Kidney Stones Removal: NCDRC holds doctor guilty of negligence
New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently held the treating doctor guilty of medical negligence while performing Percutaneous Nephrolithotomy (PCNL) on a patient who was suffering from kidney stones.
However, the top consumer court opined that the compensation awarded by the district commission was much higher and thus, it upheld the order of the State Commission, which had reduced the amount of compensation to a total amount of Rs 1,20,000.
"Respectfully following the principles laid down by the Hon'ble Supreme Court supra , we do not find any merit in the present Revision Petition and the same is dismissed. Considering the facts and injury suffered by the Complainant after the PCNL, in our considered view, the award of State Commission is just and proper," observed the Commission.
The history of the case goes back to 2005 when the patient was operated by the treating doctor in his Nursing Home for removal of kidney stone. It was alleged that the doctor had assured to perform the operation by laser method. However, after operation, the patient got to know that the operation had been done by Puncture surgery.
Although the doctor had assured the patient that no harm would happen, after three days of discharge, the patient started getting severe pain. Therefore, the doctor operated on the patient again and removed few small stones, which were present in the urinary tract.
The complainant alleged that before the operation, the doctor had not confirmed the location of the stones by Intravenous Pyelography (IVP) study and so he failed to insert catheter for appropriate drainage of material.
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As there was no relief even after the second operation, the patient took treatment at several other hospitals. Finally, she had to remove her right kidney. Thus, being aggrieved by the alleged careless treatment from the treating doctor, the complainant approached the District Consumer Court, Ranchi seeking a compensation of Rs 5,35,000.
The doctor had denied the allegations of negligence during the treatment and it was further submitted by the doctor that the patient was explained about entire procedure for removal of stone by Percutaneous Nephrolithotomy (PCNL), for which she had given informed consent. It was further submitted that the patient's kidney was functioning good and she was advised to come for a reconstructive surgery after one month. However, the patient never turned up. As there was lapse of several months, her right kidney was finally removed in Kolkata.
Holding the treating doctor deficient in his services, the District Forum had awarded a sum of Rs 3,50,000 as principal amount spent on the medical treatment and an amount of Rs 7 lakh as compensation for mental harassment and agony.
Thereafter, the doctor approached the State Commission and the complaint was partly allowed with reduced amount of compensation. The award had been reduced by the State Commission to Rs 1,20,000.
Challenging this, the complainant approached the NCDRC. The top consumer court noted that the State Commission had held that the total amount of Rs 10,50,000 was not supported by the facts and valid reasons. Therefore, the State Commission had directed the doctor to pay the cost of treatment incurred by her at the Nursing Home and the Hospital thereafter. So, the complainant had been awarded with Rs 70,000 with interest @9% per annum from the date of filing of the complaint and Rs 50,000 towards compensation for physical, financial and mental agony.
The NCDRC noted that the case concerned the question of whether pre-operative IVP was necessary before PCNL and if failure to do IVP was medical negligence.
Considering the expert opinions in the matter, the NCDRC noted that "Laser" is a procedure use of energy to break stones in to pieces. It is not an alternative of PCNL and IVP study is not mandatory or and less superior than retrograde pyelogram (RGP) which was done by the doctor.
In fact, IVP would be contraindicated in stone patients with renal insufficiency. The plain x-ray along with an ultrasound study may provide sufficient anatomical information for the procedure, whereas retrograde study during the procedure is more accurate than IVP to provide anatomical information specially in poorly functioning kidneys, opined the top consumer court.
Referring to the medical literature on Renal Pathology, the consumer court noted about the way how IVP and RGP is done and why is it performed and other details related to it.
NCDRC noted that based on the X-Ray and USG report, the treating doctor had attempted PCNL for upper ureteric calculus.
"In our view, the functional anatomy of kidney is well judged by IVP. In the instant case there was neither renal insufficiency nor any contraindication (high values of Urea / Creatinine) to perform IVP. Thus, not doing IVP prior to PCNL (05.05.2005) was deficiency in service. The exact location of renal stone was not confirmed. It resulted in to partial removal of stone and development of subsequent complications," noted the top consumer court at this outset.
Further, the apex consumer court also referred to the opinion of the Kolkata-based doctor from whom the patient had taken treatment later. The doctor had opined, "Before any major kidney operation IVU (intravenous urogram) or CT scan with contrast to be done to demonstrate the anatomy and function of kidney. if not possible at least retrograde pyleogram to be done to demonstrate the anatomy of the affected kidney."
"Thus, the IVP at initial stage would have given clear picture of the Right kidney functioning. It could be compared with the findings after 9 months noted at Kolkata. No doubt due to Pyelonephritis (renal infection), the Right kidney became nonfunctional, thus it was removed," opined NCDRC at this outset.
So, the NCDRC opined that there was no error in the State Commission's order and noted, "In the present case there is concurrent finding of the fact and the revisional jurisdiction of this Commission is limited. We do not find any illegality, material irregularity or jurisdictional error in the Impugned Order dated 04.03.2013 passed by the State Commission warranting our interference in revisional jurisdiction under Section 21(b) of the Consumer Protection Act, 1986."
Referring to the Supreme Court judgment in the case of 'Rubi (Chandra) Dutta Vs. M/s United India Insurance Co. Ltd., the top consumer court noted, "Respectfully following the principles laid down by the Hon'ble Supreme Court supra , we do not find any merit in the present Revision Petition and the same is dismissed. Considering the facts and injury suffered by the Complainant after the PCNL, in our considered view, the award of State Commission is just and proper. Consequently, the impugned Order dated 04.03.2013 passed by the State Commission is upheld. Keeping in view the facts and circumstances of the present case, there shall be no order as to costs."
To read the case order, click on the link below.
https://medicaldialogues.in/pdf_upload/ncdrc-kidney-stone-170684.pdf
