K RAVINDRA NATH Vs. VITTA VEERA SURYA PRAKASAM

JUDGEMENT

(1.) This is a case of alleged medical negligence where a gastroenterologist performed explorative Laparotomy in a suspected case of Teratoma to remove the big lump from the abdomen along with one of the ovaries and left a surgical mop in the abdominal cavity which resulted in complications which necessitated a second surgery by a surgical oncologist. Case of the complainant:

(2.) Complainant No.3 - Ms. Vitta Sireesha is a 13 years old daughter of Shri Vitta Veera Surya Prakasam. In the second week of March, 1997 she complained of stomach disorder, pain in leg and vomiting sensation. Local doctor at Kurnool advised the patient to take her to Apollo Hospital, Hyderabad. After conducting various tests, Dr Ravindra Nath, Gastroenterologist diagnosed the disease as Immature Teratoma and advised immediate surgery on 20.3.1997 and the patient was discharged on 27.3.1997. The patient was advised to have Chemotherapy at the time of discharge. On 9.4.1997 at about 4.00 p. m. as pus to the tune of 150 to 200 ml oozed out from the sutures, the patient was immediately rushed to Hyderabad. They reached the hospital at 4.00 a. m. on 10.4.1997 and though the operating surgeon was informed, he did not come out for a full day. Only the duty doctor at casualty came at 7.00 p. m. and dressed up the wound. On 11.4.1997 Dr Nath examined the patient with naked eye and told the patient that there is no need to worry and prescribed some medicines. This exercise was repeated on 22.4.1997 and 31.3.1997. As advised by Dr. R. V. Rao the patient was taken to M N J Hospital on 20.5.1997 where Dr. Rao examined her and diagnosed the disease as 'immature Teratoma' Stage III C Cancer and stated that there is no hope of survival of the patient. But the father of the patient took her to Nizam Institute of Medical Sciences (hereinafter be referred as NIMS) Hyderabad for a second opinion on 23.5.1997, where it was noticed that some foreign body was left at the time of surgery besides certain intestines were perforated and second surgery was done on 30.6.1997 and the patient was discharged. The complainant alleged that doctors at the Apollo Hospital have committed gross negligence and dereliction of their duties and claimed Rs.10 lakh as compensation for the injuries, towards mental agony, pain; expenses suffered by the complainants. Case of the opposite parties:

(3.) The Managing Director, Hyderabad Apollo Hospitals, Dr. K. Ravindranath, Gastroenterologist and Dr. R. V. Rao, Oncologist at the same hospital were the opposite parties before the State Commission. On clinical examination of the patient, the patient was found to be anemic and her abdomen had huge mass occupying almost the whole abdomen. She was diagnosed to be suffering from Immature Teratoma Right Ovary with secondaries and surgery was planned. Blood transfusion was given. Laparotomy was done under general anaesthesia on 20.3.1998 which revealed the following: (a) right ovarian tumour of variable consistency (b) ascites (c) deposits in vesico-uterine pouch and pouch of Douglas (2 in No.2 x 2cm x 1 x 2cm) (d) Omental secondaries (3 x 3 cm) (e) Small multiple deposits in pelvis (f) Small deposits in opposite ovary. Sutures were removed on 29.3 1997 and wound healed well. In view of the Immature Teratoma with secondaries, the patient was referred to Medical Oncologist who advised chemotherapy. They denied the allegation that no body turned up to enquire about the patient's condition on 10.4.1997, The second surgery conducted at NIMS was superfluous. The patient had an abscess, which drained by itself and was in the process of healing. Formation of abscess after such an extensive surgery is not uncommon. The allegation that there was surgical mop in the abscess after the surgery was baseless. Pathology report on biopsy that foreign body granulomas were present is not uncommon and histological finding is not significant.