State Consumer Disputes Redressal Commission
Sukhjeet Kaur vs Dr.Pritam Singh on 11 September, 2015
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, DAKSHIN MARG, SECTOR 37-A, CHANDIGARH.
First Appeal No. 16 of 2011
Date of Institution : 05.01.2011
Date of decision : 11.09.2015
Sukhjeet Kaur aged about 28 years wife of Sh. Kulwant Singh,
resident of Village Asel Tehsil Dabwali, District Sirsa.
...Appellant/Complainant
Versus
Dr. Pritam Singh Rajpal, Rajpal Hospital Lapro Surgery Centre
Ganesh Basti, G.T.Road, Bathinda.
...Respondent/Opposite Party
First Appeal against the order dated
26.10.2010 passed by the District
Consumer Disputes Redressal Forum,
Bathinda.
Quorum:-
Hon'ble Mr. Justice Gurdev Singh, President
Shri. Baldev Singh Sekhon, Member
Sh. Vinod Kumar Gupta, Member Present:-
For the appellant : None
For the respondent : Sh. J.S.Walia, Advocate
BALDEV SINGH SEKHON , MEMBER
This appeal has been filed by the appellant/complainant against the order dated 26.10.2010 passed by District Consumer Disputes Redressal Forum, Bathinda (in short "District Forum"), vide which her complaint filed against the respondent/opposite party ( in short 'OP') under Section 12 of the Consumer Protection Act was dismissed. F.A. No.16 of 2011 Page 2 of 12
2. Briefly stated, the facts of the case are that the complainant was suffering from severe pain in her abdomen and she approached the opposite party on 12.06.2009, who after conducting some tests, informed her that she had stone in her Gall Bladder and was advised immediate operation. On 12.06.2009, she was operated upon by OP and stone was removed from her gall bladder. Though she was told that the operation was successful, but, she continued complaining about pain. OP assured her that same was only due to operation and prescribed some medicines and discharged her from the hospital on 15.06.2009. An amount of Rs.15,000/- was got deposited from her on account of the said operation. When the pain continued inspite of consuming the medicines prescribed by OP, she again approached him on 24.06.2009. He prescribed more medicines to her, but her condition did not improve. Thereafter, she consulted Dr. Pash, who advised her to undergo Ultra Sound Test, which was done on 22.7.2009 at Parampal Diagnostic & Medical Research Centre, Bathinda. After going through the Ultra Sound report, Dr. Pash advised her to consult Dr. Rupinder Singh Sidhu of Delhi Heart Hospital, Bathinda. When she approached Dr. Sidhu, he also prescribed some medicines but her condition did not improve. Thereafter, Dr. Sidhu advised her to undergo Ultra Sound scan from Romana Ultrasound Echo & Colour Doppler Centre on 05.08.2009. After checking the Ultra Sound report, Dr. Rupinder Sidhu again prescribed some medicines. When her condition did not improve, he referred her to DMC, Ludhiana on 11.08.2009 and advised her to undergo ERCP. She got herself checked from Dr. Ajit Sood at DMC Ludhiana, who after conducting ERCP and X- ray, sent her back to Dr. Sidhu. He orally advised her to go to Govt. Medical College & Hospital, Chandigarh, where she was attended by F.A. No.16 of 2011 Page 3 of 12 Senior Dr. A K Attri and his Asstt. Doctor Dr. Sanjay Gupta. After going through the entire treatment record, the said doctors advised her MRCP. Upon conducting MRCP, it became clear that OP, while conducting the operation of Gall bladder, negligently and in a hurried manner, stitched the CBD of the complainant, which created complication. It was pleaded that OP was not competent to perform such like operation and that she had to be operated upon again by Dr. A K Attri and Dr. Sanjay Gupta on 22.08.2009, for which she spent a total sum of Rs. 1,50,000/-. Alleging medical negligence on the part of OP, she filed complaint before District Forum and sought directions to him to compensate her to the tune of Rs. 5,00,000/- on account of mental tension, agony, harassment and financial loss. She also demanded refund of Rs.1,50,000/- spent by her on her treatment and for miscellaneous expenses. Litigation charges to the tune of Rs. 20,000/- were also prayed.
3. Upon notice, OP filed written reply pleading therein that the said operation was performed on 12.6.2009 by a Surgical Team consisting of visiting Surgeon Dr. J.S.Sandhu (who is M.S.Surgery) Assistant Surgeon Dr. P.S.Rajpal and Visiting Anesthetist Dr. J.C.Garg (who is M.D.Anesthesia). The said team performed its duty with due diligence, reasonable and proper care, skill and as per their experience. They adopted standard and acceptable medical procedure to treat and cure the patient. It was admitted that patient consulted him for the pain in abdomen, which was long standing and she had been delaying the treatment. It was born out from the Biopsy/Histopathology report of the gall bladder specimen, removed during operation by OP, that the inflammation of the gall bladder was chronic. After check up of the patient, he correctly advised the operation of 'Cholecystectomy'. The F.A. No.16 of 2011 Page 4 of 12 complainant and her husband were clearly explained that in such long standing problem, there may be some inherent risk inspite of due care having been taken. They gave their consent for this operation, knowing fully well that there was a small risk of occurrence of known complications. It was further pleaded that the patient visited his hospital on 24.6.2009 with minor complaint of less appetite and she was prescribed medicines. She might have developed some symptoms much later and that is why she consulted Dr. Pash after a gap of approximately one month on 22.7.2009. It was further averred that Dr. Pash was not a qualified doctor and it was an act of carelessness on the part of the patient to have his consultation. She remained under the treatment of Dr. Pash for next 15 days and only thereafter, she consulted Dr. Rupinder Sidhu of Delhi Heart Hospital on 5.8.2009. Dr. Sidhu, after getting an ultra sound done on the patient, prescribed medicines for five days; meaning thereby that she had no significant problem. Had her condition been serious, Dr. Sidhu might have either got her admitted in his hospital or referred her to higher medical institution at that very time. It was only on 11.8.2009 that the problem of 'Obstructive Jaundice' was noticed and Dr. Rupinder Sidhu referred the complainant to DMC, Ludhiana for ERCP. Hence, it was clear that the patient developed the problem of Bile-Duct Stricture (narrowing of CBD) approximately eight weeks after surgery of gall bladder at his hospital, which was due to some inflammation in and around the Bile-Duct that had already developed. The test of MRCP could have been easily done in Bathinda . The MRCP clearly gave the finding and diagnosis of 'biliary strictures' and it was further F.A. No.16 of 2011 Page 5 of 12 opined that it was likely to be (i) either Post Inflammatory (due to long standing inflammation of gall bladder and bile-duct from which the patient was suffering) or Iatrogenic (related to treatment). In the present case, the first possibility was highly improbable. Further in MRCP report, it was not mentioned that there was complete stitching up of CBD, as alleged by the complainant. Even in the report of GMC Chandigarh, it is clearly stated that diagnosis is "biliary stricture". It was denied that doctors of GMC Chandigarh had given an opinion that 'CBD had been stitched-up or outrightly tied'. It was further averred that occurrence of CBD injury is a well known complication in such cases because according to the Medical Literature, occurrence of Bile- duct stricture (narrowing of Tube) is a well known complication in those cases where a chronic inflammation of Gall Bladder and Bile- Duct is present. Even in the Advanced Countries with best facilities, like England and America, it happens in at least 1% to 1.5% of the cases and its occurrence cannot be termed as an act of negligence. It was further averred that the operation done at GMC, Chandigarh on 22.8.2009 could also have been easily performed at opposite party- hospital by the team of well qualified doctors; namely, Dr. J.S.Sandhu, Dr. P.S.Rajpal and Dr. J.C.Garg, at much lower expense. But the patient did not consult him after 24.6.2009 and rather kept on going to various other doctors and delayed the treatment. Denying all other allegations, dismissal of the complaint with costs was prayed.
5. Parties led their evidence, by way of affidavits and documents, before the District Forum, which after going through the same, dismissed the complaint.
F.A. No.16 of 2011 Page 6 of 12
6. Aggrieved by this order the complainant has come up in appeal on the grounds that OP mislead the District Forum in the garb of medical literature by saying that complication in bile-duct occurs in those cases, where there is chronic inflammation of gall bladder. Whereas the medical negligence was clearly established because the complainant had to undergo second operation to remove the stricture of the bile-duct. It was further submitted that when the case referred to Civil Surgeon, Rajindra Medical Hospital, Bathinda, vide order dated 15.4.2010, for opinion regarding negligence then it was specifically stated by the committee of Rajindra Medical College; comprising of Dr. D.P.Singh, Dr. Mohinder Singh and Dr. Amrit Pal Singh, who examined the patient, that the patient developed jaundice after surgery and it was clear from the said report that the entire complication developed after surgery, which was done negligently by OP. It was also stated in the said report that after the various tests conducted by doctors, the complications of 'inadvertent CBD ligation during her surgery was found, but, learned District Forum did not discuss the merits of the case as well as the opinion of the board of doctors.
7. Learned counsel for the opposite party submitted that there was no merit in the appeal and the learned District Forum had arrived at the correct conclusion on the basis of the evidence and the medical literature brought on record.
8. We have thoroughly gone through the pleadings of the parties and have carefully perused the evidence brought on record.
9. The admitted facts of the case are that the complainant approached OP on 12.6.2009 with pain in her abdomen, who after F.A. No.16 of 2011 Page 7 of 12 conducting some tests, informed her that she had stone in her Gall Bladder and the removal thereof, she underwent operation, called Cholecystectomy, on 12.6.2009 itself and the stone was removed from her Gall Bladder. She was discharged on 15.6.2009. The contention of the complainant is that though she was told that the operation was successful but she continued to have pain even after consuming medicines prescribed by him and that when she approached him again on 24.6.2009, he further prescribed some medicines but her condition did not improve. Thereafter, she consulted Dr. Pash who advised ultra sound test, which was done on 22.7.2009 and thereafter, she was advised to consult Dr. Rupinder Singh Sidhu of Delhi Heart Hospital, Bathinda. He also advised her to undergo ultra sound scan from Romana Ultrasound Echo & Colour Doppler Centre on 05.08.2009. Upon checking the Ultra Sound report, Dr. Rupinder Sidhu prescribed medicines but when her condition did not improve, she was referred to DMC, Ludhiana where she was advised to undergo ERCP. However, after checking the ERCP report dated 11.8.2009, she was sent back to Dr. Sidhu, who advised her to go to Govt. Medical College & Hospital, Chandigarh, where doctors advised for MRCP. It is further the allegation of the complainant that upon conducting MRCP, it became clear that while conducting the operation of Gall bladder, OP negligently and in a hurried manner, stitched her CBD, which created complication and that OP was not competent to perform such operation. Due to the negligence of the OP, she was operated again by Dr. A.K. Attri and Dr. Sanjay Gupta of Government Medical College & Hospital, Chandigarh on 22.08.2009, for which she spent a total sum of Rs.1,50,000/-. On the other hand OP has contended that the operation for removal of the Gall Bladder i.e. F.A. No.16 of 2011 Page 8 of 12 'Cholecystectomy' was performed by a surgical team consisting of visiting Surgeon Dr. J.S.Sidhu, who is M.S. Surgery; Dr. P.S.Rajpal and Dr. J.C.Garg, Anaesthetist. They performed their duties with due diligence, proper care, skill and as per standard and acceptable medical procedure. The complainant and her husband were clearly explained that for such a long standing problem, there may be some inherent risk inspite of due care. Thereafter, they gave their consent for this operation, knowing fully well that there was a small risk of occurrence of known complications. It was further contended that she might have developed some symptoms much later and that is why she consulted Dr. Pash on 22.7.2009, after one month. It was also contended that Dr. Pash was not a qualified doctor and she remained under his treatment for 15 days and only then she consulted Dr. Rupinder Singh Sidhu on 5.8.2009, who also prescribed medicines for five days; meaning thereby that she had not significant problem. Had her condition been serious, Dr. Sidhu might have either got her admitted in his hospital. It was only on 11.8.2009 that the problem of Obstructive Jaundice was noticed and Dr. Rupinder Sidhu referred the complainant to DMC, Ludhiana for ERCP and then she went to GMCH, Chandigarh. The patient developed the problem of Bile-Duct Stricture approximately eight weeks after surgery of Gall Bladder, which was due to some inflammation in and around the Bile-Duct. In the MRCP report dated 19.8.2009 (Ex.C-32) following impression is given :
"IMPRESSION :F.A. No.16 of 2011 Page 9 of 12
POST-CHOELCYSTECTOMY STATUS, PRESENT PARENCHYMAL- MRCP STUDY REVEALS SIGNIFICANT DILATATION OF INTRAHEPATIC BILIARY RADICLES IN EITHER OF LOBES RIGHT-LEFT MAIN HEPATIC DUCTS, BILIARY CONFLUENCE, PROXIMAL MOST COMMON DUCT WITH S/O TRANSITION OF CALIBRE DUE TO DEFINITE SMALL SEGMENT OF MARKED NARROWING-STRICTURE/POST INFLAMMATORY/ IATROGENIC/IN MID COMMON DUCT. WITH VISUALIZATION OF ADDITIONAL CYSTIC DUCT STUMP AND NON-DILATED REST OF EXTRAHEPATIC BILIARY TRACT DISTAL TO IT TILL DISTAL TERMINAL END.
NO DEMONSTRABLE OBSTRUCTING CALCULUS NOTED IN INTRA-/EXTRA-HEPATIC BILIARY TRACT. NO DEMONSTRABLE FOCAL NEOPLASTIC MASS IN RELATION TO HEPATO-BILIARY/PANCREATIC REGION IN PRESENT STUDY.
10. Perusal of this report shows that CBD narrowing-stricture was post inflammatory/iatrogenic i.e. due to inflammation or post operative. But does not suggest that CBD was stitched up as alleged by complainant. During the pendency of the complaint before the District Forum complainant filed an application for seeking the report from a board of doctors of PGI, Chandigarh or from Govt. Rajindra Medical College and Hospital, Patiala, regarding the negligence on the part of OP, upon which, District Forum referred the matter to Civil Surgeon, Rajindra Medical College and Hospital, Patiala, to get the matter examined from panel of experienced doctors. Medical Superintendent Rajindra Hospital, Patiala submitted the report of the Board of Doctors vide his letter dated 22.6.2010. The same is as under:
"The committee comprising of Dr. D.P.Singh, Dr. Mohinder Singh & Dr. Amritpal Singh met on the following dates 11/5, 18/5, 28/5 & 29/5/10 F.A. No.16 of 2011 Page 10 of 12 It had asked the complainant & the Doctor to appear before it with full medical record. Both of them appeared on second reminder. Committee examined the patient, its medical record & the record brought by the doctor. It reached following conclusion.
1. Patient was operated open for Cholecystectomy by Dr. J.S.Sidhu (As per the record given by the hospital) after full workup investigations.
2. Patient developed jaundice after surgery. She after being not satisfied by the operating doctor, went to different doctors who conducted various tests and found that she had, had the complication of inadvertent CBD ligation during her surgery.
3. She was successfully operated for this complication at Chandigarh Medical College & her current liver function test reveal that, she has no permanent ill effects of this complication.
4. All the tests which were done on her after the complication, were essential and as per the norms of current Medical Practice.
5. We would like to mention here that the said complication, though "Unfortunate", can happen in 0.5 to 1.5% of cases under going Cholecystectomy even in best of the Surgical Centres in the World, as reported in the Medical Literature. Fortunately she was advised appropriately and managed successfully without any lasting ill-effects. "
11. It is stated in this report that the patient developed jaundice after surgery and that she had complication of inadvertent 'CBD ligation' during the surgery. Though the complication is said to be unfortunate but it is not attributed to any act of negligence on the part of doctors, who performed cholecystectomy. It has rather been clarified that such complication happen in 0.5 to 1.5% of cases under going Cholecystectomy even in the best of the Surgical Centres in the World. OP has further placed on record the medical literature on 'Biliary F.A. No.16 of 2011 Page 11 of 12 Injuries and its Management' by Dr. Sadiq S Sikora, Anu Behari', in which it is mentioned that such complication is "more likely to occur in presence of acute cholecystitis, scarring in the Calot's triangle, variations in the ductal and vascular anatomy and obscuring of vision by blood in the filed. It has been seen that the incidence of biliary injuries decrease with experience . However, injuries do occur even in experienced hands". Thus any such complication, which can occur even in the best hospitals, inspite of the best care, cannot be said to be an act of negligence on the part of the treating doctors. The contention of the complainant that the medical negligence was clearly established from the fact that she had to undergo second operation to remove the structure of the Bile Duct, is not tenable because the board of doctors, while giving their opinion after taking into consideration all the aspects and even examining the patient, its medical record and the record brought by the doctor, has not pointed out any such negligence. The complainant has also contended that OP i.e. Dr. Pritam Singh Rajpal, was not competent to conduct surgery of Cholecystectomy as he was not a qualified surgeon. But from perusal of surgical notes dated 12.6.2009, written in original medical record of OP at Page 103, it is seen that operation was, infact, conducted by a team of doctors headed by Dr. J.S.Sandhu, who was M.S.Surgery and was duly competent to do so.
12. In view of the above discussion, no case of medical negligence is made out against the OP. Accordingly, the appeal filed by the complainant, which is devoid of any merit, is dismissed. No order as to costs.
F.A. No.16 of 2011 Page 12 of 12
13. The arguments in this appeal were heard on 02.09.2015 and the order was reserved. Now, the order be communicated to the parties.
14. The appeal could not be decided within the statutory period due to heavy pendency of the court cases.
(JUSTICE GURDEV SINGH) PRESIDENT (BALDEV SINGH SEKHON) MEMBER (VINOD KUMAR GUPTA) MEMBER September 11 , 2015 KK