B S KRISHNA KUMAR Vs. MANIPAL HOSPITAL

JUDGEMENT

(1.) THIS complaint is filed on 15.12.1997 by the complainants Shri B.S. Krishna Kumar, his wife Smt. B. Lalitha, Smt. Laxmi, w/o Ashok Kumar and Kum. B. Sarika, d/o B. Ashok Kumar, against Manipal Hospital, doctors N.K. Venkataramana, S.N. Simha, Vamadeva Rao, Praveen Kumar Sharan, working in O.P. 1 Hospital, praying for awarding compensation of Rs. 19.00 lakh, and for a direction to O.Ps. 1 to 6 to pay it with interest @ 18% p.a. from the date of filing the complaint till payment date.

(2.) THE brief facts are that Ashok Kumar, son of complainants 1 and 2, and husband of complainant No. 3, and father of complainant No. 4, was running footwear business in Vijayawada, and on 24.12.1995 at about 6.00 p.m. in Madanapalli, he sustained bullet shot injuries to his abdomen/left lower chest in police firing, where he had gone on business. He was initially treated at Community Hospital, and discharged at 7.30 p.m. He was taken to O.P. 1 Hospital on the same day at 10.30 p.m. and admitted for treatment, on 26.12.1995, he was operated by Neuro Surgeon to remove the bullet, which was said to have been lodged adjacent to L1 -L2 Spine. Patient developed features of intestinal obstruction (paralytic ileus), after the operation. On 28.12.1995, he was operated by general surgeon by Exploratory Laparotomy (incision through the anterior abdominal wall). At that time, it was noted that there were (i) entry and exit wounds over the anterior surface of the fundus stomach (the part of stomach to the left and above the level of the opening osophagus); (ii) Jagged entry wound in the left dome of the diaphragm; (iii) contusion (injury to a part without a break in the skin or bruised of the mesentry (a membraneous fold attaching various organs to the body wall, especially the peritoneal fold attaching the small intestine to the dorsal body wall) of the splenic; (v) Bile stained fluid in the peritoneal cavity (peritoneal serous membrane, lining the walls of abdominal and pelvic cavities and investing the contained viscera). The perforations were said to have been closed in the course of the operation conducted on that day. However, on 3.1.1996, patient developed a burst abdomen - once again secondary suturing was done within a few hours. The patient is said to have died the same day. Deceased was taken for post mortem. Post mortem report shows stomach contained green coloured fluid, and on dissection of abdomen, it was found that the mesentry and coils of intestine showed adhesion softening covered by fibrinious inflammatory exudates amount 300 ml. Cause of death however was not given. Discharge summary copy and post mortem report are produced in Annexures C1 and C2. After the patient sustained injury, he was immediately shifted to O.P. 1 Hospital without delay, with the belief that the patient would receive immediate, timely, and specialized treatment, since O.P. 1 is a specialized hospital providing sophisticated diagnosis and treatment. O.Ps. were negligent in diagnosing and treating the patient as a result of which the patient died. The apparent negligence of O.Ps. is evident from the discharge summary and death of the patient Ashok Kumar to be attributed to the following factors. (a) As per discharge summary, patient was diagnosed as suffering from gun shot injuries to the lumbar spine, stomach and diaphragm again, but the patient on 26.12.1995 was operated to remove the bullet from the back (two days after admission), and on 28.12.1995 (four days after admission) when the patient suffered from features of intestinal obstruction, it was realized that exploration surgery of the abdomen had to be conducted to repair the damage that might have been caused from the point of entry of the bullet to the place, where it was lodged. The obvious and apparent delay of 4 days to detect the perforation caused as a result of the bullet entering the abdomen has proved fatal to the patient, since it is apparent that as a result of the internal wounds to the stomach and other viscera not being treated, peritonitis septicemia has been caused and ultimately be leading to the death of patient. (b) O.Ps. have not taken correct abdominal X -ray or transislateral decubitus X -ray of the abdomen to rule out air under diaphragm, which is the first thing which ought to have been done in a case of perforation of stomach since the perforations would have been revealed immediately and timely treatment would have saved the patient. (c) When the patient seen to have suffered an entry wound in the front of the body, O.Ps. ought to have traced the path of the bullet from the place of entry to the place where it was lodged and any injuries caused to the body organs in the path of the bullet ought to have been suspected diagnosed and treated in an appropriate manner. This is more apparent especially after the chest X -ray was normal and when the bullet has traversed from front to back, it had to penetrate viscera in the abdomen. An abdominal erect X -ray ought to have been taken since the patient also had periumblical pain and sluggish bowel sounds at the time of admission of the patient to O.P. Hospital. (d) Post mortem report discloses the mesentry and coils of intestine showed adhesion softening covered by fibrinious inframmatory exidates about 300 ml., which indicates intestine and other viscera were severely infected at the time of patients death. In the event, if patient was operated immediately on being admitted, and perforations to the stomach, and other organs, liver being closed effectively treated, the operation could have been prevented, and patient would have survived. (e) Discharge summary discloses that patient was subjected to ultra sound scanning, but nevertheless, the perforation in the stomach, diaphragm and intestine and mesentry were not detected. Failure of O.Ps. to diagnose and detect the perforation on the date of admission of patient to O.P. Hospital amounts to gross negligence of O.Ps. The patient has been treated casually and in slip shod manner. Negligence of O.Ps. are of such nature, amounting to total absence of reasonable skill and care that ought to have been taken/administered by a qualified medical practitioner. Delay caused as described above can be attributable to the gross negligence of O.Ps., which proved fatal to the patient. It amounts to deficiency in service rendered to the deceased by the O.Ps.

(3.) VERSION of O.Ps. 1, 3, 5 and 6 is complaint is frivolous, unrighteous and unsustainable in law and on facts. It is an attempt for an unlawful gain. It does not set -out facts fully and correctly. Several facts are mischievously twisted suit the dishonest claim of complainants for making out a false case against O.Ps. Complainant is not a consumer, and complaint made out is not a consumer dispute under the Act. O.Ps. are not traders thereunder. Health care services rendered by them do not come within the service under the Act. O.P. Hospital is non profit making organization run by Medical Relief Society of South Canara, which renders highly subsidized service in all specialities of medicine to all citizens, and particularly rural poor. Complaint is not tenable, as matter involves complexity and intricate question of medical science and technology, which are too intricate and complex to be decided in the summary proceedings before the Commission, which is not equipped with to decide such questions. It has no jurisdiction to decide the complaint. O.P. hospital is one of the best hospitals in the country known for high standard of care, hygienic and treatment, and is well equipped with sophisticated equipments. O.P. Hospital is not a legal entity being a unit of medical relief society of South Canara (Regd.) and it cannot be made O.P. Complaint is bad for non joinder of necessary party, and it is liable to be dismissed. O.Ps. 2 to 6 are not employees of O.P. 1 Hospital, but consultant surgeons. O.P. 6 Dr. Sharan Srinivasan is a post graduate in Neurology. He had neither seen, nor he was involved in any treatment medical or surgical of the patient Ashok Kumar. He had only prepared the case summary after going through all the case records at the request of other O.Ps. O.P. 6 is not a necessary party. Complainants have not come with true facts. Statements in the complaint are fully incorrect.