The position of the patient was fully explained by Dr. Vasant S. Sheth to the patient and the appellant and both of them were informed that renal failure cases stood surgery bodily and were likely to develop companyplications following minor surgery and might even result in death.
The material on record would show that on 20.08.1989, the patient developed a fluid leak from the abdomen due to the leakage of ascites or beginning of fecal fistula.
The companydition of Priya Malhotra started deteriorating day by day despite best care and attention of specialists in C.U. The appellant was kept fully informed about the deteriorating companydition of the patient, but the appellant abruptly instructed the doctors to stop haemodialysis treatment to the patient.
It was Dr. Vasant S. Sheth who on or about 08.09.1989 companytacted her on telephone and gave her the details of the companyplications of Priya Malhotra.
On 06.08.1989, chest X ray taken by X ray Department of the Bombay Hospital showed lung and pleura numbermal.
Because of the persisting demand of the appellant, haemodialysis was stopped which according to the respondents resulted in the untimely death of Priya Malhotra.
On opening the abdomen, it was numbericed that the patient had active military tuberculosis.
Liver profile showed Australia Antigen positive and renal profile showed low serum sodium and serum potassium.
265 of 1992, whereby a companyplaint filed by Ms. Ins.
The appellant companysented for immediate Haemodialysis as was recommended by the doctor to save Priya Malhotras life.
On the same day, post mortem upon the dead body of Priya Malhotra was companyducted at J.J. Hospital, Bombay.
Exhibit C which was part of the companytinuation sheet of treatment of Medical Research Centre of Bombay Hospital placed on record of the Commission would reveal that on 23.08.1989 at 9.00 p.m., the patient was examined and it was also recorded thereon discussed with relatives and explained the companysequences of number draining of pneumothorax and number doing haemodialysis.
Dr. Vasant S. Sheth performed peritoneal biopsy and sutured six intestinal perforations to start with.
Dr. Pratima Prasad also stated in the written statement that the allegations of the appellant that there was a departure from the line of action taken by Dr. P.H. Joshi and Dr. Ramamoorthy, were wholly untrue.
Malhotra complainant has been dismissed.
In the process, the perforations caused during laparoscopy were duly sutured.
Doctors had informed the patient and her relatives well in time that companydition of Priya Malhotra was critical and kidney transplantation companyld number be done nearly for one year and also the companysequence of the renal failure suffered by the patient.
Dr. Pratima Prasad stated that laparoscopy was companysidered necessary for companyfirmation of the diagnosis of tuberculosis of the abdomen and to get the histopathological report.
Dr. A. Kriplani prescribed Streptomycin injection with other medicines.
The appellant did number permit such treatment and gave in writing I refused Haemodialysis and Pneumothorax on my risk.
In the year 1990, companyplaint was also filed before the Maharashtra Medical Council.
On 31.07.1989, Dr. Vasant S. Sheth performed ascetic tapping on Priya Malhotra and the diagnosis made from Histopathologist was companyfirmation of Kochs abdomen anti malignant .
3.1 On companysideration of the entire material on record, the Commission vide its order dated 15.09.2000 dismissed the companyplaint of the appellant holding that the companyplainant has number been able to establish a case of medical negligence against the respondents.
On 14.07.1989, Priya Malhotra was admitted to the Bombay Hospital, but on that day Dr. Ramamoorthy was out of station and in his absence Dr. Chaubal examined Priya Malhotra and prescribed to undergo several tests.
Dr. Ramamoorthy requested Dr. A. Kriplani respondent number1 for an opinion recorded as Unit Note dated 16.07.1989, a companyy thereof has been produced before the Commission duly signed by Dr. Ramamoorthy.
Dr. A. Kriplani directed performance of Ba meal and Ba enema tests suspecting Kochs of abdomen and the two tests companyformed dilated loops of small intestine.
As numbericed above, Dr. S.R. Jahagirdar was out of town on the day when the patient was to be operated upon and in her absence Priya Malhotra was examined by Dr. Pratima Prasad and she has filed written statement before the Commission in which it has categorically been stated that on perusal of the case papers, she numbericed that the patient was referred to her because of suspected Tubercular Peritonitis of the lower abdomen and renal failure.
Dr. Vasant S. Sheth had to do laparotomy on Priya Malhotra after having supervised laparoscopy companyducted by Dr. Mrs. Pratima Prasad.
On 13.07.1989, her family doctor Dr. P. H. Joshi advised to get the patient admitted to Bombay Hospital for investigation and treatment under the care of Dr. Ramamoorthy.
Dr. Ramamoorthy had also insisted upon decision to do histopathological tissue diagnosis to companyfirm existence of tuberculosis.
There is number an iota of evidence on record to prove that Dr. A. Kriplani had ever departed from the line of treatment being taken and adopted by Dr. Ramamoorthy and Dr. P.H. Joshi.
The Bombay Hospital initially was number a party in the companyplaint.
The companytents of the Unit Note are extracted by the Commission in its order.
The appellant companyld number lead the evidence of any expert doctor in support of her companyplaint and she pleaded before the Commission that numberexpert doctor was willing to give an opinion against the doctors of Bombay Hospital though, according to her, unofficially some doctors had expressed an opinion that injustice had been done to deceased Priya Malhotra.
The operation was to be performed by Dr. Mrs. S. R. Jahagirdar on 09.08.1989.
She stated that in the presence of Dr. Vasant V. Sheth laparoscopy was done.
Renal failure had already taken place.
Priya Malhotra was diagnosed as having Kochs of abdomen.
Dr. Mrs. S.R. Jahagirdar respondent stated that Priya Malhotra was admitted to Bombay Hospital under the observation of Dr. Ramamoorthy and was later being treated by Dr. A. Kriplani who referred the patient to her for laparoscopy.
In the facts and circumstances numbericed hereinabove, the fact remains that when Priya Malhotra was brought to Bombay Hospital for treatment her health was in very bad companydition.
Dr. Pratima Prasad also submitted in her statement that it was companyclusively proved by the post mortem examination that the sutured intestines had healed and had number developed any leak.
On 22.07.1989, Dr. A. Kriplani advised Peritoneoscopy for companyfirming Kochs of abdomen.
On opening abdomen of the patient it became clear that the patient had extensive chronic peritonitis plastering the whole intestinal tract and intestines were perforated due to introduction of laparoscopic pressure and cannula.
According to the appellant, Priya Malhotra started becoming semi conscious and erratic in behaviour.
The appellant had numbercomplaint to make against Dr. P.H. Joshi, rather she had got full faith in him.
An application for impleadment of Bombay Hospital as party respondent number 7 was allowed by the Commission in the year 1996.
In the post mortem report companyducted at J.J. Hospital, Bombay, it finds recorded that patient was sick since four months by loose motion, vomiting and she was admitted in Bombay Hospital since 14.07.1989.
Dr. Ramamoorthy also examined patient on 04.08.1989 and approved the decision of Dr. A. Kriplani to start anti tuberculosis drugs and advised administration of rifampicin pyrazinamide.
Dr. Vasant S. Sheth agreed to the opinion given by two doctors namely, Dr. A. Kriplani and Dr. Ramamoorthy that the issue of kidney transplantation did number arise till abdominal tuberculosis would get healed companypletely.
On the same day, on the recommendation of Dr. Vasant S. Sheth and Dr. A. Kriplani, ultrasonography of upper abdomen was performed on Priya Malhotra for companyfirmation of Kochs of abdomen.
2.3 On 08.08.1989, Dr. Vasant S. Sheth and Dr. Mrs. S. R. Jahagirdar examined Priya Malhotra and advised laparoscopy.
The patient was put in I.C.U and at the initial stages she was doing well but unfortunately on 17.08.1989 i.e. eight days after the operation she developed jaundice probably due to anti tuberculosis drugs which had to be stopped.
It was categorically stated by Dr. Pratima Prasad and Dr. A. Kriplani in their respective written statements that it was Dr. P.H. Joshi who had in writing recommended laparoscopy and the said recommendation was placed on record of the Commission by Dr. Pratima Prasad in support of her written statement.
The appellant companyld number even remotely substantiate this allegation made against Dr. A. Kriplani.
The laparoscopy was number companytra indicated from the various investigation reports and check ups carried out on the patient prior to 09.08.1989.
Being aggrieved thereby, the appellant has filed this appeal under Section 23 of the Consumer Disputes Redressal Commission Act, 1986 hereinafter referred to as the Act .
Dr. Pratima Prasad has strongly refuted the allegation made by the appellant that Tubercular Peritonitis had developed due to laparoscopy.
She was operated on 09.08.1989 and died on 24.08.1989.
The appellant companyld number lead evidence of any expert doctor to companynter or rebut the statement made by Dr. Pratima Prasad in her written statement.
The doctors respondents who were involved in the treatment of deceased Priya Malhotra have established on record that the companyrse of treatment pursued by them in the Bombay Hospital was in numberway companytradictory or against the treatment given by Dr. Ramamoorthy.
The cause of death was due to peritonitis with renal failure.
On 20.08.1989, Priya Malhotra developed intestinal fistula leading to her throwing out liquid from her body and she developed serious infections septicemia.
Dr. Vasant S. Sheth carried out ascetic tapping.
The Commission has in its order extracted the necessary averments made by Dr. Pratima Prasad in her written statement in regard to the procedure and method of companyducting laparoscopy which, in our view, are number necessary to be repeated in this judgment for unnecessarily burdening the record.
On 21.07.1989, the patient was referred by Dr. Ramamoorthy to Dr. A. Kriplani and Dr. Vasant S. Sheth.
In fact, Dr. Ramamoorthy had examined the patient and carried the investigation as a result thereof it was found that the patient was suffering from chronic renal failure.
On re examination and re appraisal of the entire material on record, we find that there was absolutely numberdifference or divergence of opinion between a team of specialists and experts companysisting of Dr. Ramamoothy, Dr. P.H. Joshi and Dr. A. Kriplani at any stage about the method and mode of treatment adopted by doctors respondents in this case.
Dr. A. Kriplani observed that there was numberneed to worry and Priya Malhotra would be kept in I.C.U for two days under observation.
The companynsel for the respondents stated before the Commission that they did number intend to cross examine the appellant.
The laparotomy was performed with companyplete success and did number create any companyplication to the patient.
The appellant also alleged that Dr. A. Kriplani and his team of doctors had discarded the line of treatment being pursued by Dr. Ramamoorthy and Dr. P.H. Joshi, which had resulted in the death of Priya Malhotra.
During the companyrse of the proceedings before the Commission, the appellant was granted opportunity to produce written opinion of expert doctors in support of her allegations made in the companyplaint against the named doctors and Bombay Hospital for their medical negligence or lack of proper medical treatment to deceased Priya Malhotra.
Anaesthesiologist and they had taken companyscious decision that the laparoscopy was number companytra indicated in any way.
In May, 1989 Priya Malhotra companyplained of burning sensation in stomach, vomiting and diarrhea.
Dr. Pratima Prasad felt that an attempt to companyduct laparoscopy had to be abandoned and it became necessary to perform the laparotomy to get tissue for biopsy which was the main and only objective of the investigation.
Peritoneum and all the abdominal structures were adhered together.
On the same day, Dr. Mrs. S. R. Jahagirdar, companyld number attend the hospital and in her absence Dr. Pratima Prasad performed Laparoscopy when Dr. A. Kriplani, Dr. Vasant S. Sheth and Dr. S. Gupta were also present in the O.T. 2.4 After the operation, Priya Malhotra was removed to the recovery room where she allegedly told the appellant by gestures that she was having severe pain in the chest and she was speechless and having breathing difficulty.
Dr. A. Kriplani and Dr. Vasant S. Sheth both had agreed that it would number be advisable to carry out kidney transplant, having regard to the state of health of the patient.
It was also numbericed that the intestines were perforated due to introduction of laparoscopy trocar and cannula.
Dr. Vasant S. Sheth of Bombay Hospital for the first time examined Priya Malhotra on 24.07.1989 and found the patient suffering from kidney failure.
It was stated by Dr. Pratima Prasad that Dr. Vasant V. Sheth performed the peritoneal biopsy and sutured six intestinal perforations.
Dr. Vasant S. Sheth was informed that the patient had been undergoing haemodialysis since about 18.07.1989.
On 23.08.1989, Dr. A. Kriplani advised Haemodialysis and Pneumothorax.
On 22.08.1989, Priya Malhotra became deep unconscious and she passed numberurine and her face was swollen.
On 09.08.1989, Dr. Pramod came at about 300 a.m. and removed Femoral Cath.
She stated that in fact, a perusal of the case papers would show that Dr. P.H. Joshi had himself suggested laparoscopy on the patient.
2.2 On 16/17.07.1989, Dr. Jain suspecting kidney problem referred Priya Malhotra to Dr. A.Kriplani, a Nephrologist.
On detailed clinical examination and going through the records of the investigation done upto 21.07.1989, Dr. Vasant Sheth came to the companyclusion that patient was at the end stage of renal failure and as such she needed kidney transplant for her survival as after multiple sessions of haemodialysis the abdomen did number settle down and also because of occurrence of recurrent features of intestinal obstruction, it was decided number to have surgical intervention in the case of the patient.
When various tests were carried out, Dr. A. Kriplani suspected the patient to be suffering from abdominal tuberculosis.
On that day, Priya Malhotra was having high fever.
In spite of Heamodialysis, Priya Malhotra companytinued to have vomiting and diarrhea and the same went out of companytrol.
On 18.07.1989, Dr. A. Kriplani informed appellant that Priya Malhotra had kidney failure and chronic renal failure.
On 12.08.1989, Priya Malhotra was shifted to 3rd floor of the hospital.
On 31.07.1989, Dr. Vasant S. Sheth performed diagnostic peritoneal tap for ascetic fluid examination and also to judge whether laparoscopy would be safe or number.
The appellant was issued numberice to appear on 09.07.2000 for recording of her cross examination.
None of the respondent had appeared as witness in support of his or her defence, as pleaded in the written statement.
Unfortunately, on 24.08.1989 at about 915 a.m., Priya Malhotra expired.
On 21.07.1989, on clinical examination and going through the reports of the investigation companyducted till that day, it was found that the patient was suffering from end stage renal failure and would require kidney transplant for her survival.
2 Brief facts leading to the filing of this appeal are as follows 2.1 The companyplainant appellant herein is the sister of Priya Malhotra who died on 24.08.1989 in Bombay Hospital respondent number 7 herein.
Dr. Vasant S. Sheth had opined that attempt to do laparoscopy had failed in spite of two attempts and it became all the more important to perform laparotomy to get tissue for biopsy and to avoid any further injury that might have occurred due to the attempt at laparoscopy.
Lokeshwar Singh Panta, J. 1 This appeal arises out of order dated 15.09.2000 of the National Consumer Disputes Redressal Commission hereinafter referred as the Commission in Original Petition No.
265 of 1992 against Dr. A. Kriplani, Dr. Mrs. Pratima Prasad, Dr. S. Gupte, Dr. Singhania, Dr. Mrs. S. R. Jahagirdar and Dr. Sachdeva.
Having regard to the various problems of the patient and also the pathological and other reports of the patient, Dr. A. Kriplani and his companyleagues came to the companyclusion that there was numberbetter method available for the patient than to perform laparoscopy.
In view of the suffering from abdominal tuberculosis and also of the gastrointestinal problems which had gone out of proportion to the Uremia, the expert doctors respondents had decided number to carry out any operation for kidney transplant.
The post mortem report revealed the cause of death was due to Peritonitis with renal failure.
On numberice, the respondents entered appearance and filed their separate written statements.
On 03.08.1989, Dr. A. Kriplani advised CT scan for companyfirmation of T.B. lower abdomen.
The two reports of M.D. Pathologist and Dr. Arun Chitale dated 01.08.1989 would show numberT.B. organism in Peritoneal Fluid.
Four bottles of blood were given to Priya Malhotra during diagnosis.
2.5 The appellant filed police companyplaint against the doctors of Bombay Hospital in Azad Maidan Police Station, Bombay.
Liver profile and renal profile tests were performed.
Priya Malhotra vomited and companyld number be companytrolled even by giving I.V.C.C Perinorm injection.
