BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION:HYDERABAD.



F.A.No.597/2006 against C.D.No.8 of 2004, District Forum, Guntur.



Between:



Dr.Narlasetty Ravindra babu, M.B.B.S.,

Sri Lakshmi Hospital,

Nagaram Palem, Guntur. ..Appellant/

Opp.party.

And



Kovuri Ramanujamma,

W/o.K.Jagannadham,

R/o.Swarna Bharathi Colony

Guntur. Respondent/

Complainant



Counsel for the Appellant : M/s.V.Gourisankara Rao.



Counsel for the Respondent: :Mr.S.Satyanarayana Moorthy.



QUORUM:SMT.M.SHREESHA, HON’BLE MEMBER

AND

SRI K.SATYANAND, HON’BLE MEMBER.



MONDAY, THE THIRTIETH DAY OF MARCH,

TWO THOUSAND NINE



ORAL ORDER: (Per Sri K.Satyanand, Hon’ble Member.)

***





This is an appeal preferred by opposite party No.1 challenging the order of the District Forum, Guntur in C.D.No.8/2004 wherein it passed an order directing him to pay Rs.1,50,000/- with interest and costs by way of compensation on the ground of medical negligence on the part of the appellant.

The facts that led to filing this appeal are briefly as follows:

The complainant developed high fever and so approached the appellant on 17-9-2002 for treatment. On his advise, she got herself admitted into his hospital for treatment and admittedly paid the treatment charges. It is the case of the complainant that in the course of the treatment that lasted for two days, the appellant administered I.V. fluids through her left hand by installing a I.V. canula apart from administering other drugs as E-mal, Lariago etc., The left hand soon developed inflammation associated with pain and skin blackening. The appellant appeared to have applied some ointments only upto 19-9-2002 and became adamant when questioned as to the cause of such worsening and ultimately the appellant took a hard stand and instructed his staff to send her out. Accordingly on 19-9-2002 opposite party insisted the complainant to bring more money leaving the needle in her left hand. She claimed to have reappeared before the doctor on 20-9-2002 bringing a further amount of Rs.110/- which she claimed to have paid to the appellant. Thereupon the appellant gave some injections. At that time, the complainant claimed to have requested the appellant to remove the needle from the left hand but the appellant advised her to come the next day. But on the next day, the complainant alleged, the appellant refused to examine the complainant, and the staff of the appellant removed the needle from the left hand of the complainant after 5 days only. Later, on the advice of the local elders, the complainant approached the Government General Hospital with the infection affecting her left hand. According to her the infection was a result of the negligent treatment by the appellant. The condition of the complainant further worsened and ultimately it led to amputation of her left hand at the Government General Hospital, Guntur which was conducted by a doctor, by name, Dr.Chari. Some time later the complainant raised a dispute and approached the District Legal Services Authority for amicable settlement. The said authority issued notice to the appellant and also summoned the Government Medical Officer, Dr.K.S.N.Chari. As no settlement could be brought about, the Legal Services Authority reportedly advised the complainant to file a Consumer Dispute.

Opposite party resisted the claim, even while the factum of the complainant approaching him for treatment on 17-9-2002, claiming to have diagnosed the disease as fever, body pains, generalized weakness, vomitings and also vigorous chills etc. He also have found fault with the complainant for having taken treatment from a quack doctor etc., He submitted that he examined the complainant and observed that she was too weak and was suffering from vomitings, chills etc. and advised her to remain as inpatient in his hospital for 2 or 3 days. He admitted that the complainant represented to him that she was a servant maid and not in a position to bear the inpatient charges. Even then the appellant claimed to have allowed her to remain in the hospital on a nominal fee of Rs.150/-on sheer humanitarian grounds. He, however, insisted that she should purchase all the medicines prescribed by him. The complainant and her attendants agreed for the same. In the course of the treatment, the appellant claimed to have administered ‘saline’ by arranging intravenous canula and administered 6 bottles of saline but the temperature remained uncontrolled, though due to administration of saline, she gained some relief. The complainant asked the appellant to discharge her on 19th itself. He asserted that the intravenous canula was removed on 18-9-2002 itself while discharging. The appellant claimed to have insisted that the complainant should return to the hospital on 20-9-2002 to take Malaria injections etc. Accordingly he claimed to have given Malaria injections on 20-9-2002. Thereafter, the appellant alleged, he lost track of her till he received notices from the District Legal Services Authority.

On the basis of these pleadings, the District Forum framed two points for consideration:

i) Whether there was any deficiency in service on the part of the appellant?

ii) If so, to what relief?

In support of her case, the complainant filed the affidavit of as many

as four persons including herself. She relied upon the documents marked as Exs.A1 to A11.

The appellant on the other hand filed his own affidavit and got marked Ex.B1.

The affidavit of Sri K.S.N.Chari, Government General Hospital, Guntur is also found in record and it is not clear from the record as to which party filed the said affidavit.

On a consideration of the evidence adduced on either side, the District Forum passed an order allowing the complaint and thereby awarding compensation to the complainant to be recovered from the appellant.

Aggrieved by the said order, the present appeal is filed contending inter alia to the effect that the complainant failed to discharge the burden of proving negligence on the part of the appellant and that the Forum erred in appreciating the evidence and that the subsequent developments leading to the amputation were on the account of dry gangrene and the so called negligence cannot be attributed to the appellant. The District Forum wrongly persuaded itself that the administration of E-mal and Lariago injections led to the development of gangrene.

Heard both sides.

The point that arises for consideration is whether there are any good grounds to interfere with the order of the District Forum?

The most important aspect in this case is whether there is negligence on the part of the appellant and whether the said negligence has nexus to the further developments that led to amputating the left hand of the complainant making her physically challenged. Apart from the circumstantial evidence, the District Forum heavily relied upon to identify the negligence, the negligence being the proximate cause for the subsequent dangerous effects that led to the amputation, we find a very glaring infirmity in the treatment given by the appellant to the complainant. This is discernable from the fact that even according to his own Ex.B1, the administration of E-mal and Lariago should have been only intramuscularly. Likewise even the literature pertaining to E-mal injection clearly gives an instruction that E-mal should be administered intramuscularly. It also exerted that no other medicine should be mixed in the same syringe but as could be seen from the grounds of appeal, particularly, ground No.’O’ and ‘Q’, the appellant has taken strange defence that even if E-mal was presumed to have been given intravenously, the wet or dry gangrene would nevertheless develop. It is therefore necessary to extract ground ‘O’ and ‘Q’ in order to have a glimpse of the mind set of the appellant which is indicative of the casual nature of viewing the serious issues.

O. The Dist.Forum failed to see that even if it is presumed though not

admitted that the Opp.Party administered Inj.E-Mal intravenously

through I.V.Canula, apart from threat of death of the patient, there may

also be chances for the development of localized infection of wet

Gangrene.

Q. The Dist.Forum failed to see that even Dr.K.S.N.Chary, Retired Professor

of the surgery, Govt. General Hospital, Guntur in his affidavit never

stated that because of the administration of the Inj.E-Mal through I.V.

canula by the Opp.Party, the complainant developed blackish discoloration

of her left hand fore-arm.

It is evident from the record that all other facts including the rapid downturn of the disease from the stage of initial treatment by the appellant commenced on 17-9-2002 and culoninated in the amputation of the left hand of the complainant are not in dispute. The evidence of the expert doctor, Dr.K.S.N.Chari, clearly brought to light how complicated and complex the condition of the patient had become in quick succession ultimately leaving no option except amputation casting permanent disability on her. The evidence of the complainant and her attendants as to the attitude of the appellant cannot also be ignored as such attitude is manifest in his blurting out the alternative possibility of having administered E-mal by intravenous injection which is against the mandate in the corresponding medical literature requiring it to be administered only intramuscularly. It is pertinent to point out at this juncture that the strict principles of Law of Pleadings and also the Law of Evidence are not applicable here and the preponderance of evidence culled out from the record as well as the circumstances that are spoken to are the basic inputs in decision making in proceedings like this. The District Forum had occasion to deal with the issue in depth and highlighted all the circumstances suggestive of the negligence of the appellant. The evidence of the expert, Dr.Chari, who had conducted the operation of amputation is capable of being construed as to derive a backward presumption of negligence furnishing basis for a finding of negligence. Thus, we are of the opinion that there are no weighty grounds to interfere with the order of the District Forum.

Accordingly the appeal is dismissed with costs in a sum of Rs.2,000/-. Time for compliance of the order of the District Forum is four weeks.













LADY MEMBER. MEMBER.

(MS) (KS)

Dated 30-3-2009.