NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
FIRST APPEAL NO. 538 of 2006
(From the order dated 29.06.2006 in Complaint No.89/2002 of the
State Commission, Andhra Pradesh)
Dr.Atluri Ravindranath & Anr. … Appellants
Versus
Versus
Jangamgunta Balasubramanium & Ors. …Respondents
FIRST APPEAL NO. 203 OF 2007
(From the order dated 29.06.2006 in Complaint No.89/2002 of the
State Commission, Andhra Pradesh)
Jangamgunta Balasubramanium & Ors. … Appellants
Versus
Dr.Atluri Ravindranath & Anr. … Respondents
BEFORE:
HON’BLE MR. JUSTICE ASHOK BHAN, PRESIDENT
HON’BLE MRS. VINEETA RAI, MEMBER
For the Appellants : Mr.G.V.K. Chowdary, Mr.A.
(in F.A.No.538/2006) & Chandrasekhar, Advocates
For the Respondent
(in F.A.No.203/2007)
For the Respondents : Ms. A. Subhashini, Advocate
(in F.A.No.538/2006) & Advocates
For the Appellant
(in F.A.No.203/2007)
Pronounced on 4th September, 2012
ORDER
PER VINEETA RAI, MEMBER
Two cross First Appeals No.538/2006 & 203/2007 have been filed by Jangamgunta Balasubramanium and others, who were the complainants before the State Commission, and Dr.Atluri Ravindranath and another, Respondent before the State Commission respectively being aggrieved by the order of the State Consumer Disputes Redressal Commission, Hyderabad (hereinafter referred to as the ‘State Commission’) in Complaint No.89/2002. Since the facts and the parties involved in both Appeals are the same, it is proposed to dispose of these cases by a common order by taking the facts from First Appeal No.203 of 2007. JangamguntaBalasubramnium (hereinafter referred to as the ‘Appellant No.1’) and his three minor children are other Appellants.
FACTS
The Appellant No.1’s wife, Smt.J.Madhavi (hereinafter referred to as the ‘patient’) conceived for the second time and underwent regular medical check-ups upto the sixth month of pregnancy in Chennai where Appellant No.1 was informed that her condition was normal. In her seventh month of pregnancy, patient went to her parent’s home in Vijayawada and was under the medical care of Respondents No.1 and 2. On 1.8.2000, she was admitted in Respondent No.1’s Nursing Home and underwent a caesarean section on 2.8.2000 and delivered healthy twin babies. In the evening of 03.08.2000, there was gushing of fluids from the stitches of the surgery site as also blockage of urine and Appellant’s father-in-law informed the Respondent No.1 who after examining her referred her to a Radiologist, Dr.B.Venkata Rathnam (Respondent No.6) and thereafter informed Appellant’s father-in-law that a re-operation was necessary because complications had developed due to mounting pressure upon the kidneys because of the twin pregnancy. Respondents No.1 and 2 conducted an Exploratory Laparotomy on 04.08.2000 and thereafter the patient was admitted in Aruna Kidney Centre for dialyses as advised by Respondent No.4, who was a Nephrologist. Since her lungs had also got affected, Respondent No.4 also referred the patient to Respondent No.5 and Respondent No.6 and thereafter she was admitted in Respondent No.6’s hospital where she was put on ventilator and sent every two days to Aruna Kidney Centre for dialyses. However, patient’s condition continued to deteriorate and she died on 07.08.2000. A post-mortem conducted by a team of 3 doctors concluded that the cause of the death was Septicaemia resulting from post-operative complications. Appellant issued a legal notice to Respondents holding them responsible for the death of his wife due to their medical negligence and demanded compensation of Rs.10 lakhs which included the heavy expenditure incurred on the medical treatment of the patient.
Respondents denied that there was any medical negligence in this case. Respondents No.1 and 2 stated that the complications may have arisen after the patient was admitted in Aruna Kidney Centre since the laparotomy conducted following leakage of fluids did not reveal any urological problem. It was only re-confirmed that the patient was having pregnancy complications such as eclampsia and kidney failure because of which a Nephrologist was also consulted. Further, neither the post-mortem report nor the criminal complaint filed against Respondents (in which they were acquitted) indicated any medical negligence on their part. Other Respondents i.e. Respondents No.3,4,5 and 6 stated that by the time they had seen the patient, she was already in a critical condition and despite being given the best intensive care which included dialyses and ventilator support, patient could not be saved.
The State Commission after hearing both parties and on the basis of evidence filed before it concluded that a case of medical negligence was made out only against Respondents No.1 and 2 who conducted the caesarean operation, tubectomy and subsequently the laparotomy. The relevant part of the order of the State Commission reads as follows:
“When the pregnancy is admittedly a twin pregnancy, opposite parties 1 and 2 ought to have shown reasonable care and caution which a doctor should according to normal medical standards and taken proper care and caution while conducting the surgery, especially, when opposite parties 1 and 2 were well aware of the complications of the surgery consequent to the operation. The opposite parties admit that“the cause for urinary blockage is not found”. It is held by the National Commission in Savita Garg Vs. National Heart Institute reported in Supreme Court and National Commission Judgements on Medical Negligence and Insurance Vol.II page (1) that it is the duty of the hospital and the treating doctor who should explain the line of treatment given and the burden of proof is also on them to prove that they were not negligent and that they have followed the normal medical practices as per standard medical parlance. At the time admission, the case sheet of opposite parties 1 and 2 also does not state that the patient is a high risk one. Here, neither the case sheet nor the material evidence filed explains the cause for the fluid leakage or the urinary blockage. Except for stating that they there was no injury to the bladder which is contrary to the post-mortem report, no satisfactory explanation has been given by opposite parties 1 and 2, for which act, we are of the considered opinion that they are negligent.”
The State Commission, therefore, directed Respondents No.1 and 2 to jointly and severally pay an amount of Rs.4 lakhs as compensation towards medical expenses and mental agony suffered by the Appellants. Out of this amount, Rs.1 lakh each were to be paid to each of the three Appellants who were minors. It was further directed that Appellant No.1 who is the guardian of the three minor Appellants would put the money in respect of his minor children in a Nationalized Bank under fixed deposits till they attained the age of majority and Appellant No.1 will be at liberty to withdraw the interest on this amount every quarter and spend the same for the benefit of his children. Rs.5,000/- was awarded as costs to be paid within 6 weeks failing which the amount will attract interest @ 9% p.a.
Counsel for both parties made oral submissions. Counsel for Appellant contended that prior to the caesarean operation the patient was healthy and therefore, the twins were delivered in good condition. However, because of the negligence during the surgery which caused a wound in the urinary bladder, the patient suffered from blockage of urine as also urinary leakage resulting in Septicemia and subsequent death. This is confirmed by the post-mortem report which revealed that the interior wall of the urinary bladder showed incised wound measuring 1.5 cm sutured with catgut partially healed with leakage of urine seen from the wound. Therefore, the submissions of the Respondents that there was no injury caused to the bladder is contrary to the post-mortem report. Further, no specific explanation was given by the Respondents as to why this problem occurred within 24 hours of the surgery. The contention of the Respondents that the patient was a high risk case, has not been recorded anywhere in the case-sheet and is now being used as an excuse to hide their negligence. The State Commission while rightly concluding that there was medical negligence, unfortunately awarded very meager compensation which was not commensurate with the loss suffered and mental agony and deprivation caused to the family including to the children. Therefore, there was a strong case for enhancement of compensation.
Counsel for Respondents contended that the State Commission erred in finding them guilty of medical negligence in view of the fact that there was no medical evidence that the surgery conducted by the Respondents had caused Septicemia. Further, the patient died 40 days after the caesarean operation and she had been attended to by other doctors during this period including a Nephrologist where the problem could have occurred. Counsel for Respondents stated that Respondents are well qualified doctors and had successfully conducted the caesarean operation on the patient and healthy infants were delivered. The pre-operative and post-operative conditions were noted and found to be absolutely normal. When the urinary output of the patient stopped and some fluid started leaking from the site a urologist was immediately called and an abdominal scanning and blood test revealed kidney damage because of a high serum creatinine. The urinary bladder was opened and sutured on the same day to control the fluid leakage and the exploration did not reveal any urological problem. In fact, the patient was having pregnancy induced complications i.e. eclampsia and kidney failure which was not the result of the surgery but a pre-existing condition which caused her death.
We have considered the submissions made by both parties. The fact that the patient was pregnant and that the delivery was through caesarean section is not in dispute. It is also a fact that following the surgery, the patient for the first time had urine leakage as also urinary blockage which indicated that there was a problem with the bladder. This problem aggravated over the next one month leading to several complications and finally Septicemia leading to multiple organ failure and death. The fact that there was an injury to the bladder which caused leakage of urine has been confirmed by the post-mortem report which clearly states that there was an incised wound measuring 1.5 cm which sutured and partially healed and leakage of urine was seen from the wound right upto the time of death. Since, this could have only occurred during surgery, there is an obvious nexus between the caesarean section conducted by the Respondents and subsequent problems with the bladder. We, therefore, agree with the State Commission that there is sufficient and credible evidence to prove that this injury occurred during the course of the surgery. Further, the Respondents’ contention that patient was a high risk case with pre-eclamsia condition is nowhere noted in the case history. The principle of what constitutes medical negligence has been established through a number of judgments including of the Hon’ble Supreme Court in Jacob Mathew Vs. State of Punjab & Anr. – (2005) 6 SCC 1. Among the principles applied in such cases of negligence are whether a doctor would have done or have failed to do something which in the given facts and circumstances, no medical professional will do; and whether the negligence was so manifest and demonstrative that no professional or skilled person in the ordinary sense and prudence could have indulged in. In the instant case, applying these two principles, the Respondents were undoubtedly guilty of medical negligence because during the course of a caesarean operation, they caused injury to the urinary bladder leading to multiple complications and death which was totally avoidable had due care been taken especially since caesarean sections are fairly common surgical procedures. Respondents No.1 and 2 who had conducted the surgery have not been able to satisfactorily explain the post-operative complications and their contention that the patient was seen by 4 others doctors including a Nephrologist implying that complications could have occurred because of their treatment does not inspire any confidence since no surgery was conducted by any of these doctors. In view of the above circumstances, applying the principle of res ipsa loquitur, no expert opinion is required to prove the apparent medical negligence in this case. We, therefore, uphold the order of the State Commission that Respondents No.1 and 2 and are jointly and severally guilty of medical negligence in the instant case. The First Appeal No.538/2006 is dismissed accordingly.
In their cross First Appeal No.203/2007, Appellants have sought enhanced compensation keeping in view the loss suffered by the family because of the death of a young mother and wife. The State Commission had awarded Rs.4 lakhs as adequate compensation keeping view all the facts of the case including age and status of the patient as also the loss suffered which can only be notionally quantified.
We have considered this matter and are of the view that since three young children have been rendered motherless, two of them at infancy, and in the interest of securing their future, there is a case for enhancing the compensation. We, therefore, direct that the compensation of Rs.1 lakh given to each of the three minor Appellant be enhanced by Rs.50,000/- each and the total amount of Rs.1,50,000/- each be put in the name of the minor Appellants in a Nationalized Banks under fixed deposits till they attain age of majority. Counsel for Respondents state that 50% of the amount awarded earlier has already been deposited by Respondents No.1 and 2 before the State Commission. If that be so, this amount be adjusted towards the awarded amount and the remaining amount be paid to the three minor Appellants by Respondents No.1 and 2 jointly and severally, to be put in the fixed deposits as ordered above within six weeks from the date of receipt of this order.
The First Appeal No.203/2007 is disposed of on the above terms.
Sd/-
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(ASHOK BHAN J.)
PRESIDENT
Sd/-
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(VINEETA RAI)
MEMBER
/sks/
