Orthopaedic Surgeon held guilty, told to pay Rs 20 lakh compensation for performing Plastic Surgery procedure resulting in Amputation

New Delhi: Holding a Jaipur based Orthopaedic Surgeon negligent for performing plastic surgery on a patient suffering from a burn injury, the National Consumer Disputes Redressal Commission (NCDRC) recently directed the doctor and the hospital to pay Rs 20 lakh compensation to the patient.

Due to electric burns, gangrene formed in the body of the patient and his left hand below elbow, along with right trans-metatarsal and left symes had to be amputated.

Opining that L.D. flap is a specialized procedure involving complex procedure with micro-vascular surgery, the Commission held, "It was the domain of plastic surgeons, who deal with such procedures more efficiently... The OP-2 would have taken plastic surgeon’s assistance or opinion during the LD flap procedure. Therefore, the OP-2 shall not absolve himself from the liability for the act of omission, though he acted in the best interest of the patient."

Holding the doctor negligent, the Commission noted, "It was his “act of ommission” i.e. doing something, which he was not supposed to do. He would have referred the patient to the higher centre, but it was delayed and resulted to amputation of left hand (below elbow)."

The matter goes back to 2011 when the the patient, who was 17 years old back then, had sustained electric burn injuries in his arms, legs and abdomen due to electrocution in his village. He was taken to the Community Health Centre at Lalsot, Dausa immediately and later he was referred to S.M.S Hospital at Jaipur and got admitted in the Plastic Surgery (Burn) unit. After this, he was taken to Dhanvantri Hospital and got admitted to the Ortho Unit under Dr Saini.

Consequently, the doctor operated on the patient's hand and since the operated site was bleeding, another operation was performed two days later. It was alleged that the doctor delayed the first operation by four days and then after a gap of two days, another operation was performed. Due to the delay, 'gangrene' formed in the left arm and therefore, the left hand had to be amputated at Fortis Hospital a couple of days later.

Further, the complainants alleged that the doctor failed treating other burn injuries on both legs and right forearm which resulted in infection and gangrene. Therefore, patient had to be taken to Fortis Hospital for further management and amputation was performed in the left hand below elbow, along with right trans-metatarsal amputation and left symes amputation.

Alleging that the patient became completely handicapped and suffered 80% disability due to the gross negligence of the treating hospital and doctor, the complainants approached the State Commission, Jaipur and filed a complaint.

On the other hand, the hospital and the doctor denied all the allegations. It was submitted that the patient had approached Dhanvantari Hospital in a very serious condition and he was treated as per the accepted standards. Angiography was performed and in order to prevent further damage and infection, the Latissimus Dorsi (LD) Flap surgery of left hand was done. After surgery, the oozing of blood from the wound was noted and the patient was taken to Fortis Hospital for further treatment.

After considering the matter, the State Commission held the hospital and the doctor liable for medial negligence and noted, "If we compare the first CT-Angiography and the second CT-Angiography, then it appears that all the complications have started only after getting admitted in Dhanvantri Hospital, after operation and the bleeding. The complainant was subsequently taken to Escort Hospital, where the left hand of the complainant had to be amputated near the elbow and the right hand became lean, a finger got damaged, all the fingers got curved, the fingers of the left leg got de-generated and the toe of the left leg vanished. In this way, the complainant in total has become disabled by his both legs and both hands. On the basis of the above investigation, the complainant has succeeded in proving that the negligence of the OPs they did not employ due care and skill."

The State Commission had directed the hospital and the doctor to pay Rs 25 lakhs to the complainant along with 9% interest from 25.01.2012. Another Rs 5 lakh had been granted to the parents of the patient along with an interest of 9% from 25.01.2012. Rs 16,99,857 had been awarded as the expenses for the prosthesis and Rs 7,26,356 as medical expenses and Rs 50,000 as litigation expenses.

Challenging the order of the State Commission, the doctor and the hospital approached the NCDRC bench, which considered the arguments by both the sides, and also perused the material on record along with the medical literature and the order of the State Commission.

It was argued by the counsel for the complainant that after the operation of left forearm, there was heavy bleeding from the left forearm of the patient and despite assurance from the doctor, the bleeding continued for 48 hours. Therefore, 14 units of blood were transfused. It was also submitted that no treatment was given to the right hand and both the legs. There was no separate burn unit in the hospital and therefore, burn patients are more prone for infection, septicemia and death. It was argued that the doctor being an Orthopaedic surgeon performed plastic surgery/LD flap, which was a gross negligence.

On the other hand, the counsel for the doctor and the hospital and the Insurance Company reiterated the evidence filed and also the chronology of treatment given to the patient. He further argued that burn injury patient needs supportive treatment like dressing, maintaining electrolyte balance, administering antibiotics and pain killers.

The Counsel further submitted that the LD flap was necessary, because due to severe burn the muscle, soft tissue and blood vessels were totally damaged and bone was exposed. LD flap of left forearm was done in order to save the maximum part of limb.

After perusing the medical record of SMS Hospital and the concerned treating hospital, the top consumer court noted that the CT angiography of the both upper limbs was done at the treating hospital and it had showed satisfactory blood flow. Therefore, the commission observed that the doctor had performed the LD Flap to the left hand to save the exposed nerves, blood vessels and other muscular tissue. "It was necessary to reduce the level of amputation," observed the Commission.

Holding that the doctor performed his duty with reasonable care, the Commission observed,

"However, the oozing of blood from LD flap operative wound persisted. Therefore, the anticoagulant drugs were immediately stopped. The patient was transfused 14 units of blood and also maintained electrolyte balance with IV fluids. It was an accepted standard line of treatment in the cases of burn injuries. In my view, in the instant case, the severity of burns led to damage of muscles, nerves and blood vessels, which was the cause of development of gangrene. Therefore, the fact was the patient sustained heavy electric burn injuries with 11000 volts, which badly charred the upper limbs and lower limbs, therefore amputation was inevitable. Therefore, OP as an Orthopedician, performed his duty with reasonable care."

However, taking note of the fact that the treating doctor, who is an orthopaedic surgeon, had performed the LD Flap Surgery, the Commission held him guilty and noted,

"In my view, the L.D. flap is a specialized procedure involves complex procedure with micro-vascular surgery. It was the domain of plastic surgeons, who deal with such procedures more efficiently. It is pertinent to note that, OP-1 Hospital was in Jaipur and certainly, the availability of qualified Plastic Surgeons was not an issue. The OP-2 would have taken plastic surgeon’s assistance or opinion during L.D. flap procedure. Therefore, the OP-2 shall not absolve himself from the liability for the act of omission, though he acted in the best interest of the patient."

Referring to the Supreme Court orders describing the duties of doctor and also perusing the textbook literature on high voltage electric burns, the apex consumer court noted, "It is apparent from the medical record that, the burn injuries were inflicted due to 11000V (High Voltage) wherein patient’s both the upper and lower limbs were charred. The patient was first taken on 03/07/2011 to SMS Hospital and remained there up to 05/07/2011. The doctors opined that the limbs of the complainant to be amputated because of the onset of gangrene. Therefore, knowing about amputation, the patient absconded from SMS Hospital and approached OP-1 Hospital."

At this outset, the NCDRC bench also perused the opinion of General Surgeon Dr Devraj Taneja, who opined that electric burn cases suffer amputation, sooner or later, since the blood vessel gets blocked due to damage cause by electric burn. He also opined that L.D. Flap can be performed by an experienced Orthopedic Surgeon.

Further taking the discharge summary of Fortis Escorts Hospital into consideration, the Commission noted,

"Such high voltage burns affect multiple organ systems which makes the treatment of such patients exceptionally challenging, multi-disciplinary and resource-intensive. In the instant case the deformities and amputation of right metatarsal was the sequel of severe high voltage electric burns. Therefore, OP-2 shall not be held liable for all the injuries sustained by the patient, but liable to limited extent of performing the L.D. Flap surgery."

Holding him negligent, the Commission noted,

"It was his “act of ommission” i.e. doing something, which he was not supposed to do. He would have referred the patient to the higher centre, but it was delayed and resulted to amputation of left hand (below elbow)."

However, the Commission opined that the amount of compensation awarded by the State Commission was not justified and therefore, reduced the amount to Rs 20 lakh.

"As discussed above the OP-1 and OP-2 are not liable for the entire sufferings /deformities suffered by the patient. Therefore, in the ends of justice, in my view the lump-sum compensation of Rs.20 lakhs is just and reasonable in the instant case. Therefore, the OPs are directed to pay Rs.20 lacs to the Complainants within 6 weeks from today failing which the amount shall carry interest @ 9 % per annum till its realisation. The insurance co. shall pay the amount as per the Professional Indemnity insurance (Medical Establishment) Policy issued to the OPs," the Commission mentioned.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-20-lakhs-compensation-204364.pdf

Also Read: Orthopaedic surgeon guilty of medical negligence, liable to pay Rs 15 lakh compensation: Consumer Forum