Apollo hospital Secunderabad, Orthopaedic surgeon, Neurologist get Rs 23 crore relief in medical negligence case

New Delhi: The National Consumer Disputes Redressal Commission has dismissed a Rs 23 crore medical negligence complaint filed against Apollo Hospitals Secunderabad and two of its doctors including an orthoapedic surgeon and consultant neurologist, over the amputation of a man's right leg. 

Stating that allegations of medical negligence cannot be made lightly and must be supported by clear, convincing, and reliable evidence, the apex consumer court, comprising Dr Inder Jit Singh (Presiding Member) and Dr Justice Sudhir Kumar Jain (Member) noted that a 'doctor cannot be held liable for medical negligence due to mere fact that the right leg of the patient above knee level was amputated.' It was observed that negligence must be proved by showing that the doctor failed to exercise reasonable care and skill.

The complaint was filed by the parents of a young man who suffered a fracture in his right knee after falling from a two-wheeler in 2016. He was admitted to Apollo Hospital, Secunderabad, where he underwent surgery for a tibial condyle fracture. During the procedure, a medical condyle locking plate with screws was fixed in his knee.

After surgery, he complained that he could not feel or move his right foot and toes, though he could do so before the operation. The patient was allegedly sensation would return. He was discharged on August, 8, 2016. However, the numbness continued. He was later referred to the Consultant Neurologist, who diagnosed right foot drop and prescribed medicines.

Despite this, it was alleged that the patient's condition deteriorated, and he was admitted to Yashoda Hospital, Hyderabad. After examination, he was diagnosed with Right Lower Limb Irreversible Ischemia; Right Popliteal Artery occlusion; Foot Drop; Vitamin D Deficiency and Hyperthyroidism.

The complainants claimed that a CT angiography reportedly showed severe muscle damage and signs of ischemic myonecrosis. The complainant alleged that the patient’s condition deteriorated due to negligence during surgery and improper post-operative care at the first hospital. They claimed that he was discharged too early, was not kept under proper observation, and was not informed about possible surgical complications. They further alleged that he should have been referred to a vascular surgeon when he complained of numbness and loss of sensation.

Following this, two surgeries were performed at the second hospital. A right leg fasciotomy was first conducted under epidural anaesthesia and subsequently right leg up to knee was amputated and debridement was done under general anaesthesia. The discharge summary noted that the muscles in the leg were dead.

The complainants alleged that the Apollo Hospital Management Company is vicariously liable for the acts of the Secunderabad branch hospital, the Orthopaedic Surgeon and the Consultant Neurologist. They contended that timely observation and proper medical care could have prevented the amputation.

Alleging gross medical negligence, deficiency in service, harassment and mental agony, the complainants sought total compensation of Rs. 23.23 crore, along with interest, costs, and other appropriate relief.

Meanwhile, the hospital management denied all allegations. It was argued that they were wrongly made a party, as it did not directly treat the patient and was only alleged to be vicariously liable. They contended that no specific allegation was made against it and sought dismissal of the complaint against it.

They claimed that the doctors informed the complainants that foot drop is common in high-velocity knee injuries due to nerve swelling. 

Observation

Hearing the arguments, the bench noted, "The counsels for the opposite parties further argued that the complainant no 1 was brought to hospital on 09.08.2016 for dressing and at that time right lower limb was normal in colour, warm and swelling was also noticed by the opposite party no 3 who on this ruled out any vascular insufficiency. The complainant no 1 as a precautionary measure was referred to the opposite party no 4 who was consultant neuro physician for right foot drop who on examination did not find any symptom of vascular injury. The complainants no 2 and 3 being parents of the complainant no 1 were explained about neurology recovery which might have taken six weeks to six months and the complainant no 1 was also prescribed additional medicines. The counsels for the opposite parties emphatically argued that there was no medical/professional negligence on the part of opposite parties as alleged by the complainants."

After examining the records, the Commission observed that there was no material evidence to establish vicarious liability against the hospital management company.

Regarding the treating doctors, the Commission observed that the Orthopaedic Surgeon performed the surgery in accordance with accepted medical standards and with due skill and care. It noted that there was no evidence to show that he lacked qualification, failed to exercise due diligence, or deviated from standard medical practice.

The Commission further held that the Consultant Neurologist provided appropriate treatment based on the patient’s clinical condition. Since pulses were normal and there were no signs of vascular deficit, immediate referral to a vascular surgeon was not medically indicated at that time.

"The complainants pleaded negligence in treatment of the complainant no 1 (patient) and deficiency in service but could not prove that the opposite parties no. 3 & 4 (orthopaedic surgeon and consultant neurologist) were negligent in treatment of the complainant no. 1. The opposite parties 3 & 4 and in particular the opposite party no 3 treated the complainant no 1 and conducted surgery as per established procedure and protocol. The opposite party no 3 has acted like a reasonable man on considerations which ordinarily regulate the conduct of human affairs. There was no apparent or noticeable omission on the part of the opposite party no 3 in the treatment of the complainant no 1. The opposite party no 3 has taken appropriate care in the treatment of the complainant no. 1. There is no allegation against the opposite party no 3 that he breached an ethical protocol in the treatment of the complainant," the bench held

The Commission observed,

"It is not always necessary that in every case the condition of the patient would improve and the surgery is successful to the satisfaction of the patient. It is not case of the complainants that the opposite party no 3 was not possessing requisite qualification or skill for the treatment. There is no evidence to prove that the opposite party no 3 failed to exercise due diligence, care or skill while performing surgery of the complainant no 1 on 04.08.2016. The opposite party no 3 cannot be held liable for medical negligence due to mere fact that the right leg of the complainant no 1 above knee level was amputated. There is no evidence that the opposite party no 3 has failed to exercise the due skill possessed by him in discharging of his duties i.e. during the treatment of the complainant no 1. The opposite party no 3 cannot be levelled with negligence as he performed his duties with reasonable skill and competence. The opposite party no 3 conducted surgery in good faith for the benefit of the patient i.e. the complainant no 1 and in accordance with recognized surgical practices and was not deviated from accepted medical standards or that the outcome was the result of any dereliction of duty by the opposite parties. There was no deficiency of service on the part of the opposite parties in treatment of the complainant no1."

In the present case, the Commission found that the Orthopaedic Surgeon had carried out the surgery and post-operative care with due diligence and in accordance with accepted medical standards.

Therefore, the Commission held that the complainants failed to prove negligence or deficiency in service on the part of the hospital and the treating doctors. Accordingly, the Commission dismissed the complaint for lack of merit.

"A doctor is under an obligation to provide high quality, ethical medical care to the patients which involves diagnosis of illness and its appropriate treatment. A doctor is supposed to perform recognized medical procedures with skill and care with follow up actions. The doctors must treat patients attentively and consciously. Simultaneously medical negligence should not be infer in casual manner rather it must be established with cogent, rational and convincing evidence by the person who is claiming negligence qua medical professional. It is established on record that the opposite party no 3 had carried out all procedures during surgery and postsurgery with due diligence and in accordance with the prevailing medical standards. We in view of above discussion of the opinion that the complainants have failed to discharge the burden of establishing negligence or deficiency in service on the part of the opposite parties. Accordingly, the present complaint is dismissed as being devoid of merit. The pending applications, if any, also stand disposed of accordingly."

To view the order, click on the link below:

Also read- Apollo Hospital locks horns with WBCERC, rejects refund order