Hernia operation causing Jejunal Perforation: Delhi forum upholds Medical Negligence during surgery on high-risk patient

New Delhi: The State Consumer Disputes Redressal Commission of Delhi recently upheld the order of the District Forum, which held a surgeon and the treating hospital negligent while conducting a hernia operation on a high-risk patient.

It was alleged by the complainant that the patient had died because of the negligence by the treating doctor and hospital while operating on the patient. Even though the District Forum had found medical negligence by the treating doctor and hospital, the order was challenged before the State Consumer Court.

However, the State Commission upheld the order of the District Forum as it took note of the opinion expressed by the medical board of GTB Hospital which had observed that the Appellant Hospital was not equipped with the pre and post-operative facilities to monitor and manage the high risk patients like the patient in the present case.

The patient was suffering from multiple ailments -deranged Kidney function, anaemia and Ischemic Heart Disease with CABG. However, the board opined that the Appellant doctor failed to take preoperative advice from the nephrologist and performed such advanced laparoscopic surgery which went fatal.

The matter goes back to 2009 when the patient was suffering from hernia and was taken to the treating hospital- Surgi Centre, Nursing Home & Maternity Centre, where the doctor suggested some medical test and consequently, the patient was admitted for surgery. After two hours of the surgery, the patient experienced acute pain and his condition started deteriorating. 

Thereafter the treating doctor referred him to another hospital for management. Ultimately, the patient was taken to Sir Ganga Ram Hospital, where after examining the patient, they opined that he was suffering from Peritonitis which was caused due to negligence on the part of the doctor at the time of operating the patient.

Also Read: Cotton allegedly left inside woman's abdomen after C-section at Government General hospital, inquiry on

There was no improvement in the patient's condition and he was shifted to BL Kapur Memorial Hospital in emergency and ultimately he died on 27.08.2009. The cause of death was diagnosed as Septicemia with MultiOrgan Failure due to postoperative Jejunal Perforation with Peritonitis.

It was alleged by the complainant, who is the grandson of the patient, that after the operation, the Serum Creatinine of the patient rose to 2.8 mg/dl, the normal value of which is 0.6 to 1.5. The complainant alleged that this rise was due to negligence on the part of the treating doctor and the death occurred simply because of the negligence on the part of the treating doctor in conducting the operation.

Alleging negligence on the part of the treating doctor and hospital, the complainant prayed for Rs 5,07,410.67 as cost of treatment and Rs 10 lakg as compensation apart from the cost of litigation.

When the matter came to be considered by the District Forum, it referred it for medical opinion to a Medical Board constituted to report regarding deficiency on the part of the treating doctor. Accordingly, the Medical Superintendent of GTB Hospital, Dr. Vinod Kumar submitted the report along with a letter dated 15.12.2012. The complainant also filed on record the order passed by Delhi Medical Council on 02.01.2012 on the complaint filed by the Complainant before the Medical Council.

The District Forum took note of the fact that the Delhi Medical Council had observed that the patient was high risk case as he had deranged kidney function and he also had Ischemic Heart Disease (IHD) and CABG five years back. However, the Council observed that the treating doctor did not take any referral from the specialist before undertaking the surgery. Further, the Council noted that the treating doctor missed the important aspect of deranged kidney function and Hb at 8.5 gm% and he also did not give any treatment for bringing the two functions within the parameters before undertaking the operation.

It was further observed that the doctor did not take any Nephrologist's opinion and the Council also was critical regarding the casual approach of the treating doctor in obtaining telephonic referral from the Nephrologist. Further, the Council noted in the order that the hospital lacked adequate post-operative high dependency postoperative unit to undertake such laparoscopic procedure or any major surgical procedure in high risk patients.

Meanwhile, GTB Hospital mentioned in its report that the patient should have been given more importance and should have been investigated more extensively regarding his pre-exisitng cardiac & renal diseases prior to surgery which was not done by the treating doctor. 

The panel of doctors also noted that Nephrologist should have been physically available and his opinion should have been recorded and the patient's treatment for decreased urine output should have been regularly monitored and personally supervised.

The board opined that the treating doctor left the patient at the mercy of the God by allowing the attendant of the patient to Sir Ganga Ram Hospital without even providing the necessary documents.

Taking all these reports into consideration, the District Forum had observed in its order,

"The entire conduct of Dr. Gupta is contrary to the medical ethics and shows that he was thoroughly negligent in performing the surgery. He has committed not only the deficiency in providing the medical services to the deceased and to their attendants, but has also committed a criminal act. He has operated patient, when he was knowing that he has heart ailments, Hb very low, urea and cretanine levels high. His unsealed portion had allowed the blood to collect in the cavity, which resulted into septicemia."

Holding the treating doctor negligent, the District Forum assessed the cost of medical treatment of the patient as Rs 3 lakhs, and further awarded a compensation of Rs 7 lakhs as compensation and granted Rs 20,000 as the cost of litigation.

Aggrieved by this, the treating doctor and the hospital approached the Delhi State Consumer Court and contended that the District Forum erred in establishing deficiency on his part and failed to appreciate the evidence placed on record. Therefore, the doctor and the hospital prayed for setting aside the order passed by the District Commission.

While considering the matter, the State Consumer Court referred to the order in the case of Seema Garg & Anr. vs. Superintendent, Manohar Lohia Hospital & Anr, where the State Commission discussed in detail the scope and extent of negligence with respect of medical professionals. In this case, the Commission had earlier observed that, "In cases wherein the allegations are levelled against the Medical Professionals, negligence is an essential ingredient for the offence, which is basically the breach of a duty exercised by omission to do something which a reasonable man would do or would abstain from doing. However, negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence and they are entitled to protection so long as they follow the same.”

Citing this judgment, the Delhi State Commission observed,

"In the present case also, it will have to be ascertained whether there was any lack of skill and competence on the part of the operating doctor and/or any omission to do what was actually required in the present facts and circumstances."

Taking the case record into consideration, the State Commission noted that the District Forum had referred the matter for expert opinion to Delhi Medical Council, as per which the Board of Doctors of GTB Hospital filed its report and found the hospital not equipped with the pre and post-operative facilities.

In this regard, the State Commission observed,

"On perusal of record, we find that the District Commission has referred the present matter before the Delhi Medical Council for expert opinion as per which, the Medical Council consisting Board of doctors of GTB Hospital has filed the report dated 02.01.2012, wherein it was found that the Appellant Hospital was not equipped with the pre and post-operative facilities to monitor and manage the high risk patients like the patient in the present case. As it is evident that the patient was suffering from multiple ailments like deranged Kidney function, anaemia and Ischemic Heart Disease with CABG. However, the Appellant failed to take preoperative advice from the nephrologist and performed such advanced laparoscopic surgery which went fatal in the present case."

"Further, the perusal of the clinical records of BLK Hospital and Sir Ganga Ram Hospital reflects that there was a clear Residual Hernial Defect which was mentioned by the respective Hospitals in their report. Moreover, the findings reflects that there was perforation in the jejunum and 400-500 ml of blood in supracolic compartment. This perforation in jejunum reflects the negligence on the part of the operating doctor/Appellant as the operating doctor neither sealed the operated part properly nor ensured that there shall be no perforation in the operative part before concluding the operation," it also noted.

Therefore, the State Consumer Court upheld the order of the District Consumer Court and noted, "Therefore, combined analysis of the abovementioned shortcomings during the treatment and the negligence culled out by the District Commission through the impugned order, we are of the opinion that such recurrent negligent conduct is against medical procedure and is intolerable in light of the casual attitude of the treating doctor towards the patient. Therefore, we opine that the impugned order does not suffer any infirmity."

"Consequently, we find no reason to reverse the finding of the District Commission and uphold the order dated 27.01.2014, passed by the District Consumer Disputes Redressal Commission (East), Saini Enclave, Delhi-110092. Resultantly, the present Appeal stands dismissed with no order as to costs," it further noted.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/delhi-state-commission-218397.pdf

Also Read: HC Refuses to quash criminal proceedings against Surgeon Accused of Medical Negligence During Stent Removal