Consumer court junks spine surgery negligence complaint, absolves Ludhiana hospital, neurosurgeon

After the surgery, the patient complained of pain in the right limb, and the CT spine revealed a mild medical placement of the L5 screw. Repositioning of the screw was done on 29.05.2013, but he still did not recover from the said ailment and was discharged on 01.06.2013. After 15 days of surgery, the complainant again started complaining of backache and came to the OPD of the treating hospital along with an MRI, which he had done from outside.

The MRI revealed postoperative changes along with artifact due to the presence of the spacer. He was given conservative therapy, but there was no improvement in the condition of the complainant. The doctors decided to re-explore, and surgery was again done on 21.06.2013. Intra-operatively, it was found that there was no pressure over the thecal sac and the nerve root; as such, L-4 vertebrae were also fixed along with L-5 and S-1 vertebrae.

Post-operatively, the complainant felt improvement and regular physiotherapy was carried out. After discharge from the hospital on 04.07.2013, the complainant approached the Chief Medical Officer, Ludhiana and the Health and Welfare Ministry of Punjab for medical negligence and carelessness committed by the treating hospital and doctor during the surgery and a committee was formed for evaluation of injuries suffered by the complainant.

The said committee advised to forward the matter to specialized, skilled, and qualiffied staff of Punjab Medical Council, and accordingly, the matter was shifted to PGI Chandigarh. Thereafter, the complainant again suffered critical pain in the bilateral lower limb and weakness in the right foot and approached the treating hospital and doctor as he was feeling disabled. 

The complainant further stated that the case summary provided by the doctor and hospital to the Director of Family and Civil Welfare Officer Punjab is completely varied from the case summary provided to the complainant. Alleging that he suffered great mental tension, harassment and agony on account of deficiency in service as well as medical negligence on the part of the treating doctor and hospital, the patient filed the consumer complaint before the district consumer court and sought Rs.19,20,000/- along with interest @ 18% p.a. besides Rs.55,000/- as cost of litigation. 

On the other hand, the hospital and doctor claimed that all the required procedures were followed and there was no negligence or carelessness on their part and even the medical board constituted for assessing the condition of the complainant, categorically reported that the complainant had common complications, which are associated with the procedure and can happen with the best of hands.

It was also submitted by them that fibrosis at operative site is a normal physiological phenomenon and therefore, there was no deficiency in service on the part of the hospital or the doctor, nor it can be held liable for any false complaint on the part of the complainant. After denying the other averments made in the complaint, the treating hospital prayed for the dismissal of the complaint.

After going through the record and hearing the counsel for the parties, the District Commission dismissed the complaint. Aggrieved by this, the complainant approached the State Commission. 

The counsel for the complainant argued that the District Commission failed to appreciate the facts that the complainant was operated by the treating doctor and hospital five times and even after conducting the said five surgeries, the complainant was in pain and suffering. It was argued that the treating doctor was not in a position to know, what type of treatment is to be given to the complainant. Further, the counsel contended that if the first surgery was not successful, then it was the duty of the treating doctor and hospital to refer the patient to some higher medical opinion/ytreatment so that he may get proper treatment and relief. The counsel argued that the District Commission totally ignored the deficiency and negligence and negligence on the part of the treating doctor and hospital for providing treatment to the complainant.

After going through the case records, the State Consumer Court observed that the main point of adjudication was whether the treating hospital and doctor were deficient or negligent in providing the treatment to the appellant/complainant for his spine problem or not.

The Commission noted that there was no dispute that the complainant was initially suffering from "PIVD L5/S1 with grade I spondylolisthesis" and for the said ailment, surgery was conducted by the treating doctor on 28.02.2013 under care and observation of the treating hospital. To arrive at a just conclusion, the SCDRC perused the Medical Literature written by “Konstantinos Margetis; Christopher C. Gillis, Author Information and Affiliations” with regard to “Spondylolisthesis” and noted that spondylolisthesis is associated with several complications, which, if not appropriately addressed, can significantly affect functional capacity, quality of life, and long-term outcomes.

Further, the State Consumer Court discussed the expert opinion rendered by Medical Board constituted by PGI, Chandigarh, which observed that the complications faced by the appellant/complainant were known complications of the surgical procedure.

Even though the counsel for the complainant questioned the expert opinion by PGI Chandigarh and by the panel set up by the Civil Surgeon, Ludhiana, the Commission observed, "The appellant/complainant has pleaded in the present appeal that the board of doctors constituted by PGI Chandigarh have not given fair and clear cut medical opinion as regard to negligence or carelessness, but we are not inclined to accept the said plea of appellant/complainant as the doctors comprising of the said medical board, constituted by the PGI Chandigarh, are masters in the field of Spine and Neurosurgery and the opinion given by them is duly corroborated with the medical literature as mentioned above. Even the contention raised by the learned counsel for the appellant/complainant that the doctors of the earlier committee constituted by Civil Surgeon Ludhiana, were not expert in the field of Spine and Neurosurgery, holds no water, as they did not give any opinion, rather referred the matter to the specialized doctors in the field of spine and neurosurgery."

Referring to the Supreme Court order in the case of "Kusum Sharma and Others Vs. Batra Hospital and Medical Research Centre and others, the State Consumer Court observed that the complainant did not alleged that the treating doctor was incompetent, or the Complainant had not brought on record any counter evidence to the contrary of the finding of the said medical board.

"It is not the case of the appellant/complainant that respondent No.2/OP No.2 is not competent in his field to perform the surgeries in question. The appellant/complainant has not brought on record any counter evidence to the contrary of the finding of the said medical board and even has not examined/cross examined the doctors or their categorical medical opinion," it observed.

Opining that the back syndrome fibrosis was a normal physiological phenomenon, the Commission noted,

"The respondent No.2/OP No.2 (Associate Director of Neurosurgery-neurosurgeon) has categorically stated in his written reply as well as in his affidavit that the appellant/complainant had failed back syndrome fibrosis at the operative site, which is a normal physiological phenomenon. The said fact has also been corroborated from the disability certificate dated 31.01.2020 attached with the complaint, wherein it has been mentioned that “(B) the diagnosis in his case is case of failed back syndrome L5-S1 TLIF with L4 laminectomy with foot drop rt.” As per medical terms “Failed Back Syndrome (FBSS) with fibrosis means persistent back/leg pain after spine surgery, where scar tissue (epidural fibrosis) binds nerves, causing pain, numbness, tingling, and limited movement, often treated with nerve pain meds (gabapentin), injections, or spinal cord stimulation, though repeat surgery for fibrosis has limited success”.

Accordingly, the State Consumer Court dismissed the consumer complaint, noting,

"In view of our above discussion and ratio of judgments relied upon by respondents No.1 & 2/OPs No.1 (hospital) & 2, we are of the considered view that there was no deficiency in service or medical negligence on the part of OPs No.1&2 in providing the treatment to the appellant/complainant for his spine problem. The District Commission has rightly decided the case and there is no material infirmity and irregularity in the order of the District Commission. Finding no merit in this appeal filed by the appellant/complainant, the same is hereby dismissed & the order of the District Commission is upheld."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/punjab-scdrc-no-deficiency-in-service-320544.pdf

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