Decided on January 12,2010

Coin Par Appellant
Cosmopolitan Hospital (P) Ltd. Respondents


K.R.UDAYABHANU, PRESIDENT - (1.) THE case of the complainants are as follows: The second complainant who was a minor then had a small accidental fall on 14.3.1997 at about 12.00 hours while washing cloths at his residence. Due to continuing a mild pain on the right knee joint he was taken to the first opposite party hospital on 16.3.1997. The treatment expenses are paid partly by Vikram Sarabhai Space Centre and partly by the 3rd complainant, the father. It is the second opposite party, the Orthopaedic Surgeon who treated the second complainant. There was no visible injury or swelling on the knee and he was capable of walking without external support. Blood and urine tests and X -ray of the knee was taken and no abnormalities were noted. But the second opposite party prescribed arthroscopy to be done. The 3rd complainant was told by the second opposite party doctor that arthroscopy is a minor diagnostic method which takes less than 30 minutes and assured that the patient can go home after the same. He was not informed of the risks inherent or alternative methods and no informed consent was obtained. On 18.3.1997 the second complainant underwent arthroscopy of the right knee joint. The diagnostic arthroscopy was performed by introducing a probe called arthroscope into the knee joint. As against the earlier assurance, the patient was not discharged on the same day but retained in the hospital for 5 days under plaster. In the discharge summary it is mentioned as ACL contusion and abnormal lateral cartilages  (ACL meant anterior cruciate ligament). ECHO Doppler test was also conducted prior to arthroscopy. The second complainant has no history of any cardiological problem. The arthroscopy procedure took 4 1/2 hours. It is the allegation that ECHO Doppler test and arthroscopy was done only to extract money even after fully knowing as a result of the X -ray examination that there was no damage to the knee as such. The arthroscopy was carried out by Dr. Jesu Kumar and Dr. Kumaran Chettiar against the impression given to the 3rd complainant that the same will be performed by the second opposite party. It was the second opposite party being an expert Orthopaedic surgeon that was chosen by the complainant. Dr. Jesu Kumar was not having the required skill.
(2.) THE knee joint of the second complainant was punctured at 4 places indicative of the hit and trial done by inadept hands. The second complainant was discharged on 21.3.1997 and the stitches were removed on 26.3.1997. At the time the second complainant was having high running fever indicating infection. Effusion plus, an indication of infection, is recorded on 26.3.1997 itself. The patient was taken to the hospital on 26.3.1997 and on 11.4.1997 due to running fever and knee pain. Infection was detected only after 21 days on 16.4.1997. Only on16.4.1997 blood test was carried out and ESR was found very high. No attempt was made for a period of 30 days to culture and detect the bacteria causing the infection. In this regard the opposite party failed to exercise the duty of care required in such circumstances. Evidently, the arthroscope was contaminated due to lack of sterilization and contained virulent strains of bacteria which in turn caused infection in the synovial cavity. It is recorded by the opposite parties that the patient developed swelling, effusion and synovial thickening following diagnostic arthroscopy. The knee joint of the patient was admitted to be septic by staphylo coccus aureus as per their own test results. The patient was again admitted on 23.4.1997 for incessant fever and pain and fever continued in spite of administering very strong antibiotics. The patient was discharged for the second time on 5.5.1997. Just prior to the discharge on second time the ESR count was 82 which is indicative of very high infection. Adequate steps were not taken to surgically drain the septic foci formed inside the knee joint. The patient was also not referred to a specialist for better management.
(3.) THE patient was admitted at the hospital for the 3rd time on 18.5.1997 and the procedure of synovectomy (sic. arthrotomy) was carried out on 19.5.1997, that too by an inexperienced surgeon namely Dr. Kumaran Chettiar, although it is claimed by the opposite parties that the surgery was performed by the second opposite party assisted by Dr. Kumaran Chettiar. It is pertinent to note that the particular day was out patient day for the second opposite party. The above surgery was carried but by the inexperienced person that resulted in retention of pus beyond manageable level. Only a small cut of 2.5 cm was made on one side which contributed retention of pus on the other side although it is recorded by the opposite parties as removed fluffy thick soft material . It is evident that a thick stuff cannot be drained through a small tube from one side. It is also alleged that the sample collected from the knee joint for pathological test was a clot sample which could not give proper result. The patient was discharged on 29.5.1997 still with a swollen joint and running fever, joint pain and flexion deformity. The surgery performed on 19.5.1997 yielded no benefits, but only contributed to added pain and sufferings. After the 3rd discharge the condition of the patient worsened and he had high running fever, joint pain and could not even stand without support. On 2.6.1997 the patient was taken to Dr. Cherian M. Thomas, Director and Professor of Orthopaedics, Medical College, Thiruvananthapuram. Following the advice of Dr. Cherian Thomas, the patient was given conservative treatment at Nirmala Hospital, Thiruvananthapuram for 5 days. Then the patient was admitted at Medical College Hospital, Thiruvananthapuram from 9.6.1997 to 17.6.1997. Dr. Cherian Thomas remarked that the infection is due to the intrusion of resistant strain of bacteria during arthroscopy and recorded diagnostic arthroscopy done elsewhere followed by septic arthritis . He also opined that complete drain was essential and that the second surgery was not properly carried out to effect complete drainage. However, he cautioned the performance of another operation immediately even though it is essential. He advised to continue antibiotics to avoid complications. Subsequently Dr. Cherian M. Thomas referred the patient to CMC Hospital Velloor on 8.8.1997.;

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