Gangrene after AVA fistula surgery: Urologist directed to pay Rs 14 lakh compensation
Maharashtra: Finding medical negligence on his part, the District Consumer Forum has directed a Goregaon based doctor to pay a compensation of Rs 14 lakhs to the wife of a patient who passed away after the arteriovenous fistula surgery which allegedly led to the creation of gangrene in his hand.
The consumer forum observed that there was a clear connection between the death of the patient and the surgery performed as it led to the infection of the fistula eventually resulting in the death of the patient.
"we have already seen that the record of the opponent's hospital, does not reveal that opponent had confirmed the sugar level before performing AVF procedure and also did not perform or advised colour Doppler test even when there was a difference of opinion between him and other doctors as to the working of fistula. This prima facie shows that opponent who may have the necessary skills in the field failed to use the skills to the fullest extent and acted in a negligent and casual manner."
Mere glance at the notes recorded by opponent reveal that opponent has not recorded the history told by the patient, the observations after examining the patient. In the notes on the date of operation also, there is no reference to patient's history. Therefore, we have to infer that opponent took a casual approach while treating the patient.
In case of difference of opinion between opponent on one side and his wife and Dr. *** on the other, and having knowledge that the patient had multiple ailments and he was heavy diabetic, the opponent should have advised colour doppler test at that time to rule out the possibility of fistula not working . But this was not done. This is a significant fact leading to the inference that opponent failed to take as much care of the patient as was reasonably expected from a medical professional.
The doctor had submitted opinions on the case expert committee of JJ Hospital. The said opinions and the court observations on the relevant are mentioned below:
It states that AV fistula was performed by Dr. Badwe on 31st December 2013 and the patient was advised to follow up after ten days but the patient came on 13/01/2014 with complaints of weak thrill in the fistula. It is material to note that the report mentions that this was confirmed on Doppler. However, as discussed above, at no place in the notes it is mentioned that colour Doppler test was performed. Moreover, the report states that the patient had diabetes mellitus, chronic renal failure and stomach heart disease. However, the report is absolutely silent as regards the performance of Haemo Gluco Test previous to AVF procedure which is a material factor to consider. Due to this, we are not inclined to accept the opinion.
From the affidavit of Dr. Kripalani it appears that he is a specialist nephrologist. According to his opinion, in patients needing dialysis, it is not advisable to maintain tight blood glucose control and it was not mandatory to have blood glucose level brought down to normal before the surgery. In this context, it must be stated that we need not dispute the opinion that it was not mandatory to control blood sugar level before surgery. But, as pointed out above, there is no evidence that sugar level was tested before starting the procedure of AVF fistula to find out whether sugar level was above or below the permissible limit. Therefore, there was no question of lowering down the level.
In respect of the opinion of Doctor Lalvani, it can be seen from his affidavit that he is regularly performing fistula surgery at various hospitals. He has opined that all patients suffering from ESRD are already on dialysis and so their immunity is low and there are chances of development of sepsis in them. In this regard also, it must be kept in mind that the expert voiced that there are chances of sepsis. But he doesn't say that in each and every such case, sepsis occurs. Therefore, it can't be said that the occurrence of sepsis is usual in such patients.
The bench observed the opinion of the expert's committee of J. J. hospital can not be accepted as proof of evidence of due care at the hands of the opponent.
It further observed that there is a general tendency amongst medical professionals favoring their colleagues in giving expert opinion in medical negligence cases.
In the present case it appears that no proper record though mandatory we maintained by opponent . The expert committee did not verify from record whether blood sugar was verified before AVF procedure and whether colour Doppler test was done or at least advised anytime when the patient complained of pain after the procedure or when he visited opponent for review and it was noticed that there were blood clots on his hand. This creates grave doubt as to whether the Expert opinions were given after actually verifying the records. On the background of all this, expert opinions are to be discarded.
" we are well aware that in no case we can expect that the surgery will be 100% successful and no doctor can give such guarantee. However, the relationship of doctor and patient is of a fiduciary nature and so it is always expected that a medical practitioner should take reasonable care and precaution and perform the necessary test as the circumstances of the case demand."
Concluding on the case, the bench said:
the relationship of doctor and patient is of a fiduciary nature and so it is always expected that a medical practitioner should take reasonable care and precaution and perform necessary test as the circumstances of the case demand. In our opinion , the conduct of opponent falls short of this requirement . On account of lapse of duty on the part of opponent, the fistula resulted into gangrene.
it is clear that on account of gross negligence of opponent, the death of the complainant's husband occurred and complainant suffered much humiliation and mental suffering and huge financial loss. The complainant has submitted hospital bills and bills for purchase of medicines as proof of the expenses.