Perforation of Sigmoid Colon during Laparoscopic Surgery: Madras HC orders Infertility Hospital to pay Rs 40 lakh compensation to patient

Chennai: In a recent order, the Madras High Court bench has directed a private infertility hospital in Chennai to pay Rs 40 lakh compensation to a Sri Lankan Tamil woman, who faced perforation of sigmoid colon during a laparoscopic surgery at the hospital.

"This Court directs the defendants to pay jointly and severally a sum of Rs.40,00,000/- (Rupees Forty Lakhs only) as compensation to the plaintiff with interest at the rate of 12% per annum from the date of plaint till the date of decree and at the rate of 6% per annum from the date of decree till the date of realisation," ordered the HC bench Justice G. Chandrasekharan.

The matter goes back to 2013 when the petitioner woman, who was 43 years old back then, had approached the G.G. Hospital in Chennai for her infertility problem. After conducting required tests, the doctors had found out Fibroid in her uterus and adhesion in her abdomen. Laparoscopic Surgery had been advised for removing the fibroid in the uterus.

Consequently first Laparoscopic Surgery and then a day later Adhosiolysis had been performed back in May 2013. However, the condition of the patient worsened and she experienced breathing problem, abdomen distension. Even though doctors had been informed they claimed it be some infection and recommended for another surgery without revealing the reasons, the patient alleged.

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Allegedly, the reason for the second surgery was that the faecal matter was coming through the hole in the abdomen. After the open surgery, Colostomy bag was fixed for collecting the faecal matter. Thereafter, the patient was shifted to Apollo Hospital, where Dr Ravindran Kumaran had been examined the patient and revealed that during the Laparoscopic Surgery, the first hospital authorities carelessly punctured and badly perforated the 'Sigmoid Colon' and not stopping with that, the doctors had also removed the perforated area of 'Sigmoid Colon' in hurry and careless manner and connected the outlet of bowel system through a hole in abdomen with the bowel outside the body to collect the faeces, during the second surgery.

As a result of the perforation, the patient had developed serious infection in her abdomen. Alleging that the doctors in the treating hospital damaged her entire system's function, inflicted permanent disability and scattered the hope of begetting the child, the patient further submitted how she had to fight for her life for thirty-seven days and had to undergo three different major and minor surgeries later.

Due to the alleged medical negligence, the patient is left to live permanently with 'Colostomy Bag' to discharge the faeces, her pelvic structure is completely damaged and she developed extensive adhesions on her intestine system and excretory system. Approaching the Madras High Court, she demanded Rs 1.5 crore as compensation from the hospital and the doctors.

On the other hand, it was submitted by the hospital and the doctors that the patient had previously undergone three surgeries in France and during the treatment, it was found that due to the three previous surgeries, the Uterus, Bowel/Intestine and certain other organs of the plaintiff were stuck/attached together and were affixed to the abdominal wall thereby causing a medical condition called “Adhesions”.

It was also submitted that the adhesions were so severe that the doctor could not perform the proposed Fibroid removal from uterus without releasing the adhesions. Laparoscopic Adhesiolysis had to be performed followed by the Fibroid removal. Right fallopian tube of the plaintiff was found to be diseased and thus a right Salpingectomy also had to be performed to remove the right fallopian tube.

Further, the doctors and the hospital submitted that the patient had been counselled and explained in detail about the possibility of the above mentioned procedures in case of any difficulty during Laparoscopy, a conversion to open surgery would have to be performed.

Denying perforation of Sigmoid Colon during the surgery, it was submitted that if there was any perforation or rupture in the Sigmoid Colon of the patient during surgery, there would have been immediate emptying of the contents of the Colon through the opening in the Sigmoid Colon and that would have been seen by the surgical team.

After considering the submissions and all the evidence available, the HC bench observed,

"...this Court is of the view that the risk taken by the plaintiff at the age of 43 years after all her previous attempts to get childbirth failed; failure on the part of the Doctors at first defendant hospital to give proper advice, even to discourage the plaintiff to go ahead with pregnancy plans in view of her failed attempts and advance age; failure on the part of the fourth defendant to take all the necessary precautionary measures to avoid any damage to other body parts, especially, sigmoid colon of the plaintiff while performing adhesiolysis; failure on the part of the fourth defendant to find out the perforation of sigmoid colon in the same sitting and address the issue, all contributed to the perforation of sigmoid colon leading to the necessity of performing the second surgery on 18.05.2013. The second surgery, by the medical standards and protocol, was absolute necessary for saving the life of plaintiff. That was also admitted by PW.2."

Further noting that the hospital did not have required facilities, the bench observed,

"Even as per the admitted case of the defendants, no facilities available at the first defendant hospital to treat the plaintiff's breathlessness problem after the second surgery. The reason for shifting the plaintiff to the Apollo First Med Hospital was that it had no facilities for assisted ventilation treatment and therefore, plaintiff was shifted to Apollo First Med Hospital for assisted ventilation support in case plaintiff's condition worsened."

"When the first defendant hospital had taken the risk of performing surgery, it is expected that the facility for assisted ventilation treatment should also be in place in the first defendant hospital. Without having such a basic facility, the very idea of conducting surgery on plaintiff and going ahead with the surgery is itself a questionable decision taken by the Doctors at first defendant hospital," it added.

Holding the hospital and the doctors guilty of negligence, the bench mentioned,

"Therefore, this Court is of the view that the Doctors at first defendant hospital, especially, defendants 3 and 4 had failed in properly advising the plaintiff about the possible complications/risks that may arise while removing fibroids/adhesions and failed in properly administering the treatment when they were performing adhesiolysis."

"These repeated surgeries had affected enormously the plaintiff's health causing her lot of pain and untold sufferings during the period of treatment. Possibly, plaintiff could never give childbirth again; she suffered other disabilities related to repeated surgeries. Therefore, defendants are liable to compensate plaintiff for the pain and sufferings and disablement caused to her. Thus, Issues 19 and 20 are answered," it added.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/madras-hc-rs-40-lakh-compensation-201604.pdf

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