Patient dies post Percutaneous Nephrolithotomy: NCDRC exonerates Urologist, Hospital of Medical Negligence charges

The complainant, husband of the deceased had claimed in the petition that the patient died due to fungal septicemia and Hemolytic uremic syndrome (HUS) arising from using non-sterilized instruments during operation.

Dr. S.M.Kantikar, presiding member of NCDRC noted in the judgment dated 01.06.2021, "The death was due to septicemia induced fatal DIC, but not HUS which is a distinctly different entity. The treating doctors at OP-1 hospital followed the standard method with reasonable degree of skills and treated the patient, it was not a medical negligence."

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The case goes back to 2002 when the complainant had taken his wife to the treating hospital after she was diagnosed with a stone in the left kidney. The Urologist performed Percutaneous Nephrolithotomy (PCNL) operation on the patient on 02.10.2002.

However, the complainant alleged that although the patient was discharged from the hospital on the next day her condition was not normal. This was followed by cessation of urine and swelling of the face in the night. The condition worsened as she developed loose motions, fever, and vomiting.

Soon, she was taken to the hospital, where after investigations; the doctors revealed that the patient was suffering from Fungal septicemia and multi-organ failure. Soon, the patient was to another doctor in Apollo Hospital, New Delhi for further management.

The Complainant alleged that the treating doctor at Apollo Hospital diagnosed it as an instrument induced infection leading to Hemolytic uremic syndrome (HUS). It was alleged that the said fungal infection was developed due to infected instruments used at the first Hospital, which ultimately resulted in the death of the patient on 14.10.2002.

Being aggrieved by the orders passed by the District Forum and the Uttar Pradesh State Commission, the Complainant and his daughter filed the revision petition at NCDRC and alleged medical negligence on the Urologist and hospital.

The counsel for the complainant submitted before the Commission that the fungal septicemia was a hospital-acquired fungal and in most of the cases it develops due to non-sterilized instruments used during operations. He further contended that the treating doctor at Apollo Hospital clearly opined that the deceased suffered instrument-associated sepsis and HUS. Therefore, the principle of res-ipsa loquitor is applicable, they contended.

The doctors and the hospital on the other hand denied all these allegations and refused to accept that the patient developed septicemia due to instruments, adding that it might have developed at Apollo Hospital itself.

After perusing the entire material on record, the top Consumer Court noted that as soon as the treating hospital had suspected Hemolytic uremic syndrome (HUS) they had referred the patient to the Apollo Hospital without any delay.

The Commission also noted that during the ongoing recovery process at the Apollo Hospital, the patient was discharged from the hospital on request and was re-admitted at the first hospital, where during treatment she finally died. Thus, the Commission didn't find any medical negligence on the part of the urologist or any deviation from the standard of treatment.

Further, taking note of the fact that two samples of blood culture at Apollo Hospital didn't indicate any fungal septicemia, the Commission noted,

"As per the medical literature candida which is fungus present in oral cavity and gastrointestinal tract sometimes overgrows and enters the bloodstream. The surgery has no role to play such infection. The Complainant failed to produce any evidence that candida infection was caused by non-sterile surgical equipment."

The Commission further mentioned in the judgment that although the condition of the patient was improving at the Apollo Hospital, she was discharged on request. "..In this condition, the treatment should have continued," noted the Commission. Besides, the Consumer Court also observed,

"As per the medical literature on Hemolytic uremic syndrome (HUS)- it is a condition that affects the blood and blood vessels. It results in the destruction of blood platelets (cells involved in clotting), a low red blood cell count (anemia), and kidney failure due to damage to the very small blood vessels of the kidneys. Other organs, such as the brain or heart, may also be affected by damage to very small blood vessels. Therefore, fungal infection has no role in development of HUS in the instant patient."

Dr. Kantikar of NCDRC further relied upon the Apex Court judgment in Dr. Laxman Balkrishna Joshi v Dr. Trimbak Bapu Godbole, to finally, dismiss the Complaint.

Observing that the Complainant failed to produce any cogent evidence to prove the instruments were infected and resulted in fungal infection, the NCDRC observed,

"The treating doctors at hospital followed the standard method with reasonable degree of skills and treated the patient, it was not a medical negligence."

"I do not find merit in this Revision Petition, hence dismissed," noted the Commission.

To view the original order of NCDRC, click on the link below.