Substandard implant used During Total Knee Replacement Surgery: Orthopedic Surgeon slapped Compensation

Bengaluru: The Urbal II Additional District Consumer Disputes Redressal Commission, Bengaluru recently directed an Orthopaedic Surgeon to pay around Rs 4 lakh compensation to a patient for medical negligence while conducting Total Knee Replacement Surgery.

After the surgery, the patient had to suffer unbearable pain and had to seek treatment at another hospital. The Consumer Court held the doctor liable after noting that the Karnataka Medical Council (KMC) opined that "good quality of implant was not used" resulting in infection in the wound. KMC had also observed that the patient was not managed by proper follow-up and medication and for this, the Council held the treating surgeon responsible. 

Relying on the medical council order and noting that it was not challenged by the doctor before the National Medical Commission (NMC), the District Consumer Court directed him to pay Rs 2,95,638 as medical expenses, Rs 1 lakh as compensation towards mental agony and Rs 20,000 as cost of litigation.

The matter goes back to 2015 when the patient was admitted to the treating hospital with pain in the right knee. She was diagnosed by the treating doctor and asked to undergo several tests. Even though she was under continuous medication, she allegedly did not get any relief. Thereafter the treating doctor, who is a Consultant Orthopaedic Surgeon at the hospital, suggested the complainant to undergo total knee replacement surgery. The doctor allegedly assured that after the operation, the patient could walk easily within a short span of time. 

After the surgery, the patient was advised to undergo physiotherapy. Allegedly, the person who was doing physiotherapy was not a professional and doing the procedure without a knee brace, which is a must for physiotherapy. When the patient stood up, due to infection in the operated portion burst and stitches came out. The doctor hurried to the spot and allegedly put stitches once again by using a stapler hurriedly without conducting any further operation.

Later, the patient was discharged and paid a bill of Rs 3 lakh as hospital expenses and for purchasing all medicines. The person who had been dressing the complainant found certain black patches on the complainant's knee. Based on his suspicion of some infection, the patient approached a Consultant Orthopaedic Surgeon at a Specialist Hospital. The doctor after examining the patient, opined that the Knee Cap of the Complainant had been badly damaged due to infection, and it required to be removed. Accordingly, it was removed.

It was also alleged by the complainant that after being discharged from the treating hospital, she had developed severe, uncontrollable pain in the operated area. Her leg and knee diametrically became upright. So, being unable to tolerate the pain, she consulted a Specialist. The complainant claimed that due to the wrong treatment given by the doctor, she developed severe pain after surgery and permanently became disabled due to medical negligence by the treating doctor.

It was also alleged that inferior metal was used during implantation and due to this, the patient's knee and foot became straight due to which she was unable to walk or move.

Therefore, filing the consumer complaint, the patient demanded Rs 18 lakh as compensation. On the other hand, the doctor and hospital submitted that despite clear instructions, the patient did not follow the post-operative advice, did not report any trouble or pain to the hospital, was not brought for follow-up as required and did not consult any of the hospital or doctor on any of the alleged problems.

They denied any error in diagnosis, treatment, deficiency or negligence. Regarding the metal used for the surgery, it was submitted that the metal was purchased by the patient's son-in-law and it was an ISI-marked Inor Brand implant; the other patients on whom this same implant had been used did not report any complications.

It was also highlighted that the complainant also approached the Karnataka Medical Council (KMC) against the treating doctor and hospital in respect of her grievance.

While considering the matter, the Consumer Court noted that there were two Discharge Summary issued by the treating hospital- the first one was on 03.09.2015 and the second one was on 19.09.2015. Referring to this, the Commission observed, "So looking to Ex. P2 it appears that even after lapse of 15 days from the date of operation complainant was not good and wound was not yet healed even after taking prescribed medicines."

The Consumer Court also perused the IP Receipt/Cash Receipt issued by the Specialist Hospital and noted that the document disclosed that the patient was admitted to the Orthopedics Department of the hospital on 09.10.2015, discharged on 29.10.2015 and spent Rs 2,00,088 for treatment at the second hospital. She also underwent treatment at Bhagwan Mahaveer Jain Hospital from 26.09.2019 to 11.10.2019 for heart disease by spending Rs 1,81,990, noted the Commission.

Apart from this, the consumer court also took note of the order dated 04.06.2022 passed by the Karnataka Medical Council, which mentioned in the findings that "It appears that the good quality of implant was not used and as a result, the wound got infected and the patient was not managed by the proper follow-up and medication. Further, the records divulge the fact that again the patient was admitted in another hospital i.e. Specialist Hospital for debridement and removal of the impant and thereafter, there was slowly leaving immovable knee joint and bed sores. The wound was infected and there was no proper follow-up for the prevention of the infection and these are the crux points of the case for which, the Ist Respondent Dr. Mohammed Irshad Ahmed is responsible."

In its order, the medical council had noted that there was negligence by the treating doctor. However, it further observed that there was no medical negligence on the part of another doctor and the treating hospital. The Council had ordered the Registration number of the doctor to be removed from the KMC Registry for a period of six months as a punishment.

Referring to the medical council order, the Consumer Court observed,

"On perusal of this Ex. P6 order stated supra, it cannot be stated that there is negligence on the part of the complainant which is the contention taken by OP No. 2 in his written version. But on the contrary, it is clear that there is a deficiency of service on the part of OP No.2 Dr. *** who treated the deceased complainant by conducting Right Total Knee Replacement Surgery on 31.05.2015 by using substandard quality of implant for Right Total Knee Replacement Surgery. Further, it is to be noted here that the order passed by KMC in Ex. P6 appears to have become final since OP No.2 has not at all produced any evidence to show that he has preferred appeal against the order passed by KMC in Ex. P6 to the National Medical Commission and Ex. P6 order has been set aside."

Opining that the complainant has proved that there was a deficiency in service by the treating doctor only, the Commission partly allowed the complaint. It directed the doctor to pay Rs 2,95,638 as medical expenses, Rs 1 lakh as compensation towards mental agony and Rs 20,000 as cost of litigation. 

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/bengaluru-consumer-court-compensation-235001.pdf

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