At, Andhra Pradesh State Consumer Disputes Redressal Commission Hyderabad
By, SRI SYED ABDULLAH HONBLE MEMBER & SRI R. LAKSHMINARASIMHA RAO HONBLE MEMBER
Counsel for the Appellant : M/s. V. Gourisankara Rao
Counsel for the Respondents: M/s. A.P. Prakash for R1. R2 served.
The appellant is the unsuccessful complainant in CD 64/2003 before the District Forum, Guntur, where under, compensation was claimed under different heads to a tune of Rs.8,71,760/- from OP 1 hospital on the ground of medical negligence in performing Bypass surgery on 27.3.2002 and while conducting the operation the doctor had operated only one artery instead of three arteries as assured and the remaining arteries were substituted by Angio Patch Plasty as result of which he had to again undergo Bypass surgery in OP 2 hospital incurring huge expenditure as such the act or omission amounts to deficiency in service. The impugned order of dismissal of the complaint is assailed as erroneous and sought to be set aside.
According to the complainant on 23.2.2002 he felt pain in heart so he consulted a private doctor who had taken ECG and advised him to consult cardiologist so he immediately joined as in patient in OPs hospital where after conducing clinical tests he was advised to undergo Angiogram and thereby he joined in the hospital on 8.3.2002 and underwent angiogram after paying required fee. Basing on the angiogram report he was advised to undergo heart operation. OP 1 in its discharge summary had noted the details for performing bypass surgery. He joined in the hospital on 27.3.2002 and he was performed Bypass surgery and as per the findings mentioned in the Discharge Summary dated 08.03.2002 Bypass surgery to be done, i.e., three arteries are to be operated as there were blocks. But the Bypass surgery was done only to one right artery by replacing a new artery, whereas, for other two arteries Angio Patch Plasty which is not recommended, since he had crossed the age above 50 years. Again, some time thereafter the complainant had no proper pumping of blood so he was admitted in OP1?s hospital on 26.12.2002 for undergoing Angiogram test and discharged. The complainant was vexed with the OPs service and he consulted OP 2 hospital at Hyderabad for post-operative correction where he was again operated on 7.1.2003 for left mammary artery and left anterior clot which was successful one.
OP 1 denied the allegations and filed the version in which he has explained the details of the pre and post operative care taken towards the patient so also the procedure that was adopted as per the protocol on scientific methods by discharging duties with utmost good faith so as to relieve pain and suffering to the patient. While denying the allegations of substandard performance, lack of skill and deficiency attributed it is stated that Dr. Suresh is M.D. of the hospital who himself is a doctor worked in USA for 7 years and set up a sophisticated hospital with a team of expert doctors viz., Dr. Stephen and Dr. D. Raju, S. Layer who are experts in the field of cardiology. The details of pre and post operative treatment given at the time of operation are noted in para 7 to 11 of the version. It is further stated that the procedure was explained to the patient and after taking consent the operation was done on 26.12.2002. Later the patient was again admitted for repeat coronary Angiography which was performed which showed the RCA graft with excellent retrograde filing of the entire left system. However, the area of LMCA Angioplasty was completely occluded with abrupt cut offs with proximal and distal and vague outline of the blocked area which indicate of reasonable recent thrombus ( blood clot ) formation. Dr. Shatapathy, the consultant doctor along with Dr. M.P. Tripathy advised the patient to undergo the procedure of percutaneous Transluminal Angioplasty with Stenting of the blocked area of the LMCA which had a good proximal and distal patent segments by extending concessional expenditure for the said procedure. But the patient got discharged himself on 27.12.2002. However, the discharge summary given by OP 2 hospital itself shows that the pumping rate is 30 to 34 % while the same pumping rate ( LVEF) was 40% as late as on 16.12.2002.
OP 2 hospital was made as a proforma party has filed its counter affidavit and produced its case sheet. In para 5 of the affidavit it is stated that the allegations made in the complaint have been answered point wise by OP 1 and further details are given as per record so as to assist the Hon?ble Commission in arriving at a decision. It is stated that the patient had chest pain at rest associated with sweating and ECG showed severe ischemia of anterior lateral wall whereupon he was managed intensively as he was developing LV failure. Earlier he had suffered with ischemic heart disease and had undergone coronary artery Bypass Grafting in OPs 1 hospital after which he became Symptomatic again. It is also stated that patient is diabetic and hypertensive. Subsequent investigations revealed severe LV dysfunction with LMCA disease ( total occlusion) and critical Lad and OM Disease. So he was transferred to Cardiothoracic Surgery Division and a high risk Coronary Artery Bypass Grafting Surgery with IABP support was done on 7.1.2003. During which there was Cardiomegly with mild to Moderate Mitral Regurgitation. The patient was discharged in stable condition with mild heart dysfunction after an uneventful heart procedure. It is further stated that having regard to the chronological events the patient was given best possible treatment after making him aware of the attendant risk involved during the procedure.
To prove the allegations the complainant filed Ex. A1 to A40 which consists of the discharge summaries of the OP1 and 2 as well the bills and other clinical reports. Where as, the OP.1 filed Ex. B1 along with affidavits . Pw1 was crossed examined on the basis of questionnaire and RW. 1 had filed evidence affidavit and the doctor was cross examined.
After going though the oral and documentary evidence, the District Forum held that the operation that was done to RCA was having 100% block . However it was a successful one which was done after explaining the procedure involved by obtaining his consent. The left coronary artery having 60% block was repaired with Patch Angioplasty. Again on 27.12.2002 on the basis of Angiogram report Ex. A41 which was done after 9 months the patient had faced with other complications in LVEF reducing shortness of breathing. So again after 9 months on 27.12.2002 Dr. Tripathy conducted angiogram and found that Pallot ICT JCPNR, pedal edema negative H.R. = 100%/ minute, B P 100/80 CE present .LVS 3 + PAHTR Lungs Clinically clean. ABD. Los. After six months over LVEF deceased from 55% to 30% with shortness of breathing C12/4 with PND. Plan .. Redo CABG through the Redo CABG is high 10-15% complication and need for 1 ABP support and other option is LMCPTCA stunting as a primary procedure or bridge to CABG. Also observed that the surgery done by the OPs was successful.. But it was temporary as the patient was chronic diabetic and hypertensive . His body has etherogenic tendency means formation of cholesterol in the blood vessel. It is a disease which varies to individual to individual. Due to formation of ethyrocholorosis ( Cholesterol formation disease), coronary artery disease no one can do more than what he has done. For the above said reasons, it is held that the OP 1 had not committed amounting to any deficiency in service.
The main allegation against OP 1 is that just before performing Bypass surgery as per the discharge summary details bypass to be done to the right artery on its three passages but they have performed bypass only on one side and the rest of the two passages was done with angioplasty system which should not have been done as per medial protocol as such he developed further complications and ultimately he had to get it rectified in OP 2 hospital for which he spent huge expenditure, so OP 1 hospital is liable to reimburse the expenditure by paying necessary compensation.
The complainant had not filed any expert evidence except the discharge summary given by the Op 2 hospital. Except his self serving statement he has neither produced any medical expert evidence nor any medical literature to show the procedure adopted by the Op 1 while conducting CABG to the right artery and the remaining two blocks by angioplasty is faulty or should not have been done much less it is unscientific. On the other hand OP 2?s affidavit itself discloses that the allegations made by the complainant are liable to be demolished and nothing is said against the procedure adopted by the OP. 1 in performing the earlier operations. The record itself speaks that CABG that was done by OP 1 was uneventful, subsequently after 9 months due to other complications blood clots have formed for which the expert doctor of OP 1 hospital wanted to rectify the same by explaining the necessary procedure involved having been aware of the past history of the patient and also offered to give concessional rate for the expenditure.
In the case of medical negligence of a doctor as per the judicial precedents negligence means failure to act in accordance with the standard or reasonable competency of a doctor either in giving treatment or performing the operation. where there are two or more procedures are involved in performing the operation and if by adopting a proper standard, the doctor performs the operation it cannot be said to be wrong and he cannot be made liable for negligence at all. This aspect is made clear in the judicial precedents holding that for the simple reason that subsequently something goes wrong, the doctor cannot be attributed with any medical negligence or deficiency in service. OP 1 in its version as well in the discharge summary has made it crystal clear as to the actual procedure that was adopted while performing the operation on the right artery and Angio plasty for the two other arteries so as to reduce the risk to the patient. It cannot be said that the concerned doctor in OP 1 hospital was at fault for any deviation or attributed that he had do
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ne wrong in performing the operation. Based on the principles laid down earlier in medical negligence cases the Hon?ble Supreme Court in its recent decision in Marthin F.D. Souza Vs. Mohd. Isthak reported in 2009 Indian Law SC 174 once again made clear that in proof of the allegation of medical negligence it has to be supported by expert evidence, else, the complaint is liable to be dismissed. For the foregoing reasons and discussion we are of the considered opinion that the concerned doctors of OP 1 hospital have discharged their duties in good faith while so bad faith is attributed that he had done wrong in performing the operation. For the foregoing reasons and discussion we are of the considered opinion that the concerned doctors of OP 1 hospital have discharged their duties in good faith while so bad faith is attributed as such the complaint was rightly dismissed. In the result the appeal is dismissed confirming the order passed in CD 64/2000 as justified. Consequently, the complaint is dismissed. In the circumstances, there is no order as to costs.