Case Study

Role of investigations in diagnosis

Dr. K. Raja Rajeshwari v. Ch. V. Narsimha Rao 

Revision Petition no. 2080 of 2011, decided by the Hon’ble National Consumer Disputes Redressal Commission, New Delhi on 9-5-2017.

Facts: The complainant, Ch. V. Narasimha Rao took his wife, Smt. Pushpa Kumari, since deceased, to M/s Vignesh Nursing Home of OP 1/Dr. K. Raja Rajeshwari on 12-5-2002. The patient had complaint of stomach ache.  She paid a sum of ` 5,000 to OP 1 for which no receipt was issued on the premise that it will be adjusted at the time of final settlement.  OP 2/Dr. K. V. Appa Rao diagnosed the case as to be appendicitis.  OP 2 operated the patient and found that it was gangrenous appendicitis and removed it in piecemeal.  After operation, OP 2 never examined the patient.  The condition of patient further deteriorated and OP 1 referred the patient to Apollo Hospital, Hyderabad where the complainant spent about `1,05,000 for the treatment of his wife.  Unfortunately, the patient died on 19-5-2002.  Hence, alleging medical negligence on the part of OPs 1 and 2, the complainant filed complaint before the District Forum, Ranga Reddy. The District Forum dismissed the complaint.  The State Commission directed OP1/Dr. K. Raja Rajeshwari and OP 3/New India Assurance Co. Ltd. to deposit jointly and severally an amount of `1,50,000 in any nationalized bank in the name of the daughter (Ms. Harshita) of deceased, also awarded `4,000 as costs.

Observations: The petitioner vehemently argued that it was the case of gangrenous appendicitis.  The patient was suffering from appendicitis/appendicular lumps.  On the basis of laboratory reports and clinical findings, OP 2 operated the patient.  A day after operation, patient developed complications, therefore, she was shifted to Appollo Hospital.    Therefore, shifting or referring the patient was not a negligence. The patient did not show any symptoms which could diagnose tuberculosis prior to surgery.  The biopsy report was received one week after the death of patient, which revealed tubercular appendicitis.  The contention of complainant was that OP 1 had the knowledge of appendicular lump, which he had not discussed with OP 2 whereas OP 2 contended that he was a visiting surgeon who attended the patient on 12-5-2002 and on clinical examination of the patient she was diagnosed as a case of acute appendicitis with perforation and generalized peritonitis. He performed the emergency surgery. Post operatively, due to deteriorating condition of patient, on 14-5-2002, OPs 1 and 2 along with three other doctors, namely, Dr. Krishnam Raju, Dr. Seshagiri Rao and Dr. Satyanarayana, took a decision to shift the patient to the tertiary hospital for intensive care and further management.

Findings: We have perused the medical record. It clearly shows that OP 2 performed all the relevant investigations on the patient and then took the decision of surgery. As per the operative notes there was a lump in right iliac fossa, the appendix was gangrenous, there was peritonitis. Therefore, the appendix could not be removed in toto but it was removed piecemeal only. It is pertinent to note that on the basis of histopathology report which took almost 10 days for reporting, confirmed that it was the case of tuberculosis of intestine/appendix. In the general parlance, the diagnosis of abdominal tuberculosis is not possible unless patient had any history of chronic abdominal pain with associated fever and loss of appetite. Therefore, it was not possible for OP 2 to diagnose or suspect tuberculosis at the initial stage i.e. on 12-5-2002. In our view, we do not think that it was a failure of diagnosis. In the instant case the patient approached OP hospital with acute abdominal pain and investigations revealed acute appendicitis which needed immediate surgical intervention. On surgical exploration, the OP 2 found that it was gangrenous appendicitis along with peritonitis. After operation to control the infection, OP 2 advised broad spectrum antibiotics like injection Texin, Amikacin and Metrogyl. Despite best efforts, the patient landed into sceptic shock, therefore, she was referred to Apollo Hospital. Considering the sequence of events, we do not find lapses on the part of the OPs during treatment of the patient. The decision to refer to higher centre was taken after discussion with team of doctors.

Held: On the basis of foregoing discussion, we do not find any negligence on the part of OP1 or OP2. The State Commission erred in this regard, hence, the order passed by the State Commission is set aside and this revision petition is allowed. Consequently, the complaint is hereby dismissed.

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