State Consumer Disputes Redressal Commission
1. V. Bagyalaxmamma vs 1. M/S. Yashoda Hospital, on 25 January, 2022
DISPUTES REDRESSAL
BEFORE THE TELANGANA STATE CONSUMER
cOMMISsION:HYDERABAD
C.C.No.229/2013
Between:
1.V.Bagyalaxmamma ( Dead)
Through LRs:
2. V.Anil Kumar, S/o.late V.Jagadishwaraiah,
Aged about 47 years, Occ:Senior Citizen.
3. V.Venkaiah, S/o.late V.Jagadishwaraiah,
Aged about 42 years, Occ:Senior Citizen.
All R/o.H.No.10-3-14, East Marredpally,
Secunderabad. . Complainants
And
1.M/s.Yashoda Hospital,
Rep. by its Managing Director
Dr.G.Surender Rao
2. Dr.V.Rajeshwar Rao,
S/o.Not Known to complainant,
Aged Major, Occ:Doctor,
3. Dr.Akhil Dadi, S/o.Not known to complainant,
Aged Major, Occ:Doctor
4. Dr.P.Ratnakar S/o.Not known to complainant,
Aged : Major, Occ:Doctor,
5. Dr.J.M.Gurunath, S/o.Not known to complainant,
Aged Major, Occ:Doctor,
6 Dr.P.Venu Gopal (Died),
S/o.Not known to complainant,
Aged Major, Occ:Doctor,
7. Dr.T.Sashikanth, S/o.Not known to complainant,
Aged Major, Occ:Doctor,
(Address of opp.parties 1 to 7 is C/o.Yashoda Hospital,
Behind Hari Hara Kala Bhavan, S.P.Road,
Secunderabad.
8. The Senior Divisional Manager,
The New India Assurance Company Ltd.,
#6-3-862/A/B, 2nd Floor, Lal Bangalow,
Green Lands, Ameerpet, Hyderabad 500 016.
9. The New India Assurance Company Ltd.,
206/207, 2nd Floor Chenoy Trade Centre,
Park Lane, PB No.1708, Secunderabad 500 003.
10. Indian Medical Association, A.P.State Brnch
(Professional Protection & Welfare Scheme)
Represented by its Senior Divisional
Manager,
IMA Buildings , 1at Floor Esamai Bazar,
Hyderabad.
11, The New India Assurance Company Ltd.,
6-3-862/A/B , 2nd Floor, Lal Bungalow,
dreen Lands, Ameerpet, Hyderabad 500 016.
12. The Senior Divisional Manager,
The New India Assurance
Company Ltd,
Karimnagar BO (610904) , H.No.3-5-83,
1st Floor,
Upstairs of Andhra Bank,
Main Branch Building,
Osmanpura, Karimnagar 505 001.
Opposite Parties
Counsel for the Complainants M/s.M.Hari Babu
Counsel for the Opposite Parties Mr.G.Venugopal Rao-OPs. 1 to 7.
M/s. P.Viswajanani-OPs.8,9,11 & 12.
cORAM: Hon'ble Sri Justice M.S.K. Jaiswal, President.
And
Hon'ble Smt. Meena Ramanathan, Lady Member
TUESDAY, THE TWENTY FIFTH DAY OF
JANUARY,
TWO THOUSAND TWENTY TWO.
Order:
1. This is a complaint filed u/s.17(1)(a)i) of C.P. Act alleging deficiency in service against the opposite parties and direct them to pay the complainant jointly and severally a sum of Rs.99,00,000/- along with interest@ 24% p.a. from the date of complaint till realization and to award costs of the complaint.
2. The complainant no.1 wife of the deceased V.Jagadishwaraiah along with her sons V.Anil Kumar and V.Venkaiah has filed the present complaint alleging deficiency in service and negligence against the opposite parties in the treatment meted out to her husband/father.
During the pendency of the complaint, the wife of the deceased being complainant no.l passed away and only the sons being complainant nos.2 & 3 are on record.
On 14.3.2012, Sri V.Jagadishwaraiah underwent Right Total Knee Arthroplasty. The complainants state that no pre operative diagnostic tests, which are mandatory were conducted on the 72 year old patient. After the surgery, the patient developed several complications and they were informed that intra abdominal abscess' was observed due to Perforated Sigmoid Colonic Diverticulitis. A senior Gastroenterologist opposite party no.6 was called upon to perform the surgery on 23.3.2012. The patient however 3 developed severe complications and succumbed on 25.3.2012 during the early hours.
The deceased was a renowned dealer in the Bullion Market and having a very successful business. The complainants have further submitted that the deceased was obese, suffering from hypertension and Diabetes Mellitus Type-2 and persons with these ailments should not be advised to undergo TKR (Total Knee Replacement). Against this rule, opposite parties 1 to 3 have advised him to undergo the said surgery and failed to provide the proper care and treatment amounting to medical negligence and unfair trade practice, hence the complaint.
. Opposite parties 1 to 7 filed their written version contending that the patient/deceased Sri V.Jagadishwaraiah was having complaints of pain in the right knee and was having dificulty in walking and climbing stairs. The patient was informed about the procedure and probable complications before obtaining consent. The patient underwent a thorough physical, cardiological and anesthetic evaluation before surgery.
They admit that it is only on 17.3.2012 ( not on 15.3.2012 as stated by the complainants) the patient complained of abdominal distension which is totally unrelated to the Total Knee Replacement Surgery. Abdominal distension is an occurrence in some patients during post operative period, mostly due to electrolytes imbalance. Necessary treatment was given to the patient and he was regularly monitored by the team of doctors. Uniortunately, inspite of the best possible treatment, the patient died on 25.3.2012 at 1.10 a.m. Patient expired because of sepsis associated with multi organ dysfunction syndrome, secondary to sigmoid diverticulitis with perforation and peritonitis' The patient weighed only 84 kgs. and there is no bar for operation in respect of obese persons. With the above submissions they seek dismissal of the present complaint.
4. Written Version of opp-parties 8,9,11 & 12 iled . They submit that Yashoda Hospital (opp.party no.1) is insured with the opposite party under Professional Indemnity Insurance Policy vide Policy o.611900361 10200000006. The said policy was in effect from 31.5.2011 to 30.5.2012 subject to terms and conditions as stipulated in the policy.
As seen from the complaint, the deceased V.Jagadishwaraiah was admitted to the hospital of opposite party no.1 and provided the treatment for his ailments. A team of expert doctors complied all the protocols as specified by the Medical Board and hence the insurance company is not liable to make any payments to the complainants for the death of the patient. The insufance company has to rely on the diagnosis made by the opposite parties i.c. thc treating doctors and whether the appropriate treatment was given. Since they have provided the required treatment and therefore under the terms of the policy the complainants are not eligible for any claim. They pray to dismiss the complaint with exemplary costs.
5. Evidence affidavit of the complainant no.2 as PW.1 filed. Evidence Affidavit of complainant no. 1 as PW.2 filed. Exs.A1 to A7 are marked on behalf of the complainants. Evidence Affidavit of Dr.K.Vara Prasad Rao, Hospital Administrator of opp.party no.1 hospital filed. Evidence Affidavit of Dr.Akhil Dadi-opp.party no.3 filed deposing on behalf of opposite party no.4 also. Evidence Affidavit of opposite party no.5 & 7 filed. Evidence Affidavit of opposite party no.6 filed deposing on behalf of opposite party no.2 also. On behalf of the opposite parties 1 to 7, Ex.B1 to B8 are marked. Complainants 1 & 2 are cross examined as PWs.2 &1. Opposite parties 3 ,5,7 are cross examined as RWs.3 5 &7. Advocate Commissioner's Report is filed.
6. Heard both sides and perused the entire material on record.
7. The points that require our consideration are
i). whether the opposite parties evaluated the patient/deceased properly before surgery and whether there was any negligence established in the post operative care?
i). If yes, are the complainants entitled to the reliefs as claimed for?
i). To what relief?
8. The case of the complainants is that the patient V.Jagadishwaraiah, aged 72 years and weighing over 100 kgs. approached opposite party no.1 as he was facing difficulty walking and climbing stairs. On 13.3.2012 after three preliminary examinations, he was admitted in the opposite party hospital and advised to undergo TKR (Total Knee Replacement).
9. The undisputed facts of the case are as follows:
a). On 14.4.2012 Right Total Knee Anthroplasty was performed on the patient V.Jagadishwaraiah,
b). 17.3.2012- as per Ex.B1 ( Doctor's Notes - pg.36) patient complained of abdominal distension and a new Case Sheet was opened as submitted in the evidence of opposite parties 3 & 4.
c) The aspiration procedure could not stop the progression of sepsis, so the patient had to undergo an Exploratory Laparotomy & Segmental Resection of Sigmoid Colon +Colostomy 5
d). Patient died on 25.3.2012 at 1.10 a.m.
10. The complainants have agitated on the grounds that opposite partiess1 to 3 have not conducted the proper investigations that are mandatory prior to surgery. It is their complaint that opposite parties 1 to 3 suggested total Knee Arthroplasty in purely commercial a way and it was not advisable for the patient to undergo the said procedure. careful perusal of the documentary A evidence placed on record is necessary to establish the fact whether there has been negligence on the part of the opposite parties pre and post operatively.
Ex.Al Final Bill Statement issued by Yashoda Hospita for Ex.A2 Final Bill Statement Rs.1,82,215.84.
issued by Yashoda Hospital for Ex.A3 refers to Discharge Rs.3,24, 789.37.
Summary wherein it is stated that Right Knee Arthoplasty was done under Spinal and Epidural Anaesthesia on 14.3.2012. On pg.23 of Ex.A3 it is recorded that patient had no history of trauma, surgery. Past history nothing contributory.
11. Reference is made to the Advocate Commissioner's report & Cross Examination of the following:
PW.2 is the son of the deceased patient /complainant no.2 and he has made the following statement:
"On 15.3.2012 in the morning when I visited the hospital 1 enquired my mother about the health condition of the father then to that she replied OK there is no he is doing fine. problem and Dr.Akhil Dadi did not visit my father post duty doctors attended my father. Next day operatively but the hospital and again I visited requested Dr.Akhil Dadi to attend father, as per my request Dr.Akhil Dadi has attended my father and made my father to my undergo ambulation ( made my father to walk) then I noticed that my father was having a distended stomach and I reported the same to Dr.Akhil Dadi and he stated that he would do tests and my father was not necessary of operation."
passing motion from the date In the deposition of RW3 i.e. Dr.Akhil Dadi opposite party no.3 the
-
-
Orthopedic Surgeon who treated the deceased has stated the following:
"It is true to state that in one of my interviews as taken that more precautions will be taken for elderly people, who approach me with knee problems. It is true to say that only after seeing the B.P., Thyroid, and blood sugar level Cardiac, Urinary infection reports. Witness adds the above stated pre-evaluated test are done as medical guidelines."
The fact that despite having abdominal distention not called for , Gastroenterologist was consultation. The statement of R3 confirms this:
. " I t is true to say that Dr.Nikil and Dr.R. Venugopal are not Gastroenterologists They are General Surgeons"
. I refer to Dr.Venugopal and also Dr.Gurunath ( Physician) for the abdomen distension"
The Deposition of RW5 i.e. Dr.Gurunath, General Physician and opposite party no.5 submitted the following in his cross examination:
On 17.3.2012 patient complained of abdomen distension for last 1 day. After observation and examination I ruled out Acid Peptic disease, functional bowel disease inilammatory bowel disease and then I came to conclusion that it is a case of surgical abdomen. The patient was on the drug name nicordia on the General Surgeons suggestion to change the B.P. medicine I have changed the niocordia to Telma - 40 mg and advise to follow the surgeons treatment." It is true to say that on 19.03.2012 at 10.55 am with the problem of the SOB patient was referred to me. When the I patient was referred to me on 19.03.2012 at 10.55 am. observed the patient suffering from abdominal distension and patient complained of SOB.
.It was the cause of decease sigmoid diverticulitis with perforation peritonitis is due to infection/inflammation of the diverticulitis. Due to contemned water and food."
He further states that "It is not to true suggest that due to using of calcium gluconate injection the patient had developed diverticulitis causing death."
This is further analyzed and supported with the evidence affidavit submitted He has stated that he attended on the by opposite party no.6
-
Dr.Venugopal.
after TKR. The patient was referred to patient post operatively undergoing
him from 19.3.2012 with the complaint of abdominal distension. He advised Ultra Sound Abdomen which revealed "enlarged liver with mild altered echo texture with distended bladder filled with sludge and gas filled bowel loops".
In their Written Arguments as submitted by opposite parties 1 to 5 &
12. 7 the patient was diagnosed as suffering from sluggish bowel movements on 16.3.2012 at around 11.55 pm. and the possible complications of diverticulitis are referred to in detail. They also submit that surgery is also the available treatment of Diverticulitis before it becomes perforated Diverticulitis and develops into a medical emergency. As per the Written major TKR and there was intra Arguments, the patient had undergone a abdominal abscess before 21.3.2012. Yet on 21.3.2012, the opposite parties only chose to conduct a C.T. guided aspiration and drainage was done by taking the services of an interventional Radiologist to avoid a major surgery.
The aspiration procedure could not stop the progression of sepsis and the scheduled for only on 23.3.2012. We have referred to the patient was a surgery medical literature provided by the opposite parties and emphasis is supplied to the case plan:
" 7 . Prepare the patient for surgery as ordered. Severe acute pain due to obstruction from paralytic ileus may require immediate surgical intervention."
The delay has been inordinate on the part of the opposite parties despite constant attendance.
13. On 20.3.2012, the condition of the patient was not improving and he advised CE-CT scan of abdomen and the report submitted is as follows:
Intra abdominal abscess-likely due to perforated sigmoid colonic diverticulae He has further submitted that the patient had colonic diverticulae which was existing earlier and asymptomatic before surgery - got infected and went into perforation which produced distention of the abdomen. Once the Colon is perforated and faecal soiling of the abdominal cavity begins, the risk is very high and the patient had to undergo an "Exploratory Laparotomy + Segmental Resection of Sigmoid Colon+ Colostomy".
14 At this juncture we need to consider the pre operative assessments the patient underwent before his Knee Arthoplasty. Ex.B1 pg.11 pertains to the pre anaesthetic evaluation of the patient dated 13.3.2012.Under Medical History the following recordings are noted:
"CVS No H/o HTN, chest pain, CAD"
RS Bronchial asthma, TB
CNS:CVA, Seizures
ENDOCRINE: DM No
HYPOTHYROID/HYPERTHYROID- No
RENAL No renal abnormalities
HEPATIC-Jaundice
ALLERGIES - No"
PHYSICAL EXAMINAIrON: Build Obese..."
There are no untoward observations made with regard to the patient medical condition or history, except for the fact he was 72 years old and obese and having difficulty in climbing stairs.
In page 15 of Ex.B1 it is clearly recorded that "No H/o Trauma/Surgery. No H/o other joint - involvement. No H/o. HTN/DM/Asthma/thyroid/cOPD/ CAD
15. The patient's weight noted on page 17 is 84 kgs. He underwent a systemic evaluation as noted on page 18 prior to TKR and under the evaluation of Abdomen, no remarks have been noted by the Doctor.
8On page 23 the Primary Consultant has obscrved that cxpected outcome Prognosis fair'. This is signed by Dr.Akhil Dadi - opp-party no.3 and is dated 15.3.2012.
On 16.3.2012 at about 11.55 p.m. the patient had complaints of abdominal distension and pain (Page 35) . Test for Electrolytes was advisced.
On 17.3.2012 it is noted that abdominal distension continued and patient was sluggish and to inform Dr.Venugopal. There is a very critical noting regarding 'paralytic ileus' On page 40 dated 17.3.2012 at 2.30 p.m. it is very clearly recorded that the patient has been complaining of abdomen distension and pain since 4 days. Although the patient has been complaining continuously about pain and abdominal distension the general surgeon reviewed the case only on 19.3.2012 as evidenced vide Ex.B1 - page 52.
The patient's attendants were explained regarding the possibility of DVT on 19.3.2012.
There was a suspicion that the patient may be suffering from paralytic ileus as specifically noted on pg.35 of Ex.B1.
of intestinal blockage in the
Paralytic ileus is the occurrence an
absence of actual obstruction. Symptoms are normally abdominal swelling,
distension or bloating. This was not addressed at the earliest although it was diagnosed. An ileus can develop into a serious and potentially life threatening situation.
Primarily an ileus should have been diagnosed and the opposite party doctors should have immediately advised imaging studies to show where an ileus is located showing a build up of gas, an enlarged intestine, or even an obstruction.
The patient was 72 years old and aging also naturally slows down the
16. movement of the intestines. An older adult is at risk of ileus, specifically after more medications.
surgery when they require The patient never had any history of colonic diverticulae as stated by opposite party no.6 Doctor but this occurred due to electrolyte imbalance post not addressed by the opposite parties at the earliest. The operatively and was instant had not undergone a surgical procedure on the patient in the case abdomen. An ileus is more likely if he had undergone abdominal surgery. The other medical condition that can increase the risk of ileus is 'electrolyte imbalance' and this is also admitted to by opposite parties 3 and 4 in their Evidence Affidavit. Having been aware of this complication, the opposite did not treat it at the earliest. A CT scan or ultra sound would have parties provided detailed image and helped the doctors identify the potential area a where the ileus is located. An ileus is common but highly treatable but delay can cause severe eomplications. Two of the moat aevere complications are Neerosis leading to bowel pertoration.
related ileus often heala within few days and treatment at
Surgery a
the hospital must be imnediate and include intravenoua luida to prevent
dehydration, naso-gastric eommpression and pain relief haa made diagnosia of Hollow The opposite party no.6 Doctor a which time the patient had becn Viscous Perforation on 21.3.2012 by complaining of abdominal pain and distention for more than 4 days and he was suspected to be suffering from paralytic ileus from 17.3.2012.
17. The patient in this case, being older and having a high BMI required the elective orthopedic procedure. He greater vigilance while undergoing recognized complication of developed severe post operative ileus which is a lower extremity surgery and should have been closely monitored. The dclay in treating the patient for this complication has unfortunately led to his tragic death and the opposite parties have been deficient and negligent in not preventing this severe complication. The point no.1 is accordingly answercd.
18. Point no.2 The deceased was apparently having a successful bullion business and his tax returns are filed in support of this as cvidence vide Ex.A5. His untimely death owing to the lack of improper diagnosis and prompt care has caused irreparable loss to the family and the opposite parties_are jointly and severally liable to provide compensation to alleviate the damage caused. Based on the discussions held above, we conclude that there was medical negligence giving rise to deficiency in service on the part of the opposite parties and award a sum of Rs.5 lakhs as compensation.
19. In the result Complaint is partly allowed. Opposite parties 1 to 5 and7 to 10 are directed to pay the complainants a sum of Rs.5 lakhs towards compensation and their liability is joint and several. Time for compliance is two months, failing which the awarded amount will attract interest @ 7% p.a. thereafter till payment is made.