Rectosigmoid Perforation after DnC Procedure: Gynaecologist, Hospital told to pay over 12 lakhs

Hyderabad: Holding a Hyderabad based hospital and its gynaecologist deficient in service by not taking due care and caution post Dilation and Curettage surgery performed on a patient, the Hyderabad District Forum has directed the hospital to pay over Rs 12 lakh to the patient as compensation.

The bench observed that delayed treatment had caused immense trauma to the complainant (patient) who was admitted for a fairly regular Dilation and Curettage procedure.

The case concerns a 61-year-old female patient who was a known case of hypertension approached the Aditya Hospital and its Gynaecologist complaining of excessive white discharge in October 2015. She was advised after examination to undergo Dilation and Curettage procedure.

The patient was diagnosed with heavy white discharge, thickened endometrium. She had attained menopause 13 years ago and the diagnostic procedure and inherent complications relating to bleeding, uterine perforation and injury to surrounding structures and sepsis associated with the procedure was explained to her and consent was obtained before the surgery.

After the procedure, she was discharged the same day from the hospital and was advised for a review after 1 week. However, the patient started complaining of severe stomach pain and soon after came back to the hospital, two days after the operation

She was then diagnosed with Rectosigmoid perforation with faecal peritonitis. Accordingly, Ileostomy was also performed. After surgery, she went into septic shock and was put on the ventilator and discharged on 19-10-2015. She had undergone one more surgery for closure of ileostomy after 3 months.

Alleging gross negligence in performing the Dilation & Curettage procedure and failure to diagnose the problem in time and delay treatment accorded to her, she sought reimbursement of expenses incurred and compensation via her complaint with the district forum after the hospital authorities failed to respond to her claim.

The doctor and the hospital, in response, contended that the patient was stable with ‘PR-86/min, BP-120/80 mm of HG’ and there was no delay in investigations and she was posted for surgery as soon as she was diagnosed for peritonitis

The second procedure i.e. laparotomy - the complainant was to found to have perforation on the posterior wall of the uterus with Rectosigmoid junction perforation with fecal peritonitis. This was not detected during the Dilation & Curettage procedure. It is major surgery and the complainant was kept on a ventilator. The best medical care was given to her and she was
discharged in a stable condition

Examining the case, the court in detail went through what happens during a DnC Procedure

A Dilation and Curettage procedure involves two main steps. Dilation – which involves the widening of the lower part of the uterus and Curettage - involves the scraping of the lining to remove uterine contents. In this case the complainant also underwent polpectomy. Common side effects include: cramping or spotting. Complications such as a damaged cervix or perforated uterus are rare.

The forum noted that in the instant case, the complaint suffered severe abdominal pain and
fever with chills and this is recorded in this discharge summary.

"It is her case that despite the severity of her complaint, diagnosis and treatment was not given immediately. Given the severity of complications, she should have been attended to immediately," the court stated

After going through the submissions and contentions, the bench of Justices Sri Nimma Narayana as President and Smt Meena Ramanathan as Member opined that the hospital and concerned gynaecologist were hasty to discharge the patient without taking the necessary precautions that a treating doctor ought to exercise and held negligence on part of the hospital and the doctor.

The court noted

Peritonitis is a life threatening emergency that needs prompt medical treatment. Delay in treatment can lead to sepsis, shock and death. The opposite parties have failed to provide any substantial medical treatment given to the complainant immediately. The complication of uterine perforation in post-menopausal women they submit is 2.6%. To support this statistical figure, one needs relevant survey records and in the areas conducted. Does this necessarily apply to patients approaching a well-equipped hospital and being treated by Doctors of experience?

Further, the court noted that the delay in treating her immediately for a complication that occurred by their negligence is unacceptable.

The opposite parties have failed to explain the delay of more than 24 hours in treating the complainant, which further aggravated her condition. In their evidence or Written Arguments, there is no mention of the antibiotics used to prevent further deterioration.

The forum then also went on though previous judgements on the issue of medical negligence

All the judgments relied upon stress the need for reasonable care in the discharge of duties by hospital and doctors – that has been sadly lacking in this case. Delayed treatment has caused immense trauma to the complainant who was admitted for a fairyly regular Dilation and Curettage procedure. All the reasoning and discussions only lead to the obvious conclusion and decision that the opposite parties have been negligent and therefore the point is force fully decided in favour of the complainant and against the opposite parties

Reaching its decision, the bench took note of the massive discount given by the hospital authorities to the patient for the treatment provided. The actual bill amount was Rs 3,40,818.62 and the hospital offered a discount of Rs. 1,20,818.52. On this, the bench observed:

This generous discount further underlines their deficiency. Why would a hospital slash the bill amount and make such concessions? The inference is obvious.

Holding that the early and correct diagnosis is essential; the bench stated:

the diagnosis should have been immediate, considering the patient/complainant had just undergone a Dilation and Curettage procedure and came back the next day with the very obvious symptoms of fever, pain and nausea. Surgical intervention is nearly always required along with intravenous fluids and antibiotics. The opposite parties have delayed the treatment and caused much suffering to the complainant.

Holding the doctor and the hospital negligent the bench held that delayed treatment has caused immense trauma to the complainant who was admitted for a fairly regular Dilation and Curettage procedure.

In its verdict, the forum observed that the patient should be reimbursed the expenses she had incurred along with a compensation for the trauma suffered and allowed her plea with a compensation of Rs. 3,85,000/- along with interest @ 7% p.a. from 02-03-3016 and Rs. 8,00,000/- for the agony.

Attached is the detailed judgment below: