Bowel injury during laparoscopic cystectomy: Consumer court upholds negligence, JIPMER, Obstetrician gynaecologist ordered to pay Rs 9.25 lakh compensation

Puducherry: The Puducherry State Consumer Disputes Redressal Commission dismissed an appeal filed by Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) and a senior obsterician-Gynaecologist, upholding an earlier order directing them to pay Rs 9.25 lakh to a patient who suffered a bowel injury and serious complications following laparoscopic cystectomy.

The State Commission observed that although bowel injury is a recognised complication of laparoscopic surgery, the treating surgeon could not escape responsibility merely by citing it as a known risk without establishing that necessary precautions had been taken during the procedure.

The case dates back to July 2010, when the patient approached the Gynaecology OPD at JIPMER with complaints of pain during menstruation. Following an examination by the treating obsterician-Gynaecologist, the operating surgeon in the case, she was diagnosed with ovarian cysts and advised to undergo laparoscopic surgery.

The laparoscopic cystectomy was performed on August 12, 2010. However, according to the complaint, the patient's condition deteriorated after the procedure, and she subsequently required intensive care. On the fourth postoperative day, she was shifted to the ICU and put on artificial respiration. She underwent another surgery on August 16, 2010, after a perforation was detected in her large intestine. A colostomy was performed.

The complainant alleged that the bowel injury had occurred because of negligence during the initial laparoscopic procedure. She further stated that she developed sepsis, kidney-related complications and other serious health problems requiring prolonged hospitalisation.

The complainant submitted, "that the hole in her colon was caused by negligence and carelessness during the original laparoscopic surgery, and that thereafter she was kept in CCU for nearly 48 days and ICU for 3 days, underwent tracheostomy (a hole made in her throat for feeding, since the mouth was kept open for oxygen support), and dialysis (through holes made in her neck) as her kidneys stopped functioning -- leaving her bed-ridden for over 40 days and developing bed sores."

She was discharged on October 25, 2010, with the colostomy still in place. The closure procedure was subsequently performed at another government hospital in Puducherry in January 2011.

Claiming that the treatment had caused prolonged physical suffering, mental agony and financial hardship, the woman approached the District Consumer Commission seeking Rs 20 lakh in compensation and Rs 25,000 towards litigation expenses.

The treating doctor and JIPMER denied the allegations, maintaining that the woman had been diagnosed with Stage IV endometriosis involving dense adhesions, making the surgery complicated.

They argued that injury to the bowel during laparoscopic surgery was a recognised complication." The injury to the rectum was a recognised, indirect complication of such surgery (caused while cauterising a densely adherent cyst wall), not a direct cut or negligent act, and was not visible even on the video monitor or at laparotomy," they said.

They also maintained that the patient had been appropriately counselled, necessary consent had been obtained and subsequent complications had been managed in accordance with accepted medical protocols.

The doctor and hospital relied on a report submitted by a Medical Board constituted during the proceedings, which found that bowel injury was a recognised complication of laparoscopic surgery and that there had been no medical negligence in the treatment.

However, the District Consumer Commission partly allowed the complaint on September 30, 2024, directing the doctor and JIPMER to jointly and severally pay Rs 9 lakh as compensation for physical suffering, hardship and mental agony, along with Rs 25,000 towards litigation expenses.

Challenging this decision, the doctor and hospital approached the State Commission, arguing that the District Commission had wrongly disregarded the Medical Board's opinion and held them liable despite the absence of evidence establishing negligence.

While hearing the appeal, the State Commission examined whether the injury was merely an unavoidable surgical complication or whether the treating surgeon had exercised the precautions reasonably expected during the procedure.

The Commission noted that the Medical Board had concluded that the injury was a recognised complication and that treatment had been provided according to the prevailing protocol. However, it found that the report did not explain whether sufficient preoperative evaluation had been conducted or what specific precautions had been taken to prevent injury.

Referring to the Medical Board's findings, the Commission observed: "Hence even though the medical board has opined that there is no negligence and the treatment was given as per the current protocol, the District Commission was not bound by the same and for valid reasons may differ."

The Commission also examined the operation notes and the treating doctor's statement that due precautions had been taken.

It noted that although the doctor had maintained that the procedure was performed with necessary care, the records did not specify the precautions adopted during surgery.

The State Commission observed:

"We are unable to see anything regarding the precautions taken or difficulties encountered in performing the surgery from the Operation notes and thus the medical records produced by the Appellant does not throw any light on the precautions taken."

The Commission also referred to medical literature concerning electrosurgical injuries during laparoscopic procedures, particularly when operating near the bowel and other vital structures.

It noted that while such complications were documented in medical literature, their occurrence did not automatically absolve the operating surgeon of responsibility.

The Commission stated:

"From the above it is evident that complications during laparoscopic surgery could be prevented and they are not inevitable even though well recorded and documented. Hence the defence that the complication that arose is well known will not absolve the treating surgeon of responsibilities unless it was established that necessary precautions were taken which the appellants have not done in the case on hand."

The State Commission further noted that the woman had been diagnosed with Stage IV endometriosis, a condition requiring additional precautions during surgery.

After considering the medical records, the Medical Board's report, relevant medical literature and the arguments advanced by both parties, the Commission concluded:

"Applying the principles for determining medical negligence cases as propounded in the catena of judgments of Honb'le Supreme Court and the medical literature perused and other documents on record this Commission comes to the conclusion that the treating surgeon, the Appellant No.1 has not taken enough precautions and the required skill was not exhibited in the conduct of the surgery on the complainant."

The doctor and hospital had also argued that the complainant did not qualify as a consumer under the Consumer Protection Act because the treatment was provided at a government institution and the payments made were minimal.

Applying the principles laid down by the Supreme Court in Indian Medical Association vs V.P. Shantha, the Commission upheld the District Commission's finding that the complainant was a consumer and that the services rendered were covered under the Consumer Protection Act.

After examining the grounds raised in the appeal, the State Commission found no reason to interfere with the District Commission's finding of negligence.

It observed:

"In view of the above, we conclude that the appellants have not made out any valid grounds for allowing the present appeal on the finding of the District Commission regarding negligence of the appellants. Therefore we pass the following order:"

In its final order, the State Commission directed:

"1.The appeal is dismissed and the order of the District Commission is affirmed."

"2.The Appellants are directed to pay Rs 10,000/- as costs."

Accordingly, the Commission upheld the District Commission's order directing the doctor and JIPMER to jointly and severally pay Rs 9 lakh as compensation and Rs 25,000 towards litigation expenses. It also imposed an additional Rs 10,000 as costs in the appeal.

The District Commission's original order required payment within 30 days of receipt, failing which interest at 6% per annum would apply until realisation.

To read the full judgement click here :