NURUDDIN KUTUBUDDIN BALATI vs L.N.VORA

THIS complaint is relating to the claim of compensation on account of the injury suffered by the complainant due to the deficiency in the service of Dr. L.N. Vora, opposite party No.1.

SHORTLY stated the facts of this complaint are that the opposite party Dr. L.N. Vora is running a Polyclinic Nursing Home at Bombay in which the complainant had taken treatment for pain in his back. The complainant alleged that around February, 1991, he had severe pain in his back and underwent some treatment at Dhule. He was, therefore, advised to approach a senior Orthopedic Surgeon at Bombay. He was referred to Dr. L.N. Vora, Opp. Party No. 1. According to complainant, the Opp. Party No. 1. examined him on 3.4.91 and advised to get myelogram done at Bombay Hospital. The O.P. No. 1 advised immediate surgery to relieve the back pain and accordingly, on 8.4.91, Dr. Vora carried surgery. The complainant alleged that he was hospitalised for 19 days and had to pay Rs. 21250/- to opposite party No.1 for surgery charges. The complainant alleged that even after the surgery, his pain did not subside. On 21.4.91, the complainant was discharged from the hospital of O.P. No. 1. The complainant alleged that on 15th May, 1991 again pain started in his back and he consulted local doctor at Amalner but could not get any relief and contacted the O.P. No. 1 on phone who advised to meet him at Bombay on 29.5.1991. Again complainant was hospitalised from May 29th, 1991 to June 12, 1991 at Dr. Vora''s Clinic. During the hospitalisation, he was given various treatment by Dr. Vora, yet he could not find any relief. The complainant alleged that Dr. Vora could not find any reason for the pain and, therefore, the complainant went to Dr. Chaubal at Bombay, who got him operated in August, 1991. According to complainant, he got relief due to the surgery performed by Dr. Chaubal in Bhatia General Hospital. According to complainant the pain has since been totally stopped. The complainant alleged in this complaint that the treatment given by Dr. Vora was deficient and hence he claimed in this complaint the medical expenses and the compensation amounting to Rs. 5,47,013/-. The complainant, claim was opposed by Dr. Vora on various grounds. Dr. Vora denied the allegation of negligence in his treatment and submitted that the claim of complainant to claim compensation is misconceived and cannot be considered. We have heard Shri Chandran, Advocate for the complainant and opposite party was heard in person with Shri Singh, Advocate.

The learned Advocate for the complainant Shri Chandran tried to explain to us how the service rendered by Dr. Vora was deficient. Shri Chandran referred to us Ex. ''B'' a report from Bombay Hospital and Medical Research Centre dated 4.4.1991. According to Shri Chandran, myelogram of complainant show that there is extradural indentation with nerve sheath cut out at L-L5 on the right side. According to Shri Chandran, the diagnosis show the pain at L-4/L-5 level. This was done prior to operation of the complainant. Shri Chandran then drew our attention to Ex. ''F'', which is Bombay Hospital and Medical Research Centre report dated 6.8.1991 after the surgery was performed by Opposite Party No. 1. According to Shri Chandran, the 2nd report dated 6.8.1991 show the presence of L-4/L-5 level showing additions and, therefore, Dr. Vora did not perform the operation on complainant properly in as much as L-4/L-5 level was not corrected in operation. In support of this contention, Shri Chandran stated that complainant has filed his affidavit dated 29.8.1992. According to Shri Chandran, coupled with Ex. 2, which is the hospital certificate, the operation performed by Dr. Vora is deficient. According to Shri Chandran, the defect was properly removed by Dr. Chaubal at L-4/L-5 level. It is, therefore, argued that had there been proper operation by Dr. Vora, there was no need to have second operation through Dr. Chaubal and could avoid svifferance. Reliance also is placed on Dr. Gajansing''s opinion and hence according to complainant the deficiency in the service of opposite party No. 2 has been established and, therefore, he is entitled to a compensation of Rs. 5,47,000.37 Ps. to compensate the loss of physical, mental and financial injury.

AS against this submission of Shri Chandran, Dr. Vora in person stated that X-ray did not show any infection and no serious possibility was seen. According to Dr. Vora, he had properly corrected the L-4/L-5 level additions, and, therefore, he was not deficient in his promised service. Dr. Vora also submitted that the patient has to take complete rest to avoid the occurance of pain and, therefore, the complainant was instructed not to bent. According to Dr. Vora he removed addisive from L-4/ L-5 level of the back side. It is also submitted by Dr. Vora that although myelography show L-4 and L-5 level addisives, the surgery can be carried out depending on the space available at L3/L-6. As N.K. Salti had no pain relief with conservative treatment and that he had marked restricted spinal movement, Dr. Vora advised myelography (contrast study) which revealed L4/L5 disc prolapse with rout cut out on (R) side. Hence opinion was that the surgery only will give him relief from his symptoms.

DR. Vora explained certain salient features of anatomy before going into detail of actual surgery. The vertebral column consists of vertebrae and inter-vertebral discs. These vertebrae are grouped as 7 cervical, 12 dorsal, 5 lumbar and 5 sacral vertebrae. All sacral vertebrae are fused together. The first intervertebral disc is between 2nd and 3rd cervical vertebrae and the last one is between 5th lumbar and 1st sacral vertebrae. Dr. Vora tried to explain further by showing a small model of the spine with Discs. Each inter-vertebral disc consists of a peripheral fibrous layer (Yellow in colour in model) known as Annulus Fibrosus and a centre soft portion (Red in colour) known as Nucleus pulposus (N.P.) which is always under tension. It is this N.P. which bulges, protrudes, ruptures, seghestraces and migrate when injured. All these phenomena are loosely termed together as prolapsed inter-vertebral discs (P.I.D.). At the time of surgery only the prolapsed part is removed. In fact, the annulus fibrosus is never removed and inter-vertebral disc is never completely removed. Looking at the vertebral model from the back, one sees transverse bars of bone known as Laminae. Each vertebra has two such laminae, right and left. These laminae joins together and protect within them spinal cord and nerves etc. These are the nerves which get compressed when a disc prolapses. The neighbouring laminae at adjacent levels are connected with each other by Ligmentum Flavum. In the model they occupy vacant spaces between the laminae. Through this gap is seen the prolapsed disc, red in colour in the model. The disc can thus be approached through this gap ''inter laminar approach) by making a window in lig.fla.Fenestration. In fact, now a days at some centers the disc is removed through a ''scope passed in this space and without making any big incision. The prolapse may be in the midline or at the sides. If the fenestyration size is not sufficiently large, a part of the lamina above and below are then chipped away to enlarge the portal of access. If not, either half or full lamina is removed-laminectomy. Thus inter-iaminar approach will allow access to the respective disc level, while laminectomy will allow access to L4/L5 space and also to L-3/L-4 space higher up, while fenestration at L4/L5 level will allow access to relevant space only.

OVER and above this, Dr. Vora has produced various references which in nutshell say, (a) Post operative changes show gradual evolution over a period of time varying from six weeks to six months with a corresponding return of the cal sac margin to normal. (b) Epidural fibrosis occur in any surgical exploration. In some patients it produces symptoms and in some it may not (Reason not known) (all precautions were taken as explained previously so as to minimise scar tissue formation). (c) M.R.I, as far as possible should be avoided during period upto six months.

(d) For such recurrent symptoms in such a short period conservative treatment should be followed before taking any other action. Traction enforces strict bed rest. Traction is useful even if there is a new displacement at another level.

DR. K.V. Chaubal after referring to both Discharge Card and Operation Notes made affidavit and stated:- (1) No disc protrusion at L4 L5 level but fibrosis which were released. (2) Bulge at L3 L4 level-removed. (3) L5-S1 no disc prolapse no fibrosis.

Again, this proves that L.N. Vora has done the operation as has been said before. There is no negligence or defect in services given by DR. Vora. The certificate of DR. Gajendra Singh dated 18.9.1993 also states that cause for such interim pain after surgery could be (i) adhesions around the nerve roots (ii) prolapse of another I.V. Disc. Now comes the dramatic and sensational revealations of M.R.I, dated 6.10.93 which shows 1. L4-L5 Laminectomies are notedmeans DR. L.N. Vora has performed the operation. 2. Bulge at L5-S1 level which was not there at the time DR. K.V. Chaubal operated on Mr. Salati. 3. Fibrosis at L5-S1 level. 4. Rest of Discs are normal.

This proves that Mr. Salati is prone to bulges and fibrosis. Rest of the discs are normal does not mean that discs has not been operated upon. As DR. Vora has said previously only protruded part has been removed and not the whole, MRI will not show any significant disc changes. Patient''s tendency to have bulges and fibrosis proved further that what DR. K.V. Chaubal has said is true that he has removed bulge at L3 L4 level and fibrosis at L4 L5 level. Hence, Mr. Salati''s allegation that DR. K.V. Chaubal is trying to shield DR. L.N. Vora cannot be accepted. (4). On consideration of the facts and circumstances of this case, we are satisfied from the submission of DR. Vora that there is no negligence in the promised service of the opposite party. We find that DR. Vora has exercised reasonable skill and exercised due diligence while treating the complainant as regards his diagnosis of back pain. As explained by DR. Vora, we are also satisfied that there is no negligence while performing the operation on complainant. It is apparent that the patient was having a tendency to have bulges and fibrosis as a result of which he suffered discomfort and pain. In any case, in our view, the pain caused in the back of complainant cannot be attributed due to negligence in the performance of operation by DR. L.N. Vora. Under these circumstances, we feel that there is no substance in this complaint and, therefore, it is required to be dismissed. (5). The complaint stands dismissed. Parties to bear their own costs. Complaint dismissed.