Presented by: -
Shri Debasish Bandyopadhyay, President.
Complaint Case No. 525/2014
This case has been filed by the complainants against the OPs for getting compensation to the tune of Rs. 17,00,000/- against the OPs for loss of life of Nanda Dulal Chattoraj (predecessor of the complainants) and for causing mental pain and agony suffering etc. and also for reimbursement of cost of medical treatment to the tune of Rs. 2,60,000/- and also for any other relief / reliefs which are available according to the provisions of Consumer Protection Act, 1986.
Fact of this case
Case of the complainant
The case of the complainant which is deciphered from the petition of complaint in bird’s eye view is that the husband of the complainant No. 1 and the father of the complainant Nos. 2 & 3 i.e. Nanda Dulal Chattoraj was taken to OP No. 1 Hospital with a history of diabetes with complications of dyspepsia, anorexia, nausea, vomiting and jaundice for previous 15 days alongwith complications of generalized prurites and passage of clay coloured stool and progressive depending of urine colour and the OP No. 1 Hospital Authority admitted the said Nanda Dulal Chattoraj under the care of OP No. 2 and after various tests and Scan the OP No. 2 advised for immediate Triple Bypass Operation and as such the operation theatre as well as blood units were booked and being confused and disoriented and without getting any time to think twice about the proposed operation the patient party practically perplexed and on 18.06.2013 the OP No. 2 performed the said operation and after the said operation the complainants came to know that C.T. Scan Reports shows that there was a malignant growth in the head of the pancreas and OP No. 2 is not Oncologist and the case falls within the purview of Oncology. It is submitted that the OP No. 2 has operated the Gall Bladder and stated that it was required and then the patient was discharged from OP No. 1 Hospital on 29.06.2013 with an aggravated condition though the OP No. 2 assured the patient would be recovered soon but the said patient died on 13.09.2013 due to gross negligence of OP Nos. 1 & 2 rashly took the decision to operation the patient without referring the same to an experienced Oncologist by violating the ethics and basic principles of the profession and for commercial gain of themselves . It is alleged that in spite of operation of pancreas the OPs neither informed the complainants nor sent the sample for biopsy. It is pointed out that after discharging of said patient on 29.06.2013 , the said patient was taken to OP No. 2 at the OP No. 1 Hospital on 17.07.2013 and the OP No. 2 advised for FNAC and to contact with Dr. Arunagsha Kar which could have been done earlier and thereafter the patient was taken to Apollo Hospital, Kolkata where Dr. Shaikat Gupta after examining the patient expressed that it is next to impossible to save the life of patient as the patient party could have come earlier before the operation and Dr. referred the said patient to Dr. D.C. Ghosh. It is asserted that thereafter the complainants had taken the said patient to CMC, Vellore and after several investigations it reveals that abrupt cut off in the region of head of pancreas, whipples on 18.06.2013 and they also expressed their views similar with Dr. Shaikat Gupta . According to the case of the complainant said Nanda Dulal Chattoraj was the main earning member of the family and entire family was depending upon him and due to the death of said Nanda Dulal Chattoraj due to negligence and recklessness of the OPs the complainants have been suffering huge financial loss and sufferings mental pain and agony. For all these reasons the complainants have prayed before this District Forum / Commission for passing order to make payment of compensation of Rs. 17,00,000/- and to pay the cost of medical expenses of Rs. 2,60,000/- to the complainants by the OPs.
Defence Case
The OP Nos. 1 & 2 after receiving the notice / summons of this District Forum appeared before this Forum and contested this case by filing W/V separately.
Case of the OP No. 1 - The OP No. 1 by filing W/V has categorically denied all the material allegations leveled against OP NO. 1 and this specific case of the OP No. 1 in a nutshell is that the patient was brought to the emergency of OP No. 1 Hospital on 12.06.2013 with a history of painless of dyspepsia, anorexia, nausea, vomiting since last 15 days associated with yellowish urine and whitish stool and the said patient was diabetic and was under medication. And the first diagnosis was of jaundice going by the clinical symptoms and history told by the patient Nanda Dulal Chattoraj . It is submitted that the patient was clinically examined by OP No. 2 and he after examination and also after perusing the test reports was of the opinion that the patient had been suffering from obstructive jaundice and advised medicines like Pantoprazole, Vitamin K as conservative management for the time being and the patient was advised for C.T. Scan on 12.06.2013 for a definite diagnosis of the said patient. It is pointed out that on 12.06.2013 the patient was referred to Dr. S.K. Shah an Endocrinologist for his opinion Dr. S.K. Shah had seen the said patient regularly on and from 13.06.2013 and then the patient was again referred to Dr. S. Mukherjee (Consultant Gastroenterologist) who first saw the patient on 14.06.2013 and again on 15.06.2013 after seeing the CECT Abdomen Report opined the patient is a candidate of Triple Bypass Surgery. The CT Scan Report came on 15.06.201`3 which shown heterogeneous enhancing mass lesion seen in pancreatic head and uncinate infiltrating into pylorus and 1st and 2nd part of duodenum with consequent luminal wall thickening which clearly indicates that there is spread of carcinoma from pancreas to stomach and duodenum and it as shown dilataion of IHBR, CHD and CBD with grossly distended Gall Bladder and more importantly it shown fat plane with SMV is not well defined at one place which definitely suggests non-resectability and no curative procedure was possible due to an advanced growth. It is submitted that when carcinoma is found in two different organs then the most probable diagnosis is metastasis of carcinoma and advanced invasive disease and it is stated that from the CT Scan Report it is obvious that the jaundice was caused by definite obstruction and spread of the carcinoma from pancreas. It is pointed out that the Dr. treated the patient from the opinion that the suitable surgery for the condition faced by the patient will be a palliative Triple Bypass which was opined by S. Mukherjee and it is not possible for him to do a stenting by ERCP method due to tumour infiltrating the pylorus as well as 1st and 2nd parts of the duodenum and accordingly it was settled by the treating Drs that the standard and accepted procedure in such case for palliative Triple Bypass which was planned to be performed on 18.06.2013 according to the case of OP No. 1 the Triple Bypass Surgery is a surgery where the bile duct is cut keeping a safe margin above the blockage and reconnected to the small bowel and this bypass of the blocked part of the bile duct allows the bile to flow from the liver into the bowel which causes improvement of jaundice and alongwith this a Gastrojejunostomy is performed to bypass impending gastric outlet obstruction so that the patient can properly as long as survive. The entire treatment process as well as the reason of the surgery and the probable outcome of the surgery was repeatedly explained to the patient as well as his relatives ( wife and sons who are the complainants) . It is also alleged that the Hospital Authority had also taken consent from the patient and his relatives before performing the said surgery. It further alleged that the surgery was uneventful and the desired objective of the surgery was fulfilled and after surgery the patient was shifted to ICU and then to the ward and after 11 days of observing the patient and finding the patient to a stable condition the patient was discharged on 29.06.2013 with advice of continuing medicines like Razo, Lasilactone, Paracetamol, Inj lantus etc. and follow up after 4 days.
According to the case of the OP No. 1 there is no fault, negligence or deficiency of service on the part of the OP No. 1 has prayed before this District Commission for dismissing this complaint case with heavy cost.
The Case of OP No. 2 – The OP No. 2 also contested this case by filing W/V and has practically denied all the material allegations leveled against him by the complainant in the complaint petition. This specific case of Op No. 2 in bird’s eye view is that on 12.06.2013 the patient Nanda Dulal Chattoraj who was diabetic and under medication was brought to the OP No. 1 Hospital with history of painless dyspepsia, anorexia, nausea, vomiting for last 15 days associated with yellowish urine discharge and whitish stool discharge . OP No.1 and as such the Op No. 2 was on call surgeon. On 12.06.2013 the patient was admitted under the supervision of OP No. 2 and after examining the test reports of the patient the OP No. 2 was of the opinion that the patient was suffering from jaundice and advised medicine like Pantoprazole, Vitamin K as conservative management for the time being and advised for CT Scan for definite diagnosis of the patient and on 12.06.2013 the patient was referred to Dr. S.k.Shah, an Endocrinologist, for his opinion who had seen the said patient and thereafter the patient was referred to Dr. S. Mukherjee who had checked up the said patient on 14.06.2013 and on 15.06.2013 after checking the CECT Abdomen said Dr. was of the opinion that the said patient was a candidate for Triple Bypass Surgery. It is submitted that the CT Scan Report came on 15.06.2013 which was showing heterogeneous enhancing mass lesion seen on the pancreatic head with consequent luminal wall thickening which clearly indicates that there is a spread of carcinoma from pancreas to stomach and duodenum follows dilataion of IHBR, CHD and CBD WITH GROSSLY DISTENDED Gall Bladder. It is also stated that more importantly it shown fat plane with SMV is not well defined at one place which definitely suggests non-resectability and that no curative procedure possible due to advance growth and when the carcinoma is found two in different organs then the most probable diagnosis is metastasis of carcinoma and advanced invasive disease and from the CT Scan Report it is obvious that the jaundice was caused by the definite obstruction from the spread of the carcinoma of the pancreas and as such it was opined that the suitable surgery for the condition faced by the patient would be Palliative Triple Bypass as also opined by Dr. S. Mukherjee and as it was not possible for him to do a stenting by ERCP method due to the tumor infiltrating the pylorous as well as 1st and 2nd parts of duodenum and so it was decided to go for a standard and accepted procedure in such case which is a Palliative Triple Bypass where the bile duct is transacted keeping a safe margin above the blockage and reconnected to the small bowel alongwith a Gastrojejunostomy is performed to bypass impending gastric outlet obstruction allowing the patient to eat properly as long as he survives and also as per standard protocol the Gall Bladder is removed as a distended Gall Bladder reduces space for a good choledocho-jejunostomy and this operation a Gold Standard Palliative Operation of the pancreatic carcinoma also bear in mind that the patient was 69 years old and diabetic. It is alleged that the surgery was uneventful and desired objective was fulfilled and the patient was shifted to ICU and then to the ward and the patient was discharged on 29.06.2013. It is alleged that pre-operative FNAC was not done as because the Percutaneous Guided FNAC is not mandatory for diagnosis and still controversial with false negative rates of around 20% and the serious fatal complications like bile leak , biliary peritonitis, infection and septicaemia also another risk is of seeding of cancer cells in the needle tract as well as peritoneal cavity leading to cancer and apart from this in a patient with a bilirubin of 24.8 on admission it is definitely dangerous to do an FNAC from the pancreas which might lead to severe internal haemorrhage and also death. It is pointed out that the patient was advised for CA 19.9 Test for carcinoma which was done on 16.06.2013 and reflected a level of 884 where the normal is less than 27% and above level of 100% of CA 19.9 is suggested of unresectabililty or metastasis and hence as such level the treatment is only palliative and considering the age and the condition of the patient Triple Bypass Surgery was done to reduce the bilirubin level and to prevent the possibility of development of hepatic coma. According to the case of OP No. 2 the said surgery was performed following protocol to its trust sense but it is utter misfortune that patient party did not turn up for the follow up treatment as advised and expect immediately after discharge the patient died on 13.09.2013. It is further alleged that there is no fault, negligence or deficiency of service on the part of the of Op No. 2. For all these reasons the OP No. 2 also prayed before this District Forum / commission for dismissing this complaint case with heavy cost.
Points of consideration
On the basis of the pleadings of the parties adopted by the complainants and OPs in this case, this District Forum / Commission for the purpose of arriving at just and proper decision and also for deciding the fate of this complaint case , is going to adopt the following points of consideration :-
- Has this District Commission any jurisdiction to try this case ?
- Whether the complainants are the consumers under the OPs or not?
- Whether this case is maintainable in its present form and in the eye of law or not ?
- Is there any cause of action for filing this case by the complainants in this case or not?
- Is there any negligence, fault and deficiency of service on the part of the OPs in the matter of medical treatment provided to Shri Nanda Dulal Chattoraj ( predecessor of the complainant) or not ?
- Whether the complainants are entitled to get the order passing direction to the OPs for making payment of compensation to the tune of Rs.17,00,000/- and also for making payment of Rs.2,60,000/- which is the cost of medical treatment of deceased Nanda Dulal Chattoraj.
- To what other relief / reliefs the complainants are the entitled to get in this case?
Evidence on record
The complainants in order to prove their case has filed evidence on affidavit and against the said evidence on affidavit the OP Nos. 1 & 2 have submitted interrogatories and against the said interrogatories the complainant side has given reply.
At the same time, the OP Nos. 1 & 2 have filed their separate evidence on affidavit in this case and against the said evidence on affidavit the complainant side also have filed separate interrogatories and OPs also have given reply against the said interrogatories.
Argument highlighted by Ld. Advocates of both parties
The complainant side and OPs have filed their separate BNA in this case. Besides filing of the BNA Ld. Advocates for the said OP Nos. 1 & 2 also have highlighted verbal argument and referred series of case laws in support of their cases. In course of argument Ld. Advocates for the complainant side and OP Nos. 1 & 2 also have given emphasis on the oral and documentary evidence which have been produced by the parties in this case.
Decision with reasons
The first four points of consideration which have been framed on the ground of jurisdiction, whether the complainants are the consumers under the OPs or not, whether this case is maintainable in its present form and in the eye of law and whether the complainants have any cause of action for filing of this case or not are very vital issues for determination of the fate of this case and so these points of consideration are taken up for discussion jointly at first.
For the purpose of deciding the fate of the above noted four points of consideration this District Commission finds that there is necessity of making scrutiny of the material of this case record and there is also urgency for scanning the evidence on record.
In this regard, it is important to note that the OPs after entering appearance in this case and filing W/V, have filed separate application on the ground that this Complaint Case No. 525/2014 is not maintainable in its present form. The complainant side has filed W/O against the said petition. But fact remains that this District Commission observed that the said issue of maintainability is to be heard alongwith trial of this case.
After going through the material of this case record this District Commission finds that the complainants are the resident of Barisha, P.S. Thakurpukur , Kolkata but the OP No. 1 is carrying on business at the Andul Road which is under the District of Howrah and the OP No. 2 is also a medical practioner of the same area of Andul Road under the district of Howrah. In view of such position according to the provision of Section 11 of the Consumer Protection Act, 1986 when the OPs are carrying on business and carrying medical profession within the district of Howrah, this District Forum / Commission has the jurisdiction to try this case. In this connection with the pecuniary jurisdiction of this case, this District Commission after going through the material of this case record finds that the patient Nanda Dulal Chattoraj (predecessor in interest of the complainants) was admitted in the OP No. 1 Hospital under the care and supervision of OP No. 2 and one Palliative Triple Bypass Surgery was done at the OP No. 1 Hospital by OP No. 2 on 18.06.2013 and the said patient was admitted at the OP No. 1 Hospital on 12.06.2013 and was discharged on 29.06.2013 and total medical expenses of Rs. 2,60,000/- was paid by the complainants to the OPs who received the said amount. This factor is clearly reflecting this District Commission has its pecuniary jurisdiction to try this case. Thus the jurisdiction issue is decided in favour of the complainants.
Now, the question is whether the complainants are the consumers under the OPs or not. In this connection this District Commission has already observed that the OPs have / had received Rs. 2,60,000/- from the complainants for providing medical treatment and conducting surgery of Palliative Triple Bypass Surgery of Nanda Dulal Chattoraj since deceased who is the predecessor in interest of the complainants. It is crystal clear that OP Nos. 1 & 2 have provided service in lieu of taking money from the complainants . This matter is clearly depicting that the complainants are the consumers under the OPs.
Now the question is whether this case is maintainable in its present form and in the eye of law or not . In this connection this District Commission after going through the material of this case record and the documents provided by the complainant side and OPs finds that the Nanda Dulal Chattoraj since deceased (predecessor in interest of the complainants) was medically treated by Dr. S.K. Shah (Endocrinologist) and thereafter the said patient was medically treated by Dr. S. Mukherjee (Gastroenterologist) at the said OP No. 1 Hospital. But fact remains that the above noted two Doctors have not been impleaded as parties of this case by the complainants although they are the said parties. Moreover after discharging from the OP 1 Hospital on 29.06.2013 the said patient Nanda Dulal Chattoraj was medically treated by Dr. Shaikat Gupta at the Apollo Hospital and thereafter at CMC, Vallore. But fact remains that the said Shaikat Gupta and CMC, Vallore also have not been impleaded as parties in this case.
All these factors are clearly reflecting that this case is defective for non-joinder of necessary parties. Moreover, the name of the OP No. 1 has been changed and at present the name of OP No. 1 has been designed as Narayana Multi Specialty Hospital, Andul Road, Near Chunabati, Podra, Mourigram, Howrah – 711 109. In this regard it is important to note that the complainant side has not changed the name of OP No. 1 in this case by way of making amendment . In view of such position this District Commission is of the view that if for argument sake this case is awarded in favour of the complainant side, it would be difficult for the District Commission to execute the said award as because as per present petition of complaint, the award is required to be passed against OP No. 1 West Bank Hospital which is no longer in existence. If the award passed by this District Commission is found inexecutable at the time of execution of the case such award would be treated as “incomplete award due to defect of party”. This factor is also reflecting that this case which is filed by the complainant in its present form is not maintainable.
In this instant case the complainant side in support of their point of contention that there is negligence / deficiency of service on the part of the OPs as the CT Scan Report came on 15.06.2013 which stated “heterogeneous enhancing mass lesion seen in pancreatic head and uncinate infiltrating into pylorus and 1st and 2nd part of duodenum with consequent luminal wall thickening” which clearly indicates that there is spread of carcinoma from pancreas to stomach and duodenum. Also it showed “dilataion of IHBR CHD and CBD with grossly distended Gall Bladder”. More importantly it showed fat plane with SMV is not well defined at one place which definitely suggests non-resectability and that no curative procedure was possible due to an advanced growth. In this regard it is stated that when carcinoma is found in two different organs then the most probable diagnosis is metastasis of carcinoma and advanced invasive disease. It is stated that from the CT Scan Report it is obvious that the jaundice was caused by definitive obstruction and spread of the carcinoma from pancreas.
In order to prove this matter the complainant side refer the evidence of complainant and also the evidence of OP Nos. 1 & 2 and also has relied / given emphasis on the expert report submitted by Dr. A. K. Gupta (Endrocrinologist). In this connection it is the defence alibi that the doctor treating the patient formed the opinion that the suitable surgery for the condition faced by the patient will be a palliative Triple Bypass which was also opined by Dr. S. Mukherjee as it was not possible for him to do a stenting by ERCP method due to the tumour infiltrating the pylorus as well as 1st and 2nd parts of duodenum. Accordingly it was settled by the treating doctors that the standard and accepted procedure in such case for Palliative Triple Bypass which was planned to be performed 18.06.2013 bearing in mind that patient was nearly 69 years old, frail and diabetic.
In support of such point of contention the OPs have given emphasis on the expert report produced by IPGME & R - SSKM , Hospital on 22.05.19 and also has given emphasis on the enquiry reports submitted by West Bengal Medical Council.
On comparative studies of the above noted point of contention and the evidence given by complainant side and OPs and also after making scrutiny of the documents produced by complainant side and OPs , this District Commission finds that on 21st November, 2019 the complainant without any order of this District Commission / Forum has submitted the expert opinion of Dr. A.K. Gupta and said Dr. A.K. Gupta is a Forensic Doctor and never treated any Cardiac patient and has no academic qualification for Oncology. In this regard it is very important to note that the complainant cannot without any leave of the District Commission filed any expert opinion as a counter piece of expert report which have been produced by the 6 (six) members attached with IPGME & R – SSKM, Hospital as per direction of the Hon’ble State Commission. In this regard this District Commission / Forum shall not be out of mind that on several occasions Hon’ble National Commission and Hon’ble State Commission of West Bengal have expressed that the expert opinion of Dr. A.K. Gupta being a self-proclaimed expert in the medical field cannot be accepted as Dr. A.K. Gupta is not possessing the required medical qualification to provide any such expert opinion over the issue of Oncology.
On comparative studies of the reports submitted by IPGME & R – SSKM Hospital and West Bengal Medical Council this District Commission observed that both the above noted authority have given clean chit to the OPs. In this connection it is important to note that the Enquiry Committee which is formed by West Bengal Medical Council consisted of one Oncologist and have examined all the papers and documents produced by the complainants and the complaint which is lodged before the West Bengal Medical Council is by the complainant. But fact remains that Enquiry Report submitted by West Bengal Medical Council is also reflecting that the Drs. / OP Nos. 1 & 2 have no fault / negligence or deficiency of service on their part. In this regard it is very important to note that the complainant have lodged the complaint before the West Bengal Medical Council but surprisingly the Enquiry Report which is submitted by West Bengal Medical Council have not been challenged before the Higher Authority.
In view of such position this District Commission / Forum has no other alternative but to rely on the Enquiry Report submitted by West Bengal Medical Council and the expert report which is produced by IPGME & R – SSKM Hospital. It is also very pertinent to mention that the complainant side in support of their above noted point of contention have neither examined Dr. Shaikat Gupta of Apollo Hospital nor produced and proved the Medical Examination Papers issued by Dr. Shaikat Gupta (Oncologist). Similarly, it is also very important to note that the complainants went to CMC, Vellore alongwith said patient and at CMC, Vellore said patient was medically examined and as per case of the complainant side the CMC, Vellore Authority also supported the views of Dr. Shaikat Gupta (Oncologist). In this connection this District Commission shall not be out of mind over the issue that the papers of medical treatment produced by CMC, Vellore also have neither been produced by the complainants nor been proved by the complainants. Thus, it is crystal clear that the case of the complainants that there is a fault / negligence / deficiency of service on the part of the OPs is bereft by any cogent independent / impartial medical evidence . So, this District Commission cannot accept the point of contention and case of the complainants.
All the above noted factors are clearly reflecting that the complaint case is found not maintainable as it is bad for defect of parties and the award if it is at all passed for argument sake cannot be executed at the time of execution of this award.
When the case is found not maintainable in its present form and in the eye of law, this District Commission is of the view that the complainants have no cause of action for filing this case.
Thus, the above noted two points of consideration which have been framed on the ground of maintainability and cause of action are decided against the complainants.
The point of consideration No. 5 has been framed over the issue whether the OPs have any fault / negligence / deficiency of service in the matter of providing medical treatment of the patient Nanda Dulal Chattoraj, since deceased (predecessor in interest of the complainants) or not . In support of this issue the complainant side has adopted the plea that in spite of having knowledge that the said patient Nanda Dulal Chattoraj has been suffering from carcinoma at the head of pancreas which spread even to the stomach performed the Palliative Bypass Surgery without obtaining proper consent from the complainants or from the patient. But fact remains that in support of such contention of the complainants over the above noted issue this District Commission after going through the material of this case record finds that there is no corroborative evidence and in the absence of any cogent medical evidence the above noted point of contention and the case laws which have been referred by the complainant side in support of above noted point of contention cannot be accepted. Thus it is crystal clear that the case of complainant side in support of point of consideration No. 5 is found bereft of any cogent medical evidence. In this regard it is the settled principle of law that when there is no cogent medical evidence the Doctors cannot be held negligent for the death of the patient . This legal principle has been observed by Hon’ble Apex Court in the case of
KALYANI RAJAN VS. INDRAPRASTHA APOLLO HOSPITAL AND OTHERS
which is reported in (2024) 3 Supreme Court Cases 37
Under this position this District Commission is of the view that there is no fault, negligence or deficiency of service on the part of the OPs. So, this point of consideration is also decided against the complainants.
In this instant case the complainants have claimed compensation to the tune of Rs. 17,00,000/- and also prayed for passing order directing the OPs to pay cost of medical treatment of Rs. 2,60,000/-. In this connection it is very important to note that in determining compensation in the cases of medical negligence, a balance has to be struck between demanding of person claiming compensation, as also the interests of those being made liable to pay. This legal principle has been observed by the Hon’ble Apex Court and it is reported in 2024 (III) Indian Civil Cases 295 (SC). In this instant case the complainants have miserably failed to prove the basis of their claim of compensation of Rs. 17,00,000/-. In view of such position this District Commission is of the view that the complainant side has failed to establish that they are entitled to get the compensation amount in this case from the OPs.
Thus the points of consideration Nos. 6 & 7 are also decided against the OPs.
A cumulative consideration of the above noted discussion goes to show that this complaint case is not maintainable in its present form and in the eye of law and there is no cause of action for filing this case by the complainants and there is no fault or deficiency of service on the part of the OPs and the complainants are not entitled to get any compensation from the OPs. For all these reasons this District Commission has no other alternative but to dismiss this case on contest.
In the result, it is accordingly,
ORDERED
That this Complaint Case being No. 525/2014 be and the same is dismissed on contest. No order is passed as to cost.
The parties of this case are entitled to get a free copy of this judgment as early as possible.
Let this judgment / final order be uploaded in the official website of this District Commission immediately.
Dictated & corrected by me
President