No Medical Negligence: Consumer Court Junks Complaint Against Hospital, doctor for allegedly Conducting Total Laparoscopic Hysterectomy sans Consent

Chandigarh: In a recent order, the District Consumer Disputes Redressal Commission-I, UT Chandigarh exonerated a hospital and its doctor from the allegations of conducting a Total Laparoscopic Hysterectomy without obtaining informed consent from the patient.

The consumer court dismissed the complaint as it noted that the Complainant could not provide any evidence of negligence or deficiency of service in the treatment and care provided by the treating hospital and its doctors.

"In these set of circumstances, it can safely be concluded that there has been no deficiency in service on the part of OPs and the whole gamut of facts and circumstances leans towards the side of the Ops. The case is lame of strength and therefore, liable to be dismissed. Taking into consideration all the facts and circumstances of the case, we have no hesitation to hold that the Complainant has failed to prove that there has been any deficiency in service on the part of the OPs. As such, the Complaint is devoid of any merit and the same is hereby dismissed, leaving the parties to bear their own costs," noted the Commission in its order.

The history of the case goes back to 2021 when the patient, who had an overactive bladder with symptoms of urine urge because of the weak pelvic floor and weakening of muscle supporting bladder, consulted the treating Hospital's Dr Bansal. The doctor advised the patient for hysteroscopy evaluation and the procedure was planned 2 days after the initial consultation.

It was alleged that the complainant was made to sign an authorization paper and a blank paper with the heading medical orders just 10 minutes before the evaluation, right at the entrance of the operation theatre. The patient alleged that she was not explained in detail about the possible outcome of hysteroscopy evaluation. However, she further claimed that there were no signatures on the consent for surgery.

She further alleged that the doctor castrated all her organs- uterus, cervix, part of the vagina, lymph nodes, fallopian tubes and both ovaries by conducting Total Laparoscopic Hysterectomy without consent. It was submitted that the place at which the tumour was localized and concentrated was not effectively removed but all the other areas that were cancer-free were removed instead. This in turn also badly damaged her already weak pelvic floor and bladder.

Further, it was alleged that even after surgery, the issues were not resolved and she had to undergo high-dose radiation therapy of 23 sittings of external radiations along with 2 sittings of internal radiation. She submitted that had she known beforehand, that even after the surgery, the possibility of undergoing radiotherapy/chemotherapy may arise, she would have chosen radiotherapy as the desired primary treatment choice and not opted for surgery at all.

It was argued by the complainant that instead of conducting the surgery, the doctor should have waited till she regained consciousness and discussed the result of the hysteroscopic examination and thereafter could have gone ahead with removing her uterus and ovaries or suggested an alternate form of treatment, especially considering the fact that the hysteroscopic evaluation was unclear and inconclusive.

Later, the patient went to PGIMER, Chandigarh, where she was diagnosed with acute grade 2 bladder prolapse along with other abdominal complications. She alleged that the surgery had created a vacuum which in turn led to the sagging of adjacent organs like the rectum, intestines and bladder exerting big pressure and causing inflammation in the vagina. The Complainant claimed that the doctors at PGIMER also confirmed that there was negligence during the treatment at the first hospital. Thereafter, she approached Fortis Hospital, where she was diagnosed with cystocele, rectocele, mental damage and eye-related problems, all on account of the surgery performed by the first treating doctor.

On the other hand, the treating doctor and hospital argued that they had informed the patient and her son about the process in detail along with the potential outcomes. They claimed that the need for a hysterectomy was also intimated, depending on the findings of the hysteroscopy. They also submitted that the complainant had signed consent forms after understanding the risks and complications involved in the procedure.

As per the treating doctor, the surgery was conducted based on the findings of hysteroscopy, which suggested a lobulated lesion. Therefore, they decided to proceed ahead with the surgery i.e. total laparoscopic hysterectomy with bilateral salpingo-oophorectomy with bilateral pelvic lymph node dissection and omental sampling. The doctor submitted that the surgery was performed by him along with Gynecologist Dr. Bansal and the procedure was performed as per standard guidelines.

Further, the doctor claimed that appropriate post-operative care was provided to the patient. Referring to the histopathological test, the doctor submitted that the pathologist after examining the

He argued that post-operative care was appropriately provided and that subsequent issues were related to radiation therapy. tissue sample reported that the complainant had all margins free of tumour and that she had Adenocarcinoma of the cervix and lower uterine segment with uninvolved lymph nodes with differential diagnosis 1) Endometrioid Adenocarcinoma ii) Mesonephric Adenocarcinoma.

In view of the above findings, the Pathologist advised IHC as the same is essential for definite tumour categorization. The above findings were discussed in the Tumor Board Meeting comprising of a Radiation Oncologist, Oncologist, Surgical Oncologist, Medical Pathologist and Gynecologist at IVY Hospital who advised adjuvant chemo-radiation in the complainant's case. However, when the same was discussed with complainant she refused chemotherapy. Thus, she was referred to Medical Oncologist & Radiation Oncologist for deciding the future course of treatment. Thereafter, the complainant underwent radiotherapy both at IVY and Max Hospital, Mohali.

Therefore, the treating doctor and hospital denied any negligence or deficiency in service on their part.

While considering the matter, the District Consumer Court noted that the surgery was conducted with proper consent. It noted,

"As regards to the allegations of performing surgery without consent we have perused documents at page 36 and 37 of the complaint Annexure C-8, which is consent for surgery/major procedure, duly signed by the patient as well as her son. The said consent contains the details of surgery/procedure to be carried out, complications/major risks involved. Hence, we are of the view that the consent has been duly obtained by the OPs before the said surgery/procedure having been performed."

The Commission also rejected the complainant's reliance on the consultations with various other practitioners of other hospitals noting that such arguments were not supported by any affidavits of any of the consultants/practitioner doctors.

Dismissing the allegations of medical negligence, the consumer court noted,

"Needless to mention here that the OPs have attempted to treat their patient to the best of their ability, which was being done in the present case as well. Therefore, we do not find that OP Hospital and its well qualified and experienced doctors guilty of any negligence, much less medical negligence."

"...it has been made clear by the Hon’ble Supreme Court of India that a doctor owes to his patient certain duties of care in deciding whether to undertake the case and duty of care in the administration of that treatment and any breach thereof may give a cause of action for negligence and the patient may on that basis recover damages from his doctor. In the present case, the OPs did not fail in their duties to take due care of the Complainant," noted the commission.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/chandigarh-no-medical-negligence-240605.pdf

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