radio Frequency Probe) which was freshly purchased and brought from the medical shop, the invoice of the Kit is annexed herein as annexure no.2, and the surgery was conducted successfully and further while conducting the surgery the OP no.1 did not use the sub-standard and infected/non-sterilized needle infact the kit was freshly purchased and brought form the medical shop itself which is sold in the market after the quality check of the kit.
It is pertinent to mention here that incase of Disc FX i.e. Nucleoplasty with Annuloplasty, the patient can be discharged form the hospital within 24 hours further as per the information available on http://www.painshysicianindia. com/ precutaneous-disc-treatments/.
Under the heading Disc FX within precutaneous disc treatments for spinal pain stating that patient is discharged from the hospital same day or lat the maximum next day.
Further reference can also be taken from: http://www. painclinicofindia.com/how-we-treat/minimal-invasive- discentomy/disc-fx.html stating that patients with symptomatic, contained lumber disc herniations that have not responded to conservative treatment, may experience relief from the use of Disc-FX. Typical signs of a contained lumbar disc herniation is lower back pain or pain radiating down the leg accompanied by some lower back pain.
Potential benefits of the procedure:
Out-patient Procedure Minor skin incision Short procedure time Multiple treatment options Local Anaesthetic Targeted Access to Damaged (Diseased) Area Treat Multiple disc levels Quick relief of symptoms Earlier Return to Normal Activities Minimal tissues damage Preserves all additional surgical options, should they needed.
The Disc-FX system required the patient to lie on their stomach throughout the procedure. Minimal anesthesia requirements are typically necessary. A needle is inserted into the skin near the affected disc level, followed by a working tube into the disc. Graspers are used to manually remove and decompress the offending herniation. The patented Trigger Flex is then activated to help clean the disc and seal tears in the annulus. At the conclusion of the procedure, the tube is removed and a small bandage is applied.
It is clear that post operation the patient is discharged from the hospital after certain instruction/advices given to the patient. Hence, the OP no.1 has followed the due process of the operation and has not just discharged the complainant callously. The OP no.1 and the staff and management of the OP no.2 conducted the surgery very carefully with proper care and safety and also the entire procedure was performed in a controlled environment hence, the alleged injection was not possible in such kind of environment.
Further it is also pertinent to mention here that as per the MRI report dated 17.11.2016, the report was normal and no infection was detected then thus, it was clearly evident that there was no infection and the opposite parties were very careful and diligent while conducting the surgery and also post operation. Further, it is also pertinent to mention here that the 1st MRI was done on 17.11.2016 wherein no infection was detected in the MRI report, whereas on the 2nd MRI dated 28.11.2016, the MRI report was inconclusive which is evident from annexure no.5 of the complaint which means that the alleged infection was not detected in the first two MRI which also means that the complainant did not receive the alleged infection from the opposite parties. Further, the same was detected on 1.12.2016 i.e. the 3rd MRI wherein it was stated MRI with contact done 1.12.2016 which shows some sign of infective pathology which is clear that the alleged infection was received in the Yatharth Hospital.
The opposites parties beg to rely on the judgment of the Hon'ble NCDRC, New Delhi in, Ravindra Dnyaneshwar Patil & Anr. vs Dr. Vinay Tule & ors. First Appeal no.1291 of 2017, 2017(3) CPR 452 (NC):
The judgments noted above are squarely applicable in the instant case. It is settled legal preposition that, the onus of proving the alleged medical negligence in the treatment or diagnosis lies with the person alleging medical negligence. Therefore, in this case the onus was upon the Complainants/Appellants to prove that the OP was negligent while testing or while recording the results. Admittedly, no doctor was examined by the complainants to comment on the OPs reports as to whether there was any negligence in the procedure ARMS-PCR DNA analysis adopted by the OP. As noted above, in several medical literatures it is observed that even low level of Maternal Cell Contamination (MCC) may interfere with correct molecular diagnosis. Thus, in my view, the complainants have failed to prove any on the part of the OP.
The complainant failed to provide any expert opinion that the alleged infection was the sole cause of the carelessness and negligence of the innocent opposite parties. The opposite parties beg to rely on the judgment of the Hon'ble NCDRC, New Delhi in, Agarwal Orthopedic Hospital & anr. vs. Sandeep Arora & Anr., First Appeal no.484 of 2011, 2017(1) CPR 735 (NC),:
6. Thus, there was no expert opinion available to the State Commission to prove either that the rod implanted in the hand of the complainant or the screws used for implanting the said rod were oversized. Also, there was no expert evidence suggesting any defect or deficiency in the procedure whereby the said rod was implanted in the hand of the complainant. In the absence of such an expert opinion, the State Commission, in my view, was not justified in awarding compensation to the complainants..... . Only after examining the above referred experts, the State Commission would have been in a position to find out whether there was any negligence or deficiency on the part of the appellant in rendering servicing to the complainant or not......
7. For the reasons stated hereinabove, the impugned order is set aside.....
The opposite parties conducted the surgery with due care and precaution and also in a controlled environment. The OP no.1 duly informed the complainant and the complainant's father about the Nucleoplasty with Annuloplasty and also advised the complainant to take proper care and precaution after the surgery.
It is pertinent to mention here that the complainant re-visited the OP no.1 on 15.11.2016 and informed the OP no.1 that the pain in the complainant's back persisted post-surgery and is not fully cured and the same is gradually decreasing. After diagnosing the complainant's alleged problem the OP no.1 prescribed certain medicines and asked the complainant to re-visit for the follow up checkup. But the complainant visited the OP no.1 on 16.11.2016 with high fever and the OP no.1advised the complainant to go for a MRI spine, on seeing the MRI report the complainant was normal and there was no infection detected. But still the OP no.1 admitted the complainant in the hospital for observation and on 18.11.2016 the complainant informed the OP no.1 that he is feeling better and requested the OP no.1 to discharge the complainant from the hospital.
It is pertinent to mention here that the complainant was admitted at OP no.2 on 16.11.2016 and later on 18.11.2016 the complainant informed the OP no.1 that the complainant is feeling better and requested the OP no.1 to discharge the complainant from the hospital. Further, it is also pertinent to mention here that when the complainant's father took the complainant to Our Lady Grace Hospital, Sardhana where the complainant alleged that after diagnosis by Our Lady Grace Hospital, it came to know that the complainant is suffering from bacterial sepsis, as stated by the complainant in the instant para. ... where it was diagnosed that the complainant is suffering from bacterial sepsis which could have only occurred at the time of the surgery performed by OP no.1.. Thus, it is evident that the work could shows the probability but not surety that the bacterial sepsis occurred as a result of the surgery performed.
The complainant has failed to provide any test reports which show that the complainant is suffering from bacterial sepsis and as per the discharge slip as annexed as annexure no.5 in the complaint which shows the result as condition improved and also as per the certificate dated 20.11.2016 issued by Dr. Sandeep Rana it is stated that ... based on investigation patient is diagnosed bacterial sepsis .... , which means that the Dr. Sandeep Rana did not diagnosed the patient correctly. As per the course during hospital stay it is clearly mentioned that the ...now patient is being discharged in stable condition .
It is pertinent to mention here that the OPs are at no fault and were not negligent while conducting the surgery and the alleged infection did happen from OPs which is evident from the MRI report dated 17.11.2016. Therefore, the onus to prove that there was a gross medical negligence on the part of the OPs is on the complainant to prove the same.
In Ashok Kumar Patham v. Dr. Swarnava Roy & anr, Revision Petition no.1316 of 2016, 2017(1) CPR 251 (NC):
ASHOK KUMAR PATHAK V. DR. SWARNAVA ROY JUSTICE V.K.JAIN, PRESIDING MEMBER (ORAL)
3. The only question which arises for consideration in this petition is as to whether the respondents were negligent or deficient in rendering services to the petitioner/complainant while performing the Open Pyelolithotomy on 14.08.2010. No expert opinion was produced by the petitioner/complainant, to prove any negligence or deficiency in the performance of the aforesaid procedure by the respondents. ...... . Since the onus of proving the alleged negligence on the part of the respondents was upon the petitioner/complainant, he ought to have proved either by examining a medical expert or by producing the relevant medical literature that the formation of a new stone was not possible within a period of ten months of his discharge from the hospital. The said onus having not been discharged by him, the petitioner/complainant failed to prove the alleged negligence on the part of the respondents in performing open Pyelolithotomy of his left kidney. Moreover, had any stone been left during the procedure performed on 14.08.2010, it would have appeared in the X-Ray done on 24.09.2010, more than one month after the procedure. Therefore, I have no good reason to interfere with the concurrent finding of fact returned by the Fora below, filed by the petitioner/complainant in this regard. The revision petition being devoid of any merits, is hereby dismissed with no order as to costs.
We have heard the learned counsel for the complainant Mr. Asif Anees and learned counsel for the opposite parties Mr. Imran Aasim of Mr Rishi Singh and perused the pleadings, evidences and documents on record.
The complainant was firstly diagnosed as having prolapsed Disc L4 L5 S1 , also known as slipped disc. The treatment for it has been started but the complainant did not get any relief. The complainant visited again to the opposite party-1who advised for Neucloplasty clubbed with Annuloplasty. First we have to see the slipped disc and thereafter Neucloplasty clubbed with Annuloplasty.
The L4-L5 Disc Bulge & Disc Herniation Herniated and bulging disc at the lower back is most common at the L4-L5 segment or level. The L4-L5 is situated at your belt line. It is responsible for 95% of bending and twisting motions involving the waist. Moreover, it the most heavily burdened spinal segment, as they provide load-bearing functions that support the upper body. Due to the excessive stress placed on it, the L4-L5 section is a common site for spinal disc bulges, herniations, protrusions, prolapses, extrusion, and fragmentations. This article will provide in-depth information on the L4-L5 spinal segment to help you understand your condition and what you can do to recover fully without surgery or injections.
The L4-L5 spinal segment is a common cause of acute and chronic lower back pain (backaches). An L4-L5 disc bulge can impinge nerves that run down the legs, causing sciatic-like symptoms. A slipped disc is one of the most common causes of a pinched nerve. An L4-L5 disc bulge or slip-disc (slipped disc) pinches and leads to serious health issues, including impotence, reproduction issues, infertility, loss of bowel and bladder control, or paralysis in one or both legs. A pinched nerve at the L4-L5 level can also occur from bone-spurs (spondylosis) or ligament thickened (hypertrophy of ligamentum flavum).
This article provides in-depth information on the L4-L5 segments and the common conditions that arise from them. Regardless of the cause, an L4-L5 spinal segment is treatable without surgery or injection. The key to recovery is accurate diagnosis followed by corrective treatments that focus on the problem's root cause. Let's start with some general information on the low back (lumbar spine) before starting on disorders and treatment options.
The Function Of The Lumbar Spine The lumbar spine is also referred to as the lower back. It is a complex structure. There are a total of 5 vertebral bones in the lumbar spine. Each is attached to an intervertebral: working closely with surrounding muscles, joints, and nerves to provide a dynamic range of movements and weight-bearing. The L4-L5 spinal disc is the second-lowest disc space, and the lowest segment is the L5-S1. The L4-L5 spinal segment is the most critical of all the lower back segments as it accounts for 95% of bending at the waist. It is no accident that most back pain patients present with L4-L5 disc bulge disorders.
A herniated disc is the leading cause of spinal canal stenosis and disability. It also has a higher chance of undergoing degenerative changes and eventual disc herniation (slip disc or slipped disc). Let our expert clinical non-surgical teams provide you with the exceptional care you need today.
How The Spinal Disc Gets Damaged?
Intervertebral discs are composed of two essential parts, the annulus fibrosis on the outer rim and the nucleus pulposus in the inner portion. However, repetitive trauma, constant axial loading of the spine, injury, or weakness of the lower back muscles can cause the inner part (nucleus pulposus) to protrude through the outer ring. This can result in different types of slipped disc, such as disc bulge, disc herniation, prolapsed disc, or sequestrated disc, extruded disc, and fragmented disc.
A slipped disc can causes impingement on the exiting nerve root or nerve roots. An L4 disc herniation can impinge multiple traversing nerve roots in severe cases: L5 and even the S1 nerve root. In other words, one slip disc can pinch several nerve roots and even the spinal cord. Nerve root impingement and spinal cord compression are the main reasons why so many opt for L4-L5 surgery. However, before providing information on an L4-L5 operation or other forms of spine surgery or lumbar fusion, we like to go over some of the common symptoms associated with an L4-L5 nerve root impingement.
Common Problems Involving The L4-L5 Spinal Segments To help you understand the cause of your low back pain, we have listed some of the most common disorders that involve the L4-L5 spinal segments include:
Muscular and ligamentous disorders Disorders of the spinal joint or facet joints Slipped disc (slip-disc) Spondylolisthesis Spondylosis Spinal canal stenosis Foraminal stenosis Muscle & Ligament Disorders At L4-L5 Injury, damage, or disorders of the ligamentum flavum are common muscular and ligamentous issues that cause concern. Muscular and ligamentous issues involving the L4-L5 segments are relatively common. They are present in almost all persons over the age of 40. However, having muscles or ligament issues alone will not cause significant pain. A muscular or ligamentous source of back pain occurs when they are damaged. Ligamentum flavum is a ligament with muscle characteristics. In other words, it has contractile abilities. Damage to ligamentum flavum leads to hypertrophy of ligamentum flavum that compresses the nerve and spinal cord.
Spinal Joint Disorders As mentioned, the L4-L5 spinal segment is the most mobile and most burdened in the lower back. Moreover, the weight-bearing activities during sitting put excessive burdens on these segments' joints. Spinal joints or facet joints of the spine are lined with cartilage that contains synovial membranes. Stress during standing or sitting can lead to inflammatory changes where fluids accumulate within the joints. Excessive accumulation of fluids is the leading factor in joint degeneration (facet hypertrophy) and bone spurs (arthritis).
L4-L5 Slip-Disc (Slipped Disc) Bulging, herniated, protruded, and prolapsed discs are medical terms implying a slipped disc or slipped disc--an L4-L5 slip-disc results when the spinal disc at L4-L5 degenerates or wears out. The most common site for spinal disc degeneration, disc bulge, and the slipped disc is the L4-L5 segment. AN L4-L5 slip disc (herniated or bulged) can impinge (compress) the thecal sac (spinal cord fibers) and spinal nerves. The slightest amount of compression or impingement on a nerve or spinal cord fibers is significant. Nerve compression is significant because it causes nerve degeneration. The degenerative changes within a nerve are the leading reason for nerve pain, weakness, and paralysis.
A compressed nerve can result from a slipped disc, bone-spur, spinal misalignment (subluxations), spondylolisthesis, and ligamentous issues (hypertrophy of ligamentum flavum). Bone-spurs (arthritis and spondylosis) are the second most common cause of a compressed nerve. Regardless of the cause, compressed nerves need urgent attention, especially at the L4-L5 segment of the lower back.
Spondylolisthesis At L4-L5 An L4-L5 spondylolisthesis is a congenital or, at times, an acquired condition (degenerative spondylolisthesis) where one vertebra slips forward to the vertebrae below. The slippage of one vertebra on the other (spondylolisthesis) is graded based on its severity.:
A grade I spondylolisthesis: forward slippage of less than 24% Grade II spondylolisthesis: Slippage of 25-49% Grade III spondylolisthesis: Slippage of 50-74% And A Grade IV spondylolisthesis: slippage of over 75% Spondylolisthesis is always present with co-condition. The most common co-conditions associated with spondylolisthesis are:
Hypertrophy of ligamentum flavum: Thickening of a spinal ligament within the canal Facet Hypertrophy: Bone spurs and arthritis Disc Degeneration: Wear and tear of spinal discs Joint Degeneration: Wear and tear of spinal joints Spinal canal stenosis: Shrinkage in the spinal canal size Foraminal Stenosis: Shrinkage of the holes where spinal nerves come out As you can see, spondylolisthesis can become quite a problem. Spondylolisthesis at the L4-L5 spinal segment can cause carrying degrees of back pain, leg pain, and sciatica. It may also cause weakness in the legs, loss of bowels and bladder control, reproductive issues, and paralysis. Both degenerative and the acquired forms of spondylolisthesis are treatable without surgery.
What Is An L4-L5 Spondylosis?
Spondylosis is a relatively loose term describing spinal disc and spinal joint disorders leading to nerve root irritation. The L4-L5 segment is a common site of spondylosis. Symptoms of spondylosis at the L4-L5 vary. Symptoms depend on the severity of nerve compression resulting from spondylosis. However, having no pain does not mean that you have no spondylosis. For most, spondylosis is asymptomatic (cause o pain) until later stages. We have provided common symptoms often seen with varying degrees of spondylosis at L4-L5 below:
Mild L4-L5 spondylosis causes back pain.
Moderate L4-L5 spondylosis cause back pain, pain in the buttocks, hips, thighs, leg, or feet. It may also cause numbness, tingling, or weakness in the leg, feet, or toes.
Severe L4-L5 spondylosis causes intense back pain, weakness in legs, bladder and bowel disorders, erectile dysfunction in males, and female reproductive issues. If neglected, it will lead to partial or complete paralysis.
What Are The Dangers Of An Canal Stenosis At The L4-L5 Level?
Spinal stenosis is a common cause of pain and disability. The L4-L5 level is the most common site for spinal canal stenosis in the lower back. Spinal stenosis results from premature wear and tear of spinal joints, muscles, ligaments, and spinal discs. The shrinkage or stenosis of the spinal canal is a progressive disorder. What this means is once the shrinkage starts, it progresses.
The danger with progression is complete or partial impairment of nerves or spinal cord. Any reduction of the spinal canal is a cause for concern, especially if the reduction is at the L4-L5 level. They concern us because it leads to weakness or paralysis of lower limbs, impotence, infertility, and loss of bowel and bladder control-- Common sites of spinal canal stenosis.
L4-L5 Foraminal Stenosis Canal stenosis refers to shrinkage of the spinal canal (housing of the spinal cord). Foraminal stenosis refers to the narrowing of the opening between spinal segments. The opening (foramina) shrinks with spinal disc degeneration, joint degeneration (facet hypertrophy), ligamentous issues (ligamentum flavum hypertrophy), or bone spurs (arthritis). Foraminal stenosis at L4-L5 is the leading cause of back pain, sciatica, leg pain, numbness, and weakness in the legs.
Symptoms Of Lumbar Spinal Segment (L4-L5) Most patients may experience lower back pain that radiates to one side of the lower limb or even both sides. Tingling, numbness (pins and needles), and an aching or burning sensation in the leg and on top of the foot are widespread. In severe cases, an L4-L5 slipped disc leads to weakness in the legs or feet. Some may even have an inability to walk, leading to an inability to stand. Those who cannot walk or stand may have a condition called foot drop.
Patients with footdrop frequently present with a high steppage gait where they exaggeratedly raise the thigh while walking as if they are climbing the stairs. They also have a slapping gate, where the foot strikes the ground as they walk. A drop foot is a severe condition resulting in damage or degenerative changes in the nerves that control leg and foot movements. The degree of injury is relative to the severity of a slipped disc. Therefore, those with a slipped disc should do their utmost best to obtain the needed non-surgical care as soon as possible. While surgeons recommend surgery for foot drop, we recommend our conservative treatment through collaborative chiropractic and physical therapy (physiotherapy).
What Are The Best Treatment Options For L4-L5?
Of course, the best option is a non-surgical route. Acute lower back pain or chronic lower back pain treatment is always better with nonsurgical treatments as provided by our comprehensive methods. The best targeted, extensive measures for lumbar discs of acute or chronic nature are integrative chiropractic, physical therapy, and physiotherapy.
Chiropractic Specialty Center® offers combined treatments from clinical and experts teams of chiropractors and physiotherapists. Our physio-zone provides focused L4-L5 physiotherapy through manual or highly specialized machines. The care you will get from our chiro-zone will include spinal adjustments and flexion-distraction therapy. Therapy devices such as spinal decompression therapy, shockwave therapy, high-intensity laser therapy are among some of what you will get at our physio-zone.
Chiropractic treatment of the L4-L5 or L5-S1 consists of the realigning of malpositioning spinal segments, stabilizing joints, and depressurizations of spinal discs. The best and most effective treatment for L4-L5 slipped disc is through a non-rotatory method of chiropractic.
Rotatory chiropractic adjustments such as Gonstead or Diversified can further damage a slipped disc. As such, our chiropractors provide treatments through an Activator. The Activator is the best and most targeted chiropractic treatment for acute lower back pain or chronic lower back pain.
L4-L5 Treatment At Our Chiro-Zone & Physio-Zone our chiro and physio-zones provide precision treatment and therapies for the L4-L5 that are impossible at competing centers. Our methodology and technology for the L4-L5 segments enable our clinical teams to provide you efficacious non-invasive therapies that fix and repair the actual cause of an L4-L5 problem. Best of all, the care you get is holistic and natural without any side effects.
Physical therapy (physiotherapy) involves manual procedures provided by physical therapists or physiotherapists. Manual methods such as joint mobilizations, soft tissue mobilizations, and strengthening programs are integral to physical therapy treatment at our physio-zone. Physiotherapy is the process of providing treatments through therapeutic devices specific to the spine. In our centers, our patients receive both physical therapy and physiotherapy. We provide targeted spinal rehabilitation at our physio and chiro-zones in addition to physiotherapy and physical therapy treatments.
Our combined collective and collaborative nonsurgical treatments incorporate the best principles of lumbar disc treatments as provided through chiropractic, physical therapy (physiotherapy), and breakthrough devices (the RxDecom®) through the NSD Therapy® To summarize, NSD Therapy® is the gold standard in conservative treatments for acute or chronic lower back pain.
Can Pressure On The Nerves From A Slipped Disc Be Relieved Through Non-Surgical Treatments?
The L4-L5 Lumbar disc often places varying degrees of pressure on the nerves when they bulge, herniate or protrude. In other words, a slipped disc or slip-disc can impinge or put significant amounts of pressure on the nerves that exit the spine. Spine surgeons often attempt either destroying the nerve through a Radiofrequency Ablation (RFA or RF Neurotomy) or other forms of spine surgery to alleviate the pressure on the nerves. However, surgical interventions have not proven well in the long term. Sufferers who sought surgical interventions for an L4-L5 disc often return for additional surgeries.
Pressure on the nerves from herniated, bulging, or extruded lumbar discs are best treated without surgery. In our center, our primary goal is to take away the pressure on the nerves by correcting issues that led to nerve impingements or nerve pressure (pinched nerves). Our non-surgical treatments for the L4-L5 are not patches that spine surgeons offer. They fix the damaged joints, muscles, ligaments, and lumbar discs through our nonsurgical treatments.
Should You Opt For L4-L5 Spine Surgery?
L4-L5 lumbar fusion or minimally invasive spine surgery is not as effective as some would have you believe. Spine surgery is just that: surgery So, when they use terms such as minimally invasive spine surgery, they decrease your surgical fears by making it sound minimalistic. In other words, it is a play-on-words. Ye, it is not as intense as fusion surgery (lumbar fusion), bone graft, discectomy, foraminotomy, or laminectomy, but invasive. Even the most minimally invasive spine surgery carries risks and, as such, is better avoided, especially when effective conservative measures are available right here in town. It is just that simple We are even opposed to an l4-L5 spinal injection, such as steroidal injections at the L4-L5. Steroidal injections or any other type of injection into the spine have complications. Besides, under the best scenarios, spinal injection only provides limited improvement. But, the failure rate and risks of complications are even higher when it comes to spine surgery. Steroidal injections, facet joint injections, and spine surgery are invasive means that offer short-term gains. Our advice is to opt for nonsurgical treatments from our clinical experts.
The L4-L5 spine surgery, like the steroidal injections, is a temporary solution, often requiring additional surgical interventions. So, they are not the fix; some would have you believe. If you have a lumbar spine condition for which the surgeons recommend surgery, call our center. Visit our clinical research-based teams for effective chiropractic and physiotherapy (physical therapy) options enhanced with spine-specific technology. We have helped thousands of patients that the surgeons recommended lumbar surgical intervention. We are confident that our non-surgical treatments will provide you with better options when compared to an L4-L5 surgery.
DISC Nucleoplasty & Annuloplasty What is Disc Nucleoplasty & Annuloplasty?
In both cases of bulging and herniated disc, the spinal disc puts pressure on a nerve root or the spinal cord and causes back pain or sciatic pain.
Minimally invasive. Maximum performance Disc Nucleoplasty (and Annuloplasty) is an outpatient, minimally invasive percutaneous approach to disc decompression that is localised and controllable. Disc decompression has been shown to be effective in treating symptomatic patients with back pain associated with contained herniated discs.
With the shrinkage of the gelatinous disc nucleus (and annulus), the bulging disc retracts, the compressed nerve is released, resulting in the pain subsiding.
Disc Tissue Removal with Radiofrequency Energy Disc Nucleoplasty and Annuloplasty features patented coblation technology, which uses bipolar radiofrequency energy to remove tissue via plasma molecular dissociation.
Coblation uses radiofrequency energy to excite the electrolytes in a conductive medium such as saline solution, creating a precisely focused plasma. The energized particles in the plasma have sufficient energy to break down molecular bonds, excising or dissolving soft tissue, such as the Disc nucleus, at relatively low temperatures (typically 40oC to 70 o C), thereby preserving the integrity of surrounding healthy tissue. The result of coblation is a portion of the nucleus tissue is gently removed, decompressing the herniated disc.
Performed in an outpatient setting, Disc Nucleoplasty uses a needle that emits radio waves to shrink a disc bulge by dissolving excess tissue. This shrinkage of the disc bulge relieves the pressure inside the disc and on the nerves responsible for causing pain. The procedure should take less than one hour.
Over 35,000 patients have been treated to date with no unresolved complications.
How is Disc Nucleoplasty done?
You will be awake during the procedure to provide important feedback to the physician, but you will be under a sedative to diminish your anxiety and any discomfort.
After you are in position on the table, your lower back will be numbed with a local anaesthetic.
Under fluoroscopy(X-ray) guidance, a small, tube-like needle is placed into the centre of the bulged disc.
A small, specialised wand is inserted through the needle, where it is heated to create a series of channels within the disc by dissolving excess tissue.
The wand will then be slowly withdrawn to its original position while thermally sealing the new channel.
You will be closely monitored during your procedure.
The number of channels created is dependent on the disc size. At the end of the procedure, the wand and needle will be removed.
A small bandage will be placed over the needle insertion site, and you will take a short rest until you are ready to go home.
Adult supervision is necessary for the remainder of the day because of sedation effects.
You will receive general activity and rehabilitation guidelines.
You may experience symptoms for 7-10 days until the disc begins to heal.
Prescription medications may be given to relieve these symptoms.
Complications are rare, but we encourage you to keep track of any symptoms you experience after the procedure and report them to your physician at your follow-up visit 7-14 days after the procedure.
A full course of physical therapy will help you to fully recover, strengthen your back and core muscles, and maximise your recovery.
Which works better: Disc Nucleoplasty or Microdiscectomy?
It depends on the nature of the protrusion. A recent study analysed the effectiveness of microdiscectomy on different herniation types found that microdiscectomy performed poorly in patients with contained herniations with no sub-anular fragment, producing high rates of persistent post-operative sciatica, re-herniation and reoperation. The study concluded that the treatment of anular prolapses with no discrete fragments by means of conventional anulotomy and limited discectomy was unsatisfactory. These contained disc herniations are ideal candidates for the disc nucleoplasty procedure.
Is Disc Nucleoplasty & Annuloplasty the same as IDET?
No. Disc Nucleoplasty is a percutaneous Disc decompression, using a bipolar radiofrequency coblation plasma device to remove tissue from the nucleus and decompress the disc. A study showing disc decompression with coblation plasma technology was published in the April 2003 issue of Spine . IDET (Intradiscal Electrothermic (or electrothermal) Therapy) uses conductive heating to treat the anulus of the disc to perform annuloplasty and does not remove tissue. Disc Nucleoplasty treats symptoms arising from contained Disc herniation(bulging). IDET seeks to treat symptoms arising from DISC degeneration (wearing away).
In this case has been mentioned that the patient done and sepsis. So we should know what the sepsis is?
What Is Sepsis?
Sepsis is when your body has an unusually severe response to an infection. It's sometimes called septicemia.
During sepsis, your immune system, which defends you from germs, releases a lot of chemicals into your blood. This triggers widespread inflammation that can lead to organ damage. Clots reduce blood flow to your limbs and internal organs, so they don't get the nutrients and oxygen they need.
In severe cases, sepsis causes a dangerous drop in blood pressure. Doctors call this septic shock. It can quickly lead to organ failure, such as your lungs, kidneys, and liver. This can be deadly.
Sepsis Causes and Risk Factors Bacterial infections are most often to blame for sepsis. But it can also happen because of other infections. It can begin anywhere bacteria, parasites, fungi, or viruses enter your body, even something as small as a hangnail.
An infection of the bone, called osteomyelitis, could lead to sepsis. In people who are hospitalized, bacteria may enter through IV lines, surgical wounds, urinary catheters, and bed sores.
Sepsis is more common in people who:
Have weakened immune systems because of conditions like HIV or cancer or because they take drugs such as steroids or those that prevent rejection of transplanted organs Are pregnant Are very young Are elderly, especially if they have other health problems Were recently hospitalized or had major surgeries Use catheters or breathing tubes Have diabetes Have a serious medical condition such as appendicitis, pneumonia, meningitis, cirrhosis, or a urinary tract infection Sepsis Symptoms Because it can begin in different parts of your body, sepsis can have many different symptoms. The first signs may include rapid breathing and confusion. Other common symptoms include:
Fever and chills Very low body temperature Peeing less than usual Fast heartbeat Nausea and vomiting Diarrhea Fatigue or weakness Blotchy or discolored skin Sweating or clammy skin Severe pain Sepsis Diagnosis Your doctor will do a physical exam and run tests to look for things like:
Bacteria in your blood or other body fluids Signs of infection on an X-ray, CT scan, or ultrasound A high or low white blood cell count A low number of platelets in your blood Low blood pressure Too much acid in your blood (acidosis) A lack of oxygen in your blood Problems with how your blood clots Uneven levels of electrolytes Kidney or liver problems RELATED Sepsis Treatment Your doctor will probably keep you in the hospital's intensive care unit (ICU). Your medical team will try to stop the infection, keep your organs working, and manage your blood pressure. IV fluids and extra oxygen can help with this.
Broad-spectrum antibiotics may fight infections caused by bacteria early on. Once your doctor knows what's causing your sepsis, they can give you medicine that targets that specific germ. Often, doctors prescribe vasopressors (which make your blood vessels narrow) to improve blood pressure. You could also get corticosteroids to fight inflammation or insulin to keep control of your blood sugar.
If your case is severe, you might need other types of treatment, like a breathing machine or kidney dialysis. Or you may need surgery to drain or clean out an infection.
Sepsis Complications As sepsis gets worse, it causes more problems throughout your body. These may include:
Kidney failure Dead tissue (gangrene) on fingers and toes, leading to amputation Lung, brain, or heart damage A higher risk of infections over time Sepsis can be deadly in between 25% and 40% of cases.
Sepsis Prevention Preventing infection is the best way to prevent sepsis. Take these steps:
Wash your hands often with soap and water for at least 20 seconds each time.
Keep up with recommended vaccines for things like flu and chickenpox.
Keep control of any chronic health conditions.
If you have an injury that's broken your skin, clean it as soon as possible. Keep it clean and covered as it heals, and watch for signs of infection.
Treat any infections. Get medical care right away if they don't get better or if they seem like they're getting worse.
It is clear that the complainant was first admitted to the opposite party hospital on 07.11.2016 and discharged on 08.11.2016. Again when the complainant did not get relief from pain and also developed some ailments, he again visited the opposite party - 2 and he was admitted on 16.11.2016 and discharge on 18.11.2016. As there was no improvement even after the treatment of opposite party - 1, the complainant went to another hospital at Sardhana. We have seen the prescription dated 26.11.2016 of this hospital which is scanned here in below. In this prescription it has been written bacterial sepsis .
The concerned hospital has written a note which is also scanned hereinbelow for ready reference. This is of 26.11.2016 and in it it has been clearly mentioned that based on investigation patient is diagnosed Bacterial Sepsis . It has also been written that the patient was admitted in his hospital from 21.11.2016 till 26.11.2016.
Thus it is clear that after discharge from the opposite party hospital on 18.11.2016, the complainant visited the above-mentioned hospital on 21.11.2016 and he was admitted there till 26.11.2016 and diagnosed as bacterial sepsis. In that hospital no operation was performed on the complainant. It clearly Establishment the fact that this infection has come from the first operation which was performed in the hospital of the opposite party. There are so many risk in the hospital and it is better to mention the risk here.
Hospitals Risks Its a fact of life: people checking into the hospital face risks. Expecting to get better, some actually wind up getting worse.
Weve all heard the horror stories about hospital risks after surgery. Theres the danger of medical complications, like bleeding or infection. Then there are the human errors, like getting the wrong drug or dosage. Even though youve got a lot of well-trained people in a hospital working very hard, theyre still people, says Fran Griffin, RRT, MPA, a director at the Institute for Healthcare Improvement in Cambridge, Mass. And people sometimes make mistakes.
All these hospital risks can seem far beyond your control. It can leave you feeling pretty helpless.
But experts say thats not the case. Patients are just too passive when they check into the hospital, says Peter B. Angood, MD, vice president and chief patient safety officer of the Joint Commission in Oakbridge Terrace, Ill. According to Angood and other experts, taking an active role in your health care can reduce many of these hospital risks. While you might feel out of control when you go into the hospital, youre really not.
So what can you do to cut your risks? Heres a list of the six top hospital risks and more importantly what you can do to avoid them.
Hospital Risk No. 1: Medication Errors Far and away, the most serious hospital risk is a medication error, says Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ) in Rockville, Md. All it takes is for someone to miss a decimal point and you could have a life-threatening mistake.
A 2006 report from the Institute of Medicine estimated that every year, there are 450,000 injuries resulting from medication errors in hospitals, and perhaps many more that are unreported. Whats especially frightening about these hospital risks is they seem completely beyond your control. How would you even know what medicines you need, or how much, or how often? How can you stop a doctors poor handwriting on a prescription from being misread by a pharmacist or nurse?
But there are things you can do to reduce this hospital risk. Before surgery, you need to make sure that your doctor, your surgeon, and everyone else involved in your care know about every single medicine whether prescription, over-the-counter, or herbal supplement that you use. To make it easier, you can just stick all of your medicines in a bag and bring them to the hospital.
Then, after surgery, ask questions. When a nurse comes to give you medicine, ask what it is and why you need it, says Dale Bratzler, DO, MPH, medical director at the Oklahoma Foundation for Medical Quality in Oklahoma City. Make sure the nurse checks your ID bracelet against the name on the prescription.
If you ever feel like somethings wrong, you have to speak up,says Griffin. Shes talked to nurses who said that they were about to administer the wrong medication or dose and were only stopped because the patient asked them to double-check. Just by saying something, they averted what could have been very serious medication errors,Griffin says.
Hospital Risk No. 2: MRSA and Other Hospital-Acquired Infections Another top hospital risk is infection with bacteria or a virus. Hospitals are loaded with nasty bugs. According to the CDC, there are 1.7 million health-care-associated infections every year; 22% are infections of surgical wounds. Even more - 32% - are urinary tract infections. The rest are infections of the lungs, blood, and other parts of the body.
One of the most frightening hospital infections you can pick up is MRSA (methicillin-resistant Staphylococcus aureus) a type of staph infection thats resistant to many antibiotics. A 2007 study by the Association for Professionals in Infection Control and Epidemiology (APIC)suggested that almost one out of every 20 hospital patients is either infected with MRSA or carries it.
The risk of MRSA is growing, says Clancy. Its getting more common and more resistant to antibiotics.
So what can you do? First, ask whether youll be getting antibiotics before and after surgery to lower your risk. Then after surgery, the best protection is simple: dont let people touch you until you have seen them wash their hands. That goes for everyone including doctors and nurses.
Now of course, you might feel intimidated by the idea of scolding your doctor for their bad hygiene. But experts say that your doctor or nurse shouldnt have any problem with it especially if you ask nicely.
Hospital Risk No. 3: Pneumonia Although some might think of pneumonia as a minor complication, it can be quite serious. After urinary tract infections and wound infections, its the most common hospital acquired infection. According to the CDC, estimates of hospital pneumonias mortality rate are as high as 33%. Its most common in people who are in the intensive care unit or on ventilators.
Pneumonia is a common hospital risk after surgery for several reasons. During recovery, you might naturally take shallow breaths, since youre on your back and breathing deeply may be painful. After surgery, many people also have a partial collapse of the lung tissue called alectasis which further weakens lung function. All of this can make it easier for bugs that cause pneumonia to gain a foothold.
So what are some ways to avoid this hospital risk? Deep breathing is one. I recommend that people try to take 10 to 15 really big breaths every hour, says Angood. If you smoke, you should quit or at least stop for a week or two before surgery, says Clancy. Just a short break can make a big difference in the health of your lungs.
Aspiration pneumonia has a more specific cause. It develops when you breathe in fluids, like vomit. This can happen after anesthesia because your normal coughing reflexes may be suppressed. The best way to avoid this type of pneumonia is to follow your doctors advice about not eating or drinking after midnight the day before your surgery. If you dont have anything in your stomach to vomit up, the danger of aspiration pneumonia is quite low.
Hospital Risk No. 4: Deep Vein Thrombosis (DVT) DVT, it clearly ranks as one of the more significant risks after surgery, Clancy tells WebMD.
DVT or deep vein thrombosis is the development of a blood clot, typically deep in the veins of the leg. If the clot breaks free and travels through the bloodstream, it can get lodged in the arteries of the lungs, cutting off the bloods supply of oxygen. This complication, called a pulmonary embolism, can be fatal.
Surgery significantly increases your risks of DVT for several reasons. If youre immobile in bed, your circulation gets worse. That makes the blood more likely to pool and clot in your legs. Also the blood vessels in your legs can become very relaxed during the anesthesia used for surgery and the blood can slow down its movement enough to form a clot, especially if the vessel has had prior damage (for example, by way of a previous history of a broken leg) . The trauma of surgery itself also increases the bloods clotting tendency.
Without preventative treatment, the odds of getting DVT after a prolonged major surgery are 25%. For some surgeries, like joint replacement, the odds of DVT are more than 50%.
Fortunately, careful use of blood thinners can slash the risk of DVT without increasing your risk of bleeding. But as effective and safe as this preventative treatment is, studies have shown that these precautions are often ignored. So you should always ask about it.
Never be afraid to ask about the risk of DVT after your specific surgery, says Angood. Ask whether you will be getting preventative treatment and for how long.
Another method of DVT prevention is something you can do on your own. The sooner you can start moving around, the lower your risk of DVT, Clancy says. Stretching and when your doctor gives you the OK, getting up and walking will get your circulation back to normal.
Hospital Risk No. 5: Bleeding After Surgery While clotting is a risk for DVT, uncontrolled bleeding after surgery causes problems of its own. However, theres good news. Bleeding after surgery is not as much of a problem as it once was, Griffin says, thanks to improved surgical techniques. Still, you should make an effort to lower the risks further.
That starts with making certain that your doctor knows every medication vitamins, supplements, or homeopathic medication that you use. Common medicines like the painkillers aspirin and ibuprofen can thin your blood, increasing the risk of bleeding. Your doctor will probably tell you to stop taking any medicine that might have this effect a week or two before surgery, Clancy says.
If you forget and take one of these drugs, say something. Theres a simple blood test that can be done to check if your blood is too thin for surgery, says Griffin. But your doctor might not think to do the test unless you tell him or her.
Also mention if youve ever had excessive bleeding before, even for something minor, like the removal of wisdom teeth. The biggest predictor of serious bleeding after surgery is having bled after surgery before, says Clancy. If your surgeon knows, they can take precautions.
Hospital Risk No. 6: Anesthesia Complications While many patients still worry about anesthesia, experts say that its really quite safe these days. Theres no doubt that the biggest advances in improving surgical safety have been in anesthesiology, Clancy tells WebMD. Theyve made enormous strides.
But while the risk of problems is now low, there are still precautions you should take. First, ask to meet with your anesthesiology team to discuss your options. Some only need a local or regional anesthetic, while others will need full general anesthetic. Go over the benefits and risks of each one.
Although rare, some people have allergies to certain anesthetics. Rare genetic conditions can also trigger anesthesia complications. Its always worthwhile to check and see if any other family members have had a bad reaction to anesthesia, Clancy says. If you suspect you might be at risk, you may have testing done before the surgery.
Speaking Up Lowers Hospital Risks When you're in the hospital, its very easy to feel intimidated. While you lie in bed, groggy and disheveled in a sweaty johnny-coat, you may feel pretty powerless compared to the brisk, lab-coated doctors who appear at your bedside. What could your puny opinion matter to all these experts? It may be tempting to give up control, to lie back and just hope that your doctors and nurses will remember everything.
But you should never give up responsibility for your own health. The advice from all the experts is to pay attention and ask questions.
In the old days, good patients were the ones who didnt make any noise and were grateful, says Clancy. It turns out that those patients dont do so well. The ones who do well are the ones who ask questions.
So to lower your hospital risks, you have to be an active and involved patient. Not only will it give you a feeling of control over your situation, but it may even improve your care. If youre too dazed after surgery to pay attention, your family members should be asking questions on your behalf.
Questioning authority is never easy, says Nancy Foster, vice president of quality and safety policy at the American Hospital Association in Chicago. But remember its your body, your health, and your life. If you ever have questions or concerns about anything during your hospital stay, you have to speak up.
Thus we have seen that there is risk in the hospital because it is not clear whether the neutralize the hospital or option theatre before operation? It also establishes the fact that there was no proper post-operative care in the hospital of the opposite party which is very important part of an operation. The opposite party has said that no infection was found in MRI but the infection was found in third MRI. When the infection has already been diagnosed on 26.11.2016 , there was no need to go further for MRI because MRI is not meant for knowing the infection. It shows the negligence on the part of the opposite party and also deficiency of service. We have to see the post-operative care and what is its importance in the medical field.
Immediate postoperative care:
Now an action arises whether there was proper post-operative care taken by the opposite parties after the operation and after the complication developed in the body of the patient.
Postoperative patients must be monitored and assessed closely for any deterioration in condition and the relevant postoperative care plan or pathway must be implemented.
The NCEPOD (2011) report found that patients whose condition was deteriorating were not always identified and referred for a higher level of care. Patients should be made ascomfortable as possible before postoperative checks are performed.
Postoperative patients are at risk of clinical deterioration, and it is vital that this is minimized. Knowledge and understanding of the key areas of risk and local policies will help reduce potential problems (National Patient Safety Agency, 2007; National Institute for Health and Clinical Excellence, 2007).
Track and trigger or early warning systems are widely used in the UK to identify deteriorating patients. These have been adapted by trusts for adults and children and are based on the patient's pulse and respiratory rate, systolic blood pressure, temperature and level of consciousness. Additional monitoring may include pain assessment, capillary refill time, percentage of oxygen administered, oxygen saturation, central venous pressure, infusion rates and hourly urine output.
The National Early Warning Score (NEWS) was developed by a working party to provide a national standard for assessing, monitoring and tracking acutely and critically ill patients (not for use with children under 16 years or in pregnancy); the intention was that trusts would use it to replace their locally adapted early warning systems (Royal College of Physicians, 2012). Like other early warning systems, NEWS has six physiological parameters:
Respiratory rate;
Oxygen saturation;
Temperature;
Systolic blood pressure;
Pulse rate;
Level of consciousness (this will be impaired in patients who have had recent sedation or are receiving opioid analgesia, which should be taken into consideration in assessment).
The system also includes a weighting score of two, which is added if the patient is receiving supplemental oxygen via a mask or nasal cannulas.
When assessing the postoperative patient using NEWS, it is vital that the patient is observed for signs of hemorrhage, shock, sepsis and the effects of analgesia and anesthetic. Patients receiving intravenous opiates are at risk of their vital signs and consciousness levels being compromised if the rate of the infusion is too high. It is therefore imperative that the patient's pain control is managed well, initially by the anesthetist and then the ward staff and pain team or anesthetist, to ensure that the patient has adequate analgesia but is alert enough to be able to communicate and cooperate with clinical staff in the postoperative period.
Many trusts have yet to implement NEWS, although it is beginning to be taught in pre-registration nursing programmes. Student nurses frequently perform postoperative observations under the supervision of a nurse; it is reassuring that they receive some insight and education as recommended by NCEPOD (2011).
Vital signs;
Vital signs should be performed in accordance with local policies or guidelines and compared with the baseline observations taken before surgery, during surgery and in the recovery area.
Nurses should also be aware of the parameters for these observations and what is normal for the patient under observation. When assessing patients' recovery from anaesthesia and surgery, these observations should not be considered in isolation; the nurse should look at and feel the patient. This also applies to children and should include observation of other signs and symptoms, for example abdominal tenderness or poor urine output, which could indicate deterioration (Royal College of Nursing, 2011). The RCN (2011) provides guidance on vital signs performed post-operatively on children. Many trusts now insist that vital signs are performed manually to provide more accurate recording and assessment.
All vital signs and assessments should be recorded clearly in accordance with guidelines for record keeping (Nursing and Midwifery Council, 2009). Handheld personal digital assistants (PDAs) are used at some trusts to store track and trigger data and calculate early warning scores, which can be accessed by the clinical and outreach teams.
When a patient's condition is identified as deteriorating, this information can be passed verbally to appropriate health professionals using the Situation, Background, Assessment and Recommendation (SBAR) tool advocated by the NHS Institute for Innovation and Improvement (2008).
Airway and respirations Respiratory rate and function is often the first vital sign to be affected if there is a change in cardiac or neurological state. It is therefore imperative that this observation is performed accurately; however, studies show it is often omitted or poorly assessed (NPSA, 2007; NCEPOD, 2005).
Nurses should observe and record the following:
Airway;
Respiratory rate (regular and effortless), rhythm and depth (chest movements symmetrical);
Respiratory depression: indicated by hypoventilation or bradypnoea, and whether opiate-induced or due to anaesthetic gases.
Oxygen therapy Oxygen is administered to enable the anaesthetic gases to be transported out of the body, and is prescribed when patients have an epidural, patient-controlled analgesia or morphine infusion. Nurses should ensure and record the following:
Oxygen therapy is prescribed;
Oxygen is administered at correct rate;
Continuous oxygen therapy is humidified to prevent mucous membranes from drying out;
The skin above the ears is protected from elastic on the mask.
Pulse oximetry Oxygen saturation should be above 95% on air, unless the patient has lung disease, and maintained above 95% if oxygen therapy is prescribed to prevent hypoxia or hypoxaemia. An abnormal recording may be due to shivering, peripheral vasoconstriction or dried blood on the finger.
Nurses should ensure that:
The finger probe is clean;
The position of the probe is changed regularly to prevent fingers becoming sore.
Heart rate, blood pressure and capillary refill time The following should be checked and recorded:
Rate, rhythm and volume of pulse;
Blood pressure;
Capillary refill time to assess circulatory status, along with the colour and temperature of limbs, also identifying reduced peripheral perfusion.
Particular attention should be paid to the systolic blood pressure as a lowered systolic reading and tachycardia may indicate haemorrhage and/or shock, although initially the blood pressure may not drop and will remain within normal limits as the body compensates. Tachycardia may also indicate that the patient is in pain, has a fluid overload or is anxious. Hypertension can be due to the anaesthetic or inadequate pain control.
Body temperature Children, older adults and patients who have been in theatre for a long period are at risk of hypothermia. Shivering can be due to anaesthesia or a high temperature indicative of an infection, while a drop in temperature might indicate a bacterial infection or sepsis.
Patients' temperature should be monitored closely and action taken to return it to within normal parameters.
Use a Bair Hugger (forced-air blanket) and blankets to warm the patient if their temperature is too low;
Choose an appropriate method to cool the patient if their temperature is too high (antipyretics/fanning/ tepid sponging).
Level of consciousness .
Postoperative patients should respond to verbal stimulation, be able to answer questions and be aware of their surroundings before being transferred to the ward and throughout the postoperative period.
A change in the level of consciousness can be a sign that the patient is in shock. The AVPU scale (Box 2) is appropriate for assessing consciousness in adults, children and young people unless they have had neurosurgery (RCN, 2011).
Fluid balance The NCEPOD (2011) found, in 30% of patient data reviewed, there was insufficient recording of postoperative fluid balance. Nurses should observe/undertake and record on the fluid balance chart the following:
IV fluids (colloids and crystalloids used to replace fluid loss postoperatively) and infusions;
Oral intake;
Urine output: catheter urine measurements should not be less than 0.5ml/kg/hour. Oliguria can be a sign of hypovolaemia and should be reported to medical staff immediately. Check that the catheter is not kinked or that the patient is not lying on the tubing if urine output is reduced;
Colour of stoma (where appropriate) and whether there is any bleeding;
Nausea and vomiting: if necessary, administration of antiemetics should be checked and vomit bowls and tissues should be within easy reach of the patient;
Oral care;
Nasogastric tube drainage (aspirate if patient feels nauseous unless otherwise indicated);
Colour and amount of wound drainage: large amounts of fresh blood could be an indication of haemorrhage; if there is no wound drainage, it is advisable to check that the drain has not fallen out.
Intravenous infusions The RCN (2010) and Health Protection Scotland (2012) recommend that peripheral venous catheters (PVC) are checked daily as a minimum, and consideration given to removing any PVC that has been in situ longer than 72 hours (Health Protection Scotland, 2012) or 72-96 hours (Department of Health, 2011).
A phlebitis scale can be used to help assess the PVC site; the Visual Infusion Phlebitis Scale (Jackson, 1998) is frequently used and recommended by the RCN (2010). These national guidelines should be used as resources in caring for PVCs. The following should be checked and recorded:
The PVC site when changing IV fluids, before administering IV medication;
Signs of phlebitis (redness, heat and swelling).
Conclusion The postoperative healthcare team is under constant pressure to discharge patients quickly. This can lead to vital signs being missed and result in a delay in recovery.
Patients can be discharged quickly only when they do not experience any post-operative complications, many of which can be avoided or identified with correct and thorough monitoring of signs and symptoms.
All health professionals must continually update their theoretical knowledge and clinical skills; those working in post-operative care can do this by relying less on electronic equipment and developing their ability to combine the use of assessment tools with good observational skills; feeling, listening for abnormal sounds and closely observing their patients.
There are guidelines issued by World Health Organisation for Post Operative Care - these are Postoperative care Post operative note and orders The patient should be discharged to the ward with comprehensive orders for the following:
• Vital signs • Pain control • Rate and type of intravenous fluid • Urine and gastrointestinal fluid output • Other medications • Laboratory investigations The patient's progress should be monitored and should include at least:
• A comment on medical and nursing observations • A specific comment on the wound or operation site • Any complications • Any changes made in treatment Aftercare: Prevention of complications • Encourage early mobilization:
o Deep breathing and coughing o Active daily exercise o Joint range of motion o Muscular strengthening o Make walking aids such as canes, crutches and walkers available and provide instructions for their use • Ensure adequate nutrition • Prevent skin breakdown and pressure sores:
o Turn the patient frequently o Keep urine and faeces off skin • Provide adequate pain control Discharge note On discharging the patient from the ward, record in the notes:
• Diagnosis on admission and discharge • Summary of course in hospital • Instructions about further management, including drugs prescribed.
Ensure that a copy of this information is given to the patient, together with details of any follow-up appointment .
(WHO/EHT/CPR: WHO Surgical Care at the District Hospital 2003 Postoperative Management) If the patient is restless, something is wrong.
Look out for the following in recovery:
• Airway obstruction • Hypoxia • Haemorrhage: internal or external • Hypotension and/or hypertension • Postoperative pain • Shivering, hypothermia • Vomiting, aspiration • Falling on the floor • Residual narcosis The recovering patient is fit for the ward when:
• Awake, opens eyes • Extubated • Blood pressure and pulse are satisfactory • Can lift head on command • Not hypoxic • Breathing quietly and comfortably • Appropriate analgesia has been prescribed and is safely established (WHO/EHT/CPR: WHO Surgical Care at the District Hospital 2003 ) Post operative pain relief • Pain is often the patient's presenting symptom. It can provide useful clinical information and it is your responsibility to use this information to help the patient and alleviate suffering.
• Manage pain wherever you see patients (emergency, operating room and on the ward) and anticipate their needs for pain management after surgery and discharge.
• Do not unnecessarily delay the treatment of pain; for example, do not transport a patient without analgesia simply so that the next practitioner can appreciate how much pain the person is experiencing.
Pain management is our job.
Pain Management and Techniques • Effective analgesia is an essential part of postoperative management.
• Important injectable drugs for pain are the opiate analgesics. Nonsteroidal antiinflammatory drugs (NSAIDs), such as diclofenac (1 mg/kg) and ibuprofen can also be given orally and rectally, as can paracetamol (15 mg/kg).
• There are three situations where an opiate might be given: o Preoperatively o Intraoperatively o Postoperatively • Opiate premedication is rarely indicated, although an injured patient in pain may have been given an opiate before coming to the operating room.
• Opiates given pre- or intraoperatively have important effects in the postoperative period since there may be delayed recovery and respiratory depression, even necessitating mechanical ventilation.
• Short acting opiate fentanyl is used intra-operatively to avoid this prolonged effect.
• Naloxone antagonizes (reverses) all opiates, but its effect quickly wears off.
• Commonly available inexpensive opiates are pethidine and morphine.
• Morphine has about ten times the potency and a longer duration of action than pethidine.
(continued next page) WHO/EHT/CPR: WHO Surgical Care at the District Hospital 2003) Post operative pain relief (continued) • Ideal way to give analgesia postoperatively is to:
o Give a small intravenous bolus of about a quarter or a third of the maximum dose (e.g. 25 mg pethidine or 2.5 mg morphine for an average adult) o Wait for 5-10 minutes to observe the effect: the desired effect is analgesia, but retained consciousness o Estimate the correct total dose (e.g. 75 mg pethidine or 7.5 mg morphine) and give the balance intramuscularly.
o With this method, the patient receives analgesia quickly and the correct dose is given • If opiate analgesia is needed on the ward, it is most usual to give an intramuscular regimen:
¾ Morphine: - Age 1 year to adult: 0.1-0.2 mg/kg - Age 3 months to 1 year: 0.05-0.1 mg/kg ¾ Pethidine: give 7-10 times the above doses if using pethidine • Opiate analgesics should be given cautiously if the age is less than 1 year. They are not recommended for babies aged less than 3 months unless very close monitoring in a neonatal intensive care unit is available.
In this case when we see the facts of the case it is clear that this case comes under the maxim res ipsa loquitur. Opposite party - 1 and 2 were careless in the treatment of the patient who ultimately suffer from bacterial sepsis. Here circumstances speak themselves that the doctor was careless in toto.
The primary responsibility of a doctor is to ensure they can provide their patients with the best level of care. A talented doctor can perform these tasks efficiently while practising a range of soft skills, such as effective communication. When considering a career in medicine, it may be helpful to know the basic duties a doctor performs daily.
What are a doctors responsibilities?
There are seven key tasks that make up a doctors responsibilities that most perform as part of their daily working routine. The duties of a doctor may vary depending on where they work, the type of doctor they are and the conditions of the patients they treat that day. While there may be some differences in a doctors primary tasks, outlined below are seven common duties that doctors within any speciality can typically perform. These include the following:
Diagnosing any illness and other conditions A Dr is qualified to diagnose a range of illness, injuries, diseases or pains that a patient may be experiencing. The made in several tests on a patient before they reach their final diagnosis to ensure their decision is accurate. They also want to ensure that they can rule other illnesses out the time it takes for a Dr to make a diagnosis depends on what the ailment is and the severity of symptoms that the patient showing. For injuries, doctors can usually make an accurate diagnosis straightaway, whereas diseases or chronic illness may take a few weeks to Dr to detect.
Planning and conducting a patients course of treatment following a diagnosis, a doctor may then plan and prepare a course of treatment for the patient. Individuals in this profession use their technical knowledge and medical research skills to find the quickest and most effective form of treatment. This process may include finding suitable medication, providing care for any external wounds or referring the patient to be more specialised doctor.
A doctor typically discusses their recommended treatment course with the patient to ensure that the individual is happy to proceed. If the doctor is treating a child, they may require the parents permission to conduct the treatment plan.
Any stream follow-up care for patients if necessary if a doctor feels they cannot treat a patient effectively, they may refer the patient to a specialist organisation or healthcare provider. This may occur if a patient is experiencing problems with their teeth, eyes or mental health because a dentist, optometrist or psychiatrist is more likely to find the root of the issue.
The doctor may also ask the patient to make a follow-up appointment with them for a variety of reasons. The reasons may be to check the progress of symptoms, run further tests and administer higher or lower doses of medication. They may also ask patients to arrange a further appointment to discuss any blood test or laboratory results. For the Bulls, the doctor may want to redress bandages and thoroughly cleanse the cut to prevent infection.
Consulting with other healthcare professionals during their working day, a doctor may consult with other healthcare professionals that work at their organisation or a specialist unit. A doctor may ask a nurse practitioner to assist them with running tests or consult with a fellow doctor to gain a second expert opinion on the patients case. If they wish to have a patient admitted to hospital they may communicate with hospital staff via telephone to arrange an appointment on behalf of the patient.
If a patient is experiencing symptoms that are associated with a specific area in medicine, a doctor may contact a specialist unit to consult with a specialist Dr. For example if a patient is complaining of frequent chest pains, a doctor may consult with cardiologist to discuss a suitable treatment plan.
Prescribing medication a doctor is also responsible for prescribing the most effective medicine for a patients symptoms. They may write a prescription for the patient to take with them to a pharmacy or contact the pharmacy directly. Doctors can prescribe medication to either cure illness or offer relief from symptoms. This medication can take various forms, including tablets, gels, creams and liquids.
To ensure the prescribed medication is effective, the doctor may ask the patient to schedule a follow-up appointment. If the medicine has made no improvements to the patients illness, the doctor can then consider other medications or alternative forms of treatment. It is crucial that a doctor is aware of the patients allergies or intolerances before prescribing medication.
Staying updated with medical research A skilled doctor requires a wealth of technical knowledge to identify and treat ailments. As technological and medicinal research progresses, it is responsible to offer doctor to show that they are up to date on the latest advancements in the healthcare industry. This includes researching new diseases, understanding the risks and benefits of new medications and learning how to conduct new procedures.
Now let us see the oath taken be a doctor before entering the nobel profession of the Medical World. As per guidelines of MCI, Every member should get it framed in his or her office it should never be violated in its letter and spirit.
I solemnly pledge myself to consecrate my life to service of humanity.
Even under threat, I will not use my medical knowledge contrary to the laws of Humanity.
I will maintain the utmost respect for human life from the time of conception.
I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.
I will practice my profession with conscience and dignity.
The health of my patient will be my first consideration.
I will respect the secrets which are confined in me.
I will give to my teachers the respect and gratitude which is their due.
I will maintain by all means in my power, the honour and noble traditions of medical profession.
I will treat my colleagues with all respect and dignity.
I shall abide by the code of medical ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002.
I make these promises solemnly, freely and upon my honour.
The complexity of the human body and the uncertainty involved in the medical procedure are of such great magnitude that it is impossible for a Doctor to guarantee a successful result; and the only assurance that he can give, or can be understood to have given by implication is that he is possessed of requisite skill in that branch of profession which he is practising and while undertaking the performance of the task entrusted to him, he would be exercising his skills with reasonable competence. An ordinary physician or surgeon is not expected to be either a clodhopper or feckless practitioner of profession, as much as, he is not expected to be a paragon, combining qualities of polymath or prophet as in the realm of diagnosis and treatment, there is ample scope for genuine difference of opinion; and a Doctor cannot be treated as negligent merely because his conclusion differs from that of other persons in the profession, or because he has displayed less skill or knowledge than others would have shown. The true test for establishing negligence in diagnosis or treatment on the part of a doctor is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would be guilty of, if acting with ordinary care. Furthermore, a golden principle of law has been laid down by the Honble Apex Court in Jacob Mathew Vs. State of Punjab, (AIR 2005 SC 3180) that no sensible professional would intentionally commit an act or omission which would result in loss or injury to the patient as the professional reputation of the person is at stake. A single failure may cost him dear in his career. Even in civil jurisdiction, the rule of res ipsa loquitor is not an universal application and has to be applied with extreme care and caution to the cases of professional negligence and in particular that of the doctors, else it would be counter productive. Simply because a patient has not favourably responded to a treatment given by a physician or a surgery has failed, the doctor cannot be held liable per-se by applying the doctrine of res ipsa loquitor. Yet, another golden principle of law has been laid down by the Honble Apex Court in Indian Medical Association Vs. V.P. Santhas III (1995) CPJ 1 (SC) at para 37 that it is no doubt true that sometimes complicated questions requiring recording of evidence of experts may arise in a complaint about deficiency in service based on the ground of negligence in rendering medical services by a medical practitioner; but this would not be so in all complaints about deficiency rendering services by a medical practitioner. There may be cases which do not raise such complicated questions and the deficiency in service may be due to obvious faults which can be easily established such as removal of the wrong limb or the performance of an operation on the wrong patient or giving injection of a drug to which the patient is allergic without looking into the out patient card containing the warning or use of wrong gas during the course of an anaesthetic or leaving inside the patient swabs or other items of operating equipment after surgery. Furthermore, it has been observed in Malay Kumar Gangulis case (AIR 2010 SC 1162) that charge of professional negligence on a medical person is a serious one as it affects his professional statusand reputation and as such, the burden of proof would be more onerous. A doctor cannot be held negligent only because something has gone wrong. He also cannot be held liable for mischance or misadventure or for an error in judgment in making a choice when two options are available. The mistake in diagnosis is not necessarily a negligent diagnosis. In the instant matter, thus a simple test, in the light of aforesaid observations, needs to be conducted in order to ascertain whether the Doctor is guilty of any tortious act of negligence/battery amounting to deficiency in conducting a surgery in the delivery of child and not properly attending the patient, the complainant and consequently, liable to pay damages for leaving cotton mass in the abdomen / stomach due to failure in surgery and deteriorating condition of the patient.
Now, it is required to be seen whether an expert report is necessary in each and every case relating to medical negligence or not ? It has been observed by the Honble Apex Court in Indian Medical Association Vs. V.P. SanthaIII(1995) CPJ 1 (SC) at para 37 that it is no doubt true that sometimes complicated questions requiring recording of evidence of experts may arise in a complaint about deficiency in service based on the ground of negligence in rendering medical services by a medical practitioner; but this would not be so in all complaints about deficiency rendering services by a medical practitioner. There may be cases which do not raise such complicated questions and the deficiency in service may be due to obvious faults which can be easily established such as removal of the wrong limb or the performance of an operation on the wrong patient or giving injection of a drug to which the patient is allergic without looking into the out patient card containing the warning or use of wrong gas during the course of an anaesthetic or leaving inside the patient swabs or other items of operating equipment after surgery. Furthermore, in B. Krishna Rao Vs. Nikhil Super Speciality Hospital 2010 (V) SCC513 at para 40 the Honble Apex Court was pleased to hold that it is not necessary to have opinion of the expert in each and every case of medical negligence. The Honble Apex Court was pleased to further hold in Nizam Institute of Medical Sciences Vs. Prashant S. Dhananka and others 2009 (VI) SCC 1 that in a case of medical negligence, once initial burden has been discharged by the complainant by making of a case of negligence on the part of the hospital or the doctor concerned, the owner then shifts on 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 .
A doctrine or rule of evidence in tort law that permits an inference or presumption that a defendant was negligent in an accident injuring the plaintiff on the basis of circumstantial evidence if the accident was of a kind that does not ordinarily occur in the absence of negligencea plaintiff who establishes the elements of res ipsa loquitur can withstand a motion for summary judgment and reach the jury without direct proof of negligence-- Cox v. May Dept. Store Co., 903 P.2d 1119 (1995).
In Byrne vs Boadle, this maxim was used for the first time where the complainant was injured by a barrel that dropped from the window of the defendant. In the abovementioned case, Pollock, C. B., said here are many incidents from which no presumption of negligence can arise, but this is not true in every case. It is the duty of persons who keep barrels in a warehouse to take care that they do not roll out and I think that such a case will, beyond all doubt, afford prima facie proof of negligence.
This doctrine intends to help direct the court proceedings to a conclusion, especially if it is established through the implication of this doctrine's rule that the injury caused to the claimant would not have occurred or taken place if the defendant wasn't negligent.This also gives enough cause and evidence to hold the defendant liable for his negligent actions.
The thing speaks for itselfis the gist of the maxim Res Ipsa Loquitur Maxim. What are the essentials of this maxim.
The injury caused to the plaintiff shall be a result of an act of negligence.
There is a lack of evidence, or the evidence presented before the court is insufficient to establish the possibilities of the fault of the plaintiff or third party.
The defendant owes a duty of care towards the plaintiff, which he has breached.
There is a significant degree of injury caused to the plaintiff.
Applicability of Doctrine of Res Ipsa Loquitur.
The maxim of res ipsa loquitur came into force to benefit the plaintiff as he can use circumstantial evidence to establish negligence.
Consequently, it shifts the burden of proof on the defendant, logic being, where there is an event of unexplained cause, usually, the one that does not occur without the defendant's negligence in controlling the action which has caused the injury to the claimant or destroyed his goods.
In this scenario, the court shall presume negligence on the part of the defendant in such a case unless it includes an appropriate explanation compatible with his taking reasonable care.
In Achutrao Haribhau Khodwa and Others vs. State of Maharashtra and Others, it was considered that the maxim should not be applied in the case of general incidences of neglect and shall only be reflected when there is a significant degree of injury caused.
Section 106 of the Indian Evidence Act Section 106 of the Act provides that when any fact is especially within the knowledge of any person, the burden of proving that fact is upon him.
Res ipsa loquitur is a Latin phrase that means the thing speaks for itself. In personal injury law, the concept of res ipsa loquitur (or just res ipsa for short) operates as an evidentiary rule that allows plaintiffs to establish a rebuttable presumption of negligence on the part of the defendant through the use of circumstantial evidence.
This means that while plaintiffs typically have to prove that the defendant acted with a negligent state of mind, through res ipsa loquitur, if the plaintiff puts forth certain circumstantial facts, it becomes the defendants burden to prove he or she was not negligent.
Res Ipsa Loquitur and Evidence Law Accidents happen all the time, and the mere fact that an accident has occurred doesnt necessarily mean that someones negligence caused it. In order to prove negligence in a personal injury lawsuit, a plaintiff must present evidence to demonstrate that the defendants negligence resulted in the plaintiffs injury. Sometimes, direct evidence of the defendants negligence doesnt exist, but plaintiffs can still use circumstantial evidence in order to establish negligence.
Circumstantial evidence consists of facts that point to negligence as a logical conclusion rather than demonstrating it outright. This allows judges and juries to infer negligence based on the totality of the circumstances and the shared knowledge that arises out of human experience. Res ipsa is one type of circumstantial evidence that allows a reasonable fact finder to determine that the defendants negligence caused an unusual event that subsequently caused injury to the plaintiff.
This doctrine arose out of a case where the plaintiff suffered injuries from a falling barrel of flour while walking by a warehouse. At the trial, the plaintiffs attorney argued that the facts spoke for themselves and demonstrated the warehouses negligence since no other explanation could account for the cause of the plaintiffs injuries.
As it has developed since then, res ipsa allows judges and juries to apply common sense to a situation in order to determine whether or not the defendant acted negligently.
Since the laws of personal injury and evidence are determined at the state level, the law regarding res ipsa loquitur varies slightly between states. That said, a general consensus has emerged, and most states follow one basic formulation of res ipsa.
Under this model for res ipsa, there are three requirements that the plaintiff must meet before a jury can infer that the defendants negligence caused the harm in question:
The event doesnt normally occur unless someone has acted negligently;
The evidence rules out the possibility that the actions of the plaintiff or a third party caused the injury; and The type of negligence in question falls with the scope of the defendants duty to the plaintiff.
As mentioned above, not all accidents occur because of someone elses negligence. Some accidents, on the other hand, almost never occur unless someone has acted negligently.
Going back to the old case of the falling flour-barrel, its a piece of shared human knowledge that things dont generally fall out of warehouse windows unless someone hasnt taken care to block the window or hasnt ensured that items on the warehouse floor are properly stored. When something does fall out of a warehouse window, the law will assume that it happened because someone was negligent.The second component of a res ipsa case hinges on whether the defendant carries sole responsibility for the injury. If the plaintiff cant prove by a preponderance of the evidence that the defendants negligence cause the injury, then they will not be able to recover under res ipsa.
States sometimes examine whether the defendant had exclusive control over the specific instrumentality that caused the accident in order to determine if the defendants negligence caused the injury. For example, if a surgeon leaves a sponge inside the body of a patient, a jury can infer that the surgeons negligence caused the injury since he had exclusive control over the sponges during the operation.
In addition to the first two elements, the defendant must also owe a duty of care to protect the plaintiff from the type of injury at issue in the suit. If the defendant does not have such a duty, or if the type of injury doesnt fall within the scope of that duty, then there is no liability.
For example, in many states, landowners dont owe trespassers any duty to protect them against certain types of dangers on their property. Thus, even if a trespasser suffers an injury that was caused by the defendants action or inaction and that wouldnt normally occur in the absence of negligence, res ipsa loquitur wont establish negligence since the landowner never had any responsibility to prevent injury to the trespasser in the first place.
Res ipsa only allows plaintiffs to establish the inference of the defendants negligence, not to prove the negligence completely. Defendants can still rebut the presumption of negligence that res ipsa creates by refuting one of the elements listed above.
For example, the defendant could prove by a preponderance of the evidence that the injury could occur even if reasonable care took place to prevent it. An earthquake could shake an item loose and it could fall out of the warehouse window, for instance.
A defendant could also demonstrate that the plaintiffs own negligence contributed to the injury. To go back to the flour-barrel example, if the defendant shows that the plaintiff was standing in an area marked as dangerous it could rebut the presumption of negligence created by res ipsa.
Finally, the defendant could establish that he did not owe the plaintiff a duty of care under the law, or that the injury did not fall within the scope of the duty owed. For example, if the law only imposes a limited duty on the defendant not to behave recklessly, then res ipsa will not help the plaintiff by creating an inference of negligence since a negligent action would not violate the duty owed to the plaintiff.
According to the Blacks Law Dictionary the maxim is defined as the doctrine providing that, in some circumstances, the mere fact of accidents occurrence raises an inference of negligence so as to establish a prima facie (at first sight) case. It is a symbol for that rule that the fact of the occurrence of an injury taken with the surrounding circumstances may permit an inference or recipes omission of negligence, or make out a plaintiff's prima facie case and present a question of fact for defendant to meet with and explanation. It is merely a short way of saying that the circumstances attendant on the accident are of such a nature to justify a jury in light of common sense and past experience in inferring that the accident was probably the result of the defendant's negligence, in the absence of explanation or other evidence which the jury believes.
Its use in clinical negligence gained some traction before Bolam and Bolitho. Mahon v Osborne [1939] 1 All ER 535, is an early example of the application of res ipsa loquitur in a case where a surgical swab had been left inside a patient's body.
In Clarke v Worboys (1952) Times, 18 March, CA, a patient noticed burns on her buttock shortly after surgical excision of a breast tumour. The surgery involved cauterisation. The Court of Appeal held that this was a case where res ipsa loquitur applied. The outcome was not one that would ordinarily occur in the absence of negligence, and the surgical team were unable to explain how the injury was caused.
In Cassidy v Ministry of Health [1951] 2 KB 343, Denning LJ succinctly summarised the maxim's application to clinical negligence cases: I went into hospital to be cured of two stiff fingers. I have come out with four stiff fingers and my hand is useless. That should not happen if due care had been used. Explain it if you can.
Ng Chun Pui Vs Lee Chuen Tat, the first defendant was driving a coach owned by the second defendant westwards in the outer lane of dual carriageway in Hong Kong. Suddenly the course across the central reservation and collided with a public bus travelling in the inner lane of the other carriageway, killing one passenger in the bus and injuring the driver and three others on the bus. The plaintiff could not prove that the defendants were negligent and had caused the accident. They however proceeded on the basis of Res Ipsa Loquitur and shifted the onus on the defendants to prove that they were not negligent. However, they failed to do so. And the judicial committee of the Privy Council held the defendants liable for the plaintiffs injuries. MarkLuney and Ken Opliphant, Tort Law Text And Materials (Oxford University Press, New York, 2000) pp 173-175 In A.S. Mittal &Anr Vs State Of UP &Ors , AIR 1979 SC 1570, the defendants had organised an eye camp at Khurja along with the Lions Club. 88 low risk cataract operations were undertaken during the period of the camp. It was however, disastrous as many of those who had been operated upon lost their eyesight due to post medical treatment. Proceedings against the government initiated for negligence of the doctors. Damages worth Rs.12,500/- were paid as interim belief to each of the aggrieved. The decision was on the basis of Res Ipsa Loquitur as the injury would not ave occurred had the doctors not been negligent in not having followed up with post-operation treatment. Res Ipsa Loquitur can be applied in matters where are the procedures have not been followed and is not just limited to the commission of an act.
We can define 'Medical negligence' as the improper or unskilled treatment of a patient by a medical practitioner. This includes negligence in taking care from a nurse, physician, surgeon, pharmacist, or any other medical practitioner. Medical negligenceleads to 'Medical malpractices' where the victims suffer some sort of injury from the treatment given by a doctor or any other medical practitioner or health care professional.
Medical negligence can occur in different ways. Generally, it occurs when a medical professional deviates from the standard of care that is required.
So, we can say that any kind of deviation from the accepted standards of medication and care is considered to be medical negligence and if it causes injury to a patient then the doctor who operated on him, other staff and/or hospital may be held liable for this.
Some of the common categories of medical negligence are as follows:
Wrong diagnosis - When someone goes to a hospital, clinic or medical room, etc. the first step after admittance is the diagnosis. Diagnosing symptoms correctly is critical and important to provide medical care to any patient. However, if a patient is not treated properly due to any mistake in diagnosis, the doctor can be made liable for any further injury or damages caused as a result of the wrong diagnosis.
Delay in diagnosis - A delayed diagnosis is treated as medical negligence if another doctor would have reasonably diagnosed the same condition in a timely fashion. A delay in diagnosis can cause undue injury to the patient if the illness or injury is left to worsen with time rather than being treated. Obviously, any delay in the identification and treatment of an injury can reduce the chance of recovery for the patient.
Error in surgery - Surgical operations require an enormous level of skill and it should be done with due care and caution because even the slightest mistakes can have profound effects on the patient. The wrong-site surgery, lacerations of any internal organ, severe blood loss, or a foreign object being left in the body of the patients, all this comes under Surgical error.
Unnecessary surgery - Unnecessary surgery is usually associated with the misdiagnosis of patient symptoms or a medical decision without proper consideration of other options or risks. Alternatively, sometimes surgery is chosen over conventional treatments for their expediency and ease compared to other alternatives.
Errors in the administration of anesthesia - Anesthesia is a risky part of any major medical operation and requires a specialist (anesthesiologist) to administer and monitor its effect on the patient. Prior to any medical procedure requiring anesthesia, the anesthesiologist has to review the patient's condition, history, medications, etc. to determine the most suitable of all the medicine to use. Anesthesia malpractice can happen even during the pre-operation medical review or during the procedure itself.
Childbirth and labor malpractice - Childbirth is a difficult event for a woman and it becomes worse if not handled properly by the doctors and nurses. There are many instances of medical negligence during childbirth including the mishandling of a difficult birth, complications with induced labor, misdiagnosis of a newborn medical condition, etc. Long-Term negligent treatment - Medical negligence can also occur in subtle ways over the course of a long treatment period. Usually, the negligence can take the shape of a failure to follow up with treatment, or a doctor's failure to monitor the effects of the treatment properly.
A standard of care specifies the appropriate treatment and medication procedure as per the requirements that should be taken into account by a doctor while providing the treatment to his patients. The care should not be of the highest degree nor the lowest.Here, the degree means the level of care an ordinary health care professional, with the same training and experience, would render in similar circumstances in the same community. This is the critical question in medical malpractice cases and if the answer is no, and you suffered injury as a result of the poor treatment, you may file a suit for medical malpractice.
In the case of Dr. Laxman Balkrishna Joshi Vs. Dr. TrimbakBapu Godbole and Anr.[ 1969 AIR 128], the Supreme Court held that a doctor has certain aforesaid duties and a breach of any of those duties can make him liable for medical negligence. A doctor is required to exercise a reasonable degree of care that is set for this profession.
Dr. Kunal Saha vs Dr. Sukumar Mukherjee on 21 October, 2011 ( NC) original petition number 240 OF 1999 is one of the most important case regarding medical negligence. The brief facts of the case are-
Toxic Epidermal Necrolysis ( TEN ) is a rare and deadly disease. It is an extoliative dermatological disorder of unknown cause. A patient with TEN loses epidermis in sheet-like fashion leaving extensive areas or denuded dermis that must be treated like a larze, superficial, partial-thickness burn wound. The incidence of TEN has been reported at 1 to 1.3 per million per year. The female-male ratio is 3:2. TEN accounts for nearly 1% of drug reactions that require hospitalization. TEN has a mortality rate of 25 to 70%.
Smt. Anuradha Saha (in short Anuradha), aged about 36 years wife of Dr. Kunal Saha (complainant) became the unfortunate victim of TEN when she alongwith the complainant was in India for a holiday during April-May 1998. She and the complainant although of Indian original were settled in the United States of America. The complainant is a doctor by profession and was engaged in research on HIV / AIDS for the past fifteen years. Anuradha after acquiring her Graduation and Masters Degree was pursuing a Ph.D. programme in a university of U.S.A. She was a Child Psychologist by profession. Anuradha showed certain symptoms of rashes over her body and received treatment at the hands of Opposite Parties and some other doctors as outdoor patient uptil 10.05.1998 and she was admitted in Advanced Medicare and Research Institute Limited, Calcutta (for short, AMRI), on 11.05.1998, where she was treated by the above-named Opposite Parties and other doctors uptil 16.05.1998. As there was no improvement in her condition, she was shifted to Breach Candy Hospital, Mumbai, on 17.05.1998 by an air ambulance. She was treated in Breach Candy Hospital from 17.05.1998 evening till she breathed her last on 28.05.1998.
Our Complainant as husband of Anuradha felt that the doctors who treated Anuradha and the hospitals where she was treated were grossly negligent in her treatment and her death was occasioned due to gross negligence of the treating doctors and hospitals. Complainant, accordingly, got issued a legal notice to as many as 26 persons i.e. various doctors who treated Anuradha between end of April to the date of her death alleging negligence and deficiency in service on their part and claiming a total compensation exceeding Rs.55 crores from them. Complainant, thereafter filed the present complaint on 09.03.1999 before this Commission claiming a total compensation of Rs. Rs.77,07,45,000/- ( Seventy Seven Crores Seven Lakhs Fourty Five Thousand only). Later he also filed another complaint no. 179 of 2000 in this Commission against Breach Candy Hospital, its doctors and functionaries claiming a further compensation of Rs.25.30 crore ( though the said complaint was later on withdrawn), thereby making claim of compensation exceeding Rs.102 crores, perhaps the highest ever claimed by any complainant for medical negligence before any consumer fora established under the provisions of Consumer Protection Act, 1986 ( in short, the Act). These are some of the facts which make the present case extra ordinary.
The present complaint was filed by the complainant against the above-named opposite parties, namely, Dr. Sukumar Mukherjee, Dr. B. Haldar (Baidyanath Halder), Advanced Medicare and Research Institute Limited ( in short the AMRI Hospital ) and Dr. Balram Prasad and Dr.Abani Roy Chowdhury (physician) and Dr.KaushikNandy (plastic surgeon), the Directors of the AMRI Hospital and others claiming a total compensation of Rs. Rs.77,07,45,000/- under different heads alleging various acts of commission and omission on the part of the doctors and hospital amounting to negligence and deficiency in service. Complainant through his brother-in-law Malay Kumar Ganguly also filed criminal complaint against some of the doctors and the hospital under section 304A IPC.
The complaint was resisted by the doctors and the hospital on a variety of grounds thereby denying any medical negligence or deficiency in service on their part. Parties led voluminous documentary and oral evidence and testimonies of some of the witness were even recorded through video conferencing through a Local Commissioner. After a protracted trial and hearing and on consideration of the evidence and material so produced on record and taking note of the legal position governing the question of medical negligence, this Commission ( by a three Member Bench presided over by the then President) dismissed the complaint by an order dated 01.06.2006 holding as under:
In the result, we reiterate that Doctors or Surgeons do not undertake that they will positively cure a patient. There may be occasions beyond the control of the medical practitioner to cure the patients. From the record, it would be difficult to arrive at the conclusion that the injection Depo-Medrol prescribed by Dr. Mukherjee was of such excessive dose that it would amount to deficiency in service by him which was his clinical assessment.
Thereafter, with regard to the alleged deficiency in the treatment given to Mrs. Anuradha by Opposite Party Doctors 2, 3, 5 and 6, there is no substance. The contention against the hospital that it was not having Burns-Ward, and therefore, the deceased suffered is also without substance. Hence, this complaint is dismissed. There shall be no order as to costs.
Aggrieved by the dismissal of his complaint, the complainant filed Civil Appeal (No.1727 of 2007) in the Honble Supreme Court. It would appear that even before the said appeal was filed before the Hon'ble Supreme Court, the Supreme Court was seized of the matter in Criminal Appeal Nos.1191-94 of 2005 filed by Malay Kumar Ganguly, the complainant in the criminal complaint, against the Orders passed by the Calcutta High Court. Since the Criminal Appeals and the Civil Appeal filed by the complainant in the present complaint raised the same questions of fact and law, the Hon'ble Supreme Court heard all the appeals together and decided the same by means of a detailed judgment dated 07.8.2009. By the said order, the Apex Court dismissed the Criminal Appeals filed by Shri Malay Kumar Ganguly but allowed the Civil Appeal No. 1727 of 2007 filed by the complainant and set aside the order dated 01.6.2006 passed by this Commission dismissing the complaint and remanded the matter to this Commission for the limited purpose of determining the adequate compensation, which the complainant is entitled to receive from the subsisting opposite parties by observing as under:
So far as the judgment of the Commission is concerned, it was clearly wrong in opining that there was no negligence on the part of the Hospital or the doctors. We, are, however, of the opinion, keeping in view the fact that Dr.KaushikNandy has done whatever was possible to be done and his line of treatment meets with the treatment protocol of one of the experts viz.. Prof. Jean Claude Roujeau although there may be otherwise difference of opinion, that he cannot be held to be guilty of negligence.
We remit the case back to the Commission only for the purpose of determination of the quantum of compensation.We, keeping in view the stand taken and conduct of AMRI and Dr. Mukherjee, direct that costs of Rs.5,00,000 and Rs.1,00,000 would be payable by AMRI and Dr. Mukherjee respectively.
We further direct that if any foreign experts are to be examined it shall be done only through video conferencing and at the cost of the respondents.
Summary In view of the foregoing discussion, we conclude as under:
The facts of this case viz., residence of the complainant and Anuradha (deceased) in USA and they working for gain in that country; Anuradha having been a victim of a rare and deadly disease Toxic Epidermal Necrolysis (TEN) when she was in India during April-May 1998 and could not be cured of the said disease despite her treatment at two superspeciality medical centres of Kolkata and Mumbai and the huge claim of compensation exceeding Rs.77 crores made by the complainant for the medical negligence in the treatment of Anuradha makes the present case somewhat extraordinary.
The findings given and observations made by the Supreme Court in its judgment dated 07.08.2009 are absolutely binding on this Commission not only as ratio decidendi but also as obiter dicta also, the judgment having been rendered by the Supreme Court in appeal against the earlier order passed by a three Member Bench of this Commission and, therefore, no attempt can be allowed to read down / dilute the findings and observations made by the Supreme Court because the Supreme Court has remitted the complaint to this Commission only for the purpose of determination of the quantum of compensation after recording the finding of medical negligence against the opposite parties and others.
The task entrusted to the Commission may appear to be simple but the facts of the present case and the voluminous evidence led on behalf of the complainant has made it somewhat arduous. Still difficult was the task of apprortionment of the liability to pay the awarded amount by the different opposite parties and perhaps it was for this reason that the Supreme Court has remitted the matter to this Commission.
Multiplier method provided under the Motor Vehicles Act for calculating the compensation is the only proper and scientific method for determination of compensation even in the cases where death of the patient has been occasioned due to medical negligence / deficiency in service in the treatment of the patient, as there is no difference in legal theory between a patient dying through medical negligence and the victim dying in industrial or motor accident. The award of lumpsum compensation in cases of medical negligence has a great element of arbitrariness and subjectivity.
The foreign residence of the complainant or the patient and the income of the deceased patient in a foreign country are relevant factors but the compensation awarded by Indian Fora cannot be at par which are ordinarily granted by foreign courts in such cases. Socio economic conditions prevalent in this country and that of the opposite parties / defendants are relevant and must be taken into consideration so as to modulate the relief. A complainant cannot be allowed to get undue enrichment by making a fortune out of a misfortune. The theoretical opinion / assessment made by a Foreign Expert as to the future income of a person and situation prevalent in that country cannot form a sound basis for determination of future income of such person and the Commission has to work out the income of the deceased having regard to her last income and future prospects in terms of the criteria laid down by the Supreme Court.
There exists no straight jacket formula for apportionment of the awarded compensation amongst various doctors and hospitals when there are so many actors who are responsible for negligence and the apportionment has to be made by evolving a criteria / formula which is just going by the nature and extent of medical negligence and deficiency in service established on the part of different doctors and hospitals.
On a consideration of the entirety of the facts and circumstances, evidence and material brought on record, we hold that overall compensation on account of pecuniary and non pecuniary damages works out to Rs.1,72,87,500/- in the present case, out of which we must deduct 10% amount on account of the contributory negligence / interference of the complainant in the treatment of Anuradha. That will make the net payable amount of compensation to Rs.1,55,58,750/- (roundedofto Rs.1,55,60,000/-). From this amount, we must further deduct a sum of Rs.25,93,000/- which was payable by Dr.Abani Roy Chowdhury (deceased) or his Legal Representative as the complainant has forgone the claim against them.
In view of the peculiar facts and circumstances of the case and as a special case, we have awarded a sum of Rs. 5,00,000/- as cost of litigation in the present proceedings.
The above amount shall be paid by opposite parties no.1 to 4 to the complainant in the following manner:
(i) Dr. Sukumar Mukherjee-opposite party no.1 shall pay a sum of Rs.40,40,000/- (Rupees Forty Lakh Forty Thousand only) i.e. [Rs.38,90,000/- towards compensation and Rs.1,50,000/- as cost of litigation].
(ii) Dr. B. Haldar (Baidyanth Halder)-opposite party no.2 shall pay a sum of Rs.26,93,000/- (Rupees Twenty Six Lakh Ninety Three Thousand only) i.e. [Rs.25,93,000/- towards compensation and Rs.1,00,000/- as cost of litigation]
(iii) AMRI hospital-opposite party no.3 shall pay a sum of Rs.40,40,000/- (Rupees Forty Lakh Forty Thousand only ) i.e. [Rs.38,90,000/- towards compensation and Rs.1,50,000/- as cost of litigation .
(iv) Dr. Balram Prasad-opposite party no.4 shall pay a sum of Rs.26,93,000/- (Rupees Twenty Six Lakh Ninety Three Thousand only) i.e. [Rs.25,93,000/- towards compensation and Rs.1,00,000/- as cost of litigation] The opposite parties are directed to pay the aforesaid amounts to the complainant within a period of eight weeks from the date of this order, failing which the amount shall carry interest @ 12% p.a. w.e.f. the date of default.
So in brief, we come to the conclusion that the complainant was admitted to the opposite party hospital and the opposite party performed the surgery (Nucleoplasty clubbed with Annuloplasty). After this surgery the complainant was discharged on the very next day without giving proper post-operative care. When the complainant did not get any relief, he again came to the opposite party, who again admitted him in the hospital for two days and thereafter discharged him. Even then the complainant did not get the required attention so he went to other doctor and he was diagnosed as a case of bacterial sepsis. It developed from infection during operation or postoperation. There is direct vicinity of this bacterial sepsis with the surgery of the opposite party. Because in 3 to 5 days from the date of discharge from the hospital of the opposite party, it has been diagnosed as bacterial sepsis. It clearly shows the deficiency and negligence on the part of the complainant. We have discussed so many articles and case laws which clearly establishes the fact that negligence and deficiency of service has been caused by the opposite parties.
From the perusal of all the facts and circumstances we are of the opinion that the complainant is entitled for the following reliefs:
The complainant is entitled to Rs.15 lakhs from the opposite parties for their negligence and deficiency in services. The complainant is further entitled to get interest at a rate of 12% on this amount from 18.11.2016 if paid within 60 days from the date of judgment of this complaint case. The complainant is also entitle to get Rs.5 Lacs for mental pain and agony, Rs.50,000.00 for cost of the suit and interest at a rate of 12% on this amount from 18.11.2016 if paid within 60 days from the date of judgment of this complaint case.
The complaint case is decided accordingly.
ORDER 1- The opposite parties are directed jointly and severally to pay Rs.15 lakhs to the complainant with interest at a rate of 12% from 18.11.2016 if paid within 60 days from the date of judgment of this complaint case.
2- The opposite parties are directed jointly and severally to pay Rs.5 Lacs for mental pain and agony to the complainant with interest at a rate of 12% from 18.11.2016 if paid within 60 days from the date of judgment of this complaint case.
3- The opposite parties are directed jointly and severally to pay Rs.50,000.00 towards cost of the case to the complainant with interest at a rate of 12% from18.11.2016 if paid within 60 days from the date of judgment of this complaint case.
All the amount shall be paid within 60 days from the date of judgment of this complaint case and if not paid within 60 days from the date of judgment of this complaint case, the rate of interest will be 15%from18.11.2016 till the date of actual payment.
In the order is not complied with, within 60 days from the date of judgment of this complaint case, the complainant shall be free to file execution case at the cost of the opposite parties.
The stenographer is requested to upload this order on the Website of this Commission today itself.
Certified copy of this judgment be provided to the parties as per rules.
(Sushil Kumar) (Rajendra Singh) Member Presiding Member Judgment dated/typed signed by us and pronounced in the open court. Consign to record. (Sushil Kumar) (Rajendra Singh) Member Presiding Member Dated: 17.4.2023 JafRi, PA I Court 2 [HON'BLE MR. Rajendra Singh] PRESIDING MEMBER [HON'BLE MR. SUSHIL KUMAR] JUDICIAL MEMBER