National Consumer Disputes Redressal
Dr Harbans Singh vs Devi Lal Parikh on 29 October, 2014
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION No. 268 of 2013 (From the order dated 26.10.2012 of the Rajasthan State Consumer Disputes Redressal Commission, Jaipur in Appeal no. 287 of 2006) 1. Dr Harbans Singh Son of Amar Singh, Surgeon Kothari Medical & Research Institute Gajner Road Bikaner 334 004 (Rajasthan) 2. Kothari Medical & Research Institute Gajner Road Bikaner 334 004 Petitioners (Rajasthan) Through its Administrator Versus Devi Lal Parikh Son of Shravan Ram Parikh Resident of Vidhya Magharam Colony Respondent Outside Jassusar Gate Near Sooraj Bal Badi School Bikaner, Rajasthan BEFORE: HONBLE MR JUSTICE AJIT BHARIHOKE PRESIDING MEMBER HONBLE MRS REKHA GUPTA MEMBER For the Petitioner Mr Praveen Mahajan, Advocate For the Respondent Mr Vizzy Agarwal Advocate Pronounced on 29th October 2014 ORDER
REKHA GUPTA The present revision petition has been filed against the order dated 26.10.2012 passed by the Rajasthan State Consumer Disputes Redressal Commission, Jaipur (in short, the State Commission) in Appeal no. 287 of 2006.
2. The facts of the case as per the respondent/ complainant are that the respondent was suffering from Piles and for treatment of piles he consulted petitioner no. 1/ opposite party no. 1 herein (Dr Harbans Singh) who suggested for Cryosurgery treatment and the respondent was admitted by petitioner no. 2/ opposite party no. 2 Kothari Medical and Research Institute (in short, Medical Institute). The respondent informed Dr Singh before admission for treatment that he was suffering from Haemophilia. (Note: In Haemophilia disease the bleeding does not stop due to deficiency of cells in the blood. This can be stopped by factor VIII injection only).
3. The respondent was admitted on 11.02.2003 for piles and was operated by Cryosurgery. The respondent remains admitted till 15.02.2003 for treatment and after that he was discharged even though the bleeding had not stopped at that time. The respondent was told that medicines had been given and bleeding would stop. The respondent spent about Rs.5,000/- on the treatment. After discharge, the respondent was taking medicines at home but the bleeding did not stop, the respondent contacted Dr Singh on 17.02.2003 and he prescribed medicines which the respondent took. Even then there was no relief and again he contacted Dr Singh on 22.02.2003 and he advised for blood transfusion.
4. The respondent was admitted on the same day in PBM Hospital, Bikaner, but since, the treatment was not available there, he was advised to go to a higher centre and on the same day he was discharged. The bleeding from piles of the respondent did not stop till 23.02.2003, the respondent got admitted in SMS Hospital, Jaipur and the respondents complete blood test was performed. During treatment, 2 units of blood transfused and injection of Factor VIII of 1000 mg, 500 mg, infused. Thus the bleeding was controlled but it did not stop. The respondent was discharged on 05.03.2003 and instructed for taking 5 injections of 500 mg of factor VIII. The respondent then came to Bikaner.
5. The respondent was admitted in PBM Hospital, Bikaner from 09.03.203 to 16.03.2003 where he was injected factor VIII injection regularly but he did not benefit. The bleeding from piles of the respondent did not stop. Then the hospital advised him for treatment in a higher centre. The respondent went to AIIMS, Delhi for treatment. There the respondent was treated up to 28.03.2003 and the bleeding from piles stopped. Here also the respondent was treated with factor VIII injection and other medicines, and at the time of discharge it was advised, if bleeding started again then factor VIII of 750 mg should be infused twice daily.
6. While taking treatment in different big hospitals, the respondent came to know that the surgery of Haemophilia, should be performed after examining factor VIII level in the blood and any type of surgery should be performed with arrangement of the injection. The petitioners did not examine the factor VIII level in the blood of the respondent. Even the petitioners did not have the facility of this type of examination. Thus, the petitioners operated the respondent in the absence of necessary facility which was not only a medical negligence but was an unfair trade practice as well.
7. The respondent was operated on 11.03.2003 without examining the factor VIII level. Continuous bleeding of piles was due to this operation which stopped after a long treatment till 28.03.2003. During this period the respondent took treatment by going to Bikaner, Jaipur and Delhi. The respondent spent Rs.2,75,000/- in this treatment as one injection of Factor VIII 250 mg costs Rs.2,900/-.
8. The respondent faced severe mental agony due to daily bleeding and he was treated by Dr R P Agarwal for depression. The respondent demands Rs.50,000/- for mental agony. The respondent is doing business of selling Oil and Ghee in Phar Bazar, Bikaner. Due to the above-mentioned problem and treatment he could not open the shop for 2 months and suffered loss in the business. For that a compensation of Rs.20,000/- is demanded.
9. Petitioner no. 1/ OP no.1 (Dr Harbans Singh) in his reply before the District Consumer Disputes Redressal Commission, Bikaner (the District Forum) has admitted that the respondent was admitted on 11.02.203 and was discharged on 15.02.2003 after treatment. He stated that it was wrongly mentioned that the respondent was bleeding at that time.
10. Respondent was having disease of haemophilia. At the time of discharge there was no bleeding in the piles of the respondent. After discharge the respondent did not follow the instructions of the petitioners and for this reason the bleeding started again. For this the respondent was advised blood transfusion.
11. The respondent came to the hospital of Petitioner no. 2 (Medical Institute) on 05.02.2003 and consulted Petitioner no. 1 Dr Singh for the complaint of bleeding piles. According to the respondent he was suffering for last eight years from bleeding in Anus, which was to be treated by Cryosurgery and besides this the respondent was suffering from Haemophilia since his childhood. Therefore, before performing cryosurgery and for safety the respondent was referred by petitioner to Dr Dhanpat Kochar, Head of Department, Medicine, PBM Hospital, Bikaner so that the Haemophilia could be managed. Because, Haemophilia is treated by a physician, in which two methods are used, First the Blood is transfused to fulfil the deficiency of factor VIII or second factor VIII injection is injected. Factor VIII is a component of blood, and the physician decides which treatment is appropriate. For this the respondent was referred to Dr Dhanpat Kochar by the petitioner for the management of Haemophilia and blood was transfused to the respondent under the control and direction of Dr Dhanpat Kochar. Thereafter, the respondent came back to the petitioner on 11.02.2003 as scheduled and he was admitted by petitioner no. 1 in the hospital of petitioner no. 2 for operating bleeding piles by cryosurgery.
12. Since the respondent was suffering from Haemophilia, he was referred to Dr Dhanpat Kochar for necessary management of haemophilia, and after examination and blood transfusion and management of haemophilia by that doctor the applicant was operated after that for bleeding piles by Cryosurgery by the petitioner because treatment of piles of the respondent by cutting was not possible due to haemophilia. Therefore, cryosurgery was performed to stop bleeding from piles using cold process. The respondent was suffering from haemophilia and this was the only possible treatment. When the respondent was discharged from the hospital of petitioner no. 2 there was no bleeding in the piles. Otherwise there was no justification to discharge the patient.. Therefore, the petitioner no. 1 has not committed any negligence or deficiency in service and neither this is unfair trade practice.
13. The Haemophilia disease is a genetic bleeding disease in which due to deficiency of any blood component blood fails to clot and results extra bleeding and swelling in joints.
14. As described above that the haemophilia patient is treated by physician in which two methods are used; (1) to make up the deficiency of factor VIII, blood is transfused or (2) factor VIII is injected. According to paragraph no. 5, of the complaint, the respondent was admitted in PBM Hospital for blood transfusion. And, thereafter as per paragraph no. 6 of the complaint 2 units of blood was transfused in SMS hospital, Jaipur. And along with this factor VIII injection different potency was injected even then the respondent did not get relief. Therefore, the respondent went to AIIMS, Delhi and was treated there. In the above-treatment the respondent has mentioned clearly what was treated. But this is well established that a physician is only competent for the treatment of haemophilia and one of the ways of management is blood transfusion. That is why right in the beginning the petitioner had referred the respondent for management of haemophilia to Dr Dhanpat Kochar, Head of Department, PBM Hospital, Bikaner. There, the physician found it suitable to transfuse the blood and after that the petitioner was treated for bleeding of piles of the respondent by cryosurgery and not by cutting. The respondent was suffering from haemophilia since childhood and the petitioner who is retired from the post of Head of the Department, Surgery, exercising due care, by first referring the patient for management of haemophilia. According to the respondent his bleeding stopped on 28.03.2003. But the respondent never registered any complaint and now after a gap of two years the respondent has filed this complaint with malafide intention which was totally wrong and should be dismissed. The respondent has neither committed any deficiency in service nor unfair trade practice so the respondent does not have any right to claim compensation.
15. Petitioner no. 2/OP no. 2 in their reply before the District Forum have accepted that as per the records of the hospital that the respondent was admitted on 11.02.2003 and after treatment was discharged on 15.02.2003 and is was not available in the record that the respondent was bleeding hence this averment is not accepted.
16. As per records the respondent came on 05.02.2003 to petitioner no. 1 in the hospital of petitioner no. 2 with complaint of bleeding piles and as per records the respondent was having complaint of bleeding from anus since last eight years. With this he was suffering from haemophilia since childhood. So that before performing cryosurgery as a safety, petitioner no. 1 Dr Harbans Singh referred the respondent to Dr Dhanpat Kochar, Head of the Department Medicine, PBM Hospital, Bikaner so that Haemophilia can be managed. As mentioned above the petitioner no. 1 referred the respondent to Dr Dhanpat Kochar for management of haemophilia and after that the respondent came back on 11.02.2003 to petitioner no. 1 , the respondent was admitted in the hospital of petitioner no. 2 for operation of bleeding piles through cryosurgery by petitioner no. 1. Therefore, it was a wrong statement of the respondent that petitioner no. 1 has committed medical negligence or unfair trade practice.
17. The District Consumer Disputes Redressal Commission, Bikaner (the District Forum) vide order dated 07.01.2006 has dismissed the complaint by stating that:
in this case the complaint of the applicant is that from the beginning of consultation he informed that he is a patent of Hemophilia even then without controlling the disease his operation is done which shows negligence and deficiency in services itself. But against this there is strong sense in the plea of the learned advocate of the respondents that the applicant was referred to Dr Dhanpat Kochar for treatment of his haemophilia disease and the operation and treatment was done after controlling of haemophilia by him and after operation the applicant was fit at the time of discharge from the hospital of respondent no. 2 and he went home thereafter if there is any bleeding then this cannot be assumed negligence of respondent no. 1. From the available documents on the file this fact is clearly proved that the applicant was admitted in the hospital of respondent no. 2 and investigations done and in investigations haemophilia disease was observed and after control of haemophilia he was operated. As this point the main argument of the learned advocate of the applicant is that the haemophilia does not control by giving blood only as the treatment facts are proved in CMDT 2003 Blood 513. But in our opinion haemophilia can be controlled by blood transfusion because factor VIII is also concentrated form of blood, so that it is the treating doctor who decides to give or not to give factor VIII and when haemophilia was controlled by blood transfusion then it is not justified to conclude that the haemophilia can be controlled by factor VIII only.
Apart from this so far the question of treatment of piles by cryosurgery, we feel it appropriate to mention here that cryo is a therapy and not a surgery because in this treatment any type of sharp instrument is used and piles is dried by applying cold process. The applicant was discharged in fit condition after this treatment and if the bleeding restarts and he has to undergo treatments at different level then respondents are not at fault because the applicant was treated by them and discharged after complete fitness.
So far this argument of the learned advocate of the applicant that he had to take treatment in SMS Hospital, Jaipur and AIIMS, Delhi. Respondent no. 1 cannot be held liable for that because in both of the above hospital they have not mentioned in this treatment that the bleeding started again due to deficiency in cryosurgery of piles operated by the surgeon.
From the argument of above the applicant has failed in proving that there is deficiency in the service provided by respondent no. 1 and 2 or negligence in the treatment by respondent no. 1 as a result the complaint against the respondent is dismissible.
Therefore, the complaint of the applicant against the respondent is dismissed. All parties bear their own expenses.
18. Aggrieved by the order of the District Forum, the respondent filed an appeal before the State Commission. The State Commission gave a very detailed order while allowing the complaint. The State Commission in their order has observed that:
6. Before we proceed further, it will be appropriate to discuss a few basic aspects and guidelines with regard to management of Haemophilia in patients before surgery. As per de Gruchys Clinical Haemotology in Medical Practice (V Edition) Page no. 417, it appears that patients of Haemophilia require control of bleeding during and after surgery. Haemophilia A is a disorder when factor VIII is deficient in blood, which causes Hemorrhage and non-clotting of blood, once the bleeding starts. The coagulation abnormality has to be corrected either by blood transfusion or by infusion of fresh frozen plasma or appropriate concentrate (factor VIII).
7. From perusal of educational material on Haemophilia published by the World Health Organisation, it appears that surgical procedures in patients suffering from Haemophilia cannot be entertained lightly and should only be done in hospitals, where physicians have expertise in Haemophilia Care and adequate monitoring level is available, because patients suffering with Haemophilia are susceptible to spontaneous haemorrhage. Similar guidelines have been mentioned at page no. 116 of Oxford Test Book of Surgery (Second edition) by Sir Peter J Moris. It has been mentioned in it that patients scheduled for elective surgery should be admitted one or two days beforehand for blood test and patients with severe Haemophilia are likely to need infusions of concentrate for at least 7-10 days after any kind of surgery and there is no such thing as minor surgery for Haemophiliacs.
8. Thus, from the literature submitted by the learned counsel for the complainant, it is evident that patients suffering from Haemophilia require its proper management and monitoring. As the patients of Haemophilia are prone to incessant bleeding and haemorrhage, therefore, coagulation factor has to be maintained before and after surgery either by transfusion of blood or by infusion of factor VIII concentrate. As the factor VIII loses its 50% effectiveness within eight hours of infusion and becomes useless after twelve hours, therefore, the patients require infusion of factor VIII once again, if the surgery is delayed.
9. It is an admitted fact that the complainant initially consulted Dr Singh on 02.02.2002 for treatment of his piles and he informed him that he suffered with severe Haemophilia A. On this, Dr Singh, referred him to Dr D K Kochar, Professor and Head of Medicine, PBM Hospital, Bikaner for management of Haemophilia. From paragraph no. 8 of the reply of Dr Singh, it is an admitted fact that he know that patients of Haemophilia required its management before surgery and for this purpose either the transfusion of blood was required or factor VIII was to be infused to maintain its level. It is also evident from the reply of the respondent no. 2, that it was in his knowledge that the complainant suffered from Haemophilia A and was admitted in his hospital for cryo-surgery of piles. From the discharge ticket dated 05.02.2003 of the PBM Hospital, it is evident that complainant remained admitted there from 03.02.2003 to 05.02.2003 and two units of blood were transfused on 03.02.2003 and 04.02.2003. It is also an admitted fact that the complainant again consulted Dr Singh on 05.02.2003 and he was advised to undergo cryosurgery on 11.02.2003 at the Kothari Institute.
As the patients of Haemophilia needs to be operated upon immediately after management of Haemophilia and as the blood had been transfused on 04.02.2003 to the complainant, he should have been operated upon immediately on 05.02.2003, but Dr Singh fixed the date for surgery on 11.02.2003. As the deficiency of factor VIII in blood results in incessant bleeding and haemorrhage and if surgery is not performed immediately, then the incidents of complication are greatly increased and patient is again required to undergo infusion of factor VIII.
11. There is nothing on part of both the respondents to suggest that after transfusion of blood on 04.02.2003 and on consultation with Dr Singh on 05.02.2003 and till performance of cryosurgery on complainant on 11.02.2003, the Haemophilia A was properly managed and monitored. It is also evident from the record that neither any coagulation study was carried out to ascertain as to what was the complainants level of factor VIII nor any factor VIII concentrate was infused to ensure that it reached the desired level prior to surgery nor any blood transfusion was done immediately before surgery on 11.02.2003. It is also evident that bleeding did not stop even after the surgery on 11.02.2003, till complainants discharge on 15.02.2003 and neither blood transfusion was done nor factor VIII concentrate was infused after surgery for management of Haemophilia, which resulted in continuous bleeding and further complications.
12. When it was in the knowledge of both the respondents that the complainant was suffering from severe Haemophilia A since birth, then there arises a strong presumption that they also knew about the pre-operative and post-operative complications in such patients. Though, two units of blood were transfused in complainants body on 03.02.2003 and 04.02.2003 for management of Haemophilia but then surgery should have been performed on 05.02.2003, when the complainant consulted Dr Singh, but his surgery was deferred for 11.02.2003. As per the medical literature, the factor VIII has a half-life of 8-12 hours and, therefore, it loses 50% of its effectiveness within 8 hours and becomes useless after 12 hours. Therefore, surgery should not have been deferred for over six days after transfusion of blood. Moreover, if surgery was delayed for some reasons, then blood test should have been conducted to determine the level of factor VIII in blood and if the level was not properly maintained, then sufficient blood should have been transfused or factor VIII should have been infused to maintain its level. Respondent no. 1 Dr Singh is a qualified surgeon and had been head of the department of surgery, then it is but natural for him that he must be familiar and acquainted with the pre and post-operative complications in such patients. It was also within the knowledge of respondent no. 2 that complainant was suffering from severe Haemophilia A and that it had to be managed properly by transfusion of blood or by infusion of factor VIII and that there was no facility in his hospital for infusion of factor VIII and despite the lack of this facility, it admitted the complainant in the hospital and was subjected to undergo surgery. This conduct of respondents reflects that they were blatantly negligent and careless in conducting cryosurgery on complainant without properly determining the level of factor VIII in blood or proper management of Haemophilia A. The popular maxim res ipsa loquitur, i.e., the thing speaks for itself applied in the present matter. Thus, the conclusion arrived by the learned DCF that the complainant was completely fit and healthy at the time of discharge from the hospital of respondent no. 2 and therefore, the respondents were not negligent in treatment of the complainant, is totally against the facts and medical jurisprudence and therefore, is totally perverse, illegal and unjust.
13. The learned DCF also erred in holding that there was no negligence on part of the respondents as the complainant was operated upon after transfusion of two units of blood and therefore, Haemophilia was properly managed. On the other hand, it is evident that the complainant was operated upon six days after transfusion of the blood, whereas he should have been operated upon immediately after the transfusion or else he should have been again tested for maintenance factor VIII in blood just before surgery, which was not done.
14. The learned DCF also erred in holding that cryosurgery was not a surgery, but a therapy. Though no sharp instruments such as knives or scissors are used in it, but it is a form of surgery in which liquid nitrogen at an extreme low temperature such as around -190 C, is infused at the affected part of the body and after coagulation of necrosis of the piles, they are separated and dropped off. Thus, cryosurgery is also a medically recognised form of surgery as the affected organ or appendages are removed by way of extreme cooling instead of conventional form of surgery by sharp instruments.
15. Thus, for the aforesaid reasons, it is clearly evident that the respondents did not take proper care for management of Haemophilia by way of either transfusion of blood or by infusion of factor VIII in blood just before surgery and after surgery and this act and conduct of the respondents amounts to gross negligence in treatment of the complainant, which resulted in incessant bleeding ever after surgery. The complainant had to go to SMS Medical College Hospital, Jaipur and remained there admitted from 23.02.2003 to 05.03.2003, where factor VIII was infused in the body. After his discharge from the SMS Hospital, the complainant remained admitted from 09.03.2003 to 16.03.2003 at PBM Hospital, Bikaner and from there he was referred to Higher Centre, on which he went to AIIMs, New Delhi and he remained there from 22.03.2003 to 28.03.2003, where 750 unit of factor VIII was infused twice a day. From the cash memos pertaining to the injection of factor VIII, it appears that the complainant had to spend thousands of rupees in his treatment from 11.02.2003 till his discharge from AIIMS on 28.03.2003. As per the complainant he had spent around Rs.2,75,000/- in his treatment.
16. For the aforesaid reasons, it is clearly evident that the respondents were negligent and careless in the treatment of the complainant, which resulted in continuous bleeding and lot of expenses had to be borne by him for his treatment at various places. Thus, the findings and conclusions arrived at by the learned DCF in rejecting the complaint are totally perverse, illegal and unjust and are against the facts available on record. There is an error apparent on the face of record in the impugned judgment of the DCF and it did not exercise its discretion properly and erroneously rejected the complaint. Therefore, the impugned judgment dated 07.01.2006 of the learned DCF deserves to be quashed and set aside and the present appeal and the complaint deserves to be allowed. The complainant is entitled to get from the respondents Rs.2.75 lakh as damages for the expenses incurred by him along with Rs.50,000/- for mental agony.
17. The present appeal and complaint of the complainant is allowed jointly or severally against the respondents and the impugned judgment dated 07.01.2006 in complaint no. 38 of 2005 titled Devi Lal vs Dr Harbans Singh is quashed and set aside.
The respondents shall pay jointly or severally to the complainant an amount of Rs.2.75 lakh with 9% interest per annum from 11.02.2005, the date of filing of the complaint. The respondent shall also make a payment of Rs.50,000/- for mental agony and Rs.20,000/- as cost of proceedings.
19. Hence, the present revision petition.
20. We have heard the learned counsel for the parties and have carefully gone through the records on the file.
21. The Counsel for the petitioner while referring to the medical records on file has drawn our attention to the fact that the petitioner no. 1 was aware that the respondent was a haemophilic and hence he was referred to Dr Kochar, Professor, Head Department of Medicine, PBM Hospital, Bikaner, so that haemophilia can be managed by the Physician before the petitioner could treat the respondent for his bleeding of piles in the rectum area when the respondent went to him on 02.02.2003. Thereafter the respondent went to him on 05.02.2003 when he was prescribed some tests and asked to get admitted on 11.02.2003 for Cryosurgery. He has also stated that the doctor had opted for cryosurgery as it is a non-evasive procedure which causes no bleeding. He categorically stated that the respondent suffered no bleeding after the cryosurgery and was hence, discharged on 15.02.2003. Thereafter he visited the petitioner on 17.02.2003 when he was only recommended some medicines to ease the bowel evacuation and other symptoms. On 22.02.2003 when he was advised blood transfusion. He explained that petitioner no. 1 had opted for cryosurgery which is an accepted procedure for first, second and some selected third degree haemorrhoids. The cryoprobe of liquid nitrogen is applied to the haemorrhoid for about 3 minutes to produce liquefaction of frozen tissue, over the ensuing 2-3 weeks. This procedure is painless and requires no anaesthesia. He emphasised that the respondent being a haemophilic was not subjected to conventional surgery which could have resulted in heavy bleeding.
22. Counsel for the respondent, however, insisted that subsequent treatment that the respondent had to take for bleeding from PBM Hospital, Bikaner, SMS Hospital, Jaipur and AIIMS was due to the botched up cryosurgery and hence, there was deficiency of service on the part of petitioners. He stated that petitioner no. 1 did not take due care and knowing that the respondent was haemophilic should have taken greater care prior to performing surgery by ensuring adequate levels of factor VIII.
23. We find that the State Commission has reversed the order of the District Forum on the following grounds:
(i) That the patients of Haemophilia require control of bleeding during and after surgery and surgical procedures in patients suffering from haemophilia cannot be entertained lightly and should only be done in hospitals, where physicians have expertise in haemophilia care and have adequate monitoring level is available.
(ii) Patient scheduled for elective surgery should be admitted one or two days before for blood tests and patients with severe haemophilia are likely to need infusions of concentrate for at least 7-10 days after any kind of surgery.
(iii) Coagulation factor has to be maintained before and after surgery either by transfusion of blood or by infusion of factor VIII concentrates. Factor VIII loses 50% effectiveness without eight hours of infusion and becomes useless after twelve hours.
(iv) The discharge ticket dated 05.02.2003 of PBM Hospital makes it evident that the patient remains admitted with the respondent from 03.02.2003 to 05.02.2003 and two units of blood were transfused on 03.02.2003 and 04.02.2003. Thereafter, the respondent met the petitioner on 05.02.2003 and was advised to undergo cryosurgery on 11.02.2003. The State Commission was of the view that the respondent should have been operated immediately on 05.02.2003. They came to the conclusion that there was deficiency of service on the part of respondents that the surgery should not have been deferred for six days after the transfusion of blood.
(v) The State Commission further stated that the respondent did not take proper care for management of Haemophilia by way of either transfusion of blood or by infusion of factor VIII in blood just before surgery and after surgery and this act and conduct of the petitioners amounts to gross negligence in treatment of the respondent which resulted in incessant bleeding even after surgery.
(vi) The State Commission further in their order stated that due to this negligence the respondent had to thereafter take treatment at SMS Medical College Hospital, Jaipur, PBM Hospital and AIIMS, New Delhi.
24. To begin with respondent has nowhere in his complaint has referred to or mentioned about his treatment with Dr Kochar. Though, it is an admitted fact that the petitioner had referred the respondent to Dr Kochar, Head of Department, Medicine, PBM Hospital, Bikaner so that his Haemophilia could be managed before the date of operation which on 05.02.2003 had he given as 11.02.2003. The respondent has not mentioned in his complaint as to when he went to Dr Kochar and for how long he took the treatment for management for haemophilia before getting admitted on 11.02.2003 for cryosurgery of piles.
25. The counsel for the respondent did not show any record of the treatment given by Dr Kochar. It is not known on what basis the State Commission has come to the conclusion that the petitioner had failed in taking due care for management of Haemophilia before operation and that the delay between the treatment given by Dr Kochar and the date of operation resulted in bleeding. The respondent had been informed on 05.02.2003 that he would be operated on 11.02.2003. He had already been referred to Dr Kochar for control of his Haemophilia, to ensure that haemophilia was within control to withstand any procedure. In fact on 05.02.2003 the doctor has prescribed certain tests which were to be taken before the operation so it cannot be stated that no tests were undertaken. It is also an admitted fact that the respondent had gone to respondent no. 2 with complaints of bleeding from the rectum for last eight years. Proctoscopy revealed piles at 03.00 clock and 07.00 clock and even then bleeding was seen from proctoscopy. It is also noted that the patient was haemophilic since birth and got admitted in the PBM Hospital for transfusion of blood.
26. From the records it is seen that after the cryosurgery, knowing that the patient suffered from Haemophilia since birth, it had repeatedly been recorded in the bed ticket that the patient should be watched for bleeding. In fact on 12.02.2003 it had been recorded that if the patient is bleeding, should be informed SOS.
27. From the bed ticket dated 13.02.2003 it has been noted that there was no complaint and hence, a decision was taken to discharge the patient on 15.02.2003. Had there been any bleeding it would be mentioned in the medical record, particularly, when the doctor had warned them as soon as there was any bleeding it should be informed SOS. Hence, it is not known and on what basis the State Commission concluded that the respondents were negligent in the management of Haemophilia after the surgery.
28. Haemophilia is a group of hereditary genetic disorders that impair the bodys ability to control blood clotting or coagulation, which is used to stop bleeding when a blood vessel is broken. Haemophilia A, which the respondent is suffering from, is due to deficiency of clotting factor VIII and this is the most common form of the disorder, present in about 1 in 5000-10,000 male births. Characteristic symptoms vary with severity. In general symptoms are internal or external bleeding episodes which are called bleeds. Patient with more severe haemophilia suffer more severe and more frequent bleeds, while patients with mild haemophilia usually suffer from minor symptoms.
29. In both haemophilia A & B, there is a spontaneous bleeding. Internal bleeding is common in people with severe haemophilia and some individuals with moderate haemophilia. The most characteristic type of internal bleed is a joint bleed where blood enters into the joint spaces. This is most common with severe haemophiliacs and can occur spontaneously without evident of trauma. There is no cure for haemophilia it can, however, be controlled with regular infucsions of the deficient clotting factor VIII in Haemophilia A.
30. In the instant case, it is an admitted fact that the respondent was an Haemophilic A since birth, hence, he had to manage his haemophilic through constant monitoring and transfusion of factor VIII.
31. It is seen from the record that after the procedure he took treatment with petitioner no. 2 he took treatment from SMS Hospital, Jaipur and AIIMS, Delhi. As per the records on file relating to treatment under taken by the respondent at Sawaiman Singh Hospital, Jaipur most of the bills placed on record are for bedside ECG Cardiology and for blood supply from their blood bank as also tests in their pathology lab as also donations to the Haemophilia Society (Rajasthan) India. There is no record placed on file with regard to the treatment taken to control bleeding due to a botched up operation. As per the medical record of AIIMS, Delhi, he first went on 22.03.2003 and it is noted that the bleeding was controlled at present. He was referred to surgical OPD and it was advised that factor VIII should be given to him for seven days. On 26.03.2003 he was asked to register in Haematology Clinic and screen the coagulation with BT, PT, APTT, Factor VIII assay, VWD Work up. On 28.03.2003, he was advised Proctoscopy and Banding in Minor OT as it appears he got another hammeroid due to his old standing problem of bleeding piles. Nowhere in the record of the AIIMS, we find, anything to the effect that he was diagnosed as suffering from bleeding due to cryosurgery.
32. In view of the above, we do not agree with the State Commission that there is anything on record to show that petitioner no. 1 and 2 were deficient or negligent in the treatment protocol given to the respondent or that the act and conduct of the respondents amounts to gross negligence in treatment which resulted in incessant bleeding even after surgery. The Cryosurgery was undertaken to cure the haemorrhoids causing the bleeding from the rectum for the last eight years. However, the respondent is a haemophilic from birth and cryosurgery cannot cure and this genetic disorder for all time. He will continue to need treatment for management of his condition. Hence, we allow the revision petition, the impugned order of the State Commission is set aside and the order of the District Forum is confirmed.
Sd/-
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[Rekha Gupta] sd/-
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[ Ajit Bharihoke, J.] Satish