State Consumer Disputes Redressal Commission
Dr.J.Radha Consultant, Gyn. & Obs. ... vs Smt.G.Kusuma Tirupathi on 20 August, 2013
BEFORE THE A BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD. F.A.No.1071/2011 against C.C.No.06/2011 District Forum-II, Tirupathi. Between Dr.J.Radha Consultant, Gyn. & Obs. Apollo Multi Speciality Hospital, No.189, K.K.Layout, Tirupati, Chittoor District. Appellant/ Opposite party And Smt.G.Kusuma W/o.G.V.Ramana, D.No.13-2-248, Chinnakapu Street, Tirupathi. Respondent/ complainant Counsel for the Appellant : M/s V.Sudhakar Reddy Counsel for the Respondent: M/s A.Chandrasekhar QUORUM: SMT.M.SHREESHA, HONBLE Incharge President AND SRI S.BHUJANGA RAO, HONBLE MEMBER.
TUESDAY, THE TWENTIETH DAY OF AUGUST TWO THOUSAND THIRTEEN Order (Per Smt.M.Shreesha, Honble Incharge President) *** Aggrieved by the order of C.C.No.6/2011 on the file of District Forum-II, Tirupathi , Opposite party preferred this appeal.
The brief facts as set out in the complaint are that the complainant approached the opposite party on third week of April, 2008 for Termination of pregnancy and tubectomy operation for which the opposite party advised her to come on 27-4-2008 and she paid Rs.5000/- and got all the necessary tests done. The complainant submits that on 27-4-2008 her pregnancy was terminated and tubectomy operation was done by giving spinal anaesthesia. The complainant submits that after 7.00 pm on 24-7-02008 she became mentally imbalanced because of spinal anaesthesia and she was shifted to SVIMS by the opposite party and an amount of Rs.6000/- was paid there. Thereafter the complainants husband took the patient to Apollo hospital, Chennai where she was diagnosed to be having Cerebral Venous Thrombosis. She stayed there till 15-5-2008 and spent an amount of Rs.2 lakhs and she was readmitted on 12-6-2008 with complaints of joint aches, ankle swelling for which she was advised to take further treatment and she was discharged on 14-6-2008 for which she spent Rs.50,000/-.
The complainant was continuously under treatment of the team of doctors at Apollo hospital, Chennai and on 29-6-2009 she was advised to meet Dr.Yogaraj, Consultant Neurologist under whom she is still undergoing treatment. The complainant submits that it is only because of the negligence of the opposite party that she is suffering prolonged treatment and had to spent exorbitant amounts of money. The complainant got issued a legal notice on 30-3-2010 but there was no response from the opposite party. Hence the complaint seeking direction to the opposite party to pay Rs.10 lakhs towards compensation and Rs. 3 lakhs towards medical expenses and other costs.
Opposite party filed counter admitting that as a consultant of Apollo Multi Speciality hospital she has done termination of the complainants pregnancy and tubectomy operation and submits that a qualified anaesthetist, Dr.N.Seetarama Raju has given anaesthesia with all precautions. On the same night of 27-4-2008, opposite party observed high grade fever and delirium and gave symptomatic treatment and the complainant was stable hemodynamically but later altered sensorium persisted and she was given Mannitol for suspected cerebral edema after taking the physicians opinion.
Even after four hours there was no improvement and she was shifted to SVIMS hospital for better neurological treatment and provided all the necessary help. Opposite party denies that there was any negligence on her behalf and submits that she has taken all the precautions and discharged her duties with due care and caution and denies for want of knowledge, the amount spent by the complainant towards medical expenses and also gave a reply notice on 24-4-2010 and submits that there is no negligence in her treating the patient.
The District Forum based on the evidence adduced i.e. Exs.A1 to A7 and B1 to B3 and the pleadings put forward, allowed the complaint in part directing the opposite party to pay Rs.1,26,253/- together with Rs.25,000/- towards mental agony and legal expenses of Rs.5000/- and in all the Rs.1,56,253/- together with interest at 9% p.a. from 05-4-2010 the date of receipt of notice by opposite party.
Aggrieved by the said order, opposite party preferred this appeal.
The brief point that arises for consideration is whether there is any deficiency in service on behalf of the OPPOSITE PARTY and if the complainant is entitled for the relief prayed for?
The facts not in dispute are that the complainant approached the opposite party on 24-7-2008 for termination of pregnancy and tubectomy operation and it is also an admitted fact that in the later half of the day, the patient developed delirium and high grade fever for which the opposite party treated with Mannitol for suspected cerebral edema which is evidenced under Ex.A1, discharge summary. Ex.A1 also states within four hours of her condition, she was shifted to SVIMS. It is the complainants case that from SVIMS she was shifted to Apollo hospital, Chennai for better treatment and was diagnosed to be suffering from Cerebral Venous Thrombosis and she was in the Apollo hospital from 28-4-2008 to 15-5-2008 evidenced under Ex.A3, discharge summary. The discharge summary states that the patient had no neurological defects on discharge and reads as follows:
Obstetric consultation was obtained and a transvaginal ultrasound done which revealed echogenic material in the uterus. On 4/5/08 under mask anaesthesia, evacuation of retained products of conception under ultrasound guidance was done. Patient was subsequently started on T.Actirome and Fragmin stopped once INR was therapeutic. Patient is now on 4mg acitrome a day. She is awake, stable and walking. She has no neurological deficits on discharge Ex.B1 is the consent given by the complainant for spinal anaesthesia during sterilization operation. It is the complainants case that because of anaesthetic complications and improper surgical procedure she had developed post-operative complications for which she had to undergo treatment in Apollo Hospital, Chennai from 28-4-2008 to 15-5-2008 and even thereafter is undergoing neurological treatment for which she claims medical expenses. We observe from the District Forum record that there is a medical opinion given by NIMS and these doctors were appointed as expert committee by the Medical Superintendent, NIMS. Dr.G.Radhika, Gynaecologist, Dr.Nirmala Anaesthetist and Dr.Rukmini Mridala, Neurologist opined as follows:
1. Spinal anaesthesia is the most commonly used technique of anaesthesia for lower abdominal and lower limb surgical procedure.
During spinal anaesthesia the patient had no untoward incident and was found to be in good health as per records.
Cerebral venous thrombosis is not described for spinal anaesthesia. But under epidural anaesthesia, epidural puncture has been noticed to cause cerebral venous thrombosis very rarely i.e. in 3-4 pats/million patients
2. Pregnancy itself is a hupercoagulable state.
Predisposing anaemia, and dehydration in association with pregnancy may precipitate cerebral venous thrombosis.
3. As cerebral venous thrombosis and septicaemia manifested within 5-6 hrs after the procedure, this cannot be attributed to the procedure.
4. Incomplete abortion is an inherent complication of the procedure of MTP and does not amount to negligence if diagnosed and treated on time.
5. Fever/disorientation/mental imbalance in this patient can be attributed to the cerebral venous thrombosis rather than to the procedure Opinion:
In view of the above observations it is the collective opinion of the expert committee that:
i) Cerebral venous thrombosis and septicaemia could have been precipitated by the procedure but are unlikely to be directly caused by the procedure.
ii) The doctor at Apollo multi-speciality hospital has attended to the patient pre and post operatively and has taken care to shift the patient when facilities for further treatment were not available at their centre.
Keeping in view the aforementioned expert medical opinion and also the judgments of the Apex court and National Commission with reference to duties of the doctors to the patients, the National Commission in TARUN THAKORE v. Dr.NOSHIR M.SHROFF in O.P.No.215/2000 dated 24-9-2002 reported in Landmark judgements on Consumer Protection P-410 held as follows:
The duties which a doctor owes to his patient are clear. A person who holds himself out ready to give medical advise and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires In INDIAN MEDICAL ASSN.
v. V.P.SHANTHA (1995) 6 SCC 651 the court approved a passage from Jackson and Powell on Professional Negligence and held that The approach of the courts is to require that professional men should possess a certain minimum degree of competence and that they should exercise reasonable care in the discharge of their duties. In general, a professional man owns to his client a duty in tort as well as in contract to exercise reasonable care in giving advise or performing services.
Supreme Court then opined as under:
The skill of medical practitioner differs from doctor to doctor. The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient.
Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. Medical opinion may differ with regard to the course of action to be taken by a doctor treating a patient, but as long as a doctor acts in a manner which is acceptable to the medical profession and the court finds that he has attended on the patient with due care, skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence.
In Mc.Nair J. in Bolam v. Friern Hospital Management Committee (1957) 2 All ER 118, 121 now widely known as the Bolam test reads as under:
But where you get a situation which involves the use of some special skill or competence, then the test whether there has been negligence or not is not the test of the man on the Calpham Omnibus, because he has not got this special skill. The test is the standard of the ordinary skilled man exercising and professing to have that special skill. A man need not possess the highest expert skill at the risk of being found negligent it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art.
His Lordship agreed with the counsels statement that negligence means failure to act in accordance with the standards of reasonably competent medical men at the time was a perfectly accurate statement of the law, provided that it was remembered that there may be one or more perfectly proper standards::
A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art. Putting it the other way round, a doctor is not negligent , if he is acting in accordance with such a practice, merely because there is a body of opinion that takes a contrary view.
We observe from the record of the District Forum that though the expert opinion was called for by the Forum and the report forms a part of the record, it was neither discussed nor addressed to in the order of the District Forum. In the instant case, we observe that the opposite party had treated the complainant immediately after observing delirium and within 4 hours had taken steps to shift her to SVIMS. It is pertinent to note that the patient had later recovered in Apollo hospital, Chennai and the experts have opined that the opposite party have treated the patient with due care and caution and as per standards of medical parlance.
Hence this appeal is allowed and the order of the District Forum is set aside and consequently the complaint is dismissed. No costs.
Sd/-INCHARGE PRESIDENT.
Sd/-MEMBER JM Dt.20-08-2013.