Minor patient's Left ovary, tube removed without necessary preliminary tests: Surgeon, nursing home slapped compensation

The case, filed under Section 15 of the Consumer Protection Act, 1986, involved a minor patient who experienced intense abdominal pain and was admitted to a Nursing Home in Karimnagar. The General Surgeon (the first opposite party in the given case), performed an Exploratory Laparotomy on September 16, 2006. The patient claimed that the pain persisted, leading to a second admission on October 20, 2006, where she underwent Laparotomy again. She alleged that the doctor removed her vital reproductive organs i.e., the left tube and ovary without addressing the source of her pain, necessitating a third surgery in Hyderabad.

Aggrieved, a complaint was filed before the District Forum against the alleged negligent treatment provided by the doctor, seeking compensation. During the second surgical procedure, the father of the Respondent/Complainant stated that his daughter should have been advised to consult a Gynaecologist for diagnostic and curative technique of laparoscopy and Hysteroscopy; instead the surgeon removed the "left ovary and tube" without their consent.

In response to the allegations, the surgeon contended that he provided appropriate treatment, citing the diagnosis of a Hemtometra in the left horn of the uterus. "Needle aspiration POD revealed blood stained serous fluid and once again Laparotomy was done. Necrotic left ovarian tissue excised after explaining to the patient/Complainant's parents and obtaining the consent for the same. They were further advised to go to Hyderabad for further management i.e., rectification of congenital anomalies," the doctor submitted. He argued that the surgeries were conducted with due care, and any adverse outcomes were not due to negligence. The Nursing Home, represented by Dr. U.V. Vishnuvardhan Reddy, supported the doctor's position.

The Opposite party No.2 in the case, ie. the Indian Medical Association (IMA), represented by its Telangana State Branch Chairman, opposed the complaint, asserting that the patient received proper treatment. The IMA contended that the complaint was vexatious and aimed at extracting money.

It was further submitted by the owner of the nursing home, an MBBS doctor, physician (Opposite party 3) that utmost care was taken throughout the procedures and requested the dismissal of the complaint with costs. He assisted in the surgeries conducted by the surgeon. Before the operations, detailed explanations about the procedure's nature and risks were given to the patient's father and attendants. All anomalies were recorded in the case sheet, and the family was advised to consult a Gynaecologist for anomaly rectification, he mentioned in his argument.

The District Commission partially allowed the complaint, instructing Opposite Parties No.1 to 3 to collectively pay the Complainant Rs.6,00,000 with 9% interest from the complaint filing date (10.11.2008) until realization. Additionally, they were directed to pay Rs.5,000 as costs within one month from receiving the order.

Aggrieved, the opposite parties challenged the District Forum's decision and moved the State Commission, contending that critical aspects were disregarded. They said that a document (Ex.A8) showing the Complainant's condition wasn't properly considered. They pointed out that Ex.A8 had information about the disease and a surgery called Exploratory Laparotomy. They also stressed that the procedures during Laparotomy, like wedge resection and appendectomy, weren't observed. They mentioned that the Complainant left against medical advice. The issues continued with the Complainant's later visits, an ultrasound finding, and details from a surgery called Laparotomy.

They argued that the District Forum failed to recognize the Operation Notes from the first surgery, stating the left ovary was cystic, and the rationale for removing the diseased left ovary during the second surgery. They further criticized the inadequate examination of Dr. Kala's testimony, emphasizing her failure to assert that the surgeon erroneously removed a healthy ovary or that their services were deficient. Lastly, they underscored the neglect in harmoniously assessing operative findings.

Deliberating the case, the State Commission noted the discrepancy in the patient's age as presented in various documents and testimonies. It considered medical records, including ultrasound reports and laparotomy findings. The Commission acknowledged that the patient had a bicornuate uterus with hematometra in the left horn, a congenital condition requiring surgical intervention.

The Commission found that the surgeon failed to adequately consider pre-surgery ultrasound reports, leading to the unnecessary removal of the patient's left ovary. The Commission determined this as a case of medical negligence and deficiency in service. It highlighted the absence of a biopsy report supporting the claim of necrotic tissue.

It noted;

"In his written version, the Opposite Party No.1 Doctor has submitted that “Laparotomy was done through same old incision. Uterus enlarged bicornuate, left horn tense thick, remains of left ovary were small necrotic? Gangrenous. Necrotic left ovarian tissue”, but this is not supported by the USG trans abdomen report nor does the discharge summary support the findings. If he thought that the left ovarian tissue was necrotic or gangrenous, then it should be supported by a biopsy report and it needs to be diagnosed by blood tests. This reveals the deficiency and negligence of the Opposite Party No.1 Doctor. He conducted the two procedures without due care and skill and further removed the young patient‟s left ovary and tube without the necessary preliminary tests to confirm the necrosis or that the gangrenous tissue was cancerous."

"..the Appellants/Opposite Parties have failed to explain why they removed the “Necrotic ovarian tissues on the left side."

Subsequently, the Commission dismissed the appeal filed by the Surgeon and the Nursing Home. It upheld the District Consumer Commission's decision and affirmed the compensation awarded to the patient. It observed;

"In the glaring absence of a pathological report and the fact that Ex.A8 and A12 did not reveal any abnormality of the left ovary, we concur with the findings and conclusion of the Commission below and hold the Appellants/Opposite Parties as deficient and negligent. The Doctor who conducted the surgery is an Urologist and the hospital where the surgery was conducted did not have the necessary facilities and the patient should have been immediately referred to a hospital having the required imaging and diagnostic facilities and a Gynaecologist."

The Commission emphasized the importance of informed consent and the need for doctors to exercise due care and skill, especially in cases involving surgical interventions. It noted;

"This Commission is compelled to deduce, especially in the absence of any plausible explanation or report that the Appellants/Opposite Parties 1 & 3 have not exhibited reasonable care and needlessly caused a functional disability to the Respondent/Complainant. Further, it is our considered opinion that the Commission below awarded a lesser amount towards compensation for the negligence and deficiency as exhibited by the Appellants/Opposite Parties No.1 & 3, but in the absence of cross appeal, we restricted ourselves to the amount awarded."

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