St Stephens Hospital vs Manohar Lal Thakur

THIS revision petition has been filed by St Stephens Hospital (hereinafter referred to as Petitioner) against the order of the State Consumer Disputes Redressal Commission, Delhi (in short the State Commission), whereby the State Commission had allowed an appeal preferred by one Manohar Lal (hereinafter referred to as Respondent) in this case.

THE facts of the case as per the Respondents version is that he went to Petitioners Hospital on 26.01.1998 with a complaint of experiencing difficulty in passing urine. He was taken to the emergency room, where a catheter was inserted, after which he was sent home with advice to come next day for consultations in the OPD of the Urology department. Accordingly, he came back and was examined by one Dr R K Choudhary who recommended certain tests and after that he was again sent home. In this manner upto 14.04.1998, the Respondent was called/ visited the Hospital 15 times and on each occasion he went to the OPD by paying fees and was prescribed medicines but got no relief from his urinary problem. THE catheter which was inserted was also not changed or removed, for about 2 months and finally after suffering extreme discomfort during this period he requested that the catheter be removed. After removal of the catheter he could not pass urine so he went back to the hospital where the catheter was again inserted in the emergency room. THE Respondent unable to bear the pain and harassment any longer, decided to seek medical treatment at another hospital - Sunder Lal Jain Hospital, where an urologist diagnosed him with enlarged prostrate. After Ultrasound, he was advised to undergo surgery. All the medical tests were completed in one day and he was operated on the next day and was discharged from the hospital after four days, fully cured. On the other hand, even after spending so much time and money for his treatment in St Stephens Hospital for 2 months, the doctor never told him what his medical problem was and in fact his physical condition worsened during this period. Alleging gross medical negligence and deficiency in service, Respondent filed a complaint before the District Forum seeking Rs.4.00 lakh as compensation. Petitioner Hospital has denied the charges of medical negligence and deficiency of service. According to them, it is a fact that the Respondent was treated in their hospital after being diagnosed with enlargement of prostrate. Since he was only 45 years of age at that time and prostrate enlargement normally occurs in the age group of 60 plus, the Medical specialist after considering all aspects of his case decided that at his age surgery is best avoided, since it can lead to complications like sexual dysfunction, cardiac problems etc. It was therefore, decided to treat the patient conservatively. Surgery was also ruled out, because the Respondent had recurrent infections for which he was given courses of antibiotics from 03.02.1998, 10.03.1998 and 27.03.1998. Petitioner has denied that the catheter was not changed for 2 months. In fact, the catheter was changed from time to time and after it was removed on 14.04.1998 on the patients insistence, within an hour urine retention occurred and the catheter had to be reinserted on the same day.

The District Forum after hearing both the parties and going through the records of the case dismissed the complaint on the grounds that the complainant/ Respondent had not been able to prove either medical negligence or deficiency of service on the part of the Petitioner Hospital and its employees. The relevant portion of the order of the District Forum reads as follows:

LAW is well settled that if patient is not getting relief out of the treatment given to him, a doctor cannot be held to be guilty of deficiency of service only on this ground. LAW is also well settled that if there are more than one prescribed procedure of treatment and if a doctor has followed any of the well established procedures in this back ground also doctor cannot be held to be guilty of deficiency of service and negligence. The main grievance of the complainant is that he remained under treatment of the doctor of respondent St Stephens Hospital from 26.01.1998 to 14.04.1998, but was not cured in this long period and on the other hand when he went to Sunder Lal Jain Hospital for treatment after ultra-sound he was operated upon and he was discharged on fourth day. Stand of respondent is that when complainant came to the hospital he was only 45 years of age and enlargement of prostrate is normally seen in people belonging to age group of 60 plus or so. An attempt was made to treat him conservatively and not to operate upon him and the said decision was taken in the interest of the complainant. We accept the above explanation of respondent and therefore, respondent cannot be accused of deficiency of service simply because no operation was performed between 26.01.1998 and 14.04.1998. Next grievance of the complainant is that a catheter was fixed on his body by doctor of respondent hospital on 26.01.1998 and same was removed only on 14.04.1998, although during this period of two and half months he had to remain in a lot of pain. However, in this regard attention was drawn by Advocate of respondent towards copies of prescription No.2,3 and 5 filed by complainant. These prescriptions make mention of Foleys catheter or urobag which would clearly medical change of catheter. Complainant was asked to file an affidavit that catheter was not changed from 26.01.1998 till 14.04.1998. But no such affidavit was filed. Respondent has filed medical texts to show that use of catheter need not be limited to a few days, and therefore, simply because catheter was used from 26.01.1998 to 14.04.1998 would not show that the same was used unnecessarily for long period. It is mentioned by complainant in the complaint itself that on 14.04.1998 when the catheter was removed, complainant again felt difficulty in urinating. This admission shows that for the treatment of the complainant use of catheter between 26.01.1998 to 14.04.1998 was necessary. We, therefore, hold as a result of the above discussion that on the basis of evidence on file complainant cannot be said to have been able to prove either negligence or deficiency of service of the Hospital or its employee.

AGGRIEVED by the order of the District Forum, the Respondent filed an appeal before the State Commission. The State Commission while agreeing with the District Forum that no medical professional can be held guilty for medical negligence if he fails to prescribe a particular line of treatment if there are more than one prescribed procedures of treatment, however, believed the version of the Respondent that the catheter was not changed for almost three months which caused unnecessary mental agony to the Respondent. The operative part of the State Commissions order reads as follows: Taking an over all view of the matter and the mental agony the appellant suffered on account of non-changing of catheter within the reasonable period we deem that compensation of Rs.10,000/- besides Rs.5000/- as cost of litigation would meet the ends of justice. The appeal is allowed to the aforesaid extent as the treatment received by the complainant at the Sunder Lal Jain Hospital was an independent treatment and the Respondent was only concerned with the removing of catheter and doctor was the best judge at what stage the operation was to be done. The Petitioner has come in revision against this order. Learned Counsel for both the parties made oral submission. Learned Counsel for the Petitioner has stated that the key issue that needs to be examined is whether the Petitioner can be said to be negligent if it adopts one out of two possible lines of treatment. In the instant case, a decision was taken by the concerned specialists to follow a conservative line of treatment in the over all interest of the patient based on a host of circumstances such as nature and gravity of the ailment, capacity of the patient to withstand surgery etc., long term risks and advisability of surgery having regard to the patients age group. The normal medical opinion is that prostrate surgery should be avoided in patients belonging to younger age groups. In fact, the District Forum and the State Commission have both accepted that in the instant case there was no medical negligence per se because, the Petitioner prescribed one particular line of treatment rather than another. Regarding the complaint of the Respondent that the catheter has not been changed for over 2 months, this was not factually correct and the Petitioner had produced credible evidence to show that it had in fact been changed. On the other hand, the Respondent failed to file an affidavit in support of his contention in the District Forum when he was asked to do so by the learned forum. The District Forum therefore, rightly accepted the Petitioners version and dismissed the complaint. Unfortunately on the basis of the same set of evidence the State Commission erroneously believed the Respondents version that the catheter was not changed. Even otherwise it is a well-known medical fact that a catheter can remain inserted over a long period. The Respondent by his own admission has stated that soon after the catheter was removed he experienced urine retention. All these facts go to prove that there was no medical negligence/ deficiency in service. Learned Counsel for the Respondent has reiterated that the State Commission has rightly concluded that the catheter had not been changed. Further, it is a fact that the Respondent spent 2 months running from pillar to post in St Stephens Hospital for his treatment and got no relief, while within a short period of four days his problem was properly treated and he was cured fully in another hospital. This clearly proves the medical negligence, callous attitude and indifference of the Petitioner Hospital and its employees as well as poor hospital management where patients have to wait for hours in the OPDs. In view of these circumstances, the revision petition needs to be dismissed. We have heard the learned Counsel for the parties and have gone through the evidence on record. In the first instance, we note that both the fora below have held that the Petitioner cannot be held guilty of medical negligence merely because it pursued a particular line of treatment which was different from the one adopted in treating his case in another hospital. The Petitioner had given detailed and credible reasons before the District Forum as to why in the present case the medical specialists after due consideration of all relevant factors and clinical tests decided to treat him conservatively. It is also established from the records that the Respondent had recurrent infection for which he was given three courses of antibiotics on 03.02.1998, 10.03.1998 and 27.03.1998. We therefore, agree that there was no medical negligence or deficiency in service in the Petitioners medical treatment and care of the Respondent. The Respondent has also contended that the pain and discomfort that he suffered was because the Catheter had not been changed for a long period. This aspect has been examined at length by the District Forum on the basis of evidence adduced by both the parties. Since the Petitioner has produced written records to indicate that in fact the catheter was changed, makes it difficult for us to believe the Respondents version. In this connection, it may be noted that the Respondent had declined to file an affidavit in support of his contention. The District Forum has rightly drawn an adverse inference against the Respondent from this fact. Also medical texts produced in evidence before the District Forum by the Petitioner that a catheter can be retained in the system for a long period without any side effects. The Respondent has not been able to refute this aspect by citing any other medical text/ expert to the contrary. Further, the fact that a catheter was necessary in his case was confirmed by the undisputed fact that as soon as the catheter was removed the Respondent could not pass urine.

KEEPING all these facts in view, we cannot accept the conclusion reached by the State Commission that retention of the catheter was not necessary and caused mental agony to the Respondent and for which he was given compensation. On the other hand, District Forum has recorded correct findings on this issue. We therefore set aside the order of the State Commission in toto and restore the order of the District Forum. Ordered accordingly, with no cost.