S.Ramanujam vs C.P.SREEKUMAR

THE complainant is Mr. K. Ramanujam, aged 43 years, and is employed as Assistant Manager, Indian Overseas Bank, T. Nagar, Chennai. On 31.12.1991 at about 8.20 a.m., while going on his cycle to his office he was hit by a motor cycle. He fell down and felt pain in his right hip. His colleagues took him to Lakshmi X-ray at T. Nagar. X-ray was taken and he was informed that he sustained hairline fracture at neck of right femur.

ON the same day at about 9.45 a.m. he was taken to the opposite party Hospital. The opposite party examined the x-ray and assured the complainant that the hairline crack would join naturally within six weeks without any operation. So the complainant got admitted in the opposite party Hospital. The complainant was put in plaster of paris bandage for about 1'' length from the bottom of the right foot. Some medicines were given to him for a week. The complainant was advised not to move from the bed for six weeks strictly.

Contrary to this advice, the complainant was moved from the bed by the opposite party to take x-ray on 8.1.1992 to assess improvement in the hip joint. He was admitted in Room No. 105 at the first floor of the Hospital and X-ray Unit was situated in the ground floor and there was no lift in the Hospital.

THE complainant submitted that he was forcibly lifted by one inexperienced ward boy by name Elango and three coolies working in the Hospital building into a hand stretcher. No guidance was given to them as to how the bone fracture patient should be lifted or shifted. THE complainant was virtually rolled into the stretcher without bothering the consequences. Due to the rough handling of the patient, his right leg got folded and he shouted and cried due to unbearable pain at the fractured point. After this, x-ray was taken at the ground floor and it revealed that the fracture had widened. After seeing the x-ray, the opposite party advised surgery because of the widening of the fracture.

THE complainant submitted that the widening of the fracture was due to the negligence of the opposite party as his employees and wage workers lifted him and rolled him into the stretcher and due to this the fracture had widened. If he had been under bed rest for six weeks in the Hospital, this would not have occurred. When asked about the operation, the opposite party told him that the bones would be joined with a plate and screws. Contrary to this, the opposite party did hemiarthroplasty on 10.1.1992. The opposite party replaced the original bone (head of femur) with Austin Moore Prosthesis (metal ball with stem and stem inserted into medullary cavity of femur). The opposite party said that the original head was removed because it started liquifying. The removed original head was touched and pressed by the complainant''s wife and his off ice colleagues who said that it was in good solid condition. So what the opposite party said was a blatant lie and because the original bone (head of femur) was removed the complainant is unable to walk without crutches. The complainant consulted other orthopaedic surgeons who were of the opinion that hemiarthroplasty operation was meant for patients above 60 years and for patients below 60 years only internal fixation or nailing operations were done.

THE complainant further stated that after internal fixation surgery the patient would be back to normal activities after 2 months and would be able to walk even with a slight shortening of limb and further surgery was not required.

THE complainant further alleged that the metal prosthesis fixed during the surgery was bigger in size. As a result of this, the hip movements were very much restricted and painful. Due to bigger size metal prosthesis, there was friction between the socket and metal, resulting in wear and tear and hence the complainant had to undergo a major operation namely total hip replacement within a short period. After operation on 10.1.1992 he was not kept in the post-operative period and on the 12th day after operation the opposite party aspirated the infected area. This was due to unsterile instrument and suture materials. The opposite party put him on powerful antibiotics namely Omnatex injection 2 gms. per day for 10 days. Due to heavy antibiotics used, the complainant''s digestive system was totally spoiled. Due to infection the right thigh muscles have become weak. Due to improper prosthesis, inspite of sufficient physiotherapy his movements were painful and he is unable to walk independently.

The opposite party was negligent and careless in the mode of treatment as well as in surgery. The surgery done on him was meant for older people. The complainant has to depend on others for his activities in and out of the house and his future life is completely ruined.

THE complainant issued a notice to the opposite party on 13.7.1992 stating all commissions and omissions and demanded Rs. 3 lakhs as compensation for the failure and discharge of service of the opposite party. On receipt of the said Notice, the opposite party personally came to the complainant''s house and agreed to pay a sum of Rs. 3 lakhs and paid Rs. 50,000/- as first instalment and promised to pay the balance amount of Rs. 2.5 lakhs within one month from 10.10.1992. Since the opposite party failed and neglected to pay the balance amount of Rs. 2.5 lakhs, the complainant issued another lawyer notice on 19.11.1992 demanding the balance of Rs. 2.5 lakhs. Inspite of repeated demands and reminders, the opposite party sent a reply notice dated 15.12.1992 and denied all the liabilities. The complainant gave a rejoinder on 23.12.1992 in which he denied the averment that the sum of Rs. 50,000/- was paid as full and final settlement.

THE complainant stated that due to negligent treatment and selection of wrong mode of operation, he suffered from lingering infection, shortening of leg by 1", loose prosthesis and 60% physical disability. As the opposite party already paid a sum of Rs. 50,000/- the complainant claimed an amount of Rs. 2,50,000/- as compensation. Later on, the complainant enhanced the claim by petition dated 29.8.1996 as per order dated 26.12.1996 for a total amount of Rs. 12,00,000/-.

THE opposite party in his written version contended that the complainant was brought to his Hospital on the morning of 31.12.1991. A provisional diagnosis of fracture neck of right femur was made. THE opposite party was left with two options of treatment - one was the conservative line of management by immobilisation to prevent the rotation of the leg; the second method was by inter-fixation of the fracture.

THE merits and demerits were evaluated by the opposite party considering the condition of the patient. As the latter method would involve a second operation with months, this was not adopted. THE patient''s foot was kept in plaster and under observation. THE opposite party denied having promised or assured the complainant that the fracture would heal by itself without surgery within six weeks. Evaluation was done on 9.1.1992 and it was observed that the patient''s fracture had displaced. The opposite party denied the allegation that the complainant was moved out of his bed on 8.1.1992 for x-ray test and badly handled by the ward-boy Elango and others. There was no complaint lodged by the complainant to any doctor.

The opposite party further denied the statement that the fracture had widened due to handling of the patient during his being transported for x-ray. The fracture had displaced due to muscular spasm.

THE x-ray taken after a week, made him to decide one surgical treatment and Hemiarthroplasty was decided after a good deal of thought and in the best interest of the patient. He denied the statement of the complainant that the operation was meant for patients above 60 years and was done carelessly. There was no negligence in the operation of the complainant. A team of doctors assisted him and the post operative period was carefully monitored and treatment was given as the situation warranted. The Hospital purchased the best hospital equipments and materials and there was no negligence in surgery or the mode of selection of surgery.

IN October, 1992, the complainant extorted a sum of Rs. 50,000/- after threat of wide publicity with false allegations against him and his Hospital in public. He disturbed the privacy of his household by coming to his house and shouting. There was no agreement by the opposite party to give him Rs. 3 lakhs as alleged by the complainant. The opposite party prayed for dismissal of the case with exemplary cost. We heard both sides and perused the available records. The points for determination are: 1. whether there was any negligence or deficiency of service in the treatment of the complainant ? and; 2. if so, to what compensation the complainant is entitled ?

POINT No. 1: The first allegation of the complainant is that in his case the fracture neck of femur was Garden type I fracture. Since his age at that time was 42 years (younger age group) and the type of fracture was Garden type I, it demanded only internal fixation - page 193, Emergency Orthopaedics and Trauma by Andrew Urwin and Kirsten Jones. A week after admission, the rough handling of the patient while taking him for second x-ray caused widening of the fracture.

THE second allegation is that consent was not taken from him for the surgery hemiarthroplasty done on him. At the time of surgery, the correct size of the femoral head was not chosen and proper cementing was not done. THE prosthesis became loose and produced wear and tear of the bones which necessitated another surgery at Tamil Nadu Hospital, namely, total replacement of the hip joint. Sepsis was caused due to lack of proper sterility observed during surgery. The main allegations of the complainant are that there was negligence in the choice of surgery and the manner of surgery. Neither the complainant nor any other witness was examined on the side of the complainant.

The opposite party was examined as RW 1. He said that soon after admission, the patient was given conservative line of treatment with skin traction. Derotation boot was given for 9 days.

DUE to muscular spasm type I fracture became Garden Type III fracture. Since it was type III fracture, hemiarthroplasty was done. The reason for deciding this surgery was also for an early ambulation of the patient. There is always disturbance of blood supply in fracture neck of femur. Even with the correct size of the prosthesis, loosening of the prosthesis and erosion of bone are bound to occur.

BEFORE surgery the patient was evaluated by the cardiologist and other necessary tests were done. The consent for the surgery was taken from the patient after explaining the nature of surgery and its complications. The patient was given physiotherapy and was discharged. The opposite party denied any negligence in the choice of operation or the manner in which it was done. The learned Counsel for the opposite party pointed out that consent of the complainant was taken as evidenced by the statement in the complainant''s noticed dated 19.11.1992 [Ex. A-6] which says "however with great hesitation my client agreed for operation". No oral evidence of the complainant was taken to prove his allegation of rough handling causing widening of the fracture. In the textbook "Emergency Orthopaedics & Trauma" by Andrew Urwin and Kirsten Jenes - on page 193, it is stated "in sub capital fracture of neck of femur, a vascular necrosis of the femoral head - this is unpredictable". "The treatment of these fractures is controversial".

INSPITE of best treatment, infection, loosening of prosthesis and erosion of bones are documented complications.

THE complainant was not a diabetic or hypertensive at the time of treatment in the opposite party Hospital. Ex. A-3 is the discharge summary of Tamil Nadu Hospital dated 30.5.1992 which states that the complainant "is not a known diabetic or hypertensive". Ex. A-45 is the discharge summary of the Tamil Nadu Hospital dated 9.5.1995 which states under the heading History and Physical, the complainant, "a known diabetic for 2 years, on irregular treatment, and not a hypertensive". It shows that total hip replacement surgery was done on 28.4.1995, three years after the hemiarthroplasty surgery in the opposite party Hospital. Ex. A-9 is the case record and advice given by Prof. Dr. P.V.A. Mohandas. Ex. A-45 and Ex. A-3 are the discharge summaries of Tamil Nadu Hospital. They do not mention that there was any negligence or deficiency of service on the part of the opposite party. The learned Counsel for the opposite party further pointed out that the complainant''s claim of compensation for Rs. 12,00,000/- as amended as per orders dated 26.12.1996 is barred by limitation.

Treatment of fracture neck of femur is a difficult problem. In most cases the cause of a vascular necrosis is the disruption of the blood supply by the fracture, and the fate of femoral head is sealed at the time of injury.

THE opposite party selected a method of surgery according to his judgment and experience after assessing the type of fracture as Garden Type III fracture. Infection, loosening of prosthesis and erosion of bone are documented complications. It is not proved that widening of the fracture was due to mishandling of the complainant in the course of management of the case. In the above circumstances, we find that there is no negligence or deficiency of service on the part of the opposite party. This point we find in favour of the opposite party and against the complainant.

POINT No. 2: The question of compensation does not arise as there is no deficiency of service or negligence on the part of the opposite party. In the result, the complaint is dismissed. No costs. Complaint dismissed.