FARANGI LAL MUTNEJA vs SRI GURU HARKRISHAN SAHIB EYE HOSPITAL, SOHANA

THIS complaint was initially instituted in the Punjab State Consumer Disputes Redressal Commission, Chandigarh and subsequently it was transferred to this Commission by the Hon''ble National Commission.

BRIEFLY stated the facts are that the complainant is a senior citizen, aged 72 years and a resident of Abohar for the last so many years. The complainant had vision problem in his left eye and he came to know about the good reputation of the above said hospital and visited the said hospital accompanied by his son on 13.5.2000 for checkup of his left eye and was registered as a patient under OPD No. 4619 (CR No. 521/2k). After preliminary checkup, he was examined by Dr. Nivedita Singh who advised him to go for operation of left eye and referred him to Dr. Gurmeet Singh, Medical Superintendent of the hospital, respondent No. 2 for final checkup and fixation of the date of operation. He was thoroughly examined by Dr. Gurmeet Singh and both his eyes were checked up from all angles by various machines and instruments used in the eye checkup and decided to operate the left eye, at the very earliest. The respondent No. 2 advised him to go for routine tests like ECG, Blood and Urine Tests, etc. from the in-house laboratory immediately. He got all the tests done as advised and all his reports were 100% normal, which were examined by the said Doctor and found the complainant fully fit for the operation of his left eye and advised him to come to the hospital on 15.5.2000 for depositing of fees and completion of other formalities. He reported to the said Doctor on 15.5.2000 and though, he wanted to have Phaco Lens Operation which costs Rs. 7,000 but on the specific advice of the said doctor, he agreed to go for Phaco Folding Lens Operation which costed Rs. 11,200 as he was assured by Dr. Gurmeet Singh that the said operation needed minimum cut, gives less pain and shows best result and also the eye heals immediately. Thus, he was advised to report on 16.5.2000, the very next day, at 7.30 a.m. for conducting the operation of his left eye. Out of the requisite amount of Rs. 11,200, the complainant deposited Rs.10,000 on the same day and promised to deposit the remaining amount on 16.5.2000, prior to the performance of the operation, which he did on the next day. It was next averred that on 16.5.2000, the complainant accompanied by his son and other relatives reached the hospital and reported to the ward at 7.30 a.m. sharp. He saw an extra ordinary rush in the hospital about which he was informed that some camp was being organized on that very day and a large number of eye operations were to be performed by the respondent No. 2 Dr. Gurmeet Singh. He was advised not to bother about the rush and that the eye drops needed prior to the conduct of operation were put into his left eye for the Dilation of the Cornea, around 7.50 a.m. He had gathered knowledge before the operation that the process of putting of eye-drops in the eye to be operated starts about two hours before the operation and only after that the operation is conducted by the doctors. However, in his case, he was called in the operation theatre barely within 20 minutes after the process of putting in the eye-drops for the dilation of the Cornea had started. Astonished and shocked the relatives of the complainant enquired from the ward boy for the hurry, which could have adverse effects, they were told that the first patient, a lady, had started vomiting due to fear and, therefore, the complainant was to be operated upon. Though, the attendant nurse told the ward boy that the patient was not fit for the operation as only few minutes had passed when the eye-drops had been put, yet the ward boy did not at all listen to the fair and proper advice of the nurse and virtually dragged the complainant to the operation theatre.

It was further averred that inside the operation theatre, the complainant repeatedly told the doctor about the advice of the nurse and the very short duration of putting in the eye-drops for dilation of the Cornea and requested him to operate him later on, as there was no hurry, but everything fell on deaf ears. The said doctor angrily told the complainant that the operation could not be delayed as the machine was fixed for Phaco Folding Operation and they had to perform these operations first of all in the morning and only thereafter the machine was to be changed for other operations; and the Doctor started operating his left eye immediately. During the operation, the Doctor also kept on attending the lady, who was to be operated upon first and who had been vomiting and there was no concentration by the Doctor on a single operation as he had divided attention. In fact, most of the operation was conducted by the Assistant Doctors and within a gap of 20 minutes the operation was over. Though, he had paid the required amount and was eligible for the private room, yet he was not given the same and was made to lie on a bed in the ward. Further, he was asked to leave the ward at about 9.30 a.m. in spite of his complaint of pain and uneasiness as the campatients were waiting and ultimately he was made to leave the hospital ward at 10.00 a.m., whereas he would have been allowed a private room; the charges for which were included in the fees. Thereafter, he was advised to report for the removal of the bandage on 17.5.2000 at 8.00 a.m. When the bandage was opened by Dr. Gurmeet Singh, on next date i.e. 17.5.2000, nothing was visible to him and it was all thick fog/curtain before his left eye, whereas, in such operations, if performed perfectly, the visibility becomes almost 100% clear on the very next day. The said Doctor assured him not to worry and prescribed certain medicines and asked to report on 20.5.2000. However, on 20.5.2000, there was only 5-7% visibility/improvement and the said Doctor prescribed more medicines for a week but he became greatly worried and highly tense as he felt that he had lost his left eye.

IT was next averred that complainant consulted the eye-specialists of national repute as well as the Emergency Health Care Ward of Govt. Medical College Hospital, Sector 32, Chandigarh, on 23.5.2000 and he was told that his Cornea had been permanently damaged due to some surgical lapse during the operation and the only treatment for this was Cornea Transplantation. Respondent No. 2 was informed on 27.5.2000 about the same who refused to accept the reports/remarks and advised to continue the medicines and to visit again on 31.5.2000. On 31.5.2000, Dr. Gurmeet Singh advised him to go back to home town as the recovery of Cornea was to take 5-6 months and prescribed medicines. Thereafter, he left for his home town (Abohar) and continued the treatment prescribed by the said Doctor and remained in touch with the said Doctor on his phone/mobile, through his son, who was based locally. But even after continuing the treatment of Dr. Gurmeet Singh for about 6 months, there was no improvement in the vision, rather the condition of his eye further deteriorated. It was further averred that on seeing NIL improvement and the neglected response of the said Doctor, another famous Doctor (Eye Surgeon) of Fazilka was consulted by him who told that the chances of visibility in the left eye were NIL and hence, he gave a notice on 20.12.200 in response to which the said Doctor called him to the hospital at Sohana for check-up and he visited the hospital on 1.1.2001. Again he was advised to continue the medicines and also stated that his Cornea would be transplanted within one month, if there is no improvement. But, neither there was any improvement in the eye-sight, nor the said Doctor called him for Eye transplant. Thus, he again gave a notice on 3.3.2001.

IT was next averred that after reading a Newspaper item that some foreign Surgeons were visiting at Sohana Eye Hospital, the complainant visited the hospital on 7.3.2001 and was examined by Dr. Allan Stocks of USA, in the presence of Dr. Gurmeet Singh and others. Dr. Stocks also corroborated the version of the other reputed doctors and that of the Govt. Medical College and Hospital, Chandigarh that the Cornea had been damaged. This was also agreed by Dr. Gurmeet Singh and others who examined the left eye of the complainant on the asking of Dr. Stocks in his presence. Dr. Stocks also advised Dr. Gurmeet Singh that the only remedy left in the case of the complainant was '' Cornea Transplant'' and that on this, respondent No. 2 immediately rang up the Counsellor of the Hospital and asked her to note the name of the complainant on the Diary/Register for eye transplant. Dr. Stocks checked the right eye of the complainant and told him to go for immediate operation of the right eye as the same was also affected by cataract and transplant of left eye was a prolonged treatment with the less success rate . Thereafter, after depositing a sum of Rs. 1,000 he was operated upon by Dr. Stocks for the right eye and the operation was 100% successful and he deposited the balance sum of Rs. 5,000 with the hospital out of balance fee of Rs. 10,2000 as per the instructions of Dr. Gurmeet Singh given to the counter clerk. IT is stated that the fee concession was given to him by Dr. Gurmeet Singh to compensate him. Thus, alleging deficiency and negligence in performing operation on the part of Dr. Gurmeet Singh, complainant claimed a sum of Rs. 9,40,300 as compensation. Respondents contested the complaint and filed joint written reply. They took preliminary objection; that the complainant is not a consumer. On merits, it has been admitted that the complainant was operated upon in the left eye by respondent No. 2 on 16.5.2000, after conducting the tests required for the operation. It has also been admitted that the complainant had a vision problem and that he visited the hospital on 13.5.2000 for checkup vide OPD No. 4619 (CR 521/2K). It has been admitted that the complainant reported to the respondents on 15.5.2000 but it is denied that the respondent No. 2 advised him to go for the costly Phaco Folding Lens Operation while the complainant was inclined to have Phaco Lens. In fact, the advantages of both the lenses were explained to the complainant and decision to go for the Phaco Folding Lens Operation was of the complainant. With regard to the dilation, the stand of the respondents is that the complainant was given eye-drops for dilation of pupil and was taken to operation theatre only after required dilation was done. It has been denied that the nurse on duty said that the dilation was not proper. It has further been stated that the state of dilation was to be decided by the Doctor and not by anybody else. Further, it has been stated that the operation timings of the hospital start from 8.30 a.m. and the complainant was third patient to be taken into the operation theatre for surgery and the procedure for dilation had started at 7.50 a.m. Hence, the complainant was taken into the Operation Theatre only after proper dilation. It has been denied that the complainant was virtually dragged into the operation theatre by the ward boy against the advice of the nurse. It has also been denied that the respondent No. 2 had hurriedly operated upon the eye of the complainant despite his repeated pleadings. It has been stated that the hospital being run by the respondent No. 1 is one the best in Northern India, well equipped having three operation theatres and nine doctors/eye surgeons, so, there is no question of doing a particular type of operation at a time. It has been denied that the respondent No. 2 was attending some other lady while performing his operation. It has also been denied that the fee deposited by the complainant included charges towards private room; rather it has been stated that the fee deposited by the complainant was towards the operation fee and cost of lens. It has also been denied that the complainant was asked to leave at 9.30 a.m. It has been stated that the complainant himself insisted to go home and since, the nature of surgery conducted on him did not require a longer hospitalization, hence, he was allowed to go home. It has been admitted that the complainant visited for followup on 17.5.2000 and the bandage was done. It has been further stated that he did not bother to come for next checkup after 31.5.2000 and thereafter he never came to him till January 1, 2001, after getting treatment from different doctors. Thereafter, respondent No. 2 again checked his eye and informed that his Cornea was damaged and only treatment was Cornea transplant. It has been admitted that on 7.3.2001, complainant again visited the hospital for the checkup of his right eye which was checked up by respondent No. 2 and Dr. Allan Stocks and the complainant was informed that the right eye too requires surgery. It has been denied that the respondent No. 2 agreed to Dr. Stock''s opinion regarding the damage to the complainant''s Cornea. It has also been denied that Dr. Stocks advised respondent No. 2, in fact, Dr. Stocks agreed with the opinion of respondent No. 2 that Cornea of the complainant needed transplantation and the respondent instructed the Counsellor to register the complainant''s name for transplant. It has been denied that there was any negligence on the part of the respondent No. 2, rather it has been stated that if at all there was any negligence it was on the part of the complainant and not the respondent. It has been stated that the complainant knew very well that he himself had got his eye damaged by not reporting for followup treatment, that is why he came to respondent No. 1 for the operation of his right eye. It has been denied that the respondent No. 2 was having any guilty complex and offered any fee concession to the complainant. Since, the complainant was unable to meet the expenses for the second operation, that is why he was provided concession. It has been denied that the fee concession for the operation of right eye was provided to compensate the complainant.. It has been prayed that the complaint be dismissed.

THE Punjab State Commission vide order dated 25.6.2002, after hearing Counsel for the parties found that it was not a case of prima facie negligence to be tried by the Commission in the summary proceedings and consequently relegated the complainant to approach the Civil Court for appropriate relief and, thus, dismissed the complaint.

AGGRIEVED by the said judgment, complainant filed appeal in the National Commission. The National Commission vide order dated 18.2.2005 set aside the order of Punjab State Commission and remitted the complaint to the State Commission for fresh decision on merits by holding that it was not proper for the commission to relegate the complainant to the Civil Court for redressal of his relief and if there was some contradiction regarding the period of mydriasis ''dilation'', then State Commission could have obtained expert opinion. A miscellaneous application was also filed by the complainant in the National Commission. The National Commission rejected the application of the complainant for summoning record of other patients and to cross-examine OP No. 2 with respect to that record. However, it accepted the application of the complainant for appointment of expert to take expert opinion vide order dated 27.3.2006. We have heard Mr. Viney Kumar Mutjena, son of Sh. Farangi Lal Mutneja, complainant, Ms. Adarshpal Kaur, Counsel for respondents and carefully gone through the file.

The complainant has raised 2-3 points in the complaint ; first that the proper dilation of left eye was not done before conducting operation for cataract by way of Phaco Folding Lens Operation and secondly the left eye operation was done in a hurried manner, although, his was second turn but the woman who was to be operated upon first started vomiting and he was called in a hurried manner for operation first of all; further Dr. Gurmeet Singh had been attending to that woman patient during his operation and as such it was not done in a due care manner. It was also pleaded that post-operative care was not done properly and as such the cornea of left eye was damaged due to negligence of respondent No. 2.

NOW main question to be determined is whether Dr. Gurmeet Singh Mangat-respondent No. 2 of Sri Guru Harkrishan Sahib Eye Hospital, Sohana (Punjab) had conducted the operation of the left eye of complainant by Phaco Folding Lens operation negligently. The complainant had also filed complaint with the Medical Council of India against respondent No. 2. The Medical Council of India obtained expert opinion of two well known institutions i.e. Guru Nanak Eye Centre, New Delhi and Dr. R.P. Centre for Ophthalmic Sciences, New Delhi to know whether Dr. Gurmeet Singh Mangat had acted negligently in performing operation on the left eye of the complainant. After obtaining expert opinion, the Medical Council of India came to the conclusion that there was no negligence on the part of Dr. Gurmeet Singh Mangat-respondent No. 2. The letter of Medical Council of India dated 2.8.2006 reads as under; "Subject: Complaint against Dr. Gurmeet Singh Mangat, Medical Suptd. (Eye Surgeon), Shri Guru Harkrishan Sahib, Eye Hospital, Sohana, District Mohali. Sir, With reference to your complaint dated 3.11.2005 and all other correspondence/documents sent by you, I am to state that the above matter was considered by the Ethics Committee at its meeting held on 10th and 11th July, 2006. In this context, the Ethics Committee heard Dr. Gurmeet Singh Mangat and also considered the opinion of the experts received from Guru Nanak Eye Centre, New Delhi as follows-

"After going through all the documents enclosed with the complaint of Farangi Lal Mutneja against Dr. Gurmeet Singh Mangat, who was operated by the said doctor on 16.5.2000 for phacoemulsifi-cation with foldable intraocular lens. We are of the opinion that- (a) The patient has a complication of severe corneal oedema post phaco-emulsification. (b) Normally this edema settles with time but in this patient, this did not settle. Pseudophakic corneal oedema is a known complication of phaco-emulsification with intraocular lens and treatment for which is corneal transplantation. There does not seem to be any negligence on the part of the alleged doctors. "

Further the Ethics Committee considered the opinion of Dr. R.P. Centre for Ophthalmic Science, New Delhi which reads as follows- "From the available records with us, Farangi Lai Mutneja (who was operated on 16th of May, 2006 at Shri Guru Harkishan Sahib Eye Hospital, Sohana, Distt Mohali by Dr. Gurmeet Singh Mangat) had undergone proper pre-operative checkup and investigations for phaco-emulsification surgery for his Left Eye Catarat. The fact that the surgical time was only 20 minutes indicates that there were no major surgical problem in his case. Corneal oedema is a known complication of cataract surgery and Phaco-emulsification Surgery especially in hard cataracts Corneal oedema is normally appreciated in immediate post-operative followup. Therefore, the treatment for corneal edema had been given to the patient from the first post-operative day. Medical Management with hyperosmotic drugs is continued for reasonably long time till patient recovers or requires surgical management with corneal graft. Corneal grafting can restore vision in such eyes and it should be performed after at least six months of non-recovery of corneal oedema. In this case, standard treatment protocol had been followed and optimal procedures have been carried out. We, therefore, consider there has been no act of negligence on part of the treating doctors. After detailed deliberations, the ethics Committee was of the opinion that no negligence could be substantiated on the part of Dr. Gurmeet Singh Mangat. Yours faithfully, (DR. P. PRASNNARAJ) JOINT SECRETARY"

Therefore, as stated above, the Medical Council of India, after obtaining the expert opinion from two institutions came to the conclusion that standard treatment protocol had been followed and optimal procedures had been carried out and as such there had not been any act of negligence on the part of treating doctor. The Ethics Committee also held detailed deliberations and came to the conclusion that no negligence on the part of Dr.Gurmeet Singh Mangat had been substantiated. Therefore, in view of the opinion of the Ethics Committee of the Medical Council of India, which is based on reports of two expert institutes, there is no need to appoint any expert to know whether the respondent No. 2 had acted negligently in performing operation of the left eye of the complainant. All the documents produced by the complainant and the complaint of complainant were taken into consideration for giving the opinion. Hence, in view of the opinion of Medical Council of India, we hold that no negligence on the part of Dr. Gurmeet Singh Mangat-respondent No. 2 had been substantiated. Consequently, the complaint is dismissed. However, parties are left to bear their own costs.

COPIES of this order be communicated to the parties, free of charge. Complaint dismissed.