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--------------- Print Magazine --------------
 
  May 2016
 
  April 2016
 
 
 
 
CASE STUDY - By Anoop K. Kaushal
Opinion of Medical Board has strong Evidentiary Value
AJAY KUMAR GARG v. DR. (LT. COL.) B.P. SINGH

Original Petition No. 85 of 1998 decided by The Hon'ble National Consumer Disputes Redressal Commission, New Delhi on 26-05-2010

The complainant, a young man of 26 years of age, experienced acute pain at the lumber region. He went to a physician and as per his advice, got the x-ray of LA Spine/LAT and SI Joints done and early evidence of Ankylosing Spondilytis was found. Based on this opinion, the physician prescribed medicines and the complainant remained under his treatment for about a month and a half and got relief from his treatment. However, there was a recurrence of the pain after about a year and this time he consulted another doctor, another x-ray was got done and his problem was diagnosed to be a case of early Ankylosing Spondilytis involving the hip joints. Apart from prescribing some medicines, the doctor suggested physiotherapy and he was relieved of the pain in a period of about three months under his treatment. He again developed the same kind of pain at the same place and this time he approached Dr. (Lt. Col.) B.P. Singh, the opposite party, Orthopedic Surgeon who examined him and as usual suggested another x-ray of Pelvis Lumber Spine LAT. In the x-ray report a radiologist stated that the possibility of KOCH's left hip is to be excluded. Opposite Party wanted x-ray of chest PA and he prescribed some medicines for treatment of Bone TB i.e. Anti- Anoop K. Kaushal, Advocate anoopkaushal@gmail.com Tubercular Therapy (ATT) and advised complete bed rest. However, when the complainant told him that he was suffering from Ankylosing Spondilytis as per earlier diagnosis and not with Bone TB and wanted to go either to All India Institute of Medical Science, New Delhi or CMC Hospital, Vellore, allegedly the complainant was dissuaded from doing so stating that he may collapse on the way to New Delhi or Vellore and thereby the complainant surrendered to his treatment. There were allegations of wrong treatment over a prolonged period of 9 months in which the Opposite Party-Doctor forced the complainant-patient to remain on skin traction in the left leg rendering him completely confined to the bed and that his was a case of Bone TB (ATT) for which there is no shortcut but requires treatment of 9 to 15 months and thereby every time he visited the patient he only insisted on the treatment/medicines prescribed by him to be continued. It was also alleged that an eminent radiologist and ultrasonologist, after reviewing all the x-rays gave his opinion that the complainant was not suffering from Tuberculous Arthritis, suggested immediate withdrawal of Anti-Tuberculosis and that he be mobilized as soon as possible to avoid further Ankylosis of spinal and pelvic joints and stop further follow up x-rays to avoid radiation hazards. Complainant remained under the treatment of the Opposite Party-Doctor for about 5½ years and in the bargain was crippled, as he could not move freely nor bend forward and backward nor sit and sleep properly nor go upstairs due to acute stiffness in his backside and both hips were immobilized due to continuous prolonged skin traction, could not enjoy his conjugal life and has been living like a crippled helpless man rated to be 60% disabled by the competent authority. Contending finally that he would require total hip replacement costing Rs.3 to 4 lakhs and he had spent a huge amount of money on his treatment and his future career had been ruined, a compensation of Rs.1 crore for the sufferings undergone and for the future of his family was claimed.

On the point of diagnosis and treatment of the complainant, the Opposite Party submitted that based on his clinical experience and as per x-ray report advising the possibility of KOCH's left hip to be excluded, it was his best judgment that the complainant required the treatment for Bone TB in his own interest and accordingly advised the medicine and bed rest with skin traction. The fact that there was marked improvement consequent to the commencement of the treatment goes to prove that there was nothing wrong in his approach. Various x-rays subsequent to the treatment showed not only improvement in the condition of the patient but also tendency of being quite normal and this is proved from the fact that the complainant was able to resume his normal duty. The complainant suffering from Ankylosing Spondilytis did not by itself militate against the fact that earlier he was not suffering from Bone TB.

It was observed that the Opposite Party-Doctor, having taken note of the history of the patient, his clinical examination and after correlating his findings with the x-ray report, diagnosed the complainant to be suffering from Bone TB and, therefore, started the treatment for the same. Apart from the set of medicines prescribed for the treatment of Bone TB, he also advised skin traction resulting in complete bed rest for the complainant. While the Opposite Party-Doctor claimed that the complainant had considerable improvement in his condition and was able to rejoin his duties, the complainant's case was that there was not only no improvement but on the contrary because of the fear injected into the minds of the complainant and his father that any change of treatment may result in the death of the complainant, they were emotionally blackmailed to continue the same treatment, which had the crippling effect of the complainant not being able to walk, bend or move freely because of the stiffening of his back which has resulted in 60% disability. The finding given in the radiological appearance was suggestive of early evidence of Ankylosing Spondilytis and further when eminent radiologist and ultrasonologist opined that the complainant was not suffering from Bone TB but it was a case of Ankylosing Spondilytis, the Opposite Party-Doctor did not bother to review his own treatment and insisted on continuing with ATT.

On a perusal of the evidence produced by the parties, it was noticed that both the parties had not filed any affidavit and/or examined any expert witness and, therefore, with the consent of the counsel for both the parties, the matter was referred to the Director General of Health Services, Ministry of Health & Family Welfare, Government of India with a direction to constitute a panel of doctors (experts) who after going through the records should give their opinion if the diagnosis made and treatment given to the complainant by the Opposite Party-Doctor during the relevant period was in order or not.

The Directorate General of Health Services stated that a Medical Board constituted of concerned specialists had opined that there is no negligence on the part of the treating doctor. It was further stated that both Ankylosing Spondilytis and Tuberculosis can co-exist. The treatment given by the treating doctor at that point of time was in accordance with the radiologists' report and investigations.

On behalf of the complainant it was contended that the opinion expressed by the Medical Board should not be taken on its face value, as it neither discusses the medical papers/reports and had stated contrary to the factual position that the treatment given by the treating doctor at that point of time was in accordance with the radiologists' report and investigations as the body of experts did not seem to have critically analyzed the opinion expressed by the eminent radiologist and ultrasonologist, who in his reply to the Opposite Party-Doctor had categorically stated that the complainant was not suffering from Bone TB but his was a case of Ankylosing Spondilytis. The fact that even the Opposite Party-Doctor realized though much later that it was a case of Ankylosing Spondilytis goes to prove that from the very beginning the Opposite Party- Doctor had committed a blunder in diagnosing the case of Ankylosing Spondilytis to be a case of Bone TB and thereafter despite the reports to the contrary insisted on continuing the same therapy to the detriment of the complainant.

Held : The opinion received from a group of eminent experts cannot be discarded just because it does not give any detail discussion with regard to the xray reports, the diagnosis and the treatment, as even if they had been provided, this Commission would not have been in a better position to evaluate the technical findings. To the extent that complainant contended that the first X-ray Clinic had recorded the finding that the radiological appearance was suggestive of early evidence of Ankylosing Spondilytis, it has to be noted that this report was given on the 7th of July, 1990 whereas the patient was brought to the Opposite Party- Doctor on 15th of March, 1992 and the Opposite Party-Doctor himself had got the fresh x-ray done on the very next date, which gave the indication of Bone TB. Besides, when the opinion expressed by the body of experts clearly states that both Ankylosing Spondilytis and Tuberculosis can co-exist and in this case if the Opposite Party- Doctor has based the diagnosis on the x-ray report and arrived at the conclusion that the complainant was suffering from Bone TB and continued the treatment, which, it so happens, required a prolonged treatment over a period of 15 months, it could not be said that the Opposite Party-Doctor was negligent. Since we have the opinion of the Medical Board comprised of experts, which we value with thanks, we do not consider it necessary to discuss the interrogatories and other evidence related to the treatment.

Complaint dismissed.

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