5 Doctors Slapped Rs 15 Lakh Compensation for Negligence During Hysterectomy

Coimbatore: Holding five doctors liable for negligence and deficiency in service while treating a patient who underwent hysterectomy, the District Consumer Disputes Redressal Commission (DRDRC) Coimbatore directed them to pay Rs 15 lakh compensation to the patient.

Allegedly, the patient had to suffer bladder damage because of medical negligence during the hysterectomy procedure. Consequently, she had to undergo several corrective surgeries in two months.

Although the Commission noted that the complainant failed to prove medical negligence on the part of the treating doctors including the Chief Medical Officer, a doctor from a Private Hospital and three doctors belonging to a Government Medical College and Hospital, it observed that the hysterectomy surgery was performed based on a scan taken around seven months ago and the doctors also did not obtain a proper informed consent from the patient.

"In the result, this complaint is partly allowed directing the opposite parties 1 to 5 who are jointly and severally liable i) to pay the complainant Rs.15,00,000/- (Rupees Fifteen Lakhs only) as compensation towards mental sufferings and emotional anguish etc. caused by their negligence and deficiency in service (which includes the medical expenses incurred by the complainant) and ii) to pay a sum of Rs.5000/- (Rupees Five thousand only) towards the cost of proceedings. The above amounts to be paid within a period of one month from the date of this order failing which the opposite parties shall be liable to pay interest at the rate of 9% p.a. towards the above said total amount till it is realized," ordered the consumer court.

The history of the case goes back to 2019 when the complainant was suffering from abdomen pain. After undergoing a full body check-up, the complainant was informed that her uterus was weak and was suggested to remove it. 

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Accordingly, the complainant approached the head doctor at Sri Hari Hospital and Dr. Nandhini, the treating doctor. They instructed to undergo surgery on the same day and for this, the patient had to pay Rs 40,000. It was alleged that during surgery, the patient cried with pain and after completion of the surgery, she felt urine leakage. 

When she contacted the treating doctor, she was allegedly asked to wear a diaper and was assured that the leakage would stop within 2 days. However, the leakage did not stop even after three days and the patient felt severe pain in the area where the surgery was done. When she approached the treating hospital, she was advised to undergo a scan, the report of which revealed that during the hysterectomy surgery, the urinary tube was damaged. Following this, the head doctor at Sri Hari Hospital advised surgery to place a stent. Dr. Dinakaran from the GMCH performed the Stent Surgery and the complainant was discharged on the same day.

However, even after the stent correction surgery, the complainant suffered urine leakage for about 55 days and she had to manage by wearing a diaper. Due to the COVID-19 lockdown, she had to stay in the house in severe pain and later consulted the Head of the Private Hospital. However, she was allegedly responded in an inconsiderate manner stating that they had performed the surgery as per the norms and that they would not do any further support. As the doctors who performed the surgery were working in the Government Hospital, with no other go, the complainant was admitted to the Government Hospital, Coimbatore to undergo leakage treatment. Despite the treatment, the leakage did not stop. 

Following this, the patient was admitted to Kongunad Hospital, Coimbatore, where after a thorough check-up, a correction surgery was performed. The doctors informed that the urinary tubes were damaged and in future, another surgery would have to be performed to replace it. It was submitted by the complainant that she had been put to severe mental agony, pain and emotional distress to undergo many surgeries due to the negligence of the opposite parties. For this, she prayed before the consumer court to direct the doctors to pay Rs 50 lakh as compensation and Rs 2,17.996 as the amount spent on medical expenses.

On the other hand, the doctors denied the allegations and submitted that the Laparoscopic Assisted Vaginal Hysterectomy was performed by Dr. Kumar and Dr. Rajamani from GMCH with the assistance of Dr. Nandini from Sri Hari Hospital. According to them, the surgery was performed with full effort and there was no negligence on their part.

They claimed that the leakage was due to adhesion from previous surgeries and not from the LAVH surgery. While performing the LAVH to the complainant, the Adhesions were separated carefully. As per them, due to the separation of the adhesion of the ureter, the wall of the ureter became weak, which could not be avoided. Though the team of doctors who performed the LAVH were from the Government Hospital, they had the Government order stating that they could perform the surgery to the patients in any private hospital.

Further, the doctors pointed out that the patient complained about the doctor to the Grievance cell of CM of Tamil Nadu, management of the hospital, District Collector of Coimbatore, Inspector of Police, Coimbatore Medical College. Following this, the Joint Director of Medical and Rural Health Services, called for an enquiry on the complainant of the complainant and accordingly an inquiry was conducted by a team of doctors.

Referring to the report of the inquiry officers, the doctors argued that they had provided the best and standard treatment to the complainant and there was no deficiency or malafide intentions in the same.

While considering the complaint, the consumer court reviewed the patient records and noted that the treating doctor at the private hospital relied on a san taken around seven months before the surgery, to recommend an elective LAVH on the same day. The doctor admitted to relying solely on this older scan, which was provided by the complainant, without conducting any updated diagnostic imaging before the surgery, - observed the consumer court.

"The OPs were aware of the complainant’s medical history, including MTP (Medical Termination of Pregnancy), LSCS (Lower Segment Caesarean Section), and sterilization, indicating they were cognizant of potential complexities involved in performing a hysterectomy. Despite this, they failed to conduct necessary diagnostic imaging before determining the appropriate course of action. The OPs did not explain the reasons for not taking updated diagnostic imaging prior to assess the patient’s fitness for undergoing such a major surgery," noted the Commission.

"A more recent scan would have provided a clearer understanding of the complainant’s current anatomical condition, reducing the risk of complications. Notably, the complainant approached OP-1 hospital on November 26, 2019, and the hysterectomy was performed on the same day based on a scan report dated April 29, 2019," it further observed, holding that the doctor failed in her duty of care and it was deficiency of service. 

"In light of the above, it is evident that, the omission of the opposite parties to conduct the necessary updated diagnostic imaging before the surgery, constitutes negligence and deficiency in service," the Commission added in the report.

Regarding informed consent, the consumer court noted that the consent form produced by the doctor for performing the LAVH surgery pointed out that the signature of the complainant was missing. 

"There is no explanation, much less an acceptable one, for the absence of the complainant's signature on the consent form. Furthermore, regarding the stent placement surgery, OP-2 produced the Patient Record as Ex-B2, and there is no evidence to show that the complainant signed a consent form. The column for the person giving consent is left blank, making it evident that OP-2 did not obtain the complainant's consent before the surgery," it further noted.

"The absence of a signed consent form indicates that the complainant was not adequately informed about the risks and nature of the procedures, which is a fundamental requirement for any surgical intervention," the Commission observed, further noting that in the absence of informed consent, the hospital's actions violated the Supreme Court's order in the case of Samira Kohli v. Dr. Prabha Manchanda.

At this outset, the District Consumer Court further noted, "The nature of the information required to be furnished by a doctor to secure valid or informed consent is crucial. In the present case, there was no consent, let alone informed consent, before conducting the surgeries on the complainant. This omission by the OPs amounts to a deficiency in service and negligence."

Regarding the allegations of medical negligence, the Commission observed that the burden of proof was on the complainant to establish that the treating doctors did not follow the standard medical procedures. 

"The complainant failed to prove that the OPs did not exercise due care while performing surgeries which resulted in urine leakage with acceptable medical evidence. A mere statement by the complainant, which is denied by the opposite party, cannot be considered as evidence sufficient to prove the complainant's case. In the absence of any material much less acceptable evidence to suggest negligence by the opposite parties, no negligence can be attributed to them," the DCDRC noted in this regard.

"In view of the above discussion, the Commission concludes that the allegation of negligence and deficiency in service against the opposite parties have been established. Given the facts and circumstances of the case, liability cannot be apportioned among the opposite and hence OP-1 to OP-5 (the doctors) are jointly and severally liable," it further observed.

Accordingly, guided by the orders in similar circumstances, and considering the inconvenience experienced by the patient in wearing diapers unnecessarily for a longer period, the Commission directed the doctors to jointly and severally pay Rs 15 lakh as compensation to the complainant, which includes the medical expenses incurred by the complainant for the mental suffering and emotional anguish caused by their negligence and deficiency in service.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/coimbatore-dcdrc-rs-15-l-compensation-258854.pdf

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