B.NARASAIAH vs KANDE LAXMAIAH

THE wife of the complainant in C.D. 30/91, namely Kande Lingamma was taken to the 1st opposite party i.e. Dr. B. Narasaiah of Amangal, Mahaboobnagar District as she was suffering from severe stomach pain and continuous vomitings on 15.7.1990. THE 1st opposite party prescribed some medicines and the patient was asked to be brought after 4 (four) days. On 19.7.1990, the complainant and his wife went to the lst opposite party, who advised them to get an X-Ray. After seeing the X-Ray, the 1st opposite party diagnised that the complainant''s wife was suffering from Chronic Appendicitis and advised operation. On 28.7.1990, the complainant''s wife was admitted in Soujanya Nursing Home i.e. 2nd opposite party and was operated by the 1st opposite party on the same day and was discharged on 8.8.1990. THE complainant paid the necessary amount. But after four days, after discharge, the complainant took his wife to the 1st opposite party as she was having vomiting. THE 1st opposite party prescribed some medicines and gave injection and the complainant''s wife was thereafter taken for doctor''s treatment two or three times within 22 days. As the health of the complainant''s wife was deteriorating, on 2.9.1990 the 1st opposite party advised the patient to be taken to Osmania General Hospital, Hyderabad. According to the complainant, the Dy. Medical Officer who examined her got anguish regarding the mode of treatment and surgery done by the 1st opposite party and after testing he diagnised that the complainant''s wife was suffering from Cancer. She, thereafter underwent two operations and after the 2nd operation, she expired on 15.9.1990. Alleging that due to wrong diagnising that the complainant''s wife was suffering from Appendicitis and conducting operation for Appendicitis by the 1st opposite party, the complainant''s wife died, the complainant, claimed a compensation of Rs. 75,000/- including the costs of medicines and other expenses from the 1st opposite party with costs.

THE 1st opposite party filed a counter stating that he advised the wife of the complainant to undergo surgery, as she was suffering from Chronic Appendicitis and that to rule out the real or uretericstone which some time mimios Appendicitis. X-Ray was taken and as she expressed her unwillingness to go to Hyderabad for the surgery and insisted to prescribe some medicines. So a course of antibiotics and antiinflamatory drugs were given to her and she went to her village. Again she was brought to the 1st opposite party on 29.7.1990 with severe pain. THEn the 1st opposite party advised emergency surgery, but due to administrative reasons as the same could not be performed in Primary Health Centre in which the 1st opposite party is working, the patient was admitted in the Soujanya Nursing Home i.e. 2st opposite party''s Nursing Home and the 1st opposite party operated and the inflamed Appendicitis was removed and sent for Histopathological examination which confirmed the diagnosis of the acute appendicitis. Some time after she was discharged she was again brought to the 1st opposite party once or twice for routine check up, but she did not complain any pain. It was only on 1.9.1990 she again came with vomitings and was found to have distension of her abdomen and no mass fell through rectal examination. She was managed conservatively for submitted intestinal obstructions with fluids and nasogastric aspirations, but as there was no relief due to these medicines, she was referred to the Osmania General Hospital for further management. As she was admitted in Osmania General Hospital and as she actually died on 15.9.1990 in Osmania General Hospital after two operations, the diagnosis made is correct and there is no negligence on the part of the 1st opposite party in removing the Appendicitis. Hence there is no negligence or deficiency of service on the part of the 1st opposite party. The complainant gave evidence as PW 1 and Exs. A-l to A-7were marked on behalf of the complainant. The 1st opposite party was examined as RW 1 and Exs. B-l to B-12 were marked and the Case Sheet of the Kande Lingamma maintained by the Osmania General Hospital was marked as Ex. C-1.

On consideration of the material, the District Forum found that in the Case Sheet of the Osmania General Hospital (Ex. C-1) at page 12, there was noting dated 3.9.1990 as doctors'' orders "To, DSO (Gen.) Unit I, Sir, This is a case of Malignancy Rectosigmoid Junction with 10 patient underwent Colostomy now in shock, please examine and do the needful". Relying on the said entry, although Ex. B-4 which is Histopathology/Cytology examined report dated 30.7.1990 confirm the acute Appendicitis after examining the specimen of Appendix measuring 4x1x1 Cms. No malignancy was seen in the sections studied. In Ex. B-8, the affidavit of Dr. B. Nagendar, Civil Asst. Surgeon, Civil Hospital, Suryapet (A.P.), he says that "after initial examination and necessary investigation diagnosis of internal obstruction was confirmed and that the patient recovered after surgery and developed burst abdomen in the peritonitis post operatively on the right side while as Appendicitis operation was left side of the abdomen.

THE District Forum held that the patient was suffering from Cancer and the 1st opposite party wrongly diagnised as Appendicitis and conducted the operation, due to which the complainant''s wife died. THE complaint was allowed in part directing the opposite party No. 1 to pay a sum of Rs. 10,000/- and Rs. 200/- as costs and dismissed the complaint as against the 2nd opposite party. Aggrieved by the said order, the 1st opposite party preferred this appeal.

IT is not in dispute that the complainant took his wife to the 1st opposite party on 15.7.1990 for treatment for stomach pain and vomitings and the 1st opposite party prescribed some medicines. But according to the 1st opposite party, he advised them to get X-Ray done. But the complainant did not take any X-Ray. Again on 19.7.1990, the complainant took his wife to the 1st opposite party who advised them to get X-ray and it was diagnised that the complainant''s wife was suffering from Chronic Appendicitis. On 28.7.1990, she was admitted in the 2nd opposite party Nursing Home and was operated by the 1st opposite party for Appendicitis. After remaining in the Hospital for 12 days the patient was discharged on 8.8.1990. Again after four days, according to the complainant his wife developed vomiting and the 1st opposite party prescribed medicines and injection and was treated as Out Patient and the complainant''s wife was taken to the 1st opposite party at Amangal Primary Health Centre two or three times when the complainant''s wife was taken to the 1st opposite party on 1.9.1990 with constant and slight distension of abdomen for three days duration, the 1st opposite party diagnised and gave conservative treatment. As there was no relief she was referred to the Osmania General Hospital on 2.9.1990 and an operation was done in Osmania General Hospital on 3.9.1990 and again on 15.9.1990 and the complainant''s wife died in Osmania General Hospital on 15.9.1990. According to the complainant, the 1st opposite party wrongly diagnised the ailment of his wife as acute Appendicitis, but Ex. C-l the case sheet of the Osmania General Hospital shows that she was suffering with Malignancy Rectosigmoid i.e. Cancer and the doctors at Osmania General Hospital expressed that the 1st opposite party wrongly diagnised it as Appendicitis and should not have conducted the operation. In order to appreciate whether the 1st opposite party wrongly diagnised the ailment of the complainant''s wife, there was no material in Ex. C-l, the original case sheet and in Exs. B-5 and B-6 which are the xerox copies of the case sheet of Osmania General Hospital it was mentioned that the complainant''s wife was suffering from Appendicitis and the 1st opposite party conducted the operation wrongly. There was no mention anywhere in the case sheet that the complainant''s wife did not suffer from Appendicitis or that the 1st opposite party''s diagnosis is wrong. Rw 1 stated that on 19.7.1990 X-Ray was taken and after seeing the X-Ray film, the 1st opposite party ruled out the real or ureterictone and the inter abdominal conditions which might mimic Appendicitis and he prescribed medicines mentioned in Exs. A-2 to A-4 and A-9. After conducting the operation, and removing the Appendicitis, the specimen of Appendicitis was sent to Kapadia Diagnostic Centre for Histopathological examination and the said Diagnostic Centre reported on 30.7.1990 as could be seen from Ex. B-4 that the specimen of 4 x 1 x 1 cms. appears inflamed and edematous. Cut Section : mucosa appears inflamed and under miscroscopic examination it was stated that "Sections show mucosa lineal by tall columnar epithelium with normal appearing nuclei. Mucosa and sub mucosa are infiltrated with inflanuton cells both acute and chronic. Areas of haemorrhage and dilated blood vessels are seen. Muscle walls are infiltrated with inflamators cells". It was diagnised as "no malignancy is seen in the sections studied. Findings suggest acute Appendicitis'''' The report clearly reveals that the complainant''s wife suffered from acute Appendicitis and the 1st opposite party diagnised it rightly and removed the Appendix. Reliance is placed by the District Forum on an entry made in Ex. C-l at Page 12 i.e. doctor''s orders. Evidently after the 1st operation was conducted on 3.9.1990 as could be seen from page (6) of the case sheet. Dr. Nagendar''s operation note show that D.S.O., Dr. Krishnaiah and Dr. Nagendar conducted the operation and were assisted by Dr. D.D. Bung. It shows that the nature of the operation was exploratory laprotomy + Decompression of Bowel + Transverse Loop Colostomy the figures are mentioned as much below. Obstruction of incision and the midline incision. The findings show that distended sigmoid, Transverse, Ascending, Colon and Carcum, hard mass felt at Rectosigmoid Junction fixed to Sacrum. In the entry at page 12, it was stated by Dr. Nagendar "To, DSO (Gen.), Unit I, Sir, This is a case of Malignancy Rectosigmoid junction with I.O. Patient underwent Colostomy now in shock, please examine and do the needful". In the reverse of page 12, the DSO made an entry stating "seen by DSO (Gen) Patient Conscious, Coherent, Tongue dry. Temperature normal and to continue the same treatment. I.V. Fluids, R. Lactate 10, etc. It is, therefore, clear from the history of the case mentioned in the case sheet of the Osmania General Hospital that the patient was suffering from vomitings 20 days distension and constipation and it was diagnised as intestinal obstruction. That the second operation was performed on 15.9.1990 for burst abdomen. Thus the entry at page 12, merely stated that there is some malignancy. But the DSO was requested to examine and do the needful and the DSO examined the patient and did not say there is any malignancy. Hence, in our view the District Forum erred in solely placing reliance on page 12 of the Case Sheet (Ex. C-1) and in coming to the conclusion that the patient was suffering from Cancer and that the 1st opposite party wrongly diagnised as Appendicitis. Ex. B-4, the third party affidavit. Dr. B. Nagendar who was present at the time of the operation on 3.9.1990 and on 15.9.1990 as could be seen Ex. B-5 gave an afridavit marked as Ex. B-8. In the said affidavit he stated that Mrs. K. Lingamma wife of K. Laxmaiah hereinafter referred to as the patient was referred to Osmania General Hospital from PHC Amangal by Dr. B.Narasaiah with the diagnosis of internal obstruction on 2.9.1990. After initial examination and necessary investigation diagnosis of internal obstruction was confirmed and she was opera ted on 3.9.1990 at 4.00 a.m. at Osmania General Hospital. The operation findings were Appendictomy M.C. Bumery incision, scar, large bowel obstruction due to obstructing lession at Rectosigmoid Junction. Transverse Colostomy done. The patient recovered after surgery. The patient developed burst abdomen with peritonitis post operatively. She was operated again on 15.9.1990 at Osmania General Hospital, where she died on the same day. On examination of the patient on 2.9.1990 it could not have been said that the Appendictomy was a wrong diagnosis. The diagnosis and treatment was absolutely correct. No statement was made in the case history of the patient that her condition was because of the appendictomy earlier. The statement made by Mr. K. Laxmaiah that we Doctors at Osmania General Hospital made the diagnosis of cancer as soon as we saw patient is false. The diagnosis of recurring Appendicitis for which Appendicitis was done was never contested by the Medical Staff of the Osmania General Hospital. The death of Mrs. K. Lingamma was not attributed to any previous surgery. The Affidavit clearly discloses that the 1st opposite party is not negligent either in diagnising the ailment of the complainant''s wife as Appendicitis and in conducting the operation thereon. The action of the 1st opposite party was supported by Ex. B-4 and the extracts of Ex. B-5, the operation notes and we are, therefore/satisfied that there is no negligence on the part of opposite party No. 1 in diagnosing or in conducting the operation and in removing the Appendix.

FOR all the aforesaid reasons, we allow the appeal and set aside the order of the District FORum. There shall be no order as to costs in this appeal. Appeal allowed.