Rs 15 lakh relief to Fortis Hospital Mohali, Orthopaedic Surgeon, Anaesthetist in Medical Negligence case

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently exonerated Fortis Hospital, Mohali, from allegations of medical negligence while conducting total knee replacement surgery on a patient.

Even though the State Consumer Court, Punjab, had directed the hospital to pay Rs 15 lakh as compensation to the patient, the Apex consumer court noted that the complainant failed to provide any cogent evidence regarding the allegations of medical negligence.

"Relying on the principles laid down by the Hon’ble Supreme Court in the judgments quoted above, we are of the view that the complainant has failed to provide any cogent evidence as regards negligence of the hospital or the anaesthetist or the Orthopadic Surgeon in the course of the surgery or in the post operative care. Even the allegation that she was 100% paraplegic is not borne out from the record," noted the Commission.

In this regard, the NCDRC bench took note of the Supreme Court order in the case of PGIMER Chandigarh vs. Jaspal Singh, where it was held that in medical negligence actions, the burden was on the claimant to prove breach of duties, injury and causation.

The history of the case goes back to 2012 when the patient was admitted to Fortis Hospital for a total knee replacement. After admission, on the same day, X-ray of both knees, AP and lateral, was done. The surgery was conducted on 20.03.2012, and after the surgery, the patient felt severe pain in the back and numbness in one leg the next day. When the Orthopaedic Surgeon was informed, the doctor allegedly said that the problem was due to anaesthesia and painkillers. The doctor had assured that the patient would be alright in a day or so.

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However, the problem continued, and the patient felt numbness in the other leg also. When the doctors re-examined the patient and referred the matter to Dr. Khosla, a neurosurgeon, an MRI Spine Lumber was done and it showed a collection of some bacteria, suggesting a spinal Subdural/epidural Hematoma. 

After this, the complainant was taken for a Laminectomy under Dr. Khosla, and a surgery was performed. The patient alleged that the anaesthesia given by the treating doctor was not proper, and accordingly, they performed the corrective surgery. Further, it was alleged that due to the delay in taking corrective measures, the lower limbs of the patient had been paralysed, and the left foot of the patient did not move at all, and she had no sensation of stool or urine. Due to this, a catheter had to be inserted into her urinary tract.

Alleging medical negligence against the hospital and the doctors, a consumer complaint was filed before the State Commission seeking Rs 15 lakh as compensation for medical negligence, along with a refund of Rs 2,90,000 and Rs 1,10,000 for the cost of medicine. The complainant also prayed for a compensation of Rs 5 lakh for mental, physical, and financial harassment and sufferings along with a litigation cost of Rs 55,000.

On the other hand, the hospital and the neurosurgeon pointed out that there was no evidence of expert opinion to prove medical negligence. They also submitted that the 78-year-old patient was already suffering from 'Osteoarthritis and was having difficulty for past 2-3 years. Further, the patient also had hypertension, coronary artery disease, cardiac dysfunction and she was having breathlessness on walking on plain surface. They informed the consumer court that the patient was given combined spinal and epidural anesthesia as per standard protocol, and after a successful total knee replacement, the patient was shifted to the joint replacement ICU. Providing further details related to the medical records and treatment procedure, they claimed that there was no medical negligence on their part.

The Orthopaedic surgeon also pointed out the lack of expert evidence and claimed that the patient received all necessary pre- and post-operative treatment, including proper antibiotic coverage as per the protocols. 

While considering the matter, the State Consumer Court on 10.03.2017 allowed the complaint in part, observing that the hospital and the doctors were responsible for the 100% disabled condition of the patient after total knee replacement surgery and directed the hospital and doctors to pay Rs 15 lakh as lumpsum compensation to the complainant.

Challenging this, the hospital appealed before the top consumer court. The Counsel for the complainant argued that at the time of admission, the patient was fit for total knee replacement, but due to the negligence on the part of the treating doctors and hospital, the epidural Hematoma occurred, which resulted in total disablement of the patient. He also pointed out that the hospital and the attending doctors admitted in their appeal that the patient developed an epidural Hematoma, which was later removed. 

The complainant's counsel argued that the hospital and the anaesthetist could not show any document, oral or otherwise, to prove that they had taken all precautions on 21.03.2012 to 23.03.2012. Another thing that the counsel highlighted was that, as per the medical literature produced before the State Commission, the corrective surgery, which was required to be done within 8 hours, was done after more than two days, which led the patient to become a paraplegic as per the disability certificate.

Regarding the quantum of compensation, the complainant's counsel prayed to the NCDRC bench to enhance the same, while pointing out that due to the negligent act of the hospital, orthopaedic surgeon and anaesthetist, the patient became 100% paraplegic and was in bed for seven years.

Meanwhile, the counsel for the hospital and anaesthetist argued that the patient never complained of any numbness in the legs until 23.03.2012, and therefore, there was no reason for the doctors to suspect numbness in the legs. He further argued that after the knee replacement surgery, the patient was put on blood thinners, and the incidence of epidural hematoma was as low as 1:100000 and therefore, it could not be said that there was medical negligence on their part.

Further, it was argued that the occurrence of epidural Hematoma could not lead to presumption of negligence as evidenced by medical literature placed before the Punjab State Consumer Court, that it is an infrequent yet possible complication of spinal anaesthesia. He also claimed that the patient was discharged from the hospital in a stable condition.

Taking note of the submissions, the NCDRC bench observed that it was an admitted fact that the patient was about 78 years of age when she was admitted for Knee Replacement Surgery, and she had many comorbidities that are part of the record. NCDRC noted that the main argument was that the doctors did not pay heed to the patient's complaint of numbness in her limbs, and it was only after two days of confirming the diagnosis of epidural Hematoma, that a corrective surgery was performed.

"The allegation is of medical negligence of post operation which led to epidural Hematoma, the corrective surgery was performed late and patient became paraplegic and 100% disabled as a result thereof, which is reflected by the disability certificate that has been filed. On the contrary, as per the hospital, Orthopaedic surgeon and the anaesthetist, there was no negligence during surgery, epidural hematoma is a possible complication of spinal anesthesia, especially in a patient of advance age and with other diseases. The patient only complained of numbness etc. two day after surgery and thereafter immediately, a corrective surgery was performed," noted the Apex consumer Court.

The Commission noted that as per Dr. Khosla's prescription dated 23.08.2013, the patient was walking with support. "This prescription has not been denied or controverted by the patient. Therefore, the allegation of the patient that she became paraplegic as a result of surgery is unfounded because in 2013 she was walking with support," observed the Commission.

Further, it noted that reliance was placed on a certificate that was issued on 10.05.2016 by the Medical Officer, Civil Hospital, Jalandhar and countersigned by the Medical Superintendent, Civil Hospital, Jalandhar, which clearly stated that the certificate is not valid for Medico Legal/Court Cases. "The certificate shows that she has been diagnosed with paraparesis of both limbs and not paralysis of both limbs as contended by the patient," noted the Commission.

Reliance was also placed on a certificate of Chhabra Neuro Care & Trauma Centre dated 05.05.2016 where also, motor-disability was noted as paraparesis at 75%. It was explained that paraparasis meant weakness of limbs and not paralysis. 

"From the record, it is seen that in 2013 that patient was walking with support, Reliance on certificate dated 10.05.2016 and linking the paraparasis and subsequent disability of the patient to the surgery conducted in 2012, without any expert evidence, cannot be sustained. It is seen from the record that there is no expert evidence of any kind adduced by the complainants to show that there was any negligence in the surgery or in the post operative care. Any discount given on the bill cannot be treated as an admission of any negligence," noted the NCDRC bench.

Relying on the Supreme Court directives in earlier cases, the Apex Consumer Court concluded that the complainant failed to prove any cogent evidence regarding the negligence of the hospital, anaethstist or orthopaedic Surgeon in the court of the surgery or the post-operative care. Even the allegation that she was 100% paraplegic was not borne out by the record.

"In view of the above, we are of the view that the appeal no. 1293 of 2017 filed by the hospital, Orthopaedic Doctor and the Anaesthetist is liable to be accepted and the first appeal No. 698 of 2017 filed by the complainant for enhancement is liable to be dismissed and the order dated 10.03.2017 of the State Commission is liable to be set aside," ordered the top consumer court.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/fortis-hospital-ncdrc-290913.pdf

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