Complaint Case No. CC/98/55. Case: Mrs. Veera Rohinton Kotwal Vs P.D. Hinduja National Hospital and Medical Research Centre. Maharashtra State Consumer Disputes Redressal Commission
| Case Number | Complaint Case No. CC/98/55 |
| Counsel | For Appellant: Mr. Bimal Bhabhda, Advocate and For Respondents: Mr. Y.C. Naidu, Advocate present a/w. Dr. Suganthi Iyer, Asstt. Director of Hinduja Hospital |
| Judges | P. B. Joshi, Presiding Member and Narendra Kawde, Member |
| Issue | Consumer Protection Act, 1986 - Section 13(4) |
| Judgement Date | December 09, 2014 |
| Court | Maharashtra State Consumer Disputes Redressal Commission |
Order:
Narendra Kawde, Member
Introduction:-
[1] Consumer complaint is filed in the year1998 which was placed on board for hearing and disposal from Sine-die list. Since the old record was not in good condition, both the parties have reconstructed the record with consent.
Case of the complainants:-
[2] Under the medical advice of the opponent no.2 and 3 i.e. Dr.K.T.Dholakia and Dr.Saanjay Agarwala, the complainant underwent left knee joint replacement in the operation theatre of the opponent no.1-P.D.Hinduja National Hospital And Medical Research Centre on 29/03/1996 as the complainant was suffering due to Rheumatoid Arthritis. Opponent no.2 then being reputed name in the branch of knee replacement and with assurance that adequate follow-up will be personally carried out by the opponent no.2, the complainant was convinced to undergo for such knee replacement. However, to the dismay of the complainant, opponent no.2 never turned up during the post-operative period, though complainant continuously suffered joint pain followed with puss formation and at one such occasion, though complainant became totally immobile. One Dr.Chakravarthy claiming to be assistant of the opponent no.2 i.e.Dr.Dholakia visited the complainant who removed plaster from the knee joint on 06/04/1996 and cleaned the wound and dressing was done. Simultaneously, x-ray was taken out. On constant complaints of pains in the knee joint, the complainant was prescribed certain medicines including pain-killers. Physiotherapy exercise also was suggested. Pain in the operated area, though having taken pain killer and the antibiotics never subsided. Pain continued to be there and at the time of removal of plaster on 06/04/1996 who Dr.Chakravarthy and other team suggested that the severe pain complaint would gradually subside and there was nothing to worry about it. Complainant was never comfortable during entire hospitalization period effective from 27/03/1996 and more particularly post-operative period effective from 29/03/1996 till discharge on 06/04/1996.
[3] Dr.Chakravarthy on 10/04/1996 dressed wound as there was [serosanguineous] fluid discharge and took swab for sending it to the culture. The wound was opened to facilitate drainage. However, oozing never stopped. The report of wound swab culture showed that there was "Staph Aureus Bacteria". Oozing of fluid never stopped. Therefore, it was decided by the opponent no.2 to lavage the wound on 12/04/1996 and the complainant was kept NBM [nothing by mouth]. Lavage was carried out in the operation theatre on 12/04/1996 under general anaesthesia by Dr.Chakravarthy under the supervision of opponent no.2. Antibotic injection Vancomycin was administered after the lavage to prevent further oozing. However, oozing did not stop. Complainant was having varying temperature between 98.5oF and 100oF. Opponents were unable to attribute any reason for persistent fever. WBC count had gone up due to prevailing infection. Again on 15/04/1996, wound swab was sent for culture and sensitivity test. Report of the said wound swab culture still showed growth of Staph Aureus Bacteria and therefore, opponent no.3 changed the medicine and put the complainant on Cap.Klox 500 mg and Cap. Omizac. Additionally, Tab.Survector was prescribed by the opponent no.3 so as to contain nervousness of the complainant as probable cause for the mild fever. In spite of efforts and change of medicine from time to time, the complainant could not get any relief whatsoever and the mild fever was persistent. On second occasion, the wound lavage was carried under General Anaesthesia on 19/04/1996 and wound was sutured and swab was sent for culture and sensitivity. Since there was no relief, complainant was advised to stop exercise of left leg and was put on heavy dosage of antibiotics. On 23/04/1996, drain tip was sent for culture and the report showed that there was no bacterial growth. Opponent no.2 i.e. Dr.Dholakia, who carried out the operation, never attended the complainant in person after post-operative period in spite of complainant''s frantic efforts. Complainant was finally discharged on 25/04/1996.
[4] Again on 03/05/1996, sutures on lavage portion were removed by the opponent no.3. Complainant incurred total expenditure of Rs.2,12,589/- and Rs.4,200/- during entire hospitalization period. On advice of the opponent no.3, complainant herself got admitted on 07/06/1996 in the hospital of opponent no.1 on second time for treating infection. Pre-operative investigations, as suggested, were carried out as per the directions of the team of the doctors. Even after operation, on second time on 09/06/1996, complainant could not get relief and continued to be febrile (i.e.with fever). In spite of medication and other treatment, temperature escalated and opponent failed to explain the cause. Mild fever continued till discharge on 19/06/1996. Opponent no.3 opined possibility of rejection of prosthesis by complainant''s body and if such possibility occurred, fusion of the knee joint was the only alternative. Complainant spent Rs.48,297/- at the time of second operation.
[5] Finally on 20/06/1996, the complainant succeeded to have an appointment with opponent no.2 for 1st time after the sutures were removed on 03/05/1996. On examining complainant, opponent no.2 told that the ''Staph Aureus bacteria'' had not been totally eradicated and therefore changed and prescribed the medicines to Ceftum -- 1gm/day and Pelox 800 mg/day for two weeks. On examining, fresh x-ray and ESR level, opponent no.2 advised to stop all drugs previously prescribed and prescribed application of the Rubinsol ointment for the pain. Opponent no.2 expressed that he had performed hundreds of total replacement of knee joint operations and nothing can or has gone wrong. Even after change of prescription, there was unbearable joint pain coupled with redness and warmth, the complainant was unable to walk. Complainant and her husband therefore went to Dr.A.Mullaji for second opinion who diagnosed "possible loosening of the joint" and asked the complainant to take fresh x-rays. Said x-rays revealed distinct black line at the cement and bone contact area [loosening]. Thereupon, complainant consulted Dr.Sanjiv N. Amin, a qualified Rheumatologist who examined the complainant and observed that there was warmth, effusion and 20 degree flexion deformity. In this situation, complainant was unable to bear weight on the left knee without the support of splint. Dr.Amin diagnosed that there was rampant active infection of the knee. Dr.Amin advised revision surgery to be performed in USA. It was also advised by Dr.Amin that there was not chance of successful revision surgery in India considering the extent of rampant infection in the knee. Dr.Amin facilitated revision surgery of knee in the USA carried out by Dr.Chitranjan S. Ranawat of Lenox Hill Hospital, New York.
[6] In the USA at Lenox Hill Hospital, Dr.Ranawat examined the complainant and studied all the previous repors, x-rays and case papers vindicated varus alignment [i.e. abnormal angulation of the knee joint with the angle pointing away from the midline] grossly of about 15 degrees. He also suggested serological sepsis [bacterial invasion]. Sensitive test was carried out of the bacteria to antibiotics to prevent infection by discontinuing use of antibiotics for a week. Culture and sensitivity report carried out in Dr.Ranawant''s hosipital showed sparse amoutof methicillin resistant "Staph Aurous" infection which was detected earlier in the hospital of opponent no.1 in the culture report of 10/04/1996. Dr.Ranawat carried first stage i.e. revision of left total knee arthoplasty involving removal of components inserted by the opponents during surgery carried on 29/03/1996. Thereafter, Dr.Ranawat carried out second stage surgery for reimplantation of left knee arthoplasty after completing an antibiotics regimen of 6 weeks. During the surgery under epidural anaesthesia, the knee joint was opened and the wound swab was taken and sent for culture and sentitivity. It was found that large quantity of serosanguineous discharge from the knee. Extensive synovectomy was performed. With these two stage successful revision surgery in USA and thereafter complainant got complete relief.
[7] Complainant alleges deficiency in service against the opponents on the following counts:-
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It is alleged by the complainant that service to be rendered by a surgeon not only mean to perform the operation but also treat the patient post-operative. Opponent no.2 i.e. Dr.Dholakia rendered deficient service as in spite of frantic efforts, he could not attend the patient during post-operative period.
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Second allegation is that the Staph Aureous bacteria in the wounds entered in the operation theatre itself either through surgical equipment used in the operation or cement which used for cementing artificial knee joint to the bone or failure to provide sterile environment for the operation by ensuring sterile operation theatre. Growth of Staph Aureous bacteria developed which was confirmed in test report carried at Lenox Hospital, USA.
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Third allegation pertains to varus alignment [not in order] grossly of about 15 degrees and settling of the posterotibial femoral component into varus alignment and loss of bone attributed to gross negligence of opponent nos.1, 2 and 3.
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Fourth allegation pertains to failed lavage of wound on two occasions within a span of two weeks as infection was not totally eradicated due to lack of care and precaution by the opponent nos.2 and 3.
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Fifth allegation against the opponent nos.2 and 3 again pertains to failed lavage as entire fluid was not aspirated and as a result infection persisted and Staph Aureous bacteria continued to grow. Opponent no.2 and 3 were negligent in performing the wound lavage.
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Sixth allegation levelled against the opponent nos.2 and 3 that they were negligent in performing in knee joint surgery...
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