Kannan, S/O N.Kunhiraman vs V. Kochukrishnan

THE present Revision Petition is filed by the Petitioner, Shri Kannan, challenging the order passed by the Kerala State Consumer Disputes Redressal Commission (in short, ''State Commission '') on 22.12.2012 in Appeal No. 254 of 2007 in which the State Commission has reversed the well considered order of the District Consumer Dispute Redressal Forum, Kannaur (in short, ''District Forum ''). The State Commission allowed the Appeal filed against the order of the District Forum in Complaint No. 229/2001 dated 05.12.2006.

FACTS of this Revision Petition are: The Petitioner, a coolie, sustained dislocation of the left ankle. Dr. Damodaran who was the Orthopedic surgeon at OP -2 hospital tried to correct the dislocation after taking X -ray and his left foot was put under bandage. Thereafter, on the next day, pain increased and Dr. Damodaran referred the Complainant to Ashoka Hospital, Kannuar for better treatment. At Ashoka Hospital, the Complainant was treated by operation of open reduction and internal fixation and steel rod was fixed inside the left foot, and was hospitalized for 3 weeks. After getting discharged from the Ashoka Hospital, there was an external patch at the operated side and the Complainant approached the OP -1. As per advice of OP -1, plastic surgery by implanting skin from the right leg was performed on the Complainant at OP -2 hospital. The Complainant remained in the hospital for 21 days as he was unable to move his leg. Complainant paid Rs 21000/ - in total (Rs.14,000/ - + Rs.7,000/ -). The pain was increasing day by day. The OP -1 was not available for 3 days as he was on tour. Meanwhile, a portion of the steel rod automatically got detached and the wound started bleeding. The Complainant suffered pain and mental agony and ultimately OP -1 removed the existing rod and fixed new rod in the left ankle. The Complainant was put under plaster and the pain started increasing. Every time the Complainant was charged by OP -1 for Rs.500/ - to Rs.800/ - for his check - up. On 15.08.1999, the Complainant felt that his left foot was hanging and he was not in a position to keep the left foot straight. The OP -1 told the Complainant that infection had developed inside and operation was required. Hence, the Complainant was subjected to another operation and the Complainant remained in the hospital of the OP -2, for 27 days. The Complainant was asked to pay Rs.3,000/ - more. Hence, alleging deficiency in service, the complainant filed a complaint before District Forum. The District Forum after examining two witnesses, held OPs for deficiency in service and accordingly directed the OPs to pay compensation of Rs.2,50,000/ - and costs of Rs.5,000/ -.

HENCE , aggrieved by the order of District Forum, the OPs filed an appeal before the State Commission. The State Commission, after hearing both the parties and considering the evidence on record, allowed the appeal and dismissed the complaint.

THE complainant preferred this Revision Petition against the order of State Commission. We have heard the counsel for the petitioner on admission hearing and perused the evidence on record adduced before District Forum and State Commission.

THE Counsel for Petitioner vehemently argued that during earlier treatment with OP -1, the complainant was diagnosed as a case of TAO (Thrombo Angitis Obliterans), peripheral vascular disease. The OP -1 did not take any measures to cure TAO before doing plastic surgery. Therefore, there was negligence on the part of OP -1 and the complainant suffered further, leading to shortening of leg.

ON perusal of evidence on record, we find that there was delay of 17 days in filing this Revision Petition; the reasons stated in the application for condonation of delay satisfy us and, accordingly, the said delay is condoned. On merits, it is an admitted fact the Complainant was brought to the OP -2 Hospital, on 21/03/1999 with history of fall from a tree. The Complainant had dislocation of ankle joint and was seen by the Orthopedic Surgeon, Dr. A.V. Damodaran, who attempted reduction under anesthesia. Thereafter, Complainant was referred to Dr. Padmanabhan Nair, Orthopedic Surgeon, Ashoka Hospital, Kannaur who performed open reduction and internal fixation for the fracture of medial malleolus and discharged the Complainant on 12.04.1999, with a discharge summary and reference letter.

THE Complainant was re -admitted in OP -2 Hospital, under the care of the OP -1, on 12.04.1999, with a reference letter from Dr. P.V. Padmanabhan Nair, which is reproduced as follows: Kannan Age 42 Years DOA 23/03/1999 DOD 12/04/1999 Discharge Summary

Admitted with complete dislocation of the ankle joint Left Closed reduction attempted at Local Hospital, failed. Hence, referred for ORIF. ORIF done Fracture medical malleolus fixed with K wires. Developed superficial skin necrosis which spread gradually. Found to suffering from TAO. (Revealed by the patient only after development of the Gangrene of the skin) C and D done twice daily. Pus discharge is less. Wound is not healing. Hence, referred to a bigger centre for management by Orthopedic and Plastic Surgery Departments. Sd/ - Dr. P.V. Padmanabhan Nair

THE evidence of OP -1 clearly mentions that on 12/04/1999, OP -1 examined the Complainant who had a large infected wound over the anterior aspect of left ankle, exposing the bone and sloughing extensor tendons. The Complainant, on regular dressings, and analgesics and after culture and sensitivity test, he was put on antibiotics. The Complainant was diagnosed as a case of TAO by Dr. Padmanabhan, therefore, accordingly on 23.04.1999, the OP -1, along with Orthopedic Surgeon Dr. Amrithlal Rao, per formed the plastic surgery of Cross leg flap and the limbs stabilized with external fixators. The informed consent from the complainant was taken. Post -Operatively, usual care was given and the flap was divided on 17/05/1999. As, the Complainant had planter flexion of the ankle due to sloughing of the extensor tendons; it was maintained initially with external fixators and later on, with pop cast. The complainant was discharged with advice to come for regular follow up. The Complainant was readmitted on 15/08/1999, with infection of ankle wound and was discharged when the wound almost healed and advised him to come for review. Afterwards, the Complainant did not turn up to the hospital.

CONSIDERING the entirety of facts of this case, we are the of considered view that the Complainant was referred to the OP -1 by Dr. P.V. Padmanabhan Nair, with a reference letter, as reproduced above, which clearly shows that the Complainant required plastic surgery. The OP -1 has done cross leg flap to cover the raw area. No bony treatment was done by OP -1. Hence, the Complainant ''s allegations of the shortening of left leg, shortening of left feet, are not sustainable and it is not the result of the cross leg flap cover done by the OP -1. The external fixators were used to stabilize the cross leg flap and these were removed as per the guidelines laid down for such a procedure. The Complainant had planter flexion of the ankle due to sloughing of the extensor tendons and maintained initially with external fixators and later on, with POP cast. Hence, there is no negligence or deficiency in services on the part of the OP -1.

WE have referred the standard medical books on the subject of plastic surgery, namely, Grab ''s Encyclopedia of Falps and Mcarthy Text book of Plastic Surgery . The extent of treatment done at the OP -1 Hospital pertains mainly to plastic surgery in the form of cross leg flap cover. There is absolutely nothing to indicate that removal of necrosed portion of the Talus bone was done at the hospital of the OP. So, negligence imputed on the part of the OPs for shortening of the leg, is absolutely without any basis. In fact, TAO (Thrombo Angitis Obliterans) is a condition where blood vessels become constricted and as a result of which, there would be difficulty in healing wounds. The fact is that there is no active treatment for the condition known as TAO. Therefore, our thoughtful view is that the OP -1 has performed plastic surgery of Cross leg flap, which was the only option, to cover such a raw ulcerated area. It was performed as per standard norms, and it is not a cause for shortening of the left leg and complainant ''s permanent disability. No bony treatment of the Complainant was done by the OP -1 and hence the OP -1 is not responsible. We do not find any negligence and deficiency in service rendered by OP -1, in medical treatment and follow up.

THE revision petition is meritless, hence, dismissed. No orders as to costs.