M.SUJATHA vs R.SURYAPRAKASH

THE complainant M. Sujatha is a graduate in commerce and a student of Post Graduate Diploma Course in Computer. Her complaint is that on 12.9.1992 she had irritation and redness in the right eye and immediately seen by her family doctor Dr. Rajkumar, who prescribed Soframycin eye ointment. THEreafter she was referred to the 1st opposite party for treatment.

ON 14.9.1992, the complainant approached the 1st opposite party for treatment with normal vision and she was given Ref. No. 49060. The complainant was examined by the 1st opposite party on 14.9.1992 and the Doctor himself took corneal scraping (R/E) in the presence of the 2nd opposite party herein and the same handed over to the 2nd opposite party for analysis. The result was given immediately as "fungus negative". Subsequently the 2nd opposite party did the culture test on 16th and 18th. It was reported "culture sterile" (No growth after 5 days incubation at 37 c ). The 1st opposite party after seeing the report prescribed some medicines. She regularly visited the 1st opposite party clinic for examination with her father and relatives. She continued the treatment for about 10 days. In spite of high dose of antibiotic given by the opposite party the pain was increasing and unbearable and vision was deteriorating. The condition of the eye became worse on 23.9.1992 and the complainant''s father explained this to the opposite party on 24.9.1992. On the same day the 1st opposite party examined the complainant''s eye and did corneal scrapings and gave it to the 2nd opposite party for examination. It was reported as "fungal infection".

The 1st opposite party gave wrong treatment from 14.9.1992 to 24.9.1992 on the basis of wrong treatment which resulted in infection penetrating deeply into the cornea. He changed the prescription and administered imported drugs which was duly taken by the complainant.

ON 26.9.1992 her condition became worse due to increasing pain in the eye and vomiting. This was brought to the notice of the 1st opposite party. ON 28.9.1992 the 1st opposite party referred her to Dr. Manju Kulkarni for expert opinion. Dr. Manju Kulkarni confirmed that nothing could be done as the infection was in advanced stage. The complainant approached the 3rd opposite party on 29.9.1992 for further treatment. The 4th opposite party is a full time consultant of 3rd opposite party hospital examined the complainant. The 4th opposite party asked her to stop all the drugs she was taking previously and started her own line of treatment.

THE complainant attended the 4th opposite party hospital on 30.9.1992, 1.10.1992, 3.10.1992, 6.10.1992, 9.10.1992, 12.10.1992, 15.10.1992, 20.10.1992 & 22.10.1992 and her eye was closely monitored by the 3rd & 4th opposite parties. On 22.10.1992 the complainant was advised to undergo a THErapeutic P.K. surgery. THE complainant was admitted in the 3rd opposite party hospital on 23.10.1992 and surgery was done on the same day. The complainant came to understand from the case summary of the 3rd opposite party that during surgery, while removing necrotic exudates from the iris surface; the 4th opposite party negligently and carelessly made a small tear in the anterior capsule which resulted in total blindness of her right eye permanently. Thus the 1st & 2nd opposite parties clinically damaged the complainant''s right eye and the 3rd & 4th opposite parties surgically caused total permanent blindness of her right eye. The complainant alleged that she lost vision in her right eye on account of carelessness and negligent services of all the opposite parties.

THE complainant sent a notice dated 10.3.1993 through her Advocate to the 1st and 2nd opposite parties. In their reply notice, they blamed the 3rd & 4th opposite parties. THE complainant sent a legal notice to the 3rd & 4th opposite parties on 3.5.1993. THEir reply was false and frivolous.

THE complainant submitted that she spent Rs. 25,000/- for the treatment by 1st & 2nd opposite parties and Rs. 50,000/- by the 3rd and 4th opposite parties. She lost her job and Santhosh Hospital, Beasant Nagar, Chennai, on a salary of Rs. 1,500/- per month and also lost the fee of Rs. 11,500/- paid towards the computer diploma course, which she was unable to continue after losing right eye vision. She also claimed Rs. 8,75,000/- as compensation for mental agony, disfigurement and loosing marriage chances, altogether Rs. 9,50,000/- and cost of the Court proceedings. The 1st opposite party in his version contended that the complainant came to his clinic on 14.9.1992 at 7 p.m. with acute pain in the right eye with watering irritation and blurring of vision. Her vision was 6/60 in the right eye. The slit lamp Bio-microscopy showed a large corneal ulcer about 4x3 mm on the right cornea. The ulcer was in a bad shape and the gravity of the situation and seriousness of the disease were explained to the complainant. The 1st opposite party called the 2nd opposite party a highly skilled lab technicians and in his presence the 1st opposite party did corneal scraping and gave it to the 2nd opposite party for fungal, bacterial smear and culture. The 2nd opposite party after examination of the smear informed the 1st opposite party that there was no trace of fungal elements, gram''s staining showed occasional pus cells and gram negative bacilli and the culture report would follow. Based on this report the 1st opposite party put the complainant on wide spectrum anti-biotic treatment namely Cifran eye drops fortified gentamycin drops and Cefalong-D-Scapsules, B Complex and SSZ drops. On the first day of consultation the complainant paid the 1st opposite party a fee of Rs. 60/- only. The complainant visited the clinic on the 15th, 16th, 18th and 21st September, 1992 and her condition was improving. On the 24th September, the complainant came with her father with severe pain and redness and profused watering in the right eye. On examination it was found that the inflammatory reaction was increased and hypopyon was noticed which warranted the necessity to repeat the corneal scraping and the same was sent for examination to the lab of the 2nd opposite party. After examination of the smear the 2nd opposite party phoned and told the 1st opposite party that the smear was fungus positive and it showed pus cells with gram negative bacteria. The 1st opposite party immediately put the complainant on the latest and the best immidazole group of anti-fungal tablets and miconazole drops and Natamycin eye-drops which are imported drugs. On the 25th September, improvement was seen in the infected eye. The 1st opposite party to get a second opinion referred the complainant to Dr. Manju Kulkarni, a reputed Corneal Surgeon with many years of experience. Dr. Manju Kulkarni agreed with the line of treatment given by the 1st opposite party and only increased the dosage of fluconazole and added SSZ drops. The complainant when last visited the clinic on the 28th September had a vision of 2/60. After this the complainant discontinued her treatment with him.

The 1st opposite party further contended that on 14th September, 1992, when the complainant came to him first he did a corneal scraping for fungal, smear and culture. Smear report was given immediately as "fungus negative". Culture report was given after five days as "negative". The 1st opposite party referred to "Grayson Disease Of The Cornea" page No. 210, wherein it is stated that anti-fungal therapy should not be initiated without laboratory evidence of fungal keratitis. He further denied the administration of strong dose of anti-biotic as alleged in the complaint. The 1st opposite party stated that there was improvement in the complainant''s condition till 21st but she did not visit on the 22nd and 23rd and when reported on the 24th, there was deterioration of vision. Second scraping was done and sent for examination. It was reported as fungus positive. Immediately he put her on the anti-fungal treatment. He also took expert opinion on his line of treatment.

IN the above said circumstances the 1st opposite party contended that there was no deficiency of service and prayed for dismissal of the complaint. The 2nd opposite party contended that he worked in Sankara Nethralaya for three years as Lab Technologist. He worked in occular microbiology and occular pathology sections and has four years experience in his own lab. He is a qualified lab technologist having 7 years of experience in the field. He stated that on 14.9.1992 the corneal scraping was handed over to him. He did the analysis and gave the report as KOH preparation for fungus negative, as there was no evidence of fungus in the specimen. After doing culture on the specimen he gave a report on 18.9.1992 as culture sterile. On 24.9.1992 again the scraping was done. On that day in the specimen, fungus was present and he gave the report on KOH preparation as fungus positive. The identification of fungus depends on the quality of the specimen, the stain and duration of the infection. The 2nd opposite party submitted that in this case he did the analysis and cultures carefully and he never gave a false report. He stoutly denied the allegations that he clinically damaged the eye and was a party to the treatment given. In the above said circumstances, he denied any deficiency of service on his part and prayed for dismissal of the complaint.

THE 3rd and 4th opposite parties contended that Sankara Nethralaya is a unit of Medical Research Foundation dealing with comprehensive eye-care and protection and caters service to the suffering public irrespective of caste, creed, etc. THE complainant consulted the 3rd opposite party hospital on 29.9.1992 with the complaint of redness, pain, watering and irritation in the right eye. After routine examinations she was referred to the 4th opposite party, who is the senior consultant in the cornea department. At that time her vision in the right eye was counting fingers at 2 feet. She underwent treatment in the cornea department from 29.9.1992 to 22.10.1992 and her condition was closely monitored by the opposite party. The 4th opposite party made some alteration regarding the selection of anti-fungal drugs according to her experience. Ulcer showed signs of response to the treatment given. Subsequently as the ulcer was threatening to rupture which can occur even during the course of healing, on 22.10.1992 the complainant was advised by the 4th opposite party to undergo Therapeutic P.K. under general anaesthesia to salvage the right eye. The complainant was admitted in the hospital on 23.10.1992 and surgery was done on the same day. The complainant made several post-operative visits on 30.10.1992, 3.11.1992, 10.11.1992, 24.11.1992 and 2.12.1992, the latest being the day fixed for glass appointment. The 4th opposite party clearly informed the complainant that the therapeutic P.K. was suggested to save the eye which was about to rupture because of the corneal ulcer. The complainant''s eye and visual functions have been saved as a result of therapeutic P.K. done. The logical next step was the restoration of vision and in this connection the complainant was advised to undergo an optical penetrative keratoplasty. Even according to the complainant after the therapeutic P.K. surgery, the pain in the right eye gradually subsided and infection was eradicated which should have provided immense relief to her. The 3rd & 4th opposite parties further contended that the complainant was not totally blind and she had light perception in the right eye when last seen by the 4th opposite party. The allegation of the complainant that she spent a sum of Rs. 50,000/- was false. According to the records of the opposite party the complainant incurred a total expenditure of Rs. 8,690.75 P. only. The complainant was not entitled to any compensation, and there was no deficiency of service on the part of 3rd and 4th opposite party. So they prayed for dismissal of the complainant with costs. We heard the arguments on both sides and perused the available records. The points that arise for consideration are : (1) Whether the opposite parties 1 to 4 were guilty of deficiency of service as alleged by the complainant; (2) The quantum of compensation if any the complainant is entitled to.

POINT No. 1 : Mrs. Sujatha the complainant when examined stated that she was treated by her family doctor for her eye complaint for 2 days, and then referred to the 1st opposite party. On the first day i.e., 14.9.1992, corneal scraping was done by the 1st opposite party and the same was tested by the 2nd opposite party. The 2nd opposite party gave the report that the smear was negative for fungus. Ex. A4 and Ex. A5 are the reports. On 24th the pain was so much. She went to the 1st opposite party on that day, who did a second corneal scraping. This was reported as fungus positive. The 1st opposite party prescribed tablets and eye drops (Exs. A8 & A9). On the same day the 1st opposite party referred her to Dr. Kulkarni who gave a prescription marked as Ex. A12. The complainant consulted the 3rd and 4th opposite parties. The 4th opposite party prescribed a different line of treatment. The pain was increasing. On 23.10.1992, the 4th opposite party did a surgery to clean up the infection. She visited the 4th opposite party on 30.10.1992. The 4th opposite party did not inform her that she had to undergo optical penetrating keratoplasty. In May, 1993, the complainant consulted Dr. Anandakannan, who said that there was no possibility of restoring the eye sight. To avoid disfigurement he did corneal transplant and it was a failure. The complainant is married now.

DR. Suryaprakash is the 1st opposite party (RW 1). In his evidence he stated that the complainant visited him first on 14.9.1992. He examined her with a slit lamp and diagnosed corneal ulcer of about 4 mm x 3 mm in size. The corneal scraping was tested by the 2nd opposite party and the report was fungus negative and gram negative bacilli and pus cells positive. Based on the laboratory report, he treated her with antibacterial drugs - Ex. A3. On 24.9.1992, he did a second corneal scraping and sent it for examinations and culture. The smear was positive for fungus and so the complainant was put on" anti-fungal treatment. He referred her to Dr. Kulkarni whose reply letter is marked as Ex. B13. Ex, Bl is the case sheet. Anti- fungal treatment is a prolonged one and it takes 4 to 6 weeks for complete recovery. The complainant paid him Rs. 60/- as consultation fee and stopped coming to his clinic after 28th September. In the cross-examination, the 1st opposite party denied any deficiency of service on his part.

The 2nd opposite party in his evidence stated that he as a lab technologist worked in Sankara Nethralaya in the field of Occular Microbiology and Pathology and then started his own laboratory. The lab reports given by him in this case are marked as Ex. A4, Ex. A5 and Ex. A10. He denied any deficiency of service on his part.

THE 4th opposite party in her evidence stated that she is a corneal surgeon and a full time consultant in the 3rd opposite party hospital. THE complainant was first seen by the 4th opposite party on 29.9.1992. Examination revealed that the complainant''s right eye vision was counting fingers at two feet and there was a corneal ulcer of 4.5 mm size the right eye. THE 4th opposite party changed some of the drugs prescribed by the 1st opposite party. Ex. B19 and B19A are the case sheets and the information slip. Ex. B19C is the microbiology report, B19D, B19E and B19F are also reports of microbiologist. Exs. B19G, B19H are blood reports. The 4th opposite party further stated that the corneal ulcer was responding to treatment as evidenced in the case sheet by a decrease in the size of the ulcer, disappearance of hypopyon and presence of vascularisation. On 22.10.1992, as the cornea was threatening to perforate, she advised a surgery called therapeutic penetrating keratoplasty only to save the eye and not for restoring vision. Exs. B23, B24 and B25 are respectively the pre-operative and post-operative findings.

AT the time of surgery it was found that the infection had gone deep involving the iris and the anterior capsule of the lens. In the process of clearing the infected material a tear was inevitable in the anterior capsule and the lens was removed. The removal of the lens was in no way detrimental to the eye as done in cataract surgery. After this surgery the infection was totally cured and the eye was salvaged and the patient was cured of symptoms like pain, watering and redness. The complainant was seen by the 4th opposite party, 8 times and anti-fungal treatment was continued. When the complainant was last seen on 4.1.1992, she had light perceptions in the right eye (not totally blind) and she was advised to undergo another surgery 3 months later for restoration of vision. Ex. B26 is the Ultra-sonogram report which showed that the contents of the eye were intact. The 4th opposite party denied any deficiency of service on her part. The learned Counsel for the complainant argued that the 1st and 2nd opposite parties failed to diagnose the case at the proper time. More than one corneal scraping must have been done and examined. A biopsy, which is a more effective method of diagnose was not done in this case.

THE 4th opposite party was negligent in treating the case for many days and in the surgery she produced a tear in the anterior capsule of the lens. All the opposite parties were negligent in their treatment of the case which resulted in total loss of vision, in the right eye. He prayed for compensation for the loss of vision in the right eye, mental agony and expenditure of treatment.

THE learned Courtsel for the 1st opposite party argued that anti-fungal therapy should not be instituted unless the lab test is positive for fungus. THE response to anti-fungal therapy is slow. Once the smear was positive for fungus the complainant was put on anti-fungal treatment and the same was approved by Dr. Kulkarni, a reputed Corneal Surgeon. The learned Counsel for the 2nd opposite party argued that the first lab report smear negative for fungus was supported by the culture report that there was no fungal growth. There was no deficiency of service on his part.

The learned Counsel for the 3rd and 4th opposite parties contended that there was no deficiency of service on their part. The 4th opposite party treated the complainant with anti-fungal drug and noted some decrease in the size of the corneal ulcer. After the therapeutic P.K. surgery, complainant was relieved of the pain. The tear in the anterior capsule was inevitable as the infection had involved the anterior capsule of the lens and iris.

CLINICALLY it is difficult to establish a diagnosis of fungal-corneal ulcer as argued by the Counsel for the 1st opposite party. The use of smear and culture are of extreme importance in the diagnosis. The commonly used techniques are : (1) KOH metmount, and (2) Culture, In practice biopsy is not done on the eye with corneal ulcer, but it is done on the corneal ulcer after removal.

IN this case, once it was diagnosed in the lab as fungal ulcer, all the appropriate treatment was given by all the opposite parties. This is supported by Exs. A4, A5, A8, A9 and AID series and also Exs. B19, B19A, B19C, B19D, B19E, B23, B24 and B25 series. So, we find that there is no deficiency of service on the part of any one of the opposite parties in the treatment of the complainant. This point we find against the complainant. Point No. 2 : In view of the above findings, this point does not arise. Hence, the complaint is dismissed. No costs. Complaint dismissed.