G P Gupta vs Mehrotra Pathology

THIS appeal is directed against judgment passed by the U.P. State Consumer Disputes Redressal Commission, Lucknow (in short ''the State Commission''), in Complaint Case No. 27/SC/1999. By the said judgment, the State Commission dismissed the complaint.

THE appellant is the original complainant and was husband of deceased Smt. Subhadra Kumari Gupta. He died during pendency of the appeal. The legal representatives have been substituted in his place.

BRIEFLY stated, the complainant''s case was that his wife was admitted at Gandhi Memorial and Associated Hospitals, Lucknow (now known as King George''s Medical University) on 27.11.1996. She was suffering from abdominal pains. As a result of investigations, she was diagnosed as suffering from a disease called obstructed "umbilical hernia". She was advised to undergo operation by Dr. L. Kakkar of the said hospital. On 21.12.1996, the operation was performed. During course of operation, the surgeon suspected that the patient (Smt. Subhadra Kumari Gupta) was suffering from cancer. Therefore, a specimen of intra-abdominal mass with multiple lymphnode nodules was collected for biopsy/investigation. The specimen was sent to the Pathological Laboratory of the respondents. On 25.12.1996, the respondents gave report of Pathology examination. The report of the respondents indicated diagnoses as "Calcified Caseous Necrotic Nodules". The complainant''s wife was treated thereafter for abdominal Tuberculosis on the basis of the Pathological report submitted by the respondents. The complainant''s wife was discharged on 1.1.1997 by KGMU hospital which had advised her to continue the prescribed medicines. Though, the medicines were taken as prescribed, yet, his wife suffered from prognosis. Because of vomiting, she was again admitted to the KGMU hospital on 24.3.1997. On 16.4.1997, she was operated. The surgeons noticed malignancy and as such, collected the omental tissues and, sent it to another Pathologist, namely, Dr. K.M. Wahal. The second pathological report indicated that she was suffering from cancer. The complainant further alleged that his wife was discharged on 24.4.1998 by the KGMU hospital. He continued to give the medicines prescribed for treatment. Still, however, she died on 5.5.1997.

THE main allegation of the complainant was that while performing the biopsy-investigation of the specimen, on the first occasion, the opposite parties committed gross negligence. The pathological report was totally erroneous. Obviously, instead of giving treatment for cancer, the complainant''s wife was treated for Tuberculosis. She died due to malignancy which was result of reckless and negligent pathological report of the opposite parties. Hence, he filed complaint for compensation of Rs. 16,50,000.

BY filing their written version, the opposite parties denied any gross negligence on their part. They submitted that the surgeon did not specify the location of the biopsy and exact source of material when the specimen was sent to them on 21.12.1996. They submitted that diagnosis given by them was "Calcified Caseous Necrotic Nodules", which did not mean presence of abdominal Tuberculosis. They denied that they committed any medical negligence at the time of issuing the pathological examination report on 21.12.1996. According to them, they had clearly stated in the report that no well-formed tubercular granulomas were seen at the relevant time. They submitted that there was no definite opinion given about the Tuberculosis. Consequently, no negligence could be attributed to them. They further submitted that KGMU hospital was the necessary party to the proceedings because the complainant''s wife was treated in the said hospital on two occasions. They further submitted that the treating doctors had not called for any further details. They submitted that on the basis of erroneous interpretation of their report, the complainant''s wife was treated as patient of abdominal Tuberculosis. They, therefore, sought dismissal of the complaint.

THE parties adduced necessary evidence before the State Commission. The State Commission held that the pathological report of the opposite parties could not be treated as final diagnosis of Tuberculosis. The State Commission held that the first report of the opposite parties was dated 25.12.1996 and the second specimen was sent to another Pathologist, namely. Dr. K.M. Wahal in the month of March, 1997 and in the meanwhile, there could be rapid growth of cancerous cells. Consequently, the complaint was dismissed.

WE have heard learned Counsel for the parties. The material point that arises for determination in this appeal is: Whether it is established by the deceased complainant that the opposite parties committed "gross negligence", while giving the report of histopathology examination in respect of the specimen sent to them on 21.12.1996?

THE learned Counsel for the appellant submitted that diagnosis of the specimen examined by the opposite parties was totally incorrect and misleading. He argued that the opposite parties ought to have seen presence of cancerous cells at the very first time of examination. It is pointed out that in view of the second report of Dr. Wahal, it is explicit that the opposite parties committed gross negligence while giving the pathological report. He, therefore, submitted that the impugned judgment is improper and incorrect. Per contra, learned Counsel for the respondents supported the impugned judgment.

AT the outset, it is important to notice that the patient i.e. deceased Subhadra Kumari Gupta was taken to the KGMU hospital, Lucknow on 27.11.1996 for the first time. At that time, the diagnosis was obstructed "umbilical hernia" and, therefore, she was advised to undergo operation by Dr. L. Kakkar. Though, it was the case of the deceased complainant that the operating surgeon suspected cancer and, therefore, the biopsy test was conducted, yet, we did not find any reference letter of Dr. Kakkar which indicated his suspicion of malignancy. What appears from the record is that only advice was given to obtain "histopathology report of the specimen". The said report, however, shows that only one small piece of the abdominal section was forwarded for the purpose of examination. The report of the opposite parties reads as follows: "Microscopic-Sections from both the specimens A and B show similar appearances. They show fatty tissue surrounded by encapsulated masses. The centre of the masses consists of calcified areas of caseous like coagulative necrotic material. This is surrounded at the periphery by concentrically arranged newly formed fibrocollagenous tissue. Small number of chronic inflammatory cells are distributed in the connective tissue surrounding these masses. No well formed tubercular granulomas are seen."

THE report of the opposite parties shows that small number of chronic inflammatory cells are distributed in the connective tissues surrounding these masses. No well-formed tubercular granulomas are seen. The report issued, therefore, was that the specimen indicated Calcified Caseous Necrotic Nodule. There is no material on record to show that specimen of the abdominal part, in respect of which the malignancy was suspected was extracted by the concerned surgeon and was referred for pathological examination. One cannot be oblivious of the fact that histopathology report of the specimen is obtained for immediate further operative treatment because the sample is collected when the patient is on the operation table. Still, however, it is the medical practice to advise further medical tests and obtain pathological report of another specimen in order to verify the finding about presence of malignancy. The specimen forwarded for histopathology report may not be adequate to give a definite finding.

WE may further take note of the fact that the report of the opposite parties was to the fact that there were no well-formed Tubercular Granulomas found in the specimen. Obviously, there was no definite finding about existence of Tuberculosis cells. It is further relevant to note that the reference was made to Tata Memorial Hospital. A copy of the letter issued by the Tata Memorial Hospital, Mumbai is placed on record. The Asstt. Medical Superintendent of the Tata Memorial Hospital informed the complainant that though supportive tests like ESR, TEC, DLC, Mentos test and X-rays were not attached, yet, it appeared that the patient (deceased), Smt. Subhadra Kumari Gupta was suffering from abdominal Tuberculosis for which she was being treated adequately. Obviously, it is clear that the treating doctors ought to have directed further clinical tests like ESR, TLC, DEC, Mentos test and X-ray examination. The test like vidal test coupled with such other tests were also necessary part of the correct clinical finding which the treating doctors of the KGMU hospital were required to advise. That was not done.

WE are of the opinion that the complaint was filed only because the malignancy was subsequently noticed during pathological examination of Dr. Wahal after a period of about 3 months. We do not find it necessary to elaborately deal with the pathological reports of the opposite parties and that of Dr. Wahal. We may observe, however, that there was probability of the growth of cancerous cells after the first report of the opposite parties and moreover it was for the treating doctors to ascertain whether the case was of abdominal Tuberculosis on the strength of other tests. Nobody will deny that mere histopathology examination of the specimen could not be treated as conclusive finding. Even assuming that there was certain error committed by the opposite parties, yet, there is no substratum to say that it was "gross negligence" committed by them. At the most, it could be error of judgment on their part. In this view of the matter, we are in general agreement with the findings of the State Commission. Needless to say, the appeal is destitute of merits.

IN the result, the appeal is dismissed. No costs. Appeal dismissed.