NATIONAL
CONSUMER DISPUTES REDRESSAL COMMISSION
ORIGINAL PETITION NO. 33 OF 1997
N. Krishna Reddy …
Complainant
Son of Sri Konda Reddy
No. 11-79-9,
Piler, Chittor District
Andhra Pradesh
PIN : 517 214
Versus
1.
Rep. By
its Medical Superintendent
TAMIL NADU
PIN : 632 004
2. Dr.
G.D. Sundara Raj
Professor & Head of Department
Department
of Orthopaedic &
Accident
Surgery – Unit-I
The
Ida –
TAMIL
NADU
PIN : 732 004 ….
Opposite Parites
AND
ORIGINAL PETITION NO. 34 OF 1997
Son of Sri Konda Reddy
No. 11-79-9,
Piler, Chittor District
Andhra Pradesh
PIN : 517 214
Versus
1.
The
(A unit of the Medical
Relief Society of South Kanara)
Rep. by its Medical
Superintendent
No. 98, Rustom
Bagh
Airport Road
2.
Dr. K.M.K. Varma
Department of Orthopaedic
No. 98, Rustom
Bagh
Airport Road
BEFORE :
HON’BLE
MR. JUSTICE K.S. GUPTA, PRESIDING MEMBER
For the Complainant : Mr.
P.B. Suresh, Advocate
For the Opp.Parties: Mr. Krishna Srinivasan &
In OP No. 33/97
Mr. P.K. Ram, Advocates
For the Opp.parties : Mrs. Vimla
Sinha, Advocate
In OP No. 34/97
Dated
O R D E R
PER DR P D SHENOY, MEMBER
OP No. 33 of 1997 and OP No. 34 of 1997 are connected matters
wherein the complainant is the same. He has alleged medical negligence against
the Christian Medical College and Hospital and Dr G D Sundar
Raj Professor and HOD of the same hospital in OP No.
33 of 1997 and in OP No. 34 of 1997 the complaint is against Manipal Hospital and Dr K M K Varma
of Orthopaedic Department of the same hospital.
OP No. 33 of 1997
Case of the complainant
:
Krishna Reddy, complainant who had a
history of severe back ache was admitted for treatment in the
Thereafter Mr
Reddy, went to
The complainant was desperate and
hence he approached the
Complainant claimed damages from the
opposite parties, details of which are given below :-
a)
Damages towards medical expenses
: Rs. 80,000/-
like Hospitalisation,
cost of drugs,
surgery, etc.
b)
Accommodation
of the attendants and : Rs. 70,000/-
their transportation costs to and from
c)
Mental agony and physical torture :
Rs. 9,50,000/-
d) Damages towards further loss of : Rs. 15,00,000/-
income
and loss in profession
---------------------------
TOTAL Rs. 26,00,000/-
-------------------------
Case of
the opposite parties:
CMC,
The complainant was admitted to the hospital i.e. on
22.05.1996. Though he was initially admitted to a private ward, he was shifted
to general ward at his request on 29.5.1996.
Even then, he was attended by Prof. G.D. Sundera
Raj himself.
The surgery undertaken was debridement of the
lumbar 4th and 5th disc.
The specimens obtained at the time of the operation were sent for
culture for routine as well as tuberculosis infection. The spine was stabilized using bone obtained
from the complainant’s own hip bone. As
there was no evidence of Tuberculosis, he was treated with antibiotics for non
tuberculosis infection, pain relief tablets and was asked to be reviewed in the
out-patient department 6 weeks from the date of discharge i.e. 8.6.1996. The complainant was seen for the last time on
10.9.1996 during which his clinical condition was discussed with Prof. G.D. Sundera Raj. The complainant was advised for a further
review in six months for which the complainant did not report. As per the records of the opposite parties,
the total hospitalization charges were in the region of Rs.18,431/-
excluding the cost of drugs. According
to the opposite parties, the complaint has been filed with a view to enriching
by himself by preferring a claim of exorbitant amount by way of damages on
untenable grounds.
Submissions
of the learned Counsel for the complainant :
Learned Counsel submitted that
stoppage of Anti Tubercular treatment (ATT) by the CMC Hospital was a gross
mistake and medical negligence and because of this, the disease flared up and
spread to sternum and rib necessitating a third surgery at this site in the Appollo Hospital, Chennai. He submitted that Dr N Krishnappa, MS (Orthopaedics) and
former Professor and Head of Department of Orthopaedics
of Bangalore Medical College has stated in para 5 of
his report that anti tubercular treatment was stopped at Vellore
Hospital which had aggravated his symptoms. Further in paras
6, 7 and 8 of his report he has stated that restarting of ATT by
“It is also submitted that ‘multifocal
nichrosis’ is not a diagnosis. The correct spelling
is Necrosis which can be due to several causes including tuberculosis. Multifocal Necrosis by itself cannot be taken as clinical
diagnosis. In fact, cause for the same has not been arrived at and that is why,
there is a note of interrogation affixed after the word ‘Multifocal
Nichrosis’. Thus it is indicative of the fact that
cause is not clear to the attending doctors of
He quoted the medical literature by Shri
S M Tuli wherein it is stated that
:
“It is known that tuberculosis can recur in a different site
and tissue diagnosis may not be possible in 20% of cases particularly those
already or those with chronic disease of long standing.”
(Tuberculosis of the skeletal system – by S M Tuli page No. 23, Jaypee Brothers
– Medical Publishers (P) Ltd.,,
He quoted the discharge summary of the
He referred to the affidavit of Dr K
Venkataramaiah.
Dr K Venataramaiah a medical
practitioner of 29 years of standing has stated in his affidavit as follows :
“They (
“Surgery is only to eradicate a localized problem where drugs
do not reach. Surgery is only secondary treatment. Main stay and basic
treatment is ATT.”
In his affidavit Dr Khadar Basha, a medical
practitioner of 32 years of standing has stated that :
“No efforts were made by the CMC to relieve the compression
of left S1 root in order to relieve the back pain and neurological deficit.”
Accordingly, he submitted that the complaint may be allowed
and compensation claimed may be awarded.
Submissions
of the learned Counsel for the opposite party :
Learned Counsel for the CMC submitted that the complainant
was fully cured by the treatment given by the CMC which is evident from the
statement made by the complainant on 20.06.1996 to the Medical Supdt., of the
“Then I came back to my residence and decided to go to the
The medical record of the hospital
indicates that microbiology test was conducted at
“Microbiology :
Pus Culture and Sensitivity report : No Growth.
PUS AFB - Smear Report
Gram’s stain –
Many 2BCs, no pus cells or bacteria seen.
AFB Smear – No AFB seen.”
Dr G D Sundararaj
in his deposition has stated that :
“I submit that the material sent for culture and biopsy
failed to show evidence of TB. Tablet Ciproflox was
continued for six weeks. I submit that L4 and L5 being a major problem, it was
decided to be tackled first. Non-intervention of this condition could make the
patient paraplegic and permanently disabled or invalid.”
The two doctors namely Dr K Venkataramaiah
and Dr Khadar Basha examined by the
complainant had concealed the fact that they are not the experts and they have
not seen the patient.
Findings :
Complainant has filed affidavits
of Dr K Venkataramaiah and Dr Khadar
Basha. Neither of these doctors are
Orthopaedic Surgeons nor are they experts in TB
disease. In his cross examination Dr Khadar Basha has stated that he has given his affidavit with
regard to CMC only on the basis of discharge summary certificate dated
08.06.1996. He has not perused the medical records of Krishna Reddy relating to
the treatment given in CMC. He also stated that he was not aware that the
patient is not suffering from TB. He was aware that antibiotic CIPRO FLOX 500 mg
is an antibiotic used as a secondary line of treatment for Tuberculosis. Finally he stated that, he will take back
the statement made in the last two paragraphs of his affidavit regarding
negligence and deficiency in the treatment given by CMC,
In his cross examination Dr K Venkataramaiah has stated that he based his opinion on the
discharge summary of CMC Vellore and he has not seen
the medical record of the CMC. He further stated that he has not treated any
cases of multifocol Necrosis and he would not treat
the cases of multifocol necrosis because he is not an
expert in it. The discharge summary of CMC discloses that “biopsy showed multifocol necrosis, no evidence of tuberculosis. “In my
opinion even if the biopsy report, is negative treatment is given for
tuberculosis. CIPRO FLOX is a general antibiotic medicine.” He further stated that CIPRO FLOX can be used
as a second line of treatment for tuberculosis alongwith
other drugs. Long term treatment of ATT would affect the kidney, liver and heart.
It is clear that neither of them
have seen the patient nor perused the medical records except the discharge
summary of the hospital. Therefore, the value of their evidence gets reduced
drastically. As against this Dr Sundararaj has clearly stated in his report that there was
no evidence of TB. Further the case of the respondent is fortified by the
letter written (supra) by the complainant. The patient himself states that he
was almost cured after he received treatment from the CMC
Dr Vernon Lee in his affidavit has
stated “that the discharge summary of
He further submitted that the documents filed would reveal
that the patient was surgically cured at the time he left CMC. “I further
submit that the court may consider the out patient record of the patient dated
22.05.1996 to 10.07.1996 which would reveal that the patient was diagnosed with
multifocal necrosis and was treated with tablets/
medicines such as Ciprofloxacillin 500 mg and Brufen 400 mg being second line drugs of Tuberculosis so as
to combat both multifocal necrosis, matted lymphnodes and tuberculosis if any. It was after the tissue
culture taken during surgery that it was possible to confirm non-existence of
Tuberculosis but the medicine was still continued because of the non-specific
nature of the pathology report”. He further submitted that “the documents dated
22.05.196 to 08.06.1996 would reveal that the patient was doing well when he
was discharged from CMC. In fact the history and consultation record dated nil
would show that the history of the patient had been carefully considered before
treatment was afforded to the patient. I submit that I also rely upon the
outpatient cardiograph record dated 24.05.1996 and history and consultation
record dated nil and laboratory reports dated 23.05.1996 for the correct course
of treatment afforded to the complainant. I submit that the daily Nurses
record, intake and output chart and the diabetic Chart would reveal the amount
of care and exercise in treating the patient on day-to-day basis. I submit that
the doctors order dated 22.05.1996 and progress record
dated 22.05.1996 and graphic TPR Chart and bone scan report are all evidence
which confirm that the treatment afforded in CMC is within the prescribed
medical parameters.” Dr Vernon Lee is a
Professor of Department of Orthopaedics and Accident
Surgery and Spinal Disorders Surgery, and he has not been cross examined.
Dr N Krishnappa,
Consultant Orthopaedic Surgeon has submitted his
report which was quoted by the learned Counsel for the complainant wherein he
has stated that anti tubercular treatment was stopped at
In this connection, it is worthwhile to peruse the judgment
of this Commission in Sethuraman Subramaniam
Iyer vs Triveni
Nursing Home and Anr – 1998 CTJ 7 (CP) (NCDRC)
wherein it is held that :
“The complainant did not requisition the services of any
expert to support his allegations. In the absence of any expert evidence on
behalf of the complainant, the State Commission was right in relying upon the
affidavits filed by four doctors on behalf of the respondents and in holding
that there was no negligence on their part. The State Commission rightly analysed and appreciated the materials placed on record. It
arrived at the finding after taking into consideration the totality of the
circumstances. No case is made out by the appellant for interference with the
order passed by the State Commission. The appeal is thus devoid of merit and is
accordingly dismissed.”
Further in Mrs
Kiran Bala Rout vs
“Medical negligence must be established and not presumed. In
the absence of expert evidence on behalf of the complainant, no negligence or
deficiency in service could be found against affidavits filed by the doctors.”
The citations quoted above are
applicable to the case under consideration. In view of the above anlaysis we do not find any merit in this complaint.
Accordingly, it is dismissed. No order
as to costs.
OP No. 34 of 1997
Submissions
for the learned Counsel for the complainant :
The learned Counsel submitted that
despite aggravation of the problems instead of conducting the second surgery
the
Submissions
of the learned Counsel for the
First surgery was performed in the
year 1992 and there was no complaint at all from him. On 17.04.1996 the patient
was asked to come back to the hospital for review. He came back on 17.05.1996
when the concerned surgeon was on leave and the doctors available examined and
suggested certain required treatment. Again he was asked to come on 21.05.1996
for further treatment but he failed to turn up. Hence, his lethargy is a
contributory factor for his suffering:
The learned Counsel submitted that, the complainant was
attended to on every visit to opposite party No. 1. Even when the opposite
party no. 2 was on leave from 16.05.1996 to 19.05.1996 he was examined by one
Dr Ramanna, a Sr Orthopaedic surgeon who directed for X-ray. Since the x-ray
did not show any improvement, he was advised to continue with the Anti T B
medicine prescribed on 17.04.1996 and to see the opposite party No. 2 only after
34 days i.e. 21.05.1996 but the complainant pre-supposed that the opposite
party No. 2 would not be available and therefore did not turn up as advised. In
fact on 17.05.1996, the complainant was also examined by one Dr
Dr K M K Verma,
MS a highly qualified doctor had recommended at the time of discharge from the
hospital that “will review after one month.”
In this case, it is clear that the
complainant had not gone to
“I have gone through the documents pertaining to the above
case in detail to arrive at following opinion.
The treatment received by Mr
Krishna Reddy at
During his 2nd admission between 09.02.1996 and
12.02.1996 he was thoroughly investigated including a CT scan was taken to show
that there was no fresh lesion.
While he was admitted on 25.03.1996 the lesion at L4 L5 was
detected and prompt anti tubercular treatment was started which was the right
treatment of choice. The concerned doctor also took second opinion from his
senior colleague to continue conservative treatment for a month and had planned
for surgry if conservative treatment had failed. This
shows there has been no negligence or deficiency of service.
When patient reported to hospital OPD on 17.05.1996 even
though the concerned doctor was unavailable, patient was seen by another senior
Orthopaedic surgeon who examined him and took further
x-rays and directed him to report back on 21.05.1996 so that the concerned
doctor can treat the patient on his arrival back from leave. Patient did not
obey his advice.
Anti tubercular treatment was stopped at
It is to be noted that despite open Biopsy of the sternum and
ribs performed at Apollo Hospital Chennai, which did not show positive for
tuberculosis, anti tubercular treatment was restarted by Apollo Hospital
Chennai following the treatment pattern given at Manipal
Hospital Bangalore. This shows that the treatment given at Manipal
Hospital Bangalore was of supreme importance which only could have cured his ailment.”
Further commenting on the affidavit
filed by Dr K Venkataramaiah he stated that “it
clearly shows that restarting of anti tubercular treatment following the pattern of
Complainant cannot blow hot and cold
at the same time. While arguing the case against CMC he wants to rely upon the
report of Dr Krishnappa but not while arguing the
case against
Therefore, we are not persuaded to
accept the submissions made by the learned Counsel for the complainant that
there was medical negligence by the
……………………..J
[ K
Presiding Member
………………………..
[ P D Shenoy ]
Member
Satish