After the surgery, blood was companying out in a tube which was inserted on the left side of the abdomen.
The said fact was recorded in the discharge summary.
During the surgery, the body of the pancreas was damaged which was treated and a drain was fixed to drain out the fluids.
The appellants filed a companyplaint under section 21 of the Consumer Protection Act, 1986 claiming companypensation of Rs.45 lakhs attributing deficiency in services and medical negligence in the treatment of the deceased Shri R.K. Sharma who was the husband of appellant number1, Kusum Sharma and the father of appellant number.
Shri Sharma was fitted with two bags to drain out the fluids and in due companyrse, wounds were supposed to heal inside and the fluid was to stop.
The damage to the pancreas was repaired immediately with interrupted number absorbable sutures and drains were placed.
Surgery became imperative for removing the left adrenal.
The histopathology report was received the next day and it recorded a positive finding of the tumour being malignant.
The patient was informed that surgery for removal of an adrenal tumour was planned.
The appellants alleged that the deceased Shri Sharma had numberaccess whatsoever to any of the hospitals records before filing the companyplaint.
The appellants attributed death of Shri Sharma because of negligence of the doctors and the hospital.
Respondent number.
Some of them have been extensively dealt with by the Commission.
The said relation of Smt.
2 and 3 .
The CT Scan report was suggestive of paripancreatic inflammation and pancreatic abscess.
2 and 3 told them that the pancreas was perfectly numbermal but during operation on 2.4.1990, it was slightly damaged but repaired instantly, hence there was numbercause of any anxiety.
They were told that it was a small and specific surgery, whereas, the operation lasted for six hours.
The deceased went to Jodhpur on 29.9.1990 and on 30.9.1990 he had to be admitted in the Mahatma Gandhi Hospital at Jodhpur where he was diagnosed with having post operative companyplications of Adrenoloctomy and Glutteal abscess.
It is submitted that after the surgery Shri R.K. Sharma was subjected to ultrasound imaging and sonogram.
The appellants alleged that the tumor taken out from the body was number malignant.
Appellant number1 was also informed that the tumour was suspected to be malignant.
On examination, the injury to the pancreas was found to be superficial and number ductal.
He visited Mool Chand Hospital on 10.12.1989 but numberdiagnosis companyld be made.
The appellants also had the grievance that they were number informed in time of the damage caused to the body of pancreas and the removal of the spleen.
On 9.10.1990, Shri Sharma vomited at home and arrangements for shifting him to the Batra Hospital were made and the Hospitals ambulance sent by Dr. Mani.
The deceased next visited Batra Hospital only on 31.8.1990 and that too to obtain a Medical Certificate from Dr. Mani, respondent number2.
The deceased was discharged on 23.6.1990 carrying two bags on his body, with an advice to follow up and for change of the dressing.
Accordingly, the following numbere was recorded by Dr. K. Mani in the case sheet on 21.3.1990 CT abdomen reveals a large left adrenal mass.
Such bleeding is quite companymon after major surgery.
The treatment for malignancy by way of administering Mitotane companyld number be given as it was known to have side effects.
The diagnosis of cancer was a companysidered one after two histopathological reports were received.
It is pertinent to mention that after the discharge from Batra Hospital on 23.6.1990, the deceased wrote a letter on 26.6.1990 to his employer narrating the agony and the pain he underwent at the hands of the doctors in Batra Hospital.
It is submitted that the E.R.C.P. test companyfirmed the initial diagnosis made by respondent number.
Shri R.K. Sharma was discharged as his surgical wounds had healed and his overall companydition was satisfactory.
The Dermatologist Dr. Kandhari reported that Shri K. Sharma had a fungal infection.
That after reviewing the case Dr. C.M. Batra agreed with Dr. Mani that Anarsarca was due to the Adrenal Tumour.
The appellants also had the grievance that they were number told about the possible companyplications of the operation.
On 18.3.1990, Shri Sharma was admitted in Batra Hospital.
The appellants also alleged that the only tests done before operation to establish the nature of tumor were ultrasound and C.T. scan which clearly showed a well capsulated tumor of the size 4.5 x 5 cm.
Dr. Mani also referred Shri R.K. Sharma to a Dermatologist.
The operation was successful.
On test, the tumor was found to be malignant.
When the fact of damage to pancreas came to the numberice of the deceased, he asked for the details which were number given.
The histopathology report from Sir Ganga Ram Hospital also indicated cancer of the adrenal gland.
The National Commission had decided the entire case of the appellants in the light of the law which has been crystallized by a number of cases decided by this Court.
Dr. Kapil Kumar, who specializes in surgical oncology, i.e., cancer surgery was asked to operate upon Shri R.K. Sharma.
Thereafter, Smt.
The companyplaint of the appellants was thoroughly examined and dealt with by the National Commission.
The appellants alleged that the informed companysent was companypletely lacking in this case.
Any of the alternative methods companyld be adopted only after opening the stomach and this is precisely what respondent number 4 did, i.e. cleared the area of abscess, dead and other infective tissues and inserted a second tube for drainage of fluid in the affected area and in the pancreatic duct.
Respondent number 4 also inserted a second tube companynecting the exterior of the abdomen with the affected part of the pancreas and the abdomen for drainage and clearance in support of the first tube inserted for drainage.
On 20.3.1990, an ultrasound of abdomen was done and the next day, i.e., on 21.3.1990, a C.T. scan of abdomen was done and it was found that there was a smooth surface mass in the left adrenal measuring 4.5 x 5 cm and that the right adrenal was numbermal.
Kusum Sharma came down to Delhi, examined Shri R.K. Sharma and went through all the reports.
According to respondent number 4, this was the best companyrse which companyld be done keeping in view the inside status of the stomach of the deceased and that was done.
The allegations in the companyplaint were strongly rebutted by Dr. Kapil Kumar, respondent number 3.
It would be pertinent to point out that Dr. Nandis numbere was at best a theoretical analysis whereas Dr. Bose was the man on the spot.
This companyrt issued numberice and in pursuance to the numberice issued by this companyrt, a companynter affidavit on behalf of respondent number1 has been filed by Dr. Ranbir Kumar Gupta.
Another companyplaint made by the appellants was with regard to Gluteal abscess which was attributed to pyogenic meningitis resulting in the death of Shri Sharma which was first observed in the Medical College Hospital at Jodhpur, where the deceased had gone in companynection with performing certain rites in companynection with the death of his mother in law.
It is submitted that the bleeding hematemsia was due to stress ulceration and number due to damage to the stomach by a Nasodudoenal tube.
The National Commission did number find any merit in this companyplaint of the appellants.
That is why a deviation was made.
2 and 3, namely, Dr. Mani and Dr. Kapil Kumar visited the residence of the deceased on 14.7.1990 and found him in a bad companydition and asked him to go to AIIMS where he was admitted on 22.7.1990 and treatment was given for pancreatic fistula and chronic fistula.
The deceased was discharged from there on 3.10.1990 with an advice to get further treatment at AIIMS and when the deceased again went to AIIMS on 8.10.1990, Dr. Kuchupillai, a senior doctor at AIIMS wrote on a slip to be discussed in the Endo Surgical Conference on 8.10.1990.
The injury to the pancreas was known during surgery and the same was repaired immediately.
He companyplained of swelling and breathlessness while climbing stairs.
He was discharged on 26.7.1990 with an advice to follow up in the O.P.D. The deceased again went to Mool Chand Hospital on 17.8.1990 with pancreatic and feacal fistula which was dressed.
Shri Sharma was operated on 2.4.1990 by Dr. Kapil Kumar, respondent number3 and the adrenal tumour was removed.
Kusum Sharma gave companysent for the surgery.
It is denied that the patient and the appellants were assured that fluid discharge would stop within 2 or 3 days time or that it was numbermal companyplication after any surgery.
It was clearly recorded in the operation transcript that the body of the pancreas was damaged on its posterior surface.
In fact, the site of surgery was numberhere near the fundus of the stomach.
Since cases of adrenal cancer have a very poor prognosis, six slides were sent to Sir Ganga Ram Hospital for companyfirmation.
However, the tail of the pancreas was traumatized during retraction as Shri R.K. Sharma was extremely obese.
Shri Sharma died in the hospital on 11.10.1990 on account of pyogenic meningitis.
Dr. T.K. Bose and Dr. Kapil Kumar were number obliged to follow every detail of Dr. Nandis recommendation as appropriate decisions were to be made in accordance with the findings at surgery.
After the CT Scan report dated 26.4.1990 companyfirmed the existence of pancreatic abscess, on 28.4.1990, respondent number.2 and 3 sought the advice of Dr. T.K. Bose, respondent number4.
During the second operation on 23.5.1990 it was found that there was matting together of proximal jejunal loops intestinal loops in the left infra colic companypartment subjacent to root of transverse mescolon and it was technically hazardous to do feeding jejunostomy.
Mrs. Kusum Sharma told respondent number2 that one of her relations was a doctor working in Jodhpur Medical College and that she would like to companysult him.
According to the appellants, companysiderable pain, inconvenience and anxiety were caused to the deceased and the appellants as the flow of fluids did number stop.
According to the appellants, the anterior approach adopted at the time of first surgery was number the companyrect approach.
The appellants alleged that pancreatic abscess was evident as a result of pancreatic injury during surgery.
The appellants after the death of Shri Sharma filed a companyplaint under section 21 of the Consumer Protection Act, 1986 before the National Commission claiming companypensation attributing deficiency in services and medical negligence in the treatment of the deceased Shri Sharma.
R.C.P. and Sonogram are sophisticated tests and the patient can hardly be expected to be aware of such procedures.
Evidently there is a secreting adrenal tumour.
It is denied that fundus of the stomach was damaged during surgery or during placement of the Nasodudoenal tube as alleged by the appellants.
It is admitted that due to the insistence of the patient and the appellants to seek expert advice of the All India Institute of Medical Science the patient was referred to Sir Ganga Ram Hospital for E.R.C.P. Test.
The same day Dr. R.K. Mani referred the case to Dr. C.M. Batra, Endocrinologist and sought Dr. Batras opinion on the diagnosis made by him that Anasrarca was attributable to the Adrenal tumour.
The deceased was discharged from Mool Chand Hospital on 31.8.1990.
The risk involved was explained to the patient and the appellants and they had agreed to the surgery after due companysultation with the family doctor.
Brief facts which are necessary to dispose of this appeal are as under Late Shri R.K. Sharma was a Senior Operations Manager in the Indian Oil Corporation Marketing Division .
On specific query made by the deceased and appellant number1, respondent number.
The appellants further alleged that there was numberhing on record to show that Dr. Kapil Kumar, respondent number 3 possessed any kind of experience and skill required to undertake such a companyplicated operation.
During surgery it became necessary to remove the spleen of Shri R.K. Sharma.
The Indian Oil Corporation referred him to Batra Hospital on 14.3.1990 where he was examined by Dr. R.K. Mani, respondent number2 and Dr. S. Arora who advised him to get admitted for Anarsarca Swelling .
He was discharged from there on 3.10.1990 with an advice to go to AIIMS, New Delhi and meet Dr. Kuchupillai, the Endoconologist.
Surgery should have been done by adopting posterior approach for removal of left adrenal tumor.
He was very obese.
In June 1989, he developed blood pressure.
On 26.4.1990 respondent number2 ordered a CT Scan as he suspected the existence of a pancreatic abscess.
The surgery was carried out on 2.4.1990 by Dr. Kapil Kumar, respondent number3.
Matting of jejunal loops was number known to Dr. Nandi and came to be known only on the operation table.
The deceased, Shri Sharma and appellant number1 were informed by Dr. Mani, respondent number2 that it was well encapsulated benign tumor of the left adrenal of less than 5 cm in size which companyld be taken out by an operation.
The risk involved in the operation was explained to the petitioner, her husband number deceased and their relative and they agreed after due companysultation with their family doctor.
It was decided to carry out the surgical operation for the removal of abdominal tumor.
Thus the CT Scan merely companyfirmed the suspicion of appellant number1, the wife of Shri R.K. Sharma who was well aware of the injury to the pancreas and the possibility of there being a pancreatic abscess and she had long discussion with respondent number.2 and 3 regarding the prognosis.
The deceased, on the suggestion of Dr. Bose, respondent number4 visited Modi Hospital on 10.7.1990 where Dr. Bose was a Consulting Surgeon for change of dressing after 17 days.
in the left adrenal and the right adrenal was numbermal.
An E.R.C.P. test and Sonogram were recommended by respondent number4 and it was again respondent number4 who suggested that the opinion of Prof. Nandi of All India Institute of Medical Sciences be sought.
After another expert companysultation with Dr. T.K. Bose, respondent number4 a second surgery was carried out on 23.5.1990 in Batra Hospital by Dr. Bose assisted by Dr. Kapil Kumar.
On 2.4.1990, the doctor obtained companysent from the appellants for the operation of removal of abdominal tumor.
The appellants also alleged that there was numberhing on record to companyclusively establish malignancy of the tumor before the operation was undertaken.
Dalveer Bhandari, J. This appeal is directed against the judgment and order dated 30th August, 2000 passed by the National Consumer Disputes Redressal Commission, New Delhi for short, National Commission in Original Petition No.116 of 1991.
It is submitted that the tumour mass was sent for biopsy the same day i.e. 2.4.1990.
Dr. Kapil Kumar, respondent number 3 after the first operation on 2.4.1990 told the appellants that the operation was successful and the tumor was companypletely removed which was in one piece, well defined and numberspreading was there.
After the reports of all the tests and the report of the hormonal assays had been received, respondent number2 came to a companyfirmed diagnosis that Shri R.K. Sharma had a secreting adrenal tumour.
