State Consumer Disputes Redressal Commission
Kaireddy Hanuma Reddy, Son Of K. Venkata ... vs 1. Nizam Institute Of Medical Sciences, ... on 17 June, 2022
BEFORE THE TELANGANA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION:HYDERABAD
C.C.No.115/2014
Between:
1.Kamireddy Hanuma Reddy ( Died)
Rep. by his Legal Representatives:
2. Smt.Kamireddy Siva Lakshmi,
W/o.late Kamireddy Hanuma Reddy,
Aged about 40 years, Indian, Occ:Housewife,
R/o.8-57, Main Road,
Kothapalem - 523 264,
Talluru Mandal,
Prakasam District.
3. K.Manohar Reddy,
S/o. late Kamireddy Hanuma Reddy,
Aged about 21 years, Indian, Occ:Student,
R/o.8-57, Main Road,
Kothapalem-523 264, Talluru Mandal,
Complainants
Prakasam District.
(Legal Representatives have been brought
on record as per the orders
dt.27.12.2017
in I.A.No.1122/2017)
And
1.Nizam Institute of Medical Sciences,
Punjagutta,
Hyderabad - 500 082,
Rep. by its Director.
2. Dr.D.Sree Bhushan Raju,
MD, DM (AIIMS), DBN
Associate Professor & Unit- Head,
Department of Nephrology,
Nizam Institute of Medical Sciences,
Punjagutta,
Hyderabad - 500 082,
3. Prof. P.v.L.N.Murthy,
Urologist, Dept. of Urology & Renal Transplantation
Nizam Institute of Medical Sciences,
Punjagutta, 500 082,
Hyderabad -
4. Oriental Insurance Company Ltd.,
Divisional Office-III,
Flat No.302, 3rd Floor, Alkarim Trade Centre,
Opp: Ranigunj Bus Stop, Hyderabad.
(O.P.No.4 impleaded as per the orders
Dt.16.2.2016 in I.A.No.2171/2014). .. Opposite
Parties
Counsel for the Complainant M/s.V.Gowri Sankara Rao
Counsel for the Opposite Parties M/s.G.Anandam-OPs.1 to 3.
M/s.S.Agastya Sarma-0.P.No.4.
CORAM: Hon'ble Sri Justice M.S.K. Jaiswal, President,
And
Hon'ble Smt. Meena Ramanathan, Lady Member.
FRIDAY, THE SEVENTEENTH DAY OF JUNE, TWO THOUSAND TWENTY Two.
Order: (Per Hon'ble Smt. Meena Ramanathan, Lady Member) **
1. This is a complaint filed by the Complainants u/s. 17(1)(a)i) of the Consumer Protection Act, 1986, praying to direct the opposite parties to reimburse Rs.15,00,000/- along with interest at 15% p.a. till the date of realisation, to pay compensation of Rs.10,00,000/- and to pay costs of Rs.50,000/-.
2. The case of the complainants in brief is as follows:
The complainant no.1 aged about 40 years was suffering from generalized weakness since one month and he visited the opposite party no.1 hospital on 22.10.2011 and the opposite party no.2 examined him and after necessary investigations, it was diagnosed that he was suffering from CIN, CKD (Chronic Kidney Disease) and ESRD ( End Stage Renal Disease). On the same day the complainant admitted in opposite party no.1 hospital and he was treated with Haemo Dialysis and after stabilization, he was discharged on 25.10.2011.
The complainant no.1 visited the opposite parties on 9.11.2011 for Renal Transplantation Fitness Evaluation and after necessary investigation, the opp.parties gave clearance for the surgery on 16.11.2011. On 28.11.2011 the complainant no.1 was admitted in opposite party no.1 hospital. The complainant's wife Smt.K.Siva Lakshmi donated her kidney and the opposite party no.3 along with team of surgeons performed Renal Transplantation of the complainant on 1.12.2011 and he was discharged on 10.12.2011.3
The complainant no.1 developed lower gastro intestinal tract complications followed by urinary infection and genitals infections and on undergoing culture and sensitivity test it was revealed that there was growth of Klebsiella Pneumonia. On 2.1.2012, opposite party no.3 reviewed the case of the complainant and diagnosed that he was suffering from UTI and also left the Epidydino- Orthitis (Genital Infection) and on 5.1.2012 removed DJ Stent. On 18.1.2012 the complainant developed acute renal failure for evaluation of renal transplanted graft. Renal biopsy was and performed and was treated with Methyl Prednisolone inj. Tacrolimus and he was discharged on 26.1.2012. As the condition of the complainant no.1 was deteriorated , he was in to opposite party no.1 hospital on 3.8.2012 and he was diagnosed have hydronephrosis On 29.8.2012 Cystoscopy and on 14.9.2012 Antigrade Nephrostogram and Antegrade DJ Stent done. The suffered with recurrent chronic were complainant ailments of urine infection and deteriorated health status of kidney.
The complainant no.1 took second opinion in KIMS Hospital and doctors of the said hospital confirmed that the kidneys are failed and require re-transplantation and also till the failed suggested to undergo Hemo Dialysis thrice in a week in kidney is transplanted. The opposite parties grossly failed i.e. managing chronic pyelonephritis, ultimately lead to uremia kidney failure, despite of borderline rejection of transplanted The complainants spent about Rs.12 lakhs for the kidney.
treatment at NIMS and Rs.3 lakhs for the treatment at KIMS. The in not complainants submit that the action of opposite parties properly managing the complications of kidney transplantation, CKD Stage-5 which requires further infection, lead to transplantation and weekly thrice Heamo Dialysis till transplantation which not only amounts to negligence, deficiency in service and also amounts to unfair trade practice. Hence the complaint seeking reliefs as stated in para no.1.
Dr.K.Dilip Kumar, Executive Registrar 1/C. of opposite party
3. no.1 filed Written Version and opposite parties 2 & 3 filed Adoption Memo adopting the written version of opposite party no.1.
The opposite party no.1 admits that the complainant no.1 was admitted in their institute on 22.10.2011 with end stage renal disease initiated on maintenance of haemodialysis and he was explained about the need of transplantation. The complainant no.l's wife was a voluntary kidney donor and both of them were explained about the consequences like rejection, infections, medical and surgical complications. The complainant no.1 underwent kidney transplantation on 1.12.2011 and discharged on 12.12.2011. The complainant got admitted on 18.1.2012 with elevated creatinine probably due to non compliance with the drug therapy. After taking all precautions colistin inj. was given and the complainant no.1 responded well and became stabilized and he had normal kidney graft function till July,2012. Due to recurrent UTI infections the complainant no.1 again admitted on 3.8.2012 and he was on antibiotic therapy which was supervised by the Department of Nephrology and also underwent procedures as advised by the Urologist. He was followed up even after discharge to find stable creatinine which was gradually declining and his general condition improved well and he became asymptomatic and advised to come for regular follow up once in three days with the creatinine report. But the complainant no.1 did not come for follow up since October,2012 and did not respond to the phone calls also.
The opposite party submits that the complainant no.1 admitted in their hospital on 26.10.2012 and was discharged on 1.11.2012 in stable health condition and advised to come for review, but the complainant did not turn up. The complainant has taken treatment at KIMS Hospital, Hyderabad before admission into their hospital on 26.10.2012 and hence they are not responsible and liable for the treatment rendered at KIMS hospital.
The opposite party submits that the complainant no.1 has not followed the advises of the doctors of their hospital and he has also discontinued antibiotic (Linezolid) which was advised as per the sensitivity report and taken another antibiotic which is not sensitive as advised at KIMS hospital.
The opposite party submits that the doctors removed DJ stunt early due to recurrent UTI as it would help the resolution of infection. The DJ stent can be removed between 2-6 weeks after surgery and it will not increase the incidents of stricture. Cause of graft loss (Kidney failure) can be due to chronic ongoing rejection 5 wnich takes place in any transplant and more so in an unrelated (not a blood related) kidney transplantation. Negligence cannot be attributed to a doctor so long as he performed his duty with reasonable skill and competence and doctors can only treat but cannot guaranty success of a surgical operation which inevitable is fraught with risk. The opposite party has taken insurance policy known as Error and Omission - Medical Establishment Policy for all medical professionals and other staff in treating the patients which has been issued by the Oriental Insurance Co., Hyd. and hence the said insurance company is alone liable to make the loss good to the institute. The complainant has not filed any material showing that the doctors of opposite party no.1 institution are negligent or there is any deficiency of service. The opposite party prays to dismiss the complaint with costs.
4. The opposite party no.4 filed written version denying the allegations made in the complaint and contending that they adopts the written version of opposite party no.1. The opposite party no.4 submits that there was no medical/professional negligence by doctors of NIMS/Opposite party no.1 and there was no loss or suffering for the complainant on account of treatment by opp.parties 1 to 3, since the doctors of NIMS discharged their professional duties by displaying their functional ability in an excellent manner, as is evident from the records. It is submitted that no cause of action is accrued to file the presen complaint attributing deficiency of service or negligence against opposite parties 1 to 3 and the complaint is devoid of merits and is liable to be rejected and the complainant is not entitled for any compensation or any relief whatsoever and the complaint is liable to be dismissed against opposite parties 1 to 4.
5. Evidence affidavit of the complainant no.1 filed. Exs.Al to A23 are marked on behalf of the complainants. Chief Examination Affidavit of Dr.N.Satyanarayana, Executive Registrar of Opposite Party no.1 filed. Chief Examination Affidavit of opposite party no.2 filed. Chief Examination affidavit of opposite party no.3 filed.
Exs.B1 & B2 are marked on behalf of the opposite parties 1 to 3.
Sri A.Vinay Kumar, Senior Divisional Manager/Authorised Signatory of Oriental Insurance Company Ltd. - Opposite party no.4 filed Evidence Affidavit. Written Arguments of complainant and opposite parties 1 to 3 filed.
consideration is whether the
6. The point that arises for deficient and negligent in their opposite parties have been are treatment to the complainant/patient?
If yes, to what relief is he entitled to ?
diabetic and aged about 40 years a non
7. The complainant he was suffering non hypertensive visited the opposite parties as month. He was diagnosed from generalized weakness since one treated as suffering from CKD ( Chronic Kidney Disease) and was underwent Renal with Haemo Dialysis and subsequently Transplantation.
record to understand We have perused the material placed on the issues the complainant was diagnosed with and accordingly treated. From the medical records submitted , the following points to reconstruct the case to find out if the emerge and we have tried been deficient and negligent. The opposite parties have medical records in his complainant has not submitted any prior if any is not capacity. Therefore, his previous medical history, , The problem concerned begins with Ex.Al t h e available.
As per this exhibit Discharge Summary dated 25.10.2011.
diagnosis is
CIN CKD - ESRD"
he has no history of diabetes, hypertension, Pedal
Although
exertion and
edema, oliguria, vomiting etc. he had c/o. SOB on Evaluation revealed that serum creatinine generalised weakness.
was 9.8 mg./dl and he underwent 3 sessions of Haemo Dialysis.
He was discharged on 25.10.2011 with maintenance Haemo Dialysis thrice weekly and AV Freation as early as possible. Ex.A2 Transplant Recipient Discharge Summary reveals that:
DOA 28.11.2011
DOD 10.12.2011
The complainant was admitted for renal transplantation and his
wife was his donor. By now he has undergone multiple sessions
O Haemo Dialysis. The main contention of the complainant is that Uretero neo cystostomy was done and DJ Stent was placed, which should have been removed only after 4 weeks. On this exhibit the opposite parties have advised him to come for stent removal on 29.12.2011.
Ex.A3 Discharge Record reveals that:
DOA 28.11.11
DOD 12.12.11
Live emotionally related renal allograft transplantation done on 01/12/11. Under Immediate post-op period' the following is recorded and the same is reproduced:
"Patient underwent live emotionally related renal allograft transplantation done on 12/12/11 with wife as donor. Output was balanced with input. Patient had immediate graft function. Serum Creatinine normalised by POD4. Serum Creatinine increased from 1.5 to 1.7 mg/dl on POD6. Renal allograft biopsy done which revealed no e/o rejection, mild ATN/Tacrolimus dose decreased to 3 mg-2.5 mg. Serum Creatinine' declined to 1.6 mg/dl. During hospital stay patient had UTI. Urine c/s revealed E.coli resistant to all antibiotics but patient responded to empirical therapy with Inj.Piperacillin and Tazobactom. Patient stable at discharge.
Once again the complainant was admitted in the opposite party hospital vide Ex.A4:
DOA 18.1.12
DOD 26.1.12
Diagnosis: Post Renal Transplant Recepient (D.0.Tx.1.12.11) On Triple Immunosuppression(TAC/MPS/ Prednisoloneo Renal allograft Dysfunction? Cause Renal Biopsy Done on 20.1.12 to R/o.Rejection The renal biopsy preferred was suggestive of acute rejection. The complainant underwent the transplant procedure on 1.12.2011 and hardly within three weeks the opposite party no.3 state that the biopsy preferred is suggestive of acute rejection.8
8. taken up by the opposite The transplant operation w a s parties on a young ( 40 years old) patient and his wife was counselled and explained before becoming the donor. In an extremely short span, the opposite parties diagnose that it is a case of acute rejection.
In the post transplant period, acute rejection risk may occur any time from the first week of transplant to three months afterwards. When a person receives an organ from some one else during transplant surgery, that person's immune system recognizes that it is a foreign body and it triggers a transplant rejection. Doctors have to treat this to suppress the recipient's immune system. He was recommended and advised the necessary medicines as evidenced vide Anx.4 -pg.6 dated 26.1.2012. The next date of admission in the opposite party hospital was 4.8.2012. For a period of almost seven months, the complainant/patient has been reasonably stable and there are no records filed to show that he was admitted in the opposite party hospital.
9. On 4.8.2012 the patient/complainant underwent Cystoscopy_procedure. On 11.8.2012 he was diagnosed as having post transplantation ureteric obstruction and nephrostogram and antegrade DJ stenting was proposed. He had recurrent UTI Post operatively and he was treated accordingly. Anx-9 (page 13) dt.26.10.2012 records the following clinical summary:
40 year old male, CKD -
ESRD, underwent live emotionally related renal transplantation on 1-12-11, no induction therapy was given, on triple Immunosuppression, had immediate graft function with good urine output, no pre operative or post operative complications. H/o raised S Creatinine ( 2.2 mg /dl) on 20.1.12 renal biopsy performed for the same showed acute rejection, received anti- rejection treatment with 3 doses of Methyl Prednisolone and recovered. Patient had gradual rise ina serum creatinine, on evaluation was detected to have further graft HDN, evaluation was suggestive of CMV disease, treated with valgancyclovir 450 mg/alt.day. However as there was persistent rise in S.Creatinine and HDN, urology opinion considered intervention.....
-
The patient underwent the 1.12.2011 and
transplant surgery o n
continued to be monitored under the care of the opposite pargy
doctors till 1.12.2012 and after hat he went to KIMS for
treatment. We have perused the records pertaining to the treatment he underwent in KIMS and nowhere is there any suggestion that the opposite parties doctors have been negligent and deficient.
Post transplant graft dysfunction and hydronephrosis was detected and DJ stenting and percutaneous nephrostomy was done but Graft dysfunction sted and KIMS hospital have referred to this as vascular rejection. Their impression further records thatit is suggestive of borderline cellular rejection with probable associated element of chronic hormonal rejection". Surgical complications after renal transplantation can be classified as vascular and urologic'. The complainant suffered these complications which are expected and are potential risks of transplant surgery. Kidney transplantation is a major surgical procedure that has risks both during and after the surgery and this cannot be advocated as deficiency in service. Organ transplantation is one of the most complex procedures in medicine. No material has been placed on record or expert opinion obtained to contend that the complications suffered on account of renal transplant is because of deficiency in service and negligence. The opposite parties are not held liable for the duties performed with skill, care and competence.
10. In the result, complaint is dismissed.