Post Surgery Complications Lead to Organ Loss: Commission relief to doctors on medical negligence charges

Presiding Member, Dr Inderjit Singh observed that both the State Commission and the District Forum have given well-reasoned orders.

The major medical concerns and consequences faced by the patient in the instant case was related to post-surgery complications and infections resulting from the surgical procedure. These include severe back pain, persistent pain despite treatments and medications, Infective Spondelo Discitis at L5S1, ovarian cysts, and infection caused by contaminated surgical equipment. These medical issues led to the necessity of further surgeries like pan-hysterectomy and laminectomy, resulting in organ loss, economic loss, clinic closure, financial burden, and physical suffering. The patient alleged medical negligence by the doctors involved in her care due to these complications.

The case revolved around the complainant/petitioner and her husband, both medical professionals, who sought medical assistance for gynecological concerns in September 2011. Dr Gondkar initially diagnosed her with both uterine prolapse and a uterine fibroid. Subsequently, on October 3, 2011, she underwent surgery at Dr Pandit (Opposite Party No.1/Repondent-1) nursing home. The patient encountered severe back pain following the surgery, believed to be a consequence of the operation. Despite being discharged with painkiller prescriptions, her condition showed no signs of improvement.

Consequent medical consultations and examinations, including sonography and MRI scans, disclosed complications linked to the initial surgery. A variety of treatments and medications were administered, yet her pain endured. Seeking further insight, she consulted an orthopedic specialist, Dr Yashwant Gade (OP-2/Respondent-2), who suspected orthopedic-related back pain and advised further investigations. A subsequent MRI revealed Infective Spondelo Discitis at L5S1, likely triggered by a Koch's pathology. Subsequent prescriptions included antibiotics and antidepressants, but her condition persisted.

After ruling out gynecological or post-operative complications, she was referred back to Dr Pandit. However, the treatment provided by him allegedly failed to alleviate her pain. Enduring 55 days of suffering, she consulted Dr Mohgaonkar, an orthopedic surgeon. A CT scan conducted by Dr Mohgaonkar revealed complex left ovarian cysts, bulky right ovaries with multiple simple cysts, and minimal free fluid in the pouch of Douglas.

Alarmed by the severity of her condition, the complainant sought urgent medical attention at KEM Hospital in Pune. Medical professionals at the hospital identified an active infection resulting from contaminated surgical equipment used during her surgery by Dr Pandit. To address this infection and its associated complications, the complainant underwent a pan-hysterectomy, involving the removal of both ovaries and the uterus, along with a laminectomy of the L5 and S1 vertebrae.

Subsequently, the complainant alleged medical negligence on the part of the doctors involved in her care, contending that it led to her prolonged suffering, and moved the District Commission seeking compensation for medical expenses, deficiency in service, mental and physical agony, financial losses, and litigation costs. However, the District Commission dismissed the complaint.

Aggrieved, the complainant moved the State Commission that once again dismissed the complaint observing;

“Considering the undisputed facts that the complainant was required to visit different places before undergoing Shirodkar Sling Surgery on 3.10.2011 as well as after 3.10.2011 for pathological test, CT Scan, MRI. Possibility of bacterial infection at any such place cannot be ruled out. This fact also fortify from the evidence affidavits of opponent's witnesses Dr Dipti Vaidya, Dr Laxmikant Kshirsagar, Dr Vivek Salunke, Dr Mandipsinh Rajput, Dr Annasaheb Birajdar, and Dr Abhishek Rathi. On perusal of all these affidavits of medical practitioners it manifests that pseudomonas bacteria is found almost everywhere in nature like water, plants, environment and human body and isolation of bacteria from a single specimen as caused of infection. It can be a contamination of the specimen. Therefore possibility of bacterial infection to the complainant before performing Shirodkar Sling Surgery on her on 3.10.2011 or after that anywhere in the hospital where she visited or in KEM hospital cannot be ruled out. Therefore the contention of the complainant that due to negligence on the part of opponent Dr Palaskar there was such bacterial infection to the complainant cannot be accepted. As far as allegations against opponent No.2 Dr Gade is concern, except the mere contention of complainant that he too acted negligently, there is no evidence to substantiate it. The undisputed facts clearly indicate that whenever the complainant approached to him, he advised her for sonography and CT Scan, and tuberculosis test and on perusal of test report he referred her back to opponent No l Dr Palaskar. Therefore on any count the allegations made by the complainant against both the doctors are being unfounded, they cannot be held liable for medical negligence. Accordingly the Dist. Consumer Forum has rightly held and dismissed the complaint. We find no error or infirmity in the impugned judgment and order. Hence no interference is warranted.”

Eventually, challenging the order of the State Commission, the complainant filed a revision petition with the apex consumer commission and raised several grounds, including alleged negligence during the surgery and the failure of the State Commission to consider certain medical expert opinions. The counsel for the complainant presented substantial medical evidence indicating negligence during the surgery and subsequent infections. They emphasized the significance of expert opinions and criticized the State Commission's oversight in considering key medical expert opinions. The counsel highlighted the importance of expert evidence in clarifying direct evidence and stressed the need for a thorough analysis of preoperative and postoperative report

It was submitted that the State Commission allegedly overlooked the transmission of Pseudomonas aeruginosa bacteria through medical devices cleaned with contaminated water. It is claimed that they disregarded expert opinions from Dr Vijay Balkrishna Patil, an experienced medical expert, and Dr Changdeo Aher, another independent medical expert witness. Both experts provided detailed information on the bacteria, including its morphology, pathogenesis, and clinical significance. Dr Aher specifically highlighted unhygienic surgical conditions involving contaminated laparoscopic equipment and cotton used during the procedure as the source of infection at the L5-S1 disc. However, the courts did not consider these expert opinions, and the State Commission did not provide reasoning in its judgment regarding them.

The counsel further submitted that the laparoscopic Shirodkar Sling Surgery aimed to preserve organs, but due to the doctor's alleged negligence, a pan hysterectomy was necessary, resulting in organ loss. This negligence caused economic loss, clinic closure, and financial burden for corrective surgery, all directly linked to the doctors' actions.

On the other hand, the counsel for the doctor argued that tissue swelling and adhesions after intraabdominal surgery are normal and not signs of infection, citing medical textbooks. They disputed the complainant's claims of infection-related complications, citing histopathological examinations. They also suggested Pseudomonas Aeruginosa could have come from various sources and question the authenticity of certain reports. Meanwhile, the second doctor's counsel emphasized the lack of evidence supporting negligence claims and asserts diligent efforts in treating the complainant's back pain. They challenged the origin of the Pseudomonas aeruginosa and alleged fabricated reports by the complainant.

After careful consideration of all facts, contentions, and expert opinions, the National Consumer Disputes Redressal Commission upheld the State Commission's order, finding no jurisdictional error or irregularity in the judgment. The commission emphasized the limited scope of revisional jurisdiction and upheld the reasoned orders of the lower fora. It held;

"We tend to agree with the above observations of the State Commission. In this case both the Fora below have given concurrent findings of no medical negligence on the part of the respondents. As was held by the Hon’ble Supreme Court in Rubi Chandra Dutta Vs. United India Insurance Co. Ltd. [(2011) 11 SCC 269], the scope in a Revision Petition is limited. Such powers can be exercised only if there is some prima facie jurisdictional error appearing in the impugned order. In Sunil Kumar Maity Vs. State Bank of India & Ors. [AIR (2022) SC 577] held that “the revisional jurisdiction of the National Commission under Section 21(b) of the said Act is extremely limited. It should be exercised only in case as contemplated within the parameters specified in the said provision, namely when it appears to the National Commission that the State Commission had exercised a jurisdiction not vested in it by law, or had failed to exercise jurisdiction so vested, or had acted in the exercise of its jurisdiction illegally or with material irregularity.”

"We do not find any infirmity or material irregularity or jurisdictional error in the order of the State Commission. Both the State Commission and the District Forum have given well-reasoned orders. Accordingly, the order of the State Commission upheld and the Revision Petition is dismissed. The pending IAs in the case, if any, also stand disposed off."

To view the original order, click on the link below: