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--------------- Print Magazine --------------
 
  May 2016
 
  April 2016
 
 
 
 
CASE STUDY - By Anoop K. Kaushal
Follow up Advise should be Specific and strictly Complied with
Dr.K.M.Madappa
v.
The President and Members,
Karnataka State Consumer Redressal Commission & Anr.

Revision Petition No. 244 of 2007 decided by the National Consumer Disputes Redressal Commission, New Delhi on 4 th February, 2011.

The facts of the case are that the Respondent, B.N.Rajesh, was under medical treatment for a kidney stone in the Petitioner's Hospital where he got admitted on 21-2-2002 and an operation was performed on him on 26-2-2002 and a D.J. stent (pipe) was inserted. Three days after the surgery he was asked to undergo an X-ray which indicated that some residual stones still remained in the kidney and, therefore, a second operation was conducted on 5-3-2002. At the time of discharge on 8-3-2002 he was advised follow up visit/check up and, therefore, he visited the Petitioner's Hospital on 1-4-2002 where he was advised to undergo a urine test. Despite the two surgeries, Respondent continued to have stomach pain and he therefore, met the Petitioner/Doctor on 15-9-2003 who after scanning and X-ray advised a third operation. The operation was conducted on 26-9-2003 and the Respondent was informed that the pipe had now been removed and he was thereafter discharged on 28-9-2003. However, since the severe stomach pain continued, Respondent went to Sanjo Hospital and after diagnostic tests including X-ray, the specialist in that hospital, Dr. K.S. Venugopal, conducted an operation on 22-10-2003 during which he removed a pipe that had remained in his stomach. The Respondent was discharged from the hospital on 25-10-2003 after being fully cured.

Petitioner stated that after insertion of the stent during the operation on 5-3-2002, Respondent was informed that it would need to be removed within six months and he was therefore, advised regular follow up visits which he failed to do. Instead, he visited the Petitioner on 15-9-2003 i.e . one and a half years after the first surgery and it was because of the delay on his part that a stone had developed at the lower end of the stent which continued into the ureter. It took nearly two hours of surgery to remove the old stent as there was pus, severe inflammation and bleeding and even thereafter all the stone fragments could not be removed. However, to save the life of the Respondent a new D.J. stent was introduced which could not properly enter the kidney because of the stone fragments in the ureter and right kidney and it was therefore, left in the ureter with the other end in the bladder. Respondent was informed of the situation and told that the new stent would need to be removed within one week but did not turn up despite this specific advice. Thus, it was because of the failure on the part of the Respondent in not approaching the Petitioner in time for removal of the stent following the second surgery which resulted in the complications.

Observations:

(i) The State Commission concluded that the stent was inserted on the Respondent not on 5-3-2002 as stated by the Petitioner but on 26-2-2002 i.e. during the first surgery relying on the X-ray of the Respondent on
2-3-2002 which clearly showed the presence of the stent.

(ii) Though the Petitioner advised the Respondent during his discharge on 8-3-2002 to come-up for follow-up action, nowhere is it stated in the records of the hospital as to what should be the specific period of follow up for removal of the stent.

(iii) It further observed that the Respondent did indeed come for a follow up visit soon after the second operation on 1-4-2002 after which a urine test was done and no further medical advice was given.

(iv) Regarding the third operation, though the hospital record stated that a stent was placed half way, it does not disclose that after the removal of the old stent, a new stent was inserted, nor do the hospital records indicate the advice given to the Respondent that he was required to meet the Petitioner/Doctor for removal of the stent after one week.

(v) On the other hand, it has come in evidence that Dr.Venugopal who conducted the fourth remedial operation has stated that after he removed the stent, the Respondent's condition became satisfactory, thus, indicating clearly that the entire problem of the Respondent was because of the prolonged retention of the stent in the system by the Petitioner.

Held:

From the medical records available on file, it is clear that as observed by the State Commission, D. J. stenting was done on the Respondent during the surgery on 26-2-2002 and not on 5-3-2002. It is further clear that the second operation conducted on 5-3-2002 was, therefore, not to insert the stent as contended by the Petitioner but to remove the residual fragmented kidney stones which remained in the system despite the first surgery and no stent was inserted during this operation as is very clear from the X-ray report cited earlier. It is thus clear that right from the beginning the Petitioner's Hospital's records did not state the correct facts regarding the patient's surgeries and subsequent treatment which is a deficiency, particularly, in a well staffed hospital. Counsel for Petitioner admitted to us that the discrepancy in dates could be a typographical error but we are not convinced because the Petitioner has also sworn an affidavit that the stent was inserted on 5-3-2002. Another discrepancy pertains to the follow up/check-ups. Counsel for Petitioner has wrongly contended that the Respondent did not come for a follow up for one and a half years; in fact he came for a check-up within three weeks of the second surgery and underwent a urine test. We further find that the State Commission on the basis of facts produced before it has concluded that no specific advice to the Respondent was given regarding the need for removal of stents after the two surgeries and we see no reason to disagree with this observation of the State Commission which is a finding of fact. Even the third operation was clearly botched up with fragments of kidney stones still being retained in the system and a stent which was obviously not required, being inserted in the system. This is clear since the fourth operation by which the stent was removed cured the patient. To sum up, we agree that despite three surgeries the Petitioner failed to treat the ailment of the kidney stones and it was finally treated successfully by another doctor.

Counsel for Petitioner has tried to project that Dr. Venugopal who conducted the fourth surgery was only a pediatric surgeon; this is also a mis-statement of facts. Dr.Venugopal has an F.R.C.S. degree and had been specially trained in both adult and pediatric surgery in the U.K. Thus, right from the beginning there have been contradictions in respect of the medical facts, medical advice and the treatment given by the Petitioner to the Respondent. It is also clear that none of the three surgeries helped the patient and in fact led to one complication after another.

Taking into account all these facts, we agree with the State Commission that the Petitioner is guilty of medical negligence and deficiency in service. The State Commission in its well-reasoned order rightly appreciated these facts and awarded a compensation of Rs.1 lakh to the Respondent. We uphold the order of the State Commission. The revision petition is dismissed.

Anoop K. Kaushal, Advocate - kaushal@justice.com
 
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