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DR. K. VASANTHI & ANR. v. CHALASANI SATYANARAYANA

National Consumer Disputes Redressal Commission

Jan 9, 2023

Judgment

Subsequent
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Summary of Decision: National Consumer Disputes Redressal Commission — Revision Petition No. 1930 of 2012

Factual and Procedural Background

The Complainant, Mr. Chalasani Satyanarayana, filed a consumer complaint in the District Forum, Visakhapatnam, against Dr. K. Vasanthi (OP‑1) and Anupama Surgical Children's Hospital (OP‑2), alleging medical negligence in the treatment of a rectal abscess which, he alleged, led to septicemic shock and consequent large medical expenses.

The District Forum allowed the complaint and directed the OPs to pay Rs. 6,29,300/-, with costs of Rs. 10,000/- and Rs. 5,000/- as advocate fees. The OPs filed Appeal No. 1213/2009 before the State Commission seeking to set aside the District Forum order; the Complainant filed Appeal No. 291/2012 seeking enhancement of compensation.

The State Commission dismissed both appeals, upholding findings of deficiency in service and negligence, and maintained the award (including medical expenditure items that together totaled Rs.6,09,277/- and Rs.20,000/- for mental agony). Aggrieved, the OPs filed the present Revision Petition under Section 21(b) of the Consumer Protection Act, 1986 before the National Commission.

Legal Issues Presented

Whether the OPs were guilty of medical negligence in performing the incision and drainage (I & D) and in the pre‑operative and post‑operative care of the complainant, resulting in septicemic shock.
Whether the complainant incurred expenditure on 17 injections of Xigris (Drotrecogin Alfa) at Care Hospital to the extent claimed (and thus whether refund/compensation for that amount was payable by the OPs).
Whether non‑maintenance of medical records by OP‑1 and OP‑2 amounted to deficiency in service and warranted liability and compensation.
What quantum of compensation (if any) should be awarded against the OPs in light of the above findings.

Arguments of the Parties

Complainant's Arguments

The patient underwent surgery (I & D) on 09.03.2004; the operation was allegedly shifted forward and done without pre‑operative tests and was described to him as a minor 5–10 minute procedure.
After surgery the patient developed breathing problems and was shifted to Care Hospital where he was diagnosed with septicemic shock and treated in ICU from 9.3.2004 to 18.3.2004 and later in the ward until 23.3.2004.
The patient took subsequent treatment at various hospitals up to July 2004 and was administered 17 injections of Xigirs (20 mg) at a total cost of Rs.4,78,083/-, producing empty vials as proof.
Total claimed expenditure by the complainant was Rs.7,78,250/- towards medicines, hospitals, fees, transport and attendance charges.
There were concurrent findings in the fora below in favor of the complainant, limiting the National Commission's jurisdiction to interfere.

OPs' Arguments

The OPs contended there were apparent errors in the orders of the fora below, particularly relating to the purchase and administration of Xigris injections.
The patient presented on 09.03.2004 with severe pain and high fever for four days; incision and drainage under general anesthesia was performed after minimum basic investigations (blood count, blood sugar and ECG).
Appropriate antibiotics were given; post‑operative recovery was initially good and the patient was kept under observation in ICU when he later developed signs of septicemia and was referred to Care Hospital for further management.
The OPs maintained that the transfer to Care Hospital was for further management when septicemia signs appeared and that it was not negligent or delayed; they emphasized that basic investigations and standard treatments (antibiotics, supportive drugs) were administered.

Table of Precedents Cited

No precedents were cited in the provided opinion.

Court's Reasoning and Analysis

The National Commission reviewed the documentary record, the orders of the District Forum and State Commission, medical records and the submissions of counsel. The analysis proceeded in several discrete steps:

On the specific question of the 17 Xigris injections claimed by the complainant, the Commission found the State Commission's acceptance of two invoices and 17 empty vials to be erroneous. The National Commission observed:
- The discharge summary and medical record from Care Hospital did not record or prescribe administration of 17 Xigris injections.
- The Commission consulted the Pharmacopeia price index and noted that one vial of Xigris costs Rs.84,700/-, implying 17 vials would cost Rs.14,39,900/-, inconsistent with the claimed bill amount of Rs.4,78,083/-. The opinion records the discrepancy and states there was nothing on record to show 17 vials were purchased at the claimed price.
- The treating doctors at Care Hospital had neither prescribed nor administered 17 Xigris injections according to the available records reviewed by the court.
Based on those observations, the National Commission concluded that the complainant was not entitled to refund/compensation for the amount allegedly paid for Xigris injections.
On the broader question of medical care and record maintenance:
- The court noted that OP‑1 admitted in evidence to not maintaining a case sheet and not entering details in the ICU register, despite the patient being in ICU for about six hours following surgery under general anesthesia.
- The referral letter from OP‑1 to Care Hospital, however, clearly described the procedure (I & D at 1:30 PM under GA), symptoms (hypotension at 4:30 PM) and the medicines administered (Monocef, IV RL and DNS, Hydrocortisone, O2 inhalation and Dopamine drip) and enclosed investigations and ECG.
- The National Commission considered clinical textbooks (Love & Bailey on Surgery and Harrison's Internal Medicine) to understand septicemic shock and noted that the patient's presentation (high grade fever, acute pain and abscess) was consistent with sepsis and that prompt drainage and referral were reasonable and in accordance with standard practice.
- Accordingly, on the facts and record before it, the court held that there was no failure of duty of care in the pre‑operative stage nor negligence in performing the I & D, and that the referral to a higher centre was prompt and not negligent.
On the legal significance of record‑keeping:
- The court emphasized the critical importance of maintaining accurate medical records and noted that medical records are legal documents that provide essential evidence in litigation. The opinion quotes the maxim cited in its reasoning: "Good Record is Good Defense" and "No record is No Defense."
- Because OP‑1 and OP‑2 failed to maintain proper medical records (operative notes, anesthesia details, medication and recovery documentation), the court held them liable for deficiency in service on that basis alone, even though it did not attribute medical negligence in treatment.
Remedy and quantification:
- Given that medical negligence was not established on the merits but deficiency in service was found due to non‑maintenance of records, the National Commission modified the State Commission's order to reduce the compensation awarded by earlier fora and directed the OPs to pay jointly and severally Rs.1,00,000/- to the complainant plus Rs.25,000/- as litigation cost.
- The award was to be paid within six weeks, failing which the OPs would be liable to pay interest at 10% per annum from the end of six weeks until realization.

Holding and Implications

Holding: The Revision Petition is PARTLY ALLOWED. The National Commission reversed the State Commission insofar as it accepted the complainant's claim for refund/compensation for 17 Xigris injections and concluded that refund for that item was not warranted. However, the Commission upheld liability for deficiency in service caused by non‑maintenance of medical records and modified the quantum of compensation.

Direct consequences for the parties:

The OPs (Dr. K. Vasanthi and Anupama Surgical Children's Hospital) are held jointly and severally liable to pay Rs.1,00,000/- to the complainant and Rs.25,000/- as litigation cost, to be paid within six weeks. After six weeks, interest at 10% per annum will accrue until payment is realized.
The complainant's claim for reimbursement of the Xigris injections amount (as alleged) was rejected due to lack of corroborating medical record and pricing inconsistency on the record reviewed by the court.

Broader implications and precedent:

The opinion stresses the evidentiary importance of contemporaneous medical records—while it does not purport to lay down a new legal principle, it reinforces that poor or absent documentation can itself constitute a deficiency in service even where the clinical care might not, on the record, amount to negligence.
The opinion did not rely upon or cite prior judicial precedents; no new binding precedent was announced beyond the application of these principles to the facts of this case.

Disposition: The Revision Petition is partly allowed; order modified to award Rs.1,00,000/- and Rs.25,000/- costs, with interest provisions as stated in the opinion.

Show all summary ...

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION

NEW DELHI

REVISION PETITION NO. 1930 OF 2012

(Against the Order dated 22/11/2011 in Appeal No. 1213/2009 of the State Commission Andhra Pradesh)

1. DR. K. VASANTHI & ANR. W/o D.K Rajeshwara Rao, C/o Anupama Surgical Children's Hospital D,No-47-9-21 Dwarkanagar

Visakhapatnam - 530016

A.P

2. Anupama Surgical Children's Hospital, Rep by its Dr K Vasanthi, W/o Rajeshwar Rao

Situated ar D.No-47-9-21 Dwarka Nagar,

Visakhapatnam - 530016

A.P ...........Petitioner(s)

Versus

1. CHALASANI SATYANARAYANA

S/o Chalasani Satyanaryana, R/o D.No-50-94-15/13 Srinidhi Nivas,Santhipuram

Visakhapatnam

A.P ...........Respondent(s)

BEFORE:

HON'BLE DR. S.M. KANTIKAR,PRESIDING MEMBER For the Petitioner :

For the Respondent :

Dated : 09 Jan 2023

ORDER

Appeared at the time of arguments For the Petitioners : Mr. Manoj C. Mishra, Advocate For the Respondent : Ms. K. Radha, Advocate

Pronounced on: 9^th January, 2023

ORDER

1. The Complainant Mr. Chalasani Satyanarayana filed the Consumer Complaint before

District Forum, Visakhapatnam against Dr. K. Vasanthi (OP-1) and Anupama Surgical Children's Hospital (OP-2) for alleged medical negligence during the treatment of rectal abscess and further he suffered septicemic shock. He incurred huge expenses for treatment taken from different hospitals.

2. The District Forum allowed the Complaint and directed The OP-1 ad 2 to pay Rs. 6,29,300/- with cost of Rs. 10,000/- and Rs. 5,000/- as advocate fee. Being aggrieved, the OPs filed F.A. No. 1213/2009 for setting aside the Order of the District Forum, whereas the Complainant filed F.A. No. 291/2012 for enhancement of compensation.

3. The State Commission dismissed both the Appeals with the following observation:

18. In view of the discussion made supra, we are of the considered opinion that there is deficiency in service and negligence on the part of OP in treating the complainant properly and also for the reason that they did not maintain any pre or post operation reports so also the surgical notes etc. which lead the complainant to take further treatment in care hospital. In view of the above discussion and finding in favour of the complainant the written arguments and the decisions referred to in it are not helpful for the ops to decide the point in their favour. Thus, the point is answered in favour of the complainant and against the OPs.

19. Regarding quantum of compensation aspect, it is discussed as under: Ex. A3 final bill issued by care hospital, in favour of the complainant discloses that a sum of Rs.l,18,936/- was collected by the said hospital from the complainant for the treatment given to him. Ex.A19 two invoices for supply of 17, XIGIRS-20 mg injections reveal that the cost of the said injections was Rs.4,78,083/- the complainant produced empty viles in proof that the costly injections were administered to him in critical conditions. There is no clinching evidence from OP side that administering of such costly injections was unnecessary. Nobody would give such injections without there being any necessity and hence the version of the complainant that such injections were used to him in the care hospital and that he incurred expenditure of Rs.4,78,083/- is believed as true. Apart from the two said items, there are bills evidencing that the complainant has purchased some other medicines and had undergone diagnostic tests and thus the total medical expenditure of the complainant comes to Rs.4,90,341/- and if the said sum of Rs.l,18,936/- final bill is added the grand total of expenditure comes to Rs.6,09,277/-. Assigning satisfactory reasons the District Forum arrived at a right to conclusion that the complainant is entitled for such amount from the OPs for their deficiency in service to him and absolutely there are no reasons to scale down the said amount at all. For such a small operation, which resulted in complications to the complainant the Ops are made liable to pay such huge amount towards medical and incidental expenses and in such circumstances granting of Rs.20,000/- to the complainant for mental agony etc is also reasonable and there are no reasons to enhance the said amount. Thus, the orders under appeal are upheld and consequently both the appeals are liable to be dismissed.

4. Being aggrieved the OPs filed the instant Revision Petition under Section 21(b) of the Consumer Protection Act, 1986.

5. Heard the learned Counsel on both the sides.

6. The learned Counsel for Complainant argued that there are concurrent findings from both the fora below, therefore, National Commission has limited jurisdiction. He further reiterated the facts that on 9.3.2004 the complainant (for short 'Patient') was operated for rectal abscess by the OP-1. It was alleged that surgery fixed at 6 pm but due to non-availability of Anesthetist in the evening, the surgery was performed earlier at 1 pm without preoperative tests. The Complainant was informed about the surgery as very simple and minor one, lasting for five to ten minutes only. After surgery he was kept in intensive care unit. At 3 pm, the patient developed breathing problems and further deterioration. He was shifted by ambulance to Care Hospital, allegedly without any assistance and medical records. There, he was diagnosed as a case of Septicemic Shock. He was treated in the ICU from 9.3.2004 to 18.3.2004 and later shifted to the ward till 23.3.2004. It was further argued that till July 2004, the patient took treatment in different hospitals namely Simhadri Hospital, Nagarjuna Hospital in Vijayawada and lastly at Seven Hills Hospital, Visakhapatnam. The learned counsel further submitted that the patient was administered 17 injections of Xigirs 20 mg, for the total cost of Rs. 4,78,083/-. The Complainant incurred total expenditure of Rs.7,78,250/- towards medicines, hospital, towards fees, transport and attendance charges.

7. The learned Counsel for OPs argued that there are apparent errors in the Orders of both the fora, which failed to consider the crucial issue of purchase and administration of injection Xigirs. The Counsel further argued that on 09.03.04 the patient came to hospital with agonizing pain in the Ano-rectal region and with high grade fever for 4 days. To drain the pus, simple incision and drainage (I & D) under General Anesthesia was suggested, for which patient readily agreed. Minimum basic investigations like blood count, blood sugar and ECG were done before I & D. He was administered appropriate antibiotics. Post-operative recovery was good; he was alert and kept in the ICU under continuous observation. At 3 pm patient developed signs of septicemia and immediately ECG was performed, it was normal. Therefore, it was confirmed as a septicemic shock, accordingly for further management, the patient was shifted to Care hospital in the evening wherein the doctors confirmed the diagnosis of Septicemia.

8. Perused the medical record, inter-alia the Orders of both the fora below.

9. The relevant observation of the District forum is reproduced as below:

22. Such being the evidence placed by either side on record coming to the grievance of the complainant it is three fold. Firstly the surgery was not properly conducted, which forced him to undergo similar surgery. The other two grounds are back of proper pre- operative care as well as post-operative care to the complainant. Unfortunately in this case there is no record as to the treatment given to the complainant by the opposite party at any stage. Strange explanation given by the opposite party is that as it is an emergency no case sheet is maintained and even at the time of referring the patient to the Care Hospital she claimed to have mentioning the treatment given on her letter head. This inspite of the fact that though a minor surgery of incision and drainage was conducted but under General Anesthesia and the patient was there in the intensive care unit for about 6 hours and has shown symptoms of Septicemic Shock. We are of the view when General Anesthesia is being administered to the patient before surgery,

though a minor, one a duty is cast upon the opposite parties to open a case sheet and note down the procedure that was observed before the surgery, during surgery and treatment after the surgery.

10. In the instant case the main controversy is about use of total 17 Xigiris injections at Care Hospital. The State Commission observed that:

"Ex. A19 two invoices for supply of 17, XIGIRS-20 mg injections reveal that the cost of the said injections was Rs. 4,78,083/- the complainant produced empty vials in proof that the costly injections were administered to him in critical conditions. There is no clinching evidence from OP side that administering of such costly injections was unnecessary. Nobody would give such injections without there being any necessity and hence the version of the complainant that such injections were used to him in the care hospital and that he incurred expenditure of Rs. 4,78,083/- is believed as true."

(emphasis supplied)

11. In my view, it was an erroneous observation of the State Commission (supra), which just relied upon two invoices and 17 empty vials of Xigris and concluded that during treatment at Care Hospital, the patient was given 17 injections of Xigris (20 mg) (Drotrecogin Alfa). Surprisingly, it is pertinent to note that the medical record and Discharge summary of Care Hospital did not show any mention or advice about the administration of 17 injections of Xigris. I have gone through the Pharmacopeia price index, one vial of Xigris costs Rs. 84,700/-, thus the total cost of 17 vials would be Rs. 14,39,900/-, but nothing is on record to prove that 17 vials of Xigris were purchased at the cost of Rs.4,78,083/- .The treating doctors of Care Hospital have neither prescribed or administered 17 Xigris injections to the patient. Therefore, the Complainant won't deserve the refund of amount allegedly paid for the injections Xigris.

12. Adverting to the maintenance of patient's medical record, admittedly OP-1 in her evidence deposed that she did not maintain case sheet. She did not enter in the ICU register about the surgery was done in emergency though the patient was in ICU for 6 hours. According to OP-1 it was not a major case, therefore she did not make entry in hospital register or ICU register.

13. I have perused the referral letter given by OP-1 to Care Hospital. The letter clearly mentioned about the procedure I & D done for Peianal abscess at 1.30 PM under GA. He developed hypotension at 4.30 PM and shifting the patient after stabilizing for further management. Also mentioned about the medicines administered viz Monocef,IV RL and DNS, Hydrocortisone, O2 inhalation and Dopamine drip. The investigations and ECG were enclosed.

14. In my view in absence of medical record, the referral letter clearly mentioned about the mode of treatment adopted by the OP-1 for the painful Ano-rectal abscess. Such patient needs immediate relief from acute pain . I & D was performed after doing basic investigations viz. Blood Counts, Blood Sugar and ECG. It was reasonable standard of surgical practice. In my

view, it was neither failure of duty of care during pre-operative stage nor negligence while performing I & D. It is pertinent to note that the clinical signs and symptoms show the patient was already in sepsis. Post operatively patient was kept in ICU and administered higher antibiotic Monocef and other drugs as per standard practice. The complication of septicemia was managed by inj Steroid, Dopamine drip and Oxygen supply also. The patient for better treatment was referred to the higher centre - Care Hospital.In my view it was prompt referral and there was no delay. Referring the patient during absolute necessity is not negligence.

15. I have gone through the text books on Surgery ( Love & Belly) and Harrison's Internal Medicine to know about Septicemic shock. The patient had symptoms of sepsis - severe infection like high grade fever, acute pain and abscess. If it remains untreated, the chances of chronic sinuses, fibrosis may lead to anal incontinence.

16. Further, I can't ignore the non-maintenance of vital medical record by the OPs. It was the primary duty of treating doctor to maintain proper treatment record including anesthesia, Operative notes , the medication, details of recovery from anesthesia etc. It should be borne in mind that, though I & D was a minor surgical procedure, OP-1 performed it under General Anesthesia and post operatively the patient was in ICU for 6 hours. Proper documentation will help to prove the doctor's duty of care and to defend certain unavoidable and unforeseen complications. Therefore, the Petitioners (OP-1 & 2) are held liable for the deficiency in services.

17. Medical records not only serve as necessary documents for apt management of a patient, they are also legal documents. These records contain useful evidence for diverse litigations including personal injury cases, criminal cases, workers' compensation, disability determinations, and medical negligence claims. It should be borne in mind that "Good Record is Good Defense" Poor Record is Poor Defense" and "No record is No Defense." Thus, accurate and complete medical documentation is vital for appropriate and efficient patient care.

18. Based on the discussion above, medical negligence is not attributable to the OPs, however OPs are held liable for non-maintenance of medical record. Accordingly, the Order of State Commission is modified that, the OPs shall pay jointly and severally Rs.1 lakh to the Complainant along with the Rs.25,000/- as cost of litigation within 6 weeks from today. Beyond 6 weeks, the OPs shall liable to pay 10% interest per annum till its realisation. The Revision Petition is partly allowed.

......................

DR. S.M. KANTIKAR

PRESIDING MEMBER