1. THIS is a case wherein a patient Leelamma had gone to a doctor with a complaint of abdominal pain wherein he had performed exploratory laparotomy and removed the appendix and subsequently the petitioner had to be kept in the Nursing Home of the doctor for two different spells due to complications which arose as a result of appendisectomy. As the patient''s condition could not be medically managed by the doctor he had to be taken to the District Hospital, Manjeri wherein surgery had to be performed to remove the gangrene to rectify all the obstructions in the intestine, but after some days the patient died. In this case the treating doctor and the Nursing Home had refused to give any treatment records either to the complainant or even to the District Forum. Can the needle of suspicion about medical negligence be pointed towards the treating doctor and the Nursing Home, in such a case? The straight-forward answer to the question is: YES.
2. AS the District Forum had dismissed the complaint, K.V. Radhakrishna Menon husband of the deceased and children of the deceased filed an appeal before the State Commission. The State Commission after hearing the parties and going through what ever records which were produced before them and also analysing the case law, allowed the appeal and set aside the order of the District Forum and directed the opposite party to pay Rs. 1,50,000 as compensation as against their claim of Rs. 4,50,000 within two months of the receipt of their order failing which the aforesaid amount would carry interest at the rate of 12% from the date of their order. The State Commission also awarded Rs. 3000 as cost to be paid to the appellants. Aggrieved by the order of the State Commission, Dr Balagopal of Perinthalmanna Nursing Home has filed this revision before us.
The undisputed facts of the case are - Leelamma wife of the first complainant - Shri K V Radhakrishna Menon was admitted in the Perinthalmanna Nursing Home by Dr. Balagopal with a complaint of stomach pain. After examination, Dr. Balagopal performed exploratory laparotomy and found that the patient was suffering from appendicitis. Accordingly he performed appendisectomy on 4.4.1996. She continued to be under his treatment till 20.9.1996 on which date she was discharged. After discharge her condition became so bad that she had to be re-admitted in the same Nursing Home on 29.9.1996 but the situation did not improve. As her condition deteriorated she was taken to District Hospital, Manjeri on the same day where surgery was performed on 7.10.1996 for removing the gangrene and to rectify all the obstructions in the intestine and subsequently she died on 9.11.1996,
The main allegation of the complainant is that Dr Balagopal did not bestow care expected from a doctor but he did not even get the consent from the first complainant before conducting the first surgery on the deceased and he did not properly diagnosed the disease. On account of negligence of the opposite party, complications arose and despite surgery and treatment given in the District Hospital the patient died. The opposite party-Dr Balagopal denied the allegations of negligence. He contended that inflammation of appendix was detected after exploratory laparotomy, therefore, appendix was removed and she was relieved of her abdominal pain and was discharged. The allegation that he had wrongly diagnosed her ailment was not correct. He maintained that qualified doctors attended Leelamma and they informed her husband about the details of the disease and treatment. They took voluntary discharge for better consultation. Hence, he is not liable for any compensation.
3. IT is clear from the records that OPs have failed to produce the consent form and they even failed to produce the detailed records of treatment in their Nursing Home despite the fact that she stayed in the Nursing Home on two different spells. If the patient was relieved of her pain on the date of her discharge i.e. 20.9.1996 why she had to be re-admitted in the hospital poses a serious question. Further, it is not the case of the revision petitioner that the patient was relieved of her pain and hence she was discharged on 4.10.1996. The State Commission refers to a letter about the condition of patient from the opposite party''s hospital wherein Dr. Balagopal stated that the post-operative period was stormy and she had paralytic ileus. IT is also clear from the records that she had to be re-admitted with pain and vomiting on 29.9.1996. The State Commission has observed as follows:
"Now again it became necessary to see the condition of the patient, when the patient was taken to District Hospital, Manjeri. A reference to the evidence of PW2 in this context is necessary. In his evidence PW2 said, at the time of admission she had pain in the abdomen, on examination abdomen was found distended. She was ill-looking and toxic and de-hydrated and she was put in DIL. he further states that following investigation was done. Plain x-ray abdomen revealed multiple fluid levels indicative of intestinal obstruction. I did Laparotomy on 7.10.1996. The operation findings, a loop of iliem was gangrinized and perforated in two places and intestine was adherent to adjacent abdominal wall and adjacent intestinal loops calcum was distended and adherent to parietus with perforation in the posterior aspect. Resection of gangrinised loop of iliem which contained perforation and end to end anastomosis was made. Caecostomy was done. Iliotranserse anastamosis done. Peritonial toilet done with saline. Abdomen closed with drain. This part of the evidence of PW2 reveals what was revealed at laparotomy on 7.10.1996. What is important is, he says that the part of the intestine was gangrinised and perforated and he removed that portion. The cause of this particular feature has got paramount importance to judge the duty of the doctor who performed the appendicitis operation. PW2 the doctor said ''Adhesions are common complication in surgery. Even with reasonable care and skill adhesions can occur. Intestinal obstruction is an indication for emergent surgery. I examined the patient for the first time on 4.10.1996. My diagnosis of the patient is obstruction due to post-operative adhesion''. There is no suggestion in the cross-examination of PW2 that he was biased. As has already noted as adhesion could occur in abdominal operation a diligent surgeon should have noted the same when the patient after surgery complained of stomach-ache. He should have made examination immediately and confirmed that the same was not due to adhesions. There is nothing to show that he took x-ray. When a particular situation calls for x-ray examination and there is failure to take the same that in itself would constitute deficiency in service."
Despite complainants'' petition to produce the records before the Fora below, the treatment records were not produced by the OPs. On this issue the State Commission concludes as follows: "When a petition for discovery is allowed and the person called upon to produce the document fails to produce the same and does not justify the non-production, adverse inference has to be drawn against him. This adverse inference certainly would go in favour of the complainants in the discharge of their burden to establish negligence."
4. THEREFORE, we see no cause to interfere with the well reasoned order of the State Commission. Accordingly, the revision petition is dismissed. The revision petitioner shall also pay Rs. 10,000 as costs to the respondents. Revision Petition dismissed.
