Consumer Court holds No Medical Negligence in Subcapsular Nephrectomy, Exonerates Urologist Surgeon

This came after the Commission perused the available medical records and opined that the doctor had chosen the surgical technique best suited and also reminded that it couldn't be overlooked that the complainant was in a life-threatening situation.

"It is also pertinent to add that the complainant was a patient of the opposite party doctor for more than a decade and has been in his care for a long time. No expert opinion has been advanced by the complainant to conclude that the surgery was performed negligently. With these observations, we conclude that the complaint is devoid of any merits," noted the Commission.

The case concerned a doctor, who was a retired Professor and a private medical practitioner. Back in 2012, after he suffered pain and swelling in his back, he had approached the treating doctor, who had admitted the complainant as inpatient in his hospital and had conducted several tests. Following this, the treating doctor had diagnosed that the complainant was suffering from Nephrocytaneous Fistula with upper moiety pyanephrosis abscess.

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After this, the treating doctor had conducted surgery to the complainant's left Nephrocutony GA and had removed the affected part of the left kidney. After remaining under treatment of the doctor for four months in the hospital, the complainant was discharged in August 2012.

The complainant submitted that despite the surgery and long treatment, he still suffered severe pain and oozing. Following this, the complainant consulted other doctors and the doctors concluded that left renal remnants were in the kidney with recurrent sinus.

Consequently, the complainant sought treatment in Visakhapatnam, where tests revealed that there were small irregular cystic areas in the left renal fassa. Again, the complainant had to undergo surgery for the removal of left renal Parenchymal Remnant and after operation, he completely healed.

So, the complainant alleged that the treating doctor had failed to remove the entire inflammatory fibrous mass from the left kidney, resultantly the patient suffered chronic discharge of sinus from his left kidney. He also argued that the treating doctor had conducted the surgery most negligently and this led to a situation where remnants were left in his left kidney causing physical and mental suffering of the complainant.

On the other hand, the treating doctor denied all the allegations and contended that the complainant had suppressed facts about his previous treatment at their hospital since 1998. At that time, the doctor had allegedly operated on the complainant for a very difficult complex kidney stone in left kidney and had informed him that the part of the kidney from where the stone had been removed as infected and was not functioning. The doctor further argued that he had informed that the said part of the kidney might give rise to problems in the future or may have recurrence of the stone.

Following this, the complainant remained good health for 14 years and then developed a small pus discharge from the site of the earlier stone removal. After conducting tests, the doctor noted that there was a small tract discharging pus from upper part of the left kidney. The complainant opted for management by medication and after four months he came back with fever and pain in left flank and was toxic with signs of septicaemia.

The doctor further submitted before the Commission that because of the severity of the sepsis, the complainant had been sent for percutaneous ultrasound guided drainage for stabilization of the condition and following this a renowned Radiologist diagnosed the patient with pseudomonas aeruginosa (a deadly bacterial infection).

As the complainant continued to have spikes of fever, the doctor and a team of urologists decided to conduct urgent surgery and the complainant was made aware that it wouldn't be possible for the doctors to operate only on the upper part of the kidney but the entire kidney will have to be removed using a technique of subcapsular nephrectomy.

The doctor further submitted that it would be unfair to say that the healthy portion of the kidney was removed leaving behind the pyonephrotic part i.e. upper moiety. Referring to the Histopathological report, the doctor further claimed that there was no negligence on their part while treating the complainant for an emergency removal of kidney which was dreadfully infected.

He further claimed that the complainant consulted half a dozen doctors in different cities for their second opinion and later got a minor surgery conducted for the removal of remnants of tissue which couldn't be seen at the time of removal of infected kidney due to the area being infected and filled with pus and inflammation.

After listening to the arguments, the Commission noted that "Focal renal abscesses typically occurs in the setting of pyeleonephritis, particularly in patients with anatomical abnormalities that are pre disposed to infection. Mostly, the kidney may have suffered previous episodes of infection and be chronically pyeleonephritic and scarred. This typically develops in patients with diabetes mellitus or in the setting of delayed treatment."

At this outset, the Commission took note of the discharge summary of the second hospital where the patient was operated again. The Discharge Summary had mentioned that "Entire mass of fibrous tissue with kidney was excised. Frozen sections taken confirmed presence of kidney tissue in the specimen."

The Commission further observed, "The issue that requires to be comprehended is that in subcapsular nephrectomy the thickened capsule is left attached to the peritoneum or diaphragm. Because it requires less time than the classic nephrectomy. This approach is preferred and particularly indicated in patients who are considered poor surgical risks. In the instant case, the complainant presented a pathological condition where the condition of the kidney rendered a classic nephrectomy tedious and difficult. Nephrectomy after pyonephrosis, repeated acute pyelonephritis or chronic pyelonephritis is a challenge for any surgeon."

"None of the doctors, the complainant consulted have stated that the sub-capsular nephrectomy was done negligently. The risk of such remnant renal parenchyma is obviously more with subcapsular technique than the classic nephrectomy," further noted the consumer court.

Opining that there was no medical negligence on the part of the treating doctor, the Commission observed, "In this case the infection was a major concern and subcapsular nephrectomy was the only choice to remove the kidney without injury to surrounding structures. The aim is to analyze whether the opposite party doctor performed the procedure negligently. On the material available and the arguments advanced, we find that the opposite party doctor chose the surgical technique best suited and the fact that the complainant was in life threatening situation cannot be overlooked."

"It is also pertinent to add that the complainant was a patient of the opposite party doctor for more than a decade and has been in his care for a long time. No expert opinion has been advanced by the complainant to conclude that the surgery was performed negligently. With these observations , we conclude that the complaint is devoid of any merits," further noted the Commission as it dismissed the Complaint.

To read the order, click on the link below.