Stent broken, stuck in pancreatic duct! Chandigarh Hospital told to pay Rs 25 lakh compensation for botched gall bladder surgery

Chandigarh: The District Consumer Disputes Redressal Commission (DCDRC)- DF-1 has directed Chandigarh-based Mukat Hospital to pay Rs 25 lakh compensation for a botched gall-bladder surgery.

During the surgery, a PD stent broke, and part of the stent got stuck in the Pancreatic Duct. For this, the patient had to undergo a further procedure at Medanta Hospital. 

Apart from paying Rs 25 lakh compensation, the hospital was also directed to pay Rs 6,37,000, the amount paid by the complainant at Medanta Hospital for treatment and also pay Rs 10,000 as litigation cost.

The history of the case goes back to 2021, when the patient was suffering from upper abdominal pain and, accordingly, she approached the treating hospital, where she was diagnosed with Cholelithiasis (Gall Bladder Stone). The treating doctors advised the patient and her family to get the Gall Bladder removed via surgery, i.e., Cholecystectomy, immediately.

After the complainant and her family gave consent for a Laparoscopic Cholecystectomy, the complainant was informed that while removing the Gall Bladder, a stent would be inserted in the Pancreas. Immediately, the Laparoscopic Cholecystectomy was conducted. However, while conducting the procedure to insert the stent in the Pancreas, the stent broke down from the outside, and part of the stent was stuck in the Pancreatic Duct.

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It was alleged that the hospital and the doctors did not inform either the complainant or her family members, and they allegedly kept on trying to manage the deteriorating situation of the complainant due to the broken stent in her body. The complainant informed that even though the doctor tried to ERCP, the procedure could not be completed, and when the situation could not be managed, the complainant's family was informed about the situation that arose at that time. The family was allegedly informed that due to the broken stent, they were not being able to do anything and they lacked the expertise to remove the broken stent or to further control the damage, and accordingly, they referred the matter to Medanta Hospital, Gurugram as they have the specific expertise to cure such cases.

Following this, the patient was taken to Medanta Hospital, where all the tests were conducted, and the ERCP test revealed that "Previously placed proximally migrated and fragmented pancreatic duct stent visualized under fluoroscopy. This was caught using rattooth forcep and multiple fragments of stent removed. One distal small pancreatic duct fragment could not be retrieved which was deep in the distal pancreatic duct. Over guide wire 5Fr X 12cm GPSO plastic stent placed in pancreatic duct. Common bile duct cannulated. Contrast injection revealed leak from cystic stump. Wire negotiated across bile duct injury in left and right hepatic ducts."

It was submitted that the complainant has to admit thrice in Medanta Hospital only because of the negligent treatment of the first hospital and the treating doctor, and spend Rs 6,37,000 extra at Medanta Hospital in addition to the pain and harassment. The complainant claimed that the doctor conducted the LAP Cholecystectomy and was not an expert. Due to this, a bile leakage started after LAP Cholecystectomy, which happens only due to the improper clipping and cystic duct stump leak (CDSL), and the same could have been avoided if the endoloop or suture technique had been used. However, it was alleged that the treating doctor was negligent firstly for CDSL, who tried to insert a stent of low quality negligently, which broke from the outside and then even tried to do ERCP but failed to cure and then referred the patient to another hospital. 

On the other hand, the treating hospital stated that, during the procedure, the plastic PD stent was broken, which required special techniques and equipment such as Endoscopic Ultrasound and Cholangioscope for removal. Keeping this scenario in mind possible requirement of Endoscopic Ultrasound and Cholangioscope was comprehended. Also, seeing the acute condition, further attempts to remove the PD stent were abandoned, which might have worsened the patient's condition. 

The hospital claimed that since the patient was hemodynamically stable and was fit to be shifted, the patient's hometown being near Gurugram, it was decided to shift the patient to Medanta for the convenience of the patient's family. It was further submitted that the patient's attendant was informed in detail about the possible outcomes of the procedure. 

Therefore, submitting that standard guidelines were followed and informed consent was obtained from the patient, the hospital denied all allegations of medical negligence.

Meanwhile, the treating doctor argued that the cystic stump leak, which was noted in the discharge summary of Medanta Hospital, could be attributed to multiple reasons, like slipping of endo clips, necrosis of the cyst duct stump proximal to the clip, etc. Therefore, the doctor argued that the cystic duct stump is a known complication of gall bladder surgery.

While considering the matter, the consumer court noted that along with all other allegations, the complainant also alleged that the treating hospital advised the patient to undergo further treatment at Medanta Hospital, Gurgaon, instead of sending the patient to PGI, Chandigarh, and this resulted in financial difficulties for the patient.

The Consumer Court noted that the hospital had admitted that the stent was broken during the procedure by its doctors. Perusing the written statement of the hospital, the Commission noted,

"...it is fairly admitted that the plastic PD stent was broken which requires special techniques and equipment which were not available in their hospital rather they intimated that the same are available at research institutions and accordingly the patient was shifted to Medanta Hospital Gurgaon."

Questioning the decision of the hospital to conduct the operation even though not being equipped with all facilities, the Commission further observed,

"In view of the foregoing, we are very surprised that when the hospital OP No.1 was not equipped with all the facilities to carry out the operation and attend the side effects, still they decided to undergo the procedure, which put the life of the patient in danger and the OP No.1 and its doctors could not handle the complications caused due to not being equipped with necessary equipments with the hosital as a result of which the complainant was shifted to Medanta Hospital Gurgaon, which not only caused mental agony and physical harassment to the complainant but also put unnecessary financial burden on the complainant. Hence the aforesaid act of OPs No.1 perform through the surgical procedure without having proper equipments to handle the situation of any complication, amounts to deficiency in service."

Relying on the Supreme Court order in the case of Chanda Rani Akhouri [Dr. (Mrs.)] & Ors. Vs. M.A. Methusethupathi [Dr.] & Ors., the Commission observed that in this instant case, it was an admitted fact on the hospital's part that they were lack of specialized instruments to handle the complication caused during and after the procedure and it was also admitted that the PD stand was broken which itself proved that the hospital "has used a low quality stent to be inserted in human body which put the life of the complainant in danger."

"Hence, there is deficiency in service on the part of OP No.1 hospital," concluded the consumer court.

While deciding the amount of compensation, the consumer court relied on the Supreme Court order in the case of Sarla Verma v. Delhi Transport Corporation, and Malay Kumar Ganguly v. Sukumar Mukherjee and Ors., and directed the treating hospital to pay Rs 6,37,000 to the patient for treating expenses at Medanta hospital and further pay Rs 25 lakh as compensation.

"In view of the foregoing discussion, we determine “medical negligence” and “deficiency” on the part of OPs 1 and in view of the peculiarity of the case and in order to meet the ends of justice, we are of the opinion that the OP No.1 hospital is liable to refund Rs.6,37,000/- the amount paid by the complainant at Medanta hospital due to negligent act of OP NO.1 alongwith compensation," ordered the consumer court.

The consumer court directed the hospital-

 i) to pay 6,37,000/- to the complainant alongwith interest @ 9% per annum (simple) from the date of institution of the present consumer complaint onwards

ii) to pay 25,00,000/- to the complainant as compensation for causing mental agony and harassment;

iii) to pay 10,000/- to the complainant as costs of litigation.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/dcdrc-chandigarh-291103.pdf

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