GMCH 16, Surgeons held guilty of Medical Negligence during Gall Bladder Operation, Slapped Rs 6.5 lakh compensation

Chandigarh: Dismissing the appeals made by the Superintendent of GMSH (Government Multi Specialty Hospital), Sector 16, Chandigarh, and two surgeons of the hospital, the State Consumer Disputes Redressal Commission (SCDRC) recently held them guilty of medical negligence while performing laparoscopic procedure for removing the gall bladder of a patient.

It was alleged that the drainpipe inside the complainant's abdomen got fractured and the patient had to undergo a second surgery for removal of the same.

Holding the doctors and GMCH 16 guilty, the State Consumer Court upheld the order of the District Commission and directed them to pay Rs 6.5 lakh to the complainant for negligence, causing mental agony and litigation costs.

"...in our considered opinion, the total compensation of Rs.6 lacs awarded by the District Commission, which includes Rs.4,00,000/- towards medical negligence and deficiency in service and Rs.2,00,000/- towards pain, suffering undergone by the complainant and also mental agony and harassment, along with cost of litigation to the tune of Rs.50,000/-, is fair and adequate and in no way can be said to be on lower side, especially, when it has not been proved by the complainant that she is still suffering from complications on account of the medical negligence referred to above," read the order.

The history of the case goes back to 2015 when the complainant had approached Govt. Multi Speciality Hospital, Sector 16, Chandigarh, for removal of her gall bladder. Dr. Dabar and Dr. Bal performed laparoscopic procedure for removing her gall bladder. On that day, for draining of excess blood and fluid, standard surgical drainpipe make 'Polymed" measuring 4 mm diameter and 152 cms long was put in the abdomen of the complainant.

As per the doctors and the hospital, 21 cms of drain of pipe was placed in abdomen cavity of the complainant for proper function, whereas remaining pipe was kept out of the abdomen cavity which was linked with Reservoir (container).

Two days after her discharge, the complainant approached the hospital for removal of the drainpipe and the procedure was done on the same day. It had been claimed by the complainant that the doctors performed the removal of the drainpipe with highly negligent manner. Although 21 cms of drain pipe had been inserted in her abdomen, only 9cms had been cut and the remaining 12 cms of drain pipe allegedly remained inside the abdomen, which had not been informed to the complainant.

Therefore, after discharge, the complainant started experience pain. Following this, when she approached Dr. Dabar while removing her stitches, the doctor told her to get CECT Scan. Dr. Manasa Pandit conducted the Scan and the report revealed that there was some foreign object inside the abdomen of the complainant i.e. a hyper dense tubular structure was seen in GB Fossa extending anterior of stomach in her peritoneal cavity. It had a diameter of ~4mm and a length of ~12 cm.

Consequently, the doctor informed the complainant about the need for another operation and the doctors removed the foreign body that had been left n the abdomen of the complainant by conducting a second surgery. It has been alleged that the complainant had been discharged in near fatal condition.

Therefore, alleging gross medical negligence on the part of the doctors and the hospital, the complainant filed consumer complaint before the District Commission.

On the other hand, the doctors and the hospital claimed that the patient had been diagnosed from cholelithiasis i.e. presence of galls stone - stone in gall bladder, whereas Common Bile Duct (CBD) was normal i.e. there were no stones in it.

It was submitted that para medical staff of the hospital removed the drainpipe from the abdomen of the complainant. Referring to the removal of the incomplete drainpipe, the doctors and the hospital submitted that the reason for it might be that it broke or developed fracture due to twist, jerks and heavy movements by the complainant or due to inherent nature of the material of the drainpipe. 

The hospital and the doctors alleged that even though the complainant had been advised for removal of the drainpipe by a second surgery, she had claimed to be fine and again reported to the Hospital for getting her stitches removed. The CT scan showed a hyperdense tubular structure in her gall bladder fossa extending into the peritoneal cavity suggestive of foreign body likely residual of the broken drain. Accordingly, the procedure for removal of the part of the drainpipe was carried out under general anaesthesia through mini lap (small incision procedure) and abdomen was closed over abdominal drain. Afterward, when the complainant visited the hospital and observed that she was suffering from urinary tract infection (UTI), she had been prescribed with medicines.

Therefore, the doctors denied any carelessness on their part and alleged that the drain pipe broke inside the abdomen because of the negligence of the complainant herself and she had been immediately advised for a second surgery. With such submissions, the doctors denied all the complaints of negligence and prayed for the dismissal of the consumer complaint.

Partly allowing the complaint the District Commission directed the doctors and the hospital to pay the complainant a sum of Rs 4 lakh for causing negligence, Rs 2 lakh for causing pain and suffering and Rs 50,000 as costs of litigation.

Following this, the aggrieved hospital and doctor approached the State Commission. While considering the matter, the State Consumer Court referred to Supreme Court order and noted, "Thus, it has been made clear by the Hon'ble Supreme Court of India that a doctor owes to his patient certain duties of care in deciding whether to undertake the case and duty of care in the administration of that treatment and any breach thereof may give a cause of action for negligence and the patient may on that basis recover damages from his doctor."

Referring to the concerned case, the State Commission noted that the doctors and the hospital had contended that they are absolved from any liability after performing the surgical operation and it was the para-medical staff, who removed the drainpipe from the abdomen, was allegedly responsible for the medical negligence.

Taking note of this contention, the Commission noted, "We have considered this contention but it does not provide any help to their case. It is significant to mention here that firstly; the names of any such para-medical staff have not been mentioned in the written reply filed by the opposite parties before the District Commission."

"In our considered opinion, the operating surgeon(s) cannot absolve themselves from their liability in post operation activities and are duty bound to provide care in the administration of the treatment already given to a patient. The treating doctors/surgeons are duty bound to supervise and watch the removal of surgical drainpipe to rule out possibility of any complications out of the treatment given to a patient," further noted the consumer court.

The Consumer court also referred to the preliminary objections raised by the doctors, who accepted about the remaining drainpipe and claimed that, "......She followed up in Surgery OPD for dressings and drain removal. The job of drain removal and dressing is done by the expert staff engaged by the respondent No. 1 hospital in a separate section. The drain of the complainant was also removed by the said expert staff. On removing the drain, the said staff observed that 21 cm pipe should have come out from the abdomen of the complainant but only 9 cm drain came out of the abdomen. The matter was immediately reported to the surgeons/respondents No. 2 to 4...."

In fact, this issue had been reiterated by the doctors and the hospitals while giving para-wise reply, noted the consumer court.

Referring to this, the Commission noted, "On conjoint reading of the above-said reply by Dr.Dabar as well as Dr. Sarabjeet; and joint written reply by opposite parties no.2 to 4 i.e. Dr.Dabar, Dr.Bal and Dr.Sarabjeet, Surgeons of opposite party no.1-Hospital, it makes it very clear that immediately after the fractured drainpipe was removed from the abdomen of the complainant, the operating surgeons were informed by the paramedical staff."

However, the Commission noted that the doctors have now deviated from their original stand while filing the writing statement before the State Consumer Court. 

At this outset, the bench observed, "It is significant to mention here that opposite parties no.2 and 3 i.e. Dr.Dabar and Dr.Bal, Surgeons of opposite party no.1-Hospital have failed to place on record any document/standing instructions whereby it has been ordered that the Doctors/Surgeons who have performed surgeries and thereafter have inserted drainpipe in the body of the patient concerned, are not under obligation to remove the same."

"As stated above, in our considered opinion, the treating doctors/surgeons only are under obligation to remove the drainpipe from the body of the patient and not the para-medical staff. It is therefore held that there was a gross medical negligence on the part of the opposite parties 1 to 3. They have failed to perform their duty of care in the administration of the treatment of the complainant, which resulted into fracture of the drainpipe inside her abdominal, for which she was compelled for second surgery," noted the court.

Therefore, opining the order of the District Commission as just and proper, the SCDRC noted, "...in our considered opinion, the total compensation of Rs.6 lacs awarded by the District Commission, which includes Rs.4,00,000/- towards medical negligence and deficiency in service and Rs.2,00,000/- towards pain, suffering undergone by the complainant and also mental agony and harassment, alongwith cost of litigation to the tune of Rs.50,000/-, is fair and adequate and in no way can be said to be on lower side, especially, when it has not been proved by the complainant that she is still suffering from complications on account of the medical negligence referred to above."

"Thus, no case is made out by the complainant, for enhancement of compensation already awarded by the District Commission in the order impugned. For the reasons recorded above, we are of the considered opinion that the order impugned passed by the District Commission does not warrant interference of this Commission. Resultantly, both these appeals stand dismissed with no order as to cost. Nothing observed above shall effect the merits of the case against Dr.Sarabjeet Singh," further read the order.

To read the order, click on the link below.

https://medicaldialogues.in/pdf_upload/gmch-16-medical-negligence-182447.pdf

Also Read: Failure of treatment not ground for negligence: Consumer Court exonerates Delhi based Gynaecologist, Hospital