Infection in peritoneal cavity was not due to negligence during laparoscopic appendectomy surgery: NCDRC exonerates doctor, hospital

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However, as the patient didn't get relief from the pain she continued taking medicines. So, after a few days, she was again taken to the treating Hospital and on 29.02.2010 the treating doctor referred the patient to a second hospital for C.T. Scan and further treatment. The doctors at the second hospital operated on her and removed the pus from the abdomen. She was discharged on 12.03.2010.

Complaining that due to the deficiency in the service of the treating doctor at the first hospital the patient had lost one academic year, his father approached the District Forum of the Consumer Court and filed a complaint seeking compensation of Rs. 2,45,000/- from the doctor and the hospital.

The doctor and the hospital denied these allegations and submitted before the District Forum that the appendix showed features of mild inflammation and there was no evidence of local or generalized peritonitis. Also, there was no free fluid or pus in the peritoneal cavity. As of 24.02.2010, the patient complained of mild pain in the umbilical port site, it was treated symptomatically and the patient was discharged with a follow-up advice. Thus, the patient was treated with utmost care and caution, and there was no negligence.

However, the District Forum partly allowed the complaint and held that the doctor and hospital partly liable for negligence and deficiency in service. Directing the authorities to issue a refund of the expenses of the treatment, the District Forum mentioned in the judgment, "It is to be noted that the patient a tender aged girl had to suffer lot of inconveniences mental pain and suffering and physical agony due to the negligent acts of the Opposite Parties which could have well been avoided if proper care and caution been taken in which they failed."

However, being aggrieved, the hospital and the doctor approached the State Commission which set aside the previous order of the District Forum and observed, "From clinical examination itself the appendicitis can be diagnosed by a prudent doctor and the performance of the appendectomy is the proper diagnosis and the standard treatment had given to the daughter of the complainant."

It further stated that "the pre-operation diagnosis was acute appendectomy and it is also evident from the histopathology report showing 'impression-appendectomy showing acute appendicitis. So there can be no other possibility for any default in the diagnosis of the 1^st opposite party."

Challenging the judgment by the State Commission, the patient's father approached the NCDRC and cited his debt and other expenses due to costly treatment of his daughter and the legal proceedings as the reasons for the delay in filing the revision petition.

Giving the complainant a fair chance to decide the case on merit, the NCDRC thoroughly scrutinized the operative and clinical findings. From the perusal of the discharge summary of the second hospital, the Commission found that the patient was diagnosed with an "intra-abdominal abscess". "She had a surgical site infection in the sub umbilical region of lap site which required daily dressing and probably secondary suturing," mentioned the report.

In order to understand the matter in detail, the Commission went through the standard surgical textbooks and articles on Laparoscopic Appendicitis. From the literature analysis, the Commission came to understand that Laparoscopic Appendectomy present a lower incidence of surgical wound infection, lower incidence of postoperative ileus, lower use of analgesics in the postoperative period, an earlier resumption of normal diet, a shorter hospitalization, and a more rapid recovery to resume normal activities compared with patients undergoing open surgery.

The Commission also noted that an intra-abdominal abscess occurs rarely after Laparoscopic Appendectomy and is strongly associated with complicated appendicitis. Its treatment is associated with the need for intervention.

It was also noted by the Commission that firstly, the Histopathology Report was confirmatory of Acute Appendicitis, secondly, the operative findings of the second Hospital did not show any injury to the small bowel, stomach or any internal organs.

Thus, the Commission noted,

"The purulent turbid fluid in the abdominal cavity was due to peritonitis-infection without any injury to the bowels or internal organs. The infection or abscess in the peritoneal cavity was not due to any negligence or any shortcoming during the laparoscopic procedure."

Finally, disposing of the revision petition the Commission found the order of the State Commission to be well-appraised and well-reasoned and noted that the treating doctor "correctly diagnosed the case and treated as per the accepted standard practice."

To view the complete order, click on the link below.