"Hey Doc, you may be my Close School buddy, but pay Rs.26,50,000/- " - Dismissed. Adv. ROHiT ERANDE ©

 "Hey Doc, you may be my Close School buddy, but pay Rs.26,50,000/- " - Dismissed.

It was held that 'The patient's condition was bad and Doctors treated him properly'. 

Adv. ROHiT ERANDE ©

In the opening paragraph of the judgement it was observed by National Commission :

“The doctor/patient relationship is at a crossroads. Some patients want the doctor calling all the shots, deciding the best treatment path to follow. Patients miss the trust and warmth found in the personal bond with a caring, competent physician. Boundaries in the doctor-patient relationship is an important concept to help health professionals navigate the complex and sometimes difficult experience between patient and doctor where intimacy and power must be balanced in the direction of benefiting patients .”

Case details :

 BIBEKANANDA PANIGRAHI V/s. PRIME HOSPITALS LTD. & ORS (F.A.No.443/2010) 

Coram : J.M. Malik and Dr. S.M. Kantikar.

judgment Link :

https://indiankanoon.org/doc/77143362/

Facts in Short :

1. The complainant, Mr. Bibekananda Panigrahi took his father for acute appendicitis., (since deceased, hereinafter referred as 'patient')  was operated by Dr. Maheshwar Sahoo, (OP-2)  at Prime Hospital (OP-1),.

2. The Operation was performed on 5.6.2006 and stitches were removed on 16.6.2006, but unfortunately, the surgical wound showed gapping with pus discharge and inspite of 15 days stay in the Hospital, the wound got worsened and nobody could diagnose the infection.   Then, the patient developed fecal fistula, hence, daily, thrice, dressings was done and costly injections were given.  

3. It was alleged that the patient was diabetic, but controlled one, but the OP increased the dose of insulin, considerably.  None attended the patient during these sufferings. Even after a month, the   patient further deteriorated and therefore was shifted to the SCB Medical College, where the Professor of Surgery opined that the patient was a victim of mistake, committed by the OP-2, which developed post operational multiple complications. Patient was again operated at SCB Medical College.  It was found  that, many internal wounds were not taken care properly by the OP-2 . The patient died on 12.9.2006. Complainant alleged that, the OP-2 had performed wrong operation due to which patient suffered fecal fistula and subsequent complications caused the death of the patient.

4.       Hence, the complainant filed a complaint before the State Commission and prayed for compensation of Rs.26,50,000/- from the OPs.  The State Commission dismissed the complaint.  Hence, the complainant approached this Commission by way of this first appeal.

Defence :

1.The argument adduced on behalf of OP 2 was that patient was a school classmate and close friend of OP-2  and every care was taken to treat him.  The patient had severe gangrenous appendicitis, which was carefully operated.  The gaping wound was not due to any negligence on the part of OP, but it was due to delayed healing process.  

2. There was no lapse either in the treatment or in post operative care also.  The patient was treated for 45 days.  The patient took discharge on his own and went to SCB Medical College.  Hence, there was no negligence on the part of hospital and doctors.

3. The patient was given higher  higher antibiotics. The patient was also referred to an Endocrinologist for diabetics and a Nephrologist for high blood urea and creatinine  and was treated accordingly.  To improve anaemia and hyperproteinaemia, by blood transfusion IV, parenteral Intravenous proteins and vitamins were given.  As there was low output fistula, dressing of the wound was done 3-4 times per day to keep the wound clean and dry.

Held :

1. the NCDRC after perusing the record found that the patient had high grade fever and noticed   lump in right iliac fossa.(RIF) Hence, the decision was taken for appendectomy.  The operative notes clearly reveal that abdominal wall was opened by right para median incision.  There was pyo - peritoneum i.e. pus in peritoneal cavity. Appendix was gangrenous and in para coecal position. 

2. The base of the appendix was tied up after removing the gangrenous appendix.  There was also pus in the sub-hepatic space on right side.  Post operatively, the patient was treated with higher antibiotics, like Amikacin, Sulbactum and metrogyl.  After removal of stitches, there was gaping of wound with   pus discharge. The patient developed fecal fistula.

3.       It was observed that it should be borne in mind that the patient was presented with acute appendicitis of about four days duration. Patient had temperature 102º F, ultra-sonographically mass was confirmed in RIF (Right iliac Fossa)  and it was apprehended that patient may develop further complications like perforation and gangrenous appendix peritonitis.  The patient's blood sugar at the time of admission was 210 mg% and the kidney functions were disturbed as blood urea was 91 mg and Creatinine was 4.8 mg%, the values were very high.  The patient had hypertension and was on medication since last 10 years.

4.       The commission declined to  apply the doctrine of res-ipsa-loquitor (the principle that the mere occurrence of some types of accident is sufficient to imply negligence.) in this case, as the development of fecal fistula was a sequele of appendicular abscess or gangrenous appendicitis. The patient was diabetic; it was the additional cause for poor healing of wound.

5.     By relying on various medical literature,   it was observed that

"Appendectomy is one of the commonest procedures performed in surgical practice. When the appendix is perforated or gangrenous with peri-appendicitis, the frequency of septic complications reaches as much as 30% which includes wound infection, intra-abdominal abscess, fistula formation, and localized or diffused peritonitis. Most of the appendicocutaneous fistula are low output fistulas and close spontaneously within 3 weeks." 

"The  Post-appendectomy  faecal  fistula  formation,  though  it  is  a  rare  complication,  is  associated  with  significant  morbidity.  An early diagnosis is essential to institute proper treatment at an early stage of the disease. Most of the fecal fistulae respond to the conservative  treatment  in  the  absence  of  an  underlying  pathology  and  distal  obstruction.  The surgical  management  should  be  reserved  for  those who fail to respond to the conservative management." 

6. Lastly the Commission    put reliance upon several judgments of Hon'ble Supreme Court on medical negligence.

In the Jacob Mathews Case (2005) 6 SCC 1 it is observed as;

A medical practitioner faced with an emergency ordinarily tries his best to redeem the patient out of his suffering. He does not gain anything by acting with negligence or by omitting to do an act. Obviously, therefore, it will be for the complainant to clearly make out a case of negligence before a medical practitioner is charged with or proceeded against criminally. A surgeon with shaky hands under fear of legal action cannot perform a successful operation and a quivering physician cannot administer the end-dose of medicine to his patient.

In  Martin F. D'Souza vs. Mohd. Ishfaq AIR 2009 SC 2049  case  Hon'ble Apex Court observed as;

'medical practitioner is not liable to be held negligent simply because things went wrong from is chance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another - he would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field.'   In Roe and Woolley Vs The Ministry of Health, by Lord Denning, that, We would be doing a disservice to the community at large if we were to impose liability on hospitals and doctors for everything that happens to go wrong.

Courts/Consumer Fora should keep the above factors in mind when deciding cases related to medical negligence, and not take a view which would be in fact a disservice to the public. The decision of  Hon'ble Supreme  Court   in  Indian   Medical   Association  v.  V.P.   Shantha  (AIR 1996 SC 550) should   not  be   understood   to   mean that  doctors should be harassed  merely  because their  treatment  was unsuccessful  or caused  some  mishap which  was not necessarily  due  to negligence.

 

7. Lastly it was observed that  in this case, there appears to be a strained relationship between the Doctor-Patient. The deceased and OP doctor were classmates and close friends. The OP took utmost care and operated upon him as an emergency. The fecal fistula developed due to patient's health condition. The patient was highly diabetic with high blood urea and creatinine levels. Further, OP took proper care of the fistula by providing regular dressing, antibiotics were given. The death occurred due to multiple factors. We do not find any negligence either during the appendicectomy surgery or during treatment of fecal fistula. Therefore the appeal is hereby dismissed, with no order as to costs.

This case teaches many lessons to Doctors. The one which is always applicable is keeping of Medical Record properly and truly. The most important lesson is "रिश्ते अपनी जगह और प्रोफेशनल लाइफ अपनी जगह होने चाहिये "..? As  the patient would have been alive, the Doctor would have been a GOD..

Thanks and Regards,

Adv. Rohit Erande

Pune.©