Tamil Nadu
South Chennai
374/2007
Arun Kumar - Complainant(s)
Versus
M/s.Apollo Speciality Hospital - Opp.Party(s)
B.Rajendran
12 Dec 2022
ORDER
Date of Complaint Filed : 21.08.2007
Date of Reservation : 16.11.2022
Date of Order : 12.12.2022
DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,
CHENNAI (SOUTH), CHENNAI-3.
PRESENT: TMT. B. JIJAA, M.L., : PRESIDENT
THIRU. T.R. SIVAKUMHAR, B.A., B.L., : MEMBER I
THIRU. S. NANDAGOPALAN., B.Sc., MBA., : MEMBER II
CONSUMER COMPLAINT No.374 /2007
MONDAY, THE 12th DAY OF DECEMBER 2022
Mr. Arun Kumar,
S/o. Mr. K. Jeganatha Raja,
Flat No.19, 3rd Floor,
Baba Foundation door Nos.27 & 29,
Akbarabad 1st Street,
Kodambakkam,
Chennai – 600 024. ... Complainant
..Vs..
1.M/s. Apollo Speciality Hospital,
Rep. by the Director,
No.320, Anna Salai,
Chennai – 600 035.
2.Dr.P. Natarajan,
Consultant Neuro Surgeon,
M/s. Apollo Speciality Hospital,
No.320, Anna Salai,
Chennai – 600 035. ... Opposite Parties
******
Counsel for the Complainant : M/s B. Rajendran
Counsel for the 1st Opposite Party : M/s. N. kiruphakaran
Counsel for the 2nd Opposite Party : M/s. T.M. Pappiah
On perusal of records and after having heard the oral arguments Counsel for the Opposite Parties, we delivered the following:
ORDER
Pronounced by the President Tmt. B. Jijaa, M.L.,
1. The Complainant has filed this complaint as against the Opposite Parties under section 12 of the Consumer Protection Act, 1986 and prays to direct the Opposite Parties to pay a sum of Rs.15 lakhs towards compensation for the mental agony, wrong diagnosis, pecuniary loss, medical expenses, unnecessary sufferings due to gross negligence committed by the Opposite Parties and for the deficiency in service by the Opposite Parties with interest at the rate of 24% per annum from the date of filing till the date of realization along with cost of Rs.10,000/-.
2. The averments of Complaint in brief are as follows:-
The Complainant met with an accident in his motor cycle on 06.12.2006 at about 9.30 pm near Stella Marrys College while returning from his Gym centre. At the time of accident Dr.B.Shivram Bharatraj attached to the Apollo Hospital helped the Complainant and took him in his car, admitted him in the Emergency ward of the 1st Opposite Party. Though the Complainant was admitted in the hospital immediately the wound just below the lower haw was sutured and the blood oozing from the wound was stopped, the Complainant was not put on any immediate immobilization of the neck for more thatn 13 hours even after admission in the hospital. At the time of admission the Complainant had some movements but after that he developed paralysis of all four extremities during the initial period 13 hours following admission. The Complainant was also not given the standard intravenous cortisone during the initial time which is the most critical period in the case of spinal cord injury. After 13 hours of his admission in the hospital, the hospital authorities required the service of Dr.P.Natarajan, Neuro Surgeon, the 2nd Opposite Party who clinically diagnosed the spinal cord injury on the Complainant’s neck, but he too did not provide immediate intravenous cortisone. The 2nd Opposite Party sent the Complainant for MRI study with the main Apollo Hosipitals at Greams Road, without administering intravenous cortisone. After studying MRI and Radiologists report the 2nd Opposite Party started administering intravenous cortisone only after 20 hours of his admission. The Complainants’ uncle Dr.Desinga S.Raja, Orthopaedic Surgeon working in U.S.A was informed about his condition, and his uncle directly contacted the 2nd Opposite Party. The 2nd Opposite Party informed the Complainant’s uncle that the Complainant had central spinal cord injury and that no surgery was needed for the spinal cord injury. The Complainant and his relatives were not given MRI scan and the report of the Radiologists inspite of repeated requests. At the time of preferring an insurance claim on 12.12.2006 the reports were given which was sent to the Complainant’s uncle Dr.Desinga S.Raja, who opined of immediate and imperative need for surgery for the removal of protrucding disc. But the 2nd Opposite Party failed to do the mandatory cervical surgery to the Complainant and had subjected the Complainant to a life of permanent paralysis of all four extremities. Hence the Complainant was discharged on 14.12.2006 with an endorsement against medical advice. The Complainant then got admitted in the Malar Hospital where surgery was performed. After surgery the Complainant regained partial movement of his limbs and his condition started improving. The Complainant was employed in Satyam computes on an annual salary of Rs.6,75,000/- and due to the negligent acts by the Opposite Parties the Complainant would never be able to resume his regular work at full capacity. The Complainant had sent notice to the Opposite Parties on 28.01.2007 claiming compensation from them. Even after receipt of the notice no proper reply was given by the Opposite Parties. Hence the Complaint.
3. Written Version filed by the 1st Opposite Party in brief is as follows:-
The 2nd Opposite Party is only a consultant in the 1st Opposite Party. He is neither in the employment of the 1st Opposite Party nor in the pay roll of the 1st Opposite Party. The 2nd Opposite Party has filed a detailed Version and the 1st Opposite party adopts the version of the 2nd Opposite Party. Without prejudice the 1st Opposite Party is covered by insurance policy called ‘Professional Indemnity’ bearing Policy No,501902/46/04/8700294 with National Insurance Co. Ltd. Hence the said insurance company is a necessary party to the complaint. Hence prayed to dismiss the complaint.
4. Written Version filed by the 2nd Opposite Party in brief is as follows:-
The Opposite Party submitted that the patient was admitted on 06.12.2006 at 10.10 pm following RTA. As soon as the patient was admitted, necessary investigations for head injury including CT scan was done. As the CT scan and X rays of the skull and cervical spine were normal, the patient was ordered to be shifted to the ward. There was no external injury over the spine. Subsequently the patient developed weakness of the lower limbs followed by weakeness of the upper limbs. Hence spinal cord injury was suspected and to confirm the diagnosis and to know the nature and extent of injury, a MRI of the cervical spine was ordered. The patient was put on Philadelphia collar and the MRI was done, which revealed the spinal cord contusion with surrounding oedema at C4/C5 level with posterior end plate osteophytes with disc prolapse. There was no evidence of any bone injury to the spine or any spinal instability. It was explained to the patient and his relatives that there was no need for any emergency surgical intervention as there was neither bony spinal injury nor spinal instability. The patient was also started on cortisone infusion subsequently as at the time of admission there was no external injury over the spine to suspect spinal injury. On 08.12.2006 and 09.12.2006 there was significant improvement in the movement in the upper and lower limbs. On 11.12.2006 further motor improvement was noted along with sensory improvement. The patient was continued on conservative management with physiotherapy and other supportive measure, At this stage the patient wanted to get discharged. Hence there is no negligence and deficiency in service on the part of the Opposite Parties and the complaint is liable to be dismissed.
5. In order to prove the averments of the complaint, the Complainant has filed Proof Affidavit as his evidence and documents were marked Ex.A-1 to Ex.A-15 marked. Proof affidavit of the Opposite Parties filed and Ex.B-1 to Ex.B-16 document were marked on the side of the Opposite Parties. Both the Complainant and Opposite Parties had filed their Written Arguments.
Points for Consideration:-
1. Whether there is Medical Negligence on the part of Opposite Parties?
2. Whether there is deficiency in service on the part of the Opposite Parties?
3. Whether the Complainant is entitled for reliefs claimed?
4. To what other reliefs the Complainant is entitled to?
Point Nos.1 and 2:
The Complainant had met with an accident on 06.12.2006 at about 9.30 pm. Dr.B.Shivram Bharatraj attached to the Apollo Hospital had admitted the Complainant in the Emergency ward of the 1st Opposite Party. The contention of the Complainant was that though he was admitted in the hospital immediately and the wound just below the lower jaw was sutured and the blood oozing from the wound was stopped, the Complainant was not put on any immediate immobilization of the neck for more than 13 hours even after admission in the hospital and that he developed paralysis of all four extremities following admission. The Opposite Party contended that even though the X-ray of the cervical spine was normal by abundant precaution, the Complainant was put on Philadelphia collar while being shifted. As per Ex.A-2, the bill dated 07.12.2006 issued by the Apollo Hospitals at Greames Road for purchase of Philadelphia Collar makes it clear that it was purchased after 13 hours of admission. Even at the time of admission laceration and spinal cord involvement was diagnosed and numbness of leg and inability to move was recorded in the Nurses Chart. As per Ex.B-8, the Nurses Chart, X-Ray, CT Scan of Brain, ECG were taken on 06.12.2006. However, the Philadelphia Collar was purchased the next day on 07.12.2006 at the time of taking MRI Scan at Apollo Hospital, Greames Road. The contention that even though X-ray of cervical spine was normal by abundant caution Philadelphia Collar was put on the Complainant cannot be accepted as there is nothing on record to show that the X-Ray of cervical spine of the Complainant was normal, but the Nurses Chart, Ex.B-8 at Pg.48 would show that doctor had suggested for Philadelphia Collar and MRI Cervical Spine to be done on urgent basis at 8.00 am on 07.12.2006. Thereafter on 07.12.2006 at 11.19 am the Philadelphia Collar was purchased as per Ex.A-2 and applied to the Complainant before taking MRI Cervical scan.
As regards the contention of the Complainant that he was not given the standard intravenous cortisone during the initial time which is the most critical period in the case of spinal cord injury and after 13 hours of his admission in the hospital, the hospital authorities got the service of Dr.P.Natarajan, Neuro Surgeon, the 2nd Opposite Party who clinically diagnosed the spinal cord injury on the Complainant’s neck, but he too did not provide immediate intravenous cortisone and the 2nd Opposite Party sent the Complainant for MRI study to the main Apollo Hosipitals at Greams Road, without administering intravenous cortisone and only after studying MRI and Radiologists report the 2nd Opposite Party started administering intravenous cortisone only after 20 hours of his admission, the Opposite Party contended that the cortisone infusion was not started empirically, immediately on admission because at the time of admission there was no evidence of any external injury over the spine to suspect spinal injury and as it was felt that it was better to establish the diagnosis before starting IV cortisone as the rapid infusion of cortisone has its own serious implications. During cross examination by way of answer for the questionnaire the Opposite Parties had raised the beneficial effect of cortisone in the management of spinal cord injury D.Desingu S.Raja had produced literature to show that study by NASCIS III,(National Acute Spinal Cord Injury Studies, USA) “In a posthoc analysis, the Patients who received the steroid bolus 3 to 8 after injury demonstrated improved neurological function 6 weeks and 6 months after injury when treated with MPSS (methyl Prednisolone) and continued for 48 hours. The NASCI II and NASCI III have made use of the methylprednisolone the standard treatment in clinical practice for patients with acute Spinal Cord Injury. In contrast the American Association of Neurological Surgeons / Congress of Neurological Surgeons concluded following a systematic review that “Treatment with cortisone, methylprednisolone for 24 hours or 48 hours duration is recommended as an option in the treatment of patients with acute spinal cord injuries should be undertaken only with the knowledge that the evidence suggesting harmful effects is more consistent than suggestion of clinical benefit”. The Opposite Parties contended that administration of cortisone is only a option of treatment and not a standard of care. In this case the 2nd Opposite Party had evaluated the Complainant after 13 hours of admission and started IV cortisone after MRI report. Failure to administer cortisone within 8 hours of injury is due to the delay in evaluation by the 2nd Opposite Party which fact is admitted that without radiological examination cortisone treatment could not be provided and admittedly the MRI scan was taken after 13 hours. It is not the case of the Opposite Parties they had adopted different line of treatment than administration of cortisone but the delay caused in administering cortisone was due to the delayed evaluation by the 2nd Opposite Party, and after the delayed MRI report and its study, cortisone was infused to the Complainant.
In so far as the need for surgery when the Complainants’s uncle Dr.Desingu S.Raja, Orthopaedic Surgeon working in U.S.A was informed about his condition, who after going through the scan reports directly contacted the 2nd Opposite Party and opined for immediate and imperative need for surgery for the removal of protruding disc for which the 2nd Opposite Party informed the Complainant’s uncle that no surgery was needed for the spinal cord injury. According to the Complainant the 2nd Opposite Party failed to do the mandatory cervical surgery to the Complainant and had subjected the Complainant to a life of permanent paralysis of all four extremities. The contention of the Opposite Party was that in the absence of bony injury and/or instability surgical intervention was not advisable in the acute phase of spine cord injury, as any required or inadvertent manipulation of the spine could worsen the condition. Moreover the patient was showing good clinical improvement. The PW2 had produced to sources of literature
1. Operative Orthopedics Volume 4- Michael Chapman on “Unstable spine” and “the absolute indication for urgent surginal decompression of the compressed spinal cord by the injured cervical disc elements.
2. Americn Academy of Orthopedic surgeons sponsored Continuing Medical Edcuation on Spinal Cord Injury, Pathophysiology, Classification, Treatment and complications.
The above literature says “ The Spine Trauma Study Group define early surgical intervention in patients with SCI (Spinal Cord Injury) to be within 24 hours of injury. According to preliminary results from a large multicenter, prospective cohart trial, (Surgical Treatment for Acute Spinal Cord Injury Study – STASCIS), decompression of the spinal cord within 24 hours of injury leads to more favorable neurological recover in patients with isolated cervical SCIs (Spinal Cord Injuries).
It is pertinent to note that the discharge Summary, Ex.A-6 issued by the Malar Hospitals it is clear that there was decompression of the spinal cord of the Complainant.
The findings of Ex.A-1, the MRI Scan Cervical Spine dated 08.12.2006 is “disc prolapse at C4-C5 level indenting on the cord with edema and contusion at that level”. According to the Opposite Parties bony injury of the spine with or without dislocation and/or instability requires urgent surgical intervention.However the Complainant had spinal cord injury with paralysis of all extremities needs surgical intervention within 48 hours as per the literature. The subsequent clinical status of showing signs of improvement and the Complainant was continued on conservative management of physiotheroapy is unacceptable as the Complainant had injured prolapsed disc without movement on four limbs even at the time of subsequent admission in the Malar Hospitals
The Complainant was discharged on 14.12.2006 with an endorsement against medical advice from the 1st Opposite Party Hospital and then got admitted in the Malar Hospital where surgery was performed. In the discharge summary, Ex.A-6, it was mentioned as “There was evidence of disc injury and movement. The posterior osteophytes were very large and causing pressure. They were broken and cord decompressed”. After surgery the Complainant regained partial movement of his limbs and his condition started improving.
In this case there is gross negligence and wilful breach of duty by the Opposite Parties in their diagnosis of acute spinal cord injury on time and obtain informed consent from the Complainant after explaining the benefits and risks and treat with early surgical decompression and failure on the part of the Opposite Parties to treat with the injured prolapsed disc thereby aggravating damage to spinal cord of the Complainant would amount medical negligence by improper clinical diagnosis and wrong treatment.
Considering the facts and circumstances of the case and discussions made above this Commission is of the considered view that there is medical negligence and deficiency of service on the part of Opposite Parties 1 and 2. Accordingly Point No.1 is answered in favour of the Complainant.
Point Nos.3 and 4:
As aforesaid in Point No.1, the facts and circumstances lead to the conclusion that Opposite Parties 1 and 2 had committed medical negligence and deficiency in service this Commission is of the considered view that the Opposite Parties 1 and 2 are jointly and severally liable to pay a sum of Rs.5,00,000/- as compensation for the medical negligence and deficiency in service with interest @9% from the date of filing of the complaint till the date of realization and also for mental agony caused to the Complainant and shall pay compensation of Rs.10,000/- to the Complainant.
In the result the complaint is allowed in part. The Opposite Parties 1 and 2 are jointly and severally directed to pay a sum of Rs.5,00,000/- (Rupees Five Lakhs only) towards compensation for the medical negligence and deficiency in service on the part of the Opposite Parties 1 and 2 with interest at the rate of 9% from the date of filing of the complaint till the date of realization and to pay a sum of Rs.10,000/- (Rupees Ten Thousand Only) towards cost of the litigation to the Complainant within 8 weeks from the date of receipt of this order.
Dictated to Steno-Typist, transcribed and typed by her, corrected and pronounced by us in the Open Commission, on 12th of December 2022.
S. NANDAGOPALAN T.R. SIVAKUMHAR B.JIJAA
MEMBER II MEMBER I PRESIDENT
List of documents filed on the side of the Complainant:-
Ex.A1 | - | Medical Report given by the 1st Opposite Party |
Ex.A2 | - | Bills given by the 1st Opposite Party |
Ex.A3 | 14.12.2006 | Discharge summary given by the 1st Opposite Party |
Ex.A4 | - | Medical Reports given by the Malar Hospitals |
Ex.A5 | - | Bills given by the Malar Hospitals |
Ex.A6 | 29.12.2006 | Discharge summary given by the Malar Hospital |
Ex.A7 | - | Physiotheraphy bill given by the Malar Hospital |
Ex.A8 | - | Medical Reports given by the Malar Hospitals |
Ex.A9 | - | Bill given by the Malar Hospitals |
Ex.A10 | - | Pharmacy bills |
Ex.A11 | 28.01.2007 | Legal Notice sent to the 1st & 2nd Opposite Parties |
Ex.A12 | 29.01.2007 | Postal receipts |
Ex.A13 | 31.01.2007 | Acknowledgement card by the 1st Opposite Party |
Ex.A14 | - | Acknowledgement card by the 2nd Opposite Party |
Ex.A15 | 5.02.2007 | Reply sent by the 1st Opposite Party |
List of documents filed on the side of the Opposite Parties:-
Ex.B1 | - | Patient Registration Form |
Ex.B2 | - | Patient Registration Details |
Ex.B3 | - | Admission Slip |
Ex.B4 | - | Admission Form |
Ex.B5 | - | Head injury case sheet |
Ex.B6 | - | History and finding on admission |
Ex.B7 | - | Progress sheet and doctors Order |
Ex.B8 | - | Nurses Chart |
Ex.B9 | - | Intake/output chart |
Ex.B10 | - | Clinical Chart |
Ex.B11 | - | Neuro Observatin Chart |
Ex.B12 | - | Investigation Report |
Ex.B13 | - | Treatment Chart |
Ex.B14 | - | Discharge Against Medical Advice |
Ex.B15 | - | Discharge summary |
Ex.B16 | - | acknowledgement |
S. NANDAGOPALAN T.R. SIVAKUMHAR B.JIJAA
MEMBER II MEMBER I PRESIDENT
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