Removal of Ureter during DnC: Lilavati Hospital, Gynaecologist told to pay Rs 16.45 lakh Compensation

The forum noted that when the doctor was performing D & C the ureter was removed and it was sent to hystopathalogical department under the impression that it was some tissue or roundworm.

Mumbai: A prominent city based Lilavati Hospital and a gynaecologist has been directed to pay a compensation of Rs 16.45 lakh by the State Consumer Redressal forum after the forum held it guilty of negligence for removal a ureter during Hysteroscopy and dilation and curettage (D&C) procedure

The incident goes back to December 2013 when a female patient approached the Lilavati Hospital and Research Centre and consulted a  gynaecologist with a complaint of postmenopausal bleeding. The patient was advised to undergo a minor investigative procedure – a Hystersocopy and Dilation and Curettage (D & C) for which she was admitted in the hospital. After the said procedure, she was discharged after two days.

On the same evening, she was readmitted due to a continuous complaint of breathlessness. It was informed that an emergency operation- PCN had to be performed due to her right ureter being damaged.

It was informed later that complainant had to undergo another procedure to ensure that her right kidney does not get damaged and during the time she will have to carry a urine bag. It was noticed that her right ureter of the complainant was damaged and could not be seen on the test being conducted.

The patient still faced the problem and so she was later admitted in Hinduja Hospital where her right kidney was removed.

After the said incident, the patient moved the State Consumer Forum to register a complaint against the treating doctor and the hospital, contending deficiency in service due to which her right ureter was damaged leading to the removal of the right kidney. She sought compensation for the suffering she went through.

The hospital provided its written version where it denied the allegations made by the complainant but it did not dispute that right ureter of the complainant was damaged and removed when C & D was done. The hospital administration informed that the treating doctor was not the employee of the hospital. The complainant had alleged that the reports were not given on time by the hospital which was denied. The reply mentioned 'that the report was given in proper time and the time which was required for the process that was only taken for submitting the report and hence, there was no deficiency in service."

Taking note of the CT scan report, it mentioned that the ureter was removed and was sent to the lab mentioning it to be a worm. The reply mentioned that 'the senior Histopathologist informed opposite the gynaecologist that the long tubular/cord like structure removed at hysteroscopy was the ureter. Other pathologists in the department informed her of the report but she refused to believe them. The doctor then visited the pathology department and was shown the structure under a microscope that it was indeed the ureter. The doctor was next asked to do a CT scan to confirm the missing ureter'.

The treating doctor filed his reply in front of the forum where he contended that there was no deficiency in service on the part of the opponent. He mentioned the alleged incident cannot be construed as negligence but it is a pure misadventure that is not actionable and hence no compensation becomes due and payable. He claimed that the said incident was an instant case i.e. ureteric injury was a pure accident.

He contended that 'the ureter injury took place because of the menopause status. In menopausal patient, the uterus shrinks and the musculature also atrophies

It was submitted that the doctor, an agent of the Lilavati Hospital, therefore the hospital is vicariously liable for all of its staff whether full timers or part timers.

Considering the contentions of all the parties, the forum went through the matter in detail along with the literature of the case.

The forum went through the medical report of the entire treatment where it took note of the CT scan report provided.

The forum mentioned that

'The right ureter was not visualized during the CT scan. Thus it is very clear that it was removed by the doctor while doing D & C was a right ureter of the complainant."

The forum noted that there was procedural D & C and hence when the doctor was performing D & C the ureter was removed and it was sent to hystopathalogical department under the impression that it was some tissue or roundworm.

The forum, dissatisfied with the contention of the doctor stated that the contention of the doctor that it 'was an accident by misadventure cannot be accepted'.

The State commission further mentioned that

The reasonable degree of skill was to be exercised while doing the said process and it appeared that no reasonable degree of skill was exercised while doing D & C. Reason is that, while doing D & C the right ureter was removed by the doctor and hence, it cannot be said that it was an accident or misadventure.

The commission further added that it cannot be said that reasonable degree of skill was exercised by the gynaecologist while doing D & C and hence, the commission concluded that there was a deficiency in providing treatment to the patient.

The State Consumer Redressal Forum directed the hospital and the doctor to collectively pay compensation of Rs 16.45 lakh.