Patient suffers cut in intestine during ectopic pregnancy surgery: Consumer Court directs Gynaecologist, Hospital to pay Rs 10 lakh compensation

The consumer court bench comprising of Justice Paramjeet Singh Dhaliwal (President), Mr. Rajinder Kumar Goyal (Member), Mrs. Kiran Sibal (Member) in the judgment dated 09.04.2021 opined that the treating doctor should have opted for CT scan to understand the reason for suffering by the patient. It held the hospital and the gynaecologist guilty of deficiency in service and medical negligence.

The judgment mentioned, "The spillage of intestinal contents results into morbidity and peritoneal mortality of peritonitis. They could have recognized at least the exact cause of pain, specifically in view of history given by the patient that she was suffering from abdominal pain and vomiting etc. The clinical examination can determine such things, read with history given by the patient. In these circumstances, we are of the prima facie view that opposite parties No.1 & 2 were medically negligent while treating/operating the patient."

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The case concerned a 26-year old woman who had approached the Bathinda-based treating doctor following severe stomach pain. She was diagnosed with ectopic pregnancy and the treating doctor at the hospital examined the patient for the same. Surgery was advised and the patient underwent the procedure on 26.04.2017. Although the doctor assured the patient that the surgery was successful and discharged her on 28.04.2017, the patient continued suffering severe stomach pain and contacted the doctor again. Medicines were prescribed but the pain remained.

Again the patient consulted the treating doctor on the telephone and the doctor prescribed an injection. As the condition didn't improve and the patient started vomiting green liquid she was taken to the treating hospital once again. Mentioning the presence of some fluid in the stomach of the patient, the treating doctor continued treating the patient till 08.05.2017.

As the condition of the patient was worsening she was taken to a second hospital and was operated on again on 08.05.2017 at the second hospital. Following surgeries, the patient was discharged on 27.05.2017.

The complainant claimed that the second hospital informed her that she suffered a cut in her intestine during the previous surgery at the first hospital.

Following this, a complaint was made before the Chief Medical Officer of Bathinda but no action was taken against the treating doctor of the first hospital. The complainant also approached the High court but the application remained pending.

Thus, the complainant approached the Consumer Court seeking compensation of Rs 25 lakh from the treating doctor and hospital for medical negligence.

On the other hand, the treating hospital and the doctor denied all the allegations labelled against them and mentioned that the discharge summary of the second hospital mentioned that perforation peritonitis is secondary to enteric fever. The discharge summary nowhere mentioned that the perforation happened due to the previous surgery performed by the treating doctor at the first hospital.

They also pointed out that enteric fever may have caused these multiple perforations, which is also supported by the article "Typhoid Intestinal Perforation:24 Perforations in One Patient". The counsel for the doctor and hospital also submitted that perforation caused by surgery mostly occurs within 96 hours of surgery, but the patient complained of pain much later.

The counsel for the doctor and hospital also submitted before the Commission that the patient didn't complain of any problem during her discharge on 08.05.2017 and even took leave against medical advice (LAMA).

Mentioning that no intestine cut had happened during the surgery, the doctor and the treating hospital prayed to dismiss the complaint.

The Commission during the course of the procedure, heard the second treating hospital as well and took note of the medical record provided by them.

The complainant submitted the affidavit along with Discharge card issued by the first hospital, Discharge summary of the second hospital and other relevant documents. On the other hand, the treating doctor and the first hospital submitted the Discharge summary of the second hospital along with their own affidavit and some medical articles.

After listening to all the contentions by both the parties, the Commission noted that when the patient was admitted to the first hospital on 07.05.2017, based on the information provided by the patient and the medical history the treating doctor failed to use indicated tests to identify abdominal pain.

Thus, "it is case of inadequate evaluation, failure to recognize complications after surgery," mentioned the Commission.

Mentioning the treating doctor should have done CT scan to assess the abdominal pain, the Commission further noted, "There is also failure of thorough history for and just-in-time approach. There appears to be apparent investigation errors, such as required lab. tests and diagnostic images were not done. Opposite party No.2 (the doctor) missed the diagnosis of perforation, such is lack of gold standard for both testing and standard of care. Hence, it amounts to medical negligence and deficiency in service"

The Commission opined that probably the patient opted for LAMA as the treating doctor and hospital failed to appropriately conduct diagnostic testing and monitoring and refer the patient in time.

The Commission also noted that the LAMA certificate is deficient in many aspects as it didn't contain the signature of the doctor, the date, stamp, and seal. In fact, the Discharge card also didn't contain any date. The doctor and the hospital didn't submit the entire medical record as well. Thus all these factors add up to deficiency in service, opined the Consumer Court.

"Non-providing the medical record itself indicates that there must be some lapse on the part of opposite parties No.1 & 2, that is why they have not produced any medical record in support of their pleas. On this ground also, the deficiency in service of opposite parties No.1 & 2 is clearly established," mentioned the judgment.

"Opposite parties No.1 & 2 have failed to lead any evidence to prove that injury had not occurred during surgery of the patient in their hospital. Mere writing in opposite party No.3's record does not absolve opposite parties No.1 & 2 from the same. Intestinal perforation is a potentially devastating complication. Common cause of such perforation includes trauma, instrumentation, inflammation, infection, malignancy etc. It was otherwise the duty of opposite parties No.1 & 2 to early recognize such type of injury by making investigations through ultrasound and other means, which has not been done," observed the Commission.

Mentioning that spillage of intestinal contents results into morbidity and peritoneal mortality of peritonitis the Commission noted,

"They could have recognized at least the exact cause of pain, specifically in view of history given by the patient that she was suffering from abdominal pain and vomiting etc. The clinical examination can determine such things, read with history given by the patient."

Thus the Commission opined that the treating doctor and hospital were medically negligent while treating/operating the patient and the complainant successfully proved her case of deficiency in service and medical negligence against the doctor and the hospital.

Thus, disposing of the complaint, the Commission directed the treating doctor and the first hospital-

"i) to pay lump sum of ₹10,00,000/- (Rupees Ten Lac only), to the complainant, as compensation, along with interest at the rate of 7% per annum from the date of filing of the complaint till realization, on account of deficiency in service and medical negligence on the part of the opposite parties No.1 & 2 and resultant loss, mental agony, harassment, unavoidable pain, sufferings caused to her, including medical expenses; and
ii) to pay ₹11,000/- (Rupees Eleven Thousand only) as litigation costs."

To view the original order by the Consumer court, click on the link below.