No Medical Negligence by Neurosurgeon, NCDRC orders Hospital to pay Rs 50,000 exgratia to patient

Before arriving at this decision, R.K.Agarwal (president) and Dr. S.M.Kantikar (member) of NCDRC took note of the fact that the neurosurgeon had performed a laminectomy on the patient as the X-ray and MRI investigations didn't reveal anything about the TB Spine present in the patient.

Holding the observations of the district and Andhra Pradesh State Forum as erroneous, the top consumer court noted, "There was no negligence while conducting the surgery. Detection of Koch's spine after 6 months has no nexus with the laminectomy. The observations of District Forum and the State Commission are erroneous, wherein no negligence could be attributed to the treating doctor. Therefore we dismiss the Complaint."

"However, on humanitarian ground; considering the facts and the suffering of the patient we request the hospital Opposite Party No.1 be magnanimous and pay only Rs.50,000/- as an exgratia amount to the Complainant," further observed the Commission.

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The case concerns the patient who had been suffering for backache since 2003 and was undergoing treatment. On 13.05.2004 she approached the treating doctor at the hospital. The doctor advised immediate surgery else the limbs of the patient would be paralyzed.

On the next day, the operation was conducted on the complainant and she was discharged from the hospital a few days later. However, at the time of discharge also the patient was suffering from pain, which continued for one month and she was re-admitted to the treating hospital with complaints of backache, loss of appetite, and weakness.

At that time, her husband informed the treating doctor that the patient had a history of TB Spine. After this, the disc piece of the patient was immediately sent for biopsy to rule out TB.

Afterward, the doctor advised the complainant to consult a psychiatrist for pain and some physician for fever. However, the condition didn't approve and the patient got admitted to a second hospital with complaints of swelling on back and burning sensation. She was provided sand bag traction and medicines.

As the situation remained the same, the complainant again visited the treating doctor at the first hospital and needle aspiration of the swelling was done. However, as there was no pus or fluid the doctor assured that there was nothing serious.

Few months later, the patient consulted another doctor who diagnosed her as 'cold abscesses caused due to TB of spine'. A doctor drained out pus and the patient got some relief and she was then referred to the Nizam Institute of Medical Sciences (NIMS), Hyderabad. TB of the Spine was detected at NIMS and the patient started undergoing treatment there.

The complainant alleged that the doctor at the first hospital performed the surgery without conducting the necessary tests to diagnose the TB. This ultimately resulted in the patient's prolonged illness as she was bed-ridden for months and suffered mental agony, submitted the Complainant filling a complaint before the District Forum - II, Krishna District, Vijayawada for the alleged gross medical negligence.

Both the District and State Forum partly allowed the complaint and granted some compensation to the complainant.

However, the NCDRC, while reviewing the revision petition perused the Orders of both the fora, the entire Medical Record of the treating Hospital, the evidence of doctors at NIMS, and the Medical Literature on TB spine and its treatment.

The Commission noted that the treating doctor examined the patient in 2004 and investigated with X-ray and MRI of spine at L4 & L5. The doctor disgnosed it a case of L4 L5 prolapse, as there was no sign of TB Spine in either X-ray or MRI of spine. Ultimately the doctor performed laminectomy and the medical record showed that at the time of discharge the operative wound was healed and the patient did not have any pain or neurological signs.

Further, the discharge summary of NIMS diagnosed the patient with Koch's Spine T 12 and L1 vertebrae with pus draining sinus. In his evidence, the Head of the Department of Neurosurgery stated that the diagnosis was based on non-specific tests like ESR and Montoux Test. Even the pus aspiration did not confirm the TB and the Pus culture was negative; therefore it was suspected as Koch's and empirical treatment was started to which the patient moderately responded.

However, after going through the entire medical literature on Diagnosis and Treatment of Tuberculosis, the Commission noted:

"The ESR is a non-specific test and has a prognostic value. There are several reasons for increase in ESR like old age, anaemia, chronic diseases, polymyalgia and Rheumatoid arthritis, etc. For the confirmed diagnosis of TB it is necessary to detect Mycobacterium TB in microscopy or cultures or by immunological tests. We note the NIMS have not conducted any immunological tests to diagnose TB."

Besides, addressing the complaint that the treating doctor failed in the diagnosis of TB Spine and he didn't send the vertebral disc pieces for biopsy to confirm TB immediately after the operation, the Commission observed,

"MRI and X-ray spine did not show any abnormality or signs of TB, therefore clinically TB spine was ruled out. Thus, in our considered view sending of the removed disc piece did not make any adverse effect, as the biopsy sent at a later stage was negative for TB."

Opining that the complainant failed to prove that she was suffering from Koch's spine at the time of admission, the Commission further mentioned, "after laminectomy as per standard surgical practice, it is not mandatory to send the disc material for histo-pathological examination (HPE). The operating surgeon shall decide it on the basis of clinical surgical findings whether there is any need for HPE. We do not think it was neither a failure in standard duty of care nor deficiency in treatment. The complainant's allegation is not sustainable."

Holding the observations of the district and state forum as erroneous it was further mentioned in the judgment,

"There was no negligence while conducting the surgery. Detection of Koch's spine after 6 months has no nexus with the laminectomy. The observations of District Forum and the State Commission are erroneous, wherein no negligence could be attributed to the treating doctor. Therefore we dismiss the Complaint."

"However, on humanitarian ground; considering the facts and the suffering of the patient we request the hospital Opposite Party No.1 be magnanimous and pay only Rs.50,000/- as an exgratia amount to the Complainant" read the top Consumer Court order.

To view the complete judgment, click on the link below.