Blood sugar not checked before surgery, patient develops infection: Kolkata Apollo Gleneagles Hospital, surgeon slapped Rs 3.2 lakh compensation

Kolkata: A consumer commission in Kolkata has held a surgeon and a private hospital liable for medical negligence and deficiency in service and ordered them to jointly pay Rs 3.2 lakh to the patient, who developed an infection following a surgery.

The court noted that the hospital and the doctor failed to check a patient's blood sugar before surgery and properly record his regular medications.

According to a report by The Times of India, the patient had consulted the surgeon on February 26, 2018, after suffering from a high anal fistula. He was advised surgery and underwent the procedure at the Apollo Gleneagles Hospitals on March 10, 2018.

The patient claimed that he had informed the doctor that he was taking Ecosprin 75, a blood thinner, as well as medicines for high blood pressure, which he had been taking for nearly 10 years. He alleged that these medicines were not properly recorded and that no blood sugar test was advised before the surgery.

He was discharged on March 11 but later complained of severe pain. His wound later allegedly became infected and inflamed, following which he underwent another procedure at another hospital on April 13.

The doctor denied the allegations and maintained that the surgery had been stable. He submitted that the subsequent inflammation was most likely due to a reaction to the seton material used during the procedure. He also stated that the patient had been reviewed on March 14 and April 5 and advised further treatment.

During the proceedings, the Commission examined five allegations raised by the patient. As reported by The Times of India, it rejected the allegations concerning the continued use of Ecosprin, blood grouping, shaving of the surgical area and lack of post-operative care. However, the Commission found that the failure to check the patient's blood sugar before surgery was established.

The Commission took note of the hospital's December 2018 response stating that a blood sugar test was not required for relatively minor surgery unless the patient was already known to have diabetes. The doctor, on the other hand, maintained that the test had been conducted.

The Commission observed, "Both cannot be right. More importantly, not a single report of any such estimation has been produced. There is no mention of it in the discharge summary of the Opposite Party No. 2 Hospital.”

The Commission also took into account that the patient was 53 years old, had high blood pressure and had been taking medication for a long period at the time of surgery. It further considered the nature of the procedure and the risk of infection.

Tests conducted on April 11, 2018, before the second surgery showed a fasting glucose level of 132 mg/dl and a post-meal glucose level of 205 mg/dl. The discharge records from the second hospital subsequently mentioned borderline type 2 diabetes and treatment for high blood sugar.

Referring to the argument that blood sugar testing was unnecessary in a patient not known to have diabetes, The Commission observed:

"The whole purpose of an investigation is to ascertain what the history does not disclose. The circularity of the position taken that blood sugar is not checked unless the patient is known to be diabetic is manifest, for without the investigation the patient cannot come to be known as diabetic."

The Commission found that the failure to check the patient's blood sugar fell below the level of care expected from a competent doctor. It also found that the undetected blood sugar problem contributed to the infection that developed after the surgery.

At the same time, the Commission did not conclude that the second surgery was entirely attributable to the failure to check blood sugar. It noted that the patient's condition was complex and that further procedures could become necessary even in the absence of medical negligence.

 While holding the surgeon and hospital responsible, the Commission observed that the omission “falls below the standard of the ordinarily competent practitioner and is not saved by any responsible body of medical opinion.”

The Commission noted that the surgery had been performed at the hospital, the invoice was raised by the hospital and the medical records remained in its custody. It held that the failure to exercise proper care resulted in physical suffering and increased the risk associated with the surgery, besides causing mental agony and harassment.

Accordingly, the Commission ordered the surgeon and Apollo Gleneagles Hospitals to jointly pay Rs 3 lakh as compensation for medical negligence, deficiency in service, physical suffering, mental agony and harassment. An additional Rs 20,000 was awarded towards litigation costs.

The amount was directed to be paid within 45 days of the judgment. In case of non-compliance within the stipulated period, the unpaid amount would attract interest at 9 per cent per annum from the date of the judgment until payment.

The Commission rejected the patient's claim for Rs 6 lakh towards alleged loss of wages and promotional opportunity, noting that his salary records did not show any deduction, loss of increment or denial of promotion. It also rejected his separate claim for treatment expenses as the original surgery was covered by insurance and bills for the subsequent treatment had not been produced.