State Consumer Disputes Redressal Commission
S.Rajesh, vs Chithra Multi Speciality Hospital, on 28 September, 2013
Daily Order
Kerala State Consumer Disputes Redressal Commission Vazhuthacaud,Thiruvananthapuram First Appeal No. A/12/577 (Arisen out of Order Dated 28/05/2012 in Case No. Complaint Case No. CC/11/39 of District Pathanamthitta) 1. S.RAJESH ...........Appellant(s) Versus 1. CHITHRA MULTI SPECIALITY HOSPITAL ...........Respondent(s) BEFORE: HON'ABLE MR. SRI.K.CHANDRADAS NADAR PRESIDING MEMBER SMT.A.RADHA MEMBER SMT.SANTHAMMA THOMAS MEMBER PRESENT: ORDER
KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACADU THIRUVANANTHAPURAM
APPEAL NO.577/12
JUDGMENT DATED: 28/09/2013
PRESENT:
SHRI.K.CHANDRADAS NADAR : JUDICIAL MEMBER
SHRI.V.V.JOSE : MEMBER
S.Rajesh,
S/o Sasikumar, Maniyankuli,
Kulasekharam Tamil Nadu, -- APPELLANT
Now residing at Thalakkavil Veedu,
Manthuka Muri, Kulanada.
(By Adv.A.C.Eapen & Ors.)
Vs.
1. Chithra Multi Speciality Hospital, -- RESPONDENTS
Pandalam, rept by Dr.Jayachandran
2. Dr.Binesh Babu B,
Chithra Multi Speciality Hospital,
Pandalam.
(By Adv.Preetha John K & Ors.)
JUDGMENT
SHRI.K.CHANDRADAS NADAR,JUDICIAL MEMBER The appellant was the complainant in CC.39/11 in the CDRF, Pathanamthitta. He approached the forum alleging deficiency in service under the following circumstances. He was a mason by profession. He was suffering from continuous back pain from June-July 2010 onwards. So he approached the 1st opposite party Chithra Multi Specialty Hospital, Pandalam and consulted the 2nd opposite party who was the orthopedic specialist in the hospital. At the instruction of the 2nd opposite party the complainant took MRI scan at the Muthoot Scan Centre, Thiruvalla. After perusing the scan report, the 2nd opposite party informed the complainant that his disc was bulged and the bulged discs were to be removed for complete relief. The 2nd opposite party assured the complainant that he would get completely cured after surgery. Believing the words of the 2nd opposite party, the complainant gave consent for surgery. The 2nd opposite party also made the complainant to believe that he had done about 85 surgeries to correct the same problem and all the patients were completely cured.
At the opposite party hospital medical tests were done before surgery. The surgery was conducted on 15.9.10 to remove the bulged discs of the complainant. After surgery, the 2nd opposite party advised the complainant to take rest for one month and told him that his back pain would be cured after taking rest. The complainant did not get any relief even after one month. His back pain increased day by day. So the complainant approached the 2nd opposite party who told the complainant that there was some infection at the site where surgery was performed and that can be removed by another surgery. The 2nd opposite party told the complainant that the treatment could be continued after taking another scan which was done. After examining the scan report the 2nd opposite party advised the complainant for another surgery. Thereafter, the complainant consulted Dr.Renjith kumar, Amrita Hospital, Kochi and Dr.Reji, District Hospital, Kozhencherry. Both doctors told the complainant that there was no need for surgery and the 2nd opposite party did not remove the bulged discs. They also told the complainant that the 2nd opposite party did the surgery negligently and advised the complainant to take pain killers regularly for curing the back pain. They told that the present complications were due to the negligent surgery conducted by the 2nd opposite party. In connection with the treatment the complainant had spent Rs.2.5 lakhs and now he is not in a position to do any work and the complainant and his family are put to untold miseries. All these happened due to the negligence and deficiency in service on the part of the opposite parties. Hence the complainant sought compensation of Rs.12.5 lakhs and cost of the proceedings .
The opposite parties filed joint version and contended before the District Forum that the complainant had suppressed true facts with malafide intention. They admitted that the complainant approached them with severe back pain and pain radiating to his left leg. The pain was restricting him from earning his daily living. On examination, it was found that he had weakness of extensor hallucis longus muscle. As his pain was not subsiding with rest and pain killers an MRI LS spine was taken to find the cause. The report showed an IVDP L4-L5 level with nerve root compression and mild IVDP at L5-S1 and mild degenerative changes of the spine. In a young adult IVDP L4-L5 nerve root compression and muscle weakness is surely an indication of surgery. So the 2nd opposite party advised the complainant accordingly. Even before surgery complainant was told that persistent backache and weakness could occur as a complication of the surgery. The operation called Discectomy L4-L5 under spinal anaesthesia was done by the 2nd opposite party on 15.9.10 after obtaining written consent from the complainant. Postoperative period was uneventful and he was discharged from the hospital on 22.9.10 without any complaint. The complainant approached the opposite party hospital thereafter for follow up a couple of times. That the complainant was not having any pain during the 1st month is a clear indication that the surgery was successful. The subsequent MRI report of Amrita Hospital also shows that he has no complaint other than inflammation which is suggestive of discitis due to infection which is an unfortunate complication as in any surgery and has nothing to do with the surgeon. The opposite parties are not at all responsible for surgical infection, which can be caused due to many reasons. The opposite parties have taken maximum care and had given maximum attention to the complainant. There was no negligence and deficiency in service on the part of the opposite parties.
Before the forum, the complainant tendered oral evidence. An expert witness was examined as PW2. Exts.A1 to A40 were marked on the side of the complainant. The 2nd opposite party gave evidence as DW1. Exts. B1 and B1 (a) were marked on the side of the opposite parties.
The forum on appreciating the evidence held that the 2nd opposite party is a reasonably competent doctor and had applied reasonable skill. No deficiency in service was established on the part of the opposite parties and accordingly dismissed the complaint. The aggrieved complainant has preferred this appeal.
The only question that arises for consideration is whether the complainant has established deficiency in service on the part of the opposite parties and if so what is the quantum of compensation payable to him.
Admittedly, the complainant a mason by profession was suffering from continuous back pain and he approached the 1st opposite party hospital where the 2nd opposite party was the orthopaedic specialist. The fact that surgery was performed on 15.9.10 based on a MRI report to remove the disc that was compressing the nerve root at L4 and L5 level by the second opposite party is admitted. The grievance of the complainant is that though the 2nd opposite party assured that he would be relieved of all the complaints after surgery, contrary to the assurance the pain continued. The pain increased subsequently and he consulted Dr.Renjith kumar, Amrita Hospital, Kochi and Dr.Reji, District Hospital, Kozhencherry. Dr.Reji is examined as PW2 on the side of the complainant. Then the complainant came to know that the second opposite party did not remove the bulged discs. The complainant was also allegedly told that the complications from which the complainant was suffering were due to the surgery performed by the 2nd opposite party in a negligent manner. So the question is whether the evidence available justifies the allegations of the complainant. The details of the discectomy done by the 2nd opposite party on 15.9.10 find a place in Page 5 of Ext.B1 case records of the Chithra Multi Speciality Hospital. During the surgery, it was observed that L5 nerve root was compressed by bulging disc and forominotomy was done and disc compression of L5 root was relieved. The 2nd opposite party as DW1 deposed that the complainant approached him on 9.9.10 and based on the information given by the complainant he was advised to take rest for one week and painkillers were prescribed. He was advised to report if pain was not reduced even after one week. It was accordingly the complainant approached the 2nd opposite party with Ext.A36 MRI scan taken from Muthoot scans Thiruvalla. Among other things, the scan shows that the patient was having mild to moderate diffuse annular disc bulges noted at L3-L4 levels causing bilateral neural foraminal narrowing and moderate diffuse annular disc bulge at L4-L5 level causing bilateral neural foraminal narrowing with impingement bilateral exiting L5 nerve roots and mild annular disc bulge at L5-B1 level causing bilateral neural foraminal narrowing. The contention of the complainant is that though he was told that operation was being performed to remove the discs causing ailment that was not actually done. The argument is based on the subsequent MRI scan taken from the Muthoot Scan and marked as Ext.A37. In answer to such a question DW1 admitted that it is also stated in Exts.36 & 37 that the discs which was the cause of complaint were there. But added that the treatment is not one of removing the entire discs; only the bulged portion of the discs would be removed. For that reason the presence of the particular discs can be seen again. The suggestion was that the discs could not be removed due to inexperience and negligence of DW1 which was denied by DW1. It is pertinent to observe that it is the compression of the nerve root by narrowing of the foramina which expresses as pain. So the appropriate course of treatment would be minimal interference with the discs concerned. Entire discs need be removed only if absolutely necessary and that alone was done by the 2nd opposite party. DW1 explained categorically that though 3 discs were bulging only one disc was causing compression to nerve root that was at L5 level. Hence that disc alone was removed.
Now the question is whether from the only expert evidence of PW2 a different conclusion can be drawn. PW2 was the Orthopaedic consultant at the District Hospital Kozhencyerry. Ext.A40 is the diagnosis prescription slip given by him. He explained that as per Ext.A40 he had diagnosed that there was prolapse of 3 discs. He prescribed medicines for reducing the pain and prolapse of the discs. The accepted course of treatment, is if there was no reduction in pain even after treatment for 7 days to 6 months the next procedure would be adopted. He explained further that if no improvement is shown after taking medicines sometimes operation would be performed immediately. He asserted that it is not possible to correct disc prolapse through exercises. But claimed that disc prolapse can be cured by medicines. By having bed rest a group of patients may get relief. Ordinarily bed rest for 7 days to 6 months would be advised but it is incorrect to say that only if the ailment is cured after 6 months rest operation would be suggested. He admitted that as per Exts.A36 (a) & 37 the ailment diagnosed by him is seen. He deposed that during surgery, the bulged discs would be removed. Up to 2 discs would be removed. Only 2 discs would be removed even if more than 2 discs are bulged. Extra strain is one of the reasons for disc prolapse. Some patients would respond to treatment of traction and bed rest. He also denied the suggestion that operation would be suggested only as last resort and only if complete cure is possible. He pleaded ignorance as to the prior treatment taken by the complainant. He also deposed that even after surgery complete cure might not be possible. MRI would be advised in that instance and based on the MRI report second surgery would be advised if necessary. He also stated that inflammation at the surgical site is an accepted complication. He did not see Ext.38 MRI scan taken at the Amrita Hospital. He also deposed that the inflammation after surgery could last for 2 days or indefinitely for any number of days. PW2 did not depose that if compression of disc can be relieved by removing only portion thereof adopting such a procedure would not be an accepted one. Obviously, the second opposite party performed minimum intervention to relieve the complainant of the pain. All the MRI scans bear testimony to the fact that there was degenerative changes at many portions of the vertebral column. The 2nd opposite party obviously corrected the neural foraminal narrowing by surgical intervention and relieved the L5 nerve root which was the most affected one. The bulges at the other discs were not so much affecting the nerve roots. So, the second opposite party was cautious while conducting surgery. This is made a cause of complaint by the complainant. The evidence referred to clearly justifies the conclusion of the forum that the 2nd opposite party had not violated any medical ethics while performing surgery and he had exercised reasonable skill. Hence the forum rightly dismissed the complaint. There is no merit in the appeal.
In the result, the appeal is dismissed, but without costs.
K.CHANDRADAS NADAR : JUDICIAL MEMBER V.V.JOSE : MEMBER SL [HON'ABLE MR. SRI.K.CHANDRADAS NADAR] PRESIDING MEMBER [ SMT.A.RADHA] MEMBER [ SMT.SANTHAMMA THOMAS] MEMBER