NCDRC holds no medical negligence, Relief of Rs 17 lakh to Orthopaedic Surgeon, Nursing home

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently exonerated a Bengal based Orthopaedic Surgeon and Nursing home from charges of medical negligence while treating the femur fracture of a patient.

Previously District Consumer Court, Hooghly and the State Consumer Court had held the doctor and the clinic guilty of medical negligence while providing treatment to the patient, who ultimately died undergoing treatment at CMC Vellore. They had been told to pay Rs 17, 91,000 as compensation to the wife and children of the deceased patient.

However, while considering the matter, the NCDRC bench opined that the "State Commission has failed to appreciate the facts and medical record. The opinion of expert committee and treatment done by OP-1 was as per the reasonable standard of Orthopedic Practice. The aneurysm of Profunda Femoris is rare and incidental finding revealed post operatively. It has no nexus with the act of OP-1."

The matter goes back to 2005 when the husband of the complainant had sustained fracture of right femur and was operated by Dr Bhaskar Das at Bagbazar Nursing Home. The patient was discharged after four days with an advice to review after six weeks. Thereafter, the patient had blood stained serious discharfe from the operative site.

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So, the doctor advised the patient for regular dressing at a nearby clinic. Regular dressing was done for almost fifteen days. Ball bandage was put, but the patient was continuously dislodging dressing. One unit of blood was transfused to correct anemia.

After this, the patient telephonically informed the treating doctor that there was sudden bleeding from the operated area and therefore fresh dressing was sone and the patient was again admitted to the clinic where exploration of wound was done under general anesthesia and the patient was discharged on the same day.

However, there was bleeding again from the wound and the patient was advised to get admitted to the Nursing Home, where the patient was diagnosed as secondary hemorrhage. Two units of blood were transfused, however, again fresh bleeding was seen and fresh sutures were put.

Following this, the treating doctor consulted a senior Orthopaedic Surgeon at Kolkata and decided to shift the patient to Kolkata. Accordingly, the patient was admitted in M.B. Nursing Home at Kolkata under Dr Indrajit Sardar, who diagnosed it as a secondary hemorrhage and three units of blood were transfused that the OT was fixed for debridement on the next date.

However, the patient took discharge and approached CMC Vellore for further management. However, during treatment, the patient expired in November 2005. Aggrieved by the alleged negligence during the treatment at the treating nursing home, the wife and minor children of the patient filed the complaint before the District Forum.

Holding negligence against the doctor and the nursing home, the District Forum had directed them to pay Rs 17, 91,000 to Complainants and this order was affirmed by the State Commission. Following this, the doctor and the nursing home, approached the NCDRC bench.

Meanwhile, during the proceedings before the District Forum, the treating doctor, Dr Das had approached West Bengal Orthopaedic Association for seeking expert opinion. Consequently, an expert committee was formed with four Senior Orthopedic Surgeons, who referred to the fact that an angiogram done at Vellore revealed that the rare condition of an aneurysm of profunda femoris artery. The aneurysm was excised & the bleeding was controlled. Unfortunately, the patient died.

Referring to this, the Expert committee opined, "In our opinion the development of an aneurysm of profunda femoris is an extremely rare occurrence. Naturally it does not come in the mind of a surgeon."

It had further observed that Dr Das, the treating doctor "...took adequate care in treating this patient and there was no professional negligence on his part. In fact if the patient's party had followed the expert opinion of Dr. Indrajit Sardar, the aneurysm could have been detected earlier and treated properly by a vascular surgeon with fair chance of his survival.”

While considering the matter, the apex consumer court perused the entire medical record of the nursing home and the clinic and noted, "As there was repeated bleeding at the operated site, therefore OP-1 suspected it secondary hemorrhage and therefore, referred the patient to MB Nursing Home at Kolkota under care of Dr. Indrajit Sardar for further management."

Referring to the medical record and death summary issued at CMC Vellore, the NCDRC bench noted that Angiogram of the common femoral artery had been performed at CMC.

"It showed pseudo-aneurysm (26 x 25 mm) arising from right Profunda Femoris artery with narrow neck. The patient was treated with embolization procedure. The complete occlusion of the pseudo aneurysm was achieved with 3 steel coils x proximal right Profunda Femoris followed by injection gelfoam. The wound debridement and the bedsores were also treated. Thereafter, the patient was transferred under plastic surgery for further care. However, on 30.11.2005 at 11.30 am, the patient suffered respiratory arrest, which could not be revived and he expired," noted the bench.

While considering the question if the act of the treating doctor constituted medical negligence, the Commission noted,

"Firstly, the OP-1 performed ORIF with DHS for fracture of Rt trochanter. It was correct line of treatment, the operation was uneventful. I do not find any negligence or deviation from the standard of practice of the OP-1. It is evident that patient had anxiety disorder and repeatedly tampering with the dressing. The regular dressing of surgical wound was performed, but the bleeding from the wound was seen, therefore OP-1 referred the patient to Dr.Indrajit Sardar. In my view the referral was correct and made at appropriate time."

The bench further addressed the question whether there was any nexus between the surgery performed by the doctor and the aneurysm of right Profunda Femoris artery. At this outset, the bench referred the Campbell’s Orthopedics and few articles on the subject which stated about very unusual and rare incidence of aneurysm of Profunda Femoris artery.

Referring to the articles, the bench observed,

"Based on the discussion the District Forum as well as the State Commission has failed to appreciate the facts and medical record. The opinion of expert committee and treatment done by OP-1 was as per the reasonable standard of Orthopedic Practice. The aneurysm of Profunda Femoris is rare and incidental finding revealed post operatively. It has no nexus with the act of OP-1. The CMC Vellore also did not give any findings or negligence caused by the OP-1 while operating the patient."

Exonerating the doctor, nursing home and the clinic from the charges of medical negligence, the Commission stated,

"Based on the discussion above, there was neither failure of duty of care nor deficiency in service from the OPs. Thus no negligence is attributed upon the OPs. The Order of the State Commission is set aside and both the Revision Petitions are allowed. Consequently, the Consumer Complaint No. CDF No. 35 of 2006 filed before the District Forum, Hooghly stands dismissed."

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-no-medical-negligence-204511.pdf

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