Delay in Diagnosing Complications after Bariatric Surgery results in patient's death: Kolkata Hospital, Doctors slapped Rs 75 Lakh Compensation

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently directed a Kolkata-based hospital and its two doctors to pay Rs 75 lakh compensation and Rs 2 lakh litigation cost to the family of a man, who died due to complications after undergoing sleeve gastronomy, in the form of bariatric surgery.

After the patient's condition worsened a week after the surgery, he was taken to the hospital again. However, the doctors at the hospital, a doctor of General Medicine and an Anesthetist delayed conducting a CT scan to diagnose the problem. Due to this delay, gangrene developed in the patient's intestine, opined the NCDRC bench.

The case history goes back to 2015 and concerns the patient, the youngest son of the complainants, who was suffering from issues like diabetes, hypertension, hyperlipidemia and obesity. The patient opted for bariatric surgery after speaking to Dr. Ugale, the treating doctor, who he met for the first time at a common friend’s place, who explained the benefits of bariatric surgery and how this surgery would help the patient to lead a normal life and devoid of such common ailment. He was advised to undergo sleeve gastronomy, in the form of bariatric surgery. 

It was alleged that the doctor had not warned them about the possible complications of the surgery and had assured them that it would help the patient to lose weight. The patient was admitted to the treating hospital- Belle Vue Clinic in Kolkata on 09.01.2015. He was examined by the Anesthetist Dr. Chakraborty and underwent several pathological tests. These reports were examined by another doctor, Dr. Patel. 

Dr. Ugale and his team performed the surgery the next day and two days later, the patient was discharged and went back to his house in Jamshedpur. The complainants alleged that requisite follow-up and post-surgery observation were not done. 

After a week, he felt excruciating pain in his abdomen and was immediately admitted to Tata Main Hospital, Jamshedpur, where the senior Surgeon Dr. Pradhan examined the deceased after conducting a pathological test, he diagnosed that the cause of the pain was infection due to post-procedural acute peritonitis. Therefore, the doctor advised for immediate operation. 

When the complainants consulted the treating doctors in Kolkata, one doctor advised them to get the surgery done in Tata, while another doctor advised them to bring the patient to Kolkata. Accordingly, the patient was shifted to Kolkata from Jamshedpur on 23.01.2015 by a chartered plane.

Allegedly, the patient did not get immediate medical attention and surgery, as promised and was kept on "wait and watch" conservative approach for 48 hours. Following this, a CT scan was conducted, and Dr. Patel, Dr. Chakraborty, Dr. Bavishi, the general surgeon at the hospital, and Dr. Agrawal diagnosed the cause of pain as Mesenteric Vein Thrombosis. At that time, the CT scan report was not supplied to the complainants. Thereafter, a team of doctors conducted surgery on 25.01.2015. It was further alleged that in the operation notes, the name of Dr. Ugale was also mentioned but he was not present at the time of surgery. 

In surgery, 3 ft. out of 25 ft. intestine was found to be gangrenous and had been resected. The condition of the patient was critical post-surgery and he was kept on a ventilator. But the condition did not improve and he died a day later. 

The complainants alleged that the preoperative test reports did not indicate that the patient was fit for bariatric surgery but the doctors conducted the surgery to make financial gain. They also claimed that before the surgery, they signed a blank consent form and the doctors did not disclose anything about the risk of surgery. It was alleged that the operation notes for conducting the first surgery were undated and the discharge summary also did not mention any post-operative advice nor any prescription of medication for the patient.

Referring to the time duration when the patient was kept in "wait and watch" for 48 hours, the complainants alleged that during this long period, gangrene developed for 3 feet of the intestine. They also pointed out irregularities in the consent forms and referring to relevant medical literature, they alleged that there was gross negligence in diagnosing the possible aspects of post-sleeve gastrostomy and undertaking aggressive intensive care through operative therapy. They also pointed out that even though the treating hospital advises itself as "Bariatric & Metabolism, as one of the specialities, apart from Dr. Ugale, there is no other bariatric surgeon in the hospital. They claimed that because of this, even though the patient was admitted to the hospital for the second surgery, the operation could not be done till 48 hours. 

On the other hand, the treating doctors at Kolkata submitted that the patient had a very torrid and critical post-operative period and all throughout he was kept on medical ventilation. They submitted that they did everything best to their knowledge and experience and there was no deficiency on their part.

Dr. Patel, doctor of General Medicine at Kolkata hospital, submitted that he was simply present in the operation theatre as a physician on both occasions as requested by the patient and his family. He also submitted that the patient was given the best treatment and care and there was no deficiency on their part. The hospital also made similar submissions and denied any negligence.

While considering the matter, the NCDRC bench noted that the evidence filed on behalf of Tata Hospital mentioned that the patient was diagnosed with peritonitis and was advised for exploratory laparotomy. However, the relatives were unwilling to conduct the abdominal operation even though advised and expressed their desire to take the patient to the hospital in Kolkata. The Discharge Summary of the patient mentioned the final diagnosis as "Post Procedural Acute Peritonitis".

After perusing the medical records, the Commission noted that even though Dr. Chakraborty, the anaesthetist, asked the complainants to bring the patient to Kolkata for further management, the doctors (Dr. Patel and Dr. Chakraborty) not only ignored the discharge summary of Tata Main Hospital but also did not conduct CT scan immediately in order to diagnose Peritonitis.

It was only when Dr. Agarwal, another doctor, advised for the CT scan a day later, that the test was done and it was diagnosed that the pain was caused by Mesenteric Vein Thrombosis.

Referring to this, the NCDRC bench noted,

"Dr. *** Patel and Dr. *** Chakraborty did not conduct CT scan for 48 hours although in the case of Peritonitis every hour delay is dangerous. Dr. Tapas Chakraborty asked the complainants to bring the patient in critical condition from a distance of about 400 KM, in order to make money. In order to conceal the negligence, Dr. *** Chakraborty has fabricated a CT scan report in back date. There is not only deficiency in service but also unfair trade practice on the part of OPs-2, 3 and 4."

At this outset, the Commission referred to the Supreme Court order in the case of Jacob Mathew v. State of Punjab where the Apex Court had clarified that negligence is the breach of a duty caused by omission to do something which a reasonable man guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do.

Referring to the Apex Court's order in this case and several other judgments, the NCDRC noted,

"In CT scan report dated 25.01.2015, "extensive thrombosis involving superior mesenteric vein extending portal vein" has been noted. There are various causes of this disease out of which, abdominal surgery is also one of the cause. In CT scan report no abnormality in liver, pancreas or spleen was found. As such, it can be safely inferred that abdominal surgery performed on 10.01.2015 may be cause of this disease. Gangrene in intestine was developed due to more than 24 hours delay in its diagnosing and treating."

Therefore, considering the age of the deceased and the number of dependents relying on him, the top consumer court directed Dr. Patel, the doctor of General Medicine in the hospital, Dr. Chakraborty, the Anesthetist and the hospital to pay the complainants Rs 75 lakh as compensation and Rs 2 lakh as litigation cost. One Dr. Bavisi, General Surgeon, Belle Vue Clinic was also arrayed as opposite party-4 in the complaint but he died during the pendency of the complaint and his name has been deleted from the order.

"In view of the aforesaid discussions, the complaint is partly allowed with cost of Rs.2 lacs. Opposite parties 2 to 4 are jointly and severally directed to pay a compensation of Rs.75/- lacs with interest @ 6% per annum from the date of death till realization to complainant-2 including cost within a period of two months from the date of judgement," mentioned the order.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-rs-75-l-compensation-239864.pdf

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