Proper Cardio Opinion Not Taken Before Surgery- Doctor Slapped Rs 5 lakh Compensation

Chennai: The State Consumer Disputes Redressal Commission (SCDRC) recently directed a consultant surgeon at a Erode-based hospital to pay Rs 5 lakh compensation to the family of the patient, who died while undergoing treatment for Colon cancer. Although the Commission noted that there was no medical negligence during the surgery conducted on the patient, it ordered the treating doctor to pay compensation after noting that there was no material on record to show that proper cardio opinion was secured before the surgery.

The history of the case goes back to 2014 when the patient was diagnosed with Grade-II piles and colonoscopy revealed that there was cancer growth in the upper rectum. Consequently, the Histopathology report indicated Adenocarcinoma of Colon Grade-II. For this, the treating doctor at the treating hospital had advised for removal of the tumour by way of Anterior Resection of Colon & Upper Rectum and Staple Anastomosis. 

Further, the doctor had allegedly informed that Colostomy was not necessary considering his old age and that the patient would be normal within 7 days. After the surgery was performed on 16.04.2014, the patient was monitored for three days in the ICU and suddenly, on the 3rd day, his condition worsened due to abdominal pain and discomfort. The CT abdomen on 20.04.2014 revealed that there was a leak in the colon which warranted one more surgery by way of Colostomy.

The complainants alleged that the consent for the first surgery was taken without explaining about the known complications arising from the procedure advised. It was also alleged that when the patient was investigated for the complications of hypertension & diabetes before the procedure, the Cardiogram revealed Hypertrophy-Heart impaired Diastolic Function. Despite this, allegedly the patient was declared fit for the surgery without obtaining a Cardiologist's opinion.

Filing the consumer complaint, the complainants also alleged that even though the patient was diagnosed to be suffering from rectum cancer, the treating doctor never consulted any Surgical Oncologist or Medical Oncologist and the treatment protocol for a cancer patient was not strictly followed. Had any such consultation been done, the patient, who was diagnosed to be suffering from Stage-II cancer would have been advised for Neo Adjuvant Therapy before the surgery and thereby, he would have had survived by receiving proper treatment, argued the complainants.

On the other hand, the treating doctor and hospital denied such allegations. They claimed that the patient had been informed that a colostomy may be performed if the situation so warranted. However, the patient and his wife i.e. the 1st complainant pleaded not to go for Colostomy considering the inconvenience of having a bag. They also claimed that the patient was examined by a cardiologist and was declared fit for the surgery.

Further narrating the medical records of the patient, the hospital and doctor submitted that on the day after undergoing Colostomy, the patient suddenly developed cardiac arrest, despite being under constant monitoring. Immediately, CPR was started and despite all the resuscitation efforts, the patient could not be revived.

They also claimed that the procedures including the last surgery were conducted only after duly informing the patient about the course of treatment and the possible complications arising from the same. Consent Forms in the mother tongue were obtained for the procedures, they submitted and argued that it was highly frivolous to contend that there was an assurance given for a sure cure. 

The hospital and the doctor also referred to the final histopathology report stating that the cancer was localized and was completely removed and there were no lymph nodes. Claiming that the best way of treatment for the patient was surgery, they argued that there was no need for chemotherapy as no lymph nodes were found in the final histopathology report. According to them, the patient would not have benefitted from such a therapy considering the 2nd stage cancer which had already eaten up parts of the Colon. 

While considering the complaint, the consumer court referred to the Supreme Court order in the case of Kusum Sharma & Ors. Vs. Batra Hospital and Medical Research centre & Ors. to reiterate that negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence and that merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession.

"It is also common knowledge that Stage II colon cancers grow through the wall of the colon, for which, it cannot be said randomly that chemotherapy or new adjuvant therapy is the first and most beneficial choice uniformly for all patients; as such, when the Doctor has taken a decision in his medical wisdom and judgment to provide treatment through surgical procedure, which is mostly applied in patients suffering from Stage-II cancer, the complainants, without their allegation being supported by proper medical literature or expert evidence to suggest otherwise, cannot argue that the Doctor had wrongly chosen/performed the surgery, particularly when the cancer is said to have been removed successfully, as spelt out by the Histopathology Report. Hence, we find no merit in that segment of that argument advanced on behalf of the complainants," the Commission observed at this outset.

From the records, the Commission noted that after the procedure was performed on 16.04.2014, the patient had no noticeable complications till 19.04.2014. When he developed fever and elevated pulse rate, the doctor ordered CT abdomen suspecting anastomotic leak.

"...from those sequence of events, we are not able to accept the argument of the complainants that there was a delay of about 2 long days in diagnosing the cause behind the leakage, as the records entirely speak otherwise," the Commission noted.

However, the consumer court observed a "big flaw" on the part of the treating doctor and noted,

"we are able to see a big flaw ab initio on the part of the 2nd OP (the consulting surgeon) in his glaring failure to have any specific/direct consultation with a Cardiologist since the pre-procedure investigation of the patient, in particular his Doppler Studies report/Ex.A12 clearly showed a serious cardio issue - “HYPERTROPHY HEART – IMPAIRED DIASTOLIC FUNCTION”. One more report/Ex.A16 again carries the same impression – Hypertrophy Heart, which in plain terms means that heart muscle became thickened and Impaired Diastolic Function, which means heart muscles becoming inflexible and preventing the ventricles from filling completely, causing blood to back up in the organs."

Therefore, the Commission opined that the doctor should have dealt with the cardiological issues of the patient more seriously.

"On the face of such consistent reports, common logic and cautious medical prudence dictate that the 2nd OP ought to have dealt with that serious cardio issue of the patient at the presurgery stage in a more responsible manner by at least knowing the grade of the diastolic function/dysfunction and discussing the same with a Cardiologist, but unfortunately, no single material is presented by the said OP to suggest that a full-fledged Cardiologist opinion was secured before proceeding to perform the surgery."

Regarding the allegation that the doctor did not consult any medical or surgical oncologist before the procedure, the Commission noted that,

"the 2nd OP meet the same by stating that due consultation was done with Radiation Oncologist-Dr.P.Suthahar and although we do not deem it appropriate to delve into that aspect owing to the necessity of the procedure warranted in the case of the patient, at least, the 2nd OP could have consulted Dr.P.Suthahar, who endorsed the need for the surgery, very particularly about the feeble heart condition of the patient. Had that been done, there would not have been any room for the 2nd OP to face the allegation of negligence stemming from the weak cardio status of the patient, as borne out by records and admitted by the 2nd OP himself. Seemingly, Dr.Suthahar had only perused colonoscopy & bioscopy reports as well as the CT findings and there is no single piece of material available to either infer that the cardio status of the patient was ever discussed with the Dr.Suthahar or to notice that a solid opinion of the cardiologist was secured clearly stating that the impaired diastolic function was not contraindication for the proposed surgery."

Holding the treating doctor responsible for this, the Commission ordered the doctor to pay Rs 5 lakh compensation observing,

"In the absence of any tangible material that proper cardio opinion was secured and of proper explanation that impaired diastolic function, which is the admitted presurgical cardio status of the patient, was not contraindication for the surgery, the principles of res ipsa loquitur get well attracted to hold that the 2nd OP committed medical negligence to the extent of his glaring failure to assess the patient’s fitness for surgery over his delicate cardio status that he had hypertrophy of the heart and impaired diastolic function. As already pointed out, neither Dr.Suthahar nor Dr.Marimuthu/Expert have dealt with such crucial aspect and hence, their opinions would in no way be helpful to the 2nd OP. Inasmuch as no allegation has been made against the 1st OP/Hospital and a case of medical negligence to a limited extent is made out only against the 2nd OP, he alone shall be held liable proportionately. In the facts and circumstances of the case, we deem it just and proper to fix a sum of Rs.5,00,000/- as compensation payable by the 2nd OP to the complainants."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/tamil-nadu-scdrc-rs-5-l-compensation-259484.pdf

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