NCDRC absolves Surgeon accused of not removing stone with gall bladder surgery

Patna: In a major relief to a doctor accused of not removing gall bladder stone during surgery; the National Consumer Disputes Redressal Commission (NCDRC) has absolved him of the medical negligence charges.

The bench of Presiding Member Dr SM Kantikar and Member Dinesh Singh dismissing the petition of the patient observed that the doctor followed the accepted line of treatment and there was no fault or imperfection in the laparoscopic cholecystectomy, he performed on the patient.

The case relates to the patient who approached the doctor complaining of severe abdominal pain last year. After investigations, it was diagnosed as a case of gall bladder stone. The doctor performed laparoscopic cholecystectomy i.e. removal of the gall bladder.

After a week, the patient again experienced continuous abdominal pain and the USG report revealed a stone in Common Bile Duct (CBD) which was not evident during the operation. Therefore, he approached the doctor once again. Few blood tests and ultrasonography (USG) of the abdomen were performed. The investigations revealed jaundice to the patient and a stone was present in the abdomen.

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For proper removal of CBD stone, the doctor advised Endoscopic Retrograde Cholangiopancreatography (ERCP) and referred the patient to another doctor in Patna who accordingly performed the surgery.

However, the patient accused the first doctor of medical negligence and moved the District forum. In the complaint, the counsel appearing on behalf of the patient submitted that the doctor failed to remove the gall stone during the first operation and it was a clear case of deficiency in service and unethical practice on the part of him.

Allowing the patient’s plea, the District Forum directed the doctor to pay Rs.59,000/- along with interest @10% per annum from the date of filing of the complaint as compensation.

Aggrieved with the order, the doctor filed the first appeal before the State Commission. The State Commission allowed the appeal and consequently, the complaint was dismissed. Further, being aggravated by the impugned order of State Commission the patient filed instant revision petition with the NCDRC.

During the hearing, it was pointed out that the gall stones are most commonly seen in the gall bladder and rarely found in the biliary ductal system.

After considering the arguments and perusing the material on record, the bench slammed the District forum’s decision allowing the patient plea and stated

“In our view the District Forum wrongly came to conclusion that “how within 10 days” another stone of 1.09 mm” was formed in the abdomen of the complainant. The District Forum, on presumption held that while removing the stone possibly, the doctor applied pressure on stone and it broke and it left into the abdomen of the Complainant. It should be borne in mind that the CBD stone means a stone in common bile duct. In the instant case the CBD stone (1.09 cm) was diagnosed week after the laparoscopic cholecystectomy, diagnosis was made due to increased bilirubin level and USG study.”

The bench observed that the patient failed to establish negligence against the doctor as his case is neither supported by any expert opinion nor by any medical literature.

“The doctor followed the accepted line of treatment and we do not find any fault or imperfection in performing laparoscopic cholecystectomy. When the CBD stone was found after a week, which could be managed effectively by the conventional endoscopic method (ERCP). Accordingly, the patient who referred to an expert at Patna, who recorded CBD stone by ERCP. Thus, referring the patient for ERCP was not a wrong decision of OP.”

After finding no merit in the petition, the bench affirmed the reasoned order of State Commission and dismissed the petition filed by the patient. The bench, in its verdict, observed:

In the obtaining facts and the available evidence on record, it is not feasible to attribute negligence/deficiency

• in diagnosing stones in the gall bladder or

• in performing the laparoscopic cholecystectomy for removal of the gall bladder or

• in thereafter diagnosing stone in the common bile duct on the basis of subsequent ultrasonography or

• in advising the patient for endoscopic retrograde cholangiopancreatography by another doctor (who evidently had the wherewithal therefor, and who successfully undertook endoscopic retrograde cholangiopancreatography and removal of stone in the common bile duct), and it is difficult to conclusively establish medical negligence/deficiency in service on the respondent doctor.

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