Case Study

Primary Burden of Proof is on the Complainant

Pally Srikanth & Anr. v. M/s. Krishna Institute of Medical Sciences Ltd.

FA No. 380/2011, decided by the Hon’ble NCDRC, New Delhi, on 23rd September, 2016.

Facts:  Appellant No. 2 Smt. Pally Rohitha, wife of appellant No. 1, went to Sai Krishna Super Specialty Neuro Hospital, Hyderabad on 27-9-2006 with complaint of difficulty in walking and joint pains for one and a half months; was admitted in the said hospital under the treatment of Dr. D. Shridhar, MD, DM (Neuro Physician); was subjected to a number of investigations, including MRI of the whole spine and her ailment was diagnosed as Hyperthyroidism + MSD (Multi-symptom disease)/SMA (Spinal Muscular Atrophy).  Her Thyroid profile in the aforesaid hospital showed her T4 to be 29.6 as against the normal range of 60-200 whereas her TSH was found to be 7.4 as against the normal range of 0.25 – 5.  She was discharged with advice to take Physiotherapy and certain medicines including Thyronorm 50 mg were advised to her.  She, however, did not report back to the aforesaid hospital and on the advice of one Dr. D.P. Dhairyawan, she came to Krishna Institute of Medical Sciences Ltd. (Respondent No.1); remained in the aforesaid hospital from 19-12-2006 to 21-12-2006 under the treatment of Dr. S. Mohandas, Dr. E.A. Vara Lakshmi and Dr. B. Chandrasekhar Reddy.  When she came to the said hospital, she had complaint of pain in lower limbs, associated with weakness of limbs; her physical examination revealed weakness of proximal muscles of all four limbs.  She was discharged with advice to take Mecozen Plus tablets, Evion (Vitamin E) capsules and take physiotherapy with review after two months in Neurology OPD.  Her ailment was diagnosed as Anterior Horn Cell Disease – Probable SMA-Type III.   Doctor B. Chandrasekhar Reddy also certified that the said disease had no specific treatment.  The appellant No. 1, thereafter, went to Medwin Hospital where she was admitted on 13-2-2007.  It was diagnosed that she had primary Hyperthyroidism due to Parathyroid Adenoma and required surgical excision for the same.  That surgery was later done in Medwin Hospital.  Alleging negligence in her treatment by the doctors of Krishna Institute of Medical Sciences Ltd. (Respondent No.1), she approached the concerned State Commission by way of a consumer complaint.  Her case in nutshell was that her ailment had been wrongly diagnosed without conducting adequate investigations and in fact, the Spinal Muscular Atrophy (SMA) Type-III was not even possible at her age.  According to her, she was wrongly advised that the aforesaid disease was incurable and no medicine for its treatment was available.

Defence: That the assumption that appellant No. 2 was suffering from Spinal Muscular Atrophy (SMA) was only a suspicion which was not confirmed.  Denying the claim of the complainants/appellants, that Spinal Muscular Atrophy (SMA) cannot be developed at her age, that she having already taken treatment before coming to OP No.1 Hospital, the investigations were not repeated and only E&MG was done in their hospital, that the findings of the tests which the patient had already undergone were suggestive of Anterior Horn Cell Disease – Probable SMA-Type-III, that persons with weakness of limbs and lower motor neuron type without sensory symptoms or signs, without spinal cord involvement are considered to have either muscle or anterior horn cells disease and that in her case, E&MG findings were suggestive of Neuro Lesion and Muscle Denervation Atrophy without re-innervation..

Held: It is settled legal preposition that the onus of proving the alleged negligence in the treatment of a patient lies with the person alleging medical negligence.   No doctor was examined by the complainants to examine the record pertaining to her treatment in Krishna Institute of Medical Sciences Ltd. and give opinion as to whether there was any negligence in diagnosis of her ailment and in her treatment in the said hospital.  The surgery of complainant No. 2 was performed at Medwin Hospital.  No doctor from Medwin Hospital was examined to prove the alleged negligence in the treatment of complainant No. 2 at Krishna Institute of Medical Sciences Ltd.  Respondent Nos. 2 to 4 who themselves are doctors, have denied alleged negligence in the treatment of complainant No. 2.  More importantly, the Neurologists of Gandhi Hospital, which is a well-known Government hospital of Secunderabad, and who is in the rank of an Associate Professor, has categorically opined that prima facie there was no negligence in the treatment of complainant No. 2 in Krishna Institute of Medical Sciences Ltd.  The Professor and Head of Department of Endocrinology also examined the documents relating to her treatment and he also did not claim any negligence in her treatment.  Rather, he was of the opinion that the rare condition exhibited by complainant No. 2 occurs only in 0.1 to 0.3 per 1000 patients.  According to him, the commonest presentation of such disease is asymptomia and most of the cases are diagnosed incidentally; only rarely the patients presented with the muscle weakness. Had the case been followed properly, the condition would have been diagnosed in the subsequent sections.  Complainant No. 2 did not report back in Krishna Institute of Medical Sciences Ltd. after she was discharged on 21-12-2006.  It is quite probable that had she continued visiting the said hospital as was advised at the time of discharge, her ailment would have been diagnosed in due course.  As far as the opinion of the Radiologist of Gandhi Hospital is concerned, his opinion was given after CT scans were conducted on 20-2-2007 and 26-2-2007.  Therefore, his report does not show any negligence on the part of the respondents in treatment of complainant No.2. Even Sai Krishna Super Specialty Neuro Hospital in its report diagnosed her ailment as Hyperthyroidism + MSD (Multi-symptom disease)/SMA (Spinal Muscular Atrophy).  The said opinion was based upon several investigations conducted in Sai Krishna Super Specialty Neuro Hospital which included MRI of the whole spine and ultrasound scan of the abdomen besides several blood tests.  The respondents had no reason to suspect the report of Sai Krishna Super Specialty Neuro Hospital and therefore, they cannot be said to be negligent in the treatment of complainant No. 2 only on account of having not repeated the investigations which she had already undergone at Sai Krishna Super Specialty Neuro Hospital.  The diagnosis by Sai Krishna Super Specialty Neuro Hospital being on the lines of the diagnosis at Krishna Institute of Medical Sciences Ltd., it would be difficult to say that no qualified doctor, on the basis of the investigation reports available to him and the clinical examination of the patient, could have diagnosed it as a case of Anterior Horn Cell Disease – Probable SMA-Type III. 

 There is no quarrel with the legal preposition that a case of medical negligence can be made out even without producing the evidence of an expert.  But, where in a particular case, the alleged negligence stands proved or not, would depend upon the facts of each case.  The onus will always be upon the complainant to prove, whether by producing expert opinion or otherwise, that there was negligence at the hands of the doctor in the treatment of the patient. 

In the present case, no such negligence on the part of the doctors could be established by the complainants/appellants.  On the other hand, the opinion given by the Neurologist of Gandhi Hospital, Secunderabad indicates that there was no negligence in her treatment at Krishna Institute of Medical Sciences Ltd. The requisite investigations had already been done before complainant No. 2 came to Krishna Institute of Medical Sciences Ltd. and the doctor had no reason to suspect the evidence of the investigations conducted at the previous hospital.  They felt necessity of one additional test, namely, E&MG which they got duly conducted at the said hospital.  Therefore, it cannot be said that the doctors at Krishna Institute of Medical Sciences Ltd. had not got necessary investigations done before diagnosing the ailment of the complainant.  In fact, they could not finally diagnose her ailment since the symptoms which they found during her clinical examination and the report of the investigations available to them, did not suggest that she was suffering from Hyperthyroidism + MSD (Multi-symptom disease)/SMA (Spinal Muscular Atrophy).  Had complainant No. 2 continued treatment in Krishna Institute of Medical Sciences Ltd., in all probabilities, she would have been subjected to further investigations and the correct diagnosis would have been possible.  The appeal is accordingly dismissed with no order as to costs.

 

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