Anaesthesia complications after orchidectomy: Kerala hospital, surgeon, anaesthesiologist slapped Rs 19.5 lakh compensation

Apart from this, the consumer court has also directed them to pay Rs 25,000 to the patient's family as the cost of litigation to the complainant within 30 days of the receipt of the Commission's order. In effect, the hospital and doctors will have to pay at least Rs 19.54 lakh, applying the 6% interest from February 7, 2018. 

The history of the case goes back to 2017, when the patient, who had mental disability and was also an Endosulfan victim, suffered an infection in his testicle. The treating doctor, an MD Surgeon, advised immediate surgery, and the complainant agreed. An anaesthesiologist administered the anaesthesia, and the surgeon conducted the surgery.

However, the patient did not regain consciousness thereafter. He was shifted to Father Muller Hospital, Mangalore and the patient breathed his last on 11.03.2017.

It was alleged by the complainants that their son died due to medical negligence. A complaint was registered by Hosdurg Police, and an Inquest was made. When the patient's post-mortem was conducted by the Professor of Pariyaram Medical College Hospital, Mr. Pillai, it was revealed that the patient died due to an anaesthetic complication involving the respiratory system. They argued that the patient died due to medical negligence.

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Earlier, taking note of the issue, the Human Rights Commission directed the Medical Officer to constitute a Medical Board. However, allegedly, no report was filed. Filing the consumer court, the complainants demanded compensation for deficiency in service and medical negligence causing the death of their son.

On the other hand, the hospital and its doctors denied allegations of negligence. They submitted that the parents informed the doctor that the patient was not on medication, and they did not report that he was an endosulfan victim. Patient underwent Doppler study of the Scrotum and got a report showing right testicular torsion with early testicular Necrosis, confirming clinical diagnosis, and the only remedy was surgery. Accordingly, Right orchidectomy surgery was advised. 

They claimed that the complainant signed the consent form for surgery, and the procedure was explained to them. However, parents did not disclose the endosulfan history pre-medication. The hospital and the doctors submitted that with injection anaesthesia was induced with Propofol 100 mg as per accepted guidelines. During the surgery, which took forty minutes, the Anaesthesia was well-maintained, and the patient had an uneventful recovery from Anaesthesia. Thereafter, the patient was shifted to the post-operative ward for close observation. On 05.03.2017, the doctors decided to shift the patient to Father Muller’s Hospital, Mangalore, with oxygen support, accompanied by experienced nursing staff. The patient died after six days.

It was further submitted by the hospital that standard and accepted medical practice was provided during the treatment of the patient, and there was no negligence and no deficiency in service.

Further, the Apex Medical Board opinion later concluded "no gross or culpable negligence" on the part of the treating doctors, the hospital and the doctors pointed out. They also argued that there was no credible expert evidence proving that the Anaesthetist or surgeon acted contrary to accepted medical practice, and considering the Apex Board's opinion exonerated the doctors, the allegation of medical negligence was not established.

While considering the matter, the consumer court observed that even though the Apex Body said "No Medical Negligence", it was without reasons. Post mortem and histopathology report showed "death due to anaesthetic complication involving respiratory system". Taking note of this, the consumer court decided to treat such findings as primary medical evidence, rather than to a generalised or unreasoned Apex Body report.

Noting that the doctor claimed that the patient's history of being an endosulfan victim was not informed by the relatives, the consumer court observed it to be "not believable".

"Since the patient is deaf and an endosulfan affected mentally disabled individual, enhanced anaesthetic precautions are mandatory, including, modified consent through guardian, detailed neurological and respiratory evaluation, seizure risk mitigation, adjusted dosing of anaesthetic drugs, enhanced intra-operative monitoring and prolonged, post-operative observations, special pain assessment tools for non-verbal patients and strict documentation of all additional steps from essential components of standard anaesthetic care," it observed at this outset.

The Commission noted that the death occurred during or soon after the administration of anaesthesia. It also observed that the respiratory function was compromised, and this typically pointed to peri-operative mismanagement and while not automatically negligence, it requires- proper pre-anaesthetic evaluation, administration of correct dosage and drug, continuous monitoring of respiration and oxygen saturation, and immediate resuscitative response to complications.

In this context, the consumer court further obsevred,

"Failure in any of these constitute deficiency in service under section 2(11) of Consumer Protection Act 2019 (or section 2(1)(g)of Consumer Protection Act 1986). The complaints made out prima facie case that death occurred under Anaesthesia and the post mortem attributes to anaesthetic complications. Once that is shown the onus shifts to the hospital/anaesthetist (opposite party) to demonstrate."

"An unreasoned opinion of a Medical Board cannot override a reasoned and scientific post mortem findings. Hence the post mortem and histopathological report became decisive indicators of the proximate cause of death. When the post mortem report expressly concludes: “Death due to anaesthetic complications involving respiratory system”" it further observed.

The consumer court observed that while the post-mortem report dated 13.03.2017 categorically opined that the cause of death of the patient was due to "anaesthetic complications involving the respiratory system", the said opinion, being a contemporaneous Scientific finding supported by histopathological examination, carried high evidentiary value under section 45 of the Evidence Act. 

"The Apex Body’s subsequent unreasoned observation that there was “no gross and culpable negligence” cannot override this direct and reasoned medical evidence. Once the cause of death is medically linked to anaesthetic complications, the burden shifts to the opposite parties to prove that all standard precautions were duly observed. In the absence of such proof, the inference of deficiency in service and medical negligence is sustainable," observed the District Consumer Court.

Accordingly, the Commission ordered the hospital and its doctors to jointly and severally pay Rs 13,30,000 as lump sum amount of compensation along with interest.

It ordered, "In the result complaint is allowed in part, opposite party No. 1 to 3 are jointly and severally directed to pay Rs. 13,30,000/- (Rupees Thirteen lakhs Thirty thousand only) as lump sum amount of compensation in the above case to the complainant with 6% per annum interest from the date of complaint till realization and also pay Rs. 25,000/- (Rupees Twenty Five thousand only) as cost of litigation to the complainant within 30 days of receipt of the order."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/kerala-consumer-court-medical-negligence-312318.pdf

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