Vision loss after nasal surgery: ENT Surgeon, Hospital slapped compensation for medical negligence

Thiruvananthapuram: The State Consumer Court, Kerala recently directed an ENT surgeon and a private hospital in Alappuzha to pay Rs 1 lakh compensation for the loss of vision of a patient after undergoing a Polypectomy procedure.

After undergoing the procedure for a permanent recovery from nasal block, allegedly an injury was caused to the left optical nerve and left medial rectus of the patient.

Earlier, the District Consumer Court had ordered the doctor and hospital to pay Rs 51,000 as medical expenses, which the State Consumer Court has upheld.

The matter goes back to 2011 when the patient had consulted Dr. George, an ENT surgeon and the doctor had prescribed medicines to him for two days. After conducting a thorough examination, the doctor advised the complainant that he had Polypectomy and that he needed to undergo a surgery for permanent recovery.

Accordingly, the patient was admitted to Sahridaya Hospital, Thathampally, to which the ENT Surgeon was attached to. The Surgery was conducted for rectification of nasal polypectomy. Allegedly, on the same day evening, the bystanders of the complainant noticed swelling on the left eye of the patient and they informed the same to the doctor. 

Then the doctor visited the patient and after examining him, the doctor said that the swelling was only a side effect of the surgery which would be cured within twenty-four hours. 

However, the patient alleged that on the next evening, the vision of the left eye was lost. However, the doctor advised the complainant and his relatives that the problem would be solved within a few days. He allowed the patient to remain in the hospital and discharged him on 03.08.2011.

As per the complainant, he was admitted to the hospital with a history of breathing problem. However, after the surgery, he had been suffering from watery discharge from the nostrils, loss of vision in his left eye and severe pain.

Consequently, he got admitted to Medical College Hospital, Alleppey in the Ophthalmological Department and consulted Dr. Dalia, the ophthalmologist who informed the patient that while undergoing the previous surgery, a vein leading to the eye was injured. He had to undergo inpatient treatment in the Medical college hospital for one week and later he got admitted to Little Flower Hospital, Angamaly, where several tests were conducted and the patient availed the treatment there.

The initial diagnosis at the hospital showed "left optic nerve injury and left medial rectus injury". The complainant alleged that these injuries were caused on account of the rash and negligent act of the treating ENT Surgeon. It was submitted that if the doctor had been cautious while conducting the surgery, these problems could have been avoided. Terming it to be a clear case of negligence and deficiency in service, the patient filed a consumer complaint against the doctor and the hospital.

Apart from this, the patient also filed a criminal complaint against the doctor before the Judicial First Class Magistrate Court. He sought Rs 94,000 as the costs of the treatment and Rs 10,20,000 as compensation for his loss of earnings and Rs 1 lakh as compensation for his pain and sufferings.

Earlier, the district consumer court, Alappuzha had ordered the doctor and the hospital to pay Rs 51,000 towards medical expenses and Rs 50,000 as compensation, and Rs 2,000 as litigation costs. Challenging the district commission's order, both the complainant and the doctor approached the State Consumer Court, Kerala.

On the other hand, the doctor and the hospital claimed that there was no deficiency in service. It was submitted that the patient had consulted the doctor with a complaint of persistent nasal block and was provisionally diagnosed with allergic rhinitis and nasal polyp and he was treated for the same by providing tablets, and nasal spray.

Since the problem persisted even after continuing medicines, the patient was advised for polypectomy for the release of the obstruction. Both anaesthetic and medical checkups were done and it was found that he was fit for surgery. After the removal of the polyp, the doctor noticed a minimal fullness of the left eyelid in the left corner of the eye. So, immediately, Ophthalmologist Dr. Venugopal was consulted. He gave a tight bandage to the eye and prescribed medicines to the complainant and was shifted to post-operative room. As the patient had suffered hematemesis, physician was called into the post-operative room and blood transfusion was done. After examination, it was found that the cause of the bleeding was from the stomach. Due to timely intervention of the doctors, the patient became stable.

Around 2 days after the surgery, ecchymosis of conjunctiva on left side was noticed and he was asked to continue medicines for five more days as advised by the Ophthalmologist. They submitted that the Ophthalmologist had reported that the patient's orbit was absorbing well and it would take a few more days to absorb blood and thereafter, the patient was discharged from the hospital with an advice to take antibiotics, anti-inflammatory drugs, vitamins and nasal drops. 

Therefore, the treating doctor submitted that there was no negligence or deficiency in service on his behalf and they were unaware of the treatment allegedly availed from the other hospitals later.

It was further submitted that bleeding is an accompaniment of the surgery. As per the medical literature, when polyps are removed in nasal surgery by avulsion by Luc's forceps and when it has to be completely eradicated from root, blood may sweep into orbital cavity which appears as fullness in the lateral most corner of orbit and within two or three days, this leaked out blood will go into the lids and conjunctiva which may cause ecchymosis in the lids and laziness of vision may occur. The doctor submitted that the complainant had a bleeding tendency due to unknown factors and proper treatment was given to the complainant.

While considering the matter, the State Commission considered the submissions by both the parties and also the records received from the District Forum. The Commission noted that the discharge card issued by Medical College Hospital Alleppey showed that the patient was admitted with a complaint of redness and deviation of left eye after surgery for nasal polypectomy. 

Further, the Commission noted that the discharge card issued by the Department of Ophthalmology, Little Flower Hospital mentioned the initial diagnosis as left optic nerve injury and left medial rectus injury. The patient was having a diminution of vision LE and limited inward movement LE eye following the ENT procedure. The final diagnosis mentioned that there was a left optic nerve injury and left medial rectus injury with left divergent squint. The Consumer Court noted that the patient was again admitted to Little Flower Hospital for correction of post traumatic divergent squint.

The treatment given to the patient during this period is also shown as RE MR Exploration, BE LR Recession. A correction was done on 31.08.2010. He had also consulted with the ENT Department of the Little Flower Hospital and underwent treatment for "left Sphenoid Ostium identify and lateral wall exposed, optic nerve prominence identified traced back to Sphenoethmoidal Junction. Injury due to the previous surgery noted at the Junction with medical wall contents protruding fragments removed and contents freed". 

Meanwhile, the treating doctor moved to the son of Ophthalmologist Dr. Venugopal to identify the writings of his father, who had given evidence that if orbital haemorrhage took place there is possibility of injury of medial rectus muscles and added that on account of surgery, if any bony particles are found detached, they may cause optic nerve injury.

However, referring to the medical records, the Commission noted that

"...clear manipulation is seen in page sixteen of Exhibit B1. A paper is seen pasted on the bottom portion of the sixteen page of Exhibit B1 which bears the details regarding the Ophthalmologist consultation given to the complainant. But on further verification, it could be seen that this paper was affixed on the bottom portion of the sixteenth page above the original entries of the medical record. It is a clear case of manipulation. In the starting portion of the seventeenth page a correction is seen made by erasing the original entries. A medical record is a contemporary document simultaneously prepared by the hospital authorities during the process of treatment. So there cannot be any possibility of pasting another sheet of paper. So this is a clear example of creating evidence so as to justify the negligent act done by the hospital authorities. The opposite parties had set up a case that if a complication arose to the eye, it is up to the Ophthalmologist to look into the matter and an ENT surgeon is not liable for any such complications. But the materials on record would show that there was no Ophthalmic consultation done at the crucial stage as claimed by the opposite parties for the reason that these entries are subsequently concocted by pasting another piece of paper in the medical record. Exhibit B1 was in the custody of the hospital. So it is up to the hospital authorities to offer satisfactory explanation as to why manipulation was done in the said record."

Holding the treating doctor liable, the Commission further noted,

"The evidence let in by PW2 and PW3 would convincingly establish that while conducting the surgery, a nerve injury was also resulted. The above fact is not ruled out by the 1st opposite party when the subsequent medical records, Exhibit A3 were shown to him. When polypectomy is done there cannot be any possibility to cause an injury to the optic nerve since the optic nerve is located away from the nostrils. The doctor was trying to explain the possibility of causing injury to the optic nerve by saying that he was unable to see the internal organs as the surgery was done from the surface. A doctor is expected to assess the internal organs when surgery is sought to be carried out. If the surgery was done in a proper manner, it would never result in causing an injury to the optic nerve and medial rectus."

The Consumer court further noted that when medical negligence on the part of the hospital authorities was sought to be proved through criminal investigation, there was a calculated attempt to fabricate evidence from the part of the doctor and hospital by "forging the medical records in causing manipulations by pasting separate sheets so as to conceal the original entries contained in Exhibit B1."

Referring to this conduct of the hospital employees, the commission noted that

it is a clear indication that they had to hide certain things. In this connection, it is pertinent to observe that the patients have no access to the medical records. The entries contained in the manipulated portion is a crucial one which was subsequently incorporated with a view to escape from the consequence which may arise due to the negligent act of the opposite parties. The medical records would convincingly establish that the 1st opposite party had negligently conducted the surgery and that is why an optical nerve injury and medial rectus injury was caused to the complainant."

Therefore, the commission opined that the doctor was careless and negligent while conducting the surgery and there was a calculated attempt on the part of the doctor and the hospital to concoct evidence by pasting papers in the crucial medical record by hiding original entries to create evidence that Ophthalmic consultation was given to the complainant when the impugned surgery was conducted.

Considering the hardships suffered by the complainant, the Commission opined that the compensation awarded by the District Commission was "too insufficient" and therefore, enhanced the compensation of Rs 50,000 granted by the District Commission to Rs 1,00,000. Further, the Commission also granted Rs 10,000 as legal cost. "The order allowing the complainant to realise Rs.51,000/(Rupees Fifty One Thousand) as medical expenses is affirmed," it noted.

Allowing the appeal, the Commission ordered, "...the compensation awarded by the District Forum is enhanced to Rs.1,00,000/-(Rupees One Lakh only). The complainant is allowed to realise Rs.10,000/-(Rupees Ten Thousand only) as costs of the appeal.The complainant is allowed to realise @ 8%interest for the whole amount from the date of filing of the complaint i.e. on 22.08.2011 till the payment."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/kerala-state-consumer-court-233802.pdf

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