No Medical Negligence in Treatment of patient Suffering From Progressive Dysmeorrhoea: Consumer Court exonerates Gynaecologist

Such an observation came from the Consumer Court after it perused all the relevant documents and medical records of the case and found no negligence in the treatment of the patient who was suffering from irregular periods and progressive dysmenorrhoea for a long time.

"In view of the materials discussed above it is clear that the 2^nd opposite party Gynecologist who treated the patient has not done anything against the accepted protocol of treatment and there is no medical negligence on her part," noted the Commission.

The case goes back to 2011 when the patient had approached the treating Gynecologist with complaints regarding her menstrual period. Upon investigation, she came to know about a cyst in her ovaries and the Gynecologist had advised the complainant to remove the same, even though the growth was not cancerous, she alleged in her complaint.

The complainant further alleged that even though she was a healthy mother and had not crossed the childbearing age, she had been subjected to surgery and the doctor didn't even consider the non-surgical mode of treatment.

It had been submitted by the complainant that after the operation she developed fever and pain and the doctor advised a scan and without even giving them the opportunity to go through the scan report, the doctor advised another operation. Following this, the relatives of the patient expressed their wish to take her to a better facility, however, the doctor warned them that any delay could cause loss of life.

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Soon after the second operation, the doctor informed the relatives of the patient that the patient was in ICU and her uterus had to be removed. Following this, the patient was taken to KIMS in an unconscious state and remained in the hospital in a vegetative state for 40 days. It was alleged that the medical report clearly shows that all this was due to the fault of the treating gynaecologist.

After being discharged from KIMS, the patient had to undergo rigorous physiotherapy to regain some of her body movements. Pointing out that the patient was healthy and of childbearing age and had lost her chance to conceive again, the complainant further claimed that the treating doctor had admitted guilt before the patient party in the KIMS hospital.

Thus, filing the complaint before the Consumer Court, the complainant demanded compensation of Rs 19 lakh from the doctor and the hospital.

On the other hand, the hospital and the doctor opposed the allegations raised in the complaint and submitted that the complainant was suffering from irregular periods and progressive dysmeorrhoea since last 14 years and the investigations revealed that she had a cystc mass of right ovary measuring 7.8x4.9 cm in the right adnexa and endometriotic cyst. Uterus was enlarged with small subserous fibroid, multiple seedling fibroids and suspected Adenomyosis. It was also diagnosed from the cervical smear that she was having human papilloma virus. 97% of the cervical cancer is caused by the said virus. Hence hysterectomy was very much indicated because of all the above reasons.

It was submitted by the doctor that even though she was advised to undergo hysterectomy along with ovarian cyst removal, the complainant opted to undergo surgery for cyst removal for the time being and thus the patient was posted for laparotomy for right ovarian cystectomy. During surgery it was found that the right ovary was enlarged with endometeriotic cyst of size 10x10 cm. The doctor submitted that when the patient came back after being discharged she was examined by a duty gynaecologist and was put under close monitoring.

However, as the patient complained of giddiness and the treating gynaecologist noticed fullness and tenderness in the lower abdomen, emergency USG was ordered. Ultra sound showed two complex cystic masses with fluid levels, minimal ascitis and pleural effusion. Uterus was found to be enlarged to 9.7x4.7 cm with fibroid and adenomyosis. The fluid level indicated as per scan report could be due to hemorrhage and the gynaecologist after discussion with the kin of the patient advised emergency laparotomy and also suggested hysterectomy in view of the enlarged size of uterus with multiple fibroids and adenomyosis along with HPV(Human Papilloma Virus) infection with high risk for cervical cancer.

Post operation, as the patient was suspected to have Disseminated Intra vascular Coagulation(DIC) it was decided to shift the patient to KIMS hospital and the doctor and hospital claimed that they had treated the patient as per accepted medical practice and the treating doctor had exercised all reasonable degree of skill and care.

The counsel for the doctor and the hospital referred to the case titled Dr.Manpreet Kaur Vs Lekshmi Devi 2014(3)CPR-430(NC), where it was held that merely because of an unfortunate result there is no presumption or inference of negligence.

After listening to the contentions, the consumer court took note of the available materials placed on record, which showed that the surgery was uneventful and the medical records clearly showed that the condition of the patient was stable when she was discharged, and her wound was healing.

"In view of the above materials on record we are satisfied that the 2 opposite party has subjected the complainant to surgery for and removal of cyst at the 1 opposite party hospital was admittedly necessary and in accordance st with the accepted protocol and that there is no merit in conducting that she would have given first line of treatment such as medication etc. instead of opting for surgery," noted the Commission.

The Commission observed that when the patient was brought to the hospital again, the USG reports indicated 2 complex cyst masses with fluid levels, minimal ascitis and pleural effusion. It was also noticed that there was enlarged uterus of 9.7x4.7 cm with fibroid and adenomyosis. The fluid level indicated as per the scan report could be due to hemorrhage. On the basis of the evidence, the doctor had suggested hysterectomy in the same operation and the complainant along with her husband consented for the same. Accordingly laparotomy was conducted and abdominal hysterectomy with left salpingo opherectomy was done.

When the patient was suspected to have DIC, she was shifted to KIMS Hospital. At this outset, the commission noted,

"It is clear from the available materials that in difficult surgeries with extensive adhesions as in case of endometriosis there is a possibility of uncontrolled bleeding and there is a continuous coagulation failure it may lead to DIC. DIC can also produce uncontrolled bleeding. Undoubtedly it is a life threatening condition which requires immediate management in a major hospital, having all infra structure and expert management. In the circumstances opposite parties have rightly referred the patient at the right time to the KIMS hospital where her life was saved by timely intervention."

"In view of the materials discussed above it is clear that the 2^nd opposite party Gynecologist who treated the patient has not done anything against the accepted protocol of treatment and there is no medical negligence on her part," further noted the Commission.

In this context the Commission also referred to the opinion of the HOD and senior consultant of KIMS Hospital, who had clarified that the DIC following surgery is one of the complications of any major surgery and also clarified that the patient was brought to KIMS at the right time. The HOD had further submitted that none of the treated Gynecologist has expressed any opinion that the DIC condition of the patient was due to or after effect of initial laprotomies done by the treating gynecologist of the first hospital.

Similar view was of another expert doctor who had opined that complexity of medical condition of the coagulation failure and the resultant DIC is beyond the control and expectation of the treating doctor and simply because of such unexpected sudden complication and development, the treating doctor cannot be blamed as negligent.

Taking note of all these factors, the commission observed that the treating gynecologist and the hospital had "managed the patient/complainant to the best of their ability and within their limit. In the circumstances simply because something went wrong or complication occurred it cannot be inferred that there is some negligence on the part of the treating doctor as held by the National Commission in Lalitha Ramesh Vs Talesara Hospital-2013(2)CPR-515(NC)."

Further referring to the allegations that the removal of the uterus had been done without proper consent, the Commission after perusing the relevant documents, opined that there was no merit to such contentions.

"On evaluating the entire materials available on record we come to the conclusion that the complainant has failed to establish medical negligence, deficiency in service or any unfair trade practice on the part of the 1^st and 2^nd opposite parties in treating the complainant and the allegation that the 2^nd opposite party has subjected the complainant to the 2^nd surgery without valid informed consent is also devoid of any merit," noted the Commission as it dismissed the complaint.