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DELHI STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, NEW DELHI
Honble Mr. Justice A.P. Chowdhri, President &
Mr. Desh Bandhu, Member
A.P. BHATNAGAR & SMT. NIRMALA BHATNAGAR—Appellants
versus
DR. N.K. PATNAIK—Respondent
Case No. A-61 of 1994—Decided on 18.6.1997
MEDICAL NEGLIGENCE - OPHTHALMOLOGY - CATARACT SURGERY - INTRA OCULAR LENS IMPLANTATION - ALLEGED NEGLIGENCE IN SURGICAL PROCEDURE AND POST-OPERATIVE CARE - ASSESSMENT OF EVIDENCE - INTERPRETATION OF MEDICAL RECORDS AND EXPERT OPINIONS - APPLICATION OF LEGAL PRINCIPLES GOVERNING MEDICAL NEGLIGENCE - DETERMINATION OF LIABILITY AND COMPENSATION.
Fact of the Case:
The complainant, Smt. Nirmala Bhatnagar, underwent cataract surgery with intra ocular lens (IOL) implantation performed by the respondent, Dr. N.K. Patnaik, an eye specialist. Following the surgery, the complainant experienced complications, including inflammation, infection, and impaired vision in the operated eye. She filed a complaint before the District Consumer Forum alleging medical negligence and seeking compensation.
Finding of the Court:
The District Consumer Forum dismissed the complaint, holding that the complainant failed to establish negligence on the part of the respondent. The complainant appealed to the State Consumer Commission.
Issues: 1. Whether the respondent was negligent in performing the cataract surgery and post-operative care, leading to complications and impaired vision in the complainant's eye? 2. Whether the respondent misrepresented the nature and risks of the surgery, including the use of laser technique and the success rate of the operation? 3. Whether the respondent charged excessive fees for the surgery and post-operative care?
Ratio Decidendi: 1. Negligence in Surgical Procedure and Post-Operative Care: - The court analyzed the medical records, expert opinions, and testimonies presented by both parties. - It noted that the respondent had used a combination of YAG Laser and conventional surgical techniques to perform the cataract surgery, which was consistent with the standard practices at the time. - The court found no evidence to suggest that the respondent had deviated from the accepted norms of medical practice or failed to exercise reasonable care and skill during the surgery. - Regarding post-operative care, the court considered the testimony of Dr. V.K. Dada, a senior eye specialist from AIIMS, who opined that the inflammation and infection experienced by the complainant were not necessarily due to negligence but could occur in a small percentage of cases despite proper care. 2. Misrepresentation of Nature and Risks of Surgery: - The court examined the evidence related to the respondent's alleged misrepresentations about the use of laser technique and the success rate of the surgery. - It found that the respondent had clarified to the complainant that the laser technique was used only for a specific part of the procedure and that the overall success of the surgery could not be guaranteed. - The court held that the respondent's statements did not amount to misrepresentation or misleading the complainant. 3. Excessive Fees: - The court noted that there was no law prescribing fees for medical services and that the level of fees was determined by economic forces of demand and supply. - It found no evidence to suggest that the fees charged by the respondent were excessive or unreasonable compared to the prevailing rates for similar services.
Final Decision: The State Consumer Commission dismissed the appeal, upholding the decision of the District Consumer Forum. It concluded that the complainant failed to prove negligence on the part of the respondent or any misrepresentation or excessive charging of fees.
Mr. A.P. Chowdhri, President—Brief facts giving rise to this appeal are that Smt. Nirmala Bhatnagar (complainant No. 2) wife of Shri Atma Prakash Bhatnagar (complainant No. 1), aged 68 suffered from Herpes Zoster on the left side of the head, forehead and swelling on the left side eyebrow in June-July, 1989. After about three weeks, the swelling subsided but itching continued. Thereafter she suffered from inflammation and infection of the eyes at times for which she took treatment in January-March, 1991. She also suffered from Uvietis for which she was treated at the A.I.I.M.S. (AIIMS). On July 2,1991, she consulted the opp. party Dr. N.K. Patnaik, Eye Specialist, with regard to the cataract in the left eye. She paid Rs. 100/- as consultation fee. She was told that the cataract was mature and required to be operated and with Intra Ocular implantation her eyesight would improve in the left eye. She was further informed that the operation would be performed with YAG Laser. She agreed and accordingly the operation was performed by Dr. Patnaik on 8.7.91. She paid Rs. 5,500 /- on account of operation fee and cost of Intra Ocular Lens (IOL) and Rs. 485/- as hospital charges. She was seen by the Surgeon on the next following day and again after another two days. For these follow-up visits, she was charged a further fee of Rs. 50/- each. She could read only letter 'A' of the first line of the standard chart. The complainant was again seen on four different dates by Dr. Patnaik in the month of July and August and asked to come again after another 15 days of the last visit. These visits cost the complainant another Rs. 1,000/-. She returned to Bijnore where she resided. On 29th August, 1991 and 30th August, 1991, she was examined by Dr. Vineet Mathur, Eye Specialist. From a distance of six metres or even less, she could read only capital letter 'A' of the standard chart and her vision in left eye was found to be 6/60 with the implanted lens. The eye ball was found sticking to the implanted lens. The complaint giving rise to this appeal was filed on 1.1.92 claiming compensation of Rs. 1, 00,000/-. The grievances of the complainant were:
(i) The opp. party misrepresented that the operation would be performed with the laser technique. He also misrepresented that the operation would not be unsuccessful as he had the latest skill and appliance imported from U.S.A. and comparable with the appliances, etc. available abroad.
(ii) He charged fee many times more than average Eye Surgeon and was expected to exercise high degree of expertise and skill but he failed to do so.
(iii) He should have known that the IOL was not advisable in view of the history of the complainant, namely suffering from Uvietis, he had not given due attention to the treatment undergone by the complainant for Uvietis in the A.I.I.M.S.
(iv) He failed or was negligent in ascertaining the exact power of the lens before actually implanting the same.
(v) The opp. party again misled the complainant by using additional lens i.e. in addition to IOL and making her read 3/4 lines in order to convey the impression that the complainant's eyesight had improved.
(vi) He failed to warn that complainant's optic Nerve was affected and eyesight would not be restored to normal at the time of initial consultation.
(vii) The implanted lens having been found to be sticking to eye ball indicated that the operation had been performed negligently.
(viii) That the opp. party was guilty of misconduct for charging post operative fees.
2. Dr. Patnaik filed his written version in the form of affidavit. The preliminary objection included the plea that the service rendered by the medical practitioner was beyond the purview of service as defined in the Act and the Commission had no jurisdiction in the matter. This objection stands decided against the opp. party in view of the decision of the Supreme Court in IMA v. V.P. Santha and Others, III (1995) CPJ 1 (SC). On merits, each and every material avermen
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