2 corrective surgeries after polypectomy: Hospital, gastroenterologist slapped Rs 6.6 lakh compensation

"In the result, the complaint is allowed in part and the Opposite Parties No.1,2 & 3 are jointly and severally held liable and are directed i) To pay Rs.5,66,100/- (Rupees Five Lakhs Sixty Six Thousand only) towards the medical expenses incurred for the two corrective surgeries as mentioned above; ii) To pay Rs.1,00,000/- towards incidental expenses and compensation for the mental agony and suffering; iii) To pay Rs.50,000/- towards legal expenses," ordered the Commission.

"This order shall be complied with by the Opposite Partes No.1, 2 & 3 within 45 days from the date of receipt of the Order, failing which the above-mentioned amount @ S.No. (i) shall carry interest @9% per annum from the date of this order till the date of actual payment," read the order.

Case Background: 

The history of the case goes back to 2022 when the patient/complainant, a 49-years-old man, working in construction business consulted Dr. Kumar, the Chairman and Managing Director of Ananya Gastroenterology Hospital, with complaints of gastric and digestion related problems, and after various prescribed diagnostic tests including Endo profile, RFT, the treating doctor diagnostic it as Colonic Polyp (abnormal growth of tissue) in the large intestine and recommended Colonoscopy + Polypectomy under General Anaesthesia, and accordingly, the complainant underwent Polypectomy, which was conducted by Dr. Srinivasulu, the Consultant Gastroenterologist.

It was alleged that Dr. Srinivasulu neither examined him nor was aware of his medical history nor interacted with him before the surgery. Further, the complainant was allegedly not aware of the fact that another doctor would be conducting the surgery. After the polypectomy, the complainant was discharged from the hospital on the same day, stating that the surgery was successful. 

However, the complainant reportedly developed severe pain in the abdomen, vomiting, and fever immediately after discharge from the hospital and had to rush to the hospital the next day. When Dr. Kumar attended and examined the patient, on further investigation, it was diagnosed as 'Caecal perforation and peritonitis' and the patient was referred to Dr. Rao in AIG Hospitals. 

After getting admitted to the second hospital, the complainant was immediately shifted to ICCU and Dr. Rao and his team treated the complainant with antibiotics and painkillers and informed the complainant and his family members that caecal perforation was formed in his large intestine causing infection due to a small hole done by piercing during the procedure at the first hospital and a corrective surgery was to be done as soon as possible.

Accordingly, a surgery involving IC resection and Ileostomy was performed, wherein the diseased section of the intestine was removed and rejoined, and a stoma bag was attached for waste collection.

The complainant was discharged from the second hospital after 6 days of the second corrective surgery, and the stoma bag, which was inserted after the second surgery, had to be replaced periodically and the complainant suffered from consequential infections and pain for three months and had to undergo another surgery to join the healed healthy intestines ends and permanently remove the stoma bag.

Therefore, the complainant alleged that due to the negligence/deficiency of service on the part of the treating doctors at the first hospital, while undergoing the procedure, the complainant had to undergo two corrective surgeries at the second hospital causing him immense pain and suffering and loss of income due to hospitalization and house arrest due to post operative complications with a stoma bag inserted for waste collection for three months after the procedure done at the first hospital.

Furthermore, the complainant stated that due to additional expenses and financial burden, he had to borrow money from friends and relatives for treatment. Aggrieved by this, the complainant filed a consumer complaint seeking compensation.

On the other hand, the treating doctors and hospital denied the allegations of medical negligence and submitted that the 'colonoscopy and polypectomy' was performed under General Anaesthesia after taking the complainant's consent and both the complainant and his daughter were informed about the risk of complications (abdominal pain, bleeding, perforation) associated with the procedure. The patient was discharged on the same day in a haemodynamically stable condition.

It was also submitted that when the patient developed abdominal pain and fever, he was immediately admitted to the emergency unit, and after conducting necessary investigations, when the perforation was found, the patient was referred to another hospital, and the hospital coordinated for shifting the complainant to the second hospital for further management of the complainant's case.

Further, it was submitted that Dr. Kumar was not only actively involved in providing medical treatment but also supported him in making financial arrangements for his second surgery and Dr. Kumar personally spoke to the concerned staff of the second hospital to reduce the medical bill and the complainant was offered a discount. It was also claimed that beyond providing medical care, Dr. Kumar contributed Rs 90,000 and Dr. Srinivasulu contributed Rs 50,000 towards the medical treatment of the complainant in the second hospital.

It was further contended that colonoscopy and endoscopic procedures do carry inherent risks including bleeding, abdomen pain and perforation, which were clearly explained to the complainant and his daughter, who signed the consent form. Further, they argued that colon perforation is a known complication of polypectomy, varying from 0.7% to 0.9% and the rates of perforation have increased to 4% to 7% in endoscopic submucosal dissection (ESD). It was also submitted that colon perforation ranges from 016% to 0.2% in diagnostic colonoscopies and upto 5% in some endoscopic colonoscopic interventions including polypectomy, and are associated with patients of advanced age or with multiple comorbidities including diabetes mellitus, chronic pulmonary disease, congestive heart failure, myocardial infraction, cerebrovascular disease, peripheral vascular disease, renal insufficiency, liver disease and dementia.

Other risk factors for colon perforation reported in the literature include history of diverticular disease or previous intra abdominal surgery, colonic obstruction as an indication for colonoscopy and female gender, the doctors and the hospital submitted.

Relying on legal precedent, the treating doctors and hospital argued that no act of commission or omission that amounts to negligence or deficiency of service on them and they treated diligently, prudently as per accepted medical standards.

Observations by Consumer Court: 

After going through the Colonoscopy Report dated 19.05.2022 and the medical literature, relied on by the treating doctors and hospital, the Commission observed, "The above excerpts from the medical literature on colon perforation emphasizes the need for endoscopists to be prepared to manage complications and to use available techniques to prevent them."

Referring to the medical records, the Commission further observed at this outset, "If the doctors O.P No.2 & 3 are aware that caecal perforation is a known complication of polypectomy and also informed the complainant and his daughter, the question is, whether they have taken necessary precautions for preventing such complications and whether O.P.No.2 & 3 were adequately prepared to manage if such complications occur in the patient after polypectomy."

Further referring to missing pages in the post anaesthesia record, the Commission observed, "there is no information as to the procedure details including what was used for colon sufflation, etc, to determine whether O.P.No.2 & 3 have followed the standard procedure and whether the complainant was kept under observation and properly monitored after polypectomy to ensure and rule out if there is any incidence of colon perforation, which is a known complication of polypectomy."

At this outset, the Commission further observed that except the pre-operative and post-operative anaesthesia record filed under Pgs 9 &10 of 18 and Pg.15 of 18 under Ex.B-5 & B-6, the treating doctors and the hospital did not file any evidence on record regard the procedure notes and the findings to establish that they have followed the standard procedure, as asserted in their written version.

"There is nothing on record to show that O.P.No.2 & 3 have taken any precautionary preventive techniques to minimise the risk of colon perforation as mentioned at Page 346 of the Medical literature filed along with the expert opinion affidavit of Dr.Raghavendra, a medical gastroenterologist and a Senior Consultant at Asian Institute of Gastroenterology and Citizens Hospital, Hyderabad," it noted.

The Consumer Court noted that while opining that there is no indication of or lack of care on the part of the treating doctors, the expert witness mentioned reviewing the indoor case papers, treatment records and relevant documents pertaining to the patient/complainant.

"However, the said indoor case papers, treatment records and relevant documents which are reviewed by the expert witness, are filed before the Commission. At the cost of repetition, it is pertinent to mention that except the pre-operative and post operative anaesthesia record filed at Pgs 9 &10 of 18 and Pg.15 of 18 under Ex.B-5 & B-6, Opposite Parties No.2 & 3 have not filed any evidence on record regard the procedure notes and the findings to establish that they have followed the standard procedure or the preventive measures that are mentioned in Box 5 Of the medical literature filed on behalf of the Opposite Parties No.1, 2 & 3. There is nothing on record evidencing that Bowel preparation including residual feces and liquid are removed from the entire colon, appropriate volume of solution is injected into the submucosal space, Carbondioxide was used for insufflation as mentioned in Box-5 of the referred Medical literature to prevent potential colon perforation. In fact, in the operative findings of the exploratory laparotomy at O.P.No.4 Hospital in the case sheet filed Ex.B-13, it is mentioned as “ purulent fluid in abdomen, ascending colon perforation-1/3 circumference ascending colon loaded with stool unhealthy edges, small bowel oedematous.” Further, there is nothing on record to show if a post-procedural imaging was done to rule out any microperforation before discharging the patient/complainant herein around 7pm on the same day i.e 19/5/2022," the Commission noted at this outset.

"In the absence of any evidence on record showing that O.P.No.2 & 3 a) have taken the preventive measures to reduce the risk of colon perforation while conducting polypectomy procedure to the complainant herein at O.P.No.4 Hospital and discharging the patient within 3-4 hours after the procedure without clinically ensuring and ruling out the incidence of any perforation or any other post-polypectomy complications, it leads to the irresistible conclusion that the consequential complication/risk of caecal perforation and transmural coagulation (that was diagnosed as per Ex.A-6 and the medical records filed by O.P.No.4) led to the subsequent two corrective surgeries at O.P.No.4 Hospital causing the damage and discomfort to the complainant with stoma bag for waste collection and prolonged hospitalization and recovery from postpolypectomy trauma suffered by the complainant owing to the deficiency of service/negligence on the part of the Opposite Parties No.2 & 3. Hence, this point is answered in favour of the complainant and against O.P.No.1,2 & 3," observed the Commission.

Accordingly, the Commission held the complainant entitled for the medical expenses incurred for the two corrective surgeries underwent at the second hospital and held them jointly and severally liable to defray the expenses incurred for the corrective surgeries ( Restoration of continuity and Exp laparotomy surgery, IC resection and End ileostomy incurring Rs.4,40,000/- for the 1st surgery + Rs.2,66,100/- for the 2nd surgery as mentioned in para 12 of the complaint and evident from the medical bills filed under Ex.A-7 & A-8) along with compensation for the mental trauma and hardship caused to the complainant.

"In this context, it cannot be lost sight of the fact that, for reasons best known, O.P.No.2 contributed Rs.90,000/- and O.P.No.3 contributed Rs.50,000/- towards the medical treatment of the complainant in O.P.No.4 Hospital (as submitted in their written version and evident from Ex.A-9), after referring the patient/complainant herein as per the letter filed under Ex.A-3 and A5. Hence, O.P.No.1,2 & 3 are jointly and severally liable to pay the balance amount i.e Rs.7,06,100 – Rs.1,40,000/- = Rs. 5,66,100/- along with reasonable compensation to the complainant. Although, the complainant has sought Rs.48,00,000/- towards loss of income, as there is no substantial evidence supporting the said claim for loss of income, the same cannot be considered," it further observed.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/dcdrc-hyderabad-medical-negligence-305437.pdf

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