National Consumer Disputes Redressal
A.K. Gupta (Dr.) And Anr. vs Mahipal on 2 July, 2007
Equivalent citations: III(2007)CPJ303(NC)
ORDER
K.S. Gupta, J. (Presiding Member)
1. This revision is directed against the order dated 19.7.2004 of Consumer Disputes Redressal Commission Uttrakhand, Dehradun dismissing appeal against the order dated 6.10.2003 of aDistrict Forum whereby petitioner was directed to pay Rs. 1 lakh as compensation, Rs. 10,000 towards expenses of treatment and cost, to the respondent.
2. In nutshell, the facts giving rise to this revision are these. Smt. Suman Lata, wife of the respondent/complainant was admitted in Jawahar Lai Nehru District Hospital, Rudrapur for treatment of abdominal pain from 23.10.2002 to 24.10.2002 and again from 25.10.2002 to 26.10.2002. She left the hospital against medical advice and was admitted in Charvi Surgical Hospital run by the petitioners/opposite parties sometime in the forenoon on 26.10.2002. After examining Smt. Suman Lata the petitioners advised for immediate operation. Respondent alleged that the operation for which Rs. 15,000 were charged was performed on 26.10.2002 itself by the petitioners without getting the necessary blood tests done. Since the abdominal pain still persisted the necessary blood tests including for urea were got done on 27.10.2002 and on basis of those test reports the petitioners referred Smt. Suman Lata to K.K. Hospital, Bareilly for further treatment. She was admitted in that hospital on 27.10.2002 and she died on 29.10.2002. Alleging medical negligence the respondent filed complaint seeking refund of the amount paid as also award of compensation which was contested by the petitioners by filing written version. It was alleged that after examination of Smt. Suman Lata on 26.10.2002 it was found necessary to have her urine and blood tests done. For that purpose Dr. Smrita Srivastava was called. She took the samples of blood and urine. After examining the test reports it was suspected that Smt. Suman Lata was having pus in her abdomen. About 20 ml. substance was taken out from her abdomen and sent for pus-culture-sensitivity test to Shreya Pathology run by said Dr. Srivastava. It was further alleged that it was made known to the father-in-law of the respondent that pus from abdomen could be taken out by performing surgery. Surgery was performed on 26.10.2002 itself with the help of Dr. Manoranjan Pant, anaesthetist. On opening abdomen it was found that it was full of pus which was removed. After surgery blood tests were again got done on 26.10.2002. On complaint of palpitation and pain in abdomen by Smt. Suman Lata her blood was again got tested from the said Pathologist. Serum creatinine was found to be 6 ml%. Since no Nephrologist was available in Rudrapur, she was referred to K.K. Hospital, Bareilly. It was denied that there was any negligence on the part of petitioners in treating the deceased.
3. The District Forum held the petitioners deficient in service holding that from the first test report dated 26.10.2002 the petitioners must have known that the kidney of Smt. Suman Lata was damaged and they did not have any arrangement for treatment thereof still they did the operation. The District Forum found that the firstblood test report dated 26.10.2002 seems to have been changed as the urea and serum creatinine could not have increased to the extent noticed in the testreportdated27.10.2002 within 8 to 10 hours of the first test report.
4. We heard Mr. K.G. Sharma for the petitioners and Mr. Yogesh Sharma for the respondent and were taken through the record.
5. Smt, Suman was diagnosed to be suffering from pyo-peritoneum. Submission advanced on bthalf of petitioners was that the treatment of such an infection was immediate incision and drainage of the localised collection of pus. In support of this submission, attention was drawn to the chapter under the heading "Diagnosis and Treatment of Surgical Infections" of the Textbook of Surgery by Sabiston. It was further submitted that from the first blood test report dated 26.10.2002 it was manifest that urea of the deceased was 40 mg.% while serum creatinine was 1.8 mg.%. Blood urea was thus within permissible limit while serum creatinine was slightly high, the upper normal limit being 1.4 mg%. It could, therefore, be not said that the deceased was unfit for exploratory laparotomy at the time of performing the procedure. It was pointed out that all the test reports were given along with letter of reference on 27.10.2002 to the respondent still he did not file the first blood test report dated 26.10.2002 before the District Forum. According to the learned Counsel, in view of affidavit of Dr. Smrita Srivastava, pathologist filed by way of evidence before the District Forum there was no basis for the Forum to have found that the firstblood test report was changed by Dr. Srivastava to help the petitioners. Before this Commission along with written submissions the petitioners have filed the affidavits of Dr. Rajesh Agarwal, Urologist and kidney Transplant Surgeon and Dr. Sanjay Mittal, D.M., Nephrology. In the affidavits they have opined that pyo-peritoneum is an emergency clinical situation and because of mild increase in serum creatinine up to about 4 mg% in a patient of pyo-peritoneum, one should not delay the surgery. Since these affidavits did not form part of evidence they cannot be taken note of in deciding this case. At this stage, it will be profitable to refer to the discussion under the sub-heading "Surgical Intervention" under aforesaid chapter "Diagnosis and Treatment of Surgical Infections". The same reads thus:
The primary principle of the surgical treatment of infections is incision and drainage of localized collections of pus, The old adage "never let the sun set on an undrained abscess" is as true today as it ever was. In considering surgical intervention, one must take into account the location of the infection, the presence or absence of complicating cellulites, the complication of disseminating sepsis, the duration of the lesion, and the presence or absence of complicating disease. Surgical drainage permits the removal of bacteria and their toxins, dead leukocytes, and necrotic tissues, and the access of new phagocytes, antibiotic agents and serum opsonins to the remaining infecting bacteria. When incision and drainage are used as a method of treatment, it is essential that complete decompression be obtained. The incision must be large enough to accomplish free drainage with the use of mechanical drains whenever these are indicated. Walls between loculations must be broken down or these areas must be drained separately. Dependent drainage is a cardinal principle to be practised whenever possible. Needle aspiration of abscesses does not provide free drainage and should not be done except for the purpose of establishing a diagnosis, identifying etiologic agents or localizing the site of an abscess.
6. To be noted that in the complaint the case set up by the respondent is that no blood test was got done before performing the surgery. In the written version, petitioners have claimed that blood tests were got done before the procedure was performed and this assertion is supported by the affidavits of Dr. Smrita Srivastava and the petitioners. Though the District Forum believed that the blood tests of the deceased were got done before surgery on 26.10.2002but it found that the test report filed by way of document No. 16/13 before it (copy at page 67) was changed by Dr. Srivastava. This conclusion was reached on the basis of the blood urea having increased from 40mg% to 122 mg% and serum creatinine from 1.8mg% to 6mg% after 8 to 10 hours of the first test report dated 26.10.2002. Certificate dated 1.7.2003 issued by Dr. Sunil Kathuria, Nephrologist of said K.K. Hospital (copy at page 84) would show that the renal failure of Smt. Suman Lata which resulted in her death, was because of Septicemia. Septicemia having set in due to pyo-peritoneum there was every likelihood of blood urea and serum creatinine having increased to the extent reflected in the said test report dated 27.10.2002. In absence of cogent evidence regarding change of first test report the mere increase in blood urea and serum creatinine between 26 and 27.10.2002 could not be the basis for reaching the conclusion of change of first blood test report by the District Forum. Since pyo-peritoneum is an emergency clinical situation as is evident from the extract referred to above, the petitioners could not be said to have acted negligently in performing the procedure noticing the range of blood urea and serum creatinine reflected in the first blood test report dated 26.10.2002. Obviously, the finding returned by the State Commission in regard to blood tests of the deceased not having been got done on 26.10.2002 and the procedure having been performed in hurry by the petitioners is contrary to the evidence and the conclusions reached by us above. For the foregoing discussion, the orders passed by Fora below cannot be legally sustained and those deserve to be set aside.
7. Accordingly, while allowing revision, the orders passed by Fora below are set aside and complaint dismissed. No order as to costs.