CO2 embolism during Laparoscopy procedure: Surgeon, anesthetist told to pay Rs 33 lakh compensation after patient death

Presiding Member of the State Commission, R N Mehta observed that the two doctors were liable for not providing efficient services to the patient and that their action led to an irreversible condition of the patient and her death on the next day suggests that it was direct nexus with the cause of death of the patient.

The case involved a patient in 2015 who suffered pain in her stomach and was diagnosed with a tumor. She was advised laparoscopy procedure to remove the tumour. On June 1, 2015, while the procedure was underway at the surgeon’s hospital in Jamnagar, her condition became critical.

She was required to be shifted to a critical care unit in presence of two doctors and then was taken to another private hospital. However, the patient died and her autopsy revealed that besides three holes (as canvassed) in her stomach for laparoscopy, there was an incision of 14cm.

The discharge summary showed that there was anesthetic problem during the procedure and as a result thereof, the patient went into shock and to manage the patient services of the physician were necessitated.

Alleging medical negligence and seeking compensation, the patient’s husband Paresh Patel sued the surgeon along with the physician and the anaesthetist. However, the doctors filed detailed replies and denied that there was any negligence or carelessness on their part.

After the hearing, the consumer commission came to the conclusion that carbon dioxide embolism was established. It observed;

"Carbon Dioxide Embolism is subject matter of anesthetist to take care of. Therefore, it is always expected from the anesthetist to give complete accounts of events and he has to establish the course of action taken by him to prevent, occurrence, minimize the effects thereof through effective treatment and to manage patient. Unfortunately, there is nothing on record. The facts stated in reply must have some documentary support to place reliance on the said facts. In absence of any such information it cannot be believed that he acted diligently just because he states on oath. Having accepted the patient for treatment, it is for the doctor to explain what preventive actions have been taken using reasonable "foresights" to minimize the effects of the known complications. The above literature also canvassed that presence of another anesthesia provider in the room all times to encounter Carbon Dioxide Embolism."

The Commission added;

"In the instant case, no other anesthetist was present. Therefore this is a fit case, where presumptions can be made for absence of care on the part of doctors applying the aforesaid rule of "Res Ipsa Loquitur"."

Noting that the doctors failed to adduce best available evidence to discharge their burden, the consumer body remarked;

"Merely because "known complication" has taken place, it cannot be said responsibility of the treating doctors ceases. There are ways and measures to meet with eventual condition but doctor must come with true facts that these steps have been taken and despite that this has happened. Surprisingly, none of the opponents have produced on record any of their case papers. The anesthetist, in his reply narrated facts but to support those facts, no documents have been produced. Being anesthetist, he is supposed to prepare a note regarding the actions taken during surgery. However, no such anesthetist's note have been produced on record and therefore presumption also can be drawn that note is suppressed for the reasons best known to them."

Subsequently, the Commission pronounced;

"The doctors failed to convince this Commission that diligent efforts have been made during treatment and therefore I have no hesitation in holding that Surgeon and Anesthetist are liable for not providing efficient services to the patient Joshnaben. Their action lead to irreversible condition of patient and died on next day suggests that it is direct nexus with the cause of death of patient"

While holding the surgeon and anesthetist liable to pay compensation for the patient’s death, the commission exonerated the physician. It held;

"It is also made clear that these amount should be paid by the surgeon and anesthetist only and I do not think there was any negligence on the part of Physician because he came into picture later on and by that time condition was became critical also. Therefore, physician is exonerated from the liability in this case. This case is filed in 2015 and much water have been flown there after and value of money has been decreased. To put the complainant at par with the value of 2015, I would like to award 10 % interest on the aforesaid amount from the date of complaint so as to give him just, adequate and fair compensation."

Considering the patient’s age and occupation, the commission calculated Rs 33.70 lakh an amount for the compensation and ordered both the doctors to pay it to the deceased patient’s husband with 10% interest since 2015 in 60 days.

The doctors have also been directed to pay Rs 25,000 extra to the complainant for expenditure incurred on litigation.

To view the original order, click on the link below:

https://indiankanoon.org/doc/194250379/