CH.PADMA vs SUDHA NURSING HOME

THE complainant fell sick and she was admitted in the opposite party Nursing Home on 2.8.1991. She was operated upon on 5.8.1991 by Dr. V. Bhoom Reddy, proprietor of the Nursing Home, who released adhesions, closed Ilea perforation, anastamosis and appendicitis was also done. She was an in patient till 6.9.1991. During the post operative period, treatment was done mostly by the doctors, who were not qualified in Allopathy medicine and hence she developed severe complications including fecal fistula and bedsore. She became very weak and she developed fecal fistula due to infection. Although she was charged more than Rs. 30,000/- for the operation and her family incurred heavy expenditure, she developed severe complications due to poor post operative treatment. THEreupon she was referred to Dr. S.S. Reddy of the Apollo Hospital, Hyderabad on 21.10.1991 and she was accordingly admitted and was operated upon for resection of terminal, 1 feet of ileum along with caecum was done and end to end anastomosis of ileum to ascending colon was done. This operation had to be done in view of the complications that developed for the complainant due to poor post operative treatment by the opposite party. She incurred an expenditure of Rs. 39,566/- at the Apollo Hospital as she was discharged on 27.11.1991 after staying for more than a month and the family of the complainant also incurred a sum of Rs. 15,000/- for their stay at Hyderabad due to the said complications and operation. THE education of the complainant was severely effected; all this happened due to negligence of the doctors of the opposite party hospital. Hence, she approached this Commission claiming a compensation of Rs. 1,84,566/- under different heads.

IN the counter affidavit filed by the opposite party it is admitted that the complainant was admitted in the opposite party Nursing Home on 28.7.1991 for the complications like fever with chills and rigors for 15 days, vomiting and pain in abdomen. She was toxic and in agony. She was kept on conservative treatment. Although she had partial relief, her parents got discharged her on 31.7.1991 against the medical advice. She did not recover fully and still she was having persistent complaints. She was again brought back on 2.8.1991 in a precarious condition with complaints of fever, vomitings, pain in abdomen, distension of abdomen and her condition was moribund. Her parents were asked to take her to Hyderabad as her survival chances are only 10 to 15% but the parents of the complainant told Dr. Bhoom Reddy that they were prepared for the worst and for any outcome. Hence, investigations were carried out and it was found that the patient was suffering from acute abdomen due to enteric perforation with peritinitis. An emergency surgery was contemplated and that the parents were informed about the decision but the parents were not willing for the said course and, therefore, surgery had to be postponed. But her parents came to a decision in the morning of 5.8.1991 and accordingly gave their consent for surgery. Dr. Bhoom Reddy conducted the surgery after opening the abdomen. It was found that there was fulminant peritinitis due to perforation of the small intestine because of the typhoid ulcers. The gut was very fragile. Adhesions were relieved and the perforated gut was resected and end to end anaestamosis was carried out. The appendix was also removed. Peritonial toilet was done after leavage corrugated rubber was kept and abdomen was closed layer by layer. She had a stormy post operative period. For her, every day was a struggle between life and the death. Post operative care was carried out. Dressings were done either by Dr. Bhoom Reddy or his son Dr. V. Surayanarayana Reddy and Dr. S. Rama Reddy, the visiting physician. Only for routine functions like pulse reading, recording of blood pressure and recording of temperature were performed by other doctors under their personal supervision. There was no negligence on their part. The hospital charged only Rs. 6,000/- towards operation and hospital charges. Hence, the complaint may be dismissed. The complainant was examined as P.W. 1 and her father as P.W. 2 besides marking Exs. A-1 to A-6. On behalf of the opposite party, four witnesses were examined including himself as R.W. 1 and Exs. B-1 and B-2 were marked.

The point for consideration is whether there is negligence on the part of the opposite party in extending post operative care during the stay of the complainant in their Nursing Home and whether she developed fecal fistula and bedsore due to improper post operative care taken by the opposite party and if so to what extent ?

AS seen from the complaint the complainant was admitted on 2.8.1991 and she was operated upon on 5.8.1991 by Dr. Bhoom Reddy of the opposite party Nursing Home. However, Dr. Bhoom Reddy in his counter affidavit stated that in fact she was brought to the Nursing Home on 29.7.1991 itself with complications of fever with chills and rigors for 15 days, vomiting and pain in abdomen. Though she got partial relief her parents got her discharged on 31.7.1991 against the medical advice although she was having persistent complaints. It is also stated that her parents were asked to keep her as an in patient and carry on the treatment. It may be mentioned here that the girl was aged about 16 years at that time. That she was again brought back to the Nursing Home on 2.8.1991 in a much precarious condition like fever, vomiting, pain in abdomen which were already there and in addition to distension of abdomen. After examination, the seriousness of the condition of the patient was explained to the parents and they were advised to take the patient to Hyderabad as the survival chances of the complainant were found to be 10 to 15%. But they told him that they were prepared for the worst and for any outcome. Here, it may be observed that it is hard to believe that the parents, who have finally taken the girl to the Apollo Hospital at Hyderabad, would have taken the advice of the doctor on a deaf ear and told him that they were prepared for the worst; particularly when a girl of 15 years was suffering from acute pain in the abdomen for quite some days. According to Dr. Bhoom Reddy who is examined as R.W. 1 the patient was discharged on 31.7.1991 and hardly within a gap of two days or less, her condition has become precarious. Even here the case of the opposite party is that the patient was relieved from the Nursing Home against the medical advice. A girl, who is suffering from such acute pain without relief, was taken away not to any other Nursing Home but only to home; where there is nothing to offer to relieve the pain, is a matter which is hard to digest. AS seen from the record the attitude of the parents is not that they were reluctant to continue the treatment. Dr. Bhoom Reddy states in his counter affidavit that on investigation the patient was found to be suffering from acute abdomen pain due to enteric perforation with peritinitis and an emergency surgery was contemplated and the advice was passed on to the parents. Here again according to him the parents were reluctant and, therefore, the surgery was postponed. Ultimately the parents turn round and came to a decision on the morning of 5th August, 1991 with consent for surgery and it is stated that they were prepared for any eventuality. In this story as narrated by Dr. Bhoom Reddy, there is something more than the eye meets. P.W. 1 is the complainant. Her evidence is impressive. She has stated as simply and as fairly as possible. She denied that there was any suggestion coming from Dr. Bhoom Reddy that it is a case of immediate surgery and that her father withheld the consent. In fact the suggestion is that Dr. Bhoom Reddy advised her father that operation was necessary, but her father took her away. This was not even case of the opposite party in the counter affidavit. The case as set up in the counter affidavit is that when her parents were asked to keep her as inpatient and carry on the treatment the parents got her discharged against the medical advice. Therefore, we have no hesitation to hold that the version set up by the opposite party in this regard cannot be accepted, and we are of the opinion that as stated by P.W. 1 she was discharged after remaining for three days as an in patient and after prescribing some medicines to her. But as the pain became unbearable she was again taken to the Nursing Home and admitted.

IN view of the above discussion we hold that there is deficiency in service on the part of the opposite party in not able to identify the disease early till the complications set in. Therefore, discharging the patient at the first instance and even though the patient was brought back to the Nursing Home on 2.8.1991 complaining of severe pain, not able to take a decision about the surgery till 5.8.1991 also amounts to deficiency in service in the light of the conduct as seen above. The operation was conducted by opening the abdomen by the standard right para median incision and it was found that there was fulminant peritinitis due to perforation of the small intestine because of the typhoid ulcers. The gut was very fragile. The adhesions were relieved. The perforated gut was reselected and end to end anaestamosis was carried out. Appendix was also removed. Peritonial toilet was done after leavage corrugated rubber was kept and abdomen was closed layer by layer. It is also admitted in the counter affidavit that the patient was kept on post operated treatment during which she had a stormy post operative period and for her every day was a struggle between life and death. There is no complaint by the complainant about conducting the operation. But the post operative treatment was done mostly by the doctors who were not qualified in allopathy. In the counter affidavit it is stated that the post operative care was taken by Dr. Bhoom Reddy, Dr. V. Suryanarayana Reddy and Dr. S. Rama Reddy, the visiting physician. The dressings were done by Dr. Bhoom Reddy and his son only. Only routine functions like pulse reading, recording of blood pressure and recording of temperature were performed by other doctors under their supervision. P.W. 1 states in her evidence that the duty doctors were homoeopathy doctors and the post operative treatment was not done by qualified allopathy doctors, that she developed fecal fistula and bedsore because of infection and deficiency in post operative care in the opposite party Nursing Home. P.W. 2 also supports the said version. He stated that after the operation other doctors who were homoeopathy trained doctors used to attend on her (patient). R.W. 1 Dr. Bhoom Reddy himself admits in the counter affidavit that only routine functions like pulse reading, recording of blood pressure and recording of temperature were performed by other doctors under his personal supervision. He admits in his evidence as R.W. 1 that the homoeopathy doctors helped him in the opposite party Nursing Home and they also checked the general condition of the patients in the ward. As the presence of the homoeopathy doctors is admitted, the statement of P.W. 1 gets support from the evidence of R.W. 1 himself. Though R.W. 1 restricts his work to opposite party department and for checking general conditions of the patients in the ward, we are of the opinion that he has engaged them to look after the post operative care of P.W. 1 as complained by P.W. 1. This also in our view amounts to deficiency in service. As such we are constrained to hold that P.W. 1 developed fecal fistula and bedsore which were also not taken care of by qualified doctors of the Nursing Home and as such these defects amount to deficiency on the part of the opposite party. In view of the evidence of R.Ws. 2 to 4 we have to hold that there was necessity for an emergency operation for clearing of the paretorium and closing of the ruptured intestine. We cannot, therefore, hold any negligence in conducting the emergency operation or in having the second operation namely, resection of terminal ileum and caecum i.e. removal of damaged part of the small intestine and joining them together,.

THE next question is what are the damages to be awarded to the complainant ?

THE complainant has claimed a sum of Rs. 30,000/- towards expenses incurred in the opposite party Nursing Home, Rs. 39,566/- as expenses at Apollo Hospital, Hyderabad, Rs. 15,000/- as expenditure incurred by her family and Rs. 1,00,000/- by way of damages for the hardship caused to her. Though we do not find any exaggeration in any of the first three heads, as already seen we do not find that there is any negligence under these heads. As we held that there is negligence in providing post operative care, we feel that the complainant is entitled to a sum of Rs. 50,000/- towards hardship and suffering caused to her. Accordingly we allow the complaint in part and direct the opposite party to pay the sum of Rs. 50,000/- with interest @ 12% per annum from the date of filing of the complaint till the date of payment together with a further sum of Rs. 5,000/- towards costs. Time for payment six weeks. Complaint allowed.