PRITHVI RAJ NAYYAR vs CHRISTIAN MEDICAL COLLEGE AND BROWN MEMORIAL HOSPITAL

IT is the say of the complainant Prithvi Raj Nayyar that he was admitted at the Christian Medical College and Memorial Hospital, Ludhiana on 27. 1. 1992. After several tests and investigations it was found that he was suffering from Double Vessel Disease Normal LV Function and advised to undergo Coronary Artery Bye Pass Graft Operation (CABG ). A team of doctors headed by Dr. M. Verghese performed surgery on 10. 2. 1992 and was discharged from the hospital on 24. 2. 1992. Complainant complained of pain and hence he was checked up in the hospital from 3rd to 27th March,1992 and from 13th April to 15th April, 1992. Puss was formed in one of the lower stitches for which another minor surgery was performed during which a steel wire and nylon suture negligently left behind at the time of first surgery were removed and wound was curetted and complainant was discharged on 10th June. As the puss formation continued and rib was affected complainant was again admitted in the hospital on 31st August and another surgery was performed on 17th September and piece of bone was taken out. Further surgery was performed in 1992 and his right side lower rib which was severed and was taken out as it was damaged due to puss infection. Alleging negligence on the part of opposite parties he filed a complaint claiming Rs. 5 lacs.

THE State Commission after hearing the parties held that complainant has failed to establish negligent act on the part of the opposite parties and hence dismissed the same with cost of Rs. 5,000. Aggrieved and dissatisfied by the order of State Commission complainant has filed this appeal.

Learned Counsel for the appellant submitted that complainant has filed his own affidavit and affidavit of expert doctor. On behalf of the opposite parties the treating doctor has filed an affidavit. He submitted that he had made an application before the State Commission for constitution of an independent Medical Board with direction to examine the complainant and the relevant record pertaining to his operation and treatment and to report as to negligence, deficiency and omission in the said operation-cum-treatment. However, no order was passed on this. Learned Counsel further submitted that steel wire and nylon suture which were left behind in the body while performing first surgery were removed during subsequent surgery. Further, the very fact that patient had to go to hospital again and again for treatment and ultimately was got fed up shows that there was medical negligence on the part of the hospital of the treating doctors.

LEARNED Counsel for the respondent submitted that complainant was a heavy smoker and alcoholic and the very fact that he is still alive and performs his normal duties which shows success of the operation. Steel wire and nylon suture are required for stitching the wound after the surgery which is a normal approved practice. Treatment record shows that he was given proper treatment at the hospital. After the cross-examination of the respondent was completed, at the stage of final arguments the complainant has applied for constitution of Medical Board which was rightly not agreed to by the State Commission. Findings: This is a case of patient aged 57 years who is known to be a heavy smoker and alcoholic and who suffered from Double Vessel Disease Normal LV Function was advised to undergo Coronary Artery Bye Pass Graft Operation (CABG ). A team of doctors led by Dr. M. Verghese performed surgery on 10th February and after two weeks he was discharged. From time-to-time he had to visit the hospital for removal of stitches and for dressing the wound. These are all borne by the hospital records. In this connection it is useful to go through the affidavit of specialized doctor Dr. James who is not connected with the respondents. Relevant extracts of his affidavit are given below: "the patient''s history also revealed the past history of hypertension and that he was a chronic heavy smoker and an alcoholic for several years. He also suffered from chronic bleeding piles. He had also given a history since 1985 of similar episodes of anginal pain in the past which was characterised by severe pain in the middle of the chest in front (deep retrosternal pain), with radiation of pain to both arms and severe sweating. For these complaints in the past, he has been treated irregularly with sorbitrate and niffidipin, by his local doctors. A Coronary Angiogram revealed blockage of two vital coronary arteries supplying the heart while the third artery was very small and inadequate in size. I have noticed that by-pass surgery was performed successfully on 10. 2. 1992 and at the end of the operation the patient''s condition was recorded to be stable and satisfactory. He progressed satisfactorily on ventilatory support and he was weaned off the ventilator on the second post operative day and extubated. The sternal wound after the operation was closed using medical grade steel wire sutures, as is the practice the world over. The wire sutures afford the greatest amount of strength and are least reactive to the tissues. Muscle tissue was approximated with medical grade nylon sutures which again is universally practised. I would verify that a little wound infection can occur after by-pass surgery despite the best of care and correct operative techniques (Ref. J Thorac Cardiovasc Surg 1990:99256-63 P259 ). The causes are multi-factoral including factors related to patient''s own resistance against infections. Infection of the rib cartilage is a well known complication which again is not always preventable (Lee, Schimert, Shattin : Surgery, October 1976, P436 ). When it occurs, the treatment unfortunately is prolonged and might require repeated operative procedures as in this case. In my opinion the patient is prejudiced against CMC and the attending doctors. The fact that he is able to pursue his normal activities indicates the correctness of the diagnosis, treatment and post-operative care given to him in Christian Medical College, Ludhiana. "

DR. James was cross-examined in great detail but he stood his ground and his affidavit is a substantial piece of evidence to prove that hospital and the treating doctors have taken adequate care in treating the patient by performing surgery. The main plank of the complaint is that steel wire and nylon suture remained after first surgery and were removed in the second surgery has been repelled by the affidavit of Dr. James who stated that sternal wound after the operation was closed using medical grade steel wire sutures, as is the practice world over and the muscle tissue was approximated with medical grade nylon sutures which again is universally practised. It is not the case of the complainant that foreign body viz. mop, sponge, scissor were left inside the body after the surgery and had to be later on removed by further surgery. The Apex Court in Dr. Laxman Balkrishna Joshi v. Dr. Trimbak Bapu Godbole, AIR 1969 SC 128, laid down the following criteria for determination of the professional duty of a medical man in the following way: "a person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz. , a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give, or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. "

The ratio of the decision of Hon''ble Supreme Court in the above case is squarely applicable to the case on hand as the treating surgeon had performed his duties admirably well.

HENCE, we do not see any tangible reason to interfere with the well reasoned order of the State Commission. Appeal is, therefore, dismissed. Appellant shall pay Rs. 10,000 as cost to the respondents. Appeal dismised.