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KIDNEY STONE CENTRE v. KHEM SINGH @ KHEM CHAND
II (2001) CPJ 436
UNION TERRITORY CONSUMER
DISPUTES REDRESSAL COMMISSION
CHANDIGARH
Consumer Protection Act, 1986 – Section 14(1)(c) – Refund – Medical Service – Advertisement, stones removed without surgery – Kidney Stone Centre failed by remove the stone from complainant prostatic urethra – District Forum order for refund of fee charged along with interest – Hence appeal – Order of Forum upheld appeal.
Mrs. Devinderjit Dhatt, Member – The complainant Shri Khem Singh @ Khem Chand resident of Ropar was suffering from a stone the initial part of the prostatic urethra and was advised to undergo surgery by the doctors of General Hospital, Sector16, Chandigarh. The complainant was not in favour of surgery and hence approached the Kidney Stone Centre, Chandigarh based on 12.2.1996 on the advertisement in the newspaper that the stone are removed without surgery. However, the Kidney Stone Centre failed to remove the stone from his prostatic urethra which resulted filing of a complaint against the centre in District Forum-II, U.T., Chandigarh on 10.7.1998. The District Forum , U.T., Chandigarh in its judgment dated 11.2.2000 ordered that the opposite part should refund a fee of Rs. 10,000/- charged by interest @ 12% w.e.f. 14.2.1996 till payment and costs Rs. 2,500/- for unfair trade practices.
2. Aggrieved against the order passed by the District Forum, the present appeal has been preferred. Briefly the respondent-complainant was diagnosed to have stone in the initial part of prostatic urethra by General Hospital, Sector 16, Chandigarh, where he was advised to undergo surgery. The complainant/appelant was not in favour of undergoing surgery, therefore, on the opinion given by Dr. A.K. Gupta, a private medical practitioner, of Village Maloya, and also baseed on the advertisement in the newspaper that stones are removed without surgery, he went to the clinic of Kidney Stone Centre, Chandigarh on 12.2.1996. He paid fee of Rs. 100/- and was assured that the stone will be removed. by modern technique, i.e. E.S.W.L. - Electric Shock Wave Lithotripsy. It was stated to be a painless process without anaesthesia and sedations. It was also explained to him that the whole process will take 1/2 to 1 hour. He was explained that the cost of the E.S.W.L. will be Rs. 10,000/-. The complainant believed the said assurance and paid Rs. 10,000/- on 14.2.1996 for E.S.W.L. process for about 5 hours on that day by Dr. Rajinder Kumar and Dr. D.P. Singh in the premises of the respondent. But all was in vain. He visited the clinic again on 15.2.1996 and remained there till 5.0 p.m. but the stone remained where it was, i.e. prostatic urethra. The doctors used metallic catheters to push the stone to urinary bladder. It was a painful process that caused bleeding per-penis during the night. The complainant was shifted to a private clinic by the family members. He was told there that he was not physically fit to undergo more shock waves for removal of stone. The respondent-complainant informed the appellant that they have failed to remove the stone through painless process, hence his money be refunded to him. But the appellant refused to do so. On a subsequent day, i.e. on 26.2.1996, X-Ray film showed that the stone was still present in the initial part of the prostatic urethra measuring 15 mm. in size. The respondent-complainant averred that he has been unduly put through mental tension, harassment and suffered acute pain due to insertion of metallic catheter in the urethra to push through the stone in the bladder.
The appellant has admitted introductory facts but informed that the stone had to be pushed back into the bladder for which he has to be administered local anaesthesia/sedations and that would be followed by E.S.W.L. In case of a failure of this treatment, the facilities of open surgery were available in the clinic. Efforts were made to push the stone from the prostatic urethra to the bladder by following E.S.W.L. 1000 shocks. The appellant was scared to undergo further shocks and was not prepared for open surgery. It is relevant to mention that at appellant Centre the diagnosis was as under ” Bladder Stone “
3. The advertisement (Annexure P-8) also undertakes that the surgery is carried out through E.S.W.L. Lithotripsy which is a painless surgery for removing stones. The learned Counsel for the appellant during the course of arguments stated that the order of the Forum be dismissed, because this clinic only removes stones from kidney and not from any other part of the body like prostatic urethra in this case.
4. It is pertinent to refer to the affidavit of Dr. D.P. Singh who had been working at appellant’s clinic during the period of occurrence under reference. He has deposed in para 2 line 5 of his affidavit as under :
” It was not possible to focus this stone for ESWL as assessed by Dr. Rajendra Kumar and the team. So in order to relieve his pain retention urine, the stone was pushed back into bladder with urethral dilators under local anaesthesia and sedation a standard procedure. “
The factum of wrong assessment by hte appellant hospital is corroborated by the abovementioned statement of Dr. D.P.Singh, who is none else but the treating doctor of the appellant.
5. On thorough perusal of the entire record and evidence adduced by both the parties and hearing the learned Counsel of both the sides, we are of the considered view that this appeal lacks merit and the same is dismissed.
Appeal dismissed.
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M/s. CDR Hospitals & Ors. v. Smt. Nirmala Manaseh & Ors.
2001 (2) CPR 69 (NC)
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
D.P. Wadhwa, President; C.L. Chaudhry, J.K. Mehra, Mrs. Rajyalakshmi Rao and B.K. Taimni, Members
M/s. CDR Hospitals & Ors. - Appellants versus Smt. Nirmala Manaseh & Ors. – Respondents
First Appeal No. 64 of 2001
Decided on 11-4-2001
Consumer Protection Act, 1986 - Sections 2 and 14 – Medical negligence – Complainant suffered minor injury on cheek bone in accident and was treated in appellant hospital – Blisters appeared on face where there was no accident wound – Negligence alleged as the nurse while cleaning the wounds with saline ampule broke ampule carelessly and broken glass pieces of ampule got embedded – Defence plea that blisters were due to alergy - State Comission found appellant guilty of negligence and awarded compensation of Rs. 30,000/- with costs – Appeal - Three foreign bodies were removed from face – Doctor examined stated that complainant was not allergic to savlon – It was for appellant to bring evidence to rebut or explain as to how blisters appeared on face immediately after agonising pain suffered by complainant – No infirmity or illegality in order passed by State Comission. (Paras 3 to 5)
Result : Appeal dismissed.
ORDER
Mr. B.K. Taimni, Member – This First Appeal has been filed by the Respondent / Appellant M/s. CDR Hospitals & Ors. against the order of the State Commission, Andhra Pradesh through which the complainant / Respondent Smt. Nirmala Manaseh has been awarded a compensation of Rs. 30,000/- with interest of 12% p.a. from the date of the complaint and costs of Rs. 2,000/- finding negligence on the part of the Respondent / Appellants 1 and 2.
2. Briefly the facts are that the complainant / Respondent Smt. Nirmala Manaseh fell from scooter on 26-10-1989 and suffered minor injuries on the right eyelids and cheek bone and on the upper lip. She was rushed to the nearest Hospital where she was given first aid and was advised to go to a physician. On the same day at about 6.30 pm, she went to the Appellant’s Hospital. The allegation is that the nurse, Ms. Shobha Rani while cleaning the wounds with saline ampule broke the ampule carelessly and the broken glass pieces of the ampule got embedded in the complainant’s face and neck. The second allegation was that on 28-10-1989 while cleaning the complainant’s wound on the face, the Resident Medical Doctor (Appellant No. 2) applied first a yellow solution and then a white solution. The latter’s application resulted in severe burning which according to the complainant / Respondent was ‘spirit’ instead of saline which should have been used for cleaning of wounds. Next morning, blisters appeared on the face where there was no accident wounds. The Appellants rebutted that allegations and stated that there was no case of breaking of ampule by the nurse and appearance of blisters were attributed to alergy. After detailed examination of material on record and affidavits filed by both the parties, the State Commission came to the conclusion that there was clear case of medical negligence which resulted in blisters on the face of the Complainant / Respondent Mrs. Nirmala, basing its decision on the opinion given by Dr. I. Chandra Shekhar, that Ms. Nirmala was not allergic to savlon meaning thereby, that the blisters on the face of Ms. Nirmala could not have been on account of any allergic reaction as is made out by the Respondent / Appellant. As a result of which the State Commission awarded Rs. 30,000/- as compensation and costs of Rs. 2,000/- based on loss of income on the part of Ms. Nirmala for about six months, when she had to go to other Hospital and get plastic surgery done bringing her back to near normal. The main ground of appeal advanced by the learned counsel for the appellant is that there was no negligence on the part of his clients and the opinion of Dr. I. Chandra Shekhar relied upon by the State Commission to base its order is not maintainable as the same Doctor conducted the test on left arm and not on the face.
3. A perusal of the material record clearly reveals that after first -aid, Ms. Nirmala was admitted in the Appellant’s Hospital where she remained under treatment for a few days. It is on record that three foreign bodies were removed from her upper lip and face, two on 16-12-1989 and third on 4-4-1990. It is also a matter of record that Dr. Chandra Shekhar gave a clear opinion that the complainant / Respondent Ms. Nirmala is not allergic to savlon. In the light of the latter, the stand of the appelant the blisters on the face were caused by allergy, is not found to be maintainable. While it may not be possible for anyone to say categorically that it was ‘spirit’ and not savlon which was applied by Appellant No.2, but it is quite clear and admitted that the complainant / Respondent Ms. Nirmala did develop blisters on the face in the scooter after (Sic).
4. It was for the Appellants to bring any evidence or rebut the opinion of Dr. Chandra Shekhar or to explain as to how the blisters appeared on the face immediately after agonising pain suffered by Ms. Nirmala on application of a certain liquid by Appellant No. 2. Failure to do so have only strengthened the case of Ms. Nirmala and we find ourselves in agreement with the reasoning based on which State Commission passed its order finding the Appellants negligent as well as deficient in service towards the complainant / Respondent, Ms. Nirmala.
5. We find no infirmity or illegality in the order passed by the State Commission.
6. The learned Counsel at this stage also pleaded for extension of period to make the payment of compensation. The amount is so small and the period of agony and travails so long, that we do not see any merit in this prayer.
The Appeal is dismissed. Keeping in view the facts and circumstances of the case, no order as to costs.
Appeal dismissed.
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CH. PADMA v. SUDHA NURSING HOME
I (2002) CPJ 53
Consumer Protection Act, 1986 – Section 2(1)(g) – Medical Negligence – Deficiency in Service – Poor post operative treatment – Opposite party not able to identify the disease early till the complications arose – Patient brought back to Nursing Home on 2.8.1991, not operated till 5.8.1991 – Postoperative treatment done by doctors not qualified in Allopathy – Complainant developed fecal fistula and bedsore because of injection and deficiency in post operative care – Negligence on part of opposite party established – Complainant entitled to compensation.
Held: In view of the above discussion we hold that there is deficiency in service of the part of the opposite party in not able to identify the disease early till the complications set in. Therefore, discharging the patient at the first instance and even though patient was brought back to the Nursing Home on 2.8.1991 complaining of severe pain, not able to take a decision about the surgery till 5.8.1991 also amounts to deficiency in service in the light of the conduct as seen above.
The operation was conducted by opening the abdomen by the standard right para median incision and it was found that there was fulminant peritinitis due to perforation of the small intestine because of typhoid ulcers. The gut was very fragile. The adhesions were relieved. The perforated gut was reselected and end to end anaestamosis was carried out. Appendix was also removed. Peritonial toilet was done after leavage corrugated rubber was kept and abdomen was closed layer by layer. It is also admitted in the counter affidavit that the patient was kept on post operated treatment during which she had a stormy post operative period and for her every day was a struggle between life and death. There is no complaint by the complainant about conducting the operation. But the post operative treatment was done mostly by the doctors who were not qualified in allopathy. In the counter affidavit it is stated that the post operative care was taken by Dr. Bhoom Reddy, Dr. V. Suryanarayana Reddy and Dr. S. Rama Reddy, the visiting physician. The dressings were done by Dr. Bhoom Reddy and his son only. Only routine functions like pulse reading, recording of blood pressure and recording of temperature were performed by other doctors under their supervision.
P.W. 1states in her evidence that the duty doctors were homoepathy doctors and the post operative treatment was not done by qualified allopathy doctors, that she developed fecal fistula and bedsore because of infection and deficiency in post operative care in the opposite party Nursing Home. (Para 7 & 8)
Held further: The complainant has claimed a sum of Rs. 30,000/- towards expenses incurred in the opposite party Nursing Home, Rs. 39,566/- – as expenses at Apollo Hospital, Hyderabad, Rs. 15,000/- as expenditure incurred by her family and Rs. 1,00,000/- by way of damages for the hardship caused to her. Though we do not find any exaggeration in any of the first three heads, as already seen we do not find that there is any negligence under these heads. As we held that there is negligence in providing post operative care, we feel that the complainant is entitled to a sum of Rs. 50,000/- towards hardship and suffering caused to her. (Para 10)
Result: Complaint allowed.
ORDER
Mr. Justice P. Ramakrishna Raju, President – The complainant fell sick and she was admitted in the opposite party Nursing Home on 2.8.1991. She was operated upon on 5.8.1991 by Dr. V. Bhoom Reddy, proprietor of the Nursing Home, who released adhesions, closed Ilea perforation, anastamosis and appendicitis was also done. She was an in patient till 6.9.1991. During the post operative period, treatment was done mostly by the doctors, who were not qualified in Allopathy medicine and hence she developed severe complications including fecal fistula and bedsore. She became very weak and she developed fecal fistula due to infection. Although she was charged more than Rs. 30,000/- for the operation and her family incurred heavy expenditure, she developed severe complications due to poor post operative treatment.
Thereupon she was referred to Dr. S.S. Reddy of the Apollo Hospital, Hyderabadon 21.10.1991 and she was accordingly admitted and was operated upon for resection of terminal, 11/2 feet of ileum along with caecum was done and end to end anastomosis of ileum to ascending colon was done. This operation had to be done in view of the complications that developed for the complainant due to poor post operative treatment by the opposite party. She incurred an expenditure of Rs. 39,566/- at the Apollo Hospital as she was discharged on 27.11.1991 after staying for more than a month and the family of complainant also incurred a sum of Rs. 15,000/- for their stay at Hyderabad due to the said complications and operation. The education of the complainant was severely effected; all this happened due to negligence of the doctors of the opposite party hospital. Hence, she approached this Commission claiming a compensation of Rs. 1,84,566/- under different heads.
2. In the counter affidavit filed by the opposite party is admitted that the complainant was admitted in the opposite party Nursing Home on 28.7.1991 for the complications like fever with chills and rigors for 15 days, vomiting and pain in abdomen. She was toxic and in agony. She was kept on conservative treatment. Although she had partial relief, her parents got discharged her on 31.7.1991 against the medical advice. She did not recover fully and still she was having persistent complaints. She was again brought back on 2.8.1991 in a precarious condition with complaints of fever, vomitings, pain in abdomen, distension of abdomen and her condition was moribund. Her parents were asked to take her to Hyderabad as her survival chances are only 10 to 15% but the parents of the complainant told Dr. Bhoom Reddy that they were prepared for the worst and for any outcome. Hence, investigations were carried out and it was found that the patient was suffering from acute abdomen due to enteric perforation with peritinitis. An emergency surgery was contemplated and that the parents were informed about the decision but the parents were not willing for the said course and, therefore, surgery had to be postponed. But her parents came to a decision in the morning of 5.8.1991 and accordingly gave their consent for surgery. Dr. Bhoom Reddy conducted the surgery after opening the abdomen. It was found that there was fulminant peritinitis due to perforation of the small intestine because of the typhoid ulcers. The gut was very fragile. Adhesions were relieved and the perforated gut was resected and end to end anaestamosis was carried out.
The appendix was also removed. Peritonial toilet was done after leavage corrugated rubber was kept and abdomen was closed layer by layer. She had a stormy post operative period. For her, every day was a struggle between life and the death. Post operative care was carried out. Dressings were done either by Dr. Bhoom Reddy or his son Dr. V. Surayanarayana Reddy and Dr. S. Rama Reddy, the visiting physician. Only for routine functions like pulse reading, recording of blood pressure and recording of temperature were performed by other doctors under their personal supervision. There was no negligence on their part. The hospital charged only Rs. 6,000/- towards operation and hospital charges. Hence, the complaint may be dismissed.
3. The complainant was examined as P. W. 1 and her father as P. W. 2 besides marking Exs. A-1 to A-6. On behalf of the opposite party, four witnesses were examined including himself as R. W. 1 and Exs. B-1 and B-2 were marked.
4. The point for consideration is whether there is negligence on the part of the opposite party in extending post operative care during the stay of the complainant in their Nursing Home and whether she developed fecal fistula and bedsore due to improper post operative care taken by the opposite party and if so to what extent?
5. As seen from the complaint the complainant was admitted on 2.8.1991 and she was operated upon on 5.8.1991 by Dr. Bhoom Reddy of the opposite party Nursing Home. However, Dr. Bhoom Reddy in his counter affidavit stated that in fact she was brought to the Nursing Home on 29.7.1991 itself with complications of fever with chills and rigors for 15 days, vomiting and pain in abdomen. Though she got partial relief her parents got her discharged on 31.7.1991 against medical advice although she was having persistent complaints. It is also stated that her parents were asked to keep her as an in patient and carry on the treatment. It may be mentioned here that the girl was aged about 16 years at that time. That she was again brought back to the Nursing Home on 2.8.1991 in a much precarious condition like fever, vomiting, pain in abdomen which were already there and in addition to distention of abdomen. After examination, the seriousness of the condition of the patient was explained to the parents and they were advised to take the patient to Hyderabad as the survival chances of the complainant were found to be 10 to 15%.
But they told him that they were prepared for the worst and for any outcome. Here, it may be observed that it is hard to believe that the parents, who have finally taken the girl to the Apollo Hospital at Hyderabad, would have taken the advice of the doctor on a deaf ear and told him that they were prepared for the worst; particularly when a girl of 15 years was suffering from acute pain in the abdomen for quite some days. According to Dr. Bhoom Reddy who is examined as R. W. 1 the patient was discharged on 31.7.1991 and hardly within a gap of two days or less, her condition has become precarious. Even here the case of the opposite party is that the patient was relieved from the Nursing Home against the medical advice. A girl, who is suffering from such acute pain without relief, was taken away not to any other Nursing Home but only to home; where there is nothing to offer to relieve the pain, is a matter which is hard to digest. As seen from the record the attitude of the parents is not that they were reluctant to continue the treatment. Dr. Bhoom Reddy states in his counter affidavit that on investigation the patient was found to be suffering from acute abdomen pain due to enteric perforation with peritinitis and an emergency surgery was contemplated and the advice was passed on to the parents. Here again according to him the parents were reluctant and, therefore, the surgery was postponed. Ultimately the parents turn round and came to a decision on the morning of 5th August, 1991 with consent for surgery and it is stated that they were prepared for any eventuality. In this story as narrated by Dr. Bhoom Reddy, there is something more than the eye meets.
6. P. W. 1 is the complainant. Her evidence is impressive. She has stated as simply and as fairly as possible. She denied that there was any suggestion coming from Dr. Bhoom Reddy that it is a case of immediate surgery and that her father withheld the consent. In fact the suggestion is that Dr. Bhoom Reddy advised her father that operation was necessary, but her father took her away. This was not even case of the opposite party in the counter affidavit. The case as set up in the counter affidavit is that when her parents were asked to keep her as inpatient and carry on the treatment the parents got her discharged against medical advice. Therefore, we have no hesitation to hold that the version set up by the opposite party in this regard cannot be accepted, and we are of the opinion that as she stated P. W. 1 she was discharged after remaining for three days as an in patient and after prescribing some medicines to her. But as the pain became unbearable she was again taken to the Nursing Home and admitted.
7. In view of the above discussion we hold that there is deficiency in service on the part of the opposite party in not able to identify the disease early till the complications set in. Therefore, discharging the patient at the first instance and even though the patient was brought back to the Nursing Home on 2.8.1991 complaining of severe pain, not able to take a decision about the surgery till 5.8.1991 also amounts to deficiency in service in the light of the conduct as seen above.
8. The operation was conducted by opening the abdomen by the standard right para median incision and it was found that there was fulminant peritinitis due to perforation of the small intestine because of the typhoid ulcers. The gut was very fragile. The adhesions were relieved. The perforated gut was resected and end to end anaestamosis was carried out. Appendix was also removed. Peritoneal toilet was done after leavage corrugated rubber was kept and abdomen was closed layer by layer. It is also admitted in the counter affidavit that the patient was kept on post operated treatment during which she had a stormy post operative period and for her every day was a struggle between life and death. There is no complaint by the complainant about conducting the operation. But the post operative care was taken by Dr. Bhoom Reddy and Dr. S. Rama Reddy, the visiting physician. The dressings were done by Dr. Bhoom Reddy and his son only. Only routine functions like pulse reading, recording of blood pressure and recording of temperature were performed by other doctors under their supervision P. W. 1 states in her evidence that the duty doctors were homoepathy doctors and the post operative treatment was not done by qualified allopathy doctors, that she developed fecal fistula and bedsore because of infection and deficiency in post operative care in the opposite party Nursing Home. P. W. 2 also supports the said version. He stated that after the operation other doctors who were homoeopathy trained doctors used to attend on her (patient). R. W. 1 Dr. Bhoom Reddy himself admits in the counter affidavit that only routine functions like pulse reading, recording of blood pressure and recording of temperature were performed by other doctors under his personal supervision. He admits in his evidence as R. W. 1 that the homoeopathy doctors helped him in the opposite party Nursing Home and they also checked the general condition of the patients in the ward. As the presence of the homoeopathy doctors is admitted, the statement of P. W. 1 gets support from the evidence of R. W. 1 himself.
Though R. W. 1 restricts his work to opposite party department and for checking general conditions of the patients in the ward, we are of the opinion that he has engaged them to look after the post operative care of P. W. 1. This also in our view amounts to deficiency service. As such we are constrained to hold that P. W. 1 developed fecal fistula and bedsore which were also not taken care of by qualified doctors of the Nursing Home and as such these defects amount to deficiency on the part of the opposite party.
9. In view of the evidence of R. Ws. 2 to 4 we have to hold that there was necessity for an emergency operation for clearing of the paretorium and closing of the ruptured intestine. We cannot, therefore, hold any negligence in conducting the emergency operation or in having the second operation namely, resection of terminal ileum and caecum i.e. removal of damaged part of the small intestine and joining them together.
10. The next question is what are the damages to be awarded to the complainant ?
11. The complainant has claimed a sum of Rs. 30,000/- towards expenses incurred in the opposite party Nursing Home, Rs. 39,566/- as expenses at Apollo Hospital, Hyderabad, Rs. 15,000/- as expenditure incurred by her family and Rs. 1,00,000/- by way of damages for the hardship caused to her. Though we do not find any exaggeration in any of the first three heads, as already seen we do not find that there is any negligence under these heads. As we held that there is negligence in providing post operative care, we feel that the complainant is entitled to a sum of Rs. 50,000/- towards hardship and suffering caused to her.
Accordingly we allow the complaint in part and direct the opposite party to pay the sum of Rs. 50,000/- with interest @ 12% per annum from the date of filing of the complaint till the date of payment together with a further sum of Rs. 5,000/- towards costs. Time for payment six weeks.
Complaint allowed.