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Judgment
Dr. S.M.Kantikar, Member
This Revision Petition has been filed against the Order dated 12.11.2012 passed by the State Consumer Disputes Redressal Commission, Haryana (hereinafter referred to as the State Commission) in First Appeal No. 1803/2008, against the Order of the District Consumer Disputes Redressal Forum, Fatehabad (hereinafter referred to as the District Forum) dated 07.08.2008 in Consumer Complaint No. 44 of 2006, whereby the Complaint was dismissed.
The brief facts of the case are that on 09.03.2006 Smt. Laxmi, (hereinafter referred to as the patient) suffered fracture to her left leg and got admitted in Rajasthan Medical Centre, whereby Dr. Parveen Kumar Arora (hereinafter referred to as the Opposite Party No. 1), the Orthopedic Surgeon examined the patient. The patient told the Opposite Party No. 1 that she is a diabetic and on injection Insulin for a long period. The Opposite Party No. 1 advised operation and insertion of rod in the left leg of patient and assured that no need to worry as he had conducted many operations for diabetic patients. It was alleged that the Opposite Party No. 1 performed operation without consent. The patient was discharged on 22.03.2006, though the operative wound did not heal completely and the patient was referred to CMC Ludhiana. The patient remained admitted in CMC, Ludhiana from 22.03.2006 to 11.04.2006. On 31.03.2006 removal of nail and exfix was done, but the patient did not get relief. The wound infection was 73%. The patient took further treatment from 12.06.2006 to 08.07.2006 and 24.07.2006 to 30.07.2006 in CMC at Maharaja Agrasen Medical College, Hisar and finally her leg was amputated. Being aggrieved by the alleged deficiency in service and medical negligence on the part of the Opposite Parties, the Complainant filed the Consumer Complaint before the District Forum, Fatehabad.
The Opposite Parties filed their written versions and denied the allegations. They submitted that at the time of admission, the patient's attendants were explained about the injury and the treatment. The treating doctors were aware that the patient was diabetic. The Physician, Dr. Sunita Gupta examined the patient and put her on Insulin to control the blood sugar level. After pre-operative investigations and taking due written informed consent the Opposite Party No. 1 performed the surgery. On 13.03.2006, the drain was removed and check X-ray was done. The Knee Mobilization was advised. The Physician, Dr. Sunita Gupta reviewed the case again and continued insulin injection. The patient was kept under cover of higher antibiotics and regular wound dressing was done. On 17.03.2006 it was noted that the infection was increasing and on 18.03.2006, it was cleaned under anesthesia, the necrotic material was removed. The prognosis was explained to the attendants. On 21.03.2006 at the time of dressing, the wound was clean but the bone was visible. On 22.03.2006, the patient was referred to Medical College for plastic surgery and further management. The Opposite Party No. 1 treated the patient as per standards and any negligence could be attributed to the treating doctors.
On the basis of the averments made by the Parties and the evidence on record, the District Forum dismissed the Complaint. Being aggrieved, the Complainants preferred the First Appeal before the State Commission, it was dismissed. Hence, the Complainants filed the instant Revision Petition.
We have heard the learned Counsel for the Parties. The learned Counsel for the Petitioners / Complainants vehemently argued that knowingly the patient was highly diabetic, the Opposite Party No. 1 operated the fracture and inserted the rod which caused more infection and complications which finally led to amputation of leg. The learned Counsel for the Opposite Parties submitted that the operation was performed by an expert Orthopedic Surgeon and it was done with control of the blood sugar by injecting insulin as advised by the Physician. Moreover, the doctors, who treated the patient at CMC, Ludhiana, never stated any negligence caused during operation performed by the Opposite Parties.
We gave our thoughtful consideration to the arguments of the learned Counsel for both the sides and perused the material on record. We note that it was a compound fracture of left tibia and the Opposite Party No. 1 operated the patient after taking the informed Consent. It was a valid Consent consists of all the ingredients of informed Consent. The patient was operated under the cover of Insulin and given higher antibiotics after the operation.As per the Medical Record of CMC, Ludhiana, on 23.03.2006, it was diagnosed as an infected fracture with IMII nail''. On 31.03.2006 the doctors at CMC removed the infected nail and performed with exfix left tibia and the patient was discharged on 11.04.2006. The condition of patient further deteriorated on 09.05.2006 and she was taken to CMC, Hisar. There it was diagnosed as 'nonunion left tibia (leg)with left Peronial Nerve (LPN) Palsy'. She remained there till 27.05.2006. Again she was treated at CMC, Hisar from 12.06.2006 to 08.07.2006 for Chronic Osteomyelitis from a Plastic Surgeon Dr. Sunil Soni. Thereafter, on 12.11.2006, the patient consulted Dr. Parveen Chawla, an Orthopaedic Surgeon at Chawla Nursing Home, Hisar, who advised to control diabetes and continued again debridement and later on Orthofix. Thereafter, the patient was treated at Civil Hospital, Tohana from 19.06.2007 to 29.06.2007 and her left leg below knee was amputated.
The main question in the instant case is whether the highly diabeticpatient having fracture was to be treated or not? On careful perusal of the Medical Record, it is apparent that the Opposite Party No. 1 was a qualified Orthopedician and treated the compound fracture of tibia as per the standard procedure. Regarding diabetic status of the patient, Physician's advice was taken to control the diabetes with Insulin therapy. After the surgery higher antibiotics were administered, but the operative wound infection was uncontrolled; therefore the patient was referred to CMC Hospital, Ludhiana for institutional management. The Opposite party No.1 referred the patient at the proper time and in our view, it was not a deviation from any standard of practice. The Opposite Party No. 1 performed surgery with the skill and expertise.
We have perused the medical text from the Campbell's Operative Orthopaedics, the known complications of surgical fractures. Diabetes mellitus places patients at an increased risk of complications following tibial fractures whether treated conservatively or surgically. Much of the literature has highlighted the extremes of potentially poor outcomes, this risk is specific to patients with comorbidities of diabetes.
In the instant case, it was compound fracture of Tibia and immediate operation was necessary to avoid unforeseen complications because of uncontrolled diabetes.The operation was performed under cover of Insulin with control and monitoring the blood sugar level.After discharge from OP hospital, the patient was treated at CMC, Ludhiana and thereafter at CMC, Hisar and also at Medical College, Agroha, but her infection could not be controlled and ultimately her left leg was amputated at Civil Hospital, Tohana, where she remained admitted from 19.06.2007 to 29.06.2007. In our considered view it was due to uncontrolled infection and not due to any negligence during operation or further treatment.
The Hon'ble Supreme Court, in catena of judgments, laid down the legal principles which would apply in cases of medical negligence. In the recent judgment in the case Vinod Jain V Santokba Durlabhji Memorial Hospital & Anr, Civil Appeal No. 2024 of 2019, decided on 25.02.2019, it was observed in paragraph 10 as below:
This Court in another judgment in Jacob Mathew v. State of 2 (1957) 1 WLR 582 :: (1957) 2 All ER 118 6 Punjab3 dealt with the law of negligence in respect of professionals professing some special skills. Thus, any individual approaching such a skilled person would have a reasonable expectation of a degree of care and caution, but there could be no assurance of the result. A physician, thus, would not assure a full recovery in every case, and the only assurance given, by implication, is that he possesses the requisite skills in the branch of the profession, and while undertaking the performance of his task, he would exercise his skills with reasonable competence. Thus, a liability would only come, if (a) either the person (doctor) did not possess the requisite skills, which he professed to have possessed; or (b) he did not exercise, with reasonable competence in a given case, the skill which he did possess. It was held not to be necessary for every professional to possess the highest level of expertise in that branch in which he practices.
In the said opinion, a reference was, once again, made to the Halsbury's Laws of England as under: "To establish liability on that basis it must be shown (1) that there is a usual and normal practice; (2) that the defendant has not adopted it; and (3) that the course in fact adopted is one no professional man of ordinary skill would have taken had he been acting with ordinary care."
On the basis of the discussion above, we find the Orders of the District Forum and the State Commission to be well-appraised and well-reasoned. The State Commission concurred with the findings of the District Forum. Within the meaning and scope of section 21(b), we find no grave error in appreciating the evidence by the two fora below. We find no jurisdictional error, or a legal principle ignored, or miscarriage of justice, as may necessitate interference in the exercise of the revisional jurisdiction of this Commission.
The Revision Petition, being misconceived and devoid of merit, is dismissed.