Surgeon Cannot be held responsible for gangrene: Consumer Court relief

Mumbai: The State Consumer Disputes Redressal Commission, Maharashtra recently exonerated a Mumbai-based surgeon from charges of medical negligence, while performing AVF fistula surgery on a patient, who died after developing gangrene.

Even though earlier the District Consumer Court at Bandra had held the doctor liable for negligence, the State Commission exonerated him holding that the District Commission did not consider the report from the Urology Department of Grant Medical College, J.J. Group of Hospitals, Surgery and overlooked the expert evidence, as per which, there was no negligence by the surgeon.

"The District Commission has not considered the report of Department of Urology, Grant Medical College, J.J. Group of Hospitals, Surgery. The District Commission has also not considered the affidavits of Expert Doctors. The District Commission has casually overlooked the evidence of expert doctors on the ground that they belonged to the professions of the opponent. The said observation is not proper and correct. The due weightage ought to have been given to the report of the expert Committee as well as expert medical professionals. Therefore, we are inclined to set aside the judgment and order of the District Commission," noted the Commission.

The history of the case goes back to 2013 when the complainant's husband was suffering from chronic kidney disease. He was advised for frequent dialysis and to undergo an operation of AVF fistula in the treating hospital. However, following the surgery, the patient developed gangrene in his hand, and he died 2 months later.

It was alleged by the complainant that even though the patient was diabetic, no sugar test was conducted before the fistula surgery. The patient allegedly developed gangrene because the surgery was performed on hi when he had a high sugar level. Therefore, the complainant accused the treating surgeon of pre-operative negligence. Filing the consumer complaint against the treating surgeon, the plaintiff claimed reimbursement of medical expenses, compensation, and legal costs.

On the other hand, the doctor denied negligence contending that after the AV fistula surgery, swelling of the hand occurs in majority of the patients postoperatively and more so in the cases of brachial (elbow) A.V. fistula as compared to Radial AV fistula in wrist. It was contended that some amount of swelling developed on the fingers and hand, as is known to occur in majority cases following AV fistula. It was contended that the patient was advised to do certain finger exercises to promote the circulation of blood through the A.V. fistula as part of the routine post-operative treatment.

After considering the evidence on record, the District Commission held that the treating doctor had not taken proper precautions before the AV fistula surgery which caused gangrene to the deceased patient. Therefore, allowing the complaint, the District Commission had directed the treating doctor to refund the amount of Rs 10 lakh to the complainant, which was incurred for AV Fistula operation expenses of Rs 2 lakh incurred for taking treatment in other hospitals and Rs 2 lakh towards compensation.

Challenging the District Commission's order, the doctor filed the appeal before the State Commission, which took note of the medical records to observe that the pre-operative blood test was done by the doctor and accordingly entries were made in the Nurse's book. 

"On inspection it is established that entry is made in the said book that the blood test was done prior to the procedure. Copies of the said Nurses book was given to the complainant but it was not accepted by the Commission on the ground that genuineness of the same was doubtful. The District Commission ought to have asked the opponent to produce the original register. Said Register is produced before this Commission and we verified the same register. So, there is no scope for any tampering of the same," it observed.

Further, the State Commission noted that the complainant did not produce all the discharge summaries before the District Commission and opined that the complainant had "withheld or concealed the treatment case papers" of the deceased, which "could have thrown some light as to how gangrene was developed."

"On factual aspects, the complainant made allegations against the opponent that he was negligent in performing AV fistula surgery but the said allegations are not proved by way of expert evidence...Thus, it can be said that, except the bare words of the complainant there is no evidence on record to prove negligence of the opponent. On the other hand, the opponent has produced on record report of Expert Committee The said Committee was established at the request of police department whereby the Committee had come to the conclusion that there was no lapse in due care and application of skill from Opponent Doctor and the said Committee gave clean chit to the opponent," the State Consumer Court observed.

Therefore, after considering the judgments cited by both sides and considering the factual aspects of the case, the Commission concluded that the complainant had failed to establish negligence on the part of the treating doctor in performing the AV fistula operation. 

"There is no evidence on record to establish that the opponent was failed to take care and duty while carrying out AV fistula surgery. The opponent cannot be held responsible for the gangrene suffered by deceased ... Therefore, we are inclined to dismiss the complaint in toto," it noted.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/scdrc-maharashtra-256746.pdf

Also Read: Thumb Amputation due to gangrene- Expert Evidence Vital in Determining Medical Negligence, says Court