National Consumer Disputes Redressal
H.S. Sharma vs Indraprastha Apollo Hospital And Anr. on 1 February, 2007
Equivalent citations: 2(2007)CPJ21(NC)
ORDER
Rajyalakshmi Rao, Member
1. At the outset, we would state that over busy medical practitioners are expected to devote some time and see that post-operative treatment is also given properly and care is taken by the patient in accordance with the requirements of the disease or the operation. It is their duty. If this is not done, it is likely to create complications after operation which may on occasions be fatal or affect the health of the patient. Not doing so or not attending the patient after operation or delay in giving appointment, in case of complications, would certainly be deficiency in service.
Further, discharge summary must also contain treatment chart at the pre-operative and post-operative stages. It must also contain details of what precautions are required to be taken by the patient.
Facts:
2. This original complaint is filed by H.S. Sharma, complainant against Indraprastha Apollo Hospital, opposite party No. 1 and Dr. Arun Sethi, Senior Consultant- Opthalmology of Indraprastha Apollo Hospital, opposite party No. 2, alleging medical negligence and deficiency in service with regard to the surgery and treatment of his eye. For this, an amount of Rs. 1 crore towards compensation has been claimed for damages.
3. The complainant has retired from Indian Revenue Service and is practising as an Advocate. He is a beneficiary of the C.G.H.S Scheme (Central Government Health Scheme -in short CGHS). As per the scheme, he would be reimbursed by the Government certain amount and the remaining amount has to be borne by the complainant, pensioner.
4. On 30.5.1997, he was referred to Indraprastha Apollo Hospital, New Delhi for his eye treatment by C.M.O., CGHS Dispensary, Ghaziabad.
5. The complainant reported to the Apollo Hospital on 31.5.1997 and opposite party No. 2-Dr. Sethi examined all the relevant papers of the earlier treatment taken under the CGHS. The complainant was told by the opposite party No. 2 that the complainant being diabetic, cataract surgery requires utmost care and expertise for which he was trained in. Opposite party No. 2 did several pre-operative tests like corneal swab, slit lamp examination and asked the complainant to get his blood tested for HLC, TLC, DLC, ESR, ECG, conjectival culture and mainly blood sugar test. Opposite party No. 2 had also asked the complainant to get a certificate from the physician about control of blood sugar. All these tests were got done and, thereafter, submitted to opposite party No. 2 along with the certificate of blood sugar which was normal and controlled by the physician. After checking these, he was admitted in the hospital on 19.6.1997. The operation was scheduled at 1300 hours and accordingly, the complainant got admitted in the hospital in the early morning on the scheduled date. The operation was lasted for two hours, i.e. from 4.00 p.m. to 6.00 p.m. and the complainant was discharged on the next day, i.e. 20.6.1997.
6. However, the complainant was not satisfied with the post-operative visual recovery. O.P. No. 2 assured that in due course it would improve and asked him to come back for review on 23/24.6.97. Although the recovery was still not good, opposite party No. 2 told him to resume his normal activities and prescribed some eye drops. Complainant's vision still did not improve and he contacted opposite party No. 2 on 4.7.1997 but opposite party No. 2 did nothing as remedial measure. The complainant was advised by opposite party No. 2 to seek an appointment with the hospital, i.e. opposite party No. 1, for examination and treatment on 7.7.1997 at 9 a.m. On that day, opposite party No. 2 administered two injections in the eye, one in the morning and the other in the evening and also administered several oral tablets and medicines with the advice to report back to him on the following day. The complainant reported to opposite party No. 2 on the next morning, i.e. on 8.7.1997.
7. Opposite party No. 2 expressed his helplessness to give any effective remedy in such a post-operative situation and referred the complainant to Dr. Cyrus M. Shroff. Dr. Shroff examined the affected eye and also showed it to cornea expert Dr. Dave. Dr. Dave observed that the cornea was badly damaged and felt that it could be due to operational negligence and use of obnoxious drugs during operation.
8. The complainant then went to Sankara Nethralaya, Madras but because of some drugs prescribed by the opposite party No. 2 the complainant developed side effects and suffered from severe gastroenteritis. He was diagnosed to have (1) Bacillary Dysentery;
(2) Diabetes Mellitus;
(3) Endopthalmitis right eye and (4) Acute retention of Urine - ? BHP This necessitated immediate hospitalisation in Malar Hospital in Madras on 12.7.1997. Consequently, in these circumstances, it was not possible for Sankara Nethralaya to carry out any operation. The Chief, Dr. Badrinath, of the Sankara Nethralaya also made a detailed report regarding the injury in his eye and opined that the operated eye was infected with acute fungal infection which developed after the operation in the Apollo Hospital. He was advised to seek the intervention of Dr. Atul Kumar in R.P. Centre of All India Institute of Medical Sciences who removed the eye and saved the left eye and the life of the complainant. The complainant submitted that he is deprived of his right eye and unable to undertake any professional and other duties of an advocate and suffered irreparable loss and filed the complaint on the following grounds:
(a) Considering the past history of diabetes, patient should have been kept on insulin in a surgery like cataract and glaucoma in order to stabilise the blood sugar prior to surgery.
(b) Patient was made to wait for three hours for surgery outside the OT in a waiting room, which affected his blood sugar levels. As no blood sugar report has been filed adverse inference has to be drawn that either the patients blood sugar level at the time of surgery was not within normal limits or that the blood sugar was not tested at all.
(c) Operation theatre was not sterlised as the operation started as soon as the theatre fell vacant.
(d) The blood pressure of the patient at the start and till completion of surgery was too high. This must have left deep wound inside the operated portion.
(e) Discharge summary was mechanical and not patient friendly. There was no postoperative advice to keep check on blood sugar level and hypertension by seeing endocrinologist or diabetologist. Patient not advised to continue seriously with the medication to keep blood sugar under control.
(f) Exactly on the fourteenth day of surgery the patient experienced loss of vision in his operated eye. He called up the surgeon who advised on telephone to double the dosage of the drugs. This dosage was advised by the surgeon without any examination of the eye. In the evening the patient again complained of no improvement. The surgeon showed no urgency and told the patient to take appointment with him after two days.
(g) The surgeon examined the eye and without testing the nature of infection whether it was viral, bacterial or fungal, he straightaway put the patient on steroid named, WYSOLONE. This steroid was not known to be used in Diabetics as it delays in healing of wounds and impairs the secretion of insulin. Systemic steroids are not to be used in case of known post operative fungal endophthalmitis as it weakens the immune system of the patientr. Thus by giving the said steroid the condition of the patient further worsened and this fact was crystal clear from the letter dated 10.7.97 of Dr. C. Shroff. The surgeon should have admitted the patient immediately for identification of the infection and further treatment.
(h) It was at Dr. Shroff's nursing home that all the tests were conducted and it was found that the patient was infected with fungal enophthalimitis.
(i) The fact that the condition of the patient never improved thereafter, can be inferred from the letter dated 19.7.97 of the Sankar Nethralaya wherein it has been clearly stated that they were unable to perform operation as patient developed severe post-operative complications.
(j) Due to the said medical negligence of the hospital and the surgeon at the Apollo Hospital that the patient had to get his right eye removed in order to save the other eye. Any dexterity of action is to be judged by the result.
9. The complainant averred that he lost his eye-sight in the right eye permanently and holding opposite parties negligent and deficient in service and claimed Rs. 1,07,674.75 and Rs. 15,000 for taxis and miscellaneous expenses.
Reply by the Opposite Party No. 1:
10. It is submitted that detailed eye assessment and history confirmed the presence of long standing glaucoma in both eyes which were under medical treatment from his local eye doctor in Ghaziabad. He had cataract in both eyes (right more than left). Apart from this, the cornea in the right eye had multiple opacities and showed signs of degenerative changes. This is noted in the case history of the patient. The complainant's perimetery (Visual fields) reports suggested marked gross visual field defects in both the eyes, secondary to "Glaucoma" an irreversible cause of loss of
11. Learned Counsel submitted that the complainant was explained in detail about the status of his right eye, his severe diabetic conditions and other ailments and the condition of the glaucoma and that his cataract surgery was for his restoration of vision to some extent and that it would not bring normal restoration of vision due to the damage already done by the longstanding disease of Glaucoma and corneal opacities. After being explained, the complainant wished to undergo cataract removal surgery and for control of the longstanding Glaucoma in the right eye. As for the contention raised by the complainant regarding B.P. control it is denied that the blood pressure was not controlled during the surgery. The blood pressure was monitored by the Anaesthetist and his team. It is normal to have anxiety and apprehension of surgery which increases blood pressure which was 170 systolic at the beginning and settled to 150 systolic during the operation and the same was monitored by the Anaesthetist and the operation was uneventful. The complainant was advised to have detailed pre-operative investigations which were done at the Govt. Dispensary at Ghaziabad and confirming from the patient's doctor who has been treating him for blood sugar and that all the parameters were within the acceptable range, the surgery of right eye was performed on 19.6.1997.
12. It is averred that as the complainant had longstanding glaucoma for which he was being medically treated outside Apollo Hospital with poor compliance and control of pressure, a computerised perimetry (visual field charting) was done preoperatively to assess the irreversible damage to optic nerve caused by the long standing raised intraocular pressure (glaucoma). The post-operative examination conducted in the operated eye including biomicroscopy/slit lamp finding were satisfactory. A detailed discharge summary containing post-operative instructions were given to the complainant. The complainant made two post-operative visits to the hospital and condition of the complainant was satisfactory.
13. It is further stated that the complainant was given standard treatment which included antibiotic drops and antibiotic orally along with steroids and conjunctivital injections of antibiotic/steroid mixture was also given. The complainant was also advised to repeat his blood sugar test for which the complainant assured that it was well under control. When Apollo Hospital ordered for blood sugar test then it showed that it was markedly raised to 250 mg +. The complainant was advised admission for control of blood sugar and intensive drug therapy.
14. When O.P. No. 2 noticed that the complainant was developing inflammation/infection he was treated for the same. Opposite party No. 2 in the interest of the complainant advised him to seek the opinion of Dr. Cyrus Shroff at Shroff Eye Centre, who has specialised in posterior segment infections of the eye. The complainant was examined clinically at the said centre and was advised to be admitted for control of his diabetes and treatment of eye inflammation/infection.
Earlier the complainant was treated by Dr. Cyrus Shroff, a Senior Consultant in Vitreoretinal diseases. Dr. Shroff carried out anterior chamber tap, in the right eye of the complainant. At that stage the pathological report of diagnosis of the operated areas was suggestive of fungus infection. Dr. Shroff advised the complainant to continue his treatment under the care of Shankara Netralaya, Eye Research Foundation in Chennai.
15. The complainant was examined in Shankara Netralaya and advised vitrectomy. But unfortunately the complainant suffered from severe gastroenteritis and was advised emergency admission at the Malar Hospital in' Chennai. The complainant visited Shankara Netralaya for a review after a week's stay at Malar Hospital at Chennai. Dr. S.S. Badrinath pointed out that lot of time has lapsed after the eye inflammation/infection due to his uncontrolled diabetes and other related systematic problems and, therefore, he advised the complainant to return to Delhi and continue supportive treatment.
16. Learned Counsel for the opposite party No. 1 contended that the hospital provided disinfected sterilised environment in the operation theatre and also in the hospital premises; that they provided advanced and sophisticated medical equipment and other facilities to its patients; that all precautions for cleaning and disinfecting the operation theatre was done as a routine procedure; and, that the complainant developed inflammation/ infection due to his own negligence in not controlling his blood sugar. Lastly, learned Counsel submitted that the complainant reported telephonically in late evening on 4.7.1997 that there was a sharp fall in the sight of his operated eye but he was advised to report to the hospital immediately but it was the complainant's decision to come after 3 days, i.e. on 7.7.1997 on the basis of not having transport facility for coming to the hospital. Learned Counsel submitted that in the alternative of not visiting the opposite parties, the complainant could have easily consulted the neighbourhood ophthalmologist, as advised by opposite party No. 2 on phone.
17. On an affidavit opposite party No. 2 stated as under:
The surgical procedure was explained in detail to the complainant pre-operatively and it is always the choice of the patient to agree to the same. The complainant's post-operative visual recovery was satisfactory (considering the preoperative ocular status and guarded visual prognosis). A detailed discharge summary containing post-operative instructions including list of medicines with detailed dosages and other instructions were given to the complainant.
18. Learned Counsel for the opposite party No. 2 submitted that the complainant underwent surgery in his right eye which was uneventful. He further submitted that the complainant called opposite party No. 2 on 5.7.1997 in late evening to state that his vision which was satisfactorily improving had turned a little hazy/blurred. He had no complaint of redness/pain. Opposite party No. 2 advised telephonically to increase the dosage of his topical antibiotic drops and ring back in an hour and a half to two hours. The complainant called back to state that his blurred vision was again clearing up to his satisfaction. Since it is the policy of the hospital (O.P. No. 1) that all patients of the hospital be seen only in the hospital, opposite party No. 2 advised the complainant to come very next morning for a further detailed ocular examination and evaluation at the 'Eye OPD' in the hospital. Opposite party No. 2 advised the complainant to visit the nearest qualified eye doctor if any emergency measures are needed for the same.
19. Since the complainant expressed his inability to come due to non-availability of transportation and preferred to continue with the topical medication and reported on Monday, i.e. 7.7.1997 at 9.00 a.m. to the hospital.
20. On the 15th post-operative day, the eye examination showed the presence of inflammatory reaction which included a 1mm Hypopyon (white coagulum) and a mild inflammatory (infective) reaction in the eye.
21. It is stated by the opposite party No. 2 that the standard regime of treatment which was concentrated /fortified antibiotic drop and antibiotic orally along with steroids were started along with sub-conjuctival injections of antibiotic/steroid mixture were injected.
22. It is further stated by the learned Counsel for the opposite party No. 2 that whenever opposite party No. 2 asked the complainant regarding his blood sugar levels, the complainant repeatedly assured that it was well under control. Yet, on the initiative of opposite party No. 2 a blood sugar test was ordered in Apollo Hospital and the report showed that it was markedly raised, i.e. 250 mg +. The complainant was advised admission for control of blood sugar and intensive drug therapy.
23. It is contended by the learned Counsel for the opposite party No. 2 that complainant was himself negligent in not controlling his blood sugar levels, although he was repeatedly advised to keep that level in control in order to get good post-operative results in restoring sight especially in cases of eye surgeries. He was referred to Dr. Cyrus Shroff, a renowned Vitreo Retinal Surgeon, who also advised him that he should be admitted in the hospital firstly for the control of his diabetes in order to cure/ control eye inflammation/infection and, therefore, got him admitted in Sharma Nursing Home, Kailash Colony, New Delhi.
24. Opposite party No. 2 stated that he continued to review the progress of the complainant who was under treatment in Sharma Nursing Home under the care of Dr. Cyrus Shroff. It was explained to the complainant by all the treating doctors, viz. Dr. C. Shroff and his colleague Dr. Srivastava that the increased blood sugar was the main stumbling block to his visual problems as his recovery got compromised due to high blood sugar level and that affected his physical status that he is vulnerable to infection like fungi, etc. Dr. Dave was also called by Dr. Shroff who expressed the same opinion. Dr. Dave denied having stated that he had attributed the use of obnoxious drugs and operational negligence as the cause for the present condition of the patient. After consulting Dr. Dave, Dr. Sharma of the Sharma Nursing Home modified the treatment and did an anterior chamber tap and had the aspirate analysed to decide the future course of action. The Pathologist who examined the aspirate felt that it could be due to uncontrolled diabetic state of the complainant.
25. It was unanimously decided by the Consultants treating the complainant that Shankar Netralaya would be the best as the complainant needed corneal transplant along with vitrectomy to restore vision. The complainant has seen by Dr. Gopal, Senior Consultant of Shankar Netralaya on 12.7.1997 and AC tap confirmed fungal endophthalmitis in the right eye and planned an emergency triple procedure of corneal transplant, vitrectomy.
26. Unexpectedly, the complainant developed severe gastroenteritis and dysentery and acute retention of urine and was advised emergency admission at the Malar Hospital in Chennai. It is averred by the learned Counsel for the opposite parties that it was at Malar Hospital that his increase in blood sugar led to further deterioration. When the complainant visited Shankara Netralaya for a review after a week's stay at Malar Hospital Dr. Badrinath, a Director of Shankara Netralaya advised him to return to Delhi for continued treatment. In his letter vide July 19, 1997 to Dr. Shroff, he pointed out which is given as under:
The cornea was found to be infiltrated with the infected organism. The infection had extended to the corneoscleral section. The eye was stony hard to touch and was full of puss. Patient had only light perception in his eye, the projection being defective. Dr. Gopal considered penetrating keratoplasty and vitrectomy and predicted the anatomical prognosis to be less than 5% with the possibility of evisceration being necessitated on the operating table depending upon the condition. In my opinion, it is better to perform evisceration of the right eye considering that Mr. Sharma is 72 years old; having both diabetes and hypertension; currently had medical problems such as retention of urine and diarrhea; severe intraocular fungal endophthalmitis with corneal infiltration extending upto the limbus.
Left eye which has 6/36 vision with nuclear scierosis could be subjected to surgery at a later date.
27. The complainant was then referred to Dr. Atul Kumar in R.P. Centre of All India Institute of Medical Sciences (AIIMS), who had to eviscerate the said eye.
28. This resulted in delay of his ocular treatment by nearly a crucial week, as a result, the infection spread in his eye and there was a deterioration of vision during that time.
29. It is submitted by the learned Counsel for the opposite party No. 2 that from the above facts it is clear that the complainant's operated eye lost vision due to his uncontrolled diabetes and not due to negligence by the opposite party No. 2 during the surgery.
Expert's opinion:
30. After hearing both the parties, we have sent the documents to Symbiosis Centre of Health Care (SCHC) for obtaining expert opinion in the present case. Dr. Ravi Kolte of Kolte Eye Care & Laser Centre, Pune gave his expert opinion vide letter dated 15th May, 2005 which is given as under:
2. Delay in taking the patient for surgery can occur, if there is some problem in previous patient or there is long operation list on that day. In that case patient's blood sugar can go down instead of becoming high, which does not invite infection.
3. Operation theatre sterilization is not done after each case unless previous patient taken in O.T. is infective case.
Findings:
31. The questions that arose for our consideration in this case are:
(1) Whether there was any negligence or deficiency in service by the opposite parties at pre-operative stage?
(2) Whether there was any negligence or deficiency in service by the opposite parties during the operation?
(3) Whether there was any negligence in the treatment given by opposite parties during the post-operative stage?
32. We hold that there has been negligence on the part of the opposite parties only on last count for the following reasons.
33. The clear facts in this case are that a patient aged above 70 years at the time of surgery had been suffering from diabetes for 40 years. He was also suffering from hypertension. It is a common medical knowledge mat "Diabetes increases the general susceptibility to infection. Diabetes is associated with a wide range of bacterial, fungal and viral infection". (Handbook on Diabetes; Second Edition - Gareth Williams & John C. Pickup). The association between diabetes and severity of eye infection is also well established in medicine. Therefore, when a known diabetic goes in for a complicated eye surgery, it is incumbent upon the surgeon and the hospital to monitor the blood glucose on a continuing basis. The record produced before us no where shows any recording of blood sugar levels of the patient either prior to the operation or during operation or even till 15 days after the operation. The operation was done on 19th June, 1997. At the time of operation the surgeon merely relied on the statement of the patient that his blood sugar is under control.
34. While the operation was performed on the evening of 19th June, 1997, the patient was discharged on 20th. He had, therefore, effectively, stayed for less than a day in the hospital. In other words, the attending doctors could only monitor his blood sugar for about a day. Even this was not done. On the 20th, he was discharged and he was advised to come for check up on the 24th, i.e. 4 days later. Even on 24th when the patient came for check up, there was no review about his blood sugar position nor was any advice tendered that he should get his blood sugar monitored regularly.
35. Thereafter, according to the complainant, on the evening of 4th July, 1997, he realised that his vision has deteriorated sharply and so got in touch with opposite party No. 2 - the doctor for advice. The version of the opposite party No. 2 is that he advised the complainant to immediately come to the hospital and that the complainant expressed his inability to come to the hospital for want of transport and that the complainant came to the hospital only after 3 days, i.e. on 7.7.1997, which was Monday. As against this, the version of the complainant is that the doctor did not ask him to come to the hospital immediately but only advised to double the dosage of the medicines already prescribed The complainant's version is that he accordingly doubled the dosage but there was no improvement in the vision so he called the doctor once again on the 5th evening.
36. The Doctor's version is that the complainant did call on 5th but told him that after increasing the dosage, his vision has improved. We are inclined to agree with the version of the complainant. The complainant realised the loss of vision on the evening of 4th July, 1997 which was a Friday. The complainant's subsequent behaviour shows that he is very prompt in going from hospital to hospital without any loss of time. Therefore, we are inclined to believe that the doctor must have advised the patient to increase the dosage since the next two days are Saturday and Sunday which are holidays and he advised the patient to come to the hospital on Monday morning which patient promptly did.
37. The medical record of 7th July shows two entries, the first one without any time and the second one recorded as 4.14 p.m. For the first time in the handling of the patient, an advise was recorded as follows:
1. Controlled diabetes (blood sugar)-2 blood sugar regulation (304) PP-to be controlled.
38. This clearly indicates that there was some complication and the doctor felt compelled to record the advice to control the blood sugar. Had he promptly attended to the patient on 4th itself the infection could have been contained within three days. Obviously, the doctor had lost 3 precious days in controlling the infection.
39. Even on 7th, the doctor-opposite party No. 2, did not suspect the severity or the nature of the infection. No doubt, he had referred the patient to specialist, Dr. Cyrus Shroff, on the very next day, i.e. 8th July. Dr. Shroff immediately felt that diabetes needs to be controlled and admitted the patient under his care in the Sharma Nursing Home on the 8th itself and monitored the diabetes carefully. On the 8th itself Dr. Shroff suspected that the eye infection is a fungal infection. This treatment could have been given in the hospital.
40. The opposite party No. 2 tried to rely on the letter given by Dr. Ravi Kolte of Pune, who stated that fungal endophthalmitis is a rarity and the opposite party No. 2 is justified in starting the steroid since steroid reaction is more common phenomenon. We do not agree that this statement would help the opposite party No. 2. An extract from the Indian Journal of Ophthalmology (P. 104) Vol. 43 No. 3; December 1995) produced by the complainant on record clearly indicates the following:
Infectious Endophthalmitis following intraocular surgery is a complication that could cause severe visual loss or loss of the eye....Most of the cases of postsurgical endophthalmitis are seen following cataract surgery. It is important for all ophthamologists, irrespective of specialisation and areas of interest to be familiar with the management of endophthalmitis.
41. It also states that "Fungal endophthalmitis usually presents between 2 and 4 weeks, or later, following surgery. Persistent iritis might be the only presenting sign.5
42. The above clearly indicates that postsurgical fungal endophthalmitis occurring 2 to 3 weeks after the surgery is a clear possibility and it is important for all ophthalmologists to be aware of this and to treat it carefully. Such care should have been the highest order in the chronic diabetic patient. The opposite party No. 2 has, therefore, failed in treating the complainant from 4th July, 1997 when the complainant informed him of hazy and blurred vision.
43. The subsequent history of the patient, his rushing from Sharma Nursing Home, Delhi to Shankara Netralaya, Chennai, other common unrelated complications which plunged him to go to Malar Hospital, his rushing back to AIIMS for removal of his right eye, etc. are well-known and some of these complications would not have arisen if his blood sugar level was properly monitored by the opposite party No. 2, proper advice was given to the patient to control the blood sugar after the operation; and if the patient was promptly treated after 4th July, 1997.
44. Further, we find that medical records do not contain vital parameters such as blood sugar, blood pressure, etc. which are very important and the same has not been recorded in the case sheet on 19.6.1997, i.e. the date of surgery and on 20.6.1997,i.e. the date of discharge. At this stage, we would like to refer to the rules made by the Medical Council of India (Indian Medical Council Bare Act) under which doctors are required to maintain medical records which are produced hereinunder:
1.3 Maintenance of medical records:
1.3.1 Every physician shall maintain the medical records pertaining to his/her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3.
1.3.2 If any request is made for medical records either by the patients/authorised attendant authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours.
1.3.3 A registered medical practitioner shall maintain a Register of Medical Certificates giving full details of certificates issued. When issuing a medical certificate he/she shall always enter the identification marks of the patient and keep a copy of the certificate. He/she shall not omit to record the signature and/ or thumb mark, address and at least one identification mark of the patient on the medical certificates or report. The medical certificate shall be prepared as in Appendix-2.
1.3.4 Efforts shall be made to computerize medical records for quick retrieval.
3.4 Statement to patient after consultation 3.4.1 All statements to the-patient after or his representatives should take place in the presence of the consulting physicians, except as otherwise agreed. The disclosure of the opinion to the patient or his relatives or friends shall rest with the medical attendant.
3.4.2 Differences of opinion should not be divulged unnecessarily but when there is irreconcilable difference of opinion the circumstances should be frankly and impartially explained to the patient or his relatives or friends. It would be opened to them to seek further advice as they so desire.
45. We reiterate that post-operative treatment is also important in surgery of any kind. After operation also, surgeons are expected to devote some time for the operated patients and have regular check up, if required on holidays also, as that is part and parcel of their duty, being member of the noble profession dealing with the life and health of the patient.
46. In the result, we hold that even though the operation was successful, but at the same time, post-operative required care was not taken and for this deficiency in service complainant is entitled to receive compensation. Considering the overall view, particularly, the fact that to some extent it is contributory negligence on the part of the patient who himself is an Advocate, we assess the compensation at Rs. 2 lakh. In the result, the complaint is allowed. Opposite party Nos. 1 and 2 are directed to pay a sum of Rs. 2 lakh to the complainant within a period of six weeks from today. There shall be no order as to costs.