HARI PRASAD CHUNKAI vs MANNULAL JAGANNATH TRUST HOSPITAL

THIS is a complaint under Section 17(a)(i) of the Consumer Protection Act, 1986 filed by the complainant Hari Prasad Chunkai resident of Jakson Hotel Compound, Civil Lines, Jabalpur against the Mannulal Jagannath Trust Hospital and Dr. Smt. Indu Pandey who is consultant of Opthalmologist in the said hospital to claim a compensation of Rs. 15.00 lacs for the medical negligence in performing cataract operation.

THE complainant developed cataract in his left eye and, therefore, consulted Doctors of Vehicle Factory, Jabalpur from where the Doctors referred him to Mannulal Jagannath Trust Hospital, Jabalpur for further treatment, where he was examined by Dr. Smt. Indu Pandey who found the case of cataract, therefore, suggested operation. THE complainant was admitted in the hospital on 13.12.2000 where the patient was examined as on that day his blood pressure was on higher side, therefore, operation was postponed for 16.12.2000. On 16.12.2000 cataract operation was performed. It is alleged that post operative care was not taken properly, therefore, in his operated eye he developed infection and ultimately reached to such a situation that his left eye has to be removed to save further infection in his right eye. THE complainant alleged that it was due to medical negligence of the operating surgeon and hospital staff, cataract operation was not done properly and ultimately resulted to he has to loss of his left eye this causes him mental and physical agony and he has become permanently physically challenged person, he, therefore, claims a compensation of Rs. 15.00 lacs in various heads from the opposite party. THE opposite party resisted the complaint and submitted that they have acted with full care and diligence and have treated the complainant as per medical norms and literature. THE operation was successful and the complainant''s vision was restored. It might be due to insanitary condition that the patient had suffered from Endophthalmitis and, therefore, his left eye was removed. THEre is 1% chances of occurrence of Endophthalmitis after cataract operation. THE patient was treated with due care because the infection developed, was beyond their control which is a complication and, therefore, they are not negligent in any manner, therefore, the complaint be dismissed. In a case of medical negligence, it is to be seen whether the Doctor who undertakes for treatment of a patient has taken care in deciding whether to undertake the case and to decide what treatment to be given and also to see that the treatment is properly administered. If a doctor who possess reasonable degree of care then he cannot be said to be negligent. A Doctor has a discretion in choosing treatment which he proposed to give to the patient and if he has acted with due skill and diligence then he cannot be held responsible for any medical negligence.

In the case in hand, we have to examine, whether the opposite party No. 1 Hospital had proper facilities for conducting the cataract operation and whether the Doctor was competent to operate the patient and whether pre and post operative care was taken properly?

AFTER hearing parties and on appraisal of material on record we find that the opposite party No. 2 Dr. Smt. Indu Pandey is a post-graduate diploma in Opthalmology and is performing operations with the Mannulal Jagannath Trust Hospital at Jabalpur for last one year. Thus from the record, it is clear that the opposite party No. 2 Doctor Smt. Pandey was competent to take up the case of such cataract operation because such cataract operation is a simple operation with advanced accepted technology. Dr. Smt. Indu Pandey on examination of the complainant found that it was a case of developed/matured cataract in his left eye and, therefore, she advised for cataract operation. So far as the operation and post-operative care is concerned, papers on record reveal that first operation was advised on 13.12.2000 but because the patient had high blood pressure, therefore, the operation was not performed on that day and the patient was advised to take medicines for controlling blood pressure. After three days when the blood pressure of the complainant came to found normal, and other tests were also found normal then the operation was performed on 16.12.2000. The operation was performed successfully and it was found that after operation there was vision of 6/24 in left eye and there was no pain in the operated eye upto 20.12.2000 and till then there was no complaint about the operation. It is only on 21.12.2000, the patient complained about slight pain in his left eye. The opposite party No. 2 Dr. Smt. Indu Pandey examined the left eye of the patient complainant and found that its visual acquity was 6/24 to 6/36, therefore, higher antibiotics, steriods, antinflammatory and hypersomotic drugs systemic and local were given for treatment of his left eye and thereafter when it was found that the patient had higher percentage of blood sugar then for control of blood sugar some medicines were given/added. The papers reveal that after five days complainant developed into Endophthalmitis. The treatment chart reveals that the patient was being looked after operation by the operating surgeon and the hospital staff and when it was found that it is a case of Endophthalmitis, then on 24.12.2000, the patient was referred to higher centre i.e., Dr. Prashant Agnihotri, Ophthalmologist of Retina Care Centre, Nagpur. This shows that the hospital staff and the Doctors have been attended the patient regularly and have treated the patient with due care but unfortunately, Endophthlmitis developed on 21.12.2000 and when it was detected, the patient was referred to higher centre.

DR. Smt. Indu Pandey has drawn our attention to a Medical Litreature Book Ophthalmology Companion by Wilhelm Happe and Jakob Daniel Fischel published by ARNOLD wherein at Page 107 under the heading Catarat Surgery it has been mentioned that Post Operative Complications in straightforward Cataract Surgery like dislocated implant, mydriasis, endophthalmitis, retinal detachment, bullous keratopathy occurs in 1 in 100 i.e., in one percent of cases. The present case has been of Post-operative Endophthalmitis about which it is stated that it is a known complication after cataract surgery. The opposite party No. 2 DR. Smt. Indu Pandey has drawn our attention to a book Lens and Cataract by Norman S. Jaffe and Joseph Horwitz published by Gower Medical Publishing wherein at page 1582 in Chapter 13 Postoperative Endophthalmitis it has been mentioned : Postoperative endophthalmitis is one of the most serious complications of cataract surgery. Aside from a tragic result, for the patient in many cases, it is frustrating for the surgeon because it usually occurs after flawless cataract surgery. The medical literature reveals that Endophthlmitis can occur with any surgical procedure even in a case of minor surgery. In the same mentioned book and in the same chapter on page 1583 it has been mentioned thus : "Postoperative Endophthalmitis Infectious postoperative endophthalmitis is the most feared complication following ophthalmic surgery because it frequently leads to permanent visual loss. The poor prognosis for eyes with endophthalmitis is due to the destructive forces of bacterial infection and the host defences. Endophthalmitis can occur with any surgical procedure, even a minor one. Cases have been reported after radial keratotomy, posterior capsulotomy, anterior chamber paracentesis, and implant repositioning."

After going through the literature we find that the complainant developed Endophthalmitis which is a known complication in cataract surgery, survey of which reveals that one out of 100 cases Endophthalmitis is reported even after taking all precautions and best care. From the hospital record, and papers, we find that the opposite party No. 2 Dr. Smt. Indu Pandey got done all required tests before operation and a decision was taken to perform surgery on 13.12.2000 but when the patient had developed high blood pressure, then the operation was not performed on that day and it was posted after three days i.e., on 16.12.2000 and then operation was performed. The hospital record reveals that the patient gained proper vision which was recorded to 6/24 and upto 20.12.2000 the position continued as usual and it was only on 21.12.2000, the patient complained of pain and on examination it was found that Endophthalmitis had developed and, therefore, higher doses of medicines were given and the patient was advised to go Vitreo-Retinal Centre such as AIIMS, New Delhi, Sankara Nethralaya Chennai and Nagpur. The patient preferred to go to Nagpur where he was referred to Dr. Prashant Agnihotri Ophthalmologist of Retina Care Centre, Nagpur.

THIS all reveals that so far as the post-operative care is concerned, the Doctors have taken all necessary care. From the record, we find that there was no lapse on the part of Dr. Smt. Pandey in performing cataract operation because after operation gain of vision was proper and it is due to some infection case turned into a case of endophthalmitis.

A medical practitioner has various duties towards his patient and he must act with a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. This is the least which a patient expects from a doctor. The skill of medical practitioners differs from Doctor to Doctor. The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. Medical opinion may differ with regard to the course of action to be taken by a doctor treating a patient but as long as a doctor acts in a manner which is acceptable to the medical profession and the Court finds that he has attended on the patient with due care, skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the Doctor to be guilty of negligence. See, the decision of Supreme Court in Achutrao Haribhau Khodwas and Others v. State of Maharashtra and Others, I (1996) CLT 532 (SC)=(1996) 2 Supreme Court Cases 634. In the present case, we find that the opposite party Dr. Smt. Indu Pandey and the hospital staff acted with due care and diligence and has taken all necessary precautions for treatment and also in post-operative care and when it was found that the Endophthalmitis is developed referred the patient to higher centre i.e., Vitreo Retinal Centre, therefore, the opposite parties cannot be held for medical negligence. In the result, complaint fails and is dismissed with no order as to costs. A copy of this order be conveyed to the parties. Complaint dismissed.